[Adherence to long-term medication: the particular case of the adjuvant endocrine therapy for breast cancer]. / L'observance au traitement de longue durée: le cas particulier de l'hormonothérapie adjuvante du cancer du sein.

The aim of adjuvant hormone therapy for breast cancer is to reach, in daily practice, an efficacy similar to that obtained in clinical trials. In spite of the demonstrated efficacy of hormone therapy, compliance represents a major challenge and a multidimensional problem. A better understanding of the reasons underlying non-compliance would help identify the patients at higher risk and would permit the implementation of strategies to improve compliance to adjuvant hormone therapy. With this in mind, we undertook a review of the recent literature on the topic (Pub Med 2003-2009).

Vertebrobasilar occlusive disorders presenting as sudden sensorineural hearing loss.

BACKGROUND: Isolated sudden sensorineural hearing loss (SSHL) has been rarely related to vertebrobasilar occlusive disorders (VBOD). This is an important issue for both neurologists and otolaryngologists, since the management and prognosis of this type of hearing loss widely differs from that of hearing loss from other causes. OBJECTIVES: To describe the clinical characteristics and report the incidence of SSHL related to VBOD. METHODS: Retrospective analysis of clinical charts from 333 patients admitted for SSHL in a large ear, nose, and throat emergency tertiary care center from 1999 to 2002. RESULTS: Four cases (1.2%) of VBOD as the unique cause of SSHL were diagnosed among 333 patients. The most typical features of these cases were the presence of one of the following characteristics: (1) bilateral SSHL, (2) associated occipital or posterior nuchal pain, and (3) the occurrence of delayed neurologic deficits. The underlying vascular disease affected the vertebral arteries: dissection in two cases and atherosclerosis in two other cases. The audiometric features of hearing loss were endocochlear in one case, of both types in one case, and unknown in two cases. Hearing recovered partially or completely. CONCLUSIONS: Our results confirm the low incidence of SSHL related to VBOD and show that the observation of endocochlear audiometric features cannot preclude a central cause in SSHL. The clinical presentation of our cases related to VBOD emphasize that a careful follow-up of any patient with SSHL is warranted and that the presence of nuchal pain suggestive of arterial dissection in younger subjects, a past history of atherosclerosis or embolism in older patients, or the occurrence of delayed associated neurologic symptoms should be considered with particular caution in this situation.

[Exploration of olfactory difficulties]. / Exploration des troubles de l'odorat.

Sense-of-smell disorders are a frequent occurrence at ORL clinics. The clinical exploration must include a thorough and comprehensive interview to discover the etiology. The clinical examination is easily performed using cold-light endoscopes, which can reveal anatomical or mucous membrane pathologies, even in far- situated anatomical parts. The access to olfactometric examinations is limited by the small number of health centers which have the proper equipment and trained staff. Guided by the initial interview and clinical exploration, the diagnosis of smell disorder can benefit from the conclusive and factual contribution of the CAT scan and MRI.

[Vascular complications after acoustic neurinoma surgery]. / Complications vasculaires apres chirurgie du neurinome de l'acoustique.

OBJECTIVE: To report six cases of vascular complications occurring after acoustic neuroma surgery and to discuss the postoperative signs and symptoms that should alert the surgeon, in order to undertake the appropriate treatment as soon as possible. METHODS: Four hundred thirty-two cases of acoustic tumors operated by the same surgeons between January 1991 and December 2000 were reviewed. RESULTS: Six cases of vascular complications were identified: one case of cerebral vasospasm secondary to persistence of subarachnoid blood after injury to Dandy's vein; three cases of arterial infarction giving rise to a partial anterior inferior cerebellar artery (AICA) syndrome with an unusual nystagmus in two cases (ipsilateral in one patient and strong controlateral in one patient presenting preoperative vestibular areflexia); one case of hematoma of the cerebello-pontine angle (CPA) causing strong ipsilateral nystagmus; and one case of venous infarction of the cerebellar vermis secondary to accidental sinus thrombosis. CONCLUSIONS: Vascular complications after acoustic neuroma surgery are potentially devastating and should be identified as early as possible. Rapid extubation is recommended for systematic neurologic assessment. Among abnormal signs and symptoms that should alert the surgeon, marked nystagmus ipsilateral to the operated side or contralateral in patient presenting preoperative vestibular areflexia appears to be of great value.

[Towards better investigation of abnormal uterine bleeding and uterine pathologies]. / Vers une meilleure mise au point des saignements utérins anormaux et des pathologies utérines.

Exploration of menometrorrhagia needs perfect imaging of the uterus and pathologic analysis in order to diagnose the endometrial pathologies responsible for abnormal uterine bleeding. We present here a clinical case typical for difficulties in the exploration of abnormal uterine bleeding, and discuss the diagnostical steps.

[How I treat ... surgically benign uterine lesions in 2002]. / Comment je traite.... Chirurgicalement les lésions utérines bénignes en 2002.

For 20 years, pre-operative investigations have increasingly improved the gynaecological diagnosis, allowing to have an accurate idea on the size and the nature of the lesion to be treated when the matter is to carry out the surgical treatment. In the meantime, the gynaecological surgery has seen its endoscopic surgical techniques improved due to the development of these diagnostic techniques itself. The operative hysteroscopy allows to decrease considerably the amount of hysterectomies for benign lesions. The operative laparoscopy has become the first intended treatment for many pathologies. This latter allows performing either laparoscopic assisted vaginal hysterectomies or complete laparoscopic hysterectomies. On the other hand, even though these endoscopic techniques were developing, the vaginal hysterectomy strongly returned, in such a way that it became the dominating way, so that the rule is to perform abdominal hysterectomy only when it is impossible to carry out a low way hysterectomy. Consequently, the gynaecologist surgeon has to be capable, in 2002, to perform all these surgical techniques in order to offer to the patient the best treatment, matching as good as feasible according to the pathology to be treated and her anatomical status.

[Contribution and Cost-Effectiveness of ABR and MRI in Acoustic Neuroma screening. Retrospective Study of 151 Cases]. / Intérêt et rapport coût efficacité des PEA et de l'IRM dans le dépistage du neurinome de l'acoustique.

The aim of this study was to retrospectively assess during two periods (1991-1995 and 1996-2000) if MRI spreading had changed: (1) private ENT physicians screening habits; (2) the average tumor size at the time of diagnosis and the diagnostic delay of acoustic neuroma; and (3) the cost of acoustic neuroma diagnosis. In addition, the sensibility of each diagnostic test was calculated on 151 tumors. Our results show no significant change neither in the screening strategy (except a mild decrease in CT-scan utilization) nor in the tumor size, diagnostic delay or diagnostic cost between the two periods. Even if MRI is the gold standard for acoustic neuroma diagnosis, our 86%-sensibility of ABR, increased to 99% if combined with stapedial reflex and caloric test may still incline to use ABR in selected cases.

[Scintigraphy by l'Octreoscan in the management of head and neck paragangliomas]. / La scintigraphie à l'Octréoscan dans la prise en charge des paragangliomes de la tête et du cou.

OBJECTIVE: To assess the usefulness of somatostatin receptor scintigraphy [Octreoscan] in a series of 18 patients referred for a suspicion of paraganglioma of the head and neck between July 2001 and February 2002. PATIENTS AND METHODS: Sixteen patients had one or several paragangliomas of the head and neck diagnosed on conclusive conventional imaging including CT and MR scan. In two patients, radiological data were not conclusive. Planar images were obtained 4 and 24 hr after the iv injection of 148-185 MBq [Octreoscan]. RESULTS: Twenty-two hot spot lesions were detected. Twenty of these lesions corresponded to the twenty known paragangliomas. The volume of the smallest tumor was 0.2 cm(3). In one patient, intense thyroid nodule uptake led to the surgical diagnosis of oncocytoma. In two lesions, where conventional imaging was not conclusive, arteriography showed a typical aspect of meningioma; one patient was operated on and histology confirmed this diagnosis. No evidence of abnormal uptake was seen in site previously operated on (3 patients). CONCLUSION: Octreotide scintigraphy is a very sensitive method for detection of paraganglioma of head and neck. It provides information on potential tumor sites in the whole body after one single injection. It could be used as a screening test in patients at risk (familial or known paraganglioma) in order to detect paraganglioma at an early stage and, thus to reduce the surgical morbidity, as well as in the follow-up after surgery to detect recurrences.