[Corticotherapy in ENT. Subglottic laryngitis in children, acute sinusitis, naso-sinusal polyposis, sero-mucous otitis]. / La corticothérapie en O.R.L. Laryngites sous-glottiques de l'enfant, sinusites aiguës, polyposes naso-sinusiennes, otites séro-muqueuses.

Corticosteroid therapy is a key element in the treatment of acute subglottic laryngitis as well as certain types of sinusitis and seromucous otitis. Insufficient or lacking compensatory mechanism in the physiological regulation of the ENT mucosa favors the progression of these different conditions to chronic or life threatening situations, particularly for acute laryngitis. Corticosteroid therapy is one of the management steps; it should be adapted to each individual and of short duration. The goal of corticosteroid therapy is to decrease inflammation, provide pain relief and reestablish the physiological state of the ENT mucosa.

[Photochemotherapy in the treatment of carcinoma of the vocal cords of early stage (Tis, T1)]. / La photochimiothérapie dans le traitement des carcinomes du plan glottique à un stade limité (Tis, T1).

Photodynamic Therapy (PDT) is a treatment which can prove interesting in head and neck oncology for small squamous cell carcinomas. We studied 33 patients with vocal cord squamous cell carcinoma at an early stage who have been treated by Photodynamic Therapy from 1986 to 1992. We used a Dye Laser Aurora which produces light with a wavelength of 630 nm. The intervention was done under general anesthesia, 72 hours after the injection of hematoporphyrin derivative. The mean and the maximum follow-up was respectively 66 and 93 months. The local control after an exclusive PDT was 73% at 3 years, 5 years, 7 years. If this method fails, a conventional treatment may be used.

Chondrosarcoma of the larynx.

A case of a low grade chondrosarcoma of the cricoid cartilage which had been diagnosed initially as a chondroma is presented. The tumour recurred twice after limited surgical resections. Total laryngectomy was inevitable due to near total involvement of the cricoid cartilage and subsequent histological examination revealed a low grade chondrosarcoma. We have discussed in brief, the diagnosis and treatment of chondrosarcomas of the larynx and support the view of conservative surgical management for low grade tumours as they are slow growing and metastases are infrequent. A total laryngectomy may be reserved for salvage or primarily when more than half of the cricoid cartilage needs to be resected. Histological grading reveals the biological behaviour of the tumour and CT scans help in planning the surgery. A regular follow-up is necessary for early detection of recurrences and metastases.

[Endonasal treatment of iatrogenic or spontaneous cerebrospinal rhinorrhea of the anterior cranial fossa]. / Le traitement endonasal des rhinorrhées cérébro-spinales iatrogènes ou spontanées de l'étage antérieur de la base du crâne.

There is a 25% risk of meningitis in case of cerebrospinal fluid rhinorrhea from the anterior cranial fossa. Treatment usually is based on neurosurgery when medical management is unsuccessful. The risk of morbidity and mortality in such operations is important and recurrence is observed in 25% of the cases. The development of endonasal surgery has increased the incidence of iatrogenic breaches but has also allowed the development of new techniques for closing breaches. Certain authors recently published a recent series of patients treated via the endonasal route. We present here six cases of cerebrospinal fluid rhinorrhoea from the anterior cranial fossa treated at the Foch Hospital. Etiology was iatrogenic in 4 cases, trauma in 1 and spontaneous in 1. The operative technique and mid-term results are presented. Cure was achieved in all cases after a mean follow-up of 2 years. One patient with osteopetrosis of the cranial floor who underwent neurosurgical decompression of the optic nerve complained of recurrent rhinorrhoea which could not be confirmed by endoscopy nor by imaging. Early endoscopic treatment of cerebrospinal fluid rhinorrhoea should be the first intention option as it preserves olfactive function, limits operative morbidity and mortality and leaves open the option of neurosurgery in case of failure.

[Laser CO2 arytenoidectomy by endoscopic approach in bilateral laryngeal paralysis. Apropos of 45 cases]. / Aryténoïdectomie par voie endoscopique au laser CO2 dans les paralysies récurrentielles bilatérales. A propos de 45 cas.

Between 1980 and 1993, 45 patients with bilateral cord abductor paralysis were treated by carbon dioxide endoscopic laser arytenoidectomy. Thyroid surgery was the main cause of bilateral laryngeal palsy (67%). Seven patients, who were tracheotomised before treatment, were decanulated. Ninety-one percent of the patients recovered physiologic respiration. The follow up period lasted from one month to thirteen one-half years. Advantages and disadvantages of laser arytenoidectomy are compared with other techniques.

[Ambulatory laser and turbinectomy in the treatment of nasal obstruction. Apropos of 68 cases]. / Analyse du laser ambulatoire et de la turbinectomie dans le traitement de l'obstruction nasale. A propos de 68 cas.

The purpose of this prospective study was to compare subjectively and objectively the efficiency of laser vaporisation against surgical procedure in treatment of nasal obstruction related to vasomotor rhinitis. 40 inferior nasal turbinates laser vaporisations were compared to 28 surgical inferior turbinectomies. This trial was based on rhinomanometric data before and after laser or surgical management and on appreciation of individual nasal comfort. The results obtained with conventional surgery were slightly better than laser vaporisation; however this new procedure succeed in 75% of cases with a mean of one year follow-up. The rhinomanometric++ findings appeared especially contributing when significant disorders exist before treatment.

Effect of furosemide on prostaglandin synthesis by human nasal and bronchial epithelial cells in culture.

Inhaled furosemide protects asthmatic subjects against bronchial obstruction caused by indirect provocants. We have attempted to correlate the protective effect of furosemide with its ability to alter prostaglandin (PG) synthesis by the airway epithelium. Human epithelial cells from nasal polyps and bronchi were cultured in DME-Ham's F12 medium with 10% fetal calf serum. Confluent cells (days 6 through 8) were incubated for 30 min in fresh medium, and the PGs in the supernatant were measured by radioimmunoassay. Spontaneous output (ng.ml-1.mg-1 cell protein) was as follows (mean +/- SEM): PGE2 = 7.74 +/- 2.10 (n = 12), PGF2 alpha = 1.66 +/- 0.12 (n = 15), 6-keto-PGF1 alpha = 4.32 +/- 1.37 (n = 11), PGD2 = 0.73 +/- 0.16 (n = 11) for bronchial cells and PGE2 = 7.24 +/- 0.80 (n = 32), PGF2 alpha = 1.38 +/- 0.12 (n = 17), 6-keto-PGF1 alpha = 6.79 +/- 2.50 (n = 15), PGD2 = 0.42 +/- 0.07 (n = 17) for nasal cells. Incubation with arachidonic acid (25 micrograms/ml) for 30 min significantly increased the amounts of the four PGs. Incubation with furosemide (10(-4) M) for 30 min caused a marked reduction in both basal and arachidonic acid-stimulated production of PGE2 and PGF2 alpha but did not reduce production of 6-keto-PGF1 alpha and PGD2. Incubation with bumetanide (10(-4) M) for 30 min did not modify the PGE2 synthesis by nasal epithelial cells.(ABSTRACT TRUNCATED AT 250 WORDS)

[Injection of collagen in recurrent paralysis after thoracic surgery]. / L'injection de collagène dans les paralysies récurrentielles après chirurgie thoracique.

The author describes a new technique of treatment of recurrent laryngeal nerve paralysis by intra-cordal injection of collagen after thoracic surgery. After description of the collagen used and the technique of injection, the author presents the results. It is a new method, simple, efficient, well tolerated, giving patients a voice, and treating their swallowing troubles.

Use of photodynamic therapy in the treatment of vocal cord carcinoma.

The photodynamic therapy of superficial vocal cord carcinoma is a promising new technique. Patients were irradiated with 630 nm light from an Aurora dye laser under general anaesthesia 72 h after a haematoporphyrin derivative (HpD) injection. So far, 32 patients have been treated for small epidermoid carcinoma of the glottis without anterior commissure. There have been no undesired effects due to the photosensitizer or the dye laser. The results show seven failures and 25 positive responses, of which three patients were treated more than 4 years ago.

[A new endonasal therapy: the endoscopic YAG laser]. / Une nouvelle thérapeutique endonasale: le laser YAG par voie endoscopique.

Therapeutical fiberscopy permits ambulatory treatment of benign lesions of the nose and cavum with the use of a flexible endoscope on a patient in the sitting position. YAG gives access to the nasal fossa and, more particularly, to the cavum conchae where it is of the utmost value, since this area is normally inaccessible under local anesthesia. In the cavum, we have been able to treat primarily inflammatory lesions of the adenoids, bridles, cysts, and cases of epipharyngitis and tubal catarrh. In the nasal fossa, although the YAG method provides a means for resorbing hypertrophic conchae, it is of special values for the management of polyposis. The removal of polyps allows to withhold the utilization of adrenal corticosteroids; to delay surgery; or even to reoperate patients with early recurrences. Two ventilation middle meatotomy operations have also been performed. Results from this destructive but precise method are promising.

[Clinical efficacy of Auricularum compared with its bacteriologic efficacy in vitro]. / Efficacité clinique d'auricularum comparée à son efficacité bactériologique in vitro.

We compared the clinical efficacy of Auricularum to its bacteriological efficacy in 36 patients with a chronic middle ear disease. The clinical study confirms the very good efficacy of Auricularum with an improvement rate equal to 81% and 69.4% of "very good" results. The bacteriological study confirms the usual sensitivity of gram-negative bacilli (except the Proteus) to polymyxine B, the sensitivity of gram-positive germs to tetracycline for 60% of them and the sensitivity of fungus (isolated only once) to nystatine. Moreover, the bacteriological study shows that Auricularum with a concentration more or equal to 0.1 ml inhibits every germ, including the well-known resistant germs. This concentration of 0.1 ml corresponds to 2 drops of the drug in suspension and is less than the recommended dosage. This finding proves the very good efficacy of Auricularum in chronic middle ear diseases, including the ones due to usual resistant germs to the two antibiotics (polymyxine B and oxytetracycline) enclosed in the drug composition.