[Acinic cell carcinoma in an ectopic salivary gland]. / Carcinome à cellules acineuses d'une glande salivaire ectopique.

On the occasion of the coverage of a cervical tumefaction in a child, which led to the diagnosis of acinic cell carcinoma of ectopic salivary gland, the authors conducted a literature review of this tumour. If it is well known to pathologists when it is developed in the major or accessories salivary glands, its location within heterotopy of salivary tissue is much rarer. From a histological point of view it is difficult to distinguish, if primitive location, the occurrence of the tumour in an ectopic salivary gland, its occurrence in intra-node heterotopic salivary tissue. This distinction between glandular ectopia and intra-node heterotopia remains purely theoretical, and does not affect the therapeutic decision. This one remains empirical and discussed on a case-by-case basis for a malignant tumour that is exceptional in this location and at that age.

[Mild head trauma: complications and acousticovestibular sequelae]. / Traumatismes crâniens légers: complications et séquelles audio-vestibulaires.

Head injury with fracture of the petrous bone is frequent and directly related to the development of human activity. Head trauma is associated with nearly 75% of traffic accidents; 5% of them with petrous bone fracture. Based on a clinical case, the acute injuries and secondary acoustic or vestibular sequelae after low-energy cranio-cerebral trauma are discussed here. The subject was a victim of a low-energy head trauma with brief loss of consciousness and translabyrinthine fracture of the petrous bone. This fracture caused invalidating equilibrium disorders related to a perilymphatic fistula. These disorders persisted for 3.5 years and required several hospitalizations and three surgical procedures. The acoustic problems progressed towards cophosis and persistent and invalidating tintinus. We discuss the pathogenesis and treatment of these different sequelae of the middle ear as well as the external lesions. Among labyrinthine involvement, especially unilateral destruction, fistulization, concussion, and post concussion syndrome are especially descripted. Bony dislocations dominate middle ear sequelae. We also discuss the medicolegal problems associated with this type of pathology.

[Tinnitus and stenosis of the cavernous internal carotid artery]. / Acouphènes et sténose de l'artère carotide interne intracaverneuse.

We report a case of isolated unilateral pulsatile tinnitus. Cerebral angiography showed a right intra-cranial internal carotid artery stenosis. Treatment by dilatation and stenting resulted in symptom resolution.

A prospective, multicentre study of moxifloxacin concentrations in the sinus mucosa tissue of patients undergoing elective surgery of the sinus.

A pharmacokinetic study was carried out to determine moxifloxacin concentrations in sinus tissue, after oral moxifloxacin 400 mg once daily for 5 days to patients with chronic sinusitis, undergoing elective sinus surgery. Patients were randomly allocated to one of seven treatment groups, in which tissues were sampled 2, 3, 4, 6, 12, 24 or 36 h post-dose. A control group with non-infected nasal polyps was also included. Forty-eight patients (13 female, 35 male, mean age 47.1 years) were allocated to one of each active treatment group (n = 42) or to the control group (n = 6). Tissue and plasma samples were taken simultaneously and stored frozen until assayed by HPLC. Thirty-nine patients were fully valid for pharmacokinetic analysis. The geometric mean moxifloxacin plasma concentration increased from 2.32 mg/L at 2 h to a maximum of 3.37 mg/L at 4 h post-dose, decreasing to 0.37 mg/L at 36 h post-dose. The moxifloxacin concentration in sinus mucosa was consistently greater than that in plasma being 4.56-5.73 mg/kg from 2 to 6 h and 2.81-1.25 mg/kg from 12 to 36 h post-dose. The elimination rates in plasma and sinus tissues were similar. The tissue/plasma ratio was c. 200% between 2 and 6 h, and up to 328.9% at 36 h. Results were similar whatever the site of tissue sampling (maxillary sinus, anterior ethmoid sinus or nasal polyps). Tissue levels exceeded the MIC(90) of all pathogens commonly causing acute sinusitis (e.g. 5-30 x MIC for Streptococcus pneumoniae: 0.25 mg/L). These results sup-port the use of moxifloxacin 400 mg once daily as a regimen for the treatment of sinus infections.

Short therapy with amoxicillin-clavulanate and corticosteroids in acute sinusitis: results of a multicentre study in adults.

Evolution of bacterial resistance shortens antibiotic treatment in ENT infections. The efficacy and tolerance of amoxicillin-clavulanate (ACA), with and without associated short steroid therapy, was evaluated in acute sinusitis of adults at a dosage of 1.5 g/d for 5 d vs. 10 d. This multicentre, randomized, double-blind, placebo-controlled study included 433 patients, 417 of whom were suitable for intent-to-treat (ITT) analysis. The therapeutic success rate in the ITT population, assessed according to strict clinical and radiological criteria, was respectively, 80% and 85% in the 5-d and 10-d treatment groups. Due to the statistical risks that were evidenced, the 2 durations of treatment could not be considered equivalent. The analysis of medical history shows that some risk factors (recurrence of sinusitis, previous surgical sinus drainage) seem to promote therapeutic failure and that 5-d treatment is inappropriate in these patients. The persistence of therapeutic success on day 30 was not influenced by the initial duration of treatment. The efficacy and good tolerance of ACA in acute sinusitis in adults were confirmed. Further studies will be needed to define the indications of short treatments better, which seem to be indicated in the absence of specific risk factors.

Biological levels of aluminium after use of aluminium-containing bone cement in post-otoneurosurgery.

Use aluminium-containing biomaterials in otoneurosurgery for reconstitution of bone in contact with cerebrospinal fluid (CSF) also led to cases of encephalopathy and death. We report aluminium (Al) concentrations in the biological fluids of six French patients following use of Al-containing bone cement in otoneurosurgery. In five patients, the mean plasma Al levels (microgram/L) were: 1.20 +/- 0.05 (case 2), 9.20 +/- 0.10 (case 3), 1.00 +/- 0.05 (case 4), 2.80 +/- 0.05 (case 5) and 2.00 +/- 0.05 (case 6). In case 1, Al concentrations were 176 micrograms/L in the postauricular CSF accumulation, 34 micrograms/L in the pontocerebellar angle and 4 and 6 micrograms/L in the lumbar shunt. As a precautionary measure, in the first three cases the biomaterial was removed soon after the intervention, and no increase in plasma or CSF Al was observed. In the other cases, absence of neurobiological symptoms and normal concentrations of Al in plasma led neurosurgeons not to extract this biomaterial. Al assay thus may be considered to be a complementary and at times a decision-generating factor. Care is needed at all stages from sampling through analysis because Al is ubiquitous and factually high results may be clinically misleading. Herein, such considerations are discussed in conjunction with the neurotoxicity of this metal in man. In addition, the authors call for in-depth preliminary trials of these biomaterials in animals prior to introduction on the market.

[Actinomycosis in otorhinolaryngology. Apropos of a case with localization in the nasal cavity]. / L'actinomycose en ORL. A propos d'un cas localisé aux fosses nasales.

The authors report an atypical case of actionomycosis implanted in the nasal cavity and occurring twenty years after septum surgery. Treatment by penicillin and surgical excision gave a good result. Cervicofacial actinomycosis is caused by actinomyctes which usually lives as a saprophyte in the oral cavity. A trauma is often found in the previous history. Diagnosis with tumors and abscess may be difficult. The histopathological examination shows typical aspects of the granuloma (gram+ and Grocott+) and the bacteriological isolation of the germ is difficult to obtain. Penicillin associated with surgical excision is the best therapy, but high doses must be used for a long time. The literature is reviewed without finding such a case.

[Giant cell tumor of the cricoid bone. Apropos of a case]. / Tumeur a cellules géantes du cricoïde. A propos d'un cas.

The authors report about one case of giant-cell tumor of the cricoid bone (osteoclastoma, myeloplaxic tumor). The diagnosis is difficult as the clinical and radiological symptoms are not specific. A detailed iconography sums up the clinicopathological characteristics of this tumor. The authors emphasize the necessity to perform wide exeresis surgery through total laryngectomy.

[Analysis of prognostic factors in cervicofacial carcinology using the Cox model. An example of piriform sinus cancer]. / L'analyse des facteurs pronostiques en carcinologie cervico-faciale par le modèle de Cox. Un exemple à propos du cancer du sinus piriforme.

Analysis of prognosis factors was performed on a surgical series of 34 of piriform sinus cancer, based on the use of a multivariate study according to the Cox model. The presentation is essentially didactic emphasizing the main points: how to collect data, what data to collect, and what judgment criterion to use. The authors detail the interpretation to be drawn from the analysis results using Cox model.

Lipoid proteinosis: case report.

Lipoid proteinosis is a rare autosomal recessive condition affecting the majority of organ systems, but predominantly involving skin and mucous membranes. The mucocutaneous infiltration due to accumulation of a hyaline material is positive for both sudanophil and periodic acid-Schiff reagents. This was illustrated in a 14-year-old girl with parental consanguinity, who had classic manifestations.

Early detection of hearing loss in children with cleft palates by brain-stem auditory response.

The hearing of 23 children with cleft palates was studied at an early age (before 12 months) and before pharyngoplasty using the electrophysiologic method of auditory brain-stem response. Nineteen children showed important degrees of conduction deafness of 50 or 60 dB. Results were compared with those obtained for a group of normal children tested under the same method before age 6 months. No hearing loss was observed in this group. It is concluded that hearing defects appear at an early age in children with cleft palates and are in direct relationship to the malformation. Hypotheses concerning the etiopathogeny of these hearing losses are proposed.

[Ossiculoplasty. Trial of comparison of different mountings]. / Ossiculoplasties. Essai de comparaison de différents montages.

Functional results of tympanoplasty are partly dependent on the ossiculoplasty phase. Based on results of 331 operations using the closed technique, statistical differences were evaluated between several classical ossicular buildings carried out essentially with homograft ossicles. The study involved assessment of postoperative audiograms practised under identical conditions, patients with anatomical failure being excluded. In type II cases, the different drum to stapes mountings tried gave better results than "malleus to stapes" mountings. In type III cases the difference was not significant. In all cases, results were significantly better when ossiculoplasty was performed during the second look.

[Current status of petrositis]. / Les pétrosites actuelles.

Actual symptomatology of petrositis is often poor; Gradenigo's syndromes are rare. Petrositis can occur as large cystic cholesterol granuloma of the petrous apex. Their C.T. scan, surgical and pathological aspects are different from cholesteatoma of the apex.

[Laryngeal leishmaniasis in a patient from the Jura. Unusual cause of epitheloid and giant cell granulomatosis]. / Leishmaniose laryngée chez un Jurassien. Cause insolite de granulomatose épithélioïde et giganto-cellulaire.

A case of laryngeal leishmaniasis in a patient living in eastern France is reported. Mucosal leishmaniasis appears to be frequent in the New World but rare in the Old World, where only 9 cases have been published, including 3 from France. In this particular patient, there probably was some relationship between the laryngeal lesion and an unexplained malaria-like fever contracted in Algeria 19 years before. This case provides evidence that leishmaniasis is one single nosological entity throughout the world, its different clinical forms (cutaneous, mucosal, visceral) merely reflecting the adaptation of the parasite to its environment.