[Posterolateral retroperitoneal approach and exclusion technique in therapy of infrarenal aortic aneurysm: initial experiences]. / Posterolateraler retroperitonealer Zugangsweg und Exklusionstechnik zur Therapie des infrarenalen Aortenaneurysmas: erste Erfahrungen.

Although the infrarenal aorta is a retroperitoneal structure, the surgical access has been transperitoneal especially when dealing with infrarenal aneurysms. After the opening of the sack a tube-or bifurcated graft is implanted. With the posterolateral retroperitoneal (RP) approach described by G.M. Williams in 1980 access to the aorta can be gained without opening the peritoneal cavity. With the non resective exclusion technique the intraoperative blood loss is minimized. This method is routinely used in Albany N.Y. for the treatment of infrarenal aneurysms. We describe here our first experiences with 44 RP excluded aortic aneurysms. Despite the small number of cases we can confirm the advantages described in the larger series of Sicard et al. and Leather and Shah: the RP approach and the exclusion technique can be routinely used for infrarenal aneurysms. It is associated with a smoother and shorter postoperative period (8 to 10 days).

[Transcranial Doppler ultrasound as monitoring during carotid operation]. / Transkranielle Dopplersonographie als Monitoring während der Carotisoperation.

We describe our method of transcranial Doppler (TCD) monitoring during carotid endarterectomy (CE) procedures. During a period of 35 months we performed 257 CE with TCD monitoring. Critical flow values during crossclamping of the internal carotid artery (ICA) and the necessity of insertion of an intraluminal shunt were taken in consideration with regard to the choice of surgical procedure: TEA (with or without patching) or eversion endarterectomy. The critical flow values were around 10-15 cm/s, no pulsatility signs were detected. Further advantages of the TCD monitoring are: detection of microemboli, control of the potential collateralisation of the external carotid artery and the control of efficacy and accurate positioning of the intraluminal shunt. We comment our results of cerebral monitoring and consider it as a useful tool for optimizing the postoperative results of carotid surgery.

[Benign cervical tumors of neuroectodermal origin: apropos of 3 clinical cases]. / Tumeurs bénignes cervicales d'origine neuroectoblastique: à propos de 3 cas cliniques.

Neuroectoblastic benign cervical tumors. Report of three clinical cases. Cervical neurogenic tumors are uncommon. They arise from the cranial nerves, the cervical sympathetic chain and the paraganglion cells of the parasympathetic system (non chromaffin cells). Three cases are reported (schwannoma-ganglioneuroma-chemodectoma). The pertinent literature is reviewed for the classification, the diagnosis and the treatment.

Psychological effects of Neurotropin in man under normal conditions and after sleep deprivation: a double-blind placebo study.

Psychological effects of Neurotropin--a widely used analgesic in Japan--have been evaluated in a double blind cross-over study on volunteers belonging to the nursing staff of a hospital under sleep deprivation or not. Each subject was asked to record his feelings by self-assessment on scales registering the following states: fatigue-/rest+, mental stress-/relaxation+, cold sensation-/comfort+, dissatisfaction-/satisfaction+. Neurotropin was shown to be devoid of demonstrable psychological effects in the subjects under normal sleeping conditions. After sleep deprivation, Neurotropin globally determined significantly more psychological evolutions towards positives+ and less towards negative- mood than inactive placebo. From the self-assessed feelings, euphoria was unaffected, whereas Neurotropin significantly reduced fatigue and improved relaxation and comfort. These results are compared with the observations made on animals submitted to Specific Alternation of Rhythm in Temperature (SART) where Neurotropin relieves such symptoms as hyperalgesia. This model for experimental pain study corresponds to a depletion of brain serotonin and catecholamines. The effects of Neurotropin on exhausted volunteers could, as in the SART model, be due to an inhibition of monoaminergic depletion. The relevance of this finding to some association of chronic pain and psychogenic factors is to be considered.

[Aneurysm of the extracranial internal carotid artery]. / Das Aneurysma der extrakraniellen Arteria carotis interna.

Aneurysm of the extracranial internal carotid artery is a rarely observed condition. Intra-aneurysmatic thrombosis, cerebral embolism with possible neurological consequences, and rupture are the most common complications. Operations were performed on 20 patients for aneurysm of the internal carotid artery. The cases included 14 "genuine" arteriosclerotic aneurysms and seven "false" aneurysms in the wake of shell splinter injuries, tonsillectomy, thrombo-arteriectomy, and blunt traumata. Pulsating tumour was the most important clinical symptom in all aneurysm cases. Arterial continuity was restored by resection of aneurysm in all cases. Sixteen patients were dehospitalised without any complaint. Two patients with preoperative cerebral infarction were left with residual paresis. One patient died of pulmonary embolism, and one patient operated on for rupture died in shock.

[Prediction of speech audiometry as compared to pure-tone audiometry in the estimation of the importance of noise]. / Essai de prédiction de l'audiométrie vocale au départ de l'audiométrie tonale et appréciation de l'importance du bruitage.

The fitness of the Belgian Air Force pilots is ruled by Royal Decrees which prescribe the tolerated tonal hearing-loss. The tonal audiometry gives only the audiometry threshold of some frequencies. Vocal audiometry, with or without masking, gives elements of audition, understanding, discrimination and integration of the examined patient. We advise a vocal control for each patient who might be put aside of his professional environment according to his tonal audiometry. Complementary examination should allow to not turn down definitely experienced pilots with a bad tonal threshold but with good psycho-acoustic performance. We have selected and tested by tonal and vocal audiometry fifty pilots of the Belgian Air Force with a tonal hearing-loss which, according to the actual medico-legal criteria, should have limited flight aptitudes. Using the method of multiple regression we developed a probability formula based on the tonal threshold which gives us the vocal threshold. According to this study the frequencies 500 and 1000 Hz play a major role in the understanding of the human voice, this with or without a simultaneous masking. Each subject whose arithmetical average of tonal hearing-loss on the frequencies 500 and 1000 Hz is equal or superior to 15 dB, should be deeply controlled on his vocal performances. Our probability formula establishes indeed that those subjects have higher understanding risk problems. The method of multiple regressions has allowed us to establish that the discrimination of sensorineural hearing-impaired listeners in noisy environment is significatively less than the one of normal persons.

Survival rates after reconstructions in the aorto-iliac region.

During a twelve year period, 849 patients were operated on because of atherosclerotic diseases in the aorto-iliac region. 31 patients died postoperatively and 48 patients could not be followed up so that the fate of 770 patients is known. These 770 operated patients showed survival rates like a 12 year older normal population. By comparing the survival rates of the operated patients in different age groups, it is concluded that atherosclerotic diseases have an especially bad outcome in younger patients.

[Screening of tube permeability disorders in applicant student-pilots]. / Le dépistage des dysperméabilités tubaires chez les candidats élèves-pilotes.

The author makes a comparative study of the Eustachian tubal function tested by tympanometry and by stimulated descents in a decompression chamber of applicant pilots. The tympanometry measures only the middle ear pressure and the compliance of the eardrum. There is no exact correlation between the middle ear pressure and the ventilatory function of the Eustachian tube as given by the decompression chamber test. Two third of the candidates with a negative middle ear pressure who undergo simulated altitude exposure in a decompression chamber exhibit barotrauma of the middle ear. On the other hand one third of the patients with a normal ear pressure exhibit barotrauma. The best stress test for Eustachian tube function remains the altitude chamber flight and can not be replaced by the tympanometry.

[Etiology and therapy of Ludwig's angina]. / Etiologie et thérapeutique de l'angine de Ludwig.

After two case reports of Ludwig's angina, the pathogenesis, the bacteriology and the treatment of this syndrome is reviewed. The initial antimicrobial therapy should be broad enough to inhibit the gram-negative and anaerobic organisms. The antibiotherapy should be completed by the incision and the drainage of the submandibular region. The sudden airway obstruction will be prevented by a tracheotomy under local anesthesia.

[Morphological studies of experimental lung transplantation. I. Light microscopic and histochemical findings in autotransplants of dog lungs]. / Morphologische Untersuchungen bei experimenteller Lungentransplantation. I. Lichtmikroskopische und histochemische Befunde an der autotransplantierten Hundelunge

Morphological investigations (light microscopy, semithin sections, histochemistry) on autografted lungs showed two changes with mifferent regional distributions. In the upper lobes were found focal areas of slight fibrosis, in the upper and lower lobes degenerative changes especially of the small bronchi and bronchioles with a focal loss of activity of alkaline phosphatase, nonspecific esterase and some dehydrogenase. Possible reasons for these morphological changes are discussed in connection with functional and biochemical results.

[Comparative study of acoustic trauma caused by blasts, treated by vasodilators or by a combination of vasodilators and hyperbaric oxygenation]. / Etude comparative des traumatismes acoustiques par blasts traités par vasodilatateurs ou par association vasodilatateurs et oxygène hyperbare

The authors had comparated two series of patients with noise induced hearing loss treated by vasodilatators or vasodilatators and hyperbaric oxygen. This therapy seems to give better results than the vasodilatators only, but the patients had to be treated before ten days after the noise exposition. In the two series of acoustic trauma we see rarely a complete recovery from the hearing loss.