Human body numerical simulation: An accurate model for a thigh subjected to a cold treatment.

This article presents the development of a digital twin model of a thigh portion subjected to various thermal treatments. Two scenarios are investigated: cold water immersion (CWI) and whole body cryotherapy (WBC), for which the comparison of numerical results with experimental measurements validates the consistency of the developed model. The use of real geometry on a first subject demonstrates the high heterogeneity of the temperature field and the need for accurate geometry. A second subject with thicker adipose tissue highlights the impact of the subject's actual morphology on the validity of the treatment and the necessity to work with real geometry in order to optimize cold modalities and develop personalized treatments.

[Subcophosis and otosclerosis. Medical and surgical treatment]. / Subcophoses et otospongioses. Traitement médical et chirurgical.

The spiral ligament of the stria vascularis is nearly always damaged by otosclerotic foci when the patient is nearly totally deaf because of otosclerosis. Vascular drugs are to be prescribed in such a case, besides the Sodium Fluoride treatment. The Sodium Fluoride is, according to us, the best treatment to arrest the progression of the otosclerotic disease. Sodium fluoride will destroy the proteolytic enzymes damaging the inner ear membranes and the hair of the Corti hair cells.

[Sound injuries after surgery of otosclerosis]. / Traumatismes sonores après chirurgie de l'otospongiose.

Surgery for otosclerosis means that the sound protection due to the fixation of the footplate does not exist anymore. As the Corti hair cells have been fragilized by proteolytic enzymes, it is absolutely necessary to reconstruct the sound mechanism in order to maintain the vibration of the perilymph absolutely within acoustical physiologic limit of movement. The means to realize this reconstruction are presented in this paper, as well as the results.

[The development of tinnitus in the postoperative period of otospongiosis]. / Devenir des acouphènes en postopératoire de l'otospongiose.

Correlation between tinnitus and audiometric loss, modification of tinnitus by medical or surgical treatment, allow to suspect the origin of tinnitus due to otospongiosis and to give the patient a practically always confirmed prognosis. Audiometric localization of tinnitus is essential, as it is the best clue to etiology, treatment and prognosis of otospongiosis tinnitus. As far as irreducible tinnitus are concerned, as anxiety is the most pejorative parameter, not discouraging the patient is very important.

[Improvement in hearing as a function of type of platinectomy or platinotomy performed in the surgical treatment of otospongiosis]. / Amélioration de l'audition en fonction du type de platinectomie ou de platinotomie effectué dans la chirurgie de l'otospongiose.

The footplate fenestra should be performed in its posterior third part to avoid pressure of the piston on the membranous labyrinth, situated very close to the footplate in 2% of the cases in otosclerotic patients. Gain in bone conduction differs according to the size of the fenestra performed. Low frequencies improve most when the whole posterior third part of the footplate is removed; the audiometric gain is better for high frequencies when a 0.8 mm stapedotomy is performed. These findings demonstrate the interest of a more or less enlarged fenestra according to the language spoken by the patient, since the different languages use mainly high or low frequency phonemes.

[Prognosis for tinnitus after surgery for otospongiosis]. / Devenir des acouphènes en postopératoire de l'otospongiose.

Correlation between tinnitus and audiometric loss and modification of the former by both surgical and medical treatment provide sufficient data to suggest its origin and to give the patient a prognosis confirmed in practically every case. Audiometric localization of the tinnitus is essential, since this allows establishment of the etiology, treatment and prognosis of the symptom. When tinnitus is irreversible, the hope of a possible recovery must be given to the patient to avoid the inevitable anxiety produced.

[Result and treatment of tinnitus in our clinic]. / Bilan et traitement des acouphènes dans notre clinique.

The authors propose a test consisting in performing injections of Renovaine, a very strong anaesthetic drug, in the external ear duct in order to reduce momentarily severe and decompensated tinnitus. They discuss the usefulness of this test and develop two concepts to explain its action. They make a pragmatic approach of the tinnitus etiopathogeny.

[Means of fixing a transmission device to the center of a mobile footplate]. / Moyen de fixation d'une transmission au centre d'une platine mobile.

The authors present a new fixation device for any bony or prosthetic transmission system to the center of a mobile footplate in the absence of the stapes crura. It is a disc-shaped silicone sponge, with a central hole, fitting the bottom of the oval fossa and thus securing the maintenance of the bony or prosthetic transmission in the center of the mobile footplate, and reducing the risk of shifting of the transmission system, which is always possible in case of tympanic retraction. The silicone sponge allows as well a more physiological transmission, because the footplate will vibrate from top to bottom thanks to a central force vector, thus giving better audiometric results. The biocompatibility of the silicone sponge eradicates any phenomenon of intolerance from the tissues.

[Abortion in the first trimester of pregnancy and the risk of malpractice]. / L'I.V.G. du premier trimestre et ses risques d'engagement de la responsabilite.

PIP: Although the legalization of abortion in France has led to a reduction in the grave complications generally associated with illegal abortion, abortion legislation has left open the possibility of malpractice complaints. A study of 81 trial records and communications from insurance compaines and the National Council of the Order of Physicians, as well as personal observations, forms the basis for a new classification of malpractice complaints. 39% of cases concerned 1 or more infractions of the abortion legislation, of which only failure to observe required conditions, such as performance by a physician, performance in a hospital or other approved facility, and limiting procedures to the allowable gestational age, can lead to penal sanctions. In 12% of the records (10 cases), maternal deaths from various causes were followed by civil suits. 2 cases were in process and 3 had led to penal sanctions. The conditions of anesthesia were involved in about 1/4 of the cases. In about 20% of cases, the complications were immediate and nonfatal, such as retention, hemorrhage, and perforation. Only 3 in 16 such cases were brought to trail and most of the others were settled by insurance compaines. 6% of cases resulted from medical errors without serious consequences, and 19 cases, or 22%, from unsuccessful abortions. Although parents of children born after unsuccessful abortions have not been awarded any indemnification, the existence of means for avoiding such a failure has been cited in 1 case and the treat of a fertility effect after unsuccessful abortion could possibly be admitted in French law in the future. Abortion practitioners should exercise the greatest prudence in following the law and in performing abortions.^ieng

[Trends in indications for therapeutic abortion. Statistical study of 20 years]. / Evolution des indications de l'interruption therapeutique de grossesse. Statistiques sur 20 annees.

PIP: 2 conditions are necessary for a therapeutic abortion: a medical indication of the threat to the mother's health posed by the pregnancy or the risk of incurable malady in the fetus, and the obtaining of clear consent from the woman, who has been duly advised of the risks. Medical indications for therapeutic abortion have preceded legal dispositions. An 1850 vote after animated debate at the French Academy of Medicine approved therapeutic abortion if no other treatment could save the mother's life, but the practice was not precisely codified until promulgation of a decree in 1955. The physician was to obtain the opinions of 2 consultants. Despite a few therapeutic abortions for fetal indications, a public debate on the issue did not arise until the thalidomide crisis of 1962. The 1975 and 1979 laws permitted therapeutic abortion if the pregnancy posed a grave threat to the mother's health or there was a strong probability that the fetus would be afflicted by a grave disorder recognized as uncurable at the moment of diagnosis, 179 records of therapeutic abortions performed from 1964-82 showed that the average age of the woman varied from 29 to 33 years from 1964 to 1973 and thereafter declined to 27-28 years by 1982. The declining age is directly related to the widespread use of sonography. The average gestation at time of therapeutic abortion has been about 19 weeks since 1964. None of the 20 therapeutic abortions performed from 1964-70 were for fetal indications, while in 1982 only 6 of 24 indications involved maternal risk and the other 18 included 2 cases of German measles, 2 of anencephalie, 3 of trisomy 21 and 1 of trisomy 18, 3 of spina bifida, 4 of coelosomies, and 3 of hydrocephalies. Therapeutic abortions for maternal indications are becoming proportionately less frequent because more of the conditions posing threats to maternal health during pregnancy are amenable to treatment, while improved contraceptive methods offer greater protection against pregnancy and improved methods of prenatal diagnosis of fetal morphologic, enzymatic, or chromosomal anomalies incompatible with a normal life. The availability of therapeutic abortion poses medicolegal problems, especially concerning the right of the fetus to be born.^ieng

[Computer technology in otospongiosis. 2. Statistics on 15 years of stapedectomy]. / Apport de l'informatique dans l'otospongiose. Deuxième partie. Statistiques sur 15 ans de stapédectomies.

To complete their two previous data processing studies on systematization of parameters for otospongiosis and on statistics concerning the otospongiotic disease itself, the authors now develop the study of postoperative functional results obtained over 15 years stapectomies performed according to various techniques. The characteristic of this study is that the functional results are not considered only from the operative technique point of view, but that they also take into account all the factors having an influence upon the functional results, i.e. mechanical operative factors, otospongiotic cochlear factors and, finally the patient's general factor. This work is divided in three parts. The first part considers statistical data drawn from investigating elements taken over a period ranging from 1960 to 1975 from operative findings, surgical techniques and operative complications, particularly during reoperations, i.e., the mechanical part of hearing improvement in otospongiosis surgery. The second part deals with the problem of the medical postoperative care in stapedial surgery and with that of postoperative complications and the therapy used to combat them. It is the study of the cochlear support problem considering both the cochlear fragility facing the operative trauma, and the cochlear deterioration due to the enzymatic action of the otospongiotic microfoci of the lateral wall of the cochlear duct and of the vestibular side of the footplate. The third part is the statistical study made both by means of data processing and of manual investigation, on the long term functional results obtained, on one hand by the surgical solution of the stapedial fixation's mechanical problem, and on the other, by the medical solution of the cochlear problem considered both from the enzymatic and vascular point of view. This study of stapedectomies' long term functional results allows the authors to draw the conclusions which seem to result logically from this very elaborated statistical study concerning near 17000 stapedectomies performed from 1960 through 1975.

Mechanical explanation of the on-off effect (diphasic impedance change) in otospongiosis.

Impedancemetry gives important information in otospongiosis, both for relative compliance and impedance audiometry. The detection of the stapedius reflex is facilitated by recruitment in some audiometric types of otospongiosis and enables us to solve many of the masking problems which are particularly difficult in this disease due to the very important cross-hearing (or cross-over). Diphasic impedance changes (on-off effect) once detected must be systematically investigated since they allow us to detect otospongiosis early on. This sign is absolutely characteristic of the onset of a stapediovestibular involvement and is of primary interest in this disease because of its early appearance - before any classical audiometric change and any air-bone gap, i.e. before deafness. Diphasic impedance changes must thus be systematically investigated in case of so-called unilateral otospongiosis, in the audiometrically normal ear, and for the detection of otospongiosis in otospongiotic families. It is also helpful in confirming the otospongiotic origin of sensorineural losses before an air-bone gap appears. Our experience with routine stapedectomies and impedance audiometry measurements have led us to a purely mechanical explanation of the on-off effect, i.e. the response of an elastic system to a deformation with a different mechanism of the two inverse peaks, with a different mass and thus a different inertia. This mechanical explanation fits perfectly with anatomical findings. Everything occurs as if the evolutive stages of the onset of the stapediovestibular involvement were defined in impedancemetry, starting from the normal stapedius reflex, first by mixed forms, then by a pure on-off effect, finally by the disappearance of the stapedius reflex.

[Contribution of data processing in otospongiosis. Part I. Statistics on otospongiosis]. / Apport de l'informatique dans l'otospongiose. (Première partie). Statistiques sur la maladie otospongieuse

The use of data processing in their otology clinic allowed the authors a better approach to otospongiosis and to its treatment, thus completing the knowledge of the otospongiotic disease according to their enzymatic concept. An important material has been gathered since 1959 to the present (June 1, 1974), based on more than 16 000 stapedectomies and nearly 100 000 otology out-patients. It has been studied both through a conventional method and an informatic one on the computer of their clinic. Statistical data, apparently valuable, could be drawn from this mass of information for each patient, starting from his first consultation and following him through his secondary consultations, operation, immediate postoperative follow-up and various postoperative check-ups performed. It also takes into account the general state of the patient and all the accidents which may happen during a remote postoperative period. First of all, the authors give the data for these statistics established according to the systematization of the parameters for otospongiosis they have previously published in 1973. In the first part, they gather statistical data obtained about the otospongiotic disease itself, some of which differ from the classical notions of frequency or importance. These statistical conclusions confirm some percentages stated by other authors (predominance of the woman and of the white race, severity of the disease in the young, etc.), but differ in relation to the number of deafs, the percentage of unilateral otospongiosis in comparison, to the bilateral ones, the importance of pure cochlear otospongiosis, the separate valuation of audiometric stages and that of anatomic types, the relation between age and anatomic type, finally the respective frequency of pre-and postoperative vertigos. In the second part, which will be presented later, the authors will study the postoperative functional results obtained within a period of 15 years by stapedectomy according to three techniques. But the particularity of this study will be the fact that functional results will not be considered only from the operative point of view, but from the whole of the factors acting upon the functional result, i.e.: operative mechanical factor, otospongiotic cochlear component, finally general state of the patient. We will thus have a better knowledge of this very peculiar disease of the otic capsule, hat is otospongiosis, characterized by its two phases: a first lytic phase provoked by an enzymatic factor, then a second rebuilding phase according to a pseudo haversian process. During the long progression of the disease, these two phases intermingle and juxtapose much more than they follow each other in the course of time.

Paradoxical compliances in otosclerosis.

Results of impedancemetry have been compared with operative findings in 1 867 cases of otosclerosis, 1 583 of which were pure otosclerosis. This comparison indicated that: (1) with present techniques, the results of impedancemetry are only of a relative value in otosclerosis; it is thus necessary to asses the various connected anatomical elements in the middle ear with extreme rigor; (2) impedancemetry data have an absolute value in all disorders of the middle ear with closed eardrum associated with otosclerosis; (3) relative impedancemetry often gives informative results when it concurs with the other elements of clinical and audiometrical diagnosis; (4) impedancemetry data are a valuable element of early diagnosis of otosclerosis before the first audiometric expression, either by a lowering of compliance or, most of all, by appearance of an on-off effect (diphasic impedance change) or by disappearance of the stapedius reflex; (5) parallel or crossed paradoxical compliances are only apparently paradoxical and are usually the sign of either an early stapedo-vestibular fixation (before its audiometric expression) or an associated factor in the middle ear, both of which may have been unnoticed; (6) the problem of compliance value in otosclerosis will be solved only when the proper stapes frequency is found and when it is possible to test this frequency. This problem is the subject of our current research.