[Adrenal insufficiency after treatment of nasal polyposis]. / Insuffisance surrénale chez les patients traités médicalement pour une polypose naso-sinusienne.

OBJECTIVE: Assessment of hypothalamic-pituitary-adrenal (HPA) axis after long term and uncontrolled corticosteroid treatment in nasal polyposis. PATIENTS AND METHODS: A short synacthen test was performed in ten patients who received uncontrolled doses of corticosteroids in a population of 128 patients treated for nasal polyposis. RESULTS: Mean yearly dose of oral prednisone administered in short-term treatment varied between 1280 and 7300 mg. Mean daily dose of inhaled beclomethasone varied between zéro and 2000 microg. Morning plasmatic cortisol was abnormal in seven the patients before and after the stimulation (respectively 140 nmole/l and 359 nmole/l). DISCUSSION: High and uncontrolled doses of corticosteroids in nasal polyposis affect HPA axis.

[Olfactory disorders due to medications: analysis and review of the literature]. / Troubles olfactifs d'origine médicamenteuse: analyse et revue de la littérature.

INTRODUCTION: Olfactory disorders caused by medicinal drug intake are an uncommon occurrence. However, such an etiology should be systematically taken into account and investigated, as olfactory loss may be reversible once the particular treatment has been stopped. CURRENT KNOWLEDGE AND KEY POINTS: An analysis of the literature shows that of the large number of drugs that are apparently responsible for olfactory disorders, this adverse side effect has in fact only been observed in animal study populations, and no clinical case report has been made on the subject. The real toxicity to man is therefore only hypothetical. Of the 150,000 cases recorded in the pharmacovigilance centers in France, only 68 have reported olfactory complications (0.05% of cases), and only 22% of the medical files on this disorder reach a satisfactory level of plausibility. Cardiovascular drugs are mainly implicated in the development of olfactory disorders. Of these, certain drugs in particular should be mentioned: conversion enzyme (ACE) inhibitors which are responsible for taste disorders, some betablockers, and a calcium antagonist (a dihydropyridine derivative). Olfactory disorders have also been reported following administration of drugs used in anesthesia, in cancerology, endocrinology (carbimazole), in immunology (interferon), in the treatment of infectious diseases (ciprofloxacine, dioxycycline, terbinafine), and in rheumatology (D-penicillamine). FUTURE PROSPECTS AND PROJECTS: It is frequently difficult to establish a direct relationship between drug exposure and an olfactory disorder, and it is often not easy to determine with any certainty the causative role of the drug in the development of this disorder.

[Chemicals toxic to the olfactory system. Analysis and description]. / Produits chimiques toxiques pour le système olfactif. Analyse et description.

AN IMPORTANT PROBLEM: Occupational exposure to chemical products can have toxic effects on the olfactory system. An important number of patients have experienced olfactory disorders subsequent to the development of the chemical industry and atmospheric pollution. EPIDEMIOLOGY DATA: Straightforward data are difficult to collect because several cofactors other than the toxic product are involved. Two lists of toxic products can be made. The first list includes products for which scientific data is available and the second products for which data is lacking. Olfactory tests also differ between authors and countries. TWO TYPES OF TOXICITY: Acute, accidental toxicity is evidenced by the lesions caused by inhalation of high-doses of strongly toxic agents. Chronic intoxication caused by lower concentrations of these inhaled agents does not produce a trigeminal reflex leading to a modified respiratory rate reducing the airborne aggression. APPROXIMATIONS: Clinical data describing the olfactory toxicity of certain industrial and chemical compounds are very significant but often cannot prove a cause and effect relationship. Data obtained with experimental models in rodents are difficult to extrapolate to humans.

[Olfactory disorders in Alzheimer's disease and in Parkinson's disease. Review of the literature]. / Troubles olfactifs dans la maladie d'Alzheimer et dans la maladie de Parkinson. Revue de la littérature.

Olfactory disorders in Alzheimer's disease and Parkinson's disease have been the topic of a large body of work over the last decades. Work devoted to olfactory disorders in Alzheimer's disease includes over 300 papers providing clinical and fundamental data. Anatomy studies in Alzheimer's disease have demonstrated a specific concentration of lesions in peripheral and central olfactory structures (senile plaques, neurofibrillary degeneration) as well as lesions in layers II and III of the entorhinal cortex. These neuropathological findings led to the development of the hypothesis that olfactory disorders in Alzheimer's disease would result from a toxic process. Observed olfactory deficits involve both identification and recognition of odors and detection thresholds. Nevertheless, patients with Alzheimer's disease rarely consult for sensorial deficits as the other signs of the disease predominate. Neuropathology data on the olfactory system are much more sparse in Parkinson's disease. Lewy bodies suggestive of Parkinson's disease have been observed in the olfactory bulb and pathways, but, unlike Alzheimer's disease, the olfactory disorders appear to be stable, changing little over time, as opposed to the evolution of neurological symptoms and cognition impairment. Clinicians should be aware that olfactory disorders are an integral part of Alzheimer's disease and Parkinson's disease. Screening for sensorial impairment however is a secondary objective in the context of these neurodegenerative diseases.

[Description and analysis of olfactory disorders after head trauma. Review of the literature]. / Description et analyse des troubles de l'odorat après un traumatisme crânien. Revue de la littérature.

Olfactory disorders subsequent to head trauma can raise medicolegal problems when the olfactory deficit occurs after a work accident or a traffic accident and also raises the problem of psychological and functional tolerance when the patient consults late for a therapeutic solution. We studied the epidemiology of olfactory disorders after head trauma. Such disorders have been recognized since the XIX(th) century. Several studies have attempted to determine the prevalence of olfactory sequelae after head trauma. We then describe the pathophysiology of these lesions and emphasize that the degree of severity is related with the gravity of the head trauma and that the prevalence of these disorders varies considerably depending on the site of the trauma. Mechanisms which can lead to lesions of the olfactory system include, damage to the olfactory nerve bundles, naso-sinus lesions, or lesions of the cerebral olfactory centers. Brain MRI in anosmic patients after head trauma allows a visualization of intracranial lesions. The degree of reversibility of olfactory disorders after head trauma is imperfectly evaluated and discordant results have been reported. Some authors consider loss of olfaction is definitive. Others suggest an improvement in olfaction the year following head trauma. We reviewed the literature on these different elements. Expert opinions concerning patients complaining of olfactory disorders should relate this disorder to the initial trauma and determine the personal and occupational impact of the deficit. Attribution of cause must take into account all the clinical, radiological and psycho-olfactory factors.

[Olfactory disorders and general pathology. Analysis and review of the literature]. / Troubles olfactifs et pathologie générale. Analyse et revue de la littérature.

INTRODUCTION: Disturbances of the sense of smell have been documented in many general pathologies. The actual etiology of such impairments is often difficult to determine. The aim of the authors is to review the literature on olfactory disorders in general diseases. CURRENT KNOWLEDGE AND KEY POINTS: Acute and chronic liver disorders are frequently associated with hyposmia, which can be improved by vitamin A intake. Renal insufficiency could induce hyposmia according to the severity of the renal disease. Olfactory disorders seem to regress after transplantation but not after dialysis. Patients with AIDS--especially neurological forms--often present with taste and smell impairments. Smell alteration can also be noted in hypothyroidism and pseudohypoparathyroidism. In addition, taste and smell impairments have been described in patients with adrenal insufficiency or Cushing's disease. Subsequent to glucocorticoid therapy, adrenal insufficiency can induce regressive olfactory hypersensitivity. Olfactory impairments in diabetic patients can be associated with diabetic macrovascular manifestations due to ischemic alterations in the olfactory neuroepithelium. Impairment of the sense of smell has been described in many systemic diseases such as Horton's arteritis and Sjögren's syndrome. FUTURE PROSPECTS AND PROJECTS: Olfactory disorders should be investigated in patients presenting one of the above-mentioned diseases.

[Analysis of olfactory disorders in aging]. / Analyse des troubles olfactifs liés au vieillissement.

AGING EFFECT: The effect of aging on the olfactory system is generally observed in subjects over the age of 65 and is the number one cause of olfactory disorders. Several studies taking into account the state of the naso-sinus system and possible early stage of developing dementia have examined the precise effects of aging on olfaction. AGE-RELATED CHANGES: Aging affects olfactory thresholds, estimation of the intensity of an olfactory stimulation, and identification and memorization of odors. The elderly subject identifies food and other odors less easily than the young subject although elderly subjects can learn to improve their performance. Changes in the nasal cavity, particularly an alteration of the processes involved in neuron distribution in the olfactory neuroepithelium, may be involved. IMPACT OF OLFACTORY DEFICIENCY: There is much morphological and experimental evidence showing the effect of aging on both peripheral and central olfactory pathways allowing a better understanding of the functional impact of the sensorial deficit. Olfactory deficiency can explain in part the eating problems encountered in elderly patients.

Tibioperoneal diaphyseal toxopachyosteosis or Weismann-Netter-Stuhl syndrome: difficulties encountered in classifying this syndrome and differentiation from rickets.

Using two new cases and 70 case reports in the literature as a starting point, the authors focus on the Weismann-Netter-Stuhl syndrome. Weismann-Netter and Stuhl reported the first cases of tibioperoneal diaphyseal toxopachyosteosis in 1954. This syndrome is defined as an anomaly of the diaphyseal part of both tibiae and fibulae with posterior cortical thickening and anterior-posterior bowing. This anomaly is usually bilateral and symmetrical, and patients are therefore short in stature. The thickening of the fibula is true "tibialisation" and "is the main feature and the only feature confirming diagnosis". Routine laboratory investigations showed no abnormalities in the two new cases. The authors specify the limits encountered in classifying this anomaly and discuss the degree to which this anomaly is an entity unto itself when compared with rickets sequelae.

Role of genetic factors in bronchial cancer. Based upon a case of anaplastic lung carcinoma in identical twins.

Having observed homozygotic identical twin brothers suffering simultaneously from anaplastic bronchial cancer leading rapidly to death in both cases, the authors assessed the frequency of such cases. The available literature failed to reveal any identical observations, although four cases of twins suffering from bronchial cancer featuring different histologies (three epidermoidal and one bronchiolar-alveolar) were noted. Statistics show that, in the area where the observed twins were living, anaplastic cancer occurs each year in 0.39% of 53-year-old men. The case of these twins therefore supports the idea of the role of genetic factors in the determination of bronchial cancer.

[Computed tomography in thoracic pathology]. / Le scanner en pathologie thoracique.

The fundamental principles of computed tomography (CT), its clinical applications and costs are presented followed by the indications and results in diseases of the mediastinum, the oesophagus, heart and great vessels, and the lung and pleura. The CT scan can give the precise localization and density of mediastinal tumours and be used to distinguish thymomas, goiters, lymph nodes, lymphomas, neurinomas and different bronchogenic and pleuropericardial cystic formations. The operability of oesophageal cancer can also be determined. In cardiovascular diseases, the CT scan is particularly useful to identify inborn anomalies, aneurysms, aortic dissection or caval compression or thrombus formation. In lung diseases, the indications for a CT scan are particularly important in bronchopulmonary cancer, tuberculosis, bronchopathies and chronic lung diseases. In bronchogenic cancer, for example, the CT scan is not only a major diagnostic tool but is also particularly useful in determining the prognosis and for following the effectiveness of treatment. The CT scan can be used to identify both effusions of liquid and gas as well as pleural reactions producing thick membranes of importance for both aetiology and later follow-up. Bronchectasis can be identified on serial sections where the degree of extension can be measured. CT scan is also indicated in patients with emphysema, both for evaluating extension and follow-up. Finally the indications and contraindications for interventional computed tomography, particularly in guiding needle biopsies, is presented.

A historical case of disseminated chronic tuberculosis.

A British author has put forward a new explanation for Joan of Arc's behaviour. This author suggests that the voices Joan of Arc heard were due to the presence of a temporal lobe tuberculoma in the context of widespread chronic tuberculosis (exposure to bovine tuberculosis, amenorrhoea, heart and intestines incombustible). We consider that some elements are incompatible with widespread tuberculosis. It is difficult to draw final conclusions, but it would seem unlikely that widespread tuberculosis, a serious disease, was present in this 'patient' whose life-style and activities would surely have been impossible had such a serious disease been present.

[Magnetic resonance imaging in thoracic diseases]. / Apports de l'imagerie par résonance magnétique en pathologie thoracique.

Most all the thoracic structures are visible with magnetic resonance imaging: the mediastin, the myocardium including the endocardium and the pericardium, the pulmonary parenchyma and hile and the pleural walls. In cases of mediastrinal masses, T1 images clearly delimit their relations with neighbouring organs and vessels. The intensity of the signal is compared with that of the muscles on T1 weighted images of the preceding sections and T2 weighted images of fat. Images of aneurysms and chronic dissections can be synchronized with the ECG allowing three-dimensional measurement of the size and thickness of the vessel walls. Thrombi or extension to other vessels can also be recognized. Small hilar tumours can be differentiated from vessels but the scanner is better for analyzing systematization and bronchial lesions. For lung tissue itself, magnetic resonance imaging can detect nodules greater than one centimeter in diameter, but the low proton density and respiratory movements hinder spatial resolution. MRI is indicated for localizing tumours situated anteriorly or posteriorly or at the apex and to identify parietal extension of peripheral cancers. Spinal, vascular, pericardial, diaphragmatic and lymph node metastases can be recognized. MRI is the noninvasive method of choice for evaluating left ventricular masse, intra and paracardiac mass studies and for investigating congenital and acquired cardiomyopathies. Technical advances have made it possible to evaluate myocardial perfusion and heart function.

[Holter monitoring. Value in silent myocardial ischemia]. / Enregistrement Holter. Intérêt dans l'ischémie myocardique silencieuse.

The inclusion of the digital system in the Holter recording and analyzing systems and the development of micro-computers have multiplied the possibilities and increased the accuracy of this technique. Analysis of the ST segment has resulted in a definition of the silent myocardial ischaemia syndrome. It has also made it possible to evaluate the importance of myocardial ischaemia in daily life and to assess the efficacy of anti-ischaemic treatments.