[Value of total thyroidectomy in amiodarone-induced hyperthyroidism]. / Intérêt de la thyroïdectomie totale dans l'hyperthyroïdie à l'amiodarone.

The potential severity of amiodarone-induced hyperthyroidism, particularly in severe cardiopathy cases, necessitates a regular clinic and biologic thyroid control. The break in amiodarone and a medical treatment (synthetic antithyroid drugs, steroids, perchlorate of potassium) can be ineffective. The authors report the case of a patient with an right ventricle arythmogenic dysplasia, without thyroid history, who came back 3 years after the introducing of amiodarone with major hyperthyroidism. After failure of medical treatment, a total thyroidectomy permitted to quickly stop hyperthyroidism and to early reintroduce amiodarone. Surgery seems to be the radical treatment when hyperthyroidism doesn't respond to the medical treatment and when the cardiopathy requires amiodarone.

[Isolated facial palsy and occult adenoid cystic carcinoma of the parotid]. / Paralysie faciale isolée et carcinome adénoïde kystique occulte de la parotide.

We report a case of adenoid cystic carcinoma of the parotid disclosed by facial palsy alone. No tumefaction could be detected clinically or at imaging. The diagnosis was established at surgical exploration of the facial nerve. Total extended parotidectomy was completed by radiotherapy of the tumor site.

[Reflections on percutaneous tracheotomy. Regarding a retrospective study of 106 cases with major burns]. / Réflexions sur la trachéotomie percutanée. A partir d'une étude rétrospective chez 106 grands brûlés.

About ten years ago, a new technique for tracheotomy was invented in the United States and has tended to replace the surgical technique in intensive care units. Percutaneous tracheotomy is performed by the intensive care unit physician working in the unit at the patient's bedside. Progressive expansion seems to be the method of choice. Physicians at the Center for burn victims at the Percy Army Hospital have used this technique since 1994. We performed a retrospective study of 106 cases, between 1994 and 1998, and reviewed the international literature. Percutaneous tracheotomies were performed via a vertical cutaneous discharge incision and appeared to be particularly interesting for patients with major burns who are difficult to transport and risk secondary infections. Three early and serious complications were observed, emphasizing the need of a peroperative endotracheal fiberoptic endoscopic control. Three tracheal stenoses were observed: however respiratory tract burns had occurred all three of these patients. In the literature, most of which has been written by intensive care physicians, it is rather surprising to note the enthusiasm for percutaneous tracheotomy based on the high risk of complications of the surgical technique. Moreover, possible late after effects of percutaneous tracheotomy remain unknown as few survivors have been seen again late after use of this recent technique.

Posture control after prolonged exercise.

The perturbations of equilibrium after prolonged exercise were investigated by dynamic posturography on nine well-trained subjects (four athletes and five triathletes). A sensory organization test, where the platform and visual surround were either stable or referenced to the subject's sway with eyes open or closed, was performed before and after a 25-km run (average time 1 h 44 min) by the nine subjects. In addition, the same test was performed on the five triathletes only, before and after ergocycle exercise of identical duration (i.e. ergocycle time = running time). The results showed that the ability to maintain postural stability during conflicting sensory conditions decreased after exercise, with some differences depending on the kind of exercise. Sensory analysis revealed that the subjects made less effective use of vestibular inputs after running than after cycling (P < 0.05). Adaptation to prolonged stimulation of proprioceptive, vestibular and visual inputs had probably occurred in the integrating centres during exercise. This adaptation was maintained during the recovery period and could explain the postexercise balance disorders. Other mechanisms such as impairment of motor efferents or haemodynamic changes should not be excluded.

[Anatomo-clinical criteria of cutaneous melanoma with spontaneous and complete regression. Apropos of a case]. / Critères anatomo-cliniques du mélanome cutané spontanément et complètement régressif. A propos d'un cas.

We report a case of a 73 year old man presented a spontaneously and completely regression cutaneous malignant melanoma with cervical lymph node metastasis, confirmed by clinical and histopathologic observations. The authors examine the features of regression of primary malignant melanoma through a review of the literature.

[Inhalation burns: apropos of 198 cases. Incidence of laryngotracheal involvement]. / Les brûlures par inhalation: à propos de 198 cas incidence de l'atteinte laryngo-trachéale.

Inhalation burns and laryngotracheal involvement were studied in a retrospective series of 635 patients hospitalized for skin burns at the Center for Burn Treatment from January 1993 to January 1997. Inhalation burns were observed in 31.1% of the cases. Exclusive laryngeal involvement occurred in 19.6% of the inhalation burns. Both tracheobronchial and laryngeal burns were observed in 27.2%. Patients with inhalation burns also had facial burns (90.9%) and extensive (> 50%) or severe (UBS > 200) skin burns in 39.8% and 29.7% of the cases respectively. Mortality of skin burns was increased six-fold to 19.1% in patients who also had inhalation burns. Intubation was used alone in 60.1% and was followed by tracheotomy in 27.2%. The decision for tracheotomy was essentially based on the probable duration of ventilatory assistance. Tracheotomy was required in case of severe inhalation burns and the predictable duration of intubation was over 8 days. Laryngotracheal stenosis occurring after inhalation burns is complex and extensive, with great variability over time. Laryngotracheal calibration is indicated as first intention therapy.

[Equitest and high performance patients]. / Equitest et sujets de hautes performances.

The purpose of this study was to verify whether a clinical tool used to assess balance deficits could be used to document the enhanced equilibrium skills of highly trained individuals. A sensory organization test (SOT) based on computerized dynamic posturography (Equitest Neurocom) was administered at two levels of difficulty (sway-reference gains 1.0 and 1.99) to six populations of subjects (n = 81): controls, active duty fighters pilots, former fighter pilots, windsurfers, T-kwando athletes and firemen. The more difficult SOT (gain 1.99) provided the best estimation of performances differences among the six populations. Specifically, performance scores were significantly higher (p > 0.001) for wind surfer and active duty pilots compared to the other groups. Differences between active duty are retired pilots suggest that the enhenced balance of milots is an acquired skill required continued practice. Results furthers suggest that dynamic posturography can be reliable tool for identifying subjects with enhenced equilibrium skills.

[Vertigo in normal vestibulo-cochlear balance. Vestibular omissions]. / Zawrót w prawidlowym bilansie slimakowo-przedsionkowym. Omisja przedsionkowa.

Some vertigo can be found in normal vestibulo-cochlear balance. The authors showed diagnostic and treatment problems. Treatment of the vertigo lean for rehabilitation.

[Ambulatory surgery in otorhinolaryngology: what is possible, suitable, prohibited?]. / La chirurgie ambulatoire en oto-rhino-laryngologie: qu'est-ce qui est possible, souhaitable, interdit?

A rational examination of technical conditions in E.N.T. face and neck surgery is realized with the intention of determining the best directions of ambulatory surgery. This application is based on technical requirements due to modernization of equipment and surgical ways, specially in ear and nose surgery. In surgery of upper air and alimentary ways, patient's security is at risk. These considerations allow to discuss states in which ambulatory surgery is possible, others where it is wished and particular states where it is not recommended.

[Indications and results apropos of 290 endonasal ethmoidectomies]. / Indications et résultats à propos de 290 ethmoïdectomies endonasales.

An intranasal ethmoidectomy prospective study was carried out from 1985 to 1991 on 152 patients and 290 ethmoidectomies. This surgery is intended for patients who have been treated often for nasal polyps, chronic ethmoiditis and recurrent sinus barotrauma. A discrepancy was observed between patients satisfaction (82%) and clinical symptoms, given that results remain good in 75% of the cases three years afterwards but only in 60 cases after five years. There is a recurrence of nasal polyps in 36% of the cases.