A human homologue of the Drosophila eyes absent gene underlies branchio-oto-renal (BOR) syndrome and identifies a novel gene family.

A candidate gene for Branchio-Oto-Renal (BOR) syndrome was identified at chromosome 8q13.3 by positional cloning and shown to underlie the disease. This gene is a human homologue of the Drosophila eyes absent gene (eya), and was therefore called EYA1. A highly conserved 271-amino acid C-terminal region was also found in the products of two other human genes (EYA2 and EYA3), demonstrating the existence of a novel gene family. The expression pattern of the murine EYA1 orthologue, Eya1, suggests a role in the development of all components of the inner ear, from the emergence of the otic placode. In the developing kidney, the expression pattern is indicative of a role for Eya1 in the metanephric cells surrounding the 'just-divided' ureteric branches.

Epithelial cell proliferation in nasal polyps could be up-regulated by platelet-derived growth factor.

The modifications of epithelial differentiation and proliferation observed in nasal polyps (NP) could be related to local secretion of growth factors, among which platelet-derived growth factor (PDGF) could play a key role. We therefore prospectively studied, by immunohistochemistry, proliferating cell nuclear antigen (PCNA, an S-phase cell marker), PDGF, and CD-68 (activated macrophages marker) expression in NP and inferior turbinate mucosa (NM) in 11 patients. Our data show that PCNA and PDGF expression are increased in NP epithelium, while CD-68 expression is increased in NP epithelium and lamina propria when compared to NM. Increased local PDGF secretion by numerous activated macrophages could therefore be involved in epithelial cell proliferation up-regulation in NP. PDGF could also be involved in the pathogenesis of NP via its connective tissue remodeling actions.

Management of sinonasal hemangiopericytomas.

The purpose of the present study is to report four cases of sinonasal hemangiopericytoma (HP) diagnosed and treated in our department between 1987 and 1998. The pretreatment findings and the treatment are described and discussed in the light of the literature. HP are unusual vascular tumors, featuring pericytes distributed around normal vascular channels. Two of these four cases were located in the nasal cavity and the other two were located in the maxillary sinus. Inside the nasal cavity, HP presented as a protruding reddish-gray mass with marked bleeding on contact. Electron microscopy and immunohistochemical techniques are essential for diagnosis and to distinguish HP from other sarcomatous tumors. Preoperative assessment included routine CT, MRI, arteriography and selective embolization. These tumors must be treated surgically with complete excision. An endonasal approach was performed in two cases of intranasal HP, while a combined external-endonasal approach was required for the other two cases of HP.

[Prevention of acute otitis media. Amoxicillin versus glycoproteins from Klebsiella pneumoniae. Study in children under 5 years of age]. / Prévention des otites moyennes aiguës. Amoxicilline versus glycoprotéines de Klebsiella pneumoniae. Etude chez l'enfant de moins de 5 ans.

Several studies in the English language literature have shown that continuous antibiotic prophylaxis is more effective than a placebo in preventing recurrent otitis media. In this prospective, randomized trial the effectiveness of continuous amoxicillin therapy was compared with that of glycoproteins from Klebsiella pneumoniae (GKP). The two treatments were administered during 3 months to children aged 1 to 5 years, who had at least 3 episodes of otitis media within the 3 months preceding their admission to the trial. The trial lasted from February 1989 to July 1990. It involved 60 children (mean age: 22.6 months) who had been seen as out-patients and had recovered from their latest episode of otitis. Thirty-three children received amoxicillin 25 mg/kg/day divided into two doses, during 3 months. Twenty-seven children were given GKP 2 tablets per day during 8 days in the 1st month and 1 tablets per day during 8 days in the following 2 months. During the study period, 14 cases of otitis media were observed in children under amoxicillin, as against 22 cases in children under GKP. When the type of day-nursery was taken into account as adjustment factor, the results showed a significantly lower percentage of failures in the amoxicillin group (P less than 0.03). Both treatments were well tolerated (no child was excluded from the trial for intolerance). No Clostridium difficile toxin developed in the amoxicillin group.

[ORL localizations of Abrikosov's tumors. Apropos of 5 cases. A tumor which is not always benign]. / Localisations ORL des tumeurs d'Abrikossoff. A propos de 5 observations. Une tumeur qui n'est pas toujours anodine.

Abrikossoff's tumor is a benign lesion affecting the oropharynx in more than half the cases. Five cases are reported and symptoms and signs reviewed. Treatment was by wide excision, although a less extensive operation is possible to avoid major damage to surrounding structures. This attitude can be adapted because the course of the affection is by slow progression, with the possibility of no further growth, and the fact that surgery can be repeated.

[Current aspects of laryngeal tuberculosis. Apropos of 4 cases and review of the literature]. / Aspects actuels de la tuberculose laryngée. A propos de quatre cas et revue de la littérature.

After the discovery of streptomycin 1944, laryngeal tuberculosis became a rare complication of advanced pulmonary tuberculosis. Since that time the clinical aspects of the disease have changed. We analyzed these changes by reviewing 65 papers in English and in French published from 1965 to 1991 involving 738 cases and added our 4 new personal cases. To our knowledge, we report the first two well-documented cases of laryngeal tuberculosis in HIV positive patients. We propose a therapeutic and follow-up protocol for laryngeal and chest specialists treating such patients.

[The CO2 broncholaser in the treatment of subglottic and tracheal stenosis. Apropos of 14 cases]. / Le broncholaser CO2 dans le traitement des sténoses sous-glottiques et trachéales. A propos de 14 cas.

The authors report the results of CO2 broncholaser treatment in 14 cases of iatrogenic cricotracheal stenosis. A stable patency of the laryngotracheal airway was successfully obtained in 43% of stenoses treated with the broncholaser alone. In another 43% of patients improvement was obtained. Failure occurred in 14% of cases. Heat disruption of the cartilagenous support was the most frequent cause of failure and recurrence. The development of rigid bronchoscopes which can be coupled to CO2 laser would appear to us to be a real technical advance. The apparatus is easy to handle and is increasingly being used as first intention. It has several advantages compared to endoscopic materials used with the YAG laser. The effect of CO2 on the tissues would seem to be better adapted than the YAG for iatrogenic stenoses.

[Value of reaming of the piriform orifices in the functional surgery of the nasal cavities]. / Place de l'alésage des orifices piriformes dans la chirurgie fonctionnelle des fosses nasales.

Reaming of piriform orifices is a simple, short procedure easily integrated into functional surgery of nasal fossae. Results in 27 cases were rated as very good in 20 patients. Results are compared with those of three series reported in the literature, and the rare side effects noted are discussed.

[Critical study and role of partial vertical reconstructive laryngectomies with epiglottoplasty by the Tucker method. Apropos of 18 cases]. / Etude critique et place des laryngectomies partielles verticales reconstructives avec épiglottoplastie selon la méthode de Tucker. A propos de 18 cas.

Two groups could be distinguished in a series of 18 patients with glottic lesions: one with pure glottic tumors (12 cases) and the other with tumors extending beyond the glottic region (6 cases). All patients but one were operated upon by first intention for epidermoid carcinoma, but also for associated pronounced dysplasia. The so-called Tucker technique was used with slight modifications (less extensive resection of thyroid cartilage, conservation of the two arytenoid cartilages). The postoperative course was satisfactory with decanulation and ablation on the 13th day, and a mean hospital stay of 22 days. Two postoperative deaths due to vascular complications occurred and one patient developed a swinging epiglottis after 2 years. The remaining 16 patients are all alive, including 8 after less than 3 years. Analogous results were noted in an analysis of a total of 93 case-reports from 5 different series of patients. This method provides an elegant and satisfactory repair of pure cordal surgery, but adds nothing from the oncologic point of view since other better adapted and currently well defined operations have to be envisaged for lesions extending beyond this region.

[Results and indications of curietherapy of the eustachian tube with iridium 192 in chronic otitis in the adult]. / Résultats et indications de la curiethérapie de la trompe d'eustache à l'iridium 192 dans l'otite chronique de l'adulte.

Between January 1985 and January 1988, 56 patients received radioactive implant therapy of the Eustachian tube with Iridium 192 in the context of tympanoplasty for chronic otitis with tubal dysfunction. After reviewing the method used, we present the results by category of chronic otitis and attempt to propose its indications. Tubal dysfunction was assessed on clinical and otoscopic data and tubal manometry in each patient. A randomised study would appear to be necessary to confirm the interesting results obtained in chronic mucous otitis, in the sequelae of chronic otitis, in evolving retraction pockets and finally for certain manifestly discharging cavities.

[Treatment of antro-choanal polyp by enlarged endoscopic meatotomy. Apropos of 19 cases]. / Traitement du polype antrochoanal par méatotomie moyenne élargie endoscopique. A propos de 19 cas.

Antro-choanal polyp (ACP) is traditionally removed by performing Caldwell-Luc operation. The aim of this study was to evaluate the interest of removing ACP via enlarged middle meatotomy performed under endoscopic control (EMM). The cases of 19 patients who underwent EMM for ACP removal between 1991 and 1993 were retrospectively analyzed. The main symptom was nasal obstruction and ACP was diagnosed according to endoscopy, CT-scan and pathological examination. The usual technique for EMM included coagulation of the mucosal area of implantation of the ACP pedicle. The pedicle was localized on the external maxillary wall in 68.5% of cases. No complications was reported while ACP recurred in only one case. Using EMM to remove ACP appears therefore to be a safe and non-invasive method. The localization and removal of the ACP pedicle with coagulation of its mucosal area of implantation is recommended.

[Ewing's inverted nasosinal papilloma. Critical study of therapeutic indications. Apropos of 14 cases]. / Papillomes inverses naso-sinusiens d'Ewing. Etude critique des indications thérapeutiques. A propos de 14 cas.

Fourteen cases of Ewing's inversed papilloma of the nose and sinuses were treated as primary lesions or after recurrence. Clinical and paraclinical, mainly radiologic, endoscopic, and biologic investigations are of fundamental importance and should be as extensive for primary as for recurrent lesions. Treatment is largely dependent on the results of these examinations, is essentially surgical, and should respond to two imperatives. First, it should lead to total excision under the best possible conditions, and second, it should involve a minimum of sequelae, particular esthetic complications. Techniques for excision through the natural pathways are described, followed by those using an external approach (canine fossa or para-lateronasal approaches), as well as their advantages and inconveniences. The preferred procedure is through an open, wide, para-lateronasal approach, enabling the most effective excision to be performed, this technique appearing to be essential for recurrent lesions.

[Recovery total glossectomy with immediate reconstruction by means of a musculocutaneous flap : functional results and perspectives (author's transl)]. / Glossectomies totales de rattrapage avec reconstruction d'emblée par lambeaux musculo-cutanés. Résultats fonctionnels, perspectives.

A surgical procedure is proposed for treating recurrent or non-sterile cancer of the tongue whenever satisfactory excision of the tumor can be accomplished. The technique involves a recovery total glossectomy associated, as shown to be necessary following its application in 3 cases, with a transmaxillary buccopharyngectomy. This operation has become valid following the use of musculocutaneous flaps, which enable reconstruction of the tongue with good quality functional results.

[Curietherapy of the eustachian tube with Ir-192]. / Curiethérapie de la trompe d'Eustache par Ir 192.

An essential success factor for tympanoplasties is effective aeration of middle ear, lack of tubular permeability being a factor for failure. The anti-inflammatory effect of curietherapy with Iridium 192 introduced into the tube during middle ear surgery was studied in 38 patients. Tubular dysfunction was evaluated by clinical and manometric examinations. During operation, a sealed plastic tube 1.6 mm in diameter was introduced into the Eustachian tube, an Iridium wire inserted on the following day, and a dose of 1.5 and 3 Gy applied to two groups respectively. Tubular function was assessed as normal or almost normal in 61% of cases. Results were compared with a group of 30 patients not receiving curietherapy.

[Mandibular reconstruction by composite musculocutaneous flap in glossopelvimandibular excisions]. / La reconstruction mandibulaire par lambeau musculo-cutané composé dans les exérèses glosso-pelvi-mandibulaires.

Results of 14 mandibular reconstruction by a composite muscular flap of the pectoralis major and trapezium muscles during widespread glossopelvimandibular excisions are described. The technique employed is outlined, emphasis being placed on the need to observe strict precautions during removal and application of the bone component, to avoid accidental avulsion during reconstruction which could compromise the musculoperiosteal vascularization of the graft. Results are sufficiently encouraging for this type of reconstructive surgery to be proposed in all cases where mandibular repair is necessary after interruption of continuity.

[Wide excision in cancer of the tongue: the choice of approach, modalities of reconstruction]. / Les vastes exérèses dans les cancers de la langue: le choix d'une voie d'abord, les modalités de la reconstruction.

Surgical treatment of extensive carcinoma of the tongue requires reconsideration at the present time: firstly, because the efficacy of other therapeutic measures is rapidly suppressed by the size of the tumors, and there is not theoretical reason for excluding extensive surgery, and secondly, because esthetic and functional sequelae of these bloody treatments have been totally modified by the introduction of new reconstructive techniques. Based on a series of 16 cases treated during a one-year period, the conditions for surgery of vast malignant tongue tumors (T3, T4, N indifferent) are analyzed, and findings emphasize the need for a wide approach. Clear exposure is obtained, the continuity of the mandibular arch is conserved, and effective anatomical and functional reconstruction obtained of tissues sacrificed by the musculocutaneous flaps.

[Benign pulsatile cranial bruit in children. Apropos of 6 cases]. / Souffle pulsatile crânien bénin chez l'enfant. A propos de 6 cas.

The authors report a series of 6 patients aged 8-25 months, without any intracranial vascular pathology, presenting with an objective intracranial bruit associated with visible veins in the naso-orbital region. These bruits, frequent in children between 4 months and 5 years, become rare when patients grow older and disappear in adulthood. Naso-orbital veins are frequently normally detected until the age of 3 years. An intracranial bruit and visible facial veins may be clinical signs indicative of an underlying intracranial vascular malformation (IVM). Enhanced CT scanning should be performed when these two symptoms are associated. If the scan is abnormal, a selective angiography should be performed.

[An open randomized trial, Pediazole versus cefaclor in the treatment of acute otitis media in children]. / Etude randomisée ouverte, Pédiazole versus céfaclor dans le traitement des otites moyennes aiguës de l'enfant.

The combination of erythromycin ethylsuccinate and acetyl sulfafuroxazole (Pediazole = ES) is effective against Hemophilus influenzae, including beta-lactamase-producing strains, and against Streptococcus pneumoniae, including macrolide-resistant strains. In this study, mean daily dosage was 40-50 mg/kg for cefaclor and 50 mg/kg ES + 150 mg/kg sulfamide for Pediazole. Both products were given in three divided doses per day for ten days. Tolerance was evaluable in 106 children and effectiveness in 103 children including 52 in the ES group and 51 in the cefaclor group. Mean age was 23.5 months and both groups were comparable as concerns age, weight, previous ENT disease, and severity of the otitis media. Tolerance was satisfactory in both groups. Clinical results were as follows: failures before or at completion of the course, 5/52 in the ES group versus 13/51 in the cefaclor for the treatment of children with acute otitis media.