[In vitro studies of factors possibly influencing the performance of latex condoms]. / Etude en laboratoire de facteurs pouvant influencer la qualité des préservatifs masculins.

Male condoms are undoubtedly the best protection against sexually transmitted diseases. The French Military Health Service buys condoms from civilian manufacturers using a public purchasing process. This process includes strict technical analysis that allows selection of the best supplier. In addition each batch of condoms delivered to French armed forces undergoes quality testing in the laboratory of the Armed Services Central Pharmacy before being distributed to troops. Despite these strict control measures, several isss remain unclear. One issue involves the shelf life of condoms stored in warm humid tropical conditions. Another issue involves the effect of lubricants on condom quality. The purpose of this report is to describe a study designed to gain insight into these two issues. This study was conducted by the Armed Services Central Pharmacy in colaboration with the Procuremnt and Central Establishment Directorate. Findings showed that stage conditions have no negative effects on the intrinsic physico-chemial properties of condoms supplied by two different manufacturers. Conversely use of inadequate lubricants (alimentary or cosmetic compounds) appeared to have extremely deleterious effects on condom quality. Laboratory tests showed that lubricants composed mainly of fatty acids dramatically decreased the effectiveness of condoms.

The widened transcochlear approach to jugular foramen tumors.

The authors describe a widened transcochlear approach for large tumors of the jugular foramen with intrapetrous, intracranial, and infratemporal extensions. This approach complements the transcochlear and infratemporal approaches by enlarging the route of access to the region with disinsertion of the sternocleidomastoid, digastric, and stylohyoid muscles, by removing petrous bone in order to displace the facial nerve, by resection of the auditory canal, and by subluxation of the temporomandibular joint and zygomatic process. The use of this approach is described in seven patients.

Intranasal ethmoidectomy in nasal polyposis in children. Indications and results.

Nasal polyposis in children is a rare pathology that is difficult to treat, with results that are often disappointing. The aim of this paper is focused on the surgical possibilities of ethmoidectomy by endonasal approach. Thirty-nine ethmoidectomies were performed in 24 children with a mean age of 12 years (cystic fibrosis, n = 7; Woakes' syndrome, n = 2; isolated polyposis, n = 15). The decision for surgical treatment was based upon the severity of initial symptoms, principally nasal obstruction, lack of improvement after medical treatment, and the assurance of good surgical follow-up. Twenty-three children were followed up for a mean of 3 years. Complete recurrence was noted in 13% of the cases (n = 3). In all the other cases, including those with partial recurrence, the lives of the children were transformed. Ethmoidectomy by endonasal approach is reliable if the appropriate surgical techniques are strictly followed. It has proven its efficacy in children with nasal polyposis with results that are very encouraging compared to previously proposed therapies.

Subglottic cyst in a newborn.

Subglottic laryngeal cysts in the newborn are extremely rare. It is difficult to establish if the cyst is acquired or congenital because respiratory distress requires intubation in the I.C.U. generally without prior endoscopy. A case report is presented, followed by a discussion of possible aetiology and management protocol; the advantages of the CO2 laser make excision of the cystic sac possible without tracheotomy.

[Acoustic neurinoma. Otoneurosurgical approach]. / Le neurinome de l'acoustique. Approche oto-neurochirurgicale.

From 1973 until November 1984, 224 cerebello-pontine angle tumors, 180 of them isolated neurinomas, were operated on. In a large majority of cases (160) through the widened trans-labyrinthine approach, advocated by House and Hitselberger was used. Despite advances in diagnostic procedures two out of three of these neurinomas were discovered only when they were already quite big. The post-operative overall death rate was 5 p. 100, tumor removal was complete in 96 p. 100 of cases and the facial nerve continuity was respected in 87 p. 100 of cases. These overall results can be still improved because in the last 50 cases, no death occurred, the removal was always total and the facial nerve continuity was respected in 96 p. 100 of cases. The problem of hearing preservation, impossible by this approach, is discussed. The necessity of facial nerve preservation and total removal, in order to prevent recurrence, is emphasized. It often seems very difficult to preserve hearing and to completely remove the tumor and at the same time, have the highest chance of saving the facial nerve.

[Magnetic resonance imaging in the study of acoustic neurinoma]. / Apport de l'imagerie par résonance magnétique dans l'exploration du neurinome de l'acoustique.

Exploration of acoustic neurinoma, the most frequent benign tumor of posterior fossa, now includes magnetic resonance imaging, and an C.G.R. supraconductor apparatus (0.5 Tesla) has been in use since March 1986. This equipment provides high resolution frontal sections, not only of posterior fossa but of the two pontocerebellar angles and even the contents of the two IAC (thin, contiguous 4 mm sections in 256 x 256 matrix). A total of 43 patients were examined, 37 with surgically confirmed acoustic neurinoma and 2 with tumor recurrence. The neurinoma appears on the first echo as a hyposignal in relation to brain stem in sequences predominant in T1 and as a hypersignal in relation to peripontic CSF in sequences predominant in T2. Short sequences predominant in Tl (partial saturation or short ET and RT spin-echos) appear to be most effective for detection of acoustic neurinoma. Comparison of MRI and CT scan imaging showed that firstly, all cases detected by conventional scanography were correctly analyzed by MRI, with superiority for MRI for preoperative screening due to the frontal sections obtained without interference and, secondly, the non-invasive confirmation of diagnosis in doubtful or negative cases requiring computerized gaz meatocisternography. No false negative or false positive results were reported in our series or those documented in the literature using this new imaging technique, but high performance apparatus is necessary (thin sections ans powerful principal magnetic field of at least 0.5 resla). Improvements in this method could be obtained by the availability of more rapid programmes, the use of surface coils and the injection of paramagnetic substances (galodinium chelates) presently under study. NMR imaging is a reliable and non-invasive imaging method capable of replacing the scanner for study of acoustic neurinoma as soon as more apparatuses become available.

[A multicenter double blind versus placebos study of trimetazidine in tinnitus. A clinical approach to tinnitus]. / Etude multicentrique à double insu contre placebo de la trimétazidine dans les acouphènes. Approche clinique des acouphènes.

This multicenter controlled double-blind study versus placebo was carried out in order to determine in which types of tinnitus trimetazidine dosed at 60 mg/day was likely to be of any therapeutical benefit. This trial was conducted over a period spanning 2 months and involved 13 hospital centers. Enrolled were 315 patients presenting with subjective tinnitus. The analysis bore on 290 patients (136 receiving trimetazidine and 154 receiving placebo). Aside from the epidemiological pertinence of this study, results revealed a significantly higher rate of improvement with trimetazidine, as assessed on the basis of subjective clinical criteria, intensity (p = 0.004), periodicity (p = 0.003), and the extent of discomfort (p less than 0.001), as well as audiometric ones. The evolution of the intensity of tinnitus, as measured either by Fowler's comparative scale method or by masking the sick ear, varied significantly (p = 0.007 and p = 0.026, respectively) depending upon whether patients received trimetazidine or placebo. The type of tinnitus which responded best to trimetazidine was recent-onset tinnitus (less than or equal to 2 years) and ischemic disease related tinnitus.

[Acoustic neurinomas. Trans-labyrinthine approach (author's transl)]. / La collaboration oto-neuro-chirurgicale dans l'abord trans-labyrinthique des neurinomes de l'acoustique.

The authors, supporters of a tight oto-neuro-surgical collaboration, show their tactical evolution in front of acoustic neurinomas which they operated at first in two stages, trans-labyrinthine then sub-occipital, and now they approach only by trans-labyrinthine way. They report their experience and their results to the point of a first serie of 30 cases : 10 combined approaches in two stages, and 20 trans-labyrinthine approaches. The mortality (3 cases-10%) for this first serie is still raised. One patient, after a softening of the pons, maintained important sequelles. On the other hand, among the remaining 26 patients, 13 kept a normal facial motricity and 5 recovered but with syncinesis. These first results are still perfectible : among the 20 last cases only trans-labyrinthine approached the facial nerve preservation was realised in 72% of the cases. The most frequent surgical complication is a cerebro-spinal fluid leak (7 cases) which fortunately the most often spontaneously dry up (6 cases) but which justify a very attentive closure technic. The authors show the arguments which convinced them of the interest of the trans-labyrinthine approach such it is done by W. House.

[Technics and indications of limited petrosectomy. Value of the combined transcochlear and infratemporal approach]. / Techniques et indications des pétrectomies réglées. Intérêt de l'association d'une voie trans-cochléaire et infra-temporale.

The authors describe the extended trans-cochlear approach and define its indications on the basis of a series of 10 cases operated by the transcochlear approach, 6 of which were extended. This approach has a well defined indication between the trans-cochlear approach described by W. House and the infra-temporal approach described by Fish.

[Translabyrinthine approach in the surgery of acoustic neurinoma. How to shorten the operative time]. / La voie trans-labyrinthique dans la chirurgie du neurinome de l'acoustique. Comment raccourcir le temps opératoire.

A procedure was sought for shortening duration of operation through an enlarged translabyrinthine (ETL) approach in acoustic neurinoma surgery. Two factors appear to be of primary importance. First, the equipment used must be adapted for the purpose and of reliable quality: the 3 M craniotome for the extralabyrinthine phase, the Zimmer AMSCO ototome for the labyrinthine phase, and Yasargil's autostatic retractor to maintain retraction of the temporal lobe and lateral sinuses. Second, a precise operative methodology: wide exposure and retraction of the temporal lobe and lateral sinus in all cases to provide a panoramic view of the labyrinthine region; ablation of the incus and initiation of a posterior tympanotomy to assist dissection to expose the 2nd and 3rd portions of the facial nerve; labyrinthectomy and identification of the internal auditory canal (IAC) in the region of the small fossa of the hemisphere as an aid to continuation of the operation; identification of Limaçon's aqueduct, which is a barrier that must not be crossed when exposing the jugular bulb and mixed nerve regions; isolation of the facial nerve in the base of the IAC by reclining the superior restibular nerve, the facial nerve lying just behind the latter.

[Diagnosis of glomus jugulare tumours (author's transl)]. / Le diagnostic d'extension des tumeurs du glomus jugulaire.

The present study is based on 16 personal cases and on an analysis of the principal series published since 1968. Clinical investigations aim at detecting lesions of the sensory-motor and XIIth cranial nerves, deafness which indicates invasion of the labyrinth, lesions of central auditory and vestibular pathways and possible associated conditions. Radio-otology is fundamental in revealing alterations of the jugular foramen and above all perhaps, changes in the tympanic bone and in the 3rd segment of the fallopian canal. The most significant sign of invasion is infra-labyrinthic hollowing out on tomographic sections in lateral projection and Guillen's incidence. Angiography and jugulography supply information on the size of the tumour and on its feeding vessels which usually arise from the external carotid artery but also, in advanced forms, from the internal carotid and vertebral arteries. Computerized tomography for the time being has one single major applications : detection of lesions extending to the posterior and middle fossae. Taken together, these investigations should help to classify tumours of the glomus jugulare into : exclusively tympanic, tympano-mastoidal, tumours extending posteriorly and to the petrous bone, and tumours extending intracranially. Such a classification is of paramount importance in deciding on the best surgical approach.

[Prevention and pretherapeutic evaluation of laryngo-tracheal stenosis in adult (author's transl)]. / Prévention et bilan préthérapeutique des sténoses laryngo-trachéales de l'adulte.

The prevention of laryngo-tracheal stenosis and their etiological factors are the subject of this study. The used material (tube, balloon,...) and the patient could be the principal reason of these etiology, either for intubation or tracheotomy. The pressure in the balloon and the tracheal mucosal puls are developed. The knowledgement of the principal etiologic factors in the constitution of laryngo-tracheal stenosis, make us able to prevent them with efficacity. Finaly, a preoperative evaluation by tomography and endoscopy is establiched.

[Venous and meningeal prolapse during enlarged trans-labyrinth approach]. / Les procidences veineuses et méningées au cours des voies translabyrinthiques élargies.

One hundred consecutive operations using the enlarged trans-labyrinthic (ETL) approach for acoustic neurinoma performed by the same surgeon were analyzed to determine incidence of venous and/or meningeal prolapses. Findings showed that ETL approaches were normal in 51 cases : normal superficial sinusodural space--external auditory canal and on deep dissection a superior petrous sinus and jugular space separated from the internal auditory canal. Prolapse was observed in 49 approaches : 30 very narrow sinusodural spaces due usually to temporal meninges prolapse (76%) associated in 25% of cases with a prolapse of lateral sinus; 29 prolapses of jugular space and 10 of superior petrous sinus, detected mainly in the narrow sinusodural spaces. In these cases, superficial displacement of the temporal meninges and lateral sinus appears indispensable in order to recover normal operating conditions towards the labyrinth and pontocerebellar angle.

[The enlarged trans-labyrinthine approach of House. The use of this method in the surgical treatment of cerebello-pontine angle tumours (author's transl)]. / La voie trans-labyrinthique élargie de House. Ses possibilités dans la chirurgie des tumeurs de l'angle ponto-cérébelleux.

The authors report a series of 43 cases of cerebello-pontine angle tumours operated by an oto-neuro-surgical team. The approaches used were, once the supra-petrous approach, twice the posterior fossa, 12 times a combined trans-labyrinthine and posterior fossa approach, and 28 times the enlarged trans-labyrinthine route. This last approach, which is now being used exclusively for the last two years, is described in detail. Forty-three tumours operated on broke down into 40 neurinomas, 2 meningiomas and 1 malignant melanoma. The size of the tumours varied from 1 cm to 11 cm in diameter. Overall statistics show 9.3% of deaths and 65% of functioning facial nerves. The statistics for the nelarged trans-labyrinthine route (the last 28 cases) are: 10.7% of deaths and 75% of functioning facial nerves. In the enlarged trans-labyrinthine route, there is no complication and no mortality in the small and medium-sized tumours, i.e. up to 4 cm in diameter.

[Tissucol in septorhinoplasties]. / Le tissucol dans les septorhinoplasties.

There are two major indications for Tissucol: 1. Stabilization of structures separated by the operative procedure or of graphs, in particular cartilaginous, whether placed along the crest of the nose or at the level of the columella in sagittal position between the mesials, or frontal position under their lower edges. 2. The construction of grafts. a) Mixing of bone powder and Tissucol provides "laminated" graphs which, when placed laterally and below iliac bone grafts, avoid the grooves which all too often form along the edges of such grafts. b) Coherent moulding graphs can be obtained using Tissucol with crushed cartilage (from septum or auricular concha).

[The base of the nose in corrective rhinoplasty]. / La base du nez dans la rhinoplastie correctrice.

The authors describe a study of the labio-columellar region and of the alae of the nose in corrective rhinoplasty excluding malformations. Esthetic characteristics and the anatomical structure of this junctional area between the mobile nose and the facial plane are revealed. Surgical problems are analyzed with study in succession of surgical approaches, maxillo-septal angle, the columella, the maxilla, the muscular layer and the alo-jugal junction. Surgical techniques which can be divided into inferior septoplasties, columelloplasty and labio-columelloplasty have precise indications in accordance with the type of formation of the labio-columellar region. A technique of nostril resection with the absence of damage to and shortening plasty of the muscle layer is described.

[Grafts in esthetic and functional corrective rhinoplasty]. / Les greffons en rhinoplastie correctrice esthétique et fonctionnelle.

Results of the use of grafts in primary and secondary rhinoplasty are reported, the grafts being either of cartilage (concha auriculae, nasal septum, alar cartilage), bone (mastoid, ilium) or connective tissue (temporal aponeurosis). The distinction is made between modelling grafts of softened cartilage, supporting grafts of non-softened cartilage and mastoid bone, of bone reconstruction and of cartilaginous filling grafts.

[Superficial temporal fascia pedicle flap. Applications in cervicofacial surgery. Apropos of 20 cases]. / Le lambeau pédiculé de fascia temporal superficiel. Applications en chirurgie cervico-faciale. A propos de 20 cas.

The superficial temporal fascia is formed by a fine fibro-muscular layer situated between the subcutaneous plane of the temporal region and the temporal muscle aponeurosis. The superficial temporal artery and its branches run within the fascia which acts as a veritable vessel carrying sheet. The therefore useful in that in minimises esthetic and functional complications at the donor site. This reliable, polyvalent arterialised aponeurotic type flap behaves above all as a covering or interpositional flap. Our clinical experience involves 20 cases, in addition to the applications already published: covering material in cases of loss of facial substance, otopoiesis, organisation of open techniques, we propose its use during oro-bucco-pharyngoplasty and for sealing the base of the skull.

[Electrodiagnosis of peripheral facial paralysis. Significance of stimulation tests--detection]. / L'électro-diagnostic des paralysies faciales périphériques. Intérêt des tests de stimulation--détection

Electroneurography at present constitutes an indispensable method for the investigation of peripheral facial paralysis. It should be carried out at an early stage, in the form of three successive examinations at 3 day intervals. If decompression is necessary, it should theoretically be carried out during the first 15 days, before destruction of nerves, which is a feature of sequelae, can take place. Electroneuronography appears to be, for this purpose, on a par with histology. The authors urge that patients suffering from from facial paralysis should be referred to O.-R.-L. departments right from the start and not when all other methods of treatment have been tried, often with reprehensible empiricism, and found unsuccessful.

[Choice of surgical technic for correcting the nose tip]. / Le choix de la technique de la chirurgie correctrice de la pointe du nez.

The surgical approach should be adapted to the type of correction needed. There is no room of standard technics. The various selection criteria that have to be considered are: the structure of the alar cartilages and the infra-and suprastructural characteristics thereof, determining the upper triangle of the lobule; the relative incidence of the abnormalities encountered in rhinoplastic practice; an analysis of the failures leading to secondary rhinoplastic operations, among which the most frequent are lobule and/or irregularities and drooping apex or insufficient projection thereof. Currently, the authors' conclusions are that: Most of the times, the upper triangle of the lobule is overdeveloped: reduction is carried out by resecting a superior strip laterally, while additionally trimming the cupulae, if necessary. Much more rarely, a globally hypertrophied lobule will be found that requires management by section-reconstruction of the cupulae. In case of a "normal", excessively projected lobule, the technic of choice is apex retraction. Primary apex projection defects should be recognized and treated with molding grafts. The nose tip should be prevented from drooping by means of columellar supporting grafts.