[Hypoglossofacial anastomosis for facial palsy treatment: Indications and results]. / Réhabilitation de la face paralysée par anastomose hypoglosso-faciale. Indications et résultats.

UNLABELLED: Hypoglossofacial anastomosis is a classical surgical procedure for the treatment of facial paralysis when the trunk of the facial nerve cannot be repaired and its peripheral branches are normal. PATIENTS AND METHODS: Between 2004 and 2015, 77 patients were able to benefit from an hypoglossofacial anastomosis. The etiology of the paralysis was mainly the surgery of vestibular schwannoma, tumors of the facial nerve and diseases of the brainstem. A specific and premature speech therapy remediation was realized for all patients in order to preserve the tongue function and to upgrade the facial motricity. RESULTS: Sixty-nine patients could be studied. The House Brackmann grading scale was used to appreciate the result. Thirty-one patients are grade III, 34 grade IV and in only one case the result is a grade V despite the anastomosis works. The main predictive factor for a good result is a small delay between the onset of the paralysis and the surgery for the rehabilitation. The specific physiotherapy upgrades the result with less side effects of the anastomosis. CONCLUSION: Hypoglossofacial anastomosis is a simple and reliable surgical procedure for rehabilitation of paralysed face. The quality of the result is linked with an early surgery and a specific physiotherapy.

Randomized Trial of Primary PCI with or without RoutineManual Thrombectomy

During primary percutaneous coronary intervention (PCI), manual thrombectomymay reduce distal embolization and thus improve microvascular perfusion. Smalltrials have suggested that thrombectomy improves surrogate and clinical outcomes,but a larger trial has reported conflicting results.MethodsWe randomly assigned 10,732 patients with ST-segment elevation myocardial infarction(STEMI) undergoing primary PCI to a strategy of routine upfront manualthrombectomy versus PCI alone. The primary outcome was a composite of deathfrom cardiovascular causes, recurrent myocardial infarction, cardiogenic shock, orNew York Heart Association (NYHA) class IV heart failure within 180 days. The keysafety outcome was stroke within 30 days.ResultsThe primary outcome occurred in 347 of 5033 patients (6.9%) in the thrombectomygroup versus 351 of 5030 patients (7.0%) in the PCI-alone group (hazard ratio in thethrombectomy group, 0.99; 95% confidence interval [CI], 0.85 to 1.15; P = 0.86). Therates of cardiovascular death (3.1% with thrombectomy vs. 3.5% with PCI alone;hazard ratio, 0.90; 95% CI, 0.73 to 1.12; P = 0.34) and the primary outcome plusstent thrombosis or target-vessel revascularization (9.9% vs. 9.8%; hazard ratio,1.00; 95% CI, 0.89 to 1.14; P = 0.95) were also similar. Stroke within 30 days occurredin 33 patients (0.7%) in the thrombectomy group versus 16 patients (0.3%)in the PCI-alone group (hazard ratio, 2.06; 95% CI, 1.13 to 3.75; P = 0.02).ConclusionsIn patients with STEMI who were undergoing primary PCI, routine manual thrombectomy,as compared with PCI alone, did not reduce the risk of cardiovasculardeath, recurrent myocardial infarction, cardiogenic shock, or NYHA class IV heartfailure within 180 days but was associated with an increased rate of stroke within30 days. (Funded by Medtronic and the Canadian Institutes of Health Research;TOTAL ClinicalTrials.gov number, NCT01149044.

[Lengthening temporalis myoplasty for facial palsy reanimation after parotid surgery]. / Réhabilitation de la face paralysée au cours de la chirurgie parotidienne. intérêt de la myoplastie d'allongement du muscle temporal.

AIM OF THE STUDY: Share our experience and our results of lengthening temporalis myoplasty (LTM) for facial palsy reanimation after parotid surgery. MATERIALS AND METHODS: Study of 15 patients after they had had a lengthening temporalis myoplasty, in the same time or after a non conservative parotidectomy of facial nerve. 10 patients suffered from a parotid malignant tumor, one had a jugal epidermoid skin carcinoma invading the parotid, 2 patients had a facial palsy after removal of pleomorphic adenoma recurrence and two patients had a facial nerve schwannoma. 8 patients had a LTM surgery in the same time of the parotid tumoral removal. RESULTS: No recurrence was observed on the 11 patients who had a carcinoma (average follow up: 27 months). The LTM surgery enabled us to obtain good results at rest for 14 patients (93%) and an intermediate result for one person. The ability to smile was described as good for 10 patients (66.6%), intermediate for 4 of them (26.6%) and unsatisfying for 1 person (6,6%). In the group rehabilitation, the results observed are similar, for the patients who had one or two surgical steps. In 3 cases, we noticed an infectious complication, which led us to operate again. In the 8 cases within lengthening was performed in the same time as parotidectomy, there was no additionnal surgical difficulty. CONCLUSION: LTM surgery is an efficient method of rehabilitation. If possible, it should be performed in the same time as tumor removal. As the operational places are different, tumor checking-up and observation are not disturbed by this kind of rehabilitation.

Facial nerve decompression for idiopathic Bell's palsy: report of 13 cases and literature review.

INTRODUCTION: The prognosis for cases of idiopathic facial palsy is usually good. However, some cases develop disabling sequelae, such as synkinesis or severe facial hemispasm, despite targeted medical treatment. OBJECTIVES: The authors try to achieve that electromyography is useful to identify patients with severe palsy and an unfavourable prognosis. These patients would probably benefit from facial nerve decompression. SETTING: The otolaryngology-head and neck surgery department of Pitié-Salpêtrière Hospital, Paris, a tertiary referral centre. PARTICIPANTS: Thirteen cases undergoing surgery between January 1997 and March 2007. MAIN OUTCOME MEASURES: We describe the electromyographic findings that led to surgery. All patients underwent surgery via a subpetrous approach, within four months of the onset of palsy. Decompression involved the first and second portions of the nerve and the geniculate ganglion. RESULTS: Recovery to House-Brackmann grade III was obtained in all cases at one year follow up. CONCLUSION: These results compared favourably with previous reports. A new therapeutic procedure may allow improved results.

[Termino-terminal hypoglossofacial anastomosis, indications, results]. / Anastomose hypoglosso-faciale termino-terminale. Indications. Résultats.

OBJECTIVES: Retrospective study about the indications and the results of the end to-end hypoglossofacial anastomosis (AHF tt). MATERIALS AND METHODS: Between 2004 and 2010, 38 patients were able to benefit from an AHF tt. It was about 13 men and 25 women. The mean age was of 40 years and the average deadline of coverage after facial paralysis was of 21.3 months. The etiology of the paralysis was in 47.7% of the cases a surgery for vestibular schwannoma and in 18% of the cases, of the facial nerve schwannoma. Besides the AHF tt, a golden weight was put to 6 of our patients. A specific and premature speech therapy remediation was realized at our all patient's. RESULTS: The beginning of recovery was spread out between 3 and 9 months. The final result was a grade III HB (37%) and IV HB (60%). Only a case of grade VHB was observed. The complications often reported by the AHF tt were very widely decreased by the specific reeducation. CONCLUSION: AHF tt is a particularly reliable technique, for rehabilitation of facial palsy, when the peripheral branches are intact and it, for the deadline 4-years-old subordinate except particular cases.

[Bell's palsy: from viral aetiology to diagnostic reality]. / Paralysie faciale a frigore: de l'étiologie virale à la réalité diagnostique.

Peripheral injury of the facial nerve is a frequent disorder. It is a stressful situation for the patient and it is functionally hazardous for the cornea. Facial palsy is due to a lesion involving the facial pontine nucleus or the nerve trunk in its route from the pontocerebellar angle to the parotid. The idiopathic facial paralysis or Bell's palsy (BP) is the most common cause but acute facial palsy can also be due to tumors. A rigorous clinical history and examination must be performed to guide the additional biological, radiological and cochleovestibular investigations in order to reach the diagnosis. The pathophysiology of BP remains unclear, but seems to be due to the reactivation of Herpes simplex virus type 1 within the intrapetrous pathway of facial nerve. The treatment remains controversial but, for most of the authors, consists of early administration of corticosteroids with or without antiviral agents. Ninety percent of the patients recover normal facial function with this treatment. The severe BP resulting in hemifacial spasm must be quickly identified by electrophysiological testing. They need appropriate rehabilitation and for some authors facial nerve surgical decompression in emergency.

[Visual episodes in non-ketonic hyperglycemia: contribution of 1 case with alteration in diffusion magnetic resonance imaging]. / Crisis visuales en hiperglucemia no cetónica: aportación de un caso con alteración en resonancia magnética de difusión.

INTRODUCTION: Non-ketonic hyperglycemia (NKH) is recognized both as a direct cause of a precipitating factor of many types of epileptic seizures-partial motor, including partial motor status, complex partial, as well as reflex motor seizures and hemichorea-hemibalism syndrome. Less known is its association with isolated visual alterations. We present a clinical case with visual episodes and diffusion restriction. MATERIAL AND METHODS: Clinical description together with the results of complementary tests: magnetic resonance imaging (MRI) brain sequences: T1W, T2W, FLAIR, DP, diffusion; and magnetic resonance angio-imaging, electroencephalogram (EEG), visual campimetry, carotid echodoppler. CLINICAL CASE: 51 year old male with visual complaints manifested as bright light in left lower quadrant with progressive increase in frequency until it becomes constant. Polyuria, polydipsia and weight loss are associated. No personal background of diabetes mellitus, epilepsy or migraine. Among the laboratory tests, non-ketonic hyperglycemia of 569 mg/dl stands out. The visual campimetry showed left lower quadrantanopsia, the intercritical EEG was reported as normal and the brain MRI showed alteration in right cortical-subcortical occipital diffusion sequence. Interpreted as simple partial seizure in the occipital region secondary to hyperglycemia, it was corrected, and the subject was asymptomatic at one month of discharge. DISCUSSION: We stress that isolated visual episodes may be the initial manifestation of NKH. The rareness of the alteration in the diffussion MRI (interpretable as artifact) orients to a possible mechanism of simple partial status. A high index of suspicion of this entity is important since adequate hypoglycemic treatment permits a perfect control of the seizure.

Crisis visuales en hiperglucemia no cetónica: aportación de un caso con alteración en resonancia magnética de difusión / Visual episodes in non-ketonic hyperglycemia: contribution of 1 case with alteration in diffusion magnetic resonance imaging

Introducción. La hiperglucemia no cetónica (HNC) se reconoce tanto como una causa directa como un factor desencadenante de numerosos tipos de crisis epilépticas: parciales motoras incluyendo estatus parcial motor, parciales complejas, así como de crisis motoras reflejas y del síndrome hemicorea-hemibalismo. Menos conocida es su asociación con alteraciones visuales aisladas. Presentamos un caso clínico con crisis visuales y restricción en la difusión. Material y métodos. Descripción clínica junto a los resultados de pruebas complementarias: resonancia magnética (RM) cerebral secuencias: T1W, T2W, FLAIR, DP, difusión; así como angiorresonancia magnética, electroencefalograma (EEG), campimetría visual y eco-doppler carotídeo. Caso clínico. Varón de 51 años con quejas visuales manifestadas como luz brillante en cuadrante inferior izquierdo, con aumento progresivo en frecuencia hasta que se hace constante. Se asocia a poliuria, polidipsia y pérdida de peso. Sin antecedentes personales de diabetes mellitus, epilepsia o migraña. Entre las pruebas de laboratorio destaca una hiperglucemia de 569 mg/dl, no cetónica. La campimetría visual demostró cuadrantanopsia inferior izquierda, el EEG intercrítico se informó como normal y la RM cerebral demostró alteración en secuencia de difusión corticosubcortical occipital derecha. Interpretado como crisis epiléptica parcial simple occipital secundaria a hiperglucemia, se corrigió ésta hallándose asintomático al mes del alta. Discusión. Destacamos que las crisis visuales aisladas pueden ser la manifestación inicial de una HNC. Lo excepcional de la alteración en RM difusión (no interpretable como artefacto) orienta a posible mecanismo de estatus parcial simple. Es importante un alto índice de sospecha de esta entidad ya que un tratamiento hipoglucemiante adecuado permite un perfecto control de las crisis

Introduction. Non-ketonic hyperglycemia (NKH) is recognized both as a direct cause of a precipitating factor of many types of epileptic seizures-partial motor, including partial motor status, complex partial, as well as reflex motor seizures and hemichorea-hemibalism syndrome. Less known is its association with isolated visual alterations. We present a clinical case with visual episodes and diffusion restriction. Material and methods. Clinical description together with the results of complementary tests: magnetic resonance imaging (MRI) brain sequences: T1W, T2W, FLAIR, DP, diffusion; and magnetic resonance angio-imaging, electroencephalogram (EEG), visual campimetry, carotid echodoppler. Clinical case. 51 year old male with visual complaints manifested as bright light in left lower quadrant with progressive increase in frequency until it becomes constant. Polyuria, polydipsia and weight loss are associated. No personal background of diabetes mellitus, epilepsy or migraine. Among the laboratory tests, non-ketonic hyperglycemia of 569 mg/dl stands out. The visual campimetry showed left lower quadrantanopsia, the intercritical EEG was reported as normal and the brain MRI showed alteration in right cortical-subcortical occipital diffusion sequence. Interpreted as simple partial seizure in the occipital region secondary to hyperglycemia, it was corrected, and the subject was asymptomatic at one month of discharge. Discussion. We stress that isolated visual episodes may be the initial manifestation of NKH. The rareness of the alteration in the diffussion MRI (interpretable as arti- 89 fact) orients to a possible mechanism of simple partial status. A high index of suspicion of this entity is important since adequate hypoglycemic treatment permits a perfect control of the seizure

[The hypolossal-facial anastomosis in man. A model for studying peripheral and central nervous system plasticity]. / L'anastomose hypoglosso-faciale chez l'homme: un modèle d'etude de la plasticité du système nerveux périphérique et central.

Hypoglossal-facial anastomosis (HFA) is a cross-over between the proximal stump of the hypoglossal nerve (XII) and the distal one of the facial nerve (VII). The hypoglossal axons regrow within the sheaths of facial fibres, allowing the progressive reinnervation of the facial muscles. This model is interesting to study some mechanisms of plasticity of the nervous system for several reasons: 1) It is a quite simple and reproducible model of pathophysiological state. It allows the study of 2) the modifications of the nervous system induced by the HFA, both upwards and downwards to the lesion and 3) the modifications of reflex activities involving intrapontine connections such as the blink reflex. The electrophysiological features of the trigemino-facial (TF) and trigemino-hypoglossal (TG) connections demonstrated that a central reorganisation of the blink reflex (BR) was induced by HFA: the afferent volleys of the TF and TH reflexes elicited by cutaneous and mucosal trigeminal afferents respectively have been shown to project onto common interneurones located within the trigeminal principal sensory nucleus. A long-term prospective study showed: 1) a reinnervation of the facial muscles by the hypoglossal axons is a necessary perequisite for the central reorganisation of BR, 2) a hyperinnervation of the facial muscles by the hypoglossal axons, 3) a transient and regressive cross-innervation of paralyzed face by the healthy contralateral facial nerve.

[Emergency surgical myocardial revascularization by means of a temporary arterial angioplasty]. / Urgentní chirurgická revaskularizace myokardu umoznená docasnou angioplastikou tepny.

The authors describe the case of a patient who was admitted for four-hour lasting acute myocardial infarction of the anterior wall with elevations of ST segments on ECG. The finding obtained in selective coronarography revealed an unsuitable condition for coronary intervention (a narrow stenosis of the stem, RIA occlusion, further two narrow stenoses in the coronary vascular bed). Since an operation room was not available at the moment the patient was indicated for palliative PTCA RIA (prevention of necrosis evolution) and subsequent urgent complete surgical revascularization of myocardium. The uncomplicated post-operation course and returned function of the affected myocardium indicates that the intervention may be considered as a suitable alternative for the treatment of acute myocardial infarction.

Hypoglossal-facial nerve anastomosis: dynamic insight into the cross-innervation phenomenon.

The authors investigated the evolution of the dynamic features of the cross-innervation process in patients with complete facial palsy due to facial nerve transection during surgery for acoustic neuroma removal followed by a hypoglossal-facial nerve anastomosis (HFA). Clinical and electrophysiologic investigations were carried out before and over a 3-year period after HFA. Cross-innervation had started by the 10th day, progressed to the seventh to eighth month, then decreased and finally disappeared by the 12th month after HFA. Ipsilateral reinnervation was observed by the fourth month, progressed to the 12th to 18th month, and remained stable for the remainder of the follow-up period.

[Parapharyngeal chondrosarcoma and Ollier's disease: a case report and review of the literature]. / Chondrosarcome para-pharyngé et maladie d'Ollier.

OBJECTIVES: Ollier's disease is a constitutional pathology of unknown etiology. It is characterized by bone dysplasia generating numerous enchondromas. The malignant degeneration of this dysplasia is well known. The aim of this article is to study the diagnostic, therapeutic and prognostic characteristics of these lesions. MATERIAL AND METHODS: We report a case of parapharyngeal chondrosarcoma extended to the base of the skull in a patient with Ollier's disease. The treatment was a surgical removal by a cervicotransoral incision combined with a preauricular incision and with a mastoidectomy. It was therefore possible to control the skull base, the parapharyngeal space, the infratemporal fossa and the major neurovascular structures. The removal of the lesion was completed at the level of the clivus and sphenoid with optics (30 and 70 degrees ). We discuss this treatment and the follow up on the bases of literature data. RESULTS: The neoplastic degeneration of enchondromas is estimated between 25 to 50% of cases. The most frequent location is the pelvic bones. Chondrosarcomas are slow growing tumors and their metastatic potential is less significant as we note it in our case report. Their diagnostic is essentially based on histological criteria's and their treatment is surgical. CONCLUSION: Chondrosarcomas of the ENT area occurring with Ollier's disease is rare. Their prognostic is good if the surgical treatment is well done.

[Treatment of Bell's palsy with acyclovir and methylprednisolone]. / Traitement des paralysies faciales idiopathiques par méthylprednisolone et aciclovir.

OBJECTIVE: An open therapeutic trial was conducted in patients with Bell's palsy. Results were compared with data in the literature. MATERIALS AND METHODS: Between 1997 and 2000, 76 patients with Bell's palsy were treated with intravenous methylprednisolone (2 mg/kg/day) and acyclovir (5-10 mg/kg/8 hours) for 7 days. Treatment was initiated in all patients before the 14th day of illness. Severity of the palsy was scored on the first day of treatment and again one year later using the House and Brackman scale. RESULTS: Grade II or III palsy were observed in 38% of the patients at initial presentation, grades IV to VI in 62%. After treatment, 92% of the patients had reverted to grades I and II (good outcome) and only 8% had sequelae at 1-year follow-up. All patients with initial grade I or II recovered completely. For patients with grade IV, V, or VI complete recovery at 1 year was observed in 94, 86 and 50% respectively. CONCLUSION: Data in the literature suggest that corticosteroids should improve recovery in Bell's plasy. In our study, adjunction of acyclovir did not demonstrate any clear improvement in the cure rate. Benefit could depend on early prescription.

Midbrain deafness with normal brainstem auditory evoked potentials.

The authors report two cases of patients with word deafness. The word deafness occurred after a head injury for the first patient and after an arterio venous malformation embolization for the second patient. MRI demonstrated bilateral lesions of the inferior colliculi but brainstem auditory-evoked potentials (BAEP) were within normal limits. These cases demonstrated that lesions involving the two inferior colliculi induced pure word deafness but do not affect BAEP.

Trigeminal projections to hypoglossal and facial motor nuclei in the rat.

This study was undertaken to identify the trigeminal nuclear regions connected to the hypoglossal (XII) and facial (VII) motor nuclei in rats. Anterogradely transported tracers (biotinylated dextran amine, biocytin) were injected into the various subdivisions of the sensory trigeminal complex, and labeled fibers and terminals were searched for in the XII and VII. In a second series of experiments, injections of retrogradely transported tracers (biotinylated dextran amine, gold-horseradish peroxidase complex, fluoro-red, fluoro-green) were made into the XII and the VII, and labeled cells were searched for in the principal sensory trigeminal nucleus, and in the pars oralis, interpolaris, and caudalis of the spinal trigeminal nucleus. Trigeminohypoglossal projections were distributed throughout the ventral and dorsal region of the XII. Neurons projecting to the XII were found in all subdivisions of the sensory trigeminal complex with the greatest concentration in the dorsal part of each spinal subnucleus and exclusively in the dorsal part of the principal nucleus. Trigeminofacial projections reached all subdivisions of the VII, with a gradual decreasing density from lateral to medial cell groups. They mainly originated from the ventral part of the principal nucleus. In the spinal nucleus, most of the neurons projecting to the VII were in the dorsal part of the nucleus, but some were also found in its central and ventral parts. By using retrograde double labeling after injections of different tracers in the XII and VII on the same side, we examined whether neurons in the trigeminal complex project to both motor nuclei. These experiments demonstrate that in the spinal trigeminal nucleus, neurons located in the pars caudalis and pars interpolaris project by axon collaterals to XII and VII.

Tumour-like thallium-201 accumulation in brain infarcts, an unexpected finding on single-photon emission tomography.

Thallium-201 brain single-photon emission tomography (201Tl-SPET) is widely used to detect viable tumour tissue with increased metabolic activity. When reperfusion takes place early in cerebrovascular lesions of embolic origin, the presence of tissue areas with increased regional blood flow and preserved metabolic activity can also be assumed. In the present study our purpose was to investigate whether or not foci of 201Tl accumulation occur in reperfused areas with sustained morphological integrity indicated by computed tomography (CT) scans not showing hypodensity in the acute or subacute period. In 16 stroke patients with possible cortical embolic infarction, dual 201Tl and technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO) SPET was performed in both the acute and the subacute period. 99mTc-HMPAO SPET was performed to detect reperfusion. Follow-up CT scans from the same period were also available. In five cases 99mTc-HMPAO SPET ruled out reperfusion and 201Tl SPET was also negative. In four cases 99mTc-HMPAO studies indicated reperfusion early in the acute phase (24-72 h), and comparative CT, without showing hypodensity in the acute or subacute period, also favoured the possibility of sustained metabolic activity. In these cases 201Tl SPET was negative in both the acute and the subacute period. In seven cases CT already showed necrosis in 99mTc-HMPAO hypoperfused areas in the acute period, with negative results on corresponding 201Tl SPET. Later reperfusion occurred in the subacute period (8-14 days) as indicated by 99mTc-HMPAO SPET, at which time an unexpected focal accumulation of 201Tl was detected.(ABSTRACT TRUNCATED AT 250 WORDS)

[Sideroblastic anemias]. / Sideroblastos anaemiák.

The sideroblastic anaemias form a group of disorders of varying aetiology. They are being recognized with increasing frequency, especially as routine staining of bone marrow films for iron is now standard practice in most foreign laboratories. The sideroblastic anaemias have as a common feature the presence of large numbers of pathologic (ringed) sideroblasts in the bone marrow, ineffective erythropoiesis, a high degree of saturation of serum transferrin, increased levels of tissue iron and varying proportions of hypochromic erythrocytes in the peripheral blood. The marrow structure often exhibits dyserythropoietic features. Special attention has been focused by the authors upon the diagnostic and differential diagnostic problems, the ferrokinetics, the preleukemic condition and the therapeutics measures now available. There is also possible to draw some utilizable conclusions from the experiences of the authors.

[Time series of vital statistics and historical demography]. / Las series de los hechos vitales y la demografia historica.

PIP: This is a report of a workshop held in Valencia, Spain, March 1-2 1991, concerning problems in using time series data on baptisms, marriages, and burials for the study of historical demography. The focus was on the records available for Spain and Portugal.^ieng

[Report on a project to compile parish registers in Spain and Portugal]. / Informe sobre el proyecto de recopilacion de los registros parroquiales en Espana y Portugal.

PIP: The author presents a progress report on a project, undertaken by the Association of Historical Demography in Madrid, to coordinate historical demographic research for Spain and Portugal. In addition to cataloging all parish registers, completed research projects are being reviewed to ascertain whether all aspects of the demographic histories of these countries are being adequately studied. The project was conceived at a workshop entitled Time Series of Vital Statistics and Historical Demography, held on March 1-2, 1991, in Valencia, Spain.^ieng