[Trimetazidine and degenerative deafness. Effect on hearing and integration]. / Trimétazidine et surdités dégénératives. Effets sur l'audition et l'intégration.

This study was conducted in order to assess the activity of trimetazidine dosed at 60 mg/day in patients presenting degenerative loss of hearing. Ten centers participated in this multicenter double-blind placebo-controlled trial which spanned 6 months. Included were 251 patients (118 women, 133 men) presenting with pure perception bilateral symmetrical deafness concerning predominantly the acute frequency range. 228 patients terminated the study, including 115 in the trimetazidine group and 113 in the placebo group. The evolution over a 6-month treatment period was significantly better with trimetazidine as regards the following parameters: audibility as assessed by pure-tone audiometry, namely at the acute frequency range (p = 0.002), intelligibility as assessed by speech audiometry (p = 0.008), subjective evaluation of hearing loss and its impact on the patient's social life. Results confirm the value of trimetazidine hearing loss management, based on clinical, subjective criteria as well as audiometric ones. Parameters reflecting best trimetazidine's efficacy were intelligibility and the psychological/behavioral impact of the impairment, allowing for better social integration of the subject.

[Extensive fibromatosis of the neck muscles]. / Fibromatose extensive des muscles de la nuque.

Extensive fibromatosis, also called desmoid tumor, is a histologically benign tumor, which is nonetheless serious due to its recurrent character and to its potential for infiltration of neighboring tissues. Extensive surgery is the only effective means of treatment, radiation therapy being used only as a complement. The authors describe an elective location of the lesion in the sheaths of the scalenus muscles. This development is usually observed in young women, as is the case in the observation reported here.

[Cervicofacial non-Hodgkin's malignant lymphoma. Classification, prognosis and treatment apropos of 65 cases]. / Lymphomes malins non hodgkinien cervico-faciaux. Classification, pronostic et traitement à partir de 65 cas.

The approach to non hodgkins malignant lymphomas (NHML) has changed in recent years, notably because of advances in pathological evaluation due to histo-immuno-labelling leading to a more accurate classification. Such pathology being relatively common in the cervical facial region, with a figure of 10 to 25%, this report concerns the personal experience of the authors based upon 65 cases treated in the department between 1975 and 1985.

[Diffuse spontaneous cervical cellulitis caused by anaerobic bacteria]. / Les cellulites cervicales diffuses, spontanées à anaérobies.

Nine cases of diffusal cervical cellulitis due to anaerobes were analysed. Some of them had right away extensions (to the inferior mediastinum or to the face). From these cases, the authors argue their treatment protocol. Surgery was performed immediately after diagnosis, and associated with intensive management. The excision of the necrotic tissue and the aperture of all cervical spaces (particularly the floor to the buccal cavity and the prevertebral space) were made. The source of infection was looked for (most often this being the teeth) and treated at the same time. Bacteriologic aero and anaerobic prelevements were done. A thoracic or facial surgery, being necessary because of persistency or appearance of extension, was performed secondary, after the patient was better prepared with a hyperoxygenation and a triple antibiotic therapy. Life prognosis improved with this treatment protocol. The gravity of the conditions presented by our patients depended more on the presence of an underlying disease (diabetes, immunosuppression, age...) or the delay of the diagnosis than on the cellulitis extension.

[A new marker in oncology. Assay of gangliosides bound to sialic acid]. / Un nouveau marqueur en cancérologie. Le dosage des gangliosides liés à l'acide sialique.

Gangliosides are released from cells proliferating in serum and can be assayed by a LASA method. The authors report the assay method for sialic acid bound exclusively to glycosphingolipids (GASA method). They study the reliability and discuss the preliminary factors concerning this upper respiratory tract squamous cell marker.

[Intrapetrous neurinoma of the facial nerve. Removal by the oto-neurologic route]. / Neurinome intrapétreux du nerf facial exérèse par voie oto-neurologique.

A case of a 33 year-old woman presenting an intrapetrous facial nerve neurinoma is reported. The neurological finding was a quickly progressive facial nerve palsy without hearing loss which the initial diagnosis was a Bell's palsy. The radiological findings showing an petrous bone erosion located at the third portion of the facial nerve gave the diagnosis. It was confirmed by CT scan and arteriography that allows a pre-operative embolisation. A one stage operation performed by a triple retromastoid, transpetrous and retroparotid approach, allowed a complete removal. The post-operative course was uneventful and a reconstructive facial surgery was performed to restore a facial symmetry six months later. The authors review the literature about this tumor which remains rare and point out two facts: --A non regressive or recurrent or atypical facial nerve palsy had to be checked up by neuroradiology and even by surgical exploration. --The triple retromastoid, transpetrous and retroparotid approach is very interesting, allowing a one stage complete removal of the tumor and a check up of the facial nerve repair possibilities.

[Extensive papilloma durum of the larynx and its malignant transformation. Apropos of 15 personal cases in 15 years]. / La papillomatose cornée extensive du larynx et sa transformation maligne. A propos de 13 observations personnelles en 15 ans.

Based on a review of 13 personal cases an attempt is made to isolate a specific laryngeal lesion: extensive papilloma durum of larynx of almost ineluctable malignant transformation. Clinical, histopathologic and therapeutic aspects of the affection are reviewed.

High voltage orbital radiotherapy and surgical orbital decompression in the management of Graves' ophthalmopathy.

We report on 2 groups of patients with Graves' ophthalmopathy. A group of 21 patients was treated by high voltage (18 MV) orbital radiotherapy combined with mean doses of corticoids. The results were good or excellent in 12 patients (mean score 6.62 before and 4.0 after, soft tissues greater than proptosis greater than extraocular muscle involvement), without any complications from irradiation. Patients undergoing surgery initially presented less severe symptoms, even 7 patients treated after corticoid and/or radiotherapy failure. The results were satisfactory in all patients (mean score 5.1 before and 2.4 after, proptosis greater than soft tissues greater than extraocular muscle involvement). Both methods showed results within 3 months, and they can be combined.

[Treatment of equilibrium disorders with Ginkgo biloba extract. A multicenter double-blind drug vs. placebo study]. / Traitement des troubles de l'équilibre par l'extrait de Ginkgo biloba. Etude multicentrique à double insu face au placebo.

This study, conducted in 3 centres, included 70 patients with vertiginous syndrome of recent onset and undetermined origin. In a double-blind trial extending over a 3-month period they were given either Ginkgo biloba extract or a placebo. The effectiveness of Ginkgo biloba extract on the intensity, frequency and duration of the disorder was statistically significant. At the end of the trial, 47% of the patients treated were rid of their symptoms as against 18% of those who received the placebo.

[Surgery of functional disorders of the pharyngoesophageal sphincter. Value and contribution of cricopharyngeal myotomy]. / La chirurgie des troubles fonctionnels de la bouche oesophagienne. Valeur, apport de la myotomie du crico-pharyngien.

A series of 11 patients with severe functional disorders of superior sphincter of esophagus were treated by section of cricopharyngeal muscle. Indications for the operation are based mainly on clinical data, assisted by results of different examinations (endoscopy, manometry, radiocinema), and it could find a very wide field of application.

[Montgomery's tube in laryngotracheal stenoses in children (11 cases)]. / Le tube de Montgomery dans les sténoses laryngo-trachéales de l'enfant (11 observations).

Because of the fragility of the laryngotracheal tree in children, and the serious consequences on function of any chondritic lesion or even mucosal edema, overall endoscopic treatments combined with prosthesis insertion are preferred to any surgical procedure. Eleven cases of laryngotracheal stenosis are reported where treatment involved use of Montgomery's calibrated tube.

[Nosologic criteria for the classification of midfacial granulomatosis]. / Critères nosologiques de classification des granulomatoses médio-faciales.

The authors report three cases of Stewart's disease and five cases of Wegener's disease seen over a period of 10 years, during which time they saw no cases of non-Hodgkins malignant lymphoma presenting as a mid-facial malignant granuloma. On the basis of these cases together with a review of the literature, they argue in favour of the dissociation of Stewart and Wegener as well as that of Stewart and monomorphous NHML, raising the problem of the existence of the latter as an entity.