Cogan's syndrome. An unusual etiology of urticarial vasculitis.

We report the case of an 18-year-old black woman with urticarial vasculitis, vestibuloauditory dysfunction and superficial keratitis. Oral steroid therapy was effective in reducing most clinical manifestations with high-dosage dependency. However, only intravenous pulses of methylprednisolone allowed slight improvement of hearing. In this case, we emphasize urticarial vasculitis as a new manifestation of atypical Cogan's syndrome. A significant titer of Chalmydia trachomatis antibodies was found in our patient: their role in the pathogenesis of Cogan's syndrome is discussed.

[Neurinoma of the third portion of the facial nerve. About a case cured after hypoglosso-facial anastomosis (author's transl)]. / Neurinome de la 3 portion du nerf facial. A propos d'un cas suivi d'une réhabilitation par anastomose hypoglosso-faciale.

The authors report a case of a neurinoma of the third portion of the facial nerve, revelated by a progressive palsy completed four months later (but the muscle of the stapes was still working). After removing the neurinoma which was in the middle of the mastoïde an anastomosis between the XII and the VII nerves was performed and successful. The authors emphasize two facts: --The possibility of active reinervation by this method of the facial muscles even after a long delay of complete interruption of the facial nerve. --The advantage of performing the micro-anastomosis as close as possible to the myo-neural synapsis (just before the bifurcation of the facial nerve.

[The treatment of serve laryngo-tracheal stenosis (author's transl)]. / Traitement des sténoses laryngo-trachéales graves.

The treatment of severe laryngo-tracheal stenosis raises complex problems and we remain far from having found a universally agreed solution for all of them. The authors describe here their attitude to severe laryngo-tracheal damage without suggesting that this should be applied from the outset or to all cases seen. It consists of an operation faithful to the principle of that of Rethi as greatly improved by P. aboulker and to which we ourselves have remained faithful whilst in our turn suggesting a certain number of technical modifications which whilst in no way changing its principle simplify the performance with a teflon tube equipped with a detachable tip with a teflon diaphragm momentarily occluding the lower airway. We also suggest the use of steel wire sutures in order to hold the two hemi-larynxes and the fragments of tracheal rings apart when the degree of damage suggests the danger of postoperative trachemalacia or in the presence of recurrence of stenosis, a far from rare possibility in the late course following this type of surgery.

[Failures of surgical treatment of iatrogenic laryngotracheal stenosis (author's transl)]. / Les échecs du traitement chirurgical des sténoses laryngo-trachéales iatrogènes.

In the light of their experience involving almost 100 cases, the authors emphasize the most frequent causes of failure of the surgical treatment of laryngotracheal stenosis. Minimal procedures most including a combination of the two procedures of widening of the laryngeal lumen and conservation of this recalibration by an atraumatic tube, axial and well tolerated, run the risk of giving results which, if not poor, will be at least incomplete. The classical operation of Rethi would appear to be inadequate to ensure totally effective recalibration if stenosis is major and methods of anterior widening of the larynx, associated with the Rethi procedure or not, are more widely indicated.

[Rhinological surgical approach to the nasal ducts (author's transl)]. / Abord chirurgical rhinologique de la partie basse des voies lacrymales.

An obstruction along the nasal duct can be approached and removed by an operation through the nose: Rouge's technique for access to the orifice below the inferior turbinate, incision of the mucosal diaphragms over a sound passed into the nasal duct, insertion of a drainage tube; all under microscopic observation.

[Recent modifications of Rethi's operation (author's transl)]. / Modifications récentes de l'opération de Réthi--P. Aboulker.

Rethi's operation for laryngotracheal stenosis is discussed, together with P. Aboulker's modifications (hollow teflon intralaryngeal tube surrounding a fenestrated tracheal canula, which can be moved rapidly). The tube has been modified and its length can be more easily adjusted. Its extremities are rounded and polished (less risk of trauma), and it has an upper diaphragm which has a temporary action but is very useful for avoiding wrong directions in the first days of use.

[A proposal of a T.N.M. type of classification of the ear. O.P.A.C. classification of chronic surgical otitis]. / Proposition d'une classification de type "T.N.M." de l'orielle. La classification "O.P.A.C." des otites chroniques chirurgicales

With the advent of modern otology, cophosurgeons anxious to compare their results soon became aware of the need for a "T.N.M" type of classification for the ear. The classification described here by the authors is, in principle, a classification of the "T.N.M" type: that is, a purely descriptive classification without prognostic, pathogenetic or therapeutic pretensions. This "O.P.A.C." classification is based on a description of 4 main characteristics: 1) the existence and characteristics of potential otorrhoea, described under the letter C; 2) the characteristics of potential perforation of the tympanum, described under the letter P; 3) the appearance of the middle ear, excluding the ossicular chain, described under the letter A; 4) the condition of the ossicular chain when the surgeon has completed his exploration of the lesions, described under the letter C. Two years experience seems to have proved the convenience and usefulness of this purely clinical classification, providing otologists with a common language. While they are aware of the objections and criticisms to which it may give rise, the authors hope, on time, to improve in this classification.

[Reflections on cholesteatoma]. / Réflexions sur le cholestéatome.

Cholesteatoma, defined by Muller in 1830, has not benefited by any means to the same extent as other otological conditions from therapeutic progress. Its histological nature has been defined on information supplied by the electric microscope. It remains puzzling and the manner in which it invades the inner ear cavities imperfectly reproducing the epidermis remains very much a mystery. In spite of a certain ultra-structural unity, it would appear that there is not just one, but many cholesteatomas and if this protean condition is to be understood treated, a primary requisite is a nosological break-down which takes into account the topography of the lesions and their macroscopic appearance. From this attempt at a classification which groups together the most frequently encountered possibilities, operative indications which have to take into account several contradictory preoccupations can be arrived at. It is essential to: -- eradicate the lesions as thoroughly as possible; -- avoid damaging those structures of the middle ear which are still functional or which may be made serviceable again; -- leave open the possibility of surveillance of the cavities so as to detect relapses. These contradictory requisites can be reconciled in a great number of cases and justify the hope that a cure will go hand in hand with an appreciable gain in function. As examples, a few audiograms of patients operated on are included to show the sort of results that it is possible to obtain.