Role of pharyngeal propulsion as an indicator for upper esophageal sphincter myotomy.

Thirty-eight patients with swallowing disorders underwent cricopharyngeal myotomy. The causes of the disorders were muscular in 12 cases, neurologic in 12, cricopharyngeal achalasia in 7, and unknown in 7. Surgery succeeded in 21 patients, gave a partial improvement in 4, and failed in 13. The quality of residual pharyngeal propulsion on clinical, manometric, and radiologic assessment appeared to be a more important predictor of surgical outcome than upper esophageal sphincter relaxation and the major factor in establishing the indications for cricopharyngeal myotomy. Achalasias in the elderly and oculopharyngeal muscular dystrophies had the most favorable outcome.

[Myotomy of the upper esophageal sphincter in upper functional dysphagia. A series of 34 cases]. / Myotomie du sphincter supérieur de l'oesophage dans les dysphagies fonctionnelles hautes. Une série de 34 observations.

OBJECTIVES: Patients with disorders of the upper oesophagus often present with swallowing impairment. We evaluated our results in 34 patients treated with cricopharyngeal myotomy. METHODS: Etiologies were muscular in 11 patients, neurogenic in 10, cricopharyngeal achalasia in 7 and could not be ascertained in 6. A 4 to 6 cm myotomy of the cricopharyngeal muscle and the lower part of the oesophageal constrictor muscle was performed. Incision was made to the mucosa. Outcome was evaluated in terms of functional improvement, weight gain and post-operative mode of food intake. RESULTS: Favourable results were obtained in 19 patients. Incomplete improvement was achieved in 6 and the operation was unsuccessful in 11. CONCLUSION: The quality of residual pharyngeal propulsion appears to be the determining element in operative success and should be used in determining indications.

[Tympanoplasty using chondro-perichondral graft. Indications, techniques and results. Apropos of a series of 127 cases]. / Tympanoplastie avec greffon chondro-périchondral. Indications, techniques et résultats. A propos d'une série de 127 tympanoplasties.

In an attempt to avoid recurrence, the authors have used chondro-perichondral grafts for more than 10 years for tympanoplasty of retraction pouches. Early results were published in 1987. This new retrospective series of 127 tympanoplasties, performed from 1987 to 1991 reports the anatomic and functional results obtained and the technical modalities used. After a mean follow-up of 18 months, the results appear encouraging. Indications of this chondro-perichondral graft have been widened to cases of unsuccessful first intention myringoplasty and to certain cases of progressive perforations occurring in a setting of inflammation or tubal dysfunction. The results must be confirmed on the basis of long term outcomes.

[Sinusitis during intensive care. Prospective studies]. / Sinusites de réanimation. Etudes prospectives.

Two series of ICU patients, the first one with nasal endotracheal intubation, the other one with a tracheostomy, were included in a prospective and comparative study with repeated CT scans of the sinuses. Radiological sinus involvement is seen in both groups almost constantly; purulent sinusitis are often seen in both series. Unexplained fever should make us look for a sinusitis, even in patients with early tracheostomy. Moreover, our results ask for more study about associated causes, apart from nasal endotracheal intubation.

[Neurinoma of the 8th cranial nerve. Surgical indications in neurofibromatosis]. / Neurinome du VIII. Indications chirurgicales au cours des neurofibromatoses.

There are two types of neurofibromatosis, i.e. peripheral neurofibromatosis (type 1) and central neurofibromatosis (type 2). Neurinomas of the acoustic nerve are basically seen in central neurofibromatosis, in which case they are generally bilateral. Surgical indications for neurinoma are rare and 5 patients will be discussed: 2 of these underwent an operation on the neurinoma by the posterior route on several occasions, while 1 patient was operated by the trans-labyrinth route. Nuclear magnetic resonance remains the best means of monitoring.

[Severe lesions of the petrous bone caused by pseudomonas aeruginosa]. / Lésions pétreuses graves dues au pseudomonas aeruginosa.

Pseudomonas aeruginosa is often isolated in infections of the ear cleft. In some circumstances, this organism can cause serious petrous or peri-petrous lesions. Two pictures are seen: Malignant external otitis with severe headaches, signs of external otitis, and usually pseudomonas aeruginosa is isolated. This is usually seen in an elderly diabetic patient. Nerve paralysis is the main risk. The other complications, very grave in the past, are rare nowadays with the use of selective antibiotic treatment. Pseudomonas aeruginosa is also the causative organism in extensive osteitis of the skull base. Diagnostic problems are seen in case of specific infections or tumoral lesions. The treatment includes the same medications as for the malignant external otitis, as well as complete surgical excision.

[Cardiac toxicity of 5-fluorouracil. Reflections on a case]. / Toxicité cardiaque du 5-fluoro-uracile. Réflexions à propos d'un cas.

The authors relate a case of spasm occurring during cisplatin and 6-fluorouracil combination chemotherapy. The cardiotoxicity of 5-F.U., and namely the risk of coronary spasm, has been known since 1969. However, few cases have been reported in France. Referring themselves to the case of interest and to literature sources, the authors review current pathogenic hypotheses and specify the precautions commanded by the prescription of any protocol that includes 5-F.U.