Acute laryngeal paralysis induced by the migration of a totally implantable venous access device's catheter tip.

The authors report a case of acute vagus nerve paralysis that appeared during a course of chemotherapy. The drugs had been administered through a totally implantable venous access device (TIVAD), whose catheter tip had migrated into the right internal jugular vein (IJV) and was surrounded by a complete venous thrombosis. The supposed aetiology of this paralysis was a leakage of the cytotoxic drug (5-fluorouracil) from the vessel wall into the surrounding carotid space, because of the stagnation of the chemotherapeutic agent above the thrombosis. Four months after cessation of chemotherapy, the laryngeal paralysis was still evident.

[Sickle cell disease and vertigo: a possible diagnosis in metropolitan France. Review of the literature and case report]. / Drépanocytose et vertige: un diagnostic possible en France metropolitaine. Revue de la littérature àpropos d'un cas.

Sickle cell anemia is frequently associated with auditory dysfunction. However peripheral vestibulopathy is uncommon. The purpose of this report is to describe a patient who presented repeated episodes of severe vertigo attributable to sickle cell disease. Discussion of this case includes a review of the literature.

[Cephalic vein access for implantable venous access devices. Technique and long-term follow-up]. / Veine céphalique et chambre à cathéter implantable. Technique et suivi à long terme.

OBJECTIVE: To evaluate 1) the advantages and drawbacks of the cephalic vein access for totally implantable venous access devices (TIVAD); 2) the complications of such devices at long-term follow-up. PATIENTS AND METHODS: A retrospective study of a series of 107 cephalic vein accesses attempted on 105 patients from January 1997 to December 2001, in our department. They were 87 men and 18 women, aged from 25 to 85 years (mean: 59). The authors evaluated in each case the surgical technique, the preoperative incidents, the side of surgery, and the short-term and long-term complications. The total follow-up reached 41 284 days. RESULTS: The cephalic vein access attempt failed in 12 cases (11%). These failures were due to intravenous blockade of the flexible catheter or to misroutine of the catheter in 5 cases and to a too thin vein in 7 cases. There was no statistically significant difference between the right and left sides. There was no technique-related complication. There were 18 postoperative complications (19%) out of the 95 devices that were implanted: 6 venous thrombosis, 7 infections, 4 catheter disconnections including 3 intra-cardiac migrations, 1 catheter occlusion. In 12 of these cases, the whole device had to be withdrawn. In the whole series, the devices were withdrawn at mean of 435 days after implantation. CONCLUSION: The use of a TIVAD is necessary when a chemotherapy must be delivered for treatment of a cancer. Cephalic vein access appears to be easy, quick and relatively safe. Postoperatively, serious complications can be encountered like with any type of TIVAD. These complications must be well-known if one wants to manage them well.

[Value of total thyroidectomy in amiodarone-induced hyperthyroidism]. / Intérêt de la thyroïdectomie totale dans l'hyperthyroïdie à l'amiodarone.

The potential severity of amiodarone-induced hyperthyroidism, particularly in severe cardiopathy cases, necessitates a regular clinic and biologic thyroid control. The break in amiodarone and a medical treatment (synthetic antithyroid drugs, steroids, perchlorate of potassium) can be ineffective. The authors report the case of a patient with an right ventricle arythmogenic dysplasia, without thyroid history, who came back 3 years after the introducing of amiodarone with major hyperthyroidism. After failure of medical treatment, a total thyroidectomy permitted to quickly stop hyperthyroidism and to early reintroduce amiodarone. Surgery seems to be the radical treatment when hyperthyroidism doesn't respond to the medical treatment and when the cardiopathy requires amiodarone.