Two cases of cytomegalovirus infection revealed by hearing loss in HIV-infected patients.

Neurological complications are particularly common during HIV infection. Among various opportunistic diseases, cytomegalovirus (CMV) is one of the most frequent causes of central and peripheral neurological manifestations. Previously, there have been several reports of cranial nerve infection by CMV, but to our knowledge, no cases of auditory nerve involvement have been described. We report two cases in which CMV infection was revealed by involvement of the VIIIth cranial nerves. Cytomegalovirus (CMV) infection is frequent in severely immunodeficient patients infected by human immunodeficiency virus (HIV). The main targets of CMV are the retina, gastrointestinal tract and central nervous system. We describe two cases in which neurologic CMV infection was revealed by hearing loss.

Partial restoration of blink reflex function after spinal accessory-facial nerve anastomosis.

Functional motor control requires perfect matching of the central connections of motoneurons with their peripheral inputs. It is not known, however, to what extent these central circuits are influenced by target muscles, either during development or after a lesion. Surgical interventions aimed at restoring function after peripheral nerve lesions provide an opportunity for studying this interaction in the mature human nervous system. A patient was studied in whom the spinal accessory nerve was anastomosed into a lesioned facial nerve, allowing voluntary contractions of the previously paralysed muscles. This procedure, in addition to replacing the facial neurons at peripheral synapses, allowed a new short latency trigeminospinal accessory reflex of the R1 blink reflex type to be demonstrated, implying that trigeminal neurons had sprouted towards spinal accessory motoneurons over a distance of at least 1 cm. These results show an unexpected influence of the periphery in remodelling central connectivity in humans. The motoneuronal excitability for this R1 reflex response was therefore studied to compare the convergent properties of facial motoneurons (normal side) with those of the spinal accessory motoneurons (operated side) using a classic double shock technique with variable interstimulus intervals (conditioning test stimulus). On the normal side, conditioning stimuli (to the ipsilateral or contralateral infraliminar supraorbital nerve) produced a clearcut facilitation of the R1 blink reflex when the interstimulus interval was 30-80 ms. By contrast, a similar procedure had no effect on the R1 blink reflex mediated via the trigeminal-spinal accessory reflex arc. These data indicate that despite the heterotopic sprouting of some axons from neurons in the XIth nucleus, motoneurons involved in the newly formed reflex arc remain totally inexcitable by other trigeminal afferents and seem unable to ensure a physiological functioning of the normal blink reflex. Thus the functional relevance of the recovered R1 blink response remains unclear.

Hypoglossal-facial anastomosis alters excitability of hypoglossal motoneurones in man.

In 6 patients who had undergone a hypoglossal-facial anastomosis, showing clinical signs of recovery, a new short-latency trigemino-hypoglossal reflex of the R1 blink reflex type was demonstrated, implying a heterotopical sprouting of trigeminal neurones towards hypoglossal motoneurones. We therefore studied the motoneuronal excitability for this R1 reflex response in order to compare the convergent properties of facial motoneurones (normal side) with those of the hypoglossal motoneurones (operated side) with the use of the classical double-shock and variable interstimulus delay (conditioning-test stimulus) technique. On normal side, conditioning stimuli (ipsi- or contralateral infraliminar supraorbital nerve) produced a clear-cut facilitation of the R1 blink reflex response within a 30-80 ms interstimulus time interval. By contrast a similar procedure remained without any effect on the R1 blink reflex response mediated via the trigeminal-hypoglossal reflex arc. These data indicate that despite the heterotopical sprouting of some axons of neurones from the principal trigeminal nucleus towards the XIIth nucleus, those hypoglossal motoneurones involved in the neoformated trigemino-hypoglossal reflex arc remain totally inexcitable by other trigeminal afferents and thus appear unable to ensure the physiological function of the normal blink reflex.

[Electrophysiological study of the blink reflex in Wistar rats]. / Etude électrophysiologique du réflexe de clignement chez le rat Wistar.

The electrophysiological characteristics of the blink reflex evoked by electrical stimulation of supraorbital nerve (V1) have been studied in the awake and anaesthetized rat. This reflex has two components (R1 and R2). The first one, R1, is of short latency, strictly ipsilateral to the stimulus and exhibits all features of an oligosynaptic reflex response. The second component, R2, of longer latency, is observed bilaterally in awaked but ipsilaterally in lightly anaesthetized and totally depressed in deeply anaesthetized animals. This component possesses all characteristics of a largely multi-synaptic reflex response.

[Demonstration and electrophysiological analysis of the blinking reflex in the rat. Value of the animal model]. / Mise en évidence et analyse électrophysiologique du réflexe de clignement chez le rat. Intérêt de ce modèle animal.

The authors have developed an animal model for the electrophysiological investigation of the blink reflex. The justification for such investigations and the experimental protocol were presented. The authors studied the blick reflex with electromyographic recordings obtained after the stimulation of the supra orbital nerve (V1) in the awake rat and in the anaesthesized rat. Two components of the reflex, R1 and R2 were observed. The early component, R1 was ipsilateral to the stimulus. It was observed whatever the degree of anaesthesia. The R2 component came later and was only observed in awake or weakly anaesthesized rats. It appeared to be isolated and unprecedented by an R1 component when the contralateral supra orbital nerve was stimulated. The R1 responses were facilitated by prior ipsilateral or contralateral stimulation of V1.

[Frontal mucocele. Clinical symptoms, treatment and results apropos of 17 cases]. / Les mucocèles frontales. Signes cliniques, traitements et résultats à propos de 17 cas.

The ophthalmological signs are stressed in the management of frontal mucoceles. The authors report good results of their surgical technique with bicoronal approach, exenteration of the pathology and complete obliteration of the frontal sinus by bone chips.

Redirection of the hypoglossal nerve to facial muscles alters central connectivity in human brainstem.

Functional motor control requires perfect matching of central connectivity of motoneurones with their peripheral connections. However, it is not known to what extent central circuitry is influenced by target muscles, either during development or following a lesion. Surgical interventions aimed at restoring function following peripheral nerve lesions provide an opportunity for studying this interaction in the mature human nervous system. We have followed 8 patients in whom the hypoglossal nerve was anastomosed into a lesioned facial nerve, allowing voluntary contractions of the previously paralyzed muscles. We show that, in addition to replacing the facial neurons at peripheral synapses, a new short-latency trigemino-hypoglossal reflex, of the R1 blink reflex type, can be demonstrated in patients showing recovery, implying a sprouting of trigeminal neurons towards hypoglossal motoneurones, over a distance of at least 0.5 cm. These surprising results show an unexpected influence of the periphery in remodelling central connectivity in man.

Comparative study of laser and scalpel nerve transections.

This investigation was designed to compare standard scalpel transections of the tibial branch of the rat sciatic nerve with those performed using either a milliwatt carbon dioxide (CO2) or a potassium titanyl phosphate (KTP/532) laser. Four transection groups consisted of nerves sectioned with (1) scalpel (control), (2) milliwatt CO2 laser, (3) KTP/532 with microscope attachment, and (4) KTP/532 laser with 400-microns bare fiber. Each laser was used with the same parameters: 10 watts, 0.4-mm spot size, and continuous-wave mode. Horseradish peroxidase (HRP) was applied to the proximal stump for 30 min, and the animals were sacrificed 24 h later. Horseradish peroxidase (HRP)-labeled motoneuron cell bodies in the lumbar spinal cord were then counted. The average numbers of labeled neurons in each group were as follows: group I (n = 14) 518, group II (n = 8) 424, group III (n = 8) 351, and group IV (n = 8) 283. The standard deviations were quite large, however. When all laser transections were pooled and compared with paired scalpel transections, we found a significant difference, both by the paired t-test (P = 0.016) and by the Wilcoxon matched-paired test (P = 0.02). We conclude that laser transection significantly diminishes the number of neurons labeled by the retrograde transport of HRP.

[Chronic maxillary sinusitis of dental origin and nasosinusal aspergillosis. How to manage intrasinusal foreign bodies?]. / Sinusites maxillaires chroniques d'origine dentaire et aspergillose nasosinusienne. Quelle conduite à avoir vis-à-vis des corps étrangers intrasinusiens?

About a series of 33 patients operated in the ENT Depart. Prof. Soudant-La Pitié-Salpêtrière Hospital-Paris. Any emphasis was put on 11 cases of aspergillosis sinusitis. Most of the time, clinical signs are non specific. But X rays studies are of great help for the diagnosis. Treatment of chronic sinusitis of dental origin, particularly aspergillosis, remains surgical: caldwell-luc operation or endonasal approach. As a conclusion, the authors suggest systematic removal of all intrasinusal foreign body.

Surgical treatment for laryngotracheal stenosis in the pediatric patient.

We report our experience with laryngotracheal stenosis (LTS) in children during the last 12 years. Documentation and follow-up were available for 115 patients who underwent surgery for acquired or congenital LTS. Most were severe cases according to Cotton's classification. Forty-six weighed less than 10 kg at the time of surgery; 45 had pure congenital subglottic stenosis; 70 had acquired subglottic stenosis, mainly due to endotracheal intubation. The surgical techniques used have been various. The three main types of procedure were castellated laryngotracheoplasty, anterior cartilage rib grafting, and anterior and posterior cricoid cuts with or without grafting. All cases but 1 (44/45) of congenital subglottic stenosis have been successfully decannulated, 7 requiring a second procedure. The decannulation rate for acquired SGS was 89% (62/70), but 14 patients required multiple procedures. Current trends in subglottic stenosis management in our institution are presented.

[Subglottic stenosis and gastroesophageal reflux]. / Sténoses sous-glottiques et reflux gastro-oesophagien.

The authors report the cases of ten children treated for sub-glottic laryngeal stenosis, in the Department of Pr. Narcy in Hospital Robert-Debre. Medical treatment of the laryngeal stenosis had failed in these cases. Treatment, most often surgical, of the gastro-oesophageal reflux present in these ten cases enabled these children to be cured. A review of the literature stresses the role and responsibility of gastro-oesophageal reflux in laryngeal pathology. Based on their experience, the authors suggest: systematic investigation for gastro-oesophageal reflux during management of laryngeal stenosis, especially when laryngeal inflammation is encountered; the adoption of an interventionist attitude vis-a-vis gastro-oesophageal reflux which would seem to have an important pathogenic role in certain laryngeal stenoses.

[Surgical treatment of severe laryngeal stenoses in children]. / Traitement chirurgical des sténoses laryngées sévères de l'enfant.

This article constitutes a short review of the experience of the ENT service at the Hôpital Bretonneau, in Paris, with regards to laryngeal stenosis in children. Since 1974, 115 cases of severe stenosis have been operated on. 70 cases presented acquired lesions, primarily related to endotracheal intubation, while congenital malformations accounted for another 45 cases. 41% of the patients had stenosis that reduced the laryngeal lumen by 90%, or more. The different surgical approach (consisting in castellated incision of the anterior wall, or in anterior, or more rarely posterior, cartilage supplementation), as well as the various stenting methods used are briefly described and discussed.

[Otologic manifestations presenting and predominating in necrotizing angiitis]. / Manifestations otologiques révélatrices et prédominantes au cours des angéites nécrosantes.

The authors report on 5 observations of necrotising angiitis with a specifically otological onset, namely 4 Wegener's syndromes and one periarteritis nodosa. In all 5 cases, the initial symptomatology consisted of otological signs in a feverish context, producing pictures of serous or sero-purulent otitis. Its resistance to usual forms of therapy led in 3 cases to the installation of transtympanic aerators, and in 2 cases to the performance of an antro-attico-mastoidectomy. One of the observations led to the discovery in the middle ear of a histological aspect specific to the disease, from which it can be considered that the otologic impairment could be a specific seat of the disease. The 5th observation is particular in that it was the otological signs which revealed each time a new progression of the disease, enabling the immediate implementation of an adapted treatment prior to the occurrence of the systemic signs. 3 observations proved the difficulty of diagnosis at the initial stage, when at times only the otological signs are present, together with the importance of its discovery prior to the occurrence of systemic lesions that are occasionally irreversible. Any isolated otological symptomatology in a feverish context, resisting usual therapies, should evoke the diagnosis, and lead to the performance of further duly adapted examinations (sedimentation rate, pulmonary X-ray, proteinuria, hematuria).