[Endonasal endoscopic surgery in the treatment of spontaneous or post-traumatic cerebrospinal fluid (csf) leaks]. / La chirurgie endonasale sous guidage endoscopique dans le traitement des fuites de LCR spontanées ou post-traumatiques.

The incidence and the risk of meningitidis justify treatment in all cases of cerebrospinal fluid rhinorrhea with spontaneous etiology or after traumatic injury. Endonasal surgery with endoscopic instruments provides many advantages compared with transcranial or transfacial approach used by neurosurgeons. We report our experience and our surgical technique in the treatment of CSF leaks in 5 patients. Intrathecal injection of fluoresceine was very useful in all cases for detecting the CSF leak. Total or selected ethmoidectomy depended on the localization of the leakage. Wide sphenoidotomy enables detection and repair of CSF leaks from the sphenoid cavity. A free graft of inferior turbinal mucosal was used to repair the breache. This rapid low morbidity surgery offered secure closure of rhinorrhea in 4 cases after one procedure and in 1 case after two procedures with an average follow up of 22 months. Cerebrospinal fluid rhinorrhea can be managed in first line therapy with endoscopic intranasal surgical techniques when they are localized in the anterior ethmoid or in the sphenoid cavity.

Smell dysfunction and related factors in diabetic patients.

OBJECTIVE: To analyze smell function in diabetic patients and healthy control subjects, with reference to individual characteristics and major complications of the disease. RESEARCH DESIGN AND METHODS: A cross-sectional study of smell recognition in 68 diabetic patients and 30 control subjects without known cause of smell impairment was conducted. Smell was studied using a kit of flavors that patients were asked to recognize, leading to a smell recognition score ranging from 0 (no recognition) to 20 (perfect recognition). Demographic and clinical data, and the electrogustometric threshold were recorded in both groups. Metabolic control and degenerative complications were studied in diabetic patients. RESULTS: The SRS was significantly lower in diabetic patients than in control subjects (12.4 +/- 0.5 vs. 15.1 +/- 0.5, P < 0.001). By use of univariate and multivariate analyses, this difference could not be explained by individual factors such as age, sex, body mass index, blood pressure, or tobacco or alcohol consumption but was related to diabetes. SRS correlated with EGT (r = 0.70, P < 0.001). In the diabetic group, SRS was associated with age (r = 0.29, P < 0.05), duration of diabetes (r = 0.27, P < 0.05), microalbuminuria (12.2 +/- 0.8 vs. 14.4 +/- 0.9, P < 0.05), peripheral neuropathy (10.3 +/- 1.0 vs. 14.1 +/- 0.9, P < 0.01), and EGT (r = 0.39; P < 0.001). By use of multivariate analysis, the strongest association was found with EGT (R2 = 0.15). CONCLUSIONS: These results suggest that smell recognition is impaired in patients with diabetes mellitus. Smell dysfunction is associated with age and degenerative complications of diabetes, suggesting a degenerative mechanism related to diabetes.

[Human papillomavirus and nasosinusal inverted papilloma]. / Papillomavirus humain et papillomes inversés naso-sinusiens.

Eight inverted papillomas were evaluated for the presence of human papillomavirus (HPV) DNA. The techniques used were Southern Blot Hybridization in five cases and Polymerase Chain Reaction (PCR) in three cases. All eight lesions contained the characteristic features of inverted papillomas. Two lesions showed areas of dysplastic change and one lesion contained koilocytes. In three patients, invasive squamous cell carcinomas were found. The presence of HPV was noted in one of these specimen of inverted papilloma with squamous cell carcinoma. Specific testing for HPV types 6, 11, 16, 18 and 33 on this specimen was negative, thus indicating that the specimen is associated with a different HPV type. The results of this study, with only one case of positive HPV testing, leads us to question the precise role of HPV as an etiological agent in nasal inverted papillomas. The fact that this single positive case did not test positive for the HPV type 16 suggest that this is not the only "high risk" HPV type associated with the progression of inverted papilloma to a carcinoma.

Early detection of diabetic patients at risk of developing degenerative complications using electric gustometry: a five-year follow-up study.

OBJECTIVES: Taste impairment has been reported during the course of diabetes. Although a degenerative mechanism has been suspected, the natural history of taste disorders in diabetes remains unknown. The purpose of this study was to describe the five-year evolution of electric gustometry in diabetic patients compared to healthy control subjects and with reference to degenerative complications of the disease. METHODS: Electrogustometry was studied initially and after 5 years in 73 diabetic out patients and 25 control subjects. None of them had any known cause of taste impairment other than diabetes. Diabetic patients and control subjects did not differ for demographic data and confounding factors. RESULTS: After five years, the electrogustometric threshold (EGT) significantly increased (51 +/- 6 vs 95 +/- 11 microA; p < 0.001), whereas slight changes occurred in control subjects (23 +/- 4 vs 25 +/- 5 microA; NS). Frequency of electric hypogeusia (EGT > or = 100 microA) increased from 11 to 46% in diabetic patients (p < 0.001), but did not vary in control subjects (4%). EGT was not strongly associated with individual factors such as blood pressure, tobacco and alcohol consumption, but correlated with age (p < 0.001). In the diabetic group, higher EGT were observed in patients treated with insulin (p < 0.001). EGT and its changes were associated with degenerative complication (p < 0.001), but neither with metabolic control, nor with duration of diabetes. Using multivariate analyses, the strongest associations were found with peripheral neuropathy and microalbuminuria (28 to 45% of variance explained; p < 0.001). The predictive value of initial hypogeusia on neuropathy at follow-up was 88% for a positive test and 63% for a negative one. CONCLUSIONS: These results suggest that the taste nerves transduction function is impaired during the course of diabetes. This impairment is associated with an increased occurrence of degenerative complications, leading to suspect a similar pathophysiological mechanism. Electric gustometry could be an interesting test for early screening for diabetes complications.

[Inverted papilloma of the nose and paranasal sinuses. Retrospective study of 18 cases]. / Papillomes inversés naso-sinusiens. Etude rétrospective portant sur 18 cas.

The authors report about 18 cases of inverted papillomas treated between 1981 and 1991. The average age of the patients is 51 years, with a marked male predominance. The average follow-up is of 4 years. The most often noted revealing sign is unilateral nasal obstruction. A history of polypectomy and nasosinual surgery is found in 45% of the cases in our series. The treatment was surgical in all cases, including 4 De Lima's procedures, 11 procedures through a paralateronasal approach, 2 ethmoidectomies through an endonasal approach, and 1 degloving for a septal lesion. Endonasal surgery was performed for two limited tumors, for which the diagnosis of inverted papilloma never could be made preoperatively. The recurrence rate observed in our series is 5%. Out of 18 patients, 4 presented with a malignant change, either at once (2 cases) or some time after the primary exeresis of the inverted papilloma (2 cases). In the light of the results, and after analyzing the literature, the authors reassert the necessity of radical exeresis for inverted papilloma. Rhinosinual endoscopy must remain a diagnostic means and never is an indication of exeresis of inverted papilloma. The authors emphasize the difficulty of the histological diagnosis and set forth the various problems arising from the malignant degeneration of inverted papillomas. Recent discoveries on viral etiopathogenesis and on the oncogenic potential of the type-16 papilloma virus may allow characterizing the evolutive and prognostic features of inverted papillomas in the future.

Factors related to the electric taste threshold in type 1 diabetic patients.

To specify the factors related to taste function in Type 1 diabetes mellitus, 50 diabetic out-patients and 50 control subjects paired for age and sex were screened for taste disorders. None of them consumed significant amounts of alcohol, smoked, or had disease or took drugs capable of altering taste. Taste was studied with electrogustometry, retinopathy was detected by fluorescein angiography, nephropathy by measurement of albuminuria and microalbuminuria, peripheral neuropathy by electroneurography and electromyography, and autonomic neuropathy by cardiovascular function tests. The electrogustometric threshold was, on average, significantly higher in the diabetic group (133 +/- 30 microA) than in the control group (29 +/- 9 microA; p less than 0.001). Electric hypogeusia (electrogustometric threshold greater than 100 microA) was found among 54% of the diabetic patients vs 2% of the control subjects (p less than 0.001). In the diabetic group, the electrogustometric threshold was associated with complications of diabetes, especially with peripheral neuropathy (210 +/- 24 vs 90 +/- 22 microA; p less than 0.001) and microalbuminuria (185 +/- 25 vs 86 +/- 21 microA; p less than 0.01). It was correlated with age (r = 0.37; p less than 0.01) and duration of diabetes (r = 0.52; p less than 0.001) but not with HbA1c (r = -0.04). Using multivariate analysis, duration of diabetes and peripheral neuropathy had the strongest association with taste impairment. These results support previous findings, suggesting that taste impairment is a degenerative complication of diabetes mellitus.

Taste impairment and related factors in type I diabetes mellitus.

To study taste in type I (insulin-dependent) diabetes mellitus, 57 consecutive diabetic outpatients (mean +/- SE duration of diabetes 11.4 +/- 0.4 yr) and 38 control subjects were screened for taste disorders with electrogustometry and chemical gustometry. Both groups were comparable for all subject characteristics except body mass index, which was higher in the diabetic group (P less than .05). A taste impairment was found in the diabetic group relative to the control group with electrogustometry (mean threshold 184.3 +/- 15.8 vs. 58.7 +/- 9.2 microA; P less than .001) and chemical gustometry (mean score 13.2 +/- 0.7 vs. 17.1 +/- 0.8; P less than .001). Hypogeusia was found among 73% of the diabetic patients versus 16% of the control subjects (P less than .001). The four primary tastes were involved in taste impairment. With multivariate analysis, taste disorders were related to diabetic status and tobacco and alcohol consumption. In the diabetic group, taste impairment was significantly associated with complications and duration of disease. With multivariate analysis, peripheral neuropathy had the strongest association with taste disorders. These results suggest that taste is impaired during the course of type I diabetes mellitus and that taste impairment could be a complication of the disease. A mechanism of the neuropathic type could be involved.

[Taste disorders and associated factors in type 1 diabetes]. / Altération du goût et facteurs associés dans le diabète de type 1.

In order to study taste in type 1 diabetes (insulin-dependent), 57 consecutive diabetic patients (mean duration of diabetes +/- SEM = 11.4 +/- 0.4 years) and 38 control subjects underwent electrogustometry and chemical gustometry. The diabetic and control group were comparable with the exception of the ponderal index which was significantly higher in diabetics (p less than 0.05). A deterioration in taste appreciation was confirmed in the diabetic group compared to the control group on electrogustometry (mean threshold: 184.3 +/- 15.8 vs 58.7 +/- 9.2 mu A; p less than 0.001) and chemical gustometry (mean score: 13.2 +/- 0.7 vs 17.1 +/- 0.8; p less than 0.001). Electrical hypogueusia was found in 73% of the diabetics compared to 16% of controls (p less than 0.001). The 4 primary tastes were involved in the deterioration. Multivariate analysis associated the taste disorder with the diabetic status of the subjects, their alcohol and tobacco consumption. In the diabetic group the deterioration in taste was associated with the complications and duration of diabetes. On multivariate analysis peripheral neuropathy had the strongest association with taste disorders. These results suggest that deterioration in taste occurs during the progression of type 1 diabetes and that the taste disorder could be a degenerative complication of the disease. A neuropathic type mechanism could be involved.