[Cancer arising in a cyst of the thyroglossal tract]. / Cancer sur kyste du tractus thyréoglosse.

Two new cases of thyroglossal cyst carcinoma are reported. Such cancers concern rather young women. The diagnosis must be suspected whenever a thyroglossal cyst is associated with cervical adenopathies. The most performing investigation seems to be fine-needle aspiration guided by echography. The malignant diagnosis is made during surgery by frozen section of the lesion, confirmed by histology. Two type of cancer must be distinguished: squamous cell carcinoma and carcinoma of thyroid type. The management of squamous cell carcinoma includes a large resection. For thyroid type carcinomas, total thyroidectomy and bilateral neck dissection are to be considered. Because of up-to-date insufficiency following, it is difficult to make a prognosis.

[Cholesterol granuloma of the middle ear. Apropos of 3 cases]. / Granulomes a cholestérol de l'oreille moyenne. A propos de 3 cas.

Cholesterol granulomas arise scarcely within the middle ear cavities revealed by a conductive deafness. They appear on the CT scan as a non specific mass developed in the middle ear cavities with bone defects. MRI allow the diagnosis as cholesterol granulomas is defined by hyperintensity on all sequences.

[Effects of mannitol on the fluids of the internal ear. Use in the treatment of deafness]. / Effets du mannitol sur les liquides de l'oreille interne. Application au traitement des surdités.

The action of mannitol upon the inner ear fluids was studied experimentally by means of kinetics of mannitol entry into cochlear perilymph and endolymph in rats. A daily two hours infusion of 10% mannitol induces an osmotic water flow from cochlear fluids toward plasma. Following this therapeutic protocol, progressive, non-tumoral sensorineural hearing loss is enhanced in 32% of the cases. The rate of hearing improvement is larger than 50% in case of Ménière's disease. For sudden hearing loss, 75% of the cases are improved by mannitol, and 92% of the cases when the delay between the hearing loss onset and the mannitol therapy is less than two weeks. Sudden hearing loss should be considered as a sensory emergency.

[Recent data on malignant melanoma of the upper respiratory and digestive tract mucosa. Apropos of a case]. / Données récentes sur les mélanomes malins des muqueuses aéro-digestives supérieures. A propos d'une obervation.

The choice of a therapeutic strategy for the treatment of mucosal malignant melanomas from upper digestive and respiratory tracts remains difficult. This is due to the very low frequency of such malignancies and to the subsequent scarcity of data on parameters of diagnosis and prognosis. Such informations have been available on cutaneous malignant melanoma as they have been known for a longtime and occur with much higher frequency. Parameters of diagnosis and prognosis have been determined from randomised clinical traits. Based on such parameters a more efficient therapeutic strategy can be applied to the various clinical cases. In this paper we review these parameters and in particular those which seem to apply to the mucosal malignant melanomas from upper digestive and respiratory tracts. Finally we report on currently used therapeutic protocols and we present recent data from the literature on adoptive immunotherapy of malignant melanomas in mice.

[Acquired facial paralysis in children. Our experience apropos of 72 cases]. / Les paralysies faciales acquises de l'enfant. Notre expérience à propos de 72 observations.

Results of therapy as a function of etiology are discussed in relation to 72 cases of acquired facial palsy in children. Spontaneous recovery occurred in 28 of the 33 cases with idiopathic facial palsy, this representing the most common form (46 p. cent of total) and appearing to have a still better prognosis than in adults. An infectious origin was determined in 19 cases (26 p. cent). Medical treatment produced complete recovery in 7 of the 8 cases with otitis, while simple mastoidectomy relieved 8 of the 11 patients with facial palsy due to mastoiditis. The indications for operative intervention should be widened in post-traumatic cases (14 in this series) with immediate onset of paralysis. Similarly, medical treatment of secondary paralysis should not delay surgery in cases with no regression after three weeks.

[Neonatal facial paralysis. Our experience apropos of 44 cases]. / Les paralysies faciales néonatales. Notre expérience à propos de 44 cas.

Forty-four cases of neonatal facial paralysis have been treated in the ENT department for children in the hôpital Trousseau, paris. In nearly half of the cases the etiology was related to nervous or muscular aplasia, while in the other cases of traumatic, infective, or doubtful etiology, the severity and course of the paralysis served as a guide to choice of therapy. Surgery was indicated in only 13 cases and recovery was obtained in 4 infants, with more or less marked sequelae. Prognosis is very poor in cases treated at a late stage, especially when the nerve appears to be greatly altered or compressed by callus. Surgical exploration should therefore be undertaken reasonably early (6 weeks to 2 months) when total paralysis persists or becomes worse after initial improvement.

[Periodic laryngeal dyspnea in bi-opercular syndrome]. / Dyspnée laryngée périodique au cours d'un syndrome bi-operculaire.

Periodic bouts of laryngeal dyspnea in a 77-year-old man were observed early in the course of a syndrome due to bilateral opercular infarcts. Laryngoscopy showed alternate slow opening and closure of the glottis superimposed on respiratory vocal cord movements. The disorder could result from bilateral removal of cortical control of bulbar centers, its periodicity suggesting analogies with Cheyne-Stokes' dyspnea.

[Therapeutic approach to laryngeal nerve paralysis]. / Approche thérapeutique des paralysies des dilatateurs.

The numerous surgical procedures proposed for the treatment of bilateral recurrent laryngeal nerve paralysis, since the operation first described by Rethi, are reviewed. Because of the principle involved and the simplicity of Loboryles operation it is the preferred method, and the technique employed is described in detail. Results have been satisfactory in a series of patients treated by this procedure and its further development is justified.

[Trans-tympanic aeration in mastoiditis. Study of 42 cases (author's transl)]. / L'aérateur transtympanique dans les mastoïdites.

The authors review the diagnostic protocol of mastoiditis based upon 382 cases with 1.3% errors (histological confirmation). Up to the present time, mastoidectomy was the only treatment which could be envisaged. In a new series of 90 cases, 48 constituted the control group and 42 the study group, trans-tympanic drains were inserted routinely in the latter. It was thus possible to avoid mastoidectomy in 62% of cases in the study group (evaluation based upon the number of ears). The period of postoperative observation was on average 8 months. No complications related to the drain were seen. Up to the present time, there exist no precise criteria which may be used to decide between insertion of a drain or mastoidectomy from the outset. Insertion of a drain must thus be considered as a therapeutic test, justified by its harmlessness and simplicity.

[Pathological manifestations of tonsillar hypertrophy (author's transl)]. / Les manifestations pathologiques de l'hypertrophie amygdalienne.

The authors describe the rare but essential indication for tonsillectomy in the child based upon 4 personal cases of pseudolaryngeal dyspnoea during sleep due to prolapse of the tonsils in the hypopharynx. They indicate the grave cerebral and cardiac consequences which could result from neglect of this symptom which at first sight has the characteristics of ordinary snoring. Paediatricians, anaesthetists and laryngologists are equally concerned by this alveolar hypoventilation of high obstructive origin.

[Eosinophilic granuloma of the ear. General review apropos of 2 case reports]. / Granulome ésoinophile de l'oreille. Revue générale à propos de deux observations.

The eosinophilic granuloma is part of the histiocytosis X classification, having a common histological substratum, the granuloma, which is characterized by a proliferation of histiocytes (reticulo-endothelial cells) and a cytoplasmic inclusion body (the X body) whose étiopathogenic significance is not yet established. These histiocytes are accompanied by other cells and in particular granulocytes, the majority of which are eosinophils. Histiocyte proliferation leads to a destruction of bone which is the organ preferentially affected. At first there is osteolysis (this explains the lacunar aspects seen radiologically) followed by sclerosis. The clinical classification established by Lichtenstein in 1953 outlines the tissue form (eosinophil granuloma), the acute disseminated form (Letterersive) and the chronic disseminated form (Hand-Schüller-Christian). This classification is still accepted today but it needs to be refined to include the transitionary forms, and solitary bone granulomas whose long terme evolutive nature it is impossible to measure clinically, biologically, or histologically. From our observation we note that therapy (surgery, radiotherapy, chemotherapy) is effective in controlling the acute growth spurts in a majority of the cases but does not seem to effect the potential long terme evolution.

[Does mastoiditis still exist? (author's transl)]. / Les mastoïdites existent-elles encore?

The authors report 382 cases of mastoidectomy verified by histological examination and draw certain conclusions: There were 5 errors in diagnosis, i.e. 1.3 per cent. Most cases were aged between 4 and 12 months. Below the age of two years it was usually bilateral, exceptionally so after the age of two years. Diagnosis was mainly clinical and based on the following axiom: "All infants with acute otitis who, in spite of proper medical treatment, have at the end of one month of a weight curve either stationary or falling, and eardrums not strictly normal, have mastoiditis". This therefore implies close and prolonged supervision by the same observer throughout the period antibiotic treatment and at least one week after stopping the latter. The treatment is still mastoidectomy and not antrotomy but one may hope with more accurate diagnosis that new methods of treatment may be developed to the extent where immediate and long term supervision of the child may be ensured.

[Assessment of a thirty year long experience in treatment of esophageal caustic stenosis (author's transl)]. / Bilan de 30 ans de traitement des rétrécissements cicatriciels de l'oesophage.

Among 457 esophageal stenosis treated between 1954 and 1977, 258 (56%) were caustic stenosis. The treatment of those is the most difficult. Functionnal healding was satisfactory in 93% of the treated cases by dilatations. Four strict rules ought to be observed in the management of this cases. Immediate and long terme antibiotic treatment of the corrosive esophagitis. X rays are the only means to be used during evolution of corrosive esophagitis. No instrumental performance until sufficient cicatrization. Retrograde dilatations after gastrostomy shall be prefered in serious cases. Gastro-esophageal reflux may complicate this evolution and require surgery. Total esophageal replacement can be averted in most cases.

[Facial paralysis in children]. / Paralysies faciales de l'enfant

Facial paralyses in children may be grouped under headings displaying a certain amount of individuality. Chronologically, first to be described are neonatal facial paralyses. These are common and are nearly always cured within a few days. Some of these cases are due to the mastoid being crushed at birth with or without the use of forceps. The intra-osseous pathway of the facial nerve is then affected throughout its length. However, a cure is often spontaneous. When this desirable development does not take place within three months, the nerve should be freed by decompressive surgery. The special anatomy of the facial nerve in the new-born baby makes this a delicate operation. Later, in all stages of acute otitis, acute mastoiditis or chronic otitis, facial paralysis can be seen. Treatment depends on the stage reached by the otitis: paracentesis, mastoidectomy, various scraping procedures, and, of course, antibiotherapy. The other causes of facial paralysis in children are very much less common: a frigore or viral, traumatic, occur ring in the course of acute poliomyelitis, shingles or tumours of the middle ear. To these must be added exceptional causes such as vitamin D intoxication, idiopathic hypercalcaemia and certain haemopathies.