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The aim of this study was to evaluate long-term efficacy and tolerance of nasal mask ventilation (NMV) in a comparative case-control study. Fourteen patients with diffuse bronchiectasis and severe chronic respiratory failure (CRF), treated by long-term oxygen-therapy (LTO) and NMV, were case matched with 14 patients with diffuse bronchiectasis and severe CRF treated with only LTO. Patients and control subjects were compared based on the following parameters: blood gases, FEV1, vital capacity, hospitalizations, and survival. Symptoms, Kamofsky function score, and clinical evolution were also monitored in patients. Three subgroups may be identified according to outcome: two early deaths (subgroup 1), six patients with initial improvement and subsequent deterioration (subgroup 2), and six patients whose conditions remained improved for >2 years (subgroup 3). PaO2 decrease slope was slighter in this last subgroup than subgroup 2. The days of hospitalization were significantly reduced after institution of NMV in the patient group. Comparison between patients and control subjects did not show any difference on PaO2evolution and on the overall median survival (46 and 40 months in NMV and control group, respectively). Long-term tolerance and compliance remained satisfactory for 11 patients. These results suggest that NMV is feasible as a long-term home treatment in patients with diffuse bronchiectasis. Although our results may have failed to prove a long-term efficiency on the course of blood gases and survival, a beneficial effect is observed with reduction of hospitalizations and improvement of functional status. This study warrants further investigation, in a prospective series, with a larger number of patients.

The Extreme Ultraviolet Imaging Telescope (EIT) on board the SOHO spacecraft has been operational since 2 January 1996. EIT observes the Sun over a 45 × 45 arc min field of view in four emission line groups: Fe IX, X, Fe XIIi, Fe xv, and He II. A post-launch determination of the instrument flatfield, the instrument scattering function, and the instrument aging were necessary for the reduction and analysis of the data. The observed structures and their evolution in each of the four EUV bandpasses are characteristic of the peak emission temperature of the line(s) chosen for that bandpass. Reports on the initial results of a variety of analysis projects demonstrate the range of investigations now underway: EIT provides new observations of the corona in the temperature range of 1 to 2 MK. Temperature studies of the large-scale coronal features extend previous coronagraph work with low-noise temperature maps. Temperatures of radial, extended, plume-like structures in both the polar coronal hole and in a low latitude decaying active region were found to be cooler than the surrounding material. Active region loops were investigated in detail and found to be isothermal for the low loops but hottest at the loop tops for the large loops.

The SOHO (SOlar and Heliospheric Observatory) satellite was launched on December 2nd 1995. After arriving at the Earth-Sun (L1) Lagrangian point on February 14th 1996, it began to continuously observe the Sun. As one of the instruments onboard SOHO, the EIT (Extreme ultraviolet Imaging Telescope) images the Sun's corona in 4 EUV wavelengths. The He II filter at 304 A images the chromosphere and the base of the transition region at a temperature of 5 − 8 × 104 K; the Fe IX–X filter at 171 A images the corona at a temperature of ∼ 1.3 × 106 K; the Fe XII filter at 195 A images the quiet corona outside coronal holes at a temperature of ∼ 1.6 × 106 K; and the Fe XV filter at 284 A images active regions with a temperature of ∼ 2.0 × 106 K. About 5000 images have been obtained up to the present. In this paper, we describe also some aspects of the telescope and the detector performance for application in the observations. Images and movies of all the wavelengths allow a look at different phenomena present in the Sun's corona, and in particular, magnetic field reconnection.

Objectif Les auteurs presentent un cas de carcinome epidermoide developpe sur un kyste du tractus thyreoglosse chez une adulte. Les modalites de prise en charge et la necessite d’une prevention sont discutees. Patient et methode Patiente de cinquante-cinq ans suivie pour un kyste du tractus thyreoglosse en raison d’un refus parental d’une chirurgie au cours de l’enfance. Resultats Le diagnostic a ete evoque sur une augmentation de volume et des douleurs cervicales. En raison d’un envahissement carotidien et de l’axe larynge, le traitement radiochirurgical n’a pas permis de guerison bien que l’evolution locale soit controlee par une chimiotherapie palliative avec deux ans de recul. Discussion L’exerese dans l’enfance des kystes du tractus thyreoglosse (KTT) est davantage pratiquee afin de prevenir des poussees infectieuses qu’une transformation maligne. Bien que faible, le risque de developpement d’un carcinome sur kyste du tractus thyreoglosse est certainement sous-evalue en raison d’une chirurgie d’exerese preventive tres souvent realisee dans l’enfance. Conclusion L’evolution dramatique du cas presente nous amene a recommander encore une fois une chirurgie d’exerese preventive de ce type de malformation, et a discuter les modalites de prise en charge de ce type d’evolution.

The total pressure in the middle ear depends on the air composition of this gas pocket, i.e. on gas exchanges occurring through either the Eustachian tube (ET) or mucosa. The aim of this study was to develop an experimental model to investigate the exclusive role of trans-mucosal gas exchanges in the middle ear (ME).Both tympanic membranes of 20 Sprague-Dawley rats were punctured under general anesthesia. Rats were divided into two equal groups. Group 1 had no ET obstruction. In Group 2, the ET was blocked, after velar incision, by cauterization and application of cyanoacrylate glue into the lumen. One open transparent glass tube containing a droplet of colored water was placed horizontally and connected hermetically to each ear canal. The ME was then flushed with room air through the tube. Variations in ME gas volume were measured by reading the displacement of the liquid droplet in the horizontal tube. The kinetics of variations in gas volume between groups were displayed and statistically compared using a two-sided t-test.The pattern of variations in ME gas volume with time was similar in the two groups. Both were characterized by a decrease with three phases and an elimination rate of approximately 0.152 +/- 0.026 microl/min. There was no significant difference in the mean rate of ME volume changes between the two groups.This experimental model allows investigation of trans-mucosal gas exchanges. These exchanges exhibit an absorptive function resulting in a negative pressure that must be compensated, under physiological conditions, by air flow through the ET.

We report the case of a 27 years-old man with a left colo-colic intussuception due to a lipoma. CT scan allowed diagnosis of the obstruction, of the intussuception and showed his cause as an intraluminal fatty mass in the left colic angle, typical of lipoma. Resection of the mass was performed and mature fat cells were identified microscopically.

A cross-sectional study involving 143 farrow-to-finish herds was carried out to identify herd-level noninfectious factors associated with pneumonia and pleuritis in slaughter pigs. Data related to herd characteristics, biosecurity, management and housing conditions were collected by questionnaire during a farm visit. Climatic conditions were measured over 20 h in the post-weaning and finishing rooms where the slaughter pigs were kept. After these on-farm investigations, the finishing pigs were examined at slaughter for lung lesions. A sample of 30 randomly selected pigs per herd was scored for pneumonia and pleuritis. Herds were grouped into three categories according to their pneumonia median score (class 1: ≤ 0.5; class 2: 0.5score ≤3.75; class 3:3.75). For pleuritis, a herd was deemed affected if at least one pig had a high pleuritis score (≥ 3). A multinomial logistic regression model was used to identify factors associated with pneumonia classes 2 and 3. A logistic regression for binary outcome was used to identify risk factors for severe pleuritis. An interval of less than four weeks between successive batches (OR=4.5, 95% confidence interval (95% CI): 1.5-13.6, p0.01), large finishing room size (OR=4.3, 95% CI: 1.6-11.6, p0.01) and high mean CO(2) concentration in the finishing room (OR=4.2, 95%CI: 1.6-11.3, p0.01), significantly increased the odds for a herd to be in class 2 for pneumonia. The same risk factors were found for class 3 and, in addition, a direct fresh air inlet from outside or from the corridor in the post-weaning room vs an appropriate ceiling above the pigs (OR=5.1, 95% CI: 1.4-18.8, p=0.01). The risk for a herd to have at least one pig with a high pleuritis score was increased when the farrowing facilities were not disinsected (OR=2.7, 95% CI: 1.2-5.8, p=0.01), when tail docking was performed later than 1.5 days after birth (OR=2.6, 95% CI: 1.2-5.7, p=0.01) and if the piglets were castrated when more than 14 days old (OR=2.7, 95%CI: 1.1-6.8, p=0.03). A temperature range of less than 5°C for the ventilation control rate in the farrowing room (OR=2.7, 95% CI: 1.2-5.9, p=0.01), a mean temperature in the finishing room below 23°C (OR=3.0, 95% CI: 1.3-6.8, p0.01) and large herd size (OR=3.1, 95% CI: 1.4-6.9, p0.01) were also associated with increased risk of pleuritis. The factors affecting pneumonia and pleuritis seemed to be different. All rearing steps from farrowing to finishing must be taken into account in any health programme aimed at controlling pneumonia and pleuritis and lung health may be improved through several pathways, i.e. correcting managerial and hygienic factors, implementing an appropriate and well-functioning ventilation in order to offer favorable climatic conditions.

In this study, 322 patients were evaluated with two aims: determination of identifiable factors at the time of admission to an ICU that predict short-term survival. Application of the SAPS to this population. Characteristics of patients were as follows: age, 65.5 ± 14.5 years; COLD, 45 percent; restrictive, 13.4 percent; obstructive and restrictive CRI, 13 percent; asthma progressing to CRI, 11.2 percent; diffuse bronchiectasis, 7.2 percent; neuromuscular diseases, 2.2 percent; others, 8 percent. Cachectic patients, those confined to home, those with initial coma or those who required MV had a higher percentage of M. The SAPS at admission was higher in those patients who died; however, there was no link between the SAPS and M. Prognostic factors in ARF complicating CRI and identifiable at the time of admission to an ICU are few and reflect severity of chronic respiratory disease; SAPS appears to be less useful in ARF complicating CRI.

We report on direct measurements of the electronic shot noise of a Quantum Point Contact (QPC) at frequencies ν in the range 4–8 GHz. The very small energy scale used ensures energy independent transmissions of the few transmitted electronic modes and their accurate knowledge. Both the thermal energy and the QPC drain‐source voltage Vds are comparable to the photon energy leading to the observation of the shot noise suppression when Vds

Otitis media with effusion are defined as the persistence of middle ear effusion for more than 3 weeks. If the diagnostic is easy, questions remain about pathogeny and treatment.Literature was reviewed regarding the pathogeny and the best treatment strategy.Except in the case of middle ear effusion due to trauma, effusion is an exudate due to mucous cell metaplasia. The main causal factor is middle ear inflammation, which is secondary to viral or bacterial infection. Inflammation causes dysfunction of the sodium transports in the middle ear. Responsibility of the otitis media with effusion in the genesis of the various chronic otitis media remains controversial. Treatment is justified when otitis media last more than 3 months, that is to say few months observation is required. The aim of treatment is to reduce local inflammation and to treat effusion. Prevention and treatment of local inflammation is difficult. Indeed, it is difficult to avoid rhinitis that is mainly viral. Effusion must be treated in order to avoid local middle ear deterioration and language deficiency. Insertion of tympanostomy tube is the only effective treatment. It decreases middle ear depression and Eustachian tube obstruction and restores the mucociliary clearance. Adenoidectomy and amygdalectomy are not effective in otitis media with effusion but, in association with tympanostomy tube, could decrease recurrence of acute otitis media.Otitis media with effusion remains a frequent disorder, for which the only effective treatment is the tympanostomy tube.

International audience; Determining when GPS gives false positioning due to Space Weatherconsequences has been one of the aims in a study done by Team Nina 2002 during the Alpbach Summer School. For that, TEC maps (Total Electron Contents of the Earth atmosphere at a certain position) must be derived because the precision is invert proportional to the number of particles along the line of sight for satellites. These maps are sensible to the fluctuations day/night but also particles injections coming from the solar corona via Coronal Mass Ejections (CMEs) or Coronal Holes (CHs). Also a 3D prevision of which structures could erupt toward the magnetosphere are needed for these aspects of Space Weather. We first present the SOHO mission and its European data base MEDOC at IAS. SOHO has 12 instruments including a EUV imageur EIT and 3 coronagraphs LASCO. Densities and temperatures can be measured by SOHO/EIT wavelength ratios and the spectroscopic CHIANTI code. SOHO/EIT has observed CMEs evolution in projection. If the CMEs are coming toward the Earth, magnetosphere perturbations can be observed.The understanding and the forecasting need 3D observations and interpretations of such structures. As the solar corona is optically thin, thus the intensity is deduced from the emission measure integrated along the line of sight. This integrationcreates uncertainties when we want to determine precisely structures morphology and geometrical parameters. Portier-Fozzani [4, 5] has shown that the classical stereo methods do not work directly. Tomography methods would be the most appropriate for optical thin material, but because of the low number of different viewangles, these methods cannot be applied easily. Meanwhile, by introducing constraints to stereographics methods such as the geometrical shape of the object (example: loops = circle, plumes = conics,...), it is possible to derive some geometricalparameters. Afterward, the physical coherence of this model purely observational is checked. Thus in Aschwanden et al. (APJ. 515–842 (1999)), we could measure from a more sophisticated method the geometrical parameters of loops. From the EIT image ratio, physical parameters of potential loops are determined. Considering thepossibilities of small deformations, Portier-Fozzani, Demoulin et al. (Sp. Sci. Rev. 97, 51–54 (2001)) took into account that the loops could be twisted. They measured that in an emerging active region, loops appear first twisted and detwist as they expand.This result, if we assume that magnetic helicity has to be conserved, gives important stability criteria in function of the size and the twist degrees for coronal loops. Then we describe the future observations that the STEREO/SECCHI Mission will made. It is two satellites separating themselves from 22.5◦ per year. That will improve stereovision reconstruction that is actually limited to the high temporal dynamic of structures as CMEs involved in Space Weather.

Double-slit electron interferometers, fabricated in high mobility two-dimensional electron gas (2GES), proved to be very powerful tools in studying coherent wave-like phenomena in mesoscopic systems [Yacobi 1994; Yacobi 1995; Schuster 1997; van der Viel 1997; Buks 1998; Ji 2000]. However, such interferometers have their disadvantages. They support multiple channels in each slit and consequently suffer from a small fringe visibility [Schuster 1997]. Their open geometry, required to eliminate multiple paths interference, allows only a small fraction of the injected current to be collected [Buttiker 1986; Schuster 1997; Buks 1998; Ji 2000]. Moreover, they do not function in a high magnetic field, which imposes a strong Lorentz force on the electrons and destroys the symmetry between the left and right slits. Hence, they are limited in their applications and cannot be employed, for example, in the quantum Hall effect (QHE) regime. We have fabricated and measured a novel, single channel, two-path electron interferometer, that functions in a high magnetic field. It is the first electronic analog of the well-known optical Mach-Zehnder (MZ) interferometer [Born 1999]. Based on a single edge state transport in the QHE regime, the interferometer collects all the injected electrons, hence having extremely high visibility (up to 62%) and high sensitivity to a small number of injected electrons. We find, unexpectedly that the interference pattern is extemely sensitive to the electron temperature or energy. By performing shot noise measurements of the interfering electrons we show that the observed loss of interference results from phase averaging among electrons and not due to incoherent scattering processes.

Surgery of invasive endo- and suprasellar pituitary macroadenomas remains difficult. The records of 13 consecutive patients who underwent transsphenoidal surgery were analyzed in order to evaluate advantages and limitations of endoscopy for surgery of invasive pituitary macroadenomas.A transseptal transsphenoidal intersepto-columellar approach was performed with a nasal 0-degree endoscope. Removal of the macroadenoma was performed under the control of a microscope. When the tumor seemed to be completely removed with microscope, a rigid 30-degree endoscope was inserted in the intrasellar and suprasellar regions in order to detect residual adenoma tissue. These residues were removed when technically possible.No rhinologic complication was noted. In 7 patients, the intra- and suprasellar endoscopic view detected a tumor residue which could be removed in each case. Two cases of cerebrospinal fluid leakage occurred during the complementary tumor resection. Two cases of diabetes insipidus and two of rhinorrhea were reported postoperatively. The analysis of the postoperative MRIs showed a complete removal in 23% of the patients (3/13), 75 to 100% removal in 54% of the patients (7/13), 50 to 75% removal in 8% of the patients (1/13) and 50% removal in 15% of the patients (2/13). More than 75% removal was thus achieved in 77% of the patients (10/13). The mean follow-up was 27.2 months.Rhinologic morbidity was reduced with the endoscopic endonasal approach. Endoscopy complemented with a microscope offered an optimal view of the intra- and suprasellar regions. Endoscopy also improved tumor resection of the invasive endo- and suprasellar pituitary macroadenomas by visualizing hidden suprasellar tumor residues. However, endoscopy was associated with a higher rate of postoperative rhinorrhea.

Von Hippel-Lindau (VHL) disease is a hereditary cancer syndrome that predisposes to the development of a panel of highly vascularized tumors including CNS and retinal hemangioblastomas, endolymphatic sac tumors, clear-cell renal cell carcinomas (RCC), pheochromocytomas and pancreatic neuroendocrine tumors. CNS hemangioblastomas and RCC are the two main life-threatening manifestations. The disease is caused by germline mutations in the VHL tumor-suppressor gene that plays a major role in regulating the oxygen-sensing pathway by targeting the hypoxia-inducible factor HIF for degradation in proteasome. Somatic inactivation of the VHL gene occurs also in most sporadic RCC and sporadic CNS hemangioblastomas. The demonstration of the critical role of VHL in angiogenesis is paving the way for the development of new specific drugs that could represent an attractive potential treatment for VHL but also for sporadic RCC and other cancers.

Background and purpose Compliance with continuous positive airway pressure (CPAP) treatment in obstructive sleep apnoea syndrome (OSAS) may be difficult. Patient education is important but strategies and their outcomes are not clear. Patients and methods We studied the effects of four education strategies on compliance and quality of life changes with CPAP treatment in seven centres in the French ANTADIR homecare network. Patients received from prescribers either a simple oral explanation (SP) or an oral and written explanation (RP) of CPAP use. In addition, they received from homecare technicians either a single home visit (SH) at CPAP onset or repeated home visits at CPAP onset and at 1 week, 1 month and 3 months after (RH). Compliance and quality of life were evaluated at CPAP onset, and at 3, 6 and 12 months after initiation of treatment. Results One hundred twelve patients with severe OSAS (mean age 58 ± 11 year, apnoea–hypopnoea index 58 ± 25/h) were allocated randomly to groups (SP + SH; SP + RH; RP + SH; RP + RH) with no initial differences. Quality of life, evaluated by the generic SF-36 questionnaire, improved in the combined emotional domains. Compliance was over 5 h in all four education groups. These effects were sustained over 12 months and were not different between the four groups. We conclude that standard education strategies for CPAP induction in France are sufficient for good compliance and improved quality of life with CPAP. Education with reinforced input should be focussed on identified subgroups prone to problems.

Conclusion As we demonstrated previously that transcription of alpha-ENaC was correlated with oxygen tension in the culture medium, this study suggests that the increase in alpha-ENaC expression observed under ALI conditions may result from greater oxygenation of ME cells. Objective The physiology of the middle ear (ME) is primarily concerned with keeping the cavities fluid-free, to allow transmission of sound vibrations from the eardrum to the inner ear. ME epithelial cells are thought to play a key role in this process as they actively absorb sodium and water in order to clear any excess fluid present in the cavities. Material and methods As an air-liquid interface (ALI) model has been shown to improve differentiation and enhance sodium absorption in other respiratory epithelia, we established an ALI model for ME cells. Results ME cells cultured under ALI conditions exhibited a fourfold increase in sodium absorption, which was not related to either a metabolic effect or to enhanced morphological differentiation, but instead to an increase in expression of the alpha-subunit of the epithelial sodium channel (alpha-ENaC).

To present a case of squamous cell carcinoma developed on a thyroglossal duct cyst in an adult patient. Modalities of treatment and prevention are discussed.A 55-year-old woman had a thyroglossal duct cyst since childhood. Surgical resection had not been performed because of parental refusal.Diagnosis of malignant degeneration was suggested by an increase in volume associated with cervical pain. Surgery was incomplete because of carotid artery and laryngeal involvement. Postoperative radiotherapy was given. At two years follow-up, local progression was controlled by palliative chemotherapy.For most authors, the risk of recurrent infections is the main reason for surgical resection of a thyroglossal duct cyst during childhood. The risk of malignant degeneration is generally not put forward. It is rather uncommon for carcinoma to develop on a thyroglossal duct cyst. The risk is probably underestimated because surgery is generally performed early in childhood.This observation of malignant degeneration emphasizes the importance of surgical resection of thyroglossal duct cysts during childhood. We discuss treatment in the event of malignant degeneration.

Postpartum ovarian vein thrombophlebitis (POVT) is an uncommon life-threatening situation. It should be systematically evoked in case of persistent fever during the postpartum. We describe here the imaging techniques to assert the diagnosis and the different therapeutic options.We report five cases from 1997 to 2002. Only one patient was surgically treated.No death was observed. In all cases, fever and pain rapidly disappeared.Search for postpartum ovarian vein thrombophlebitis should be undertaken in patients with persistent fever. Treatment is more often medical.

The paper deals with orthogonal space-time block coded MC-CDMA systems in outdoor realistic downlink scenarios with up to two transmit and receive antennas. Assuming no channel state information at the transmitter, we compare several linear single-user detection and spreading schemes, with or without channel coding, achieving a spectral efficiency of 1-2 bits/s/Hz. The different results obtained demonstrate that spatial diversity significantly improves the performance of MC-CDMA systems, and allows different chip-mapping without notably decreasing performance. Moreover, the global system exhibits a good trade-off between complexity at mobile stations and performance. Then, Alamouti's STBC MC-CDMA schemes derive full benefit from the frequency and spatial diversities and can be considered as a very realistic and promising candidate for the air interface downlink of the 4/sup th/ generation mobile radio systems.

Obstructive sleep apnea syndrome is a very common disease. Nasal continuous positive airway pressure is a useful and efficient treatment but compliance depends on several factors including the degree of nasal obstruction.The aim of this study was to evaluate the effects of surgical correction of nasal obstruction on compliance to nasal continuous positive airway pressure in obstructive sleep apnea syndrome.This retrospective study (from March 1998 to March 2000) included ten patients suffering from a severe obstructive sleep apnea syndrome (apnea-hypopnea index greater than 30 per hour) treated by nasal continuous positive airway pressure for at least three months and presenting an anatomic nasal obstruction limiting the use of nasal continuous positive airway pressure. Surgical procedures included one septoplasty, two inferior turbinectomies and seven septoplasties with turbinectomies.The post-operative polysomnography showed that surgical correction of nasal obstruction had no effect on obstructive sleep apnea syndrome severity (no significative change of apnea hypopnea index after surgery) but allowed the use of lower nasal continuous positive airway pressure levels (7.1 mmHg after surgery versus 10 mmHg before) and improved compliance to treatment (six compliant patients after surgery versus no compliant patient before). These results were compared with those published in the literature.An examination of the nose has to be performed before initiating nasal continuous positive airway pressure. If nasal continuous positive airway pressure cannot be tolerated because of nasal obstruction, surgery is required to improve compliance and tolerance to treatment.

Medical management of patients with obstructive sleep apnea syndrome (OSAS) implies a multidisciplinary organization. Dietary advice is always needed because the great majority of these patients are significantly overweight. Drinking alcoholic beverages before bedtime and smoking must be advised against. Re-learning good sleeping habits is also necessary for certain patients with a chronic disorder. In patients with a mild to moderate OSAS, or whose diagnostic tracing demonstrates position-related respiratory events, it may be useful to avoid dorsal decubitus when sleeping. Sedatives should of course be totally avoided. Drug treatment for OSAS has generally been disappointing, but new serotoninergic receptor antagonists offer new possibilities. Medical management of associated conditions such as hypothyroidism must also be an integral part of the long term treatment of OSAS. The gold standard treatment remains continuous nocturnal positive pressure ventilation with proven efficacy largely demonstrated in several controlled trials showing often spectacular response within days. Prescription is guided by the intensity of the clinical diurnal and nocturnal symptoms, better results being obtained in patients with a high index of respiratory events. For patients with mild to moderate disease (index30) or for patients with severe disease who do not tolerate positive pressure ventilation, surgery or a mandibular advancement device should be considered.

We report two cases of iliocaval occlusion caused by retroperitoneal fibrosis; one presented acute symptoms and one chronic. Both were treated by use of transluminal angioplasty and stenting with excellent clinical, hemodynamic, and imaging results at 36 and 51 months. These cases confirm the benefit of endovascular techniques in the treatment of nonmalignant obstructive disease of large veins, and specifically in the case of retroperitoneal fibrosis.

We report a case of Lemierre syndrome with extensive suppurative thrombophlebitis involving concomitantly the internal jugular, facial and anterior jugular veins. This case illustrates two unusual clinical and imaging features: the lack of characteristic neck symptoms at admission and a negative initial neck US exam. The value of postcontrast CT of the neck and chest for diagnosis of this potentially life-threatening syndrome is illustrated.

Background and aims: This study determined correlations of clinical and manometric features with those of anal endosonography (AES). Patients and methods: Between 1996 and 1999 we examined 58 patients suffering from anal incontinence (AI) by AES using a linear probe and anorectal manometry following a standardized protocol. Results: Twelve of the 58 patients (21%) had a history of anal surgery. Of the 40 women who had undergone at least one vaginal delivery 22 (55%) sustained an obstetric tear and 12 (30%) required forceps for delivery. A perineal descent was observed in 24 of 32 women with AI (75%) and urinary incontinence in 24 of 44 (54%). An anal sphincter defect was diagnosed in 45 of the 58 patients (77%). The internal anal sphincter defects occurring in 42 patients (72%) were significantly associated with a decrease in the resting anal pressure. The external anal sphincter defects occurring in 33 patients (57%) were significantly associated with a decrease in the voluntary anal contraction. Conclusion: Considering AES and manometric findings, a good correlation was observed between internal sphincter defect and the resting anal pressure and between external sphincter defects and the voluntary anal contraction. AI is usually associated with a global perineal insufficiency requiring special attention in terms of both training and medical management.

The aim of this study was to retrospectively assess during two periods (1991-1995 and 1996-2000) if MRI spreading had changed: (1) private ENT physicians screening habits; (2) the average tumor size at the time of diagnosis and the diagnostic delay of acoustic neuroma; and (3) the cost of acoustic neuroma diagnosis. In addition, the sensibility of each diagnostic test was calculated on 151 tumors. Our results show no significant change neither in the screening strategy (except a mild decrease in CT-scan utilization) nor in the tumor size, diagnostic delay or diagnostic cost between the two periods. Even if MRI is the gold standard for acoustic neuroma diagnosis, our 86%-sensibility of ABR, increased to 99% if combined with stapedial reflex and caloric test may still incline to use ABR in selected cases.

To review the diagnostic strategy of management of multiple trauma patient during the first hours.Extraction from Pubmed database of French and English articles on the management of multiple trauma patient published for ten years.The collected articles were reviewed and selected according to their quality and originality. The more recent data were selected.The first hours of management of multiple trauma patients are a particular challenge. The first dilemma is to drive the patient toward an adequate structure. In case of poor haemodynamic tolerance, the patient will be drive in the nearest hospital. When haemodynamic parameters are restored, multiple trauma patient has to be receive in a high level hospital by a trained medical team with an anesthesiologist, intensivist, neurosurgeon, general surgeon and radiologist. The initial assessment may have two priorities: quality and speed. The total body CT scan is actually the answer to these priorities.

We report the case of a 27 years-old man with a left colo-colic intussuception due to a lipoma. CT scan allowed diagnosis of the obstruction, of the intussuception and showed his cause as an intraluminal fatty mass in the left colic angle, typical of lipoma. Resection of the mass was performed and mature fat cells were identified microscopically.

The influence of age at the time of implantation of a stimulating electrode unilaterally in the inner ear on central auditory pathways was investigated in rats deafened shortly after birth. Immunoreactivity for Fos served as a functional marker of neuronal activity. Electrodes were implanted in the left cochlea of rats aged 3 weeks or 4 months. Stimulation lasted 45 minutes, then rats were sacrificed and tissues processed for immunocytochemistry. The younger animals showed significantly more neurons with Fos immunoreactivity bilaterally in the dorsal cochlear nuclei (DCN) and inferior colliculi (IC) than the older rats or control animals with normal hearing receiving the same stimulation. Activity was more prominent in the left DCN and right IC. The results show that electrical stimulation of the inner ear is more effective in younger animals in eliciting gene expression associated with development of a functional network in the auditory pathways. This suggests that deaf children should be provided with cochlear implants as early as possible. J. Comp. Neurol. 438:226–238, 2001. © 2001 Wiley-Liss, Inc.

The production of nitric oxide (NO) within the middle ear has not previously been characterized. The presence of NO synthase (NOS) transcripts was demonstrated using RNA amplification by reverse transcriptase-polymerase chain reaction in rat middle ear mucosa and in rat primary cultured middle ear epithelial cells. The expression of NOS was indirectly assessed by nitrite measurement in the supernatant of primary cultured cells. The effect of NO on ion transport was investigated in a previously described middle ear epithelial cell line using the short-circuit current (Isc) technique. NO per se had no effect on Isc. However, previous work has shown that sodium transport is stimulated by reactive oxygen species (ROS). NO blunted this stimulation, an inhibition probably related to the toxicity of peroxynitrite, ONOO-, a highly reactive compound. These results suggest that NO is produced by middle ear epithelial cells and that, in the presence of ROS, NO may be responsible for an inhibition of ion transport viaperoxynitrite formation.

Aneurysmal bone cysts are vascular lesions that destroy and expand bone. We report a recently treated case of an aneurysmal cyst of the sphenoid bone. A 14-year-old girl presented with frontal headaches, bouts of nausea, and vomiting. Computed tomography and magnetic resonance imaging showed typical features of an aneurysmal bone cyst. Arterial embolization was undertaken before surgery. The endoscopic transnasal procedure used allowed the complete removal of the aneurysmal bone cyst. This use of minimally invasive surgery makes this case of interest to surgeons of the skull base and sinuses.

We report a case with successful surgical separation of female omphalo-xiphopagus conjoined twins. Ultrasonographic examination at 20 weeks of gestation showed twins joined at the abdomen from the xiphoid process to the umbilicus. Conjoined structures included liver. Karyotype was normal. The parents refused interruption of the pregnancy. Plain films, US and MRI confirmed findings at prenatal ultrasound examination. There was no cross circulation into the livers and the gastrointestinal tract was not conjoined. In our observation, postnatal MRI did not offer additional information.

We are discussing methods of stereoscopic 3D reconstruction of coronal loops structures. In our most sophisticated method we fit loops observed with SOHO/EIT to a set of shape parameters including the internal twist of the loops field lines. We define this twist as the number of turns of the field line around a torus axis between the footpoints of the loops. Twist numbers of the order 0–2 are observed. We observe the emergence of an Active Region with twisted loops which detwist as they expand. The same correlation between detwisting and expansion is observed with filaments in relation to CME formations. On longer time scale, loops seem to accumulate twist, perhaps due to differential rotation. Rapid losses of twist temporarily correlate with flares. From our analysis, we expect that the internal twist of coronal structures will play an important role for the space weather forecast.

Many authors have recently reported hearing preservation for approximately two-thirds of acoustic neuroma patients. The results have driven them to recommend early surgery for all patients whose hearing might be saved. Inversely, other authors advocate that MRI-screening may be beneficial in some patients and suggest surgery only in case of tumor growth or progressive hearing loss. In order to facilitate therapeutic decision making, we reviewed the techniques and results in the main papers dealing with hearing preservation in the course of acoustic neuroma surgery published since 1990. This analysis showed that the average percentage of useful hearing preservation is about 31%. It is however difficult to compare the different series due to the different methodologies used. This emphasizes the need for standardization of hearing selection and reporting criteria to a) identify factors predictive of success (tumor characteristics, preoperative hearing, monitoring, surgical pathways), and b) elaborate well accepted decisional guidelines (early surgery or MRI screening), notably for small and non-symptomatic tumors which show increasing prevalence.

The diagnosis of renal pedicle rupture in children is difficult and often delayed. Ultrasound alone is insufficient in the assessment of all cases of renal contusion. This often leads to nephrectomy, due to the uncertain results of a late surgical revascularization procedure. A minimally invasive endovascular approach is therefore sometimes useful.1st case: a 6-year-old boy was admitted to the emergency department with contusion of the right flank caused by a road accident. The immediate test for haematuria was negative. Twenty-four hours after trauma, renal duplex ultrasound was performed due to the appearance of microscopic haematuria and it demonstrated trunkal thrombosis of the right renal artery, while the initial ultrasound was normal. 2nd case: a 15-year-old girl who jumped out of a window. 48 hours after the trauma, IVU was performed because of persistent microscopic haematuria and revealed a silent kidney, while the initial ultrasound was normal. Renal arteriography showed complete dissection of the right renal artery in both cases. Stenting was performed. The postoperative course was uneventful. In the first case, follow-up duplex ultrasound revealed a modification of the echostructure of the superior pole (absence of blood supply) while the lower pole had a normal interlobular blood supply. CT scan at the 2nd month confirmed normal excretion from the lower pole. In the first case, revascularization was satisfactory on the follow-up duplex ultrasound. After 20 months of follow-up, the kidney presented a normal functional and morphological appearance.The diagnosis of renal pedicle lesions remains difficult and is based on emergency CT angiography. Treatment by vascular stenting can be performed in children. In some cases of renal artery dissection, it can constitute an alternative to surgery. However, it raises the question of the medium- and long-term repercussions of renal artery stenosis on the child's growth.

CT has become a major tool in the management of multiple trauma. Concerning pelvic trauma, visceral and bone injuries can be detected. We review here the different pelvic injuries focusing on CT diagnostic approach.

We describe our experience in treating 7 patients who underwent skull base reconstruction with free flap (6 latissimus dorsi, 1 rectus abdominis) between October 1996 and November 1998. Four patients underwent temporal bone resection with auricular resection, 2 patients underwent anterior and middle cranial fossa resection, 1 patient underwent frontotemporal resection. There have been no failures of the free flaps and one cerebrospinal fluid leak. We advocate free flap reconstruction after temporal bone resection with auricular resection, and after anterior or middle cranial fossa resection when local flap options are not available or with complex dead space.

We report here a series of 118 patients (79% women) who developed dysomia after acute rhinitis. Mean age was 59 years. Mean follow-up after the initial rhinal episode was 36 months. The dominant olfactory disorder was anosmia (71% of the patients) and dysgeusia in 71%. The prognosis of anosmia was poor as it persisted in 50% of the patients. Six patients (5%) recovered normal olfaction after a delay of 11 months. Partial recovery was observed in 45% of the patients with a mean 14-month delay. Recovery of olfaction was thus observed within the first year. Parosmia was also frequent (59% of the patients). In two out of three cases, parosmia persisted. Improvement generally occurred during the first 18 months. These olfactory disorders have an impact on the patients' psychic equilibrim since a depressive syndrome was observed in 60% of the cases.