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The main aim of the study was to determine whether the perception of synkinesis by patients with peripheral facial palsy (PFP) matched their clinician's severity assessment. Secondary objectives comprised: (1) to determine whether objective measurement of synkinesis matched the patient's perception; and (2) is to identify factors influencing patients' perceptions.This retrospective study took place from January to May 2020. Forty patients (8 per PFP grade, I-V/VI; 20 women, 20 men) filled out the Synkinesis Assessment Questionnaire (SAQ) and were assessed on the Sunnybrook Facial Grading System (SFGS). Photographs were analyzed on MEEI-Facegram software.Perceived synkinesis (total SAQ) matched objective grades (SFGS) (Z=2.89; P=0.004), especially for smiling (Z=3.84; P0.001) and lip protrusion (Z=3.79; P0.001). Synkinesis on lip protrusion was a more sensitive indicator of perceived synkinesis than synkinesis on smiling (Z=2.96; P=0.003). Duration (ρ=0.5137; P0.001) and grade of PFP (ChiPatient-reported outcome measures (PROMs) such as the SAQ are relevant for clinical evaluation.

Background Left ventricular (LV) remodeling is associated with elite athletics. This study aimed to assess the effects of recreational exercise on LV remodeling and mechanics in healthy adults. Methods A prospective cross-sectional study evaluated 38 healthy adult recreational exercise participants with a Bruce protocol treadmill exercise stress test, and 2D and speckle-tracking echocardiography. Fitness level was stratified by the achieved age- and sex-predicted metabolic equivalents (METS) as average/good (group A, N=20; METS=13.9) and high (group B, N=18; METS=18.2) groups. Results Mean age was 33 years, and 58% were female. Participants in Group B used more multi-modality (67 vs 20%; p=0.008) or running (50% vs 15%; p=0.04) exercise regimens, and had larger LV mass (66 vs 56 g/m2; p=0.05) and left atrial volume indices (28 vs 22 ml/m2; p=0.02), when compared with group A. However, all LV strain and torsion mechanics were similar between groups (Figure). Multivariate linear regression analysis revealed independent associations between global longitudinal strain (GLS) and transmitral E-wave (β=−0.57), maximum systolic blood pressure (β=0.32), and LV end-diastolic volume index (β=0.32) (model r=0.72; p Conclusion Recreational exercise and fitness are associated with healthy LV geometry and mechanics in adults. Early diastolic LV filling, LV chamber size, and peak exercise blood pressure are correlated with GLS. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Florida Heart Research Foundation

Although many more eyes of children with retinoblastoma are salvaged now compared to just 10 years ago, the control of vitreous seeding remains a challenge. The introduction of intravitreal injection of melphalan has enabled more eyes to be salvaged safely but with definite retinal toxicity. Intensive treatment with high-dose intravitreal topotecan may be a strategy to control tumor burden because of its cell cycle-dependent cytotoxicity and the proven safety in humans. Therefore, we evaluated the ocular and systemic safety of repeated high-dose intravitreal injections of topotecan in rabbits. Systemic and ocular toxicity was assessed in non-tumor-bearing rabbits after four weekly injections of three doses of topotecan (10 μg, 25 μg, and 50 μg) or vehicle alone. Animals were evaluated weekly for general and ophthalmic clinical status. One week after the last injection, vitreous and plasma samples were collected for drug quantification and the enucleated eyes were subjected to histological assessment. Weight, hair loss, or changes in hematologic values were absent during the study period across all animal groups. Eyes injected with all topotecan doses or vehicle showed no signs of anterior segment inflammation, clinical or histologic evidence of damage to the retina, and ERG parameters remained unaltered throughout the study. Vitreous and plasma topotecan lactone concentrations were undetectable. Four weekly intravitreal injections of topotecan up to 50 μg in the animal model or a 100 μg human equivalent dose were not toxic for the rabbit eye. High doses of topotecan may show promising translation to the clinic for the management of difficult-to-treat retinoblastoma vitreous seeds.

Background Ventricular tachycardia (VT) and ventricular fibrillation (VF) remain a challenging problem in patients with implantable cardioverter-defibrillators (ICDs). Objectives This study aimed to determine whether ranolazine administration decreases the likelihood of VT, VF, or death in patients with an ICD. Methods This was double-blind, placebo-controlled clinical trial in which high-risk ICD patients with ischemic or nonischemic cardiomyopathy were randomized to 1,000 mg ranolazine twice a day or placebo. The primary endpoint was VT or VF requiring appropriate ICD therapy or death, whichever occurred first. Pre-specified secondary endpoints included ICD shock for VT, VF, or death and recurrent VT or VF requiring ICD therapy. Results Among 1,012 ICD patients (510 randomized to ranolazine and 502 to placebo) the mean age was 64 ± 10 years and 18% were women. During 28 ± 16 months of follow-up there were 372 (37%) patients with primary endpoint, 270 (27%) patients with VT or VF, and 148 (15%) deaths. The blinded study drug was discontinued in 199 (39.6%) patients receiving placebo and in 253 (49.6%) patients receiving ranolazine (p = 0.001). The hazard ratio for ranolazine versus placebo was 0.84 (95% confidence interval: 0.67 to 1.05; p = 0.117) for VT, VF, or death. In a pre-specified secondary analysis, patients randomized to ranolazine had a marginally significant lower risk of ICD therapies for recurrent VT or VF (hazard ratio: 0.70; 95% confidence interval: 0.51 to 0.96; p = 0.028). There were no other significant treatment effects in other pre-specified secondary analyses, which included individual components of the primary endpoint, inappropriate shocks, cardiac hospitalizations, and quality of life. Conclusions In high-risk ICD patients, treatment with ranolazine did not significantly reduce the incidence of the first VT or VF, or death. However, the study was underpowered to detect a difference in the primary endpoint. In prespecified secondary endpoint analyses, ranolazine administration was associated with a significant reduction in recurrent VT or VF requiring ICD therapy without evidence for increased mortality. (Ranolazine Implantable Cardioverter-Defibrillator Trial [RAID]; NCT01215253)

Aggressive contests between animals are common but rarely result in death because the benefits of winning a fight rarely exceed the cost of losing. Lethal combat can evolve, however, when the contested resource translates to much of the future reproductive success of each combatant. Female agaonid fig wasps pollinate and lay their eggs in the flowers within the enclosed inflorescences (“figs”) of fig trees (Ficus spp.). Wasps rarely leave the first fig entered so the reproductive success of each “foundress” usually depends on the availability of flowers within a single fig. We report for the first time lethal combat between female agaonids, in the undescribed Pegoscapus sp. that pollinates Ficus citrifolia in southeastern Brazil. In staged dyadic contests, wasps showed no aggression outside or inside the fig until one foundress oviposited. The first wasp to oviposit then became aggressive, which usually resulted in the death of its competitor. Examination of dead foundresses in naturally occurring figs showed that injuring competitors, particularly through decapitation, was effective at reducing their oviposition rates. In a Panamanian F. citrifolia population, pollinated by another wasp species, Pegoscapus tonduzi , there was little aggression between foundresses in similar contests. We suggest that reduced aggression in P. tonduzi reflects less competition for resources essential for successful reproduction due to on average fewer foundresses per flower in Panama.

Objectives The French ENT Society (SFORL) created a workgroup to draw up guidelines for the management of immunodeficient patients with head and neck cancer of cutaneous origin. The present guidelines cover diagnostic and therapeutic management and prevention of head and neck cancer of cutaneous origin in immunodeficient patients, and in particular in transplant patients and those with HIV infection. Materials and methods The present guidelines were based on a critical multidisciplinary reading of the literature. Immunosuppression and its varieties are defined. The usual risk factors for skin cancer and those specific to immunodeficiency are presented. The prevention, assessment and management of cutaneous carcinoma, melanoma, Kaposi's sarcoma and lymphoma are dealt with. The level of evidence of the source studies was assessed so as to grade the various guidelines. When need be, expert opinions are put forward. Results Immunodeficient patients are at higher risk of head and neck skin tumors. The level of risk depends on the type of deficiency; there is an especially high risk of squamous cell carcinoma in transplant patients and of Kaposi's sarcoma in HIV-positive subjects. Various viruses are associated with skin cancers. Skin tumors are often evolutive in case of immunodeficiency, requiring rapid treatment. Management is generally the same as in immunocompetent subjects and should be discussed in a multidisciplinary team meeting. Immunosuppression may need to be modulated. In organ transplant patients, the only class of immunosuppressants with proven antitumoral efficacy are mTOR inhibitors, particularly in cutaneous squamous cell carcinoma. The rhythm of clinical surveillance should be adapted according to the risk of recurrence. Preventive measures should be undertaken. Conclusion Skin cancers in immunodeficiency are highly evolutive, requiring the earliest possible treatment. Immunosuppression may need modulating. As the risk of recurrence may be elevated, careful surveillance should be implemented. Preventive measures should also be undertaken.

Resume Objectifs La Societe francaise d’otorhinolaryngologie (SFORL) a organise un groupe de travail charge de la redaction de recommandations pour la prise en charge des patients immunodeprimes atteints de tumeurs de la tete et du cou de point de depart cutane. Ces recommandations abordent la prise en charge diagnostique et therapeutique ainsi que les mesures de prevention des tumeurs de la tete et du cou a point de depart cutane survenant chez les immunodeprimes, en particulier les transplantes et les patients infectes par le VIH. Materiels et methodes L’elaboration de ces recommandations repose sur une lecture critique multidisciplinaire de la litterature. L’immunosuppression et les differents types d’immunosuppression ont ete definis. Les facteurs de risque habituels des tumeurs cutanees et ceux specifiques a l’immunodeprime sont presentes. La prevention, le bilan et la prise en charge des carcinomes cutanes, du melanome, de la maladie de Kaposi et des lymphomes sont traites. Le niveau de preuve des etudes a ete estime, permettant de grader le niveau des recommandations. Le cas echeant, des avis d’experts ont ete proposes. Resultats Les immunodeprimes ont un risque accru de developper des tumeurs cutanees de l’extremite cervico-cephalique. Le risque de developper ces tumeurs varie en fonction du type d’immunosuppression ; il existe un risque particulierement eleve de carcinomes epidermoides chez les transplantes et de maladie de Kaposi chez les patients seropositifs pour le VIH. Differents virus sont associes a ces cancers cutanes. Les tumeurs cutanees de l’immunodeprime sont souvent caracterisees par leur evolutivite justifiant une prise en charge therapeutique rapide. La prise en charge specifique, en general similaire a celle du sujet immunocompetent, doit etre discutee en RCP. La modulation de l’immunosuppression doit etre envisagee. Chez le transplante d’organe, la seule classe d’immunosuppresseurs ayant un effet anti-tumoral documente est celle des inhibiteurs de mTOR en particulier pour les carcinomes epidermoides cutanes. La frequence de la surveillance clinique doit etre adaptee au risque de recidive. Des mesures de prevention doivent etre proposees. Conclusion Les tumeurs cutanees de l’immunodeprime sont souvent caracterisees par leur evolutivite justifiant une prise en charge therapeutique la plus precoce possible. Une modulation de l’immunosuppression doit etre discutee. En raison d’un risque souvent eleve de recidive, une surveillance attentive doit etre proposee. Les mesures de prevention doivent egalement etre respectees.

A patient who needs a surgery for facial rehabilitation must have a complete assessment. The etiology of the facial palsy must be clear. It is necessary to have a MRI of the facial nerve for the statement of the initial pathology or to search a lesion on the nerve. The facial palsy must be definite which is depending of the delay of the palsy and the etiology. An electromyography must be done. The choice of the procedure depends on the delay of the palsy, the site on the nerve, the associated diseases and the opinion of the patient after a good explanation.

Hypoglossofacial anastomosis is a classical surgical procedure for the treatment of facial paralysis when the trunk of the facial nerve cannot be repaired and its peripheral branches are normal.Between 2004 and 2015, 77 patients were able to benefit from an hypoglossofacial anastomosis. The etiology of the paralysis was mainly the surgery of vestibular schwannoma, tumors of the facial nerve and diseases of the brainstem. A specific and premature speech therapy remediation was realized for all patients in order to preserve the tongue function and to upgrade the facial motricity.Sixty-nine patients could be studied. The House Brackmann grading scale was used to appreciate the result. Thirty-one patients are grade III, 34 grade IV and in only one case the result is a grade V despite the anastomosis works. The main predictive factor for a good result is a small delay between the onset of the paralysis and the surgery for the rehabilitation. The specific physiotherapy upgrades the result with less side effects of the anastomosis.Hypoglossofacial anastomosis is a simple and reliable surgical procedure for rehabilitation of paralysed face. The quality of the result is linked with an early surgery and a specific physiotherapy.

Using powder X-Ray Diffraction and Perturbed-Angular-Correlation spectroscopy, the crystal structure and the hyperfine interaction at 181 Ta probe in Sr 0.75 Ba 0.25 HfO 3 have been studied. A tetragonal (I4/mcm) to cubic (Pm &3macr;m) phase transition was observed. A two-phase field region, where the tetragonal and cubic phases coexist, was found between 673 and 923 K. The spin precession curves were measured from room temperature up to 1373 K. A static, asymmetric and disordered electric field gradient model was used to fit these time spectra. The hyperfine parameters corresponding to the tetragonal structure changed as the temperature increases: y T Q diminishes, m T is almost constant and i T diminishes. This interaction was observed to be unique up to 673 K. Above this temperature, a second interaction appeared and these two phases coexist up to 923K. Above this temperature, the hyperfine parameters corresponding to the cubic structure was only observed. The tetragonal to cubic transformation is char...

Share our experience and our results of lengthening temporalis myoplasty (LTM) for facial palsy reanimation after parotid surgery.Study of 15 patients after they had had a lengthening temporalis myoplasty, in the same time or after a non conservative parotidectomy of facial nerve. 10 patients suffered from a parotid malignant tumor, one had a jugal epidermoid skin carcinoma invading the parotid, 2 patients had a facial palsy after removal of pleomorphic adenoma recurrence and two patients had a facial nerve schwannoma. 8 patients had a LTM surgery in the same time of the parotid tumoral removal.No recurrence was observed on the 11 patients who had a carcinoma (average follow up: 27 months). The LTM surgery enabled us to obtain good results at rest for 14 patients (93%) and an intermediate result for one person. The ability to smile was described as good for 10 patients (66.6%), intermediate for 4 of them (26.6%) and unsatisfying for 1 person (6,6%). In the group rehabilitation, the results observed are similar, for the patients who had one or two surgical steps. In 3 cases, we noticed an infectious complication, which led us to operate again. In the 8 cases within lengthening was performed in the same time as parotidectomy, there was no additionnal surgical difficulty.LTM surgery is an efficient method of rehabilitation. If possible, it should be performed in the same time as tumor removal. As the operational places are different, tumor checking-up and observation are not disturbed by this kind of rehabilitation.

The facial palsy cause serious consequences for patients. Studies have also shown that in these patients, the inability to produce an appropriate and spontaneous smile would be a key factor of depression. When facial palsy is considered complete and the nerve cannot be repaired, the patient can benefit from palliative surgery to regain a better quality of life in the aesthetic, functional, and psychological aspects. The hypoglossal-facial anastomosis (AHF), temporal myoplasty (MAT) and gracilis transposition (TG) are the major surgeries currently used for this purpose. The aim of our study is to assess quantitatively and qualitatively the effects of each of these surgeries on the lip mobility and production of smile. From this perspective, we proposed a protocol of an evaluation of facial motricity, of quality of life, and more particularly on the quality and the analysis of the smile. The results underline that there is no significant difference in the recovery of the facial motricity according to the surgery. Only the slower, deferred deadline of recovery at the patients AHF and TG who have to wait several months, it is for the same levels as that of the patients' MAT. A premature and intensive rehabilitation such as the patients of our protocol benefited from it what is nevertheless essential to a good recovery whatever is the surgery.

The aim of study of prosody in facial palsy is to assess the intensity of pathology in suprasegmental viewpoint in order to establish a proper rehabilitation.Patients were recorded during a reading and spontaneous speech test and a prosodic observation of speech spectrogram provided by Praat software.The Accentual Groups lowering and significant dysprosodics elements (adverse effects and breaking balance) and a larger amount of disfluencies showed that the prosody of patients with facial palsy is altered because they need to swallow their saliva intentionally. Then, the decrease of Mean Length of Utterance (MLU) and the opinion of the jury highlight a decrease in desire to communicate and a loss of speech informativeness.In patients with severe facial palsy, there is an impact of swallowing disorder (caused by salivary stasis) on the prosody of speech, with variations in the position of intonations boundaries and the intensity of prosodic marking. This also creates impact on fluency and on the perception of the message by the listener.

We report the crystal structure together with the electric field gradient (EFG) tensor at the Hf site in Sr 0.5 Ba 0.5 HfO 3 as a function of temperature. High-temperature X-ray diffraction data show a second-order tetragonal-to-cubic phase transition at 700 K. The hyperfine interaction measured at 181 Ta probe corresponds to a static, asymmetric and disordered EFG. The hyperfine parameters V zz and η also display evident changes close to 673 K confirming the phase transition observed by XRD. The line width of the quadrupole interaction is relatively small compared with other perovskite-type compounds.

Retrospective study about the indications and the results of the end to-end hypoglossofacial anastomosis (AHF tt).Between 2004 and 2010, 38 patients were able to benefit from an AHF tt. It was about 13 men and 25 women. The mean age was of 40 years and the average deadline of coverage after facial paralysis was of 21.3 months. The etiology of the paralysis was in 47.7% of the cases a surgery for vestibular schwannoma and in 18% of the cases, of the facial nerve schwannoma. Besides the AHF tt, a golden weight was put to 6 of our patients. A specific and premature speech therapy remediation was realized at our all patient's.The beginning of recovery was spread out between 3 and 9 months. The final result was a grade III HB (37%) and IV HB (60%). Only a case of grade VHB was observed. The complications often reported by the AHF tt were very widely decreased by the specific reeducation.AHF tt is a particularly reliable technique, for rehabilitation of facial palsy, when the peripheral branches are intact and it, for the deadline 4-years-old subordinate except particular cases.

Rheological and sedimentation studies were used to determine floc structure in aqueous alumina suspensions in which the degree of flocculation was varied by modifying the pH of the suspensions. A slip-casting technique was developed to allow fabrication of alumina bodies with differential porosities by varying the degree of flocculation of the suspensions during the forming period. The porosity and density of the pre-sintered bodies were determined. The results show that the conditions of the starting suspensions influence the density of the bodies and that their variation during the slip-casting process enable samples to be fabricated with differential porosity.

Conformation of alumina bodies with differential porosities was carried out using a slip-casting technique. Preliminary results, showing the relationship between changes of rheological properties of the suspensions caused by pH variation and wall characteristics of the bodies, have been reported previously. The research was continued in order to establish the dependence of the structure of flow units in suspension on type and amount of deflocculants and its influence on the porosity of the walls obtained by slip casting. Rheometry, sedimentometry and electrophoresis were used to characterize the suspensions. Mercury porosimetry enabled the determination of porous structure. Results show a strong correlation between the properties of the suspensions and the characteristics of the presintered bodies and corroborate the possibility of fabrication of articles with differential porosities.

In this work we studied the tetragonal to cubic (t‐c) phase transition as function of temperature in compositionally homogeneous ZrO2‐CeO2 powders by synchrotron radiation X‐ray diffraction (SR‐XRD). Transitions are correlated with changes in the local order of the second coordination shell of Zr atom, studied by EXAFS.

Resume Parmi les nombreuses formes de neurofibromatose (NFM), deux sont actuellement bien caracterisees: la NFM1 ou maladie de Von Recklinghausen ou NFM peripherique, et la NFM 2 ou NFM centrale. La NFM 2 , dont notre patient presentait une forme typique, est definie par l'existence soit d'un neurinome bilateral de l'acoustique, soit l'association d'un neurinome unilateral de l'acoustique, de tumeurs du systeme nerveux central (neurinome, gliome, schwannome, meningiome) et d'antecedents familiaux de NFM 2 . il s'agit d'une maladie rare, liee a la perte d'un gene situe sur le bras long du chromosome 22. Elle s'oppose a la NFM 1 ou maladie de Von Recklinghausen, beaucoup plus frequente, liee a une anomalie situee sur le chromosome 17. Au cours de la NFM 2 , les signes cliniques apparaissent le plus souvent dans la deuxieme decennie, comportant une hypoacousie et plus rarement une baisse de l'acuite visuelle. La symptomatologie se complete en fonction des diverses localisations tumorales. Les neurinomes bilateraux de l'acoustique sont histologiquement des schwannomes, developpes dans la partie vestibulaire du nerf (« schwannomes vestibulaires ). La demarche diagnostique comprend un examen cutane soigneux a la recherche de tâches cafe au lait ou de neurofibromes cutanes, un examen oto-rhino-laryngologique pour depister une atteinte du VIII et un examen ophtalmologique pour depister une cataracte sous capsulaire et eliminer un nodule de Lish. L'imagerie par resonnance magnetique nucleaire est actuellement la plus performante pour rechercher un neurinome de l'acoustique ou d'autres tumeurs intracraniennes. Le diagnostic porte chez un patient impose un depistage systematique dans la fratrie et la descendance, meme chez les sujets asymptomatiques. Les patients qui sont pour la plupart, en âge de procreer, doivent connaitre le risque de transmission de 50 %, quelque soit le sexe de l'enfant. Dans un avenir proche, la localisation precise de l'anomalie chromosomique devrait permettre un diagnostic ante-natal.

To discuss about management of facial paralysis reccurence and to highlight the ENT's important role in the diagnosis of systemic diseases.This article presents a case report about a controlateral facial palsy recurrence, two months later in a fifty-two year's old woman. This cranial nerves involvement was due to non-Hodgkin lymphoma with neuro-meningeal spreading. The first palsy had completely recovered with steroids. The early recurrence of the palsy and the lymph nodes areas exam lead to the diagnosis. The patient was treated by chemotherapy with good neuromeningeal diffusion. The facial score rapidly improved, according to facial electromyography results.Specific biological and radiological explorations are usually carried out in recurrent facial palsy. Complete clinical examination and cerebrospinal fluid study are useful in this case. Moreover it should be preferable to do these explorations before steroid therapy. A diffuse meningeal enhancement on the MRI can complete sometimes clinical and biological data.Cranial nerves involvement is sometimes one of the first symptoms of neuro-meningeal lymphoma. Facial palsy reccurence has to conduce ENT pratician to do more specific explorations, of which CSF analysis is required.

Hypoglossal-facial anastomosis (HFA) is a cross-over between the proximal stump of the hypoglossal nerve (XII) and the distal one of the facial nerve (VII). The hypoglossal axons regrow within the sheaths of facial fibres, allowing the progressive reinnervation of the facial muscles. This model is interesting to study some mechanisms of plasticity of the nervous system for several reasons: 1) It is a quite simple and reproducible model of pathophysiological state. It allows the study of 2) the modifications of the nervous system induced by the HFA, both upwards and downwards to the lesion and 3) the modifications of reflex activities involving intrapontine connections such as the blink reflex. The electrophysiological features of the trigemino-facial (TF) and trigemino-hypoglossal (TG) connections demonstrated that a central reorganisation of the blink reflex (BR) was induced by HFA: the afferent volleys of the TF and TH reflexes elicited by cutaneous and mucosal trigeminal afferents respectively have been shown to project onto common interneurones located within the trigeminal principal sensory nucleus. A long-term prospective study showed: 1) a reinnervation of the facial muscles by the hypoglossal axons is a necessary perequisite for the central reorganisation of BR, 2) a hyperinnervation of the facial muscles by the hypoglossal axons, 3) a transient and regressive cross-innervation of paralyzed face by the healthy contralateral facial nerve.

The authors report a case of an open mallet injury with a traumatic arthrotomy which was complicated with a destructive infection involving both the middle and distal phalanges of a ring digit and which was treated with two-stage reconstructive surgery with good results. In the first stage, after the osteomyelitic portion of adjacent phalangeal bones were excised en bloc, the dead space was filled by means of an antibiotic-impregnated cement spacer. In the second stage, an autogenous corticocancellous bone graft from the iliac crest was secured into the defect with a intramedullary Herbert scaphoid screw.

Speech disorders were often allotted to hypoglossal-facial anastomosis (HFA) without being clearly shown. We have compared patients with a peripheral facial paralysis at those with HFA.Retrospective study comparing verbal communication (articulation) and non-verbal within two groups of patients: patients with patient FP versus with HFA.10 patients with idiopathic FP versus 7 patients with HFA took part in this study. The series of tests includes an evaluation of the motor possibilities, bilabial pressure measurement (for the patients with FP), speech capacities and finally an evaluation of the verbal and non-verbal communication from a scale of satisfaction.The results highlight: the presence of real speech disorders (permanent) among patients with FP and their absence among patients having profited from HFA; a real satisfaction of the HFA versus FP on the quality of life compared to daily tasks, more specifically concerning verbal and food skills.The HFA is not responsible for speech disorders, and makes undeniable improvements confirmed subsequently by the patients.

Ollier's disease is a constitutional pathology of unknown etiology. It is characterized by bone dysplasia generating numerous enchondromas. The malignant degeneration of this dysplasia is well known. The aim of this article is to study the diagnostic, therapeutic and prognostic characteristics of these lesions.We report a case of parapharyngeal chondrosarcoma extended to the base of the skull in a patient with Ollier's disease. The treatment was a surgical removal by a cervicotransoral incision combined with a preauricular incision and with a mastoidectomy. It was therefore possible to control the skull base, the parapharyngeal space, the infratemporal fossa and the major neurovascular structures. The removal of the lesion was completed at the level of the clivus and sphenoid with optics (30 and 70 degrees ). We discuss this treatment and the follow up on the bases of literature data.The neoplastic degeneration of enchondromas is estimated between 25 to 50% of cases. The most frequent location is the pelvic bones. Chondrosarcomas are slow growing tumors and their metastatic potential is less significant as we note it in our case report. Their diagnostic is essentially based on histological criteria's and their treatment is surgical.Chondrosarcomas of the ENT area occurring with Ollier's disease is rare. Their prognostic is good if the surgical treatment is well done.

An open therapeutic trial was conducted in patients with Bell's palsy. Results were compared with data in the literature.Between 1997 and 2000, 76 patients with Bell's palsy were treated with intravenous methylprednisolone (2 mg/kg/day) and acyclovir (5-10 mg/kg/8 hours) for 7 days. Treatment was initiated in all patients before the 14th day of illness. Severity of the palsy was scored on the first day of treatment and again one year later using the House and Brackman scale.Grade II or III palsy were observed in 38% of the patients at initial presentation, grades IV to VI in 62%. After treatment, 92% of the patients had reverted to grades I and II (good outcome) and only 8% had sequelae at 1-year follow-up. All patients with initial grade I or II recovered completely. For patients with grade IV, V, or VI complete recovery at 1 year was observed in 94, 86 and 50% respectively.Data in the literature suggest that corticosteroids should improve recovery in Bell's plasy. In our study, adjunction of acyclovir did not demonstrate any clear improvement in the cure rate. Benefit could depend on early prescription.

A new experimental therapy for squamous carcinoma was tested by sensitizing human tumor cells with light-sensitive anticancer drugs followed by laser illumination at visible or infrared wavelengths. The anthrapyrazole DUP-941 and the isoquinoline derivative DUP-840 were compared with the dianthraquinone hypericin. P3 human squamous carcinoma cells were incubated for 2 h with the drugs at escalating doses ranging from 5 to 100 micrograms/ml, then exposed to visible green 532-nm or infrared 1064-nm light at 300 J output from a KTP/Nd:YAG laser. Tumor cell toxicity measured by in vitro MTT viability assays was minimal after DUP-840 uptake but was slightly enhanced by infrared laser emissions. By contrast, the strong tumoricidal effects seen after DUP-941 uptake were amplified over 10-fold by 532-nm light and up to 2-fold by 1064-nm light. Hypericin-sensitized tumor cells were killed after 532 nm irradiation even at the lowest drug dose but were not affected by 1064-nm illumination. The results suggest that laser chemotherapy with drugs sensitive to photothermal energy could become a useful new treatment modality for cancer.

To study the long term effects of monthly intravenous cyclophosphamide therapy in Wegener's granulomatosis.Fourteen consecutive patients with active Wegener's granulomatos treated with a first-line combination of high-dose prednisone and monthly intravenous pulse cyclophosphamide were retrospectively studied.One patient died from septicemia complicating severe leukopenia after the first pulse. At 8 months after instituting intravenous pulse cyclophosphamide therapy, failure was observed in 6 other patients. Between month 16 and 18, 2 other patients relapsed when the time between 2 pulses was lengthened. Five patients developed cyclophosphamide-related side-effects: infection (n = 2), amenorrhea (n = 1), alopecia (n = 2) and vomiting (n = 2). Except for one fatal infection, no major side-effect of intravenous cyclophosphamide therapy was observed. At the end of the study, all patients were off intravenous cyclophosphamide therapy with more than 6 months of followup. The 6 responders were in remission on low-dose prednisone or without treatment.A combination of high-dose prednisone and intravenous cyclophosphamide may achieve long-term remission in 42% of patients with Wegener's granulomatosis. Responders to intravenous cyclophosphamide therapy had less extensive disease than non-responders.

An increased interest has developed in active fixation leads for several reasons. Exit block is an uncommon complication that is seen with both active and passive fixation leads. Exit block has not been a significant problem with passive fixation steroid-eluting leads and has been treated with these leads. A new steroid-eluting active fixation lead was examined for its performance in patients in whom exit block had previously occurred. The lead function was evaluated prospectively in 24 patients with a history of exit block (15 ventricular and 9 atrial). The results in patients with atrial exit block are encouraging with an average chronic stimulation threshold of 0.19 msecs at 2.5 volts. Results in the ventricle are less encouraging with 3 occurrences of recurrent exit block in 15 patients; however, the remaining patients had a good mean threshold of 0.21 +/- 0.11 msecs at 2.5 volts. There were a remarkable number of non-lead related complications suggesting that this is a substantially different group than routine implantations.

The incidence of infectious maxillary sinusitis (IMS) and its clinical relevance was prospectively studied in 162 consecutive critically ill patients who were mechanically ventilated for a period longer than 7 d. All had a paranasal computed tomographic (CT) scan within 48 h of admission and were divided into three groups according to the radiologic aspect of their maxillary sinuses: Group 1 = normal maxillary sinuses (n = 40), Group 2 = maxillary mucosal thickening (n = 26), Group 3 = radiologic maxillary sinusitis (RMS) defined as the presence of an air fluid level and/or opacification of maxillary sinuses (n = 96). Group 1 patients were randomized between nasal and oral endotracheal intubation with a gastric intubation performed via the same route and had a second paranasal CT scan 7 d later. Endotracheal and gastric tubes were left in their original position in Group 2 patients and a second paranasal CT scan was performed 7 d later. All patients of Group 3 underwent a transnasal puncture for bacteriologic analysis of maxillary sinus content. Forty-five spontaneously breathing patients served as a control group. In all patients with RMS, the occurrence of bronchopneumonia (BPN) was prospectively assessed for 7 d following the initial CT scan. Upon inclusion, only 25% of the patients had normal maxillary sinuses whereas all patients in the control group had normal paranasal CT scans. After 7 d, 46% of Group 2 patients had evidence of RMS. Risk factors for RMS were nasal placement and duration of endotracheal and gastric intubation.(ABSTRACT TRUNCATED AT 250 WORDS)

An unusual case of clear cell sarcoma (CCS) found in the parotid region of a 75-year-old man with a long history of chronic lymphoid leukemia is reported. Treatment of the patient included a total parotidectomy with preservation of the facial nerve. The tumor was pathologically consistent with a clear cell sarcoma. Since CCS originates from the neural crest and is melanin producing, we suggest that this particular tumor originated from the superficial musculo-aponeurotic system (SMAS). To our knowledge, this is the first case of CCS that has been reported in the parotid region.

It has recently been shown that the rare and ominous disease called « lethal midline granuloma » was in fact a true malignant lymphoma in most cases [1]. This disease represents a formidable challenge for the clinician: he has first to reach the diagnosis by the exclusion of dozens of other diseases capable of destroying the center of the face; then he must select a curative treatment together with supportive measures including nutrition therapy in those cachectic patients; and he must manage severe sepsis problems arising from the ulcerated face. We present here our 10-year experience of those ulcerative lymphomas of the midface (ULM).