[Clinical manifestations of spinal lesions in dysraphic malformations of the caudal neuropore in children]. Disorders in the development of the spine and the spinal cord in the caudal neuroporus region significantly contribute to the morbidity and the lasting invalidity of children. Clinical investigations of the malformations manifest through different forms of body abnormalities, ranging from asymptomatic forms of "spina bifida occultae" to the severe forms of open "meningomyelocele". The nature and the level often cannot be detected before the development of the structural changes in the course of growth and development of the child, which can hardly be treated later. At the Department of Child Surgery in Novi Sad 12 infants were surgically treated in the last 5 years, while 30 children were surgically and conservatively treated after the detection of the clinical and subclinical manifestations of dysraphism. The indications for the surgical treatment were open meningomyelocele as well as those subclinical forms indicating the development of the tethered corn syndrome, hydrocephalus and tumefactions in the lumbosacral region. Moreover the study points to the significance of certain clinical features and investigations in the diagnosis of spinal dysraphism.


[Breech presentation terminated by cesarean section]. The prospective study was carried out in 86 mothers and their newborns born in breech presentation; 41 were delivered by cesarean section, 45 vaginally. The incidence of prepathologic and pathologic CTGs was rather high in both groups (34.14% and 24.34%) as well as the presence of meconium in the amniotic fluid (34.15% and 22.22%). The infants delivered by cesarean section have significantly (p < 0.05) higher pH levels (7.28 +/- 0.068) than those delivered vaginally (7.25 +/- 0.093). The acidosis incidence (pH +/- 7.20) is significantly (p < 0.01) lower in the first (9.76%) than in the second (26.66%) group. In the early neonatal period 24.35% of the children in the first group and 35.55% of the children in the second group developed a disease (p < 0.05). The difference in the morbidity rate can also be found in the fact that in the studied group no intracranial hemorrhage was diagnosed while in the control group it was found in 17.77% of the children. Manifest cerebral disfunction syndrome was detected in 2.44% of the children delivered by cesarean section and in 8.88% of the children delivered vaginally. One child (2.22%) delivered with manual help has died. The morbidity of the mothers was significantly (p < 0.05) higher in women who gave birth abdominally (17.68%) than in those who gave birth vaginally (8.88%).


[Patellar height in patients with chondromalacia]. A radiogrametric assessment of the patellar height performed by three measurement methods, in the lateral views of radiograms of 136 patients with chondromalacia of the patella was aimed at the establishment of certain parameter values in the studied population and the assessment of the influence the altered patellofemoral ratio has upon the onset of the disease. The results of the study verified the remarkable advantages of the method by Insall and Salvati for the measurement of the patellar height and showed a significant involvement of patellofemoral incongruity in the development of chondromalacia, since in 15-16% of the cases the patella was not properly placed.


[Prophylaxis and therapy of infections in allogenic bone marrow transplantation in patients with hematologic diseases]. Infection and acute graft versus host disease (GVHD) are the most common complications of allogeneic bone marrow transplantation, which compromise this therapeutical method for hematologic diseases. Beside the appreciation of customary preventive measures and the treatment of infections, it is necessary for every bone marrow transplantation center to analyze the development of bacterial, fungal and viral infections in the patients and to generate the most efficient and most rational program for their prevention and treatment. At the Hematology Department in Novi Sad seven allogenic bone marrow transplantations were performed in patients with malignant hematologic diseases and severe form of aplastic anemia. Prevention of the infection by isolation of the patient in a sterile unit, selective decontamination of the digestive tract with sterile food, skin and mucus hygiene and prophylactic drug administration proved rather beneficial and adequate for patients with the graft accepted, hematopoiesis recovered and immunity reconstructed. Risks of infections were increased by permanent vein catheter, acute GVHD and rejection of the bone marrow graft. Prompt isolation and identification of bacteria and fungi, especially in blood, the establishment of a minimal suppressing and bactericide antibiotic concentration, along with the assessment of their synergism, as well as early diagnosis of cytomegalovirus and administration of specific drugs, can significantly contribute to the more successful treatment of infections in transplanted patients.


[Standard histopathologic criteria in intraoperative diagnosis of thyroid gland diseases]. The objective of intraoperative histological diagnostics of thyroid gland diseases using the tissue freezing method is planning the appropriate surgical scope at the time of operation. This necessitates maximal diagnostic accuracy having in mind the fact that freezing changes the tissue structure resulting in numerous technical defects in the histological preparation. These defects can be eliminated by multiplying histomorphological criteria, accurate explanation of their significance and interdependency and by making a conclusion in the form of ex tempore diagnosis. We studied 88 cases of ex tempore diagnosed changes in the thyroid gland using 15 different morphological criteria. The adjustment of the metrics scale to arithmetic progression enabled us to use certain number of parametric tests. A universal approach along with non-parametric methods with highly significant results made it possible to evaluate histomorphological criteria which can be regularly used in intraoperative diagnostics of pathological changes in the thyroid gland.


[The effect of chronic alcohol administration on specific features of the adenohypophysis in young animals in relation to the adult adenohypophysis]. We investigated chronic effects of ethyl alcohol on adenohypophysis in adult Wistar rats and adenohypophysis in development including the postnatal period up to 30 days. Morphological findings in gonadotropic, prolactin and follicular cells were compared. After three months of constant alcohol consumption in the form of a 15% liquid solution, vacuolization of gonadotropic cells which acquire the shape of a seal ring, as well as nodular hyperplasia of chromophobe cells combined with sparse somatotropic cells, occur in the adenohypophysis of adult male rats. Electronic microscope revealed a small quantity of prolactin granules in light-microscopic chromophobe cells. In young rats exposed to alcohol gonadotropic and prolactin cells are unchanged but an accumulation of follicular cells within multiple smaller pseudofollicles is present. In the explanation of the differences between the findings obtained in adult and young rats with reference to LH/FSH and PRL cells, a stress is given to the role of the peripheral metabolism of testosterone and of hyperestrogenemia caused by alcohol consumption in adult rats lacking in young ones. The increased number of the follicular cells in adenohypophyses of young rats is likely to reflect the suppressed maturation of hypophyseal secretory cells.


[Hereditary sensory-motor polyneuropathy. Case report and problems in differential diagnosis]. The study reports a family in which three children were found to have marked sensory-motor polyneuropathy. Clinical investigations revealed a recessive hereditary form of highly progredient mostly motor polyneuropathy with atrophy and weakness of distal muscle groups and electrophysiologic evidence of neurogenic lesion-delayed neural conduction. Apart from the peripheral nerves, clinical examination and additional investigations showed that the degenerative process encompassed central nerve system structures, posterior bundles of the spinal cord, spinal cerebral pathways, cerebellum and cerebrum (cerebral sings, mental retardation, epilepsy, brain atrophy on CT, increased IGG in the liquor are present). Although clinical and electrophysiological analyses suggest type III HSMN, muscle and nerve biopsy, as well as additional diagnostic methods broaden the differential diagnostic range toward other forms of hereditary polyneuropathy, whose differentiation in practice is, in spite of clear diagnostic criteria, rather difficult, due to the presence of its transitive forms.


[Favre-Racouchot syndrome: case report]. The authors present a case of Favre-Racouchot syndrome (elastoidosis nodularis cystica et comedonica) in a male mason aged 65, associated with nodular-ulcerative type of basocellular skin neoplasm and seboroic keratosis of the irritative type. A special reference is given to nodular cystic elastoidosis (NCE) with concurrent numerous skin changes characteristic for chronic actinic skin lesions which were clinically evidenced. An objective examination of the patient revealed the presence of multiple follicular comedones, black in colour, the size of a pinhead, and of yellowish follicular papulas, 2-5 mm in size, of solid consistency, on the top of which is a formation similar to comedone. These eflorescences are densely disseminated in periorbital, zygomatic and temporal regions of the face, sparsely on the nose, forehead and preauricularly. In other regions of the face and neck other manifestations of chronic actinic skin lesions with characteristics of "citrine skin", cutis rhomboidalis nuchae and elastoma Dubreuilh are present as wall. In the right nasolabial furrow a clearly edged tumefaction, 1.2 x 0.8 cm, which belongs to the nodular-ulcerative type of basocellular skin neoplasm is seen. Seboroic keratosis of the irritative type was observed on the skin in the middle of the upper lip was histologically verified.


[Pneumococcal meningitis from 1974 to 1984]. We examined a group of 22 patients presented with the acute infective meningeal syndrome. Lumbar punction confirmed diagnosed purulent meningitis--meningoencephalitis, and bacteriologic liquor culture identified Streptococcus pneumoniae as a cause of the disease. Patients were mostly aged over 30. Clinical picture revealed signs of general infection and the meningeal syndrome. The severity of the disease was assessed on the basis of apparent signs of general infection, state of consciousness and endotoxic shock symptoms. Severe consciousness disorders were present in 16 (72.72%) patients. In our patients possible pneumococcus infection foci were: sinusitis, otitis media, pneumonia, mastoiditis and adnexitis. Lethal outcome occurred in 5 (22.72%) patients. In the therapy we used penicillin, chloramphenicol and ampicillin along with corticosteroid administration.


[The significance of radioisotope methods in the diagnosis of liver hemangiomas]. A growing use of ultrasonography for the examination of abdominal organs has resulted in an easier detection of hemangioma-like focal benign changes in the liver. Such cases ask for further diagnosis. Apart from other methods, the diagnosis of hemangiomas is possible by in vivo technetium-labeled erythrocytes. The authors present the erythrocyte labeling technique and the scintigraphic method carried out in 44 patients. On the basis of the obtained results they conclude that scintigraphy can be successfully used for the diagnosis of hemangiomas, especially if the changes seen by ultrasonography are big enough for the scintigraphy. If they are below 20 mm only tomography (SPECT) with labeled erythrocytes is to be considered.


[Ultrasonic diagnosis of transitory synovitis of the hip joint in children]. The most common cause of a limp in childhood is transitory synovitis of the hip. At the Paediatric Surgery Clinic in Novi Sad, in the period from 1989 to 1991, 58 children were treated for hip transitory synovitis and the diagnosis was confirmed by ultrasonic finding of the exudate in the joint. The ultrasonic investigation of the hips was performed by using Siemens and Kretz scanners equipped with 5 MHz linear or sector transducers. The approach to the hip was frontal and the lower extremity has been in the neutral position. The distance between the femoral neck and the joint capsule was verified according to the Adam's morphometric procedure. The measured pathological values were from 7 mm to 14 mm (normal values are from 2 mm to 4 mm). In the routine transitory synovitis diagnosis, real-time arthrosonography of the hip shows high sensitivity, accuracy and selective values compared to other diagnostic procedures.


[Modern trends in the treatment of ulcer disease (clinical study of nizatidine "Galitidine")]. By an analysis of nizatidine vs ranitidine activity, the authors show a contemporary controlled approach to the treatment of ulcer disease. In a prospective, randomized, double-blind, parallel comparative, multicentric study, the treatment of duodenal ulcer was carried out in 120 patients with H2-receptor blockers, nizatidine and ranitidine. The treatment lasted one or two months with endoscopic control of the results. The recovery of the ulcer nische in patients who received nizatidine, 150 mg twice daily over a month, was achieved in 89.75% of the cases, while in those who at the same time received ranitidine twice daily ulcer was suppressed in 84.61% of the patients; in those who received Nizatidine, 300 mg once daily it was suppressed in 88.24% of the patients. Statistically, x2 = 2.177 with p > 0.3 which shows that there is no statistically significant differences between the groups although the first group shows the best results. Adverse effects of the drugs were not observed.


[The effect of transcutaneous electric nerve stimulation on pain in knee arthroses]. The paper deals with effects of the TENS on disappearance of pain in knee arthrosis. Relevant investigation covered 40 patients of both sexes, different occupations and various age. The group was homogeneous in respect of subjective feeling of pain, length of illness and clinical findings. The results that were obtained clearly indicate the possibility of extinguishing the pain completely or reducing its intensity by application of the TENS which is to be used in medical treatment of knee arthrosis simultaneously with common drugs and physical therapies.


[Skin and laboratory tests: comparison of the epicutaneous patch test with the TTL and LIF tests in the diagnosis of medicamentous allergic contact dermatitis]. We investigated 158 patients from 15 to 82 years of age with clinically evident contact dermatitis, diagnosed at the Department for Allergic Diseases Investigations-Clinic for Dermatovenerological Diseases, Medical Faculty in Novi Sad, during the period of 1 year. We performed patch-epicutaneous test, lymphocyte transformation test (TTL) and leukocyte migration inhibition test (LIF). Among the 130 (82.2%) patients suffering from contact dermatitis, with the positive patch tests to commercial or standard battery epicutaneous allergens, 26 (20%) had at least one positive patch test to the medicament. In these cases contact allergic medicamentous dermatitis (SAMD) was proved by positive clinical and allergic investigations. In only one case, patch test was negative, with booth the TTL and LIF test positive. Among the medicaments TTL and LIF tested, antibiotics were the most frequent in 9 (34.61%) cases, analgetics were found in 6 (23.08%). Professional contact allergy to medicaments has been estimated in 5 patients (19.23%). According to the obtained results and statistic findings, relationships between the two variables-TTL and patch test, and LIF and patch test, were estimated due to the contact allergy to medicaments. Both of them were low and negative without statistic significance. Patch test remains to be the irreplaceable test with regard to CAMD.


[Smoking--I. Smoking habits, number of cigarettes smoked]. A multiphase, oncologic, population screening was carried out in 5.555 residents (91% of the expected number) over 40 years of age, from three districts of the community of Mali Idos. The poll showed that 83.1% of males and 21.9% of females are familiar with smoking (ex-smokers or active smokers); 45.7% of males and 11.6% of females are active and 37.4% of males and 10.3% of females are exsmokers; 314 residents--11% of males and 1.3% of females smoke more than one pack of cigarettes daily; some of them smoke more than 60, 80, even 100 cigarettes daily. In two age groups (40-44, 45-49) 100% of male respondents is familiar with smoking; in the group over 75 years of age this percent is reduced to one third (21.8%). We can conclude that the distribution of smoking in this population differed in the middle and in the second half of the century.


[Dry eye as a therapeutic problem].

[Dry eye as a therapeutic problem]. Effects of substitution therapy was investigated in 42 patients having the dry eye syndrome associated with systemic diseases of connective tissues (systemic lupus, Sjögren's syndrome, etc). Artificial tears were applied: Liquifilm sol, Hydroxypropyl methylcellulose 0.3% (HPMC) and Ocutal sol. After the one-month application of each preparation, mean values of Schirmer's test were approximately identical and the differences were not statistically significant (4.5 +/- 3.5; 4.95 +/- 4.4; 4.01 +/- 3.6), differing slightly from mean values of Schirmer's test prior to the treatment (4.4 +/- 3.4; 3.9 +/- 2.5). The lacrimal secretion did not increase after the administration of the above therapy. The therapy with artificial tears resulted in the improvement of subjective complaints (scratching, dryness and burning sensation) in 65% of cases treated with Liquifilm sol, in 69% upon the administration of HMPC 0.3% and in 60% after the application of Ocutal sol.


[Dr. Valdimir Jakovljević--his contribution to the art of surgery]. In this article we present biographical data of Dr Vladimir Jakovljević, a surgeon (1893-1960), and his contribution to the technical approach to cephalic duodenopancreatectomy: the first pancreatico-jejunostomy, and first reported in world's literature triple different anastomosis of the jejunum with part of the stomach (after a 2/3 resection of the organ), choledochus and a part of the head of the pancreas, done by Vladimir Jakovljević in 1934, and published in "Medicinski pregled" (Medical Review) in 1935. A basic surgical teaching of Dr Jakovljević school of surgery is an aspiration toward the "physiological surgery", a technical viability for performing the most difficult operation on the biliary tract, a strong surgical imagination and full information about contemporary knowledge on surgery.


[The elderly person and retirement].

[The elderly person and retirement]. The present aimed at characterizing the retired old population (members of the retired people and pensioners Association of Ribeirão Preto, São Paulo) who live in this town. The study was carried out from 01/01/89 through 31/12/89. This population was composed of 38 retired and old age pensioners: 30 (78.9%) males and 8 (21.1%) females. It was used the method for data collecting which was the questionnaire with close and open questions; the used technique was the recorded interview. As in our country the retired benefit is inferior to be work's remunerations in the period of activity, the retired person is obliged to look for other ways of income to complement that benefit, and the medical assistance, where it was not expected by the population.


[The nurse in mental health outpatient clinics]. This study emerged from the preoccupation to evaluate the learning needs of psychiatric nurses working in an ambulatory of Mental Health. We verified the type of education they had, the actions they performed and the difficulties and facilities they found in the development of nursing interventions. It was also examined whether these actions are in conformity to the ones prerecognized by the literature or not. The data analysis showed that the majority of the actions are performed by nurses in distinct manners in 6 ambulatories. We perceived, in some events, the "function deviation" in nursing activities of nurse and the nursing team.


[The results of self-irrigation in colostomy patients who have undergone a process of systematic training]. The present study comprises the results of the use of self-irrigation by 40 colostomized patients, trained by us through a process of systematized training. The effectiveness of the training process can be checked out considering that the most part of the patients have adopted it in its basic features, pointing out a few number of technical difficulties. As to the results of self-irrigation, as a method for controlling the intestinal habit, we can say that 37.50% of the population showed an absence of fecal leakages and 42.50%, sporadic leakages between the irrigations; 27.50% and 35.00%, with absence of gases in the intervals of time and partial use of the collecting pouch, respectively.


[Discharge of the surgical patient within the context of the health system]. Based on the assumption that surgical patients, together with their families, take responsibility for their own care after being discharged from the hospital and that they are not duly prepared for this task, we undertook the present study to investigate the problems of surgical patients related to discharge and to determine the type of care offered to these individuals within the context of the health system. The study included patients submitted to elective, medium surgery at the University Hospital, Faculty of Medicine of Ribeirão Preto, USP, during the first semester of 1989. Fifty patients (42 women and 8 men) of the various surgical specialties were interviewed during home visits. The instrument for data collection consisted of three parts: the first involved social and environmental aspects such as housing, job, family and others, the second involved the relationship of the individual with the health system, his/her perceptions and difficulties, and the third involved the biological aspects related to the surgical process. The data were analyzed in a descriptive manner on the basis of the theoretical referencial of Lalonde, which sees health as the result of a dynamic process of individual integration with the environment.


[Health promotion and disease prevention: an individual responsibility or social responsibility]. This article is about some theoretical assumptions that have guided health promotion and disease prevention strategies. Some questions are raised in relation to the professional's interventions that consider health promotion as an individual responsibility. It is suggested that the focus should be on social changes through the professionals' consciousness in social, political, behavioral and economic aspects that exert influences over the population's health. These ideas ought to be incorporated to the nurse-client interaction.


[Reflections on qualitative research methods in nursing]. This essay brings considerations about quantitative and qualitative research methods in Nursing. It boards the quantitative and qualitative methods specifications, makes the distinction between method and technique, and gives emphasis to the episthemological pressuppositions which gives basis to the method.


[The role of the hospital nurse in teaching patients]. Patient teaching by hospital nurse has been recognized as a relevant form of a patient care throughout the history of nursing. However, there are obstacles to carry on this practice. On the basis of the experience reported in the literature, the present study analyses factors which hinder the widespread use of this practice.


[The human attitude in a situation facing death]. The present paper was produced in order to help students, to deal with the death situation. It focus on concepts and conflicts related to terminal stage, death and post-death period, which demands attitudes of involvement of the professional in this situation, and other complementary informations about the whole issue.


[Psychomotor skills versus intelligence and affectivity]. It is an study, based on specific Bibliography, which purpose is to divulge up dated knowledge capable of establishing the importance of psychomotor skills. The article also describes the relation between the action and mental capabilities, both in the phylogenesis and ontogenesis level. The notion of relationship between all aspects that make up the human being and the environment with which man interacts, confirms the new global conceptions of the modern pedagogy.


[The patient classification system. I. The allocation of nursing personnel]. A classification system can be an essential management tool of nursing administrative practice. This system should exist to provide nursing with useful and meaningful information for decisions about staffing allocations, monitoring productivity, and costing of nursing services. The purpose of this study is to show the importance of a patient classification system, after a review of current literature, in the hope that a research agenda on the topic can be established in Brasil.


[Developing a teaching-learning process: teaching prerequisites and methods in the discipline of preventive and community nursing in a nursing degree course]. This paper describes the development of a teaching-learning process (TLP) guided by presuppositions such as: historicity, participation and horizon. This process has been developed by the Community and Preventive Nursing Discipline of the School of Nursing of São Paulo University, and its objectives, methods and strategies are described here. It is articulated to the Assistance-Teaching Integration Project involving the School of Nursing and São Paulo Mayorality. This process has been a valuable experience for both teachers and students, and it has also enabled a real approach with the Health Unit personnel.


[Labyrinth fistula in chronic otitis with cholesteatoma]. The authors studied 116 surgically treated patients with labyrinthine fistulae due to cholesteatoma. The fistulae were most commonly localized on the lateral semicircular canal (75%) and much less frequently involved only the oval window area (7%) and the promontory (4%). The multiple fistulae were found in 14% patients. The closed technique was used, while the open technique was adopted only when the ear was deaf preoperatively, in cases of multiple fistulae and associated intracranial complications. The cholesteatoma matrix was not removed from the fistula of the oval window area or the promontory or in the cases of multiple fistulae and large fistulae of the lateral semicircular canal if the cholesteatoma matrix had penetrated into the labyrinth. The fistulae on the lateral semicircular canal were covered by a piece of fascia. Postoperatively deafness occurred only very exceptionally.


[Vertigo and diving].

[Vertigo and diving]. The appearance of a vertigo during scuba-diving result from different pathophysiological mechanism at which oppose specific therapeutic. Whether it's during barotrauma or decompression accident, the vestibular reach can cause drowning. It is possible to make the difference between barotrauma and decompression accident, with the good study of the scuba-diving and the time when the vertigo has came. So, the therapeutic will use recompression in a multiplace hyperbaric chamber or only hyperbaric oxygen.


[Current data on barotraumatic ear disease with isolated vestibular expression during apnea diving]. The authors have taken an interest in isolated vertiginous symptoms observed from free diving patients. In order to achieve a current bibliographic synthesis, they resume, on basis of 6 cases, the basic principles of the physics theories and the etiopathogenic mechanisms. They try so to help in the understanding of the vestibular clinical signs observed in this successful sport.


[Subglosso-epiglottectomy: carcinologic and functional results]. The authors report on 26 cases of patients treated by subglosso-epiglottectomy from 1978 to 1989. Whilst as far as survival and local oncological control are concerned the results are encouraging, the functional results are disappointing.


[Contralateral ear in cholesteatoma].

[Contralateral ear in cholesteatoma]. The authors examine 224 contralateral files of patients suffering from cholesteatoma. They record that the systematic study of the opposite ear can prove to be of interest, given the numerous anomalies found. One ear in two has a contralateral pathology. In 32% of the cases, there is a retraction pocket, and in 14% a cholesteatoma. The mean time for a cholesteatoma to appear from a retraction pocket varies by 24 months in 44% of the cases, thus demonstrating the necessity of examining the opposite ear, as a dynamic evolution exists. Of these pockets, 2% in fact evolved, these statistics, to a true cholesteatoma.


[Morphofunctional correlations in children with upper maxillary endognathia]. In this study 23 oral breathing children suffering from maxillary hypoplasia (endognathia associated with skeletal class II or III), selected for rapid maxillary expansion (RME) have been investigated by active anterior rhinometry. None of these patients presented O.R.L. pathologies during clinical examination except for some sporadic cases of adenoid hypertrophy (5 cases). Rhinomanometric and cephalometric examinations carried out before and after RME treatment showed a good correlation between the nasal respiratory function parameters and the structural cephalometric elements investigated by means of teleradiography. In particular, an important reduction in nasal respiratory resistance in all patients with conversion from oral to nasal respiration in the majority of cases corresponds, together with cross-bite resolution, to increased transversal dimension of the maxilla produced by RME. A clear regression in adenoid hypertrophy, where present, is also noted without any type of O.R.L. treatment. The improved respiratory situation could therefore produce benefits on the trophism of the nasal mucous and the lymphatic rhinopharyngeal tissue. Agreement between clinical, radiological and rhinomanometric findings confirm the usefulness of this method in diagnosing and following-up patients with this problem.


[Congenital cholesteatoma of the middle ear and mastoid. Apropos of 5 cases]. Five cases of congenital cholesteatoma of the middle ear and mastoid as defined by Derlacki's criteria were encountered over a 14 month period. They make up 5% of all cases of cholesteatoma managed over the same period of time. Three were young children and all presented with unilateral hearing loss. One had associated multiple congenital abnormalities of the external and middle ear. Only in one patient was the diagnosis made on initial otoscopic examination and the remainder diagnosed on CTscan, myringotomy and tympanotomy. All were operated on; three by the intact canal wall technique, one by the canal down technique with mastoid cavity obliteration and one by atticotomy with lateral attic wall reconstruction. One patient required a second stage operation for excision of an extension of disease deep to the superior semicircular canal via the middle cranial fossa approach in order to preserve cochlear function. These five cases illustrate the diagnostic pitfalls of this condition in which silent danger lurks behind an intact tympanic membrane.


[Arachnoid cysts of the cerebellopontine angle]. The authors report two cases of arachnoid cysts of the cerebello-pontine angle. The otologic symptoms were unsteadiness, hearing fall and tinnitus. In the first case, the patient who presented a cerebellar syndrome was operated. Afterwards the hearing felt and he developed a transient hydrocephalus. The symptoms disappeared in 9 months. In the second cas, the patient was not operated. She was treated medically and supervised. Then the symptoms disappeared too. The authors review the paraclinic exams especially MR, relevant to the diagnosis and discuss the opportunity of a surgical operation.


[Primary meningioma of the geniculate ganglion: apropos of a case]. Based on a clinical observation and a literature review, etiologic hypothesis, clinical, radiological and therapeutics characteristics of intratympanic primitive meningioma are described. Those tumors arise from arachnoid cells, some may be carried along the nerve sheath within the Fallopian canal during embryology.


[Ankyloglossum superius: apropos of a case]. The authors report a rare observation of ankyloglossum superius i.e. the attachment of the tip of the tongue to the anterior part of the palate, with an ectrodactyl of the fingers and toes. Following a review of the literature, this provide an opportunity to recall this pathology, the physiopathogenesis of which remains unknown falling within syndromes of malformation affecting both the mouth, face and limb, namely orofacio-digital syndromes and syndromes of hypogenesis of the mouth, jaw and limbs.


[Congenital laryngeal atresia: apropos of a case]. A case of congenital laryngeal atresia in which the laryngeal lumen was obstructed by a soft, smooth protrusion is reported. Laryngeal stenosis was located at the glottic level and appeared as a protrusion reducing the laryngeal lumen to a few millimeters. The stenotic tissue consisted of striated muscle fibres cross-linked through their midlines.


[Spontaneous hematoma of the thyroid gland: apropos of 2 cases]. Authors report two cases of spontaneous hematoma of the thyroid gland. Emergency surgery was performed on note of them. After reminding the role of different investigations, they discuss the interest of computed tomography to exclude extracranial carotid artery aneurysm. They explain a therapeutic approach according to the repercussions of hematoma: a compressive syndrome requires a difficult emergency surgery.


[Multistaged cryopreservation of tympano-ossicular grafts. I. Preservation procedures]. Good conservation of tympano-ossicular grafts is still actual. Theoretical principles of cryobiological action and the detailed description of applied method are given. Newly developed multistaged cryoprocedure in liquid nitrogen AT-196 degrees C with 9% DMSO showed well the microscopic appearance of connective tissue transplants without alterations of metabolical and mineral content. The conservation was mainly successful in peripheral, perivascular and perihaversian regions, while central zones gave signs of hypothermic lesion.


[Congenital cholesteatoma of the middle ear in children]. In a series of 16 middle ear cholesteatomas of a congenital type are reported in children; the youngest (18 months) presented with a bilateral case. Whereas a simple tympanoplasty could cure a localized pearl, typically anterosuperior in the mesotympanum, the stapes is fast eroded (7 cases) if progression goes on. Intact canal wall technique in 2 stages was the typical procedure. Good hearing results were generally achieved (except in one case of fixed footplate): 9 cases/14 with an ABG within 20 dB and an AC level within 30 dB.


[Multistaged cryopreservation of tympano-ossicular grafts. II. Transplantation procedures]. Tympano-ossicular transplants conserved by multistaged cryopreservation in liquid nitrogen on AT -196 degrees C were transplanted ortho and heterotopically in rats. This experimental histological investigation showed well the biofunctionality and biocompatibility (preservation of osteoneogenetically potent cells, signs of reorganization and decreased transplantative reactions on such grafts). Thus adequate preservation of tissues by means of this procedure was proven.


[Surgical rehabilitation of deglutition after partial surgery of the pharyngo-larynx]. The authors report four cases of severe deglutition disorders after partial laryngectomy. Three had collagen injection and one had a plastic reconstruction. They propose to use dynamic imagery in order to have a better selection of the patients.


[Tumors of the parotid area. Apropos of 203 surgical explorations]. The authors present their clinical, radiological and histological conclusions, according to a retrospective personal study about 203 chirurgical explorations from the parotid gland. The pleomorphic adenoma and the cystadenoma are presented more precisely and basically their chirurgical indications; the other histological types met are only presented through several tables.


[Bilateral chylothorax after radical neck dissection. Apropos of a case]. Bilateral chylothorax following radical neck dissection is an uncommon complication of head and neck surgery. Only 9 more cases have been reported in the English literature until now. Early recognition is not difficult if it is bear in mind when evaluating dyspnoeic patients with bilateral pleural effusions after neck dissection. In this paper the authors report their experiences with a case and comment on the treatment employed. The authors believe that due to its potential severity, it must be considered when ever head and neck surgery is performed.


[Leiomyosarcoma of the larynx: presentation of a case]. The authors report a new case of laryngeal leiomyosarcoma. The patient was a 43-year-old-man. The tumor extended to the left vocal cord, the paraglottic space and the deep layers of the left false vocal cord. Histologically, the lesion showed the typical pattern of a grade-3 leiomyosarcoma. Immunochemical studies revealed a strong positive staining with the actin smooth muscle antisera. A partial laryngectomy was performed. There was no evidence of recurrent or metastatic disease 10 months after surgery.


[Results of audiometric and vestibular tests in Cogan syndrome: apropos of a case]. The authors report on a case of Cogan's syndrome pointing out that hearing loss is due both to cochlear lesions from likely immunitary origin as well as to widespread alterations of auditory central nervous structures. This interpretation allows to explain the apparent discrepancy of the found clinical and instrumental data. From a therapeutic point of view, the authors assert the necessity of an early corticosteroid therapy to obtain some appreciable result. Anyway, they point out how prognosis for auditory function in Cogan's syndrome is often very poor.


[Our experience with percutaneous endoscopic gastrostomy in pharyngo-laryngeal surgery]. Percutaneous endoscopic gastrostomy (PEG), is an enteral feeding procedure, easy to tolerate and simple to perform. PEG appears to be an alternative to surgical gastrostomy. Used in ten patients with E.N.T. cancer, we only observe two minor complications. Advisable in a first time for the feeding of patients with palliative treatment, we propose PEG for patients in position to have a long and difficult rehabilitation of swallowing.


[Deafness, induced by sodium ethacrynate in guinea pigs, alleviated by microwave treatment]. Microwave is used to treat temporal hearing loss caused by intravenous injection of the ethacrynic acid in guinea pigs. The recovery of hearing is much faster in the treated groups than in the control group. The article proposes possible mechanism of the effects against the ethacrynic acid induced deafness and assume that the result of this research can provide an experimental basis for treatment of some perceptive deafness due to ischemia of stria vascularis of the cochlea.


[Comparison of 2 materials in the reconstruction of the tympanic membrane. Our experience in 300 patients]. The authors evaluated the results obtained from the tympanic membrane reconstruction in 300 patients affected by simple, purulent or cholesteatomatous chronic middle ear otitis. In this tympanic membrane reconstruction they used: jugular vein strip of a calf and temporal muscle fascia in 150 cases. On pathological basis (simple, purulent and cholestéatomatous otitis) they used the overlay or the underlay method. In 5 years that follows, the materials (vein and fascia), if properly used, would give similar results. For such reasons the authors proposed: temporal muscle fascia autotransplantation with underlay method in partial myringoplasty; heterotransplantation of modelled jugular vein strip with overlay method in subtotal or total myringoplasty.


[Apropos of the infratemporal pre-auricular approach (its value in the approach to the midline skull base]. The role of the infratemporal pre-auricular pathway to the median base of the skull resides in the fact that it enables very wide access to this region while sparing the facial and auditory nerves. Among the operations performed on the approaches of the base of the skull by their teams, the authors chose a particularly typical observation dealing with the indication of this pathway: a 34-year old male with a giant cholesteatoma of the tip of the petrous bone totally surrounding the internal carotid artery along its entire (intrapetrous) length, from the cervical region to the cavernous sinus, having invaded the clivus and pushed back the brainstem. This lesion is located on the side of the only healthy ear. The patient is completely deaf in the ear on the other side. The operation enabled its complete exeresis while respecting the facial, auditive and vestibular functions.


[Secondary rhinoplasties: failures at the bone stage]. Based on a personal experience, the author exposes the problems and describes the failures who can occur during and after the "bony stage" of the rhinoplasty. The surgical treatment will be exposed. Successively: correction of the dorsum (resection of the bony hump) with incorrect nasofrontal angle, residual hump, "saddle nose"; lateral osteotomy and bony step; transversal and paramedian osteotomy with possibility of "open roof" so as residual deviation.


[Acute vertigo caused by cerebellar vascular accident]. At the beginning, small cerebellar strokes may present only with acute onset of vertigo, unsteadiness and unidirectional nystagmus, like a vestibular neuritis. In some cases, it is associated with tinnitus and hearing disturbance, like an endolymphatic hydrops. Other cases may mimic a benign cupulolithiasis, with only a paroxysmal positioning vertigo. Attention should be focused on transient associated symptoms: headache and blurred vision. One should not wait for classical cerebellar clinical signs: they are subtle and they appear late. Within a few days, the clinical picture will change: vertigo will disappear, while unsteadiness will progress. The electronystagmography confirms the integrity of the vestibular peripheric system. The cerebral CT Scan will show the ischaemic lesions only several days after the onset of the symptoms. A magnetic resonance imaging is far more efficient. Small cerebellar strokes have a good prognosis: complete recovery may be hoped with acetylsalicylic acid treatment and kinesitherapy.


[Predictive value of high frequency audiometry in otosclerosis]. A study was carried out to evaluate the value of high-frequency audiometry in stapes surgery in cases of otosclerosis. The hearing function was measured pre- and postoperatively by means of conventional and high-frequency audiometry (Demlar 20k). The operative findings of the gradation of otosclerosis were compared with the pre and postoperative audiometrical measurements. The results of this study point out that a clear relation exists between the preoperative high tone audiogram and the gradation of otosclerosis. In conclusion, we state that high-frequency audiometry can predict the state of stapes fixation in otosclerosis and that can be important in stapes surgery.


[Malignant cervical epithelial adenopathy from unknown primary source. Apropos of a series of 54 cases]. Fifty four patients with cervical lymph node metastasis from an unknown primary tumor underwent treatment from 1969 to 1988. Fourty five underwent radical neck dissection. 69% had node capsular effraction and 36% perinodal vascular embolism. Thirty four patients underwent postoperative radiotherapy including rhinopharynx, cervical oesophagus and all the bilateral cervical nodes. The primary tumor appeared after treatment in 7 cases. Total survival rate is 36% 5 years after treatment. Vascular embolism aggravates the prognosis. Radiosurgical association allow effective control of loco-regional cancer but does not improve survival rate. Prognosis is aggravated by metastases arising (18%).


[Repair of the auricular area after petrosectomy]. The authors report a retrospective series of 12 patients presenting periauricular tumors having invaded the external auditory canal and concha: 5 squamous cell carcinomas, 3 basal cell carcinomas, 2 Darrier-Ferrand sarcomas, 1 parotidean adenocarcinoma, 1 radionecrosis. The operation included an extralabyrinthic petrosectomy, an amputation of the pavilion, and a ganglionic evidement following a histological analysis. The reconstruction processes used 3 pedicle grafts and 9 free grafts. The carcinological extension modalities of the cancers invading the entire external auditory canal require the sacrifice of the tympanic cavity and an external temporalectomy in a single block for carcinological and functional reasons. The massive invasion of the concha inevitably leads to the sacrifice of the auricular pavilion. The best means of reconstruction is with the free graft of the musculus latissimus dorsi. The price to be pay esthetically must be reduced by the placement of an epithesis.


[RNA extraction, in vitro translation and two-dimensional analysis of oncoproteins in cancers of the upper respiratory and digestive tracts]. After a review of the literature concerning oncogenes expression of in head and neck carcinomas, the authors studied RAN extraction, in vitro transduction and two dimensional analysis of oncoproteins in head and neck carcinomas. The results between the tumoral tissue and normal tissue were compared significantly more oncoproteins spots were found in the tumoral tissue analysis.


[Comparative contribution of endoscopy, x-ray computed tomography and MRI in the preoperative evaluation of cancers of the endolarynx: apropos of 18 surgically-treated patients]. The authors carried out a prospective and comparative study of 18 patients with endolaryngeal carcinoma, with preoperative imaging of the extent of the disease by computed tomography (CT) and magnetic resonance imaging (MRI). The correlations between CT, MRI, endoscopy and postoperative histology are reported. It appears to the authors that the contribution of imaging is evident and that at present the reliability of CT is comparable to that of MRI, taking account of the current technical problems of MRI.


[Melanoma of the ORL mucosa].

[Melanoma of the ORL mucosa]. The study of ENT mucous melanomas (ENT MM) was performed retrospectively, based on 20 patients treated in Bordeaux and 156 detailed files taken from the international literature. Each paragraph is followed by a review of the general literature. The ENT MM, a rare form of melanomas, presents a majority of nasal locations. The mean age is 63 years old. The sex ratio trend is towards one. The aspecific call signs partially explain the delayed diagnosis. The difficult pathological examination is assisted by tumoral markers. Mean survival is two and a half years without any clear prognostic factors as for cutaneous melanomas. Treatment is essentially surgical, but adjuvant radiotherapy may have a significant effect. The other treatments are palliative.


[Olfactory esthesioneuroma. Apropos of 12 cases]. The authors report a 12-case series of olfactory esthesioneuromas, in which they review the main characteristics of this rare tumor. The olfactory esthesioneuroma diagnosis should be evoked for all nasal tumors, especially for tumors originating in a high position. This diagnosis is confirmed by the difficult pathological examination, which currently benefits widely from immunohistochimy. Prognosis is poor and surgery is the main treatment, associated with varying degrees of radiotherapy. As far as chemotherapy is concerned, its role must be clarified.


[Indications and results apropos of 290 endonasal ethmoidectomies]. An intranasal ethmoidectomy prospective study was carried out from 1985 to 1991 on 152 patients and 290 ethmoidectomies. This surgery is intended for patients who have been treated often for nasal polyps, chronic ethmoiditis and recurrent sinus barotrauma. A discrepancy was observed between patients satisfaction (82%) and clinical symptoms, given that results remain good in 75% of the cases three years afterwards but only in 60 cases after five years. There is a recurrence of nasal polyps in 36% of the cases.


[Maxillary Aspergillus sinusitis. Comments apropos of 20 cases]. About a series of 20 aspergillus maxillary sinusitis, the correlation between this pathology and previous dental treatments is emphasized. In some cases such as sinusitis can occur without any dental pathology and/or in absence of foreign body on the X-rays. C.T. findings are the basis of the diagnosis. Surgical treatment, using endonasal micro surgery, has been performed in all cases.


[AIDS and lymphoma of the ear].

[AIDS and lymphoma of the ear]. The authors describe the circumstances for detection of an AIDS lymphomatous complication revealed by an otological picture in one patient. The lymphomatous pathology not related to HIV is reviewed. The particularity of these lymphomas, when they are related to HIV, is their frequent initial extra-ganglionic location, their high grade histological type and their poor prognosis. The authors emphasize the need to perform a biopsy rapidly when confronted with any external otitis resistant to general and local treatments.


[Laryngeal sarcoidosis: apropos of a case]. The authors report an unusual case of laryngeal sarcoidosis. After having explained it, they describe the elements of diagnosis about this rarely isolated pathology, its complications and treatment as well.


[Thyroid teratoma in adults].

[Thyroid teratoma in adults]. A new case of thyroid teratoma is reported in an adult and the heighten other cases of the literature are reviewed. This pathology, rather frequent and always benign in infants, is distinguished in adults by a malignant metastatic course for 14 cases of 19. The reported case, the second one in a male adult, remains a benign one after 14 years.


[True osteoma of the maxilla. Apropos of 3 cases]. The authors report 3 cases of authentic maxillary osteoma. Two cases concerns an exceptional osteoma with multiple localisation and the third case a giant maxilla osteoma. Topographic, diagnostic and therapeutic notions of these tumors are related.


["Conservative" transmandibular buccopharyngectomy]. Tumors of the amygdaline region were up until now most often treated by transmandibular buccopharyngectomy (TMBP) with a systematic sacrifice of the mandibular angle. This exercise justified by wide carcinological imperatives, a larger surgical facility and simple immediate postoperative follow-up, in fact systematically shows a substantial esthetic and functional prejudice. This principle was reinforced by the occurrence of osteitis during the first attempts of osseous reconstruction using steel wires opposite the mandibular angle (Dargent, Charachon, 1963). In 1989, Gehanno and Beauvillain published a mandibular conservation technique by vertical paramedian osteotomy, right in front of the mental nerve, shifted from the future field of radiation, with osteosynthesis by titanium plates. This technique appeals to us because it is easy to use, reliable and carcinologically safe. We have currently adopted it with satisfaction for 8 of our patients over an 18-month period, without any case of osteitis and with both good esthetic and functional results.


[Tobacco and cancer of the larynx: a prospective survey of 58 patients]. A prospective investigation about the influence of the tabagism and its characters on the laryngeal cancer has been led in the department of oncology in the Hospital Center Ibnou Rochd in Casablanca from December 1990 to June 1991. The investigation concerned 58 new patients. We conclude from this investigation that the risk of cancer increases with the intensity of the tabagism (the precocious age at the beginning, long duration, high number of packets/years; black tobacco, deep inhalation of the smoke, absence of weanling). The risk increases with the association with an intense alcoholism. We don't find the professional exposition. These cancers related to tobacco have epidermoid predominance. Finally, the major interest of this study is to convince us about the ampleness of this flail and to lead us through an educative action for the preventive fight against tobacco because of the risk of laryngeal cancer.


[Laryngeal and tracheal complications of prolonged intubation]. Based on a retrospective study of 595 patients having undergone prolonged intubation, the authors present the main complications encountered and, in particular, the mucous ulceration which appears to be systematic and is itself at the origin of secondary stenosizing or granulomatous sequelae. Research is still needed concerning the follow-up of the intubated patients in order to limit the pressures exerted between the cordal mucosa or the tracheal mucosa in contact with the endotracheal tube. A systematic check upon removal of the tube decreases the secondary sequelae by starting adapted antacid, anti-inflammatory and antibiotic treatments, as well as certain acts of laryngeal microsurgery and, in some cases, laryngeal rehabilitation for both the voice and deglutition.


[Stuttering: what does it tell us (body and speech)? What can be proposed (body and psyche)?]. The language can not be broken away from the oral: the actual psychoanalytic conceptions are called again. That allows to approach the stammering in its clinical theoretic aspects. One can consider the relation to the mother, the accession to the spoken word, the voice's wealth and possibilities, the necessity of the listening and of silence, with in all its aspects the emergence of the differences in stammerer subject or not. The links with the body and/or with the corporeal bring the notions on the psyche or psychic reality and permit to understand better the importance of a therapeutic activity (sufficient or with other treatments) the relaxation: its effects are multiples and I can give to the spoken word more spoken word.


[Some considerations on stuttering].

[Some considerations on stuttering]. Stuttering implements communication with interference through challenges other than sharing information, messages and emotion. This dramatic behaviour implies a phobic origin. The therapist must reproduce the symptom in its overall economy. Attentive listening, reassurance and non-submission of the esteem to the performance of expression should lead to a veritable reassessment of the challenges of expression.


[Parkinson disease and communication].

[Parkinson disease and communication]. Communication abilities imply multifactorial analysis. These disorders in Parkinson's disease involve speech, graphism, functional and paraverbal gestures. The patient's isolation in a major form of disease is dramatic. Functional study requires an analysis of each factor; progress should be realized for an objective approach. With a therapeutic objective in view, the most impaired features, and the patients real situation and way of life must be evaluated. Some training measures are useful especially for social adjustment and motivational reinforcement.


[Vocal dysfunctions: bases for rehabilitation]. Based on our observations of vocal dysfunction modes, we set up a classification of dysfunctions. Most often, we encounter a "prolonged and usual vocal forcing on an anatomically normal larynx". This forcing often essentially predominates breathing, but it may predominate the larynx, in the posterior glottis or on the vibrating area of the vocal cords. We individualized the very specific group of dysphonias with limited tone where the forcing in located, especially in the resonators. We reviewed the dysphonias with modified larynx, by secondary lesions or primitive pathologies. Analysis of the vocal dysfunction mode makes it possible to establish a therapeutic programme adapted to each case with a functional aim.


[Phoniatric and orthophonic management of patients during the awakening phase of coma]. The creation of a structure adapted to serious head injuries, in the awakening phase of a coma, enables early treatment of these patients upon leaving intensive care. Along with a pluridisciplinary team, speech therapists will help establish non-verbal communication by setting up a yes-no code and by favouring and programming the resumption of deglutition before soliciting verbal communication and recuperation of the memory and all the cognitive functions.


[How to evaluate velar insufficiency?].

[How to evaluate velar insufficiency?]. The evaluation of velar insufficiency is absolutely necessary in order to assess the results of surgery of the labial palatal cleft. In addition to the clinical examination which remains indispensable, the aerophonometer, applicable to adults and children as from the age of 3, enables simultaneous measurement of the flow of buccal air, the flow of nasal air, and the buccal phonogram. The comparison of the lines, the relation of the nasal air and buccal air flows, upon the emission of two standard sentences with and without nasal components, enables an objective assessment of velar functioning.


[Phoniatric aspects of reconstructive laryngectomy]. Reconstructive laryngectomy has been performed at the E.N.T. Clinic in Ferrara for some time. After surgery the patients undergo speech therapy and phoniatric treatment for a period of time varying from 2 to 6 months. In order to better evaluate the vocal quality obtained after such reeducation the vocal emissions of 25 patients were examined and recorded. The recorded material, made up of prolonged vowels and 6 phonetically balanced sentences, was then evaluated by a panel of 7 "trained" listeners. The evaluation score-card proposed by Woiers in 1977 was used in taking the data. This not only provides a scale for evaluating the main voice quality features, but also includes a final judgement on parameters including intelligibility, acceptability and pleasantness. Statistical processing of the data inherent to voice quality indicated a decrease in intensity and pitch when compared to normal values. Nonetheless, the listening test showed a high degree of intelligibility, acceptability and pleasantness. These values confirm the fact that, although the new voice achieved through reconstructive laryngectomy surgery is less sonorous, it allows for perfectly understandable, socially acceptable speech.


[Crico-arytenoid articulation and reconstructive laryngectomy]. The crico-arytenoid articulation is a functional, anatomical entity the preservation or damage of which plays an important role in laryngeal carcinological surgery. In reconstructive laryngectomies, particular biomechanics of the neoglottis were observed at the origin of a specific rehabilitative protocol as well as an evolution over time of this crico-arytenoid unit. Functional readaptation should simultaneously deal with breathing, swallowing and speech. From D1 to D7, breathing work is started. From D6 to D14, swallowing is begun by establishing the sphincter. From D3 to D120, phonation work is dealt with by establishing a sphincter and the vibrator.


[Etiology of specific types of dysphasia and dyslexia as well as their natural supporting mechanism (theoretical approach and therapeutic response)]. The respective role of the organic and psychological factors is discussed. The importance of the individual's reaction to his own disorder is emphasized. This reaction according to the author promotes an evolution from a simple delay to a specific deviation. It is this reaction that the program "Natural Accompaniment" aims to contain or to defuse in proposing re-educative technics relying upon two principles: demands requiring no effort, priority to the words' significance.


[Vocal audiometry: the "phonatome" recognition test. Principle, technique, initial results]. Whereas tonal audiometry makes it possible to analyze the elementary deficits of hearing, vocal audiometry enables an overall synthetic assessment of these deficits. The vocal material usually used is composed of lists of sentences, words, logatomes or even phonemes. The authors suggest resorting to lists of phonetically balanced phonatomes or diphonemes. Among the advantages this technique offers, are the rapidity of the test, the excellent representativity of the most informative acoustic components of speech and the elimination of the extralinguistic factors of speech recognition.


[Acoustic and mechanical interpretation of the "on-off" effect]. The on-off effect is a particular form of the stapedial reflex. It is presented as a double positive deflection appearing when the stimulus starts and stops. This type of reflex is very frequent in beginning otospongiosis. The mixed theory assimilates the annual ligament of the stirrup to an elastic pin which obeys the physical laws of a spring. Otospongiosis produces a shortened sement and thickening of the annular ligament, with an increase in its rigidity, responsible for deafness of the low sounds at the beginning of the disease. The acoustic and mechanical theory enables a clear explanation of the lines supplied by the different types of instruments (220 Hz or 600 Hz). It also specifies the role of the annular ligament in various hearing pathologies.


[Use of standard protocols in the evaluation of voice disorders]. The purpose of this paper is to present a protocol for the use of standard forms in the evaluation of laryngeal structure and function in patients with voice disorders. The forms are designed to cover all the essential parameters needed to reach an accurate descriptive diagnosis which allows us to have an appropriate therapy plan according to the individual's detailed observations. It also gives us a consistent standardized evaluation form to measure changes after therapy whether behavioral, medical or surgical, and to compare different observations across patients. Reporting observations in this consistent manner will make characteristic patterns of different vocal behaviors readily obvious to the researcher or the clinician and reduce the possibility of missing any important details. The protocols are: indirect laryngoscopy, video-stroboscopic-evaluation form, functional voice and auditory perceptual voice evaluation.


The evaluation of the changes of voice registers in trainee singers by using the two-channel signal processing method. This study was done at the ENT Department of the Ege University Medical Faculty on twenty trainee singers. Using the two-channel signal processing method, the electroglottographic (EGG) signals and the voice signals were digitized with an analog-digital converting card during an ascending and descending glissando exercised by the trainee singer. These signals were recorded on the computer's hard disk and the obtained data was analysed. It has been determined that the EGG signals were more irregular the singing formant of the voice signal was very weak or absent and the change of register was more significant in less trained singers. This method can be used to evaluate objectively the change of voice registers in the training of the singers and be easily performed by adding an analog-digital converting card to a PC computer, without the need of expensive modern devices.


[Pharyngeal video-fibroscopy: value in the management of apneic snoring]. The pharyngeal video fibroscopy (P.V.F.) should complete the classical diagnostical management of each snoring associated with obstructive sleep apnea. Easily made on a seated awake patient the P.V.F. is the one dynamical pharyngeal procedure. It also let see the snoring and reproduce the upper airway obstruction. The Müller test seats the level of this obstruction, helps the surgeon in the choice of the procedure and should reduce the failure rate.


[Hearing aids and AIDS: apropos of a case]. Aids carriers must be fitted with hearing aids early due to their life expectancy. Hearing aids of which the electro-acoustic specificities make it possible to lessen the successive aggravations must be foreseen.


[Deviations of the nasal septum and their relation to tubal physiopathology]. It is frequently shown by the specialist, the relation exists between an obstructive septal deviation and the bad function of the Eustachian tube. Nasal physiopathology, as regulator of the tubaric function has been established as a controversial subject during the past two decades. This research demonstrates the relation between the septal deviation and tubaric pathology.


Transtympanic ventilator tubes in the treatment of seromucous otitis. Indications and results. 400 patients with bilateral secretory otitis media (SOM) were treated with ventilating tubes (VT) in a prospectiv study. The ear drums were normal on both sides before VTs treatment thus allowing ear drum changes and complications during VT treatment to be recorded. 618 VT were placed in the ear drum after suction of the fluid. In 182 patients unilateral myringotomy with suction of fluid were done and VT placed in the contralateral ear. Adenoidectomy with myringotomy, with an obstructing adenoid, gave 30% better chance. 10 different VTs were used. The most frequent pathology found in the ear drum after one period of VT treatment was tympanosclerosis. In the ears only treated with myringotomy tympanosclerosis occurred in 1%. 3 factors seemed to give more tympanosclerosis: metal (stainless steel or titanium), polyethylene and prolonged stay-time in the ear drum. Chronic perforations of the ear drum occurred with great variations between the different tubes. The Goode modified T-tube caused perforations in 17%. In the other VTs the perforations occurred in 2.1%. Chronic perforation together with tympanosclerosis will happen more often when the VT is made of polyethylene compared to silicone or fluoroplastic (p < 05). 90% of the perforations were located at the site of the VT. The ideal VT will stay in for 8-18 months at an average and it can be shown to improve middle ear function better than only waiting or myringotomy. Long-term VTs should not be used at the first VT procedures.


Stapedectomy versus stapedotomy: a comparison. Two hundred and fifty consecutively operated stapes procedures operated by the author for otosclerosis are presented. A fat-wire stapedectomy prostheses (Schuknecht) was used in 152 cases and a Fisch teflon-wire piston was used in 98 ears. Of the 250 procedures 33 patients had bilateral surgery. The operations were done in local anaesthesia in most cases and with endomeatal incision. The fat-wire prostheses gave in 95% a closure within 10 dB and the rest 5% closed within 11-20 dB. The Fisch teflon-wire piston gave a closure within 10 dB in 87%, within 11-20 dB in 12% and within 21-30 dB in 1%. The speech reception was better after operation in 97% of patients operated with the fat-wire prostheses and in 99% of patients having the teflon-wire piston. It was a significant difference at 20 dB level of speech improvement (p < 02) in favour of the teflon-wire piston. The surgery for otosclerosis is a special procedure seeking refinements in surgical techniques to increase safety and maintain acceptable results. Our results show that the small fenestra technique with 4 mm piston will give better speech reception and better hearing in the high frequencies. To achieve a high standard the operations for otosclerosis should probably be centralised to let the surgeon do a minimum of 8 to 10 procedures every year.


[Somatosensory evoked potentials in peripheral diseases of the facial nerve: a new investigation method]. In 1988, at the Facial Nerve Congress in Rio de Janeiro, results of facial nerve somatosensory evoked potentials (SEPs) by electrical stimulation of the Ramsay-Hunt zone were presented. In the clinical phase of this work, we have tested 8 normal subjects and 5 patients with unilateral peripheral facial palsy by the SEP method. Significant and reproducible responses were obtained in the normal nerves; general wave-form and different parameters are described: latency of different activities, differences inter and intra-subjects. In one case, we performed a brain mapping by stimulation of the Ramsay-Hunt zone to improve the localization of the different activities and to differentiate them from a possible auditory response to the electrical stimulation. In the pathological nerves, we observed significant changes in the morphology of the cortical waves with regards to the healthy nerves. Detailed results are presented in two cases with a long-term follow-up. We concluded that the electrical stimulation of the Ramsay Hunt zone evokes a cortical response like the electrical stimulation of other cutaneous zones. This response is significantly altered in peripheral facial palsy. Following studies should define the prognostic value of such modifications.


Physiological bases and a technique for testing the full range of vestibular function. The vestibulo-ocular reflex (VOR) is most active at higher frequencies (> 2 Hz) during locomotion, in order to stabilize vision. Use of active head movements, monitored by a sensor on a head strap, is a new method of testing the horizontal and vertical VORs which utilizes this natural frequency range, and doesn't require a rotating chair. Specialized computer processing based on Fourier analysis is necessary to analyze head and eye signals, which can be erratic. Higher harmonics of these erratic movements are particularly useful for VOR testing, in the analogous sense that complex sound processing is necessary for speech processing in audition. Use of portable computers with VOR active head analysis can be done at the bedside, as a portable vestibular test. Sophisticated software can effectively substitute for rotating chair hardware, provided that physiological corrections are applied to actively-generated movements at higher frequencies. In summary, the resulting test is brief, comfortable to the patient, portable, and useful for diagnostic screening over the frequency range that is most active during common daily movements.


Retrolabyrinthine vestibular neurectomy. 10 years' experience. The advances in the diagnosis of the vertigo patient and in the transtemporal approach to the cerebellopontine angle, have promoted the development of the retrolabyrinthine vestibular nerve section, for the surgical treatment of vertigo with hearing preservation. In a 10 years period (1982-1992), 45 patients underwent a vestibular nerve section through the retrolabyrinthine approach. The vertigo was controlled in 95% of the entire series, with 86% of hearing preservation, 6% of hearing improvement and 6% of hearing loss.


Malformations of the inner auditory canal. Malformations of the internal auditory meatus (I.A.M.) are often accompanied by other radiological abnormalities affecting the entire inner ear. In our series of cases we demonstrate solitary deformities of the IAM ranging from the stenosis of the canal (4 cases) to extreme narrowing (2 cases) or complete atresia. Another anomaly is the presence of a thick bony wall dividing the canal in two separate compartments, superior and inferior (3 cases). Most of the cases of solitary malformations were unilateral; they can be diagnosed at any age, considering that the patient has normal hearing in the opposite ear. When the malformation of the IAM occurs, associated with major deformities of the labyrinth (5 cases), we found an abnormal communication of CSF to the tympanic cavity, due to a severe anomaly of the fundus of the IAM. Meningitis is a frequent complication in patients with this abnormality.


Cerebrospinal fluid fistula: frequency in head injuries. The authors present 11,074 patients with head trauma managed in the Xoco and Juarez Hospitals from Mexico City, from 1980 through 1990. They report a frequency of cerebrospinal fluid fistulas in 1.3% of head trauma: 55% were anterior fossa fistulas and 39% middle fossa fistulas. The most common symptoms and the treatment are presented.


[Bone-anchored epitheses and audioprostheses: 4 years' experience with the Branemark system in Germany]. Osseointegration describes direct contact between titanium and vital bone. The Branemark System uses this principle for bone anchorage of hearing aids and craniofacial prostheses. The experience made in the ENT Department of the University Hospital in Homburg/Germany with this procedure in the last 4 years is described. During this period, 40 patients have been operated and 119 titanium fixtures have been implanted. 30 patients got bone anchored prostheses (ear, nose or orbit) and 25 patients received bone anchored hearing aids. The large group of 15 patients with congenital ear malformation presented both indications. 100 out of 119 implants i.e. 84% caused no major problems. The most frequent complications were granulations (10 implants i.e., 8.4%). More severe problems as non-integration of three pillars or rejection of one pillar were rare. Our experience for 4 years in an important number of patients was very positive in the majority of cases and allows us to consider the bone anchorage of hearing aids and craniofacial prostheses as a major advance in craniofacial rehabilitation and audiology.


[Osseointegrated implants in facial prosthesis and hearing aids]. The principles of osseointegration defined by Branemark are reviewed. The authors describe the otological applications of titanium implants: bone anchorage hearing aids (B.A.H.A.) and ear epitheses. Obtaining good results depends on the selection of the patients and the observance of a rigorous technique.


[Maxillofacial prosthesis, fixation by endo-osseous implants and transcutaneous pillars]. Osseointegrated facial prostheses are an interesting solution in maxillo-facial rehabilitation when reconstructive plastic surgery is not envisageable. Authors report two cases and give their opinion on the use of this kind of prostheses.


The endoscopic Congo red test during proximal gastric vagotomy: an essential procedure. A previously described method for evaluating the completeness of proximal gastric vagotomy (PGV), the intraoperative endoscopic Congo red test (ECRT), may allow for a more complete parietal cell denervation and thus result in a lower long-term incidence of postvagotomy ulceration. Of 20 patients undergoing PGV, 12 (60%) required further gastric denervation after intraoperative ECRT of the following sites: right gastroepiploic nerve (7), the nerve of Grassi (4), and the lesser curvature (3). Confirmation of completeness of PGV by the ECRT was easily performed and ensured intraoperative quality control. The routine performance of intraoperative ECRT during PGV may ultimately decrease the incidence of subsequent recurrent ulceration.


Laparoscopic cholecystectomy combined with endoscopic sphincterotomy and stone extraction or laparoscopic choledochoscopy and electrohydraulic lithotripsy for management of cholelithiasis with choledocholithiasis. Six hundred twenty-two laparoscopic cholecystectomies were performed at St. Vincent Hospital over a 14-month period. We reviewed the records of 366 of these patients who were referred to the authors. Thirty-six patients had suspected choledocholithiasis. The primary author (M.E.A.) performed 38 endoscopic retrograde cholangiopancreatography (ERCPs) on these patients for diagnosis and management. Seventeen of the 36 patients had common bile duct stones; 19 patients had negative studies. Of the 17 patients with choledocholithiasis, 15 had successful cannulation of the common bile duct, and, of these, 10 underwent laparoscopic cholecystectomy plus endoscopic sphincterotomy and extraction of the common duct stone(s). In one high-risk elderly patient, we extracted the stone from the common duct and left the gallbladder in situ. Two patients failed endoscopic cannulation and underwent open cholecystectomy with common bile duct exploration. Four additional patients, cannulated successfully, had unsuccessful endoscopic stone removal because the stones were too large or were impacted. Two of these patients underwent open cholecystectomy and common duct exploration. The two other patients underwent laparoscopic cholecystectomy and choledochoscopy through the cystic duct with the flexible choledochoscope. An electrohydraulic lithotripsy probe was then inserted through the choledochoscope to fragment the stones, and stone fragments were allowed to pass through the previously created sphincterotomy. We believe our data, supported by data in the literature, show that these alternative methods for treating choledocholithiasis are safe and effective and should be considered primary modalities for treating this condition now that laparoscopic cholecystectomy is the treatment of choice for cholelithiasis.


Comparative surgical and colonoscopic appearance of colon anastomoses constructed with sutures, staples, and the biofragmentable anastomotic ring. The following animal study was undertaken to compare and assess the endoscopic gross appearance and histology of colonic anastomoses constructed with sutures, staples, and the biofragmentable anastomotic ring (BAR). Three anastomoses--1 BAR, 1 stapled, and 1 sutured--were placed in each of 48 dogs and colonoscopy and anastomotic evaluation were done. No leaks were found by air insufflation at surgery. Grossly, the BAR had serosal hematomas in 27/48 anastomoses vs 7/48 for stapled and 1/48 for sutured (BAR vs stapled P < 0.0005 and sutured vs stapled P = 0.07). Adhesions were significantly greater for BAR (35/36) and sutured (34/36) compared to stapled (26/36) (BAR vs stapled P = 0.01 and sutured vs. stapled P = 0.04). Colonoscopic exams at days 3, 7, and 28 showed no significant difference among groups with respect to bleeding, ulceration, necrosis, granulation, or contour. Sutured anastomoses were more stenotic (24/31) than stapled (4/31) or BAR (3/31) ones (BAR vs sutured and sutured vs stapled P < 0.005). At 28 days, 10/10 sutured vs 2/10 stapled vs 3/10 BAR were stenotic (BAR vs sutured P = 0.02, sutured vs stapled P = 0.01). Inflammation on histologic exam at 28 days was not significantly different: sutured (12/12), stapled (12/12), or BAR (9/12). Fibrosis was more prominent in sutured (12/12) than in stapled (5/12) or BAR (4/12) anastomoses (BAR vs sutured P = 0.001, sutured vs stapled P = 0.004, and BAR vs stapled P = 1.00). All anastomoses healed primarily without necrosis or obstruction. (1) Colonoscopy to evaluate anastomoses can be done safely even in the early post-operative period. (2) The BAR anastomoses had the most serosal hematomas; BAR and sutured had more adhesions than stapled anastomoses; and sutured anastomoses had the most stenosis and fibrosis. None of these differences was of clinical significance.


Pelviscopic uterine surgery.

Pelviscopic uterine surgery. About 15-20% of the time uterine surgery via laparotomy is replaced in our department by operative pelviscopy. Of these, in reference to myoma surgery, about 70% were tackled with operative pelviscopy and a laparotomy was avoided. This allows the preservation of the uterus, especially for those women who desire to bear children in the future. Organ-preserving, minimally invasive surgery is the current accepted operative ideal. Postoperative sequelae like adhesion formation, subacute intestinal obstruction, and chronic abdominal pain are thus decreased. The importance of correct and safely functioning equipment and instruments cannot be overstressed for optimal results. A closed drain, i.e., the Robinson drainage system, can be kept in place for at least 12-24 h to check the postoperative ooze. In two cases of extensive ooze, repeat pelviscopy was performed within 12 h and hemostasis was achieved by the use of endosutures and endocoagulation.


T-tube placement during laparoscopic cholecystectomy. The management of common bile duct stones during laparoscopic cholecystectomy can pose a challenge to the surgeon as no definitive management plan is universally accepted at this time. We present a case where a common bile duct exploration was performed through a choledochotomy, describing how the t-tube was placed.


Bile leak after laparoscopic cholecystectomy. Laparoscopic cholecystectomy has now become the preferred surgical approach to symptomatic cholelithiasis. With the widespread use of this technique there have appeared reports of complications. We report the case of a patient who developed a cystic duct stump bile leak after laparoscopic cholecystectomy. Percutaneous drainage of the biloma, endoscopic retrograde cholangiopancreatography and papillotomy led to resolution of the problem. The literature on cystic duct stump leaks after laparoscopic cholecystectomy is reviewed and the various therapeutic modalities are outlined.


Peroral enteroscopic removal of a retained percutaneous transhepatic guidewire from the jejunum using a colonoscope. Several authors have described the ability to perform small-intestine endoscopy with long, flexible fiberscopes. A peroral colonoscope has been used for small-bowel enteroscopy and biopsy. A pediatric colonoscope for jejunoscopy has been described. Herein we report a patient undergoing percutaneous transhepatic decompression for the extrahepatic biliary obstruction in whom the guidewire broke and was lost in the liver. The proximal end of the wire was within the liver, while the distal end exited the ampulla and lay within the upper jejunum. Utilizing a peroral approach with the flexible pediatric colonoscope, we recovered the guidewire without advancing it further into the jejunum, where it may have been lost and have necessitated a celiotomy.


Peroral tunable-dye laser lithotripsy of intrahepatic stones in oriental cholangitis. This case report details the use of a pulsed tunable-dye laser lithotripter in the endoscopic management of recurrent intrahepatic stones in a patient with Oriental cholangitis. A 42-year-old Chinese man had a cholecystectomy and choledochoduodenostomy in 1980. Subsequently he had three episodes of recurrent cholangitis which responded to medical treatment. The patient presented in April 1989 with a fourth attack of cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) and ultrasound demonstrated a large mass of stones in the right intrahepatic ductal system. A flexible upper gastrointestinal endoscope was passed into the right hepatic duct via the choledochoduodenostomy. The stones were fragmented with a tunable-dye laser and the residual fragments were removed endoscopically.


Mechanism of thrombosis caused by sclerotherapy of esophageal varices using sodium tetradecyl sulphate. The mechanism of thrombosis following intravariceal injection of sodium tetradecyl sulphate (S.T.D.) was investigated with respect to effects on the vascular endothelium, the coagulation cascade, and platelet function. Using an umbilical cord model designed to simulate blood flow over the endothelium, it was found that S.T.D. is a potent toxin for endothelial cells in that brief exposure to even low concentrations of the agent were effective in stripping endothelium over a considerable distance, exposing highly thrombogenic endothelium in the process. Effects on coagulation and platelet function were found to be dependent on concentration. Diluted S.T.D. induced a hypercoagulable state, possibly in consequence of a selective inhibition of the physiological anticoagulant, protein C, and promoted platelet aggregation. Higher concentrations inactivated the coagulation cascade and lysed platelets completely. These results suggest that intravariceal infusion of S.T.D. at considerable dilution may be at least as effective in inducing thrombosis as standard dosage, and possibly more so.


Therapeutic laparoscopic suturing techniques. With the introduction of the technique of Interventional laparoscopy, a new era of minimally invasive general surgery has begun. The well-established principles of general surgical technique have not been altered by this new technology. As the new laparoscopic technology has become available, intraabdominal laparoscopic suturing and ligating techniques have been developed. The authors have attempted to elucidate the techniques of endoligation, "Endoloop" application, endosuture placement, sling suture placement, and continuous suture placement in laparoscopic surgery.


Endoscopic evaluation of gastric cancer infiltrating the lower esophagus. Endoscopic and histopathological findings were compared in 74 patients with gastric cancer infiltrating the lower esophagus who had undergone gastrectomy to evaluate mode of esophageal infiltration. There were no early cancers. Cancer infiltration modes were histopathologically broken down into three types: superficial, whole layer, and deep layer. Endoscopic findings were broken down into five types for proximal infiltration. Endoscopy used for histological evaluation frequently revealed the protruded type to be whole layer and had a highly accurate diagnosis rate (94%); it revealed the histology of the other four types to be primarily superficial. Extent of cancer invasion was underestimated in giant-rugae tumors (40%), as endoscopy could barely detect the small nest of esophageal infiltrations. Lugol staining was useful in preventing underestimation. For flat cancer, which is poorly demarcated and is often accompanied by vascular invasion, preoperative evaluation is very difficult, requiring preoperative examination of a frozen section taken from the proximal edge of resected specimen.


Thoracoscopic dissection of the esophagus: an experimental study. In order to reduce the respiratory morbidity of thoracotomy in esophageal surgery, several methods have been used, such as blunt dissection and endoscopic dissection through mediastinoscopy. It seems that the latter reduces drastically the morbidity but does not allow full visualization of the esophageal wall, a disadvantage in some circumstances. We describe a thoracoscopic dissection of the esophagus which gives a large and magnified view of the pleural cavity, of the mediastinum, and of the esophagus.


Acute acalculous cholecystitis in severely traumatized patients: a prospective sonographic study. Acute acalculous cholecystitis is a well known complication in severely traumatized patients. Existing data originate from retrospective analyses and episodic case reports. In a prospective ultrasonographic study 25 polytraumatized patients admitted to our intensive care unit between January 1, 1989, and December 31, 1989, were examined in daily intervals for this condition. Trauma scoring was performed according to the injury severity score (ISS) and polytrauma score (PTS). "Stress cholecystitis" was defined as a combination of hydrops of the gallbladder, an increased mural thickness (> 3.5 mm), and the demonstration of "sludge." We were able to demonstrate this diagnostic triad in four out of 25 patients (= 16%). As a consequence early elective cholecystectomy was done in one patient. The remaining patients were treated conservatively. The incidence of stress cholecystitis in severely traumatized patients is probably higher than figures so far published suggest. Ultrasonography is a reliable method of early detection and follow-up for this complication.


Effect of herbicides on human skin. Penetration of herbicides through the epidermis "in vitro". Penetration of herbicides GRAMOXONE and REGLONE through human epidermis was studied "in vitro". A special diffusion equipment was used and the method of Calderbank and Yuen was modified for quantitative determination of efficient components (paraquat, diquat) of both herbicides. Penetration of the chosen herbicides was different and surfactants contained in herbicides were found to play a role in penetration into the skin.


Experimental nonspecific immunostimulation by the Propionibacterium acnes vaccine. The immunostimulation effect of the selected Propionibacterium acnes strain 16073 was described. The optimal conditions for the preparation of the P. acnes vaccine and the nonspecific immunostimulation effects of the vaccine on various experimental infections were evaluated.


Hemobilia--successful treatment by angiographic embolization. Hemobilia after major liver trauma is a difficult problem to manage. We report a case of an 18-year-old male who sustained major liver trauma. Bleeding was controlled at laparotomy. Seventeen days after surgery hematemesis and intermittent bleeding from the drain occurred. Hepatic artery angiography demonstrated a pseudoaneurysm of one of the branches. Gelfoam embolization successfully controlled the bleeding. Review of the literature reveals that hemobilia has been treated by a conservative means as well as by surgery. Hepatic angiography to localize the site of bleeding and then embolization to control the hemorrhage now constitute the preferred method of treatment.


Laser-assisted removal of a foreign body from the colon. An 81-year-old woman underwent a colonoscopy because of a sigmoiditis poorly responding to conservative therapy. A rod-shaped foreign body found in the sigma proved impossible to remove conventionally. Irradiation with a low laser energy caused the foreign body to break apart, after which its extraction was straightforward. The further clinical course was uncomplicated. In this case a partial sigmoidectomy would have been indicated had the laser-supported extraction not been successful. The authors suggest that a similar procedure could be helpful in the management of foreign bodies in the esophagus.


Immunohistochemical determination of some tumour markers (blood group antigens A, B, H, T-antigen, CEA) in colonic and rectal tissue after endoscopic polypectomy. The expression of blood group antigens A, B, H, T-antigen and CEA was determined in tissue samples of polyps of the rectosigmoideum removed by endoscopic polypectomy. On average 39 months later, during colonoscopic examination bioptic samples were removed at the site of previous polypectomy and the expression of the same tumour markers as previously was determined. In contrast to literary data, the cellular expression of blood group antigens was demonstrated only in one case out of seven adenomas of the rectosigmoideum. On the other hand, cellular expression of blood group antigen B was found in 6 cases at the site of previous polypectomy and in 6 cases, this antigen was incompatible. Interpretation of these results is difficult at this time.


Effect of physical load on the platelet function and ultrastructure in patients with ischemic heart disease. The aggregability of the blood platelets and their ultrastructure were examined during the bicycle exercise test in 20 patients with ischemic heart disease and stable angina pectoris. In 8 patients with unequivocally positive exercise test a significant increment of stimulated aggregation from 58.2 (CV7%) to 71.2 (13.6%) resulted in comparison with a group of patients who did not fulfilled criteria of exercise testing. In this group the aggregability dropped from 56.0 (5%) to 38.7 (8.4%) eventually. No changes in a diameter and shape were observed during the exercise test was positive the amount of granules decreased. It is considered to be an indirect proof of the functional changes in thrombocytes during a certain rise in aggregability.


Dextrocardia and Marfan's syndrome.

Dextrocardia and Marfan's syndrome. It is described the occurrence of dextrocardia together with the congenital cyanotic heart disease in 20 year old man included in the fruste forme of the Marfan's syndrome. The diagnosis was made by the physical examination with the evidence of the arachnodactyly by the metacarpal indices and confirmed by autopsy with the following results: dextrocardia, large atrial septal defect, common ventricle, atresia of the pulmonary artery with the collateral lung perfusion from the descending aorta. There were found neither ocular manifestations, nor unambiguous manifestations of the aortic lesions. The ultrastructural examinations showed only greater accumulation of the PAS positive substances. Dextrocardia as the cardiovascular manifestation of the Marfan's syndrome has not yet been reported in the available literature.


Prognostic value of electrocardiographic stress testing compared to thallium scintigraphy. The highly sensitive and specific thallium scintigraphy is compared to loading electrocardiography with regard to the two crucial parameters: loaded angina pectoris (AP) and horizontal or descendant depression of ST segment of 1.5 mm and deeper (ST). Effectiveness of loading ecg test was determined quantitatively in terms of sensitivity, specificity, prognostic value and test accuracy. Those criteria of positivity of the loading test showed that sensitivity was higher for AP than for ST (73% and 63%, resp.), but specificity was higher for ST (100%) than for AP (79%). The result of thallium test was estimated according to AP occurrence with 80% probability for positive prognosis and 70% probability for negative prognosis; with ST, probability of positive prognosis was 100% and that of negative prognosis was 69%. Test accuracy is 75% for AP and 79% for ST. The 100% probability of positivity of thallium scintigraphy in ST depressions of 1.5 mm and deeper discredits indication of this method in this cases. In the absence of ST depressions, the origin of typical pain during the loading ECG enhances probability of positivity of thallium scintigraphy more than twofold (53 vs. 21%).


Can arachnoidal adhesions lead to hypoperfusion of the nervous tissue? The author presents the possible mechanism that probably lead to deterioration of neurological finding after changes of parenchymatous pressure of neural tissue in the course of lumbar puncture, ventriculography or some neurosurgical interventions. The possible cause are arachnoidal adhesions impeding free circulation of cerebrospinal fluid. "Trapped" cerebrospinal fluid leads to the ischemia of the neural tissue because of relative increasing of cerebrospinal fluid pressure.


Radio-chemotherapy in the treatment of advanced cancer. Tests in vitro and first clinical studies proved a radiosensitizing effect of cisplatin. In our study 40 patients with advanced resistant cancer of head, neck, lungs and rectum were treated by conventional radiotherapy and cisplatin. The drug was administrated in 10 mg after each irradiation. The tumor dose varied between 30-50 Gy in 3-5 weeks, within the total dose cisplatin 150-250 mg. In more than 70% of cases remarkable retreat of tumors, in some cases even a complete regression, were observed. Adverse reactions and toxicity often associated with administration of platin were very mild, so that even patients in rather poor physical condition could have been treated. Having performed no special hydratation serious nephrotoxicity was never observed. The potentiation of radiation by cisplatin can be therefore considered a relatively harmless treatment of inoperable advanced cancers useful especially in cases where other forms of palliative treatment have been exhausted or not feasible.


Long-term prognosis of prehepatic portal hypertension. The study is a report of the long-term follow-up of 53 patients with prehepatic portal hypertension, their life and work conditions. The average time of the follow-up was 25 years. It was concluded, that the long-term prognosis is derived from the development of the disease, its recognition, the used therapy and from the function of the patient's liver. From the battery of therapeutic modalities a very good experience has been achieved with the endoscopic treatment of bleeding varices. The portosystemic shunt is a pathophysiologically well justified but selective procedure, which is indicated in about 20% of bleeding patients. The long-term prognosis of the disease was found good in 75% of patients.


Cryosurgery in neovascular glaucoma.

Cryosurgery in neovascular glaucoma. Cryocoagulation was used to treat 21 eyes with neovascular glaucoma. In 6 eyes, cyclocryocoagulation was used as an independent method and in 15 eyes cyclocryocoagulation and following transscleral panretinal cryocoagulation in one session. The author has followed up the postoperative development of the intraocular pressure, pain in the eye, rubeosis iridis, and the central visual acuity. Markedly better results were achieved by the author by using the combined cryosurgical method. The author assumes the cause of the unsatisfactory final central visual acuity to be the rather late treatment of the neovascular glaucoma-most of the patients were operated on 2 to 3 weeks after the acute increase of the intraocular pressure. A good final central visual acuity was achieved in patients who were operated on immediately after the acute increase of the intraocular pressure. After the use of the combined cryosurgical intervention, we noted in all the patients: within 3 days normalization of the intraocular pressure in all the patients, on the first postoperative day a marked relief from pain in all the patients and, also in all the patients, a marked regression of rubeosis iridis within 6 weeks after operation.


Neovascular glaucoma and intraocular pressure: II. Reduction of intraocular pressure--our 5-year experience. The paper reports the results obtained with reduction of intraocular pressure in 38 eyes of 38 patients with acute neovascular glaucoma. Cyclocryocoagulation alone was made in 12 eyes, 26 eyes were treated by transscleral panretinal cryocoagulation combined with cyclocryocoagulation. In eyes treated by cyclocryocoagulation alone the intraocular pressure less than 26 mmHg was on 5th day after operation in 41.6%, on 10th day in 66.7%. However, this effect was transient in one-third of the patients, and no effect was found in one-third of eyes. In eyes treated by transscleral panretinal cryocoagulation combined with cyclocryocoagulation, the intraocular pressure less than 26 mmHg by 3 days after operation was recorded in 50%, by 10 days in 76.9%. Postoperative hypotension developed in 27%. It is concluded that intraocular pressure in neovascular glaucoma is better managed by transscleral panretinal cryocoagulation with concurrent cyclocryocoagulation than by cyclocryocoagulation alone.


Preliminary experimental experiences with xenotransplantations. In our xenotransplantation experiments has been a major aim to induce specific tolerance. The results from the meeting of the donor's and the recipient's immunocompetent systems already in the period of embryonic development and/or the influence of methylprednisolone are described.