Comparison between caloric and canal impulse rotatory test.

It has been suggested that the rotatory test using videonystagmoscopy can also be applied for identification of vestibular canal paresis. In this study, we test this hypothesis by comparing the results of a canal impulse rotatory test with those of the caloric test using the method described by Freyss. Our study indicates that only in 38% of all tested patients, the same results between the two tests have been obtained.

Comparison between caloric and canal impulse rotatory test.

It has been suggested that the rotatory test using videosnystagmoscopy can also be applied for identification of vestibular canal paresis. In this study, we test this hypothesis by comparing the results of a canal impulse rotatory test with those of the caloric test using the method described by Freyss. Our study indicates that only in 38% of all tested patients, the same results between the two tests have been obtained.

[Giant pleomorphic adenoma of the parotid gland: a case report and review of the literature].

We report the case history of a 72-year-old patient who had a giant parotid adenoma that developed over 12 years. Worrisome clinical signs started to develop when the tumor had reached the size of 50 cm and a weight of 2.6 kg.

[Atelectasis of the maxillary sinus. Analysis of progression stages. Apropos of 4 cases].

We analyzed atelectasic processes occurring in the maxillary sinus. Several publications in the literature have tempted to analyze the pathogenesis. Clinically the processes are often silent and only revealed when the major opthalmological complication, enophthalmia, becomes patent.

[Use of endoscopy in pituitary surgery].

Endoscopy has changed many of surgical procedures concerning nasal and paranasal cavities. It has been proposed for transnasal removal of pituitary adenomas. The authors report their experience concerning four pituitary macroadenomas operated with the neurosurgical team of Sainte-Anne hospital.

[Atypical involvement of undifferentiated carcinomas of the nasopharyngeal type. Apropos of 3 cases].

We report 3 cases of undifferentiated carcinomas of nasopharyngeal type (UCNT) found in unusual sites and compare them with histologically identical tumors found in the nasopharynx. Using viral serology and viral marquers found in the tumor cells, we looked for a link with the Epstein Barr Virus (EBV) which exists in the nasopharyngeal site. It appears that UCNT found in unusual sites have a poorer prognostic than the same nasopharyngeal tumors; no link was found with EBV.

[Apropos of 2 cases of mucocele with major ophthalmologic complications treated by endoscopic endonasal surgery].

We report two cases of frontal and ethmoidal mucocele revealed by severe ophtalmologic complications and present the clinical data and computed tomography and magnetic resonance imaging results together with the treatment. The surgical approach and technique are discussed. Recovery of ophtalmologic deficiency was excellent.

Neoadjuvant chemotherapy with carboplatin/5-fluorouracil in head and neck cancer.

In a prospective, randomized, multicenter study, neoadjuvant chemotherapy (CT) with carboplatin and 5-fluorouracil (5-FU) followed by locoregional treatment (LRT) was compared with locoregional treatment alone in the treatment of patients with head and neck cancer. This study, which includes 324 patients, was conducted from January 1988 to July 1991. The aim of this study was to evaluate the impact of the carboplatin/5-FU regimen both on the incidence of mutilating surgery and on the survival rate.

Neoadjuvant combination of carboplatin and 5-FU in head and neck cancer: a randomized study.

A prospective, randomized, multicenter study of patients with oropharyngeal and pharyngolaryngeal tumors compared locoregional treatment alone with neoadjuvant chemotherapy with carboplatin/5-fluorouracil (5-FU) followed by locoregional treatment. The aim of the study was to evaluate the role of chemotherapy on survival and on the need for mutilating surgery. Since 1988, 219 patients (105 with oropharyngeal and 114 with pharyngolaryngeal tumors) have entered the study.

Randomized study of 5 fluorouracil and cis platin as neoadjuvant therapy in head and neck cancer: a preliminary report.

A randomized prospective study of 5 fluorouracil (5-FU) and Cis platin preceding definitive local treatment for squamous cell carcinoma of the head and neck region was initiated in September 1986. Seventy-five patients were stratified by site (oral cavity-12, oropharynx-28, larynx-16, hypopharynx-19), and by Stage (Stage II-20, Stage III-43, Stage IV-12) and randomized to receive definitive local treatment (surgery and post-operative radiation or radiation alone) or chemotherapy followed by definitive local treatment. Chemotherapy consisted of three cycles of 120 hr 5-FU infusion 1 g/m2/day plus Cis platin 100 mg/m2 on day 1 on each cycle.

[Evaluation of cochleovestibular sequelae of craniocervical injuries].

After reviewing the elements of cochleovestibular assessment designed to demonstrate objective disorders, the authors try to evaluate the principal sequelae of cranio-cervical trauma.

[Medicolegal aspects of esthetic surgery].

The particular features of the contractual agreement binding patient and plastic surgeon are recalled. The obligation of the result appears to be distorted in the course of jurisprudence. The severity of the judgements means that great care must be taken in the management before, during and after the operation (study of the patient's motivations, informed consent, iconographic survey, technical equipment, postoperative care,.

[Severe complications of tonsillectomy].

The authors report 15 fatal complications after tonsillectomy based on the claims made between 1976 and 1986 to three insurance companies specialised in medical defence. The advantages and disadvantages of tonsillectomy with intubation and with the Sluder apparatus are recalled. Analysis of the legal proceedings of these cases reveals the principal points of jurisprudence: the importance of the preoperative assessment, pre-anaesthetic examination and informed consent.

[Severe iatrogenic complications of surgery of the middle ear and their medicolegal aspects].

The authors analysed 62 cases of severe iatrogenic complications occurring after middle ear surgery (death, cophosis, PFP) between 1976 and 1986. They compared their results to those of a similar study conducted between 1950 and 1975. They observed an increase in the number of legal proceedings, probably due more to the increased demand by patients than to a higher incidence of these complications.

[Iatrogenic complications of nasal sinuses surgery].

In order to illustrate the necessity of obtaining informed consent before any form of nasal sinus surgery, the authors present 23 cases of insurance claims filed between 1976 and 1986 in private practice. Ten serious complications (6 cases of blindness, 4 fractures of the anterior cranial (fossa) and eight cases of oculomotor nerve paralysis are reported. The legal proceedings demonstrate the real risks of radical surgery to the sinuses, as well as intranasal ethmoidectomy and rhinoplasties.

[Drug ototoxicity. Medicolegal aspects].

Drug ototoxicity is a preoccupying iatrogenic complication. Experimental studies over recent years, in particular a pharmacokinetic study of the elimination of aminoglycosides, have enabled the authors to define rules of prescription for parenteral aminoglycosides designed to reduce to a minimum the risk associated with their use. New aminoglycosides such as Netromycin appear to be associated with reduced toxicity.

[Postoperative iatrogenic lesions of the external branch of the accessory spinal nerve].

Iatrogenic lesions of the spinal nerve are rare and generally occur during cervicotomy for aetiological assessment of adenopathy. The spinal nerve is essentially damaged at two sites: the supraclavicular fossa (where the nerve is very superficial) and in the antero-lateral triangle of the neck (where the nerve approaches the sterno-cleido-mastoid muscle). The lesion of the spinal nerve essentially presents in the form of paralysis of the trapezius; which should be examined systematically postoperatively and at subsequent consultations, as the clinical signs may only develop after a certain latency period.

[Several principles of jurisprudence on the medicosurgical error].

When medical responsibility is questioned in a court, the fault notion is more often the center of interest of the debates. The fault reproached to the doctors are of different kinds: clumsiness, imprudence, error in the diagnosis, surpassing of their competences, dereliction of duty to inform the patient of the risks or on the medical evident consequences of a surgical intervention etc. The principles which have motivated the decisions dispensed by civil, administrative and penal jurisdictions are exposed in some of these cases.