[Parapharyngeal chemodectomas. Apropos of 2 case reports].
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Biomedical subjects
Publications and source records attributed to M Wayoff.
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The classification of types of vasomotor rhinitis remains controversial. Too frequently, the presence of salvoes of sneezing leads to a diagnosis of allergy. The authors point out the only relatively accuracy of skin tests and show that marked local histamine liberation may occur in the absence of allergy. They have perfected a battery of vasomotor tests using nicotinic acid, histamine, 48/80 and acetylcholine. On this basis, they propose a pragmatic clinical classification of types of vasomotor rhinitis. Underlying tendency to tetany is the most common aetiology, going hand in hand with increased histamine sensitivity.
An ectopic thyroïd gland causing hypothyroïdism was found in a 7 years old girl. The treatment was stopped six months later, nevertheless the growth rate was not affected. Sudden mechanical airway obstruction caused by the lingual goiter needed at the age of 16 years a surgical management. A thyröid nodule auto-transplantation was performed with a rather good success. Special comments about some physiopathological aspects of this original case.
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Cases of deafness due to Paget's disease can be separated into two types : (1) deafness of a mainly mixed type in which progressive aggravation occurs particularly in the inner ear, and (2) perceptional deafness which progresses without involvement of the transmission apparatus. Among 35 hospitalized patients with Paget's disease, 21 of whom suffered cranial involvement, 18 cases of deafness related to the bone disease were discovered by means of systematic examinations. The deafness was of the mixed type in 11 cases and of the perceptional type in the other 7. Of the 11 patients with the mixed type of deafness with an ankylosis syndrome of the ossicles, 3 were operated upon : one of them underwent an operation to mobilize the stapes, and the two others underwent total stapedectomy followed by venous interposition and the positioning of a Teflon piston. The long-term results were frankly disappointing and did not suggest that these attempts at surgical treatment should be followed up. Calcitonin was employed in 9 patients (6 with mixed deafness and 3 with perception type deafness), with comparative audiograms in 5 cases, and was also not very effective : this lack of effect was a result of the long duration of the Paget's disease and of the deafness in the patients treated. The value of hormonal treatment in cases of deafness associated with Paget's disease will probably be in the prevention of this complication.
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Jugulo-tympanic chemodectomas are usually treated by means of surgical ablation and radiotherapy, these two techniques being used either in isolation or association. The recent advent of embolization, which has undergone considerable development in the field of vasular neuro-radiology within the last few years, open up new therapeutic possibilities for these vascular tumours. A study of three personal cases, followed up after a substantial lapse of time, gives a good idea of the importance of embolization in the therapeutic armoury. In fact, although embolization used alone can cause a reduction in functional symptomatology and even and objective clinical improvement (disappearance of some lesions of the cranial pairs, for exemple), it is regularly followed by repermeabilization of the various pediculi. Embolization used in isolation should therefore be reserved for patients who are inoperable for reasons for extension or associated deficiencies. Embolization appears to be of value before the operation as it results in less haemorrhage and may also be of value before radiotherapy.