Biomedical subjects
Publications and source records attributed to H Lacombe.
The 12 intracochlear electrode placement is greatly facilitated by using our electrode-bearer which is introduced through the round window via a posterior tympanotomy approach. However, partial or complete ossification of the cochlea may oblige us to use again our first technique of one-by-one electrode placement, using Silastic pieces through 12 cochlear fenestrations. The microconnectors and the receptor are also described.
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Most cases of total deafness are due to destruction of Corti's organ leaving some of the auditory nerve fibres untouched. When these fibres are electrically stimulated the patient may perceive sounds the pitch of which depends upon the location of the stimulated nerve-endings along the cochlea. An intracochlear electronic device with 12 electrodes implanted in different areas and driven from outside by a portable radiofrequency emitter provides the patient with new hearing and some speech intelligibility. After several months' training words and sentences can be recognized without having recourse to lip reading. Performances depend upon a variety of factors, many of which can be determined prior to implantation. The long-term results obtained in 54 totally deaf patients are reported.
Clinical results obtained with the multichannel cochlear implant are described in 48 cases of total deafness (27 cases of prelingual and 21 cases of postlingual deafness). The tolerance for implanted material and the survival of the electrode-nerve interface have not yet been altered after more than 5 years. After some months of training the patients, the percentages of phoneme-, word-, and sentence-recognition vary from one patient to another, but depend approximately on the value of the threshold level of the round-window stimulation test, and the degree of socialization of each patient. These results suggest that the multichannel cochlear implant may now be considered as a useful tool in the rehabilitation of totally deaf persons.
In about a third of cases transcutaneous stimulation during a few minute by mean of electric square waves substantially improves severe tinnitus. This very simple treatment must be frequently repeated two or three times to be successful. If a notable improvement is not obtained after two or three attempts, failure must be considered as certain. The parameters of these stimulation are described and clinical results are reported. The mechanism of these improvement is uncertain.
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Multiple electrode cochlear implants were employed in 34 patients with total deafness (25 cases of acquired deafness of an adult age, and 22 cases of congenital or neonatal deafness). Complications encountered initially (eardrum perforation, receiver breakdown) are no longer observed, but emphasis has also to be placed on the reliability of the electrode-nerve interface, which remained unaltered after a follow-up period of nearly five years. The advantages of the method are that it enables frequency discrimination, followed by that of phonemes and finally words and phrases, without the need for up-reading, results being variable from one case to another. Results are dependent on the effectiveness of the electrode-nerve interface and the intellectual development of the patient. Only measurable objective results are reported.
Osteoid osteoma can be distinguished from compact osteoma by the presence in its centre of a cavity (nidus) which is distinctly visible on tomography or CT scans. Contrary to osteomas, osteoid osteomas are rarely found in facial sinuses. The authors report on one exceptional case located in the ethmoid bone and review the clinical and anatomicopathological features of this benign tumour.
The authors report a series of 37 cases presenting with tuberculosis of the mucosa of the upper naso-pharynx. The localization broke down as: 5 cases of tuberculosis of naso-sinuses, 6 of the buccal cavity, 3 of the cavum, 10 of the oro-pharynx, 1 of the hypopharynx, and 12 of the larynx. -- The male-female ratio was unequal (2:1 M:F) -- The mean age was 52.5 years -- Most patients were European. The 3 rhinopharyngeal cases were in North Africans. -- Macroscopically the lesions were of a malignant character in 70%. -- There was palpable lymphadenopathy in 56% of patients. The most commonly involved chain was the jugulo-carotid, especially the subdigastric group. -- There was tuberculosis in the entourage in 20/37 cases. CXR was normal in 17 cases. On hospitalisation active T.b. was discovered in 15 cases. -- Biopsy confirmed a definitive diagnosis in every case. -- All patients were treated medically. There were no cases of resistant organisms. The results were excellent.
The authors report the results of 297 fibroscopies in 69 patients suffering from laryngotracheal stenosis. These examinations were carried out either before treatment or for follow-up purposes. The majority of patients had undergone respiratory intensive therapy. The underlying reason for this intensive therapy was analysed, as well as the techniques used : intubation 26 %, tracheotomy 33,5 %, intubation followed by tracheotomy 40 %. Results of fibroscopy before treatment (111) are described, emphasizing the fact that this fibroscopy was adequate in the great majority of cases (96 %) to reach a decision as to wether surgery was necessary or not, and this even though certain patients had suffered severe respiratory failure. Follow-up fibroscopies (185) were useful in all cases for aspiration of the patient and observation of the suture. In 17 cases, the opportunity was taken to remove a polyp and in 10 cases removal of a suture. Finally, the authors emphasize the safety of this method of investigation (4 % of untoward incidents) which they feel to be necessary and adequate in the evaluation of laryngotracheal stenosis.,
The authors describe the rare but essential indication for tonsillectomy in the child based upon 4 personal cases of pseudolaryngeal dyspnoea during sleep due to prolapse of the tonsils in the hypopharynx. They indicate the grave cerebral and cardiac consequences which could result from neglect of this symptom which at first sight has the characteristics of ordinary snoring. Paediatricians, anaesthetists and laryngologists are equally concerned by this alveolar hypoventilation of high obstructive origin.
BACKGROUND: Brain heterotopia can be reflected in disturbances of the oropharynx during the neonatal period, such as acute upper airway obstruction. The main differential diagnosis is encephalocele, which must be recognized before undertaking any surgical procedure. CASE REPORT: A boy, aged 5 days, with a cleft palate and bifid uvula, was admitted for respiratory distress. The distress initially occurred during bottle-feeding, but later became permanent. A solid mass, seemingly implanted in the superior wall of the pharynx, was successfully removed by forceps. A later CT scan showed the absence of any defect in the cribriform plate, thus excluding diagnosis of encephalocele. Histological, examination of the mass showed glial tissue without neurons. CONCLUSION: The presence of a pharyngeal mass in a newborn signals three possibilities: teratoma, heterotopic brain tissue or encephalocele. Encephalocele must by ruled out by a preoperative CT scan with a water soluble contrast agent in order to avoid CSF leakage and meningitis. Respiratory distress should be treated by oral endotracheal intubation to allow time for CT scan investigation.
The authors report a case of thyroid metastasis of a rectal carcinoma 9 years after excision of the primary tumour. They study the prevalence of thyroid secondary localisations of the chief primary tumours responsible, the time before appearance of the metastasis, and clinical and histological features on the basis of cases reported in the literature. They then describe the pathogenic factors and criteria in prognosis which is always grave, as a result of the dissemination of metastases.