Short- and long-lasting tinnitus relief induced by transcranial direct current stimulation

A significant proportion of the population suffers from tinnitus, a bothersome auditory phantom perception that can severely alter the quality of life. Numerous experimental studies suggests that a maladaptive plasticity of the auditory and limbic cortical areas may underlie tinnitus. Accordingly, repetitive transcranial magnetic stimulation (rTMS) has been repeatedly used with success to reduce tinnitus intensity. The potential of transcranial direct current stimulation (tDCS), another promising method of noninvasive brain stimulation, to relieve tinnitus has not been explored systematically. In a double-blind, placebo-controlled and balanced order design, 20 patients suffering from chronic untreatable tinnitus were submitted to 20 minutes of 1 mA anodal, cathodal and sham tDCS targeting the left temporoparietal area. The primary outcome measure was a change in tinnitus intensity or discomfort assessed with a Visual Analogic Scale (VAS) change-scale immediately after tDCS and 1 hour later. Compared to sham tDCS, anodal tDCS significantly reduced tinnitus intensity immediately after stimulation; whereas cathodal tDCS failed to do so. The variances of the tinnitus intensity and discomfort VAS change-scales increased dramatically after anodal and cathodal tDCS, whereas they remained virtually unchanged after sham tDCS. Moreover, several patients unexpectedly reported longer-lasting effects (at least several days) such as tinnitus improvement, worsening, or changes in tinnitus features, more frequently after real than sham tDCS. Anodal tDCS is a promising therapeutic tool for modulating tinnitus perception. Moreover, both anodal and cathodal tDCS seem able to alter tinnitus perception and could, thus, be used to trigger plastic changes

La controverse de la dépression en Afrique noire: etude des causes culturelles.

Epidemiological data about depression in Africa are contradictory. Until the fifties, an almost absence of depression was reported in the studied population and from the fifties till today, a prevalence comparable to these of others continents is found. The authors discussed methodological and technical grounds susceptible to explain this controversy, with a special focus on cultural factors according to the parental and way of thinking of the Kongos in Zaïre

Craniofacial fibrous dysplasia: A 10-case series

International audienceObjective: Fibrous dysplasia of bone is a rare sporadic benign congenital condition in which normal cancellous bone is replaced by fibro-osseous tissue with immature osteogenesis. Sarcomatous transformation is exceptional. Lesions may involve one bone (monostotic) or several (polyostotic). Fibrous dysplasia may be associated with cafe-au-lait skin macules and endocrinopathy in McCune-Albright syndrome, or with myxoma in Mazabraud's syndrome. Methods: We report ten cases of patients followed up for craniofacial fibrous dysplasia in our center between 2010 and 2015. Results: Mean age was 43 years (range, 10-72 years). Clinical symptoms comprised headache (n = 3) and sensorineural disorder: recurrent anterior uveitis (n = 1), visual acuity loss, epiphora and vestibular syndrome (n = 1), and hearing loss (n = 1). All cases were monostotic. The sphenoid bone was most commonly involved (n = 5), followed by the ethmoid (n = 1), frontal (n = 1), fronto-ethmoid (n = 1), temporal (n = 1) and fronto-ethmoido-sphenoid (n = 1) bones. Five patients were treated with intravenous pamidronate, a bisphosphonate: evolution was favorable for 3 of them at 1-6 months after treatment initiation, with resolution of headache or vestibular syndrome; the other 2 patients were stable. Two patients were operated on. Conclusion: Diagnosis of craniofacial fibrous dysplasia should be considered in case of headache, neuralgia, sensory disorder, functional disorder or infectious ENT complications. A medico-surgical approach is useful for these patients

Sinonasal mucosal melanomas

SummaryObjectivesSinonasal mucosal melanomas account for approximately 1% of all melanomas. These tumors are particularly aggressive, with a recurrence rate between 37 and 54% and a 5-year survival rate between 20 and 46%. Metastases are frequent. The main objective of this study was to analyze all of our cases of sinonasal mucosal melanomas and determine any prognostic factors.Patients and methodsAll our cases of sinonasal mucosal melanoma over a period of 10 years were included. Ten cases were analyzed. The mean age was 71 years (range: 61–85 years) for seven women and three men. The clinical, radiological, anatomopathological, and surgical data as well as the characteristics of disease progression were analyzed. These data were compared to those reported in the literature.ResultsThe mean follow-up was 36.3 months (range: 2–96 months). The 5-year overall survival was 40%. Seven patients developed local recurrences after a mean follow-up of 16 months (range: 2–27 months) with associated metastases in three cases. Analysis of the prognostic factors showed that tumors classified as T1 and limited to the nasal fossae had a better prognosis.ConclusionSinonasal mucosal melanomas are rare tumors with a high mortality rate. Treatment of these tumors requires extensive surgical treatment associated with external radiotherapy

Les atrésies choanales: à propos d'une série rétrospective de 39 cas.

[Choanal atresia: a retrospective study of 39 cases]. The purpose of this study was to investigate the clinical characteristics and the surgical management in patients with choanal atresia. We performed a retrospective study at the Saint-Luc University hospital, Brussels, between January 1988 and June 2000. Surgical corrections were performed using different approach (transnasal endoscopic, transpalatal) and different instrumentations (urethral sounds, laser nd-YAG, laser CO2, microdebrider). Portex endotracheal tubes were inserted as nasal stents in the vast majority of the patients with bilateral choanal atresia. Thirty-nine children with choanal atresia (22 unilateral and 17 bilateral) (9: M, 30: F) were studied. 38 of them were surgically managed. Based on clinical inspection and On CT-Scan, choanal atresia was defined as membranous for 4 patients, osseous for 6 and mixte for 29. Associated congenital anomalies were found in 22.7% of unilateral and in 70.5% of bilateral choanal atresia (Total: 43.5%). Of those children with bilateral choanal atresia, 75% were asymptomatic after four surgical procedures. In children with unilateral choanal atresia, 45% were asymptomatic after one surgical correction and 100% after three surgical corrections. Four patients were managed using an endoscopic endonasal approach with the microdebrider and showed no evidence of recurrence. Outcome analyses of factors that may influence the results of surgery are difficult to establish since many different surgical options were taken during this period. However, it seems that bilateral choanal atresia is associated with more surgical corrections before achieving a normal nasal breathing than unilateral choanal atresia. After this review, our current strategy regarding the choanal atresia will be to begin with the endoscopic endonasal approach using the microdebrider (stents if bilateral) and to propose the transpalatal approach in case of recurrence

Condorcet

Il y a deux cents ans, le 29 mars 1794, on retrouvait Condorcet sans vie dans la prison de Bourg-la-Reine : occasion pour le groupe de travail sur Condorcet de se joindre aux célébrations nationales et de présenter un état actuel des recherches menées depuis 1988, date du premier colloque consacré à l’un des grands hommes du XVIIIe siècle. Outre des aperçus sur la biographie, chantier toujours ouvert car bien des ignorances subsistent, on trouvera, groupés sous deux grands thèmes – « Sciences et instruction », présenté par Michèle Crampe-Casnabet et « La Révolution et la République », introduit par François Hincker – une vingtaine d’études apportant des éléments nouveaux à notre connaissance des œuvres et des activités de Condorcet. Les interventions et discussions lors de la table ronde : « Éditer Condorcet aujourd’hui » terminent ce recueil de textes où les disciplines se complètent et s’unissent pour une meilleure approche de la complexité