[Auditory and vestibular findings in Fabry disease: a study of 25 patients]

PURPOSE

Fabry disease (FD, OMIM 301500) is an X-linked lysosomal storage disorder due to deficient activity of the enzyme alpha-galactosidase A. Males and females exhibit severe organ involvement. The high incidence of otological symptoms was recently reported.

PATIENTS AND METHODS

Monocentric and retrospective study of twenty-five patients with FD (13 families; seven males and 18 females). The patients underwent audiological assessment before initiation and during enzyme replacement therapy. We also analysed neurologic heart and kidney status.

RESULTS

Twenty patients (80%; 13 females and seven males) complained of otologic symptoms. Audiological evaluation showed a sensorineural hearing loss in 17 patients, bilateral in 16 out of them. Vestibular examination showed a functional impairment in two patients (one female, one male). Correlations were found between hearing loss and either kidney disease (73,3%), neurological complications (100%) and cardiomyopathy (80%). Fourteen patients (56%; seven females, seven males) received enzyme replacement therapy. Improvement or stabilization of the audiological evaluation was reported in seven patients, whereas worsening was observed in three patients.

CONCLUSION

This study confirms the high frequency of audiological involvements in females and males with FD. Our analysis suggests that the frequency of hearing loss is increased in the presence of renal or neurologic involvement or cardiomyopathy. There is no clinically significant efficacy of enzyme replacement therapy on hearing function. Although the pathophysiology remains unknown, a vascular mechanism responsible of the inner ear involvement seems to be privileged.

Endoscopic endonasal skull base surgery

Skull base surgery has been transformed by the development of endoscopic techniques. Endoscopic procedures were first used for pituitary surgery and were then gradually extended to other regions. A wide range of diseases are now accessible to endoscopic skull base surgery. The major advantage of the endoscopic endonasal approach is that it provides direct anatomical access to a large number of intracranial and paranasal sinus lesions, avoiding the sequelae of a skin incision, facial bone flap or craniotomy, and brain retraction, which is inevitable with conventional neurosurgical incisions, resulting in decreased morbidity and mortality and, indirectly, decreased length of hospital stay and management costs. Moreover, the increasing number of publications in this field illustrates the growing interest in these techniques. This paper provides a review of endoscopic skull base surgery. The indications and general principles of endoscopic endonasal skull base surgery are described. Progress in exposure and especially reconstruction techniques is described. This progress now allows more extensive resections, while maintaining acceptable morbidity. The limits of this surgery are also discussed; in particular, although this surgery is often described as "minimally invasive", it is not completely devoid of morbidity.

Pulsatile tinnitus and venous cerebral thrombosis: report of a case and literature review

BACKGROUND

Pulsatile tinnitus can be caused by fatal vascular disease. The authors reported a very rare case of pulsatile tinnitus that revealed a sigmoid sinus thrombosis.

CASE REPORT

A 43-years-old man was referred to our department for a left pulsatile tinnitus that had lasted for 2 years. The CT angiography and the MRI retrieved a sigmoid sinus thrombosis that was responsible for emissary vein ectasis. The biological check up was normal. The tinnitus disappeared after two months of anticoagulation.

CONCLUSIONS

Ten cases of pulsatile tinnitus associated with cerebral venous thrombosis have been published in the literature. In most of cases, pulsatile tinnitus was the only symptom. Few cases of headache, hearing loss and vertigo were described in association with the tinnitus. In 5 cases a cause was retrieved (hemostasis troubles, head injury and dural arteriovenous fistulas). Full recovery can be obtained for nearly all cases as a result of anticoagulation.

[Complications from sinonasal surgery]

Endoscopic sinonasal surgery is the main procedure in sinonasal pathology. Complications are rare but potentially severe given the close relationship between the nasal cavities and sinuses and the orbit, skull base and carotid arteries. The different types of surgeries along with the mechanisms of injury, presenting signs and symptoms, and imaging features of the different surgical complications will be reviewed. We will also review the anatomical variants increasing the surgical risk that radiologists should describe on preoperative imaging studies.

[Primary and secondary prevention for women at high risk for breast cancer]

Many factors determine a woman's risk of breast cancer; some genetic are related to family history, others are based on personal factors such reproductive and medical history. A high-risk woman must benefit of a specific screening regimen including breast examination, mammography, ultrasonography and contrast material-enhanced magnetic resonance. But she can also benefit of chemo prevention or/and risk-reducing surgery such bilateral prophylactic salpingo-oophorectomy and bilateral prophylactic mastectomy.

[Breast cancer in Belgium: why are we the first in Europe?]

Breast cancer incidence in Belgium is on the top of European countries, with 9.697 new cases in 2008 and 106/100.000 women/year. The explanation of this high incidence in our country is probably the accumulation of risk factors (many of them are linked to lifestyle), and the impact of screening and registration of cases. The relative impact of each of theses factors is less clear because we don't have powerful statistical studies. Belgium is slightly above the European mean for breast cancer mortality, with 19,4/100.000 women/year and an all stages 15-year survival of 75%. Breast cancers are responsible for around 3% of all-cause mortality in Belgian women. This article discusses the causes of this high Belgian incidence and of current decrease of incidence in western countries, and reviews known and less known risk factors of breast cancers, with a special focus on menopause hormonal treatments.

[Hormone therapy for breast cancer]

Following Beatson's publications in 1896, various modalities of endocrine therapy applied to breast cancer have been developed. Endocrine treatment has greatly contributed to the improvement of the disease's prognosis. Tamoxifen has established itself as a first choice adjuvant therapy for patients with tumors expressing hormone receptors. Over the last decade, third generation aromatase inhibitors have demonstrated their efficacy amongst menopausal patients, alone or in combination with tamoxifen. Efficacy of these medications is dependent on patient's compliance. This article proposes a synthesis of the main knowledges available in the field of breast cancer endocrine therapy.

Methodology of the biological risk classification of animal pathogens in Belgium

Since many micro-organisms are a biological hazard, they have been categorised into risk groups by many countries and organisations and classification lists have been developed. Current classification systems rely on criteria defined by the World Health Organization, which cover the severity of the disease the micro-organism might cause, its ability to spread and the availability of prophylaxis or efficient treatment. Animal pathogens are classified according to the definitions of the World Organisation for Animal Health, which also consider economic aspects of disease. In Europe, classification is often directly linked to containment measures. The Belgian classification system, however, only considers the inherent characteristics of the micro-organism, not its use, making the risk classification independent of containment measures. A common classification list for human and animal pathogens has been developed in Belgium using as comprehensive an approach as possible. The evolution of scientific knowledge will demand regular updating of classification lists. This paper describes the Belgian risk classification system and the methodology that was used for its peer-reviewed revision (with a focus on animal pathogens).

[Reverse phonation: pathological and therapeutic aspects. Study of a clinical case]

If the phenomenon of reverse voice is well known as a transitional phenomenon occurring during normal phonation, it is less known as a pathological entity. In this connection it seemed interesting to get a fix on this type of phonation. We will illustrate our discussion with one of our patients for which the reverse voice was continuously used instead of the usual blown voice. We will present all clinical and functional investigations conducted with this patient. We also focused on the particular psycho-dysfunctional context this patient was struggling with. Instrumental investigations concerning the fundamental frequency and the laryngeal aspect allowed us to find the same results as the literature ones. We will then talk about speech therapy, its difficulties and the means proposed to patient in order for him to accept his blown exhalation voice.