Obstructive sleep apnea (OSA) results from a combination of several factors leading to the obstruction of the upper respiratory tract (URT). OSA represents a systemic pathophysiological entity and leads to many comorbidities such as hypertension, coronary ischemia, and stroke. Patients with this pathophysiological entity experience also an increased risk of postoperative complications. Obesity is certainly the main cause of developing OSA. However, many other predisposing factors influence the genesis of obstructive apnea. It is important to understand the complexity of the interactions between predisposing factors to understand the relationship between weight loss following obesity surgery and the improvement in the severity of OSA. In this narrative review, we expose the seven major categories of predisposing factors that interact to generate obstructive apneas in patients, namely the anatomic abnormalities of the URT, the mechanical and the metabolic responses of the upper airway musculature, the loop gain, the arousal threshold, and the hormonal abnormalities. The genesis of apnea is the result of a complex dynamic interaction between the anatomical risk factors and the compensatory neuromuscular reflexes. All of these points are integrally part of the perioperative care of the obese patients. Finally, we will discuss different options for weight reduction.

The company NEXCIS has developed a 2-step process based on the electrodeposition (ED) of a metallic precursor subsequently annealed to produce Cu(In,Ga)(S,Se) 2 absorbers (CIGS). The metallic precursor is electrodeposited on a highly conductive Mo-based back-contact on glass. It is subsequently reacted in an atmospheric pressure thermal treatment unit under chalcogens atmosphere to produce CIGS cells up to 17.3% externally certified and 60×120cm 2 modules up to 14.0% aperture area efficiency. These figures demonstrate that a low-cost electrodeposition-based process can successfully produce modules with efficiencies close to the ones obtained from vacuum-based processes such as coevaporation or 2-step Sputtering followed by annealing in hydride gases. Still, to be proven acceptable for production, the developed process must also demonstrate that it is robust and capable of repeatedly generating the same output. In this work, statistical process control techniques are used on more than one hundred 60×120cm 2 plates to calculate the process capability and show that the ED-based process is well suited for a CIGS production line.

Enregistrer les actes essentiels du soin dietetique : Evaluation Diagnostic (etat nutritionnel) Intervention Notification Suivi Indicateurs proposes au SPF: Le premier indicateur qualite est le nombre de determinations d’etat nutritionnel rapporte au nombre de prises en charge (PEC) initiales. Les indicateurs suivants concernent chaque PEC realisee, il s’agit du nombre de: • Conseils dietetiques personnalises apportes, • Propositions ou mise en places d’EN, • Propositions de PN. Le dernier indicateur est un indicateur du suivi du patient, il s’agit du nombre de PEC de suivi parmi l’ensemble des PEC.

Many of us take our sense of taste for granted, but a taste disorder can have a negative effect on your health and quality of life. If you are having a problem with your sense of taste, you are not alone. More than 200,000 people visit a doctor each year for problems with their ability to taste or smell. Scientists believe that up to 15 percent of adults might have a taste or smell problem, but many don’t seek a doctor’s help.

La cachexie cancéreuse est rarement identifiée, évaluée et activement prise en charge (1). Elle se caractérise par une perte de masse maigre, qui peut être ralentie, voir même contrecarrée par une intervention nutritionnelle, multimo-dale, adaptée et précoce (1–2). Le but de l’étude est de valider la pratique diagnostique nutritionnelle des diététiciens du Centre du Cancer des Cliniques Universitaires St. LUC (UCL). Matériel et méthodes. -Nous avons étudié l’accord entre la détermination de l’état nutritionnel après un entretien diététique et après l’évaluation nutritionnelle de référence en oncologie, le Patient-Generated Subjective Global Assessment (PG-SGA) (3). L’étude a été réalisée au Centre de Traitement Ambulatoire, au Centre de Radiothérapie Oncologique et au sein de l’Hôpital de Jour d’Hématologie Adulte. 151 patients adultes ambulants, avec diagnostic histologique de cancer posé, quel que soit le groupe de tumeurs, ont participé à l’étude. Les critères d’exclusion sont : œdèmes sévères et étendus, amputation, immobilisation, perte de poids volontaire significative (5 % en 3 mois ou 10 % en 6 mois), incapacité de répondre aux questions. 5 patients ont abandonné et 1 n’a pu bénéficier de l’évaluation nutritionnelle complète. Le même jour et de façon indépendante, l’évaluation et le diagnostic nutritionnel ont été réalisés par : le diététicien agréé et référent dans le domaine, après consultation diététique, le responsable de la qualité du soin nutritionnel au Centre du Cancer, après réalisation du PG-SGA. Les paramètres évalués concernent la perte de poids, la prise alimentaire, la couverture des besoins nutritionnels, les difficultés pour s’alimenter, l’activité, l’âge, les examens physiques, la maladie et les besoins métaboliques. Les diagnostics nutritionnels obtenus sont : A. absence de dénutrition, B. à risque ou dénutrition modérée, C. dénutrition sévère. Ils ont été comparés par le test de concordance kappa. Le seuil de signification statistique est de < 0,05. Empty CellEmpty CellÉtat nutritionnel après PG-SGAEmpty CellEmpty CellA n = 65B n =51C n = 29Etat nutritionnel après entretien diététiqueA51 (35,2 %)7 (4,8 %)n (% total)B14 (26,2 %)38 (26,2 %)1 (0,7 %)C8 (19,3 %)28 (19,3 %) Le coefficient de concordance K obtenu est de 0,701 (p < 0,001). Ceci signe une bonne à très bonne concordance entre la détermination des états nutritionnels après réalisation du PG-SGA et après entretien diététique. Au vu de la bonne à très bonne concordance avec le diagnostic du PG-SGA, cette étude permet de valider la pratique diagnostique des diététiciens référents du Centre du Cancer, des Cliniques Universitaires St. LUC (UCL) ayant participé à l’étude. Des pratiques diététiques cliniques plus « intuitives », non figées dans un protocole, semblent tout-à-fait pertinentes en nutrition.

Draf in 1991. The procedure--which is also known as the modified endoscopic Lothrop procedure--aims to create the largest possible anteroposterior and lateral to lateral opening between both frontal sinuses and the nasal cavities. This requires the resection of the medial floor of both frontal sinuses, the intersinus septum and the superior nasal septum. The authors present a retrospective study including a cohort of 120 patients who underwent surgery in six Belgian university ENT departments. Mean follow-up was 24.6 months (range: 5-36 months). This paper describes the surgical procedure and reviews the indications, comorbidities, outcomes and complications of the type III frontal sinusotomy. Some correlations are also established with the data published in the worldwide literature. The authors conclude that the Draf III is a demanding procedure requiring considerable expertise in endoscopic sinus surgery. The procedure is effective with a success rate of 87.5%. Indeed, 12.5% of patients only experienced closure of the neoostium while 20% of all the patients had unchanged or worse symptomatology. The percentage of post-operative complications is 7.5%. All complications were managed successfully.

Rhinosinusitis (RS) is a heterogeneous group of diseases. It is a significant and increasing health problem that affects about 15% of the population in Western countries. It has a substantial impact on patients' health-related quality of life and daily functioning and represents a huge financial burden to society and the health care system as a result of the direct and indirect costs. In addition, RS is not well-understood, and little is known about the etiology and pathophysiology. In the past decade, many papers have been published that have changed our understanding of RS. RS is commonly classified into acute and chronic RS based on symptom duration. In acute RS, an inflammatory reaction initiated by a viral infection characterizes most uncomplicated, mild to moderate cases. Therefore, the first line of treatment for these cases are intranasal steroids and not antibiotics. In severe and complicated cases, antibiotics combined with topical steroids remain the treatment of choice. On the other hand, chronic RS is actually subdivided into two distinct entities (chronic rhinosinusitis with and without polyps), as growing evidence indicates that these entities have specific inflammatory pathways and cytokine profiles. The authors review recent data regarding the clinical presentations, cytokine profiles, tissue remodeling, and modalities of treatment for each form of RS.

We discuss the physiopathology and relevant anatomy of the nasal valves--internal and external--paying particular attention to the dynamics of the airflows in this area. We describe and comment on methods for medical examination, anterior rhinoscopy, endoscopy and fibrescopy of the valve, as well as the causes and sites of nasal valve dysfunction. We propose a review of the various treatments, medical and surgical, with a special emphasis on nasal valve surgery. Surgical techniques commonly used by the authors in daily practice for nasal valvuloplasty (such as spreader grafts and Z-plasty of the nostrils) are discussed and illustrated in depth. Some one-year postoperative results are presented and discussed.

Grafting is one of the current range of instruments that rhinoplasticians deploy to achieve durable and desired aesthetic and functional outcomes. Grafts can be classified according to anatomical site and, in the vast majority of cases, they involve augmentation rhinoseptoplasty. Visible grafting material is used for aesthetic purposes and functional grafting may involve invisible grafts. This article reviews the more widely described and more common indications for grafts in rhinoseptoplasty. The authors' rhinoseptoplasty philosophy involves a preference for autogenous grafts rather than alloplastic implants to achieve both aesthetically and functionally favourable results, particularly in long-term follow-up. They also prefer grafts in an open approach, reserving graft insertion with an endonasal approach for selected cases. The rate of complications associated with grafting is very low. The aim of this paper is to discuss the relevant anatomy, functional purpose and terminology, and to describe the authors' philosophy for grafting in rhinoseptoplasty.

A medial maxillectomy (MM) consists of a complete resection of the medial wall of the maxillary sinus. Traditionally the surgery is performed via an open approach. With more familiarity and expertise in endoscopic sinus surgery the endonasal approach is feasible.To expose the surgical technique and report the results of endonasal endoscopic MM in a series of 6 consecutive patients.Between August 2006 and October 2009, 6 patients were operated with this procedure. All were men. The mean age was 62-year-old (range: 43-83). In 5 cases, the surgery was performed for inverted papillomas confined to the maxillary sinus. In one case it was a primary surgery whereas it was a revision surgery for the others. The sixth patient was operated for a solitary extramedullary plasmocytoma inserted on the intersinonasal wall persistent after an external radiation therapy.All the patients are free of disease at the time of writing with a mean follow-up of 18,2 months (range: 9-38). This has been confirmed by a nasal endoscopy and CT scans. There were no major per or postoperative complications. Patients suffered from crusting for at least 6 months postoperatively necessitating daily nasal douches. One patient is still complaining of intermittent epiphora when he is exposed to wind.Endoscopic MM can be successfully performed for the resection of expanding processes involving the maxillary sinus and/or the intersinonasal wall. Compared to open approaches, it seems to be as effective with less postoperative morbidity. An important technical point is to do the anterior osteotomy in front of the nasolacrimal duct in order to expose the prelacrimal recess that is typically an area for possible recurrence. Exact determination of the tumor attachment during the surgery is another key point for success.

Numerous techniques are available in the clinic for the investigation of chemosensory function. Psychophysical testing using orthonasal and retronasal stimulation routes may help to distinguish anosmic from hyposmic patients. These psychophysical tests are most frequently used for odour identification and odour threshold. Chemosensory event-related potentials using olfactory and trigeminal stimulation have become part of the routine investigation of patients with olfactory loss in specialised smell and taste centres. The interpretation of results from psychophysical testing is frequently supported by the assessment of chemosensory event-related potentials. This review will discuss these methods, including how to perform them, focusing on normative data and describing some clinical examples from our centre (olfactory and trigeminal event-related potentials).

A dacryocystocele refers to a sterile cystic dilatation of the lacrimal sac resulting from a complete obstruction of the lacrimal pathway above and below the lacrimal sac. In most cases, it is a congenital disorder that typically occurs in neonates. It is characterized by a bluish cystic swelling just below the medial canthus accompanied by epiphora. In some cases, there is also an intranasal expansion beneath the inferior turbinate. When this expansion is large and bilateral, it can lead to respiratory distress in neonates since they are obligate nasal breathers. Although congenital dacryocystoceles may resolve with conservative measures, many become infected and require systemic antibiotic treatment, and most require early surgical intervention. Herein, the authors report a rare case of dacryocystocele in an adult that was successfully managed with an endonasal endoscopic dacryocystorhinostomy. The pre-operative images and the intra-operative findings are shown, and the available literature is reviewed.

OBJECTIVES Post-traumatic olfactory loss (PTOL) is the third most common aetiology for olfactory disorders. Mechanisms that lead to post-traumatic olfactory disorders include sinonasal affections, damage to the olfactory nerve and lesions of the cerebral olfactory centres. The purpose of this review is to present an update of this condition and to present a cohort study of 90 patients. METHODOLOGY A review of the literature was made on Medline Pubmed up to May 2009 and a review was also conducted of patients with post-traumatic olfactory loss. RESULTS The degree of olfactory impairment was related to the severity of head trauma and was particularly frequent in cases of occipital impact. Typically, patients experienced a sudden onset of olfactory symptoms and were more severely affected than in other aetiologies. Results from orthonasal and retronasal testing, chemosensory event-related potentials and olfactory bulb (OB) volume confirmed previous findings: patients are usually anosmic, OB volume correlates with the degree of olfactory loss (better correlation with retronasal scores than with orthonasal scores) and olfactory event-related potentials were recorded in only 18 patients. CONCLUSIONS Accuracy in the evaluation of PTOL patients is based on the expertise and the time spent by the clinician on defining the complaint. Failing treatment, complete evaluation of the PTOL patients may help in counselling for the recovery prognosis, and appropriate counselling must be given to secure the environment and alimentation.

A Pott's Puffy Tumour (PPT) is a rare clinical entity, which, traditionally has been described as an acute abscess with periosteitis secondary to osteomyelitis of the external table of the frontal bone of the skull, complicating an acute frontal sinusitis. The aim of this article is to present a case of progressively evolving PPT, which emerged during the course of a common rhinitis, in a patient who, thirty years previously, had undergone a reconstruction of the frontal sinus involving osteosynthesis. The patient was treated with antibiotic therapy coupled with external access surgery using the Cairn Unterberger approach. This allowed the drainage of pus, the removal of infected osteosynthetic material and a complete debridement of osteomyelitic bone from the affected area. Frontal sinus obliteration was undertaken using methyl methacrylate, preferable in this case to hydroxyapatite, due to the direct communication with the neighbouring sinus cavities and the presence of defective bone in the superior orbit. A review of literature available on Medline up to January 2008 reveals that this is the third published case of PPT complicating a frontal reconstruction.