[Orbital metastasis revealing an undifferenciated Carcinoma of nasopharyngeal type: a case report]

The evolution of the undifferentiated carcinoma of the nasopharynx [NPC] is marked by the occurrence of regional or distant metastasis. We report a rare observation of bilateral orbital metastasis of NPC. Clinical symptoms were ocular proptosis, blurred vision and eye redness. Imaging permitted to precise the extensions of the tumor which was classified T4N1M1 after clinical and paraclinical exams. The treatment consisted of concomitant radiochemotherapy. The evolution didn't revealed recurrence of the disease after 18 months

[Contribution of serum total immunoglobulin E measurement in the diagnosis of respiratory allergic diseases]

Serum total IgE measurement is one of the first allergic inflammation marker test. It has been currently used for the diagnosis of allergy. However, when it has been widely used in clinical practice, we discover its limit in the diagnosis of allergic disease. We carried a retrospective study about 1111 consecutive patients, seen in the Allergology Unit of the Home Ministry Hospital with suspicion of atopic disease. The aim of our study is to evaluate the contribution of serum total IgE measurement in the diagnosis of respiratory allergic diseases. Our population was divided into three groups. Group A: 771 allergic symptomatic subjects [371 children with mean age of 7.8 +/- 3.4 years and 467 adults with mean age of 30.1 +/- 6.6 years]. Group B: 117 controls [70 children with mean age of 6.6 +/- 3 years, and 47 adults with mean age of 30.7 +/- 6 years]. 221 patients with doubtful diagnosis of allergy were excluded [group C]. If we consider the cut-off I of 150 UI [for adults], 75% of allergic subjects have elevated serum total IgE, 62% of adults and 77.6% of children. When doubling the cut-off [cut-off II], 49% of allergic subjects have serum total IgE over 300 UI/ml, 36% of adults and 57% of children. In the control group: 35.8% of patients have total IgE over the cut-off value I and 17% over the cut-off value II. The variation of serum total IgE was related in allergic subjects to the type and the number of symptoms. The levels of total IgE were higher in asthma than in rhinitis and more elevated if the patient has several symptoms. With cut-off I we found a quite good sensibility of the test of 75% [62% in adults and 77.6% in children] and a poor specificity of 64% [68% in adults and 61% in children], with a negative predictive value of 28% and a positive predictive value of 93%. When doubling the cut-off, the sensibility falls to 49% and the specificity was improved at 82%. The serum total IgE measurement was in agreement with prick-tests in 80% of cases and with Phadiatop in 56% of cases if we consider cut-off I. Our results showed a large overlapping of serum total IgE in both allergic and control populations. The measurement of serum total IgE is not helpful for the diagnosis of allergic respiratory diseases because it has a quite good sensibility, a poor specificity and a poor negative predictive value. The test was more sensible and less specific in children

[Asthma in the elderly]

Asthma in elderly is actually well individualized. Two entities are considered: - "Ageing asthmatics" who have had asthma since childhood, adolescence or adulthood and persisting after 65 years old. This situation is the most frequent.- Late-onset asthmatics in persons 65 years old and more. Clinically, asthma in elderly is frequently represented by a dyspnoea at rest during the day. Diagnosis remains difficult because of the non-specifity of clinical symptoms and the frequency of comorbidity. Many differential diagnosis must be considered, dominated by congestive heart failure and COPD. Concerning treatment of asthma in the elderly, a few particularities should be known: prudence in the prescription of beta-2-adrenergic drugs. Anticholinergic drugs have a place in the treatment. contrary to younger asthmatics. A great importance to inhalation devices should be allowed because of their use difficulties in the elderly. The main goal of asthma management in the elderly is to improve the quality of life