[Traumatic perilymphatic fistulae: about 13 cases]

Post-traumatic peri-lymphatic fistulas have been described following ear and temporal bone injury, particularly in the setting of temporal bone fractures. The symptoms and signs of perilymphatic fistulae [PLF] are very varied and frequently misleading. The diagnosis can be suspected on the bases of the clinical and the audiometrial findings. Indications for exploratory surgery in cases of trauma are vague and not well described. To assess the principal clinical and radiologic signs of PLF. Study of 13 patients with different symptoms of posttraumatic peri-lymphatic fistulae. Ten patients had vertigo, and 2 presented otoliquorreha. Two patients had tympanic perforation. Nine patients presented neurosensorinal hearing loss and 5 were completely deaf. A CT Scan was realized in 12 cases and showed the fracture in 10 cases [91%] with a pneumolabyrinth in 4 cases. Medical and postural treatment was indicated for all the patients then a surgery was indicated in all of them in an average wait of 4 months realizing an ear exclusion in one case and a filling-up for 12 patients. Vertigo improved in 10 cases and the hearing loss in 2cases. The diagnostic of perilymphatic fistulae is not easy. The trauma and the clinical signs can help but the confirmation is surgical. The indication of surgery and its timing are still discussed

[Parotid basal cell adenoma of membranous type]

Basal cell adenoma [BCA] is a rare benign neoplasm characterized by the basaloid appearance of the tumour cells and the lack of myxochondroid stromal component present in pleomorphic adenoma. We report a case of basal cell adenoma of membranous type, highly suspected of malignancy because of the presence of mediastinal lymph nodes and pulmonary nodules which finally were related to an associated sarcoidosis. Our patient was an 80-year-old woman who presented a swelling of the right parotid two years ago. The clinical examination revealed a solid, indolent and mobile mass. A chest radiography noted mediastinal lymph nodes. The CT-scann confirmed the presence of mediastinal and tracheal lymph nodes with pulmonary nodules. So the diagnosis of metastatic malignant salivary gland tumor was suspected. Finally, the histological examination concluded to a basal cell adenoma of membranous type with sarcoidosis granulomas in the parotid and in the lymph nodes. The BCA is a benign tumor located generally in the parotid gland. When the malignancy is suspected, like in our case, this tumor must be differentiated from the basal cell enocarcinoma using histological criteria

[Odontogenic descending necrotizing mediastinitis]

Descending necrotizing mediastinitis [DNM] following an oropharyngeal infection is a rare disease with a rapid course and a mortality rate of up to 40%. The aim of this study, is to outline the diagnosis and the appropriate treatment of DNM. A retrospective study [1986-2007] of patients with DNM was made. Only patients with cervical cellulitis associated with DNM were included. Eight men and two women with an average age of 43 years were treated. Five had diabets. The average for diagnosis and treatment was eight days. In eight cases, we found a dental origin and in two cases a pharyngeal origin. The diagnosis of DNM was made thanks to cervico thoracic CT scan in six cases. In the others patients. they had at presentation clinical and radiological evidence of mediastinal diffusion. All patients were treated by broad spectrum antibiotherapy. All had cervical drainage. Mediastinal drainage was made by cervical approach in 2 two cases and via a right thoracotomy in eight cases. Eight patients died. Odontogenic DNM is a rare disease with rapid course Clinical diagnosis is difficult and early recognition with a lowi thresold for CT scanning is essential. CT is also useful for the treatment and in the post operative assessment. All affected tissue plane must be debrided. Surgical management and mediastinal drainage remain controversial about the indication of thoracotomy

[Topical and systemic chemotherapy with 5- fluorouracil in facial carcinoma secondary to xeroderma pigmentosum]

To evaluate the feasibility, tolerance/toxicity and therapeutic efficacy of 5-fluorouracil[5-FU]by topical application and systemic use, in facial carcinoma associated with XP. This is a prospective study of 10 patients with a median age of 22.9 years and a sex ratio of 4. Tumour lesions were facial mainly in the jugal and temporal region [36%]. Chemotherapy indication was discussed in multidisciplinary committee, the topical 5-fluorouracil was applied locally twice a day, whereas the systemic treatment consisted of FUFOL protocol [every 4 weeks a combinaison of a short perfusion of 340mg/m 2 5-FU and preceded by an infusion of 20mg/m 2 of folic acid, day I to 5]; or C-FU protocol, combining continuous infusion of 5-FU [Ig/m 2] 5 days associated with cisplatin [100mg/m 2,dayl] every 3 weeks. The median topical treatment duration was of 12 months in 10 patients. We noted a full tumoral regression in 10% of cases. Concerning systemic treatment, the median number of FUFOL cycles was 4 [2 to 6] and we observed a complete response in 6 patients [60%], partial in 2 cases [20%]. Treatment was well tolerated in most cases except for the cutaneous irritation on 5-FU application zone and a 4 grade cisplatin otoxicity. Systemic or topical chemotherapy represents an interesting palliative option for facial carcinoma associated with XP, avoiding reiterated surgery and its cosmetic consequences

Deux cas de cancerisation des stenoses caustiques de l'oesophage

The incidence of carcinoma of the esophagus within patients with chronic esophageal stricture caused by ingestion of corrosive agents is reported to be significantly higher than in the general population. Two patients developed carcinoma of the esophagus respectively 25 and 40 years after corrosive injury. One of these patients had initially gastrostomy and repeated esophagal dilation. Taking into account the high incidence of carcinoma in the site of esophageal stricture, we conclude that the resection of the esophagus is indicated in patients with chronic caustic stricture if there is any finding suggestive of malignancies such as a long duration of the lesions more than 20 years particulary when the ingested agent was caustic soda or sudden aggravation of preexisting dysphagia

malformations lymphatiques cevico-faciales de l'adulte

A case report of 38 years old man who exprerienced syncope and torsade de pointes is presented with the short coupled variant. The patient had a normal QT interval [QTC 0,37 secondes] and multiform ventricular premature beats on the resting electrocardiogram. Under antiarrhythmic treatment [intavenous xylocain], torsades de pointes suddenly appeared and cardiac arrest was followed, After cordioversion, sinus rythm was restored. A cardiovascular disease was excluded, the echocordiography, the left and right venlncular angiography and coronarography were normal, Three months after, the patient presented at home a sudden cardiac death

[Amniotic bands syndrome. A case report]

Amniotic band syndrome is a rare fetal malformation involving limb ring strictions, cranio-facial and trunck abnormalities. The authors report a case of 5 months old infant with also facial cleft. The plastic reconstructive surgery leads to a better functional result. This affection represents a sporadic disease without genetic causes. The pregnancy ultrasonography visualise fetal abnormalities