[Tuberculosis of the upper aerodigestive tract]

Tuberculosis of upper aerodigestive tract is rare. Was to report our experience in the diagnosis and the management of this disease with a review of the literature. We carried a retrospective study between 1990 and 2005, about 10 cases. Diagnosis of tuberculosis was confirmed by histopathological examination. All patients were treated with antituberculous chemotherapy. Follow-up was based on clinical, biological and endoscopic examinations with a mean duration of 24 months. Mean age was 29 years. Nine patients were male. Clinical examination and panendoscopy showed nasal, pharyngeal and laryngeal lesions respectively in 1, 6 and 3 cases. Sputum examinations were negative in all cases. After confirming diagnosis by biopsy and anatomopathological examination, all patients received antituberculous treatment for 8 to 9 months. Nine patients were followed regularly. They had all recovered from their symptoms, and lesions had completely disappeared. Tuberculosis of upper aerodigestive tract must be suspected in front of unusual evolution of any nasal or laryngo-pharyngeal symptom. Early and well-conduced medical treatment achieves a good outcome

[Endonasal surgery in the management of choanal atresia]

To assess results after surgical management of choanalatresia in order to determine indications and advantages of endonasal surgery. We carry a retrospective study about 25 patients having choanal atresia treated in our department between 1987 and 2005. All patients had had nasal endoscopy and sinonasal CT. Treatment was surgical in all cases. Three surgical techniques were performed. Postoperative follow-up was endoscopic with a mean period of 4 years. Atresia was unilateral in 21 patients and bilateral in 4 neonates. After emergently putting of a Mayo cannula and endoscopic control, divulsion was performed in the 4 bilateral forms. For unilateral atresias, transpalatal approach was performed in 4 cases and endonasal approach in 17 cases. Fibrous restenosis occurred in 6 cases. It happened in 3 children operated by endonasal approach, in 2 operated by transpalatal approach and in one that underwent divulsion. All revision surgeries were performed by endonasal approach using the laser diode. Thus, a definitive repermeabilisation of malformed choana was achieved for all cases. Endonasal surgery is now the treatment of choice of choanal atresia, with a high success rate and minimal risks of complications

[Congenital cysts and fistulas of the neck in children and adolescents]

Congenital malformations of the neck make up a wide range of pathological processes in children. They present as cysts or fistulas. A retrospective study was performed in order to present an overview of the relevant embryology, pathophysiology, epidemiology and diagnostic modalities for these anomalies. It describes a serial of 117 children treated for congenital cysts and fistulas of the neck between 1994 and 2006. The average age was 12 years. Malformations of the midline included the thyroglossal duct cyst [89 cases], dermoId cysts [7 cases], thymic cysts [2 cases] and cervical cleft in one case. The commonest malformations of the laterocervical region were cysts and fistulas of the 2nd cleft [10 cases], fistulas of the 3rd cleft [5 cases] then cystic hygroma [2 cases]; the 4th cleft fistula was found in only one case. All the patients undertook a surgical treatment except one who had sclerotherapy for an extended cystic lymphangioma. The complications of these malformations, especially infectious, do not result from a difficult management, which is well codified but from the diagnosis delay. An accurate preoperative diagnosis and appropriate surgical therapy are essential to prevent recurrence and to ensure optimal cosmetic outcomes

[Idiopathic sudden sensorineural hearing loss what's the appropriate management]

Background: Sudden sensorineural hearing loss remains a challenge in otology, controverse affect mainly etiopathogeny and treatment

Aim: To evaluate our experience in the diagnosis and the treatment of sudden hearing loss

Methods: We report a retrospective study including 30 patients presenting a Sudden sensorineural hearing loss. All patients were hospitalized for treatment. The audiometry evaluated the hearing deafness before and after treatment

Results: The average age was of 48 years. In all the cases no etiology has been found

All The patients were hospitalized and corticotherapy was administrated in all cases. It was associated to hyperbare oxygenotherapy in 7 patients

Recovery was observed mainly in patients with moderate [71.4%] and severe hearing deficiency [69.2%]

Conclusion: corticosteroids are the less controversed treatment of sudden sensorineural hearing loss

[Ambulatory pediatric morbidity. Evaluation of one year activity of consultation in department of Pediatrics, emergency and consultations of children's hospital of Tunis]

Pediatric morbidity has been the subject of many studies, nevertheless those concerning with ambulatory morbidity are rare. The subject of this study is to establish the epidemiologic profile of patients. Identify the encountered pathologies and their frequency, precise morbidity characteristics and raise difficulties in the diagnostic and therapeutic management. In this retrospective study we reviewed the data of 4387 children that have consult for the first time external consultation of the department of Pediatric External Consultations and Emergency [PUC] of the Children's Hospital of Tunis during the year 2003. The 4387 patients benefit from 7323 consultations which represent 44.3 per cent of the total of consultations of the year 2003 [16 507]. 59.4 percent of the studied population was male [sex ratio = 1.2] and two thirds were aged under 6 years old. The main motif of consultations was recurrent bronchopneumonia [15.2 percent], cutaneous disease [6.2 percent], vomiting [6.1 percent] and abdominal pain [5.6 percent]. 3.2 percent of the children were admitted. Ambulatory morbidity was dominated by four pathologies: digestive 16 percent, pulmonary 14.9 percent, neurologic 6.7 percent and hematologic pathothologies [6 percent]. Gastro-oesophageal reflux was the major digestive disease followed by acute diarrhea [10.6 percent]. The principal pulmonary disease were bronchopneumonia [60.5 percent], acute bronchitis [21.6 percent] and asthma [14.4 percent]. 59.9 percent of the neurologic pathology were represented by seizures. 28.4 percent of the seizures were feverous. Anemia is the most frequent hematologic pathology [55.1 percent]. It was caused by iron deficiency in 87 percent of cases. The endocrinologic pathology is essentially represented by the short stature. We suggest to informatize medical data so it would be more exploited for studies, to make more complementary explorations available in the Children's Hospital of Tunis and to decentralize the management of the simples diseases

Diagnosis and impact on fertility of subclinical varicocele: a series of 6 cases

The varicocele is the most common and identifiable cause of subfertility in men. Its subclinical form is underestimated. Its impact on male fertility is not well known. Doppler sonography is a non invasive and reliable mean of diagnosis. It enabled us to detect subclinical varicocele in six subfertile men. After ligation of the internal spermatic vein, the semen analysis was improved in two cases and pregnancy was achieved in one. Therefore, doppler sonography is the correct procedure in men unexplained subfertility

L'hallucinose des buveurs: une complication rare de l'alcoolisme chronique

The authors report 5 cases of hospitalized patients for hallucinatory board. The given diagnosis in the entry were more diesperate than different. It was then clear that these patients, chronic alcoholics presented the drunkards hallucinosis board described by WERNICKE in 1900. lnspite of being a rare chronic alcholism complication should evoke this nosograp-hic entity during the hallucinatory board diagnosis discussion