[Performances of imaging investigations and scintigraphy for pre operative hyperparathyroidism]. / Résultats et limites de l'exploration radiologique et isotopique préopératoire de l'hyperparathyroïdie.

BACKGROUND: Hyperparathyroidism is a frequent affection. Therapeutic management is based on surgical removal of pathological glands. Therapeutic results are ameliorated thanks to preoperative imaging approach. AIM: To evaluate performances of different imaging investigations and scintigraphy for preoperative parathyroid localization. METHODS: Retrospective study about 26 patients with confirmed hyperparathyroidism. RESULTS: After radio-surgical and histological correlation, scintigraphy showed the best rate of sensitivity (92.3%), compared to other morphologic imaging (ultrasonography: 66.6%, CT-scan: 33.3% and MRI: 66.6%). The specificity was the same (100 %). No difference was obseved for both scintigraphic modalities. CONCLUSION: Our results compared to the literature showed that scintigraphy is the most satisfying for preoperative localization of abnormal parathyroid glands in hyperparathyroïdism.

[Clinical and phmetric evaluation of gastro-esophageal reflux impact on upper airways in adult]. / Evalution clinique et phmétrique de l'impact du reflux gastro-oesophagien sur les voies aérodigestive supérieures chez l'adulte.

BACKGROUND: Gastroesophageal reflux is a frequent and benign affection. It represents an etiopathological entity in otorhinolaryngology; that may occasion a large variety of ENT manifestations. AIM: To evaluate clinical and pHmetric impact of gastro esophageal reflux on upper airways in adult. METHODS: Prospective study about 95 cases diagnosed and treated at the ENT department of military hospital of Tunis. Clinical features, pH metric profiles and therapeutic approach are reported and compared to the literature. RESULTS: The mean age was 37 years old. Sex ratio was 1.16. Pharyngolaryngeal symptoms dominated ENT manifestations (41 cases). Laryngeal dyspnea, cough and dysphonia were predictive of danger. Positive pH metric rate collated to posterior laryngitis and pharyngitis were respectively 81.2% and 79.1%. Posterior laryngitis, dental erosion and chronic sinusitis, seem to have pejorative significance. CONCLUSION: Otorhinolaryngologist must think about asymptomatic reflux every time when chronic or recurrent ENT affection remain unexplained after complete clinical investigations. PH monitoring confirms gastroesophageal reflux disease.

[Preoperative CT Scan in middle ear cholesteatoma]. / Apport de la tomodensitométrie dans le bilan pré opératoire de l'otite moyenne chronique cholestéatomateuse. A propos de 60 cas.

AIM: To compare preoperative CT scan finding and per-operative lesions in patients operated for middle ear cholesteatoma, METHODS: A retrospective study including 60 patients with cholesteatoma otitis diagnosed and treated within a period of 5 years, from 2001 to 2005, at ENT department of Military Hospital of Tunis. All patients had computed tomography of the middle and inner ear. High resolution CT scan imaging was performed using millimetric incidences (3 to 5 millimetres). All patients had surgical removal of their cholesteatoma using down wall technic. We evaluated sensitivity, specificity and predictive value of CT-scan comparing otitic damages and CT finding, in order to examine the real contribution of computed tomography in cholesteatoma otitis. RESULTS: CT scan analysis of middle ear bone structures shows satisfaction (with 83% of sensibility). The rate of sensibility decrease (63%) for the tympanic raff. Predictive value of CT scan for the diagnosis of cholesteatoma was low. However, we have noticed an excellent sensibility in the analysis of ossicular damages (90%). Comparative frontal incidence seems to be less sensible for the detection of facial nerve lesions (42%). But when evident on CT scan findings, lesions of facial nerve were usually observed preoperatively (spécificity 78%). Predictive value of computed tomography for the diagnosis of perilymphatic fistulae (FL) was low. In fact, CT scan imaging have showed FL only for four patients among eight. Best results can be obtained if using inframillimetric incidences with performed high resolution computed tomography. CONCLUSION: Preoperative computed tomography is necessary for the diagnosis and the evaluation of chronic middle ear cholesteatoma in order to show extending lesion and to detect complications. This CT analysis and surgical correlation have showed that sensibility, specificity and predictive value of CT-scan depend on the anatomic structure implicated in cholesteatoma damages.

[Management of thyroid microcarcinoma. Report of 13 cases]. / Prise en charge des microcarcinomes de la glande thyroïde: a propos de 13 cas.

BACKGROUND: Thyroid microcarcinoma is defined as a tumour of one centimeter or less in its greater diameter. Prognoses and therapeutic modalities remain controversial therapeutic guidelines for surgical treatment. AIM: To analyse the anatomical and clinical characteristics and discuss the modalities of care and therapeutic indications of these microcarcinoma. METHODS: We report a retrospective study concerning 13 cases of thyroid microcarcinoma, diagnosted and treated at the ENT department of Military Hospital of Tunis from 1998 to 2007. RESULTS: The mean age was 41 years and sex-ratio was 0.18. Clinical investigation by cervical ultrasonography found an isolated nodule in 30.7% and a multinodal goiter in 69.2%. Lymph node metastasis was precessiving in two cases. Five patients underwent loboisthmectomy and higt patients had a total thyroidectomy. Surgical lymph node removal was practiced for both cases with preceding cervical node involvement. Iodine 131 ablation was necessary every time when total thyroidectomy was practiced. A six years mean follow-up revealed no recurrence or death. CONCLUSION: Thyroid microcarcinoma is favorable long-term prognosis. Therapeutic modalities are closely depending on risk factors such as histology type, tumor size, lymph node involvement and extra thyroid extension.