Castleman disease of the parapharyngeal space: Diagnosis and management.

INTRODUCTION: Castleman's disease (CD) is a rare and benign disease often identified in the mediastinum with few cases in the head and neck area. Parapharyngeal Castleman's disease was rarely reported in the literature. The aim of our work was to discuss the management of this particular location of CD. It was about a case report that has been reported in line with the SCARE 2020 criteria (Agha et al., 2020 [1]). CASE PRESENTATION: We report the case of a 53-year-old female patient who presented a left parotid tumefaction. Radiological investigations showed a parapharyngeal mass that was surgically removed. Definitive pathologic report concluded to Castleman's disease. She presented, one year later, a retropharyngeal recurrence, which was treated by radiotherapy with good response. CLINICAL DISCUSSION AND CONCLUSION: Castleman's disease located in parapharyngeal spaces is an entity that was rarely reported in the literature. Surgical excision is the golden standard treatment. Radiotherapy is also an effective treatment that can be offered for unresectable cases or recurrences of Castleman's disease.

Risk of developing chronic myeloid neoplasms in well-differentiated thyroid cancer patients treated with radioactive iodine.

Exposure to ionizing radiation increases the risk of myelodysplastic syndromes (MDS) and myeloproliferative neoplasms (MPN), but such risks are not known in well-differentiated thyroid cancer (WDTC) patients treated with radioactive iodine (RAI). A total of 148 215 WDTC patients were identified from Surveillance, Epidemiology and End Results registries between 1973 and 2014, of whom 54% underwent definitive thyroidectomy and 46% received adjuvant RAI. With a median follow-up of 6.6 years, 77 and 66 WDTC patients developed MDS and MPN, respectively. Excess absolute risks for MDS and MPN from RAI treatment when compared to background rates in the US population were 6.6 and 8.1 cases per 100 000 person-years, respectively. Compared to background population rates, relative risks of developing MDS (3.85 (95% confidence interval, 1.7-7.6); P=0.0005) and MPN (3.13 (1.1-6.8); P=0.012) were significantly elevated in the second and third year following adjuvant RAI therapy, but not after thyroidectomy alone. The increased risk was significantly associated with WDTC size ⩾2 cm or regional disease. Development of MDS was associated with shorter median overall survival in WDTC survivors (10.3 vs 22.5 years; P<0.001). These data suggest that RAI treatment for WDTC is associated with increased risk of MDS with short latency and poor survival.

Radiation Therapy for Primary Eyelid Cancers in Tunisia.

Management of eyelid cancers is based on surgery and/or radiotherapy (RT). The treatment objective is to control tumors with acceptable functional and esthetic outcomes. The aim of this study was to evaluate the results of radiation therapy in management of epithelial eyelid cancers, reviewing retrospectively the clinical records of patients treated in our institution from January 1989 to December 2013. We focused on clinical and histological features, treatment characteristics, tolerance and disease control. One hundred and eight patients (62 men and 46 women) were enrolled, with a mean age of 61 years [ranges 1587]. The most frequent tumor location was the inner canthus (42.6%). Median tumor size was 21 mm [ranges 470]. Histological type was basal cell carcinoma in 88 cases (81.5%), squamous cell carcinoma in 16 (14.8%) and sebaceous carcinoma in 4 (3.7%). Radiation therapy was exclusive in 67 cases (62%) and postoperative for positive or close margins in the remaining cases. Kilovoltage external beam radiotherapy (KVRT) was used in 63 patients (58.3%) and lowdoserate interstitial brachytherapy in 37 (34.3%). Eight (7.4%) were treated with cobalt or with a combination of KVRTcobalt, KVRTelectron beams, KVRTbrachytherapy or cobaltelectron beams. The total delivered radiation doses were 70 Gy (2 Gy/fraction) in 62 patients (57.4%), 66 Gy (2 Gy/fraction) in 37 (34.3%) and 61.2 Gy (3.4Gy/fraction) in 9 (8.3%). After a median followup of 64 months, we noted 10 cases of local recurrences(9.2%): 7 after exclusive and 3 after postoperative RT. No local recurrence occurred in patients treated with brachytherapy. Actuarial 5year local recurrencefree rate, diseasefree survival and overall survival were respectively 90%, 90% and 97%. Tstage was found to be a significant factor for recurrence (p=0.047). All acute radiationrelated reactions were scored grade I or II. Delayed effects were eye watering in 24 cases (22.2%), eye dryness in 19 (17.6%), unilateral cataract in 7 (6.4%) and ectropion in 4 (3.7%). Radiation therapy and especially brachytherapy is an efficient treatment of eyelid cancers, allowing eye conservation and functional preservation with good local control rates and acceptable toxicity.

[Radiotherapy in the treatment of retinoblastoma: about 40 cases]. / Place de la radiothérapie dans le traitement du rétinoblastome : à propos de 40 cas.

PURPOSE: The aim of this study is to analyze the results and the complications of radiotherapy in the treatment of retinoblastoma. PATIENTS AND METHODS: Between 1994 and 2004, 40 children received radiotherapy for a retinoblastoma in Salah Azaiz Institute. The average age of the patients was 36 months (four to 132 months). There were 16 girls and 24 boys. Sixteen children presented a bilateral disease and 24 children a unilateral disease. Twenty eyes and thirty-six orbital cavities in 40 children with retinoblastoma were treated by radiotherapy. One child with a unilateral anterior retinoblastoma was treated with 106 ruthenium brachytherapy. External radiotherapy has been used to treat the 39 patients. In 20 cases the irradiation was conservative and in 36 cases postoperatively. The latter (n=36) presented at least one risk factor of relapses noted in the histological examination. The average dose was 44 Gy (1.8 to 2 Gy per fraction, five fractions weekly). This radiotherapy was associated with chemotherapy in 24 cases. RESULTS: Thirty-five children were followed with an average follow-up of 53 months (3-108 months). The average delay of relapses was of 10 months (two to 26 months). We found four orbital relapses and seven metastasis in nine children. The conservation of the eye with a useful visual field was noted in 18 cases among the 20 conservative irradiated eyes. The major therapeutic complication was the growth defect of the bones face. A femoral bone sarcoma was noted five years after the end of the irradiation and chemotherapy in one case. CONCLUSION: If the radiotherapy offers the advantage of the functional conservation and the improvement of the local control, its indications are more and more restricted in favor of the other therapeutic methods (chemotherapy, thermochemotherapy) and this considering the iatrogene risk. The development of new techniques of brachytherapy and the progresses of the conformational radiotherapy appear to reduce considerably this risk.

[Hodgkin disease of the nasopharynx: report of three cases]. / Maladie de Hodgkin du cavum: à propos de trois cas.

We report three cases of Hodgkin's disease (HD) involving the nasopharynx. Their clinical presentations, morphological and immunohistochimical features and their therapy modalities are discussed. The patients were aged 36, 41 and 77, presenting with increasing bilateral nasal obstruction in one case and a cervical mass in the two others. Histological study showed mixed cellularity type of HD in all cases. The Reed Sternberg cells expressed both of CD15 and CD30 in one case, and only one of them in the other cases. In one case, LMP1 was detected, CD20 and CD3 were not. HD of nasopharynx should be differentiated from EBV-associated lymphoproliferations. The treatment is based on radiotherapy that can be associated to neoadjuvant chemotherapy if nodes are involved.

[Regional failure of hypopharyngeal squamous cell carcinoma]. / Echecs ganglionnaires du carcinome épidermoïde de l'hypopharynx.

PURPOSE: Lymph nodes and distant metastases contribute to the poor prognosis of hypopharyngeal squamous cell carcinoma. The purpose of this study is to estimate the frequency, mode and prognosis factors related to regional and distant metastasis. PATIENTS AND METHOD: The authors' report is based on a retrospective study concerning 271 hypopharyngeal squamous cell carcinoma, compiled in the service of Surgery of Head and Neck Cancers of the Salah-Azaïz Institute (1977-2002). Frequency and histoclinical characters of cervical and distant metastases have been assessed, as well as their prognosis factors among 155 patients treated in a curative purpose. RESULTS: 39.1% of the tumours were classified N0, 24.4% N1, 10.7% N2 and 25.8% N3 (UICC 2002). The cervical nodal invasion was significantly more frequent for the classified tumors T3T4 than for the T1T2 (for pyriform sinus, postcricoid esophagus, posterior wall, and total hypopharynx, respectively : P =0.001, P =0.007, P =0.047 and P =0.0005). A cervical lymphatic evidement was preferred in thirty two patients. Among N0, 46.9% were N+; The frequencies of the capsular effraction were not significantly different for the N0N1 from for the N2N3 (P =0.11). The two and five years survival rates were respectively 32.5 and 20.5% for N0, and 10.9% and zero for N3. The survival differences after two and five years between the N0N1 and the N2N3 were significant (P =0.04). A regional failure was noticed for 18.5% of the patients. The tumoral site did not influence significantly the rate of nodal failure (P =0.98), neither the clinical status N (P =0.34). Capsular effraction was a significant factor for the regional failure (P =0.007). Distant metastasis significantly occurred more frequently among the patients initially classified N2N3 than those classified N0N1 (P =0.03), and in case of capsular effraction (P =0.0009). CONCLUSION: Hypopharyngeal squamous cell carcinoma has a high rate of lymph nodes metastasis, correlated to the local extension, and a high rate of occult nodal metastasis. Lymph node clinical status does not seem to have influenced the patients survival; however, capsular effraction constitutes a major prognosis factor of regional failure and distant metastasis. Distant metastases are frequent, particularly in case of wide local and regional tumoral extension.

[Hypopharyngeal squamous cell carcinoma: retrospective study of 149 patients]. / Carcinome épidermoïde de l'hypopharynx: étude rétrospective de 149 traitements à visée curative.

PURPOSE: Hypopharyngeal squamous cell carcinoma is associated to one of the most unfavorable prognosis among the cancers of the head and neck. The purpose of this study is to analyze its therapeutic modalities in the Salah-Azaïz Institute (Tunis) and to compare their results. PATIENTS AND METHOD: This retrospective study concerns 271 hypopharyngeal squamous cell carcinomas, compiled in the Carcinologic Surgery Department of Head and Neck of the Salah-Azaïz Institute over a period of 25 years (from 1977 to 2002). The average age of the patients was of 56 years; sex-ratio was on average of 1.2 (man/woman). The indication of a curative treatment was initially retained for 149 (55%) patients, who were the only ones retained for the analysis of results. RESULTS: We retained the indication of a protocol including surgery and postoperating radiotherapy for 26.2% of the patients. Postoperation mortality rate was 5.1%; the operating rate of morbidity was 46.2%. For 13.5% of the patients, postoperating radiotherapy was permanently interrupted because of a gradual deterioration of the patients' health in the course of treatment. We retained the indication of exclusive radiotherapy for 59.7% of the patients. The average age was of 56 years and the sex-ratio of 1.2. The external radiotherapy was conventional. Radiotherapy had to be permanently interrupted in progress in 32.6% of cases on account of an deterioration of the patients' health; the rate of morbidity of the radiotherapy was 33.3%. We indicated a protocol of conservation of organ with induction chemotherapy for 21 patients (14.1%). The average age was of 53 years (28-65 years) and sex-ratio (man/woman) of 0.5. The global survival was 25.5% at one year, 18.1% at two years, 11.4% at three years and 7.4% at five years. All the patients selected for chemotherapy died in the course of treatment. The rates of survival in two and five years according to protocols surgery-radiotherapy and exclusive radiotherapy were respectively: 21.5 and 12%, and 18.3 and 10%. The difference between the rates of survival of this two protocols is not significant (P =0.08). CONCLUSION: Although the induction chemotherapy entails a particularly high death rate in our series, the association surgery-radiotherapy and the exclusive radiotherapy seem to be similarly efficient for the treatment of the hypopharyngeal carcinoma.

[Solitary bone plasmocytoma: treatment and outcome features].

PURPOSE: - To describe natural history of solitary bone plasmocytomas (SBO) after treatment. PATIENTS AND METHODS: - Between 1975 and 1998, we retrospectively identified 13 patients with SBO treated in the department of radiotherapy at Salah-Azaïz institute of Tunis. To be included in this study, three criteria were needed: histologic confirmation and only one bone lesion without medullary infiltration (or less than 10%). Mean age was 43 years (22-64) with sex-ratio of 3,3. Tumor sites were vertebra (6), flat bones (6) and tibia (1). Megavoltage radiotherapy was given to all patients, associated to surgery in eight cases (5 excisions and 3 laminectomies) and to chemotherapy in three. RESULTS: - With a mean follow-up of 63 months, two local failures were noted at 24 and 48 months. Two patients developed multifocal lesions and one patient had an extramedullary lesion. Multiple myeloma occurred in four patients (30%) after a median follow-up 3,5 years. Unfavorable outcome could not be predicted by age, gender or site of disease but by myeloma protein. CONCLUSION: - Radiotherapy is an effective local treatment for solitary bone plasmocytoma. Prospective studies are needed to better define predictive parameters of unfavourable outcome and indications of combined chemotherapy.

[Primary intramedullary ependymomas: retrospective study of 16 cases]. / Les épendymomes intramédullaires primitifs: étude rétrospective de 16 cas.

PURPOSE: To review the radiotherapy department experience in treating primary spinal cord ependymomas (PSCE), analyse prognostic factors and provide treatment recommendations regarding literature review. MATERIALS AND METHODS: Sixteen patients with PSCE received postoperative radiotherapy between 1972 and 1997. There were 10 male and 6 female patients with a mean age of 34 years (range 2-63). Surgery was gross total resection in 2 cases, subtotal resection in 9, biopsy in 4 and of unknown type in one patient. All patients were treated with radiotherapy to the craniospinal axis (4 cases), spinal cord (1 case) and to the site of primary tumour in 11 cases. RESULTS: Five year-survival rate was 73%. Two patients had recurrent tumours within the primary site. Gender, extent of surgery and treatment field extent were not prognostic factors. Histologic type was the only variable predictive of outcome. Patients with myxopapillary type had a 5-year survival rate of 100% compared with 47% for those with other histology types. CONCLUSION: We conclude that aggressive surgery is not necessary in the management of PSCE, localised field radiotherapy is associated with favourable outcome, and tumour grade is an important prognostic factor.

Redox characteristics of Schiff base manganese and cobalt complexes related to water-oxidizing complex of photosynthesis.

In an effort to obtain synthetic analogues of water-oxidizing complex (WOC) of photosystem II (PS II) of plant photosynthesis, a Schiff base manganese and a cobalt complex, employing Niten, a SALEN type ligand, have been prepared. Cyclic and square wave voltammetric measurements have been performed to assess their redox characteristics. Both complexes undergo several reduction processes in cathodic negative potential region at more or less similar potentials. In view of these reductions being independent of the nature of the metal, they are thought to be ligand-localized. Although similar in negative region, a marked difference in the behavior of the complexes is observed in anodic region. While the cobalt complex is electrochemically inactive in the positive potentials up to +1.0 V vs. Ag/AgCl, the manganese complex displays two oxidation waves at +0.25 and +0.5 V vs. Ag/AgCl. The presence of oxidation wave in manganese complex at +0.5 V vs. Ag/AgCl or +0.7 V vs. NHE suggests that this complex can catalyze the oxidation of water and can, thus, simulate the WOC of PS II.

United Kingdom Prospective Diabetes Study (UKPDS). Effects of glucose and blood pressure control on complications of type 2 diabetes mellitus.

The United Kingdom Prospective Diabetes Study (UKPDS) showed that intensive treatment (i.e., glucose-lowering drugs, with a goal fasting blood glucose level of 108 mg/dL) decreases the microvascular complications of type 2 diabetes mellitus. We summarize the key study results and their implications for clinical management of type 2 diabetes mellitus.

Quantitative determination of the polyphenolic content of pomegranate peel.

The quantitative determination of total phenols, ellagic tannins and gallic and ellagic acids in the peel of the Tunisian pomegranate variety Chelfi, has been carried out. The ellagic tannin content is prominently less than the amount of total phenols, which led us to look for the presence of the condensed tannins. The determination of the content of catechic tannins in eight Tunisian varieties of the pomegranate was carried out using weekly samples over a period of 2 months.

Instillation rate effects of Exosurf on cerebral and cardiovascular haemodynamics in preterm neonates.

The acute effects of surfactant instillation rate on the cerebral and cardiovascular haemodynamics were studied in a randomised trial of 27 preterm neonates with respiratory distress syndrome (RDS). Cerebral blood flow velocity (CBFV), mean arterial blood pressure (MABP), blood gases and electroencephalogram (EEG) were continuously recorded before, during, and for at least 10 minutes after the administration of surfactant. The measurements were repeated one, three, and six hours later. Left ventricular output (LVO) and ductal patency were assessed 10 minutes before and then one, three, and six hours after surfactant administration. Surfactant (Exosurf) was instilled rapidly over five minutes in 13 infants and slowly over 15 minutes in 14 infants. The rapid group showed a significant but transient increase (mean 38%) in CBFV, a rise strongly related to an increase in carbon dioxide tension. No significant change in CBFV was observed in the slow group. There were no significant changes in EEG, MABP, LVO, or ductal shunting in either group. The findings suggest that rapid instillation of Exosurf leads to an increase in CBFV and partial carbon dioxide pressure (PCO2) and requires a close monitoring of blood gases to maintain adequate ventilation. Furthermore, the findings should alert clinicians to the need for slow infusion of Exosurf.

Perinatal pharmacology and cerebral blood flow.

Many of the drugs used in neonatal intensive care units might impede cerebral blood flow, thereby increasing the risk of intraventricular hemorrhage and periventricular leukomalacia. Our studies focussed on sick preterm neonates who were treated with the following drugs: caffeine (20 mg/kg i.v., as caffeine citrate); phenobarbital (loading dose: 20 mg/kg); indomethacin (0.2 mg/kg/dose, every 12 h three doses), and synthetic surfactant (Exosurf; 50 mg/kg = 5 ml/kg intratracheally). All of the drugs studied, except indomethacin, had no adverse effect on cerebral hemodynamics.

Superoxide anion scavenging effect and superoxide dismutase activity of Ginkgo biloba extract.

Ginkgo biloba extract is known to be efficient in diseases associated with free radical generation. The purpose of this work was to study, under in vitro conditions, the action of Ginkgo biloba extract (Gbe) against superoxide anion (O2-.), which is directly or indirectly implicated in cell damage. Gbe appears to have both an O2-. scavenging effect and also a superoxide dismutase activity. Its antiradical effect was demonstrated by low temperature electron spin resonance and in a non-enzymatic system (phenazine methosulfate-NADH), and its enzymatic activity was shown by polarographic determination.

[Anatomical and physiological bases of labor onset]. / Bases anatomiques et physiologiques du déclenchement du travail.

The induction of labor involves a series of complex mechanisms, the control of which is only partially explained in humans. It is accepted today that the maturing of the uterine cervix is independent of the onset of uterine contractions. These two phenomena are regulated by a complex system where prostaglandins play a key role.