Life-threatening subglottic hemangioma in an infant successfully treated with propranolol.

Subglottic hemangioma is a rare benign tumor in children. It causes an obstruction of the upper airway and can be life-threatening. Several therapeutic options have been used in the literature, including surgery. Currently, the treatment is essentially based on propranolol. We report the case of a 2-month-old female infant hospitalized for severe obstructive dyspnea secondary to a subglottic hemangioma. Diagnosis was confirmed by laryngoscopy and magnetic resonance imaging. The child underwent a tracheotomy and was treated with propranolol. The progression was favorable with regression of the subglottic hemangioma and improvement of laryngotracheal airway obstruction.

Malignant degeneration of a branchial cyst: A case report.

INTRODUCTION: Malignant degeneration of a branchial cyst is rare (Thompson, 1997). It varies from 4% to 22% (Unal et al., 2005). CASE REPORT: A74-year-old man presented to our department with a left painless upper neck mass which was excised and histopathology revealed squamous cell carcinoma in a cystic lesion. The appropriate clinical tests and imaging were performed to determine the possible presence of a primary tumor. No primary carcinoma was found. This finding suggests that this was a malignant degeneration of a branchial cyst. The patient was treated with adjuvant radiotherapy and followed up over a 2-year-period and no recurrence was found. DISCUSSION: The development of an epidermoid carcinoma in situ in the amygdaloid cyst wall is a very rare entity. The challenge is to be able to distinguish between cystic metastasis of squamous cell carcinoma of the aerodigestive tract and a primary epidermoid carcinoma developed in the wall of an amygdaloid cyst. Martin and Khafif proposed some criteria to confirm the diagnosis of branchiogenic carcinoma.

Contribution of imaging in the initial management of ballistic trauma.

INTRODUCTION: The purpose of this study is to specify the role of imaging in the initial management of ballistic traumas. METHODS: This is a retrospective study that colligated 83 victims of a gunshot wound during demonstrations, treated in our trauma centre between 12 January and 3 February 2011. All of the patients were haemodynamically stable and examined by conventional radiography and/or ultrasound and/or 16-slice CT-scan (CT). RESULTS: The mean age of the victims was 26years with a sex ratio of 0.02. All wounds were unique. Injury to the limbs was most common in 75.5% of the cases (n=64) followed by that of the torso in 19.5% of the cases (n=16). Wounds in the spine (n=2), brain (n=2) and facial skeleton (n=1) were observed. Conventional x-rays objectified 32 cases of open fractures 95% of which were in the legs. Twenty-one of the victims of gunshot wounds had a CT-scan that objectified the path of the bullet and an assessment of the wound was made in all cases. The confrontation of the data from the CT-scan and that noted during surgery and during the monitoring demonstrated that the CT-scan is very efficient in the diagnosis of pleural effusion, vascular wounds, thoracic parenchymatous wounds and wounds of the solid organs and brain lesions and the facial skeleton. However, the sensitivity is low for the diagnosis of hollow organs. CONCLUSION: The CT-scan is very useful in the initial care of stable patients with gunshot wounds as regards the haemodynamics and helps objectify the path of the bullet and obtain a precise assessment of the damage. Conventional x-rays are unavoidable for wounds to the legs and spine.

Cervical unicentric Castleman's disease in children.

INTRODUCTION: Unicentric Castleman's disease (CD) is a rare benign lymphoproliferative disorder. A cervical location has rarely been reported in the pediatric literature. CASE REPORT: A 13-year-old boy presented with a mass in the right neck region of 3 months' evolution. Clinical examination revealed a smooth mobile 5 cm node deep in the sternocleidomastoid muscle. The diagnosis of hyaline vascular type CD was confirmed by complete surgical excision and histopathologic examination. Postoperative course was simple, without recurrence over 1 year's follow-up. DISCUSSION AND CONCLUSION: Cervically located CD often shows few symptoms, and is rarely suggested by a cervical mass found in children. Definitive diagnosis is histopathological. The hyaline vascular type of unicentric CD has a good prognosis after complete resection of the lesion.

Particularites des infections invasives a streptocoque du groupe B de l'adulte

Une augmentation de l'incidence des infections invasives a streptocoque du groupe B (SGB) de l'adulte a ete notee dans plusieurs pays developpes. Tres peu de series decrivent la situation dans les pays en voie de developpement. Objectifs : Determiner les particularites epidemio-cliniques; les facteurs favorisants et les modalites evolutives de ce type d'infections observees dans un hopital tunisien.Methode : Analyse retrospective de 65 episodes suivis entre 1993 et 2007. Resultats : Le sex-ratio etait de 0;3 et la mediane des ages etait de 59 ans. Au moins un facteur favorisant etait note dans 73;8des patients. Ces facteurs etaient domines par le diabete et les infections urinaires recidivantes (25). Les urosepsis; les infections genitales et les bacteriemies sans foyer primitif evident dominaient les tableaux cliniques. Les infections etaient polymicrobiennes dans 13;9des cas. Tous les isolats de SGBetaient sensibles aux penicillines. L'evolution etait souvent favorable; 4;6des patients etaient decedes et 7;7avaient eu des recidives d'infections invasives au meme germe. Conclusion : Notre etude montre un spectre clinique particulier des infections invasives a SGB de l'adulte et confirme le role du terrain sous jacent dans ce type d'infection. Une etude tunisienne a plus large echelle permettra de preciser l'ampleur de ces infections dans notre pays

[Bronchoscopic findings in children with prolonged respiratory symptoms]. / Indication de la bronchoscopie chez des enfants avec une symptomatologie respiratoire trainante traitement.

OBJECTIVE: This retrospective study aims to establish an algorithm indicating a bronchoscopy, based on clinical and radiological criteria predictive of the presence of a foreign body (FB), in children with prolonged respiratory symptoms and no history of foreign body aspiration (FBA); to establish a study of these criteria and to compare the clinical, radiological and broncoscopic findings in such cases. METHODS: We chose to review the records of 73 children (age < or = 15 years) with prolonged respiratory symptoms (for at least 15 days) and no history of FBA who underwent bronchoscopy at our institution between 1996 and 2005. RESULTS: The mean age was 3 years and 2 months, the majority of the patients were between 1 and 3 years of age (56%), 59% of the patients were boys and the mean of evolution of symptoms before the broncoscopy was 3 months and 3 weeks. We found a foreign body (FB) in 17 cases (23.2%). The FBs were in 88.2% of the cases of vegetable origin. A granulation tissue was associated in 47% of positive bronchoscopies. There were no complications related to bronchoscopy. The clinical and the radiological findings were no specific of FBs. CONCLUSION: Bronchoscopy must be indicated in suspected cases of FBA to prevent delayed diagnosis and pulmonary sequelae. The clinical and radiological findings may help the clinician to indicate it.

[Parotid retention cyst revealing a mucoepidermoid carcinoma]. / Kyste parotidien rétentionnel révélateur d'un carcinome mucoépidermoïde.

OBJECTIVES: To describe a case of mucoepidermoid carcinoma of the parotid gland that caused obstruction of a salivary gland duct and manifested as a parotid retention cyst. PATIENT AND METHODS: A 21-year-old woman presented with a 5-cm cystic swelling in her left parotid region. Ultrasound examination and a computerized tomography scan showed a clearly outlined parotid cyst. Through a conventional parotidectomy incision, the cyst was excised with parotid gland tissue around the lesion. The patient had an uncomplicated recovery. RESULTS: Histopathological examination of the resected parotidectomy material showed a parotid retention cyst and a mucoepidermoid carcinoma measuring 5mm in diameter. CONCLUSION: Among acquired cysts of the parotid gland, retention cysts are the most frequent. They may be the presenting symptom in patients with occult cancer of the parotid. In this case report, a mucoepidermoid carcinoma played a significant role in the obstruction of a salivary gland duct and caused a parotid retention cyst. Thus, a wide excision of the parotid retention cyst is necessary, as is a careful review of the histology searching for malignant lesion.

Stenose tracheale post-intubation

Objectif : Rappeler les principales caracteristiques etiopathogeniques des stenoses tracheales post-intubation; preciser le bilan preoperatoire et discuter les differentes modalites therapeutiques. Materiel et methodes : Notre travail porte sur une etude retrospective de vingt huit stenoses tracheales cicatricielles traitees de 1987 a 2003 au service d'ORL et de chirurgie cervico-faciale du CHU Farhat Hached de Sousse. Resultats : Elles sont toutes acquises; secondaires a une intubation et/ou a une tracheotomie. Les resultats de notre travail montrent le role primordial du traitement medical et endoscopique. Cependant; le meilleur traitement des stenoses tracheales reste le traitement chirurgical base sur la resection anastomose tracheale dont on a precise les indications et evalue les resultats; juges bons avec 89de cas favorables. Conclusion : Nos resultats montrent que le traitement endoscopique des STPI peut etre considere comme un traitement de premiere ligne. Les stenoses complexes et resistantes au traitement endoscopique relevent d'un traitement chirurgical

Les tumeurs parotidienne de l'enfant a propos de 13 cas

Introduction : Les tumeurs parotidiennes de l'enfant sont rares. Plusieurs types histologiques peuvent etre rencontres et rappellent souvent ceux de l'adulte. But : Analyser les particularites epidemiologiques; cliniques et therapeutiques des tumeurs parotidiennes chez l'enfant. Materiel et methodes : Il s'agit d'une etude retrospective; portant sur 13 observations de tumeurs parotidiennes de l'enfant colligees sur une periode de 23 ans de Janvier 1985 a Decembre 2007. Resultats : Nos malades se repartissaient en 8 filles et 5 garcons. L'age moyen etait de 11 ans. Notre serie avait comporte 12 cas (92;3) de tumeurs benignes et un cas (7;7) de tumeur maligne. Tous nos malades ont eu un traitement chirurgical. L'examen histologique definitif a conclu a un adenome pleomorphe dans 5 cas; un oncocytome dans un cas. Deux malades etaient porteurs d'une tumeur vasculaire; un malade d'une tumeur nerveuse; deux de kystes lymphoepitheliaux; un malade d'un kyste hydatique et un patient d'un carcinome mucoepidermoide. L'evolution a ete marquee par l'absence de recidive tumorale avec un recul variant entre 8 mois et 6 ans pour tous nos malades. Conclusion : Bien que les tumefactions parotidiennes soient rares chez l'enfant; elles representent une grande variete de diagnostics histologiques y compris des tumeurs malignes

L'otite externe necrosante place de l'oxygenotherapie hyperbare

L'otite externe necrosante est une pathologie grave qui pose de plus en plus de difficultes dans la prise en charge therapeutique. Nous rapportons dans ce travail une observation d'otite externe necrosante compliquee d'une paralysie faciale qui avait resiste au traitement medical et chirurgical bien conduits. L'adjonction de l'oxygenotherapie hyperbare comme traitement complementaire a permis une regression des signes cliniques et une guerison de l'infection. Il s'agissait du premier cas d'otite externe necrosante ayant beneficie en mars 1996 de l'oxygenotherapie hyperbare en Tunisie. A travers cette observation; nous discutons l'indication de l'oxygenotherapie hyperbare dans le traitement de l'otite externe necrosante

Paragangliome bilateral : a propos de deux observations

Objectifs: Rappeler les caracteristiques cliniques; paracliniques; et les modalites therapeutiques adaptees devant des paragangliomes bilateraux. Methodes: Nous rapportons deux observations de paragangliomes bilateraux; l'un tympano-jugulaire bilateral et l'autre cervical (carotidien et vagal); colligees durant une periode de 22 ans (1985-2007). Nos deux patients avaient eu un examen clinique complet un bilan radiologique et biologique. Resultats: Notre premier malade a eu une radiotherapie exclusive; le deuxieme a eu une exerese chirurgicale complete de la tumeur vagale et on a opte pour une surveillance de la tumeur controlaterale. Pour nos deux patients l'evolution etait favorable marquee par une stabilisation tumorale. Conclusion: Les paragangliomes cervico-cephaliques bilateraux sont des formes cliniques rarement observees. Le diagnostic positif repose sur l'imagerie. L'attitude therapeutique n'est pas univoque et doit etre adaptee en fonction du siege de la tumeur et du bilan d'extension locoregional

Mastiodite masquée : à propos de deux observations

La mastoïdite masquée (MM) se définit comme un état inflammatoire latent de la muqueuse et de l'os mastoïdien avecun tympan normal. Elle est révélée par une complication généralement endocrânienne. Le traitement est une mastoïdectomie associée à une antibiothérapie intraveineuse.Nous rapportons deux observations de mastoïdites masquées dont le diagnostic a été évoqué par l'examen tomodensitométrique qui a rattaché les complications endocrâniennes à leur origine mastoïdienne. Le but de notre travail est de discuter les circonstances diagnostiques, les investigations paracliniques et le traitementdes mastoïdites masquées

Thrombophlebite du sinus caverneux d'origine otogene : a propos d'un cas

But : Nous illustrons un cas de thrombophlebite du sinus caverneux compliquant une oto-mastoidite. Nous etudions a la lumiere de la litterature les difficultes diagnostiques et l'importance de la mise en oeuvre d'un traitement precoce et adapte afin d'eviter les sequelles ulterieures. Observation : Il s'agit d'un enfant age de 14 ans; qui avait presente une exophtalmie avec oedeme palpebral bilateral et une baisse de l'acuite visuelle d'aggravation progressive au decours d'un episode otitique. L'examen avait objective uneparalysie faciale peripherique droite et a l'otoscopie un tympan droit bombe congestif. La TDM avait mis en evidence une thrombophlebite du sinus caverneux associee a un abces cerebral et a un abces retropharynge avec une oto-mastoidite homolaterale. Le malade a ete traite par une antibiotherapie a large spectre associee a une heparinothe-rapie; avec mastoidectomie droite et drainage de l'abces retro-pharynge. L'evolution a ete marquee par la regression totale de la paralysie faciale; avec repermeabilisation du sinus caverneux et disparition totale de l'abces temporal au controle scannographique. Le patient a garde comme seule sequelle une cecite mono oculaire gauche.Conclusion : La thrombophlebite du sinus caverneux est une affection rare; surtout dans son origine otogene elle doit etre diagnostiquee et traitee le plutot possible; afin de prevenir les sequelles ou d'obtenir la regression de ces dernieres. Le traitement doit associer une antibiotherapie a large spectre; les anticoagulants et un drainage chirurgical approprie du foyer septique

Les tumeurs oncocytaires de la thyroide : a propos de 25 cas

But : Les tumeurs a cellules oncocytaires de la thyroide (TOT) ont donne jusqu'a ces dernieres annees de nombreuses controverses; du fait des difficultes a differencier les tumeurs benignes des tumeurs malignes; entrainant des attitudes therapeutiques divergentes. L'objectif de cette etude est de voir a travers une revue de litterature les aspects cliniques et pathologiques particuliers aux tumeurs oncocytaires de la thyroide et d'essayer de reunir les elements cliniques et anatomopathologiques pouvant predire l'aspect malin de ces tumeurs. Methodes : Il s'agit d'une etude retrospective menee sur une periode de 19 ans etalee de janvier 1988 a decembre 2006; pendant laquelle nous avons collige 25 cas de tumeurs oncocytaires de la thyroide. La circonstance de decouverte etait un nodule thyroidien pour tous les patients. Resultats : Notre travail repose sur une serie de 25 tumeurs oncocytaires de la thyroide; dont 3 cancers oncocytaires (12). Ces tumeurs representent 1;2 des tumeurs thyroidiennes operees durant la meme periode. L'age moyen des patients ayant eu un carcinome oncocytaire etait de 65 ans; la taille moyenne de ces carcinomes etait de 4 cm. Le traitement a consiste en une loboisthmec- tomie pour les adenomes et en une thyroidectomie totale associee a un curage ganglionnaire cervical suivi d'une iratherapie pour les carcinomes. Une seule patiente ayant presente un carcinome oncocytaire a developpe une metastase a distance. L'evolution etait favorable chez tous les autres patients avec recul variable de 9 mois a 22 ans avec une moyenne de 5 ans. Conclusion : Les tumeurs oncocytaires de la thyroide sont reconnues a la lumiere des travaux recents comme une entite anatomo-clinique particuliere; se differenciant des tumeurs vesiculaires (auxquelles elles ont ete longtemps assimilees) par une evolution plus pejorative et par une insensibilite a l'iode radioactif avec une frequence accrue de metastases pour les carcinomes

[NK/T-Cell lymphoma of nasopharynx]. / Lymphomes T/NK du nasopharynx.

OBJECTIVE: Discussion of the clinical and paraclinical features of a rare tumor in the nasopharynx, the NK/T-cell lymphoma, with an emphasis on the implications of Epstein Barr Virus (EBV) in its pathogenesis and prognosis. CASES REPORT: We report the cases of a woman and a man aged 34 and 48, respectively. Clinical presentation was non-specific and diagnosis was established with deep biopsies under general anesthesia. Immunochemistry and in situ hybridization were positive for Epstein Barr virus in tumor cells in both cases. The patients were first treated with chemotherapy (CHOP regimen), then underwent radiotherapy. The first patient achieved complete response at twenty months follow-up. The second patient presented two recurrences which were treated by chemotherapy. He died from acute renal failure during treatment of the second recurrence. CONCLUSION: Diagnosis of NK/T-cell lymphoma may be delayed in the event of non-specific symptoms. Deep biopsies outside necrotic tissue must be obtained. Search for EBV is important as its presence is a factor of poor prognosis.

[Mycobacterial cervical lymphadenitis: role of surgery]. / Adénopathies cervicales tuberculeuses: place de la chirurgie.

OBJECTIVE: To discuss the place of surgery in the management of mycobacterial cervical lymphadenitis. PATIENTS AND METHODS: It's a retrospective study (1982-2002) about 246 patients treated in the ENT department of Farhat Hached Sousse for cervical lymph node tuberculosis. Resolution was considered when neither symptoms nor lymphadenopathy in examination were noted. RESULTS: The mean age of our patients was 28 years. A light female prevalence was noted. In 5 patients diagnosis was established by lymph node punction. A medical treatment of first intention was then managed with a failure in 3 cases, after deadlines from 3 to 4 months. All other patients were operated: cellulolymphadenectomy (47%), adenectomy (47%) or drainage of a cervical abscess (4%). Recurrence and antituberculosis treatment resistance were noted respectively in 6% and 3% of cases. DISCUSSION: Two questions are still discussed in the management of mycobacterial cervical lymphadenitis: 1- Is surgery necessary for the diagnosis? 2- When is surgery indicated directly? Histological specimen established the diagnosis in all cases and excluded a mestastatic lymph node. In some situations surgery must be indicated at first: cold abscess, lymph node fistulation. CONCLUSION: Surgery still has an important place in the treatment of tuberculosis lymphadenopathy.

[Diffuse pseudotumorous oncocytosis of the parotid gland. A case report]. / L'oncocytose diffuse pseudo-tumorale de la glande parotide.

Pseudotumorous oncocytosis of the parotid gland is very uncommon and frequently misdiagnosed since it generally presents as a true tumor. The clinical presentation and imaging features of a 6-cm diameter left parotid mass led to the diagnosis of a tumor in a 73-year-old man. At pathology examination of the partial parotidectomy specimen the "tumor" was found to be a metaplastic oncocytic lesion. We discuss the diagnostic criteria, differential diagnosis, and etiopathogeny of this lesion.

[Submandibular lithiasis. Report of 48 cases]. / Les sous-mandibulites lithiasiques. A propos de 48 cas.

This retrospective study concerned 48 patients treated surgically for sub mandibular lithiasis. Results of medical imaging (plain films, sialography, ultrasonography) are confronted with operative findings. The surgical indications are analysed according to lithiasis localisation.

[Ear myiasis. Two case reports]. / Les myiases auriculaires. A propos de deux observations.

The authors report two cases of aural myiasis. This pathology rarity induced us to search after epidemiologic, clinic and therapeutic peculiarity of this parasitical disease.