Particularités du cancer du larynx chez le sujet jeune / Epidemiological and clinical predictive factors of success in septoplasty: Study of 250 patients

Discuter à travers une étude descriptive ainsi qu'une revue de la littérature, les particularités cliniques, démographiques et pronostiques des patients de moins de 45 ans, ayant un cancer du larynx. Materiels et Methodes: Il s'agit d'une étude rétrospective descriptive portant sur des patients atteints d'un cancer du larynx, âgés de moins de 45 ans suivis dans le service d'ORL et de chirurgie cervico-faciale du CHU Habib Bourguiba Sfax durant la période s'étendant de 1989 à 2018. Resultats: Nous avons trouvé 31 patients avec une prédominance masculine. Un cancer dans la famille a été trouvé dans 16,12% des cas sans corrélation statistique avec le stade avancé de la maladie. Une importante intoxication tabagique a été trouvée (96%). Trois patients avaient une laryngite chronique et un patient une papillomatose laryngée avec des lésions de dysplasie. Les motifs de consultation étaient dominés par la dysphonie (87%). La maladie a été classée en stades avancés dans 70% des cas. Le traitement chirurgical était préconisé chez 87% des patients et la préservation fonctionnelle chez 38,7%. Le taux de survie globale et sans maladie étaient respectivement, à un an de 96% et 84%, à 3 ans de 87% et 76%, et à 5 ans de 77% et 75% Conclusion: Notre travail n'a pas permis de retenir de différence en termes de données cliniques, de l'évolution de la maladie, de l'algorithme thérapeutique ni du pronostic entre les jeunes patients et les plus âgés

[Idiopathic facial paralysis in children]. / Paralysie faciale idiopathique de l'enfant.

BACKGROUND: Idiopathic facial palsy is the most common cause of facial nerve palsy in children. Controversy exists regarding treatment options. The objectives of this study were to review the epidemiological and clinical characteristics as well as the outcome of idiopathic facial palsy in children to suggest appropriate treatment. PATIENTS AND METHODS: A retrospective study was conducted on children with a diagnosis of idiopathic facial palsy from 2007 to 2012. RESULTS: A total of 37 cases (13 males, 24 females) with a mean age of 13.9 years were included in this analysis. The mean duration between onset of Bell's palsy and consultation was 3 days. Of these patients, 78.3% had moderately severe (grade IV) or severe paralysis (grade V on the House and Brackmann grading). Twenty-seven patients were treated in an outpatient context, three patients were hospitalized, and seven patients were treated as outpatients and subsequently hospitalized. All patients received corticosteroids. Eight of them also received antiviral treatment. The complete recovery rate was 94.6% (35/37). The duration of complete recovery was 7.4 weeks. DISCUSSION: Children with idiopathic facial palsy have a very good prognosis. The complete recovery rate exceeds 90%. However, controversy exists regarding treatment options. High-quality studies have been conducted on adult populations. Medical treatment based on corticosteroids alone or combined with antiviral treatment is certainly effective in improving facial function outcomes in adults. In children, the recommendation for prescription of steroids and antiviral drugs based on adult treatment appears to be justified. CONCLUSION: Randomized controlled trials in the pediatric population are recommended to define a strategy for management of idiopathic facial paralysis.

Pancreaticojejunostomy vs. pancreaticogastrostomy following pancreaticoduodenectomy: results of comparative study.

AIM: Several techniques have been proposed for reconstructing pancreatico-digestive continuity, which the first goal is reducing the rate of pancreatic leakage after pancreaticoduodenectomy. Only a limited number studies have been carried out. Our objective is to compare the results of pancreaticojejunostomy versus pancreaticogastrostomy following pancreaticoduodenectomy. METHODS: This is a retrospective and comparative study about 80 patients who underwent pancreaticoduodenectomy. These patients were divided into two groups: pancreaticojejunostomy (group PJ) and pancreaticogastrostomy (group PG). RESULTS: The PJ group included 39 patients, while 41 patients were included in the PG group. There were no differences between the two groups concerning: patients' demographics, risk factors, indication, mean duration of surgery, texture of pancreatic tissue, need for intraoperative blood transfusion and postoperative prophylactic octreotide. Overall, the mortality postoperative rate was 7.5% (N.=6), the incidence of surgical complications was 50% (51.3% in PJ, 48.8% in PG; P=0.823, not significant). Pancreatic fistula was the most frequent complication, occurring in 17.5% of patients (25.6% in PJ and 9.8% in PG; P=0.062, almost significant). 7.7% of patients who underwent PJ and 14.6% of patients who underwent PG required a second surgical intervention (P=0.326, not significant). There were no differences between the two groups PG and PJ concerning: Postoperative hemorrhage (P=0.63), biliary fistula (P=0.09), acute pancreatitis (P=0.95), delayed gastric emptying (P=0.33). The mean postoperative hospitalisation period stay was similar in both groups (P=0.63) CONCLUSION: There were not any significant differences between the two groups in the overall postoperative complication rate, the incidence of postoperative haemorrhage, biliary fistula, acute pancreatitis, and delayed.

[Spouses and bipolar disorder]. / Conjoints et trouble bipolaire.

OBJECTIVE: To assess the quality of life of a population of spouses of bipolar patients compared with a control population. PATIENTS AND METHODS: We conducted a cross-sectional study which included two groups: a group of 30 spouses of patients followed for bipolar I disorder according to DSM IV criteria and a second group of 30 subjects from the general population. Both groups were matched by age, sex, marital status and socioeconomic level. This device was designed to limit the differences between the two groups solely those of the bipolar illness. Evaluating the quality of life was achieved using the quality of life scale: SF-36. This is a scale that has already been translated and validated in dialect Arabic. RESULTS: Regarding sociodemographic variables, the two study groups differed only for: recreation, friendly relations and the couple relationship that included more and better skills among the control group. In the categorical approach, the quality of life was impaired in 60% of spouses and 40% of controls with a statistically significant difference. The following standardized dimensions: mental health (D4), limitation due to mental health (D5), life and relationship with others (D6) and perceived health (D8) and mental component (CM) were significantly altered in patients' spouses compared to controls. We found significant differences between the two groups for: overall average score (51.1 vs. 68.2), mental health (D4), limitation due to mental health (D5), life and relationship with others (D6), perceived health (D8) and perceived health (D8) standards. DISCUSSION: The impairment of quality of life of bipolar patients' spouses is related to the extra responsibility, stress, financial problems and health problems, stigma, and loss of security of the person loved. CONCLUSION: Considering the consequences that the appearance of bipolar disorder on the patient's spouse may have, certain measures must be proposed to improve their quality of life.

[Schizophrenia and violence, incidence and risk factors: a Tunisian sample]. / Schizophrénie et violence: incidence et facteurs de risque à propos d'une population tunisienne.

INTRODUCTION: Schizophrenia appears to be the mental pathology the most associated with violence. The aim of this study is to show the incidence and the different risk factors of violence among schizophrenics. MATERIAL AND METHOD: We have compared a group of 30 violent schizophrenic inpatients with another group of 30 nonviolent schizophrenic inpatients hospitalised during the same period. These two groups have been matched according to age and gender. The comparison concerned: sociodemographic parameters, family and personal psychiatric history, legal antecedents, social insertion, clinic, Clinical Global Impressions (CGI), Global Impairment Scale (GIS) and Positive And Negative Syndrome Scale (PANSS) scores for admissions, familial support and insight, compliance to treatment, administered treatments, and awareness degree. RESULTS: Violent schizophrenics represent 18.07% of all hospitalisations and 26.08% of schizophrenic patients. When compared to violent schizophrenic patients, nonviolent schizophrenic patients have a better socioeconomic level (77% versus 43%), better professional adaptation (67% versus 10%) and familial support (60% versus 10%), better insight (87% versus 23%) and therapeutic control (70% versus 17%). Differences are significant. We found significantly more personal antecedents of inflicted violence within violent schizophrenics (50% versus 13%), more addictive behavior (53% versus 13%), and more paranoid and indifferentiated forms (87% versus 47%) than in nonviolent schizophrenics. The average of CGI scores was significantly higher within violent schizophrenics (5.27+/-0.8 versus 3.77+/-0.5). Conversely, the average of EGF scores was lowest (37.6+/-6.5 versus 47.8+/-5.6). The comparison of PANSS scores revealed that violent schizophrenic subjects are characterised by the existence of more positive signs and more general symptoms (34.4+/-4.7 versus 20.2+/-4.5; 55.1+/-11.4 versus 46.1+/-6.9). Violent schizophrenics are characterised by higher neuroleptic doses (2375+/-738 mg/d versus 1610+/-434 mg/d). Differences here are also significant. DISCUSSION: Addictive behaviour seems to considerably increase the risk of turning to violence. Thus in our study, 53% of violent patients showed an addictive behaviour. These results have also been reported by other authors. It is obvious that alcohol and drug abuse double the risk of violence among schizophrenic subjects. Psychotic decompensation and rich symptomatology increase the violent potential among the schizophrenics. In our study, the PANSS scores were higher among violent subjects. Nonviolent schizophrenic subjects have a lesser symptomatology of psychiatric disorders and a better outcome as shown by the CGI and EGF scores. In our study, the group of violent subjects needed higher neuroleptic doses and were noncompliant. Compliance permits the acquisition, and then maintains, the stability of the mental status and plays an essential role in decreasing dangerousness. In fact, violent schizophrenics exhibit low insight, implying diminished awareness of the legal implications of their acts, and are little aware of their illness and its dangerousness. In our study, we noted better familial support among nonviolent subjects. According to the literature, violent schizophrenics are characterised by a particularly hostile and rejecting familial environment. CONCLUSION: Awareness of these factors will allow us to provide improved prevention of violence within schizophrenic subjects.