RESUMO
Penetrating neck and facial injuries are rare withonly a few cases reported in literature. Indeed, they are extremely rare in developed countries but remain relevant in our rural areas that are characterized by the recurrence of intertribal clashes. It was in thiscontextthatwereceivedtwo patients in the department of ENT of Niamey National Hospital. They presented with head and neck trauma. The middle stage of the neck in the first case and, in the left lateral face of the nasal pyramid in the second. Surgical management, under general anesthesia, enabled the removal of an arrow in both cases.
Les plaies pénétrantes cervico-faciales par flèche ont fait l'objet de très peu de publications dans la littérature. En effet, elles sont d'une extrême rareté dans les pays développés mais restent encore d'actualité dans nos régions à communautés majoritairement rurales, caractérisées par la récurrence des affrontements intertribaux. C'est dans un tel contexte que nous avons reçu deux patients au service d'ORL et CCF de l'hôpital national de Niamey. Ils présentaient un traumatisme cervico facial. L'agent vulnérant, une tige métallique, était enfoncé dans l'étage moyen du cou chez le premier et, dans la face latérale gauche de la pyramide nasale chez le second. Une prise en charge chirurgicale, sous anesthésie générale, a permis l'extraction d'une flèche dans les deux cas.
RESUMO
We report a case of bilateral Primary tuberculosis of the parotid gland that evolve more than one year, in a 35 years old patient, without any pathologic antecedent, where physical examination showed bilateral parotid swelling, in a context of conservation of general state. Ultrasound showed parotids increased in volume, heterogeneous with many fluid tissue formations, whose largest voluminous at right measure 28 millimeters, against 25 millimeters at left, with necrosis areas. The scan showed homogenous tissue density lesions, enhanced after contrast product injection. The fine needle aspiration was in favor of granulomatous lymphadenitis, suggestive of tuberculosis. Intradermoreaction to tuberculin was positive (15 millimeters in diameter).The diagnosis of bilateral primary tuberculosis of the parotid was retained. A 6 months antituberculosis medical treatment was established with disappearance of parotid swelling, without recidive or others complications, on a decline of 14 months after treatment.
Nous rapportons un cas de tuberculose parotidienne primitive bilatérale évoluant depuis plus d'un an, chez une patiente de 35 ans, sans antécédents pathologiques particuliers, chez qui l'examen clinique a noté une tuméfaction des 2 régions parotidiennes dans un contexte de conservation de l'état général. L'échographie a noté des glandes parotides augmentées de volume, hétérogènes, avec plusieurs formations tissulo-liquidiennes dont la plus volumineuse à droite mesure 28 mm contre 25 mm à gauche, et présence des zones de nécrose. La TDM a retrouvé des lésions de densité tissulaire, homogènes, rehaussées après injection de produit de contraste. La cytoponction a été en faveur d'une lymphadénite granulomateuse évocatrice d'une tuberculose. L'IDR à la tuberculine a été positive (15 mm de diamètre). Le diagnostic de la tuberculose primitive bilatérale de la parotide a ainsi été retenu. Un traitement médical antituberculeux de six (6) mois a été instauré et s'est soldé par une disparition totale des tuméfactions parotidiennes, sans récidive ou autres complications sur un recul de 14 mois après la fin du traitement.
RESUMO
OBJECTIVE: To evaluate the nutritional status at the time of diagnosis of patients treated for head and neck cancer. MATERIAL AND METHODS: Single-centre prospective study. Nutritional assessment comprised: clinical interview, physical examination, and a laboratory work-up. Clinical interview assessed: reference weight, diet, calorie intake, causes of weight loss, use of dietary supplements. A subjective global assessment of nutritional status (Detsky index) was established on the basis of clinical interview. The patient's height and weight were determined and serum albumin was assayed. Weight loss, body mass index, and Buzby index were then calculated. Two groups of malnourished patients were distinguished: moderately malnourished (group 1), severely malnourished (group 2). Variables were compared between the two groups by Chi(2) test. RESULTS: One hundred and sixty-nine patients were included in the study: 145 had a history of smoking and alcohol abuse, 82 (48.5%) were malnourished and 47 of them were classified in group 1. All patients of group 1 had a normal or pureed diet. 21 (69%) patients of group 2 had a pureed or liquid diet. The mean daily calorie intake was 31kcal/kg/24h for group 1 and 20kcal/kg/24h for group 2. The main causes of weight loss were pain and dysphagia. Dietary supplements were not used by any of the patients in group 1 and by four (13%) patients in group 2. The concordance between the Detsky index and objective nutritional status was 92% for the overall population. Malnutrition was significantly more frequent among males (P=0.01), alcohol users (P=0.02), elderly subjects (P=0.01), patients with pharyngeal tumour (P=0.03), and patients with advanced tumour stage (P=0.01). CONCLUSION: The prevalence of malnutrition among patients with head and neck cancer is high. Assessment of nutritional status and appropriate management must be part of the initial work-up of these patients.
