Subject(s)
Asthma , Pulmonary Medicine , Adult , Asthma/diagnosis , Asthma/therapy , Child , Follow-Up Studies , HumansABSTRACT
OBJECTIVES: To evaluate the reliability of magnetic resonance imaging (MRI) for the diagnosis of middle ear cholesteatoma and to determine the contribution of each MRI sequence. PATIENTS AND METHODS: A series of 97 cases was reviewed, corresponding to 89 patients (43 women, 46 men). Each patient was assessed by the following MRI protocol: T1-weighted, T2-weighted, early contrast-enhanced T1-weighted, delayed contrast-enhanced T1-weighted, and diffusion-weighted sequences. All patients were operated, for the first time in 16 cases and for second-look surgery in 81 cases. Radiological findings were compared to surgical and histological findings. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each sequence. RESULTS: Seventy-four cholesteatomas were diagnosed at surgery. These lesions had a mean diameter of 8.29±5.46mm. The smallest cholesteatoma in this series was 2mm in diameter. Diffusion-weighted and delayed contrast-enhanced T1-weighted sequences had a sensitivity of 84.9% and 90.4%, a specificity of 87.5% and 75%, a positive predictive value of 95.4% and 91.7%, and a negative predictive value of 65.6% and 72%, respectively. T1-weighted, T2-weighted, and early contrast-enhanced T1-weighted sequences had a low specificity. CONCLUSIONS: MRI is a reliable imaging modality for the diagnosis of middle ear cholesteatoma. Diffusion-weighted and delayed contrast-enhanced T1-weighted sequences were discriminant. In the context of postoperative follow-up of cholesteatoma, these sequences allow better selection of cases requiring second-look surgery.
Subject(s)
Cholesteatoma, Middle Ear/diagnosis , Magnetic Resonance Imaging/methods , Adult , Cholesteatoma, Middle Ear/surgery , Contrast Media , Diagnosis, Differential , Female , Humans , Longitudinal Studies , Male , Predictive Value of Tests , Prospective Studies , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
This article reviews the concept of selectivity in peritumoral microscopic disease to be included in the Clinical Target Volume (CTV) for elective treatment for larynx and hypopharynx squamous cell carcinoma (50 Gy or 54-60 Gy for SIB-IMRT), using the local tumoral spread. The objective of the present article is to present the different delineations of the target volumes, required for an appropriate application of 3-DCRT and IMRT (supraglottic larynx, vocal cord, subglottic larynx, pyriform sinus, lateral and posterior pharyngeal wall and postcricoid pharynx). These propositions are for the delineation of microscopic peritumoral target volumes when external beam irradiation is required. CTVs are illustrated on CT sections.
Subject(s)
Hypopharyngeal Neoplasms/radiotherapy , Laryngeal Neoplasms/radiotherapy , Humans , Hypopharyngeal Neoplasms/pathology , Hypopharynx/anatomy & histology , Hypopharynx/radiation effects , Laryngeal Neoplasms/pathology , Larynx/anatomy & histology , Larynx/radiation effects , Lymph Nodes/diagnostic imaging , Lymph Nodes/pathology , Neoplasm Metastasis , Radiotherapy, Conformal/methods , Tomography, X-Ray Computed/methodsABSTRACT
OBJECTIVES: Lacrimal sac tumors are usually primary and of epithelial origin. Overall, 55% of lacrimal sac tumors are malignant. Mortality rates for malignant tumors depend on tumor stage and type, with a mean rate of 38%. The main objective of this study was to review our experience with these malignancies and to compare this with the published literature. PATIENTS AND METHODS: A 15-year retrospective review of all malignant lacrimal sac tumor patients was completed in our department. Seven patients were found to have malignant sac tumors. The mean age was 53 years (range, 32-74 years) with six women and one man. The patients' clinical records were reviewed for data regarding patient symptoms, preoperative investigations, pathology reports, treatment results, and outcome. These data were compared with the available literature. RESULTS: All patients presented with epiphora and a palpable lump of the internal canthus. In two cases, a history of recurrent dacryocystitis was noted. The histological types were as follows: squamous cell carcinoma (n=5), one case of adenoid cystic carcinoma, and one case of malignant lymphoma. Surgery was performed in six cases with additional radiotherapy in four. One patient was treated exclusively with external radiotherapy. The mean follow-up was 68 months (range, 6-204 months). Two patients developed recurrences: three were disease-free at the time of the study. CONCLUSIONS: Malignant epithelial lacrimal sac tumors are rare cancers with significant recurrence rates. Correct diagnosis and appropriate therapy require a multidisciplinary management approach. Treatment of these malignant epithelial tumors is first and foremost complete surgical removal with wide excision.
Subject(s)
Eye Neoplasms , Lacrimal Apparatus , Adult , Aged , Eye Neoplasms/diagnosis , Eye Neoplasms/therapy , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
OBJECTIVES: Determinate the different prognostic factors of survival in ethmoidal sinus adenocarcinomas (ADK). MATERIAL AND METHODS: 60 patients with ethmoidal sinus ADK. 59 men and one woman. Average of 62.2 years (41-82). Retrospective study between 1985 and 2005. The following data were analyzed: exposure time to wood dust, disease incidence, primary clinical symptoms and ASA score. Radiological data were recovered by tomodensitometry and magnetic resonance imaging. Histological groups were described. TNM classification according to UICC 2002 and Roux/Brasnu was established on clinical and radiological constatations. Different treatments used were analyzed. Estimate of survival rate and impact of different prognostic factors were based on Kaplan-Meier actuarial method and multivariate analysis. RESULTS: Incidence rate was 2.86 patients a year. Exposure average time to wood dust was 25.6 years (2-44). T3/T4 stages were predominant (66.7%). the survival rate was 46.5% at 5 years. The survival rate was significantly superior respectively in T1 and T2 stages than in T3 and T4 stages, and in T4a than in T4b stages. Extension of the lesion to the sphenoid sinus was revealed as a significant bad prognostic factor. The ASA score and the exposure time to wood dust were not identified as statistically significant prognosis factors. CONCLUSION: Survival factors of ethmoïd sinus ADK were T stage and the extension of the tumor to the sphenoid sinus. On the results of this study, we consider that extension in sphenoïd sinus could be include in TNM classification of ethmoïd sinus adenocarcinomas.
Subject(s)
Adenocarcinoma/diagnosis , Ethmoid Sinus , Occupational Diseases/diagnosis , Paranasal Sinus Neoplasms/diagnosis , Adenocarcinoma/etiology , Adenocarcinoma/mortality , Adenocarcinoma/therapy , Adult , Aged , Aged, 80 and over , Dust , Female , France/epidemiology , Humans , Incidence , Male , Middle Aged , Neoplasm Staging , Occupational Diseases/etiology , Occupational Diseases/mortality , Occupational Diseases/therapy , Occupational Exposure/adverse effects , Paranasal Sinus Neoplasms/etiology , Paranasal Sinus Neoplasms/mortality , Paranasal Sinus Neoplasms/therapy , Prognosis , Retrospective Studies , Risk Factors , Survival Rate , Wood/adverse effectsABSTRACT
OBJECTIVE: To report a nasal leishmaniasis diagnosed by septal perforation biopsy. MATERIAL AND METHODS: We report a case of septal perforation with crusty rhinosinusitis and nasal vestibulitis in a 54-year-old woman with cirrhosis. RESULTS: Mucocartilaginous biopsy revealed a mucosal leishmaniasis. Biological and radiologic findings were normal. Clinical follow-up with anti-parasitical treatment showed a regression of the patient's muco-cutaneous lesion and regression of her hepatic insufficiency. CONCLUSION: Biopsy of septal perforation is a useful diagnostic tool, advocated for differentiate infectious, neoplasic and inflammatory pathology. Leishmaniasis may be evoked in rhinologic pathology.
Subject(s)
Leishmaniasis , Nasal Septum , Female , Humans , Leishmaniasis/pathology , Middle Aged , Nose Diseases/parasitology , Nose Diseases/pathologyABSTRACT
Two cases of internal carotid artery aneurysm arising within the petrous bone are described, bringing up to 56 the number of such cases reported to date in the medical literature scanned through Medline. The first case presented as a moderately bleeding tumor of the petrous apex, while the second was revealed by a massive otorrhage. In both cases a pulsatile nasopharyngeal mass was associated with otorrhage. The treatment required in both cases the aneurysm to be embolized in extreme emergency. One patient suffered transient hemiplegia and aphasia that completely recovered, while the second eventually died, although the carotid occlusion had been well tolerated in the first two weeks that followed this procedure. From their own experience and a literature review, we can emphasize the need for arterial extra-intracranial bypass before an aneurysm embolization be proposed, since the neurological issue following internal carotid occlusion cannot be predicted.
Subject(s)
Aneurysm/surgery , Carotid Artery Diseases/surgery , Aged , Carotid Artery Diseases/diagnostic imaging , Cerebral Angiography , Female , Humans , Male , Petrous Bone , Tomography, X-Ray ComputedABSTRACT
UNLABELLED: The aim of this study was to test the hypothesis that optimism is a predictor of quality of life (QOL) in a sample of upper aerodigestive tract (UADT) cancer patients. MATERIALS AND METHODS: Consenting patients with squamous cell carcinoma of the UADT were included during the week following disclosure of the diagnosis of their illness, and before the start of treatment. QOL and optimism were evaluated by questionnaires presented to the patients before the start of treatment, after the treatment, and 6 and 12 months after the end of the treatment. PRELIMINARY RESULTS: 92 patients were included. The average age was 58.7+/-11.4 years. Their QOL scores were significantly correlated, first with age (r =- 0.23, p =0.03) and second with degree of optimism (r =0.32, p =0.002). No correlation was found between QOL scores, degree of optimism, and sociodemographic and clinical data. Optimism was the sole variable significantly associated with QOL before treatment (F =4.1, p =0.002, r(2) =0.19). The difference between QOL scores before and after treatment was not significant. CONCLUSION: Continuation of the study and analysis of survival of the patients may help pinpoint new prognostic factors, both objective and subjective, that will facilitate an overall approach to patient care by allowing for their preferences.
Subject(s)
Attitude to Health , Carcinoma, Squamous Cell/psychology , Laryngeal Neoplasms/psychology , Pharyngeal Neoplasms/psychology , Quality of Life , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Surveys and QuestionnairesABSTRACT
CT patterns of a relapsing polychondritis affecting the laryngeal cartilages are reported in a 42-year-old man with a 10-year medical history of this disease, corresponding to an irregular enlargement of the cricoid, thyroid cartilages and tracheal rings, with a moderate endoluminal narrowing. CT is useful to differentiate this rare inflammatory disease from others causes of airway narrowing, and could help in certain cases of diagnosis of beginning polychondritis.
Subject(s)
Laryngeal Cartilages/diagnostic imaging , Polychondritis, Relapsing/diagnostic imaging , Tomography, X-Ray Computed , Trachea/diagnostic imaging , Adult , Humans , Male , Polychondritis, Relapsing/diagnosisABSTRACT
The authors report the results of a therapeutic trial aimed at assessing the efficacy and costs of a twin-antibiotic therapy associating Pefloxacin and Amoxicillin-clavulanic acid for the prevention of infectious complications in major surgery for cancer of the upper respiratory and digestive tracts. The results obtained show 10% of complications, including 6.5% of local complications, with 4.5 to 9.5 day treatments. In our opinion, the poor results noted in the literature in studies on a simple intraoperative antibiotic prophylaxis confirm the need to use a real, so-called "curative" antibiotic therapy over a sufficient period for this type of surgery. This antibiotic therapy must be well tolerated, active for the contaminating organisms, produce no selection of resistant bacteria, and raise hopes to reduce postoperative infectious morbidity, therefore the costs of treatment.
Subject(s)
Amoxicillin/therapeutic use , Bacterial Infections/prevention & control , Clavulanic Acids/therapeutic use , Head and Neck Neoplasms/surgery , Pefloxacin/therapeutic use , Adult , Aged , Bacterial Infections/etiology , Drug Therapy, Combination , Female , Head and Neck Neoplasms/drug therapy , Humans , Laryngectomy/adverse effects , Male , Middle Aged , Pharyngectomy/adverse effects , Surgical Flaps/adverse effectsABSTRACT
The diagnosis of mucoceles of the facial sinuses is essentially based on CT scans. The authors define here the main features of these benign tumours, the evolution of which is sometimes formidable.
Subject(s)
Mucocele/diagnostic imaging , Paranasal Sinus Diseases/diagnostic imaging , Tomography, X-Ray Computed , Diagnosis, Differential , Ethmoid Sinus/diagnostic imaging , Frontal Sinus/diagnostic imaging , Humans , Maxillary Sinus/diagnostic imaging , Mucocele/etiology , Nasal Polyps/complications , Paranasal Sinus Diseases/etiology , Paranasal Sinus Neoplasms/complications , Paranasal Sinuses/injuries , Radiographic Image Enhancement , Sphenoid Sinus/diagnostic imaging , Tomography, X-Ray Computed/methodsABSTRACT
Based on the synergistic action of 5-fluorouracil (5-FUra), cis-dichlorodiamminoplatinum(II) (cis-DDP) and gamma-rays, which was suggested in experiments on murine tumours, a sequential treatment combining irradiation and chemotherapy for human solid tumours known to be resistant to conventional treatments has been developed. A pilot study was carried out on 30 patients with recurring head and neck cancers previously treated by radiotherapy and surgery. The good tolerance and the initial results justified applying this protocol to previously untreated cases. The second study involved 40 patients with stage III and IV tumours. After 3 cycles of combined radio- and chemotherapy followed by a conventional radiotherapy, 78% were good responders (51% in complete remission). Oropharynx and oral cavity, without base of tongue, have a 51% actuarial survival at 3 years when they achieved an early complete remission.