[Adenocarcinomas of the ethmoid sinus: retrospective analysis of prognostic factors]. / Adénocarcinomes de l'ethmoïde: analyse rétrospective des facteurs pronostics.

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.

[Cervical and para-pharyngeal bone tumors: two cases report]. / Tumeurs cervicales et para-pharyngées d'origine osseuse.

OBJECTIVE: The purpose of the study was to report two cases of cervical and para-pharyngeal bone tumors. MATERIAL AND METHODS: Patients were two 29 and 67-year-old men. Presentation of the lesions included respectively a right cervical mass and a left para-pharyngeal mass. Clinical features and radiological, anatomopathological and therapeutic characteristics of the tumors were retrospectively studied. RESULTS: A cervical approach was made in both cases. Tumor biopsies revealed a vertebral aneurismal cyst and a corporeo-pedicular chordoma respectively. CONCLUSION: Vertebral bone tumors with cervical expression are very uncommon entities. Diagnosis could be systematically evoked in patients with a cervical or para-pharyngeal tumor presenting vertebral lysis.

Concomitant type I thyroplasty and thoracic operations for lung cancer: preventing respiratory complications associated with vagus or recurrent laryngeal nerve injury.

OBJECTIVES: We sought to prevent postoperative swallowing disorder, aspiration, and sputum retention in cases of recurrent laryngeal or vagus nerve section occurring during lung cancer resection. METHODS: In 14 of 25 consecutive patients, type I thyroplasty and thoracic operations were performed during the same period of anesthesia. All patients had a preoperative laryngeal computed tomographic scan providing us with indispensable measurements for vocal fold medialization under general anesthesia (ie, without intraoperative phonatory control). Nine remaining patients had a type I thyroplasty delayed from thoracic operations because of intraoperative doubt about laryngeal innervation injury, and 2 did not need a laryngeal operation. Main postoperative records consisted of swallowing ability, respiratory complications, and quality of voice. RESULTS: No swallowing disorder, aspiration, or sputum retention occurred in cases of concomitant laryngeal and thoracic operations. Of these 14 patients, a single case (7%) of major complication (vocal fold overmedialization) occurred and required an early and successful revision thyroplasty; one case of cervical hematoma that did not require surgical drainage was considered a minor complication (7%). Twelve (86%) patients who underwent the concomitant association of both operations were fully satisfied with their quality of voice. CONCLUSIONS: Type I thyroplasty and thoracic operation can be advantageously associated in case of injury to laryngeal motor innervation to prevent postoperative swallowing disability and dramatic respiratory complications.

[Early otorhinolaryngological manifestations of Wegener's granulomatosis. Analysis of 21 patients]. / Les manifestations ORL précoces dans la granulomatose de Wegener. Etude de 21 patients consécutifs.

UNLABELLED: Wegener's Granulomatosis (WG) is a necrotizing granulomatous vasculitis that has a strong affinity for the upper respiratory tract. OBJECTIVE: To retrospectively study the clinical features of otorhinolaryngological manifestations from 21 WG patients. PATIENTS: Eleven men and 10 women were studied with respectively a mean age of 62.7 (23-79) and 63.9 (53-73). METHODS: Otorhinolaryngological manifestations were recorded before and during the course of WG. RESULTS: Upper respiratory tract involvement occurred in 81% of cases (17/21 patients) and was isolated in 42.8% of cases (9/21 patients). Nasosinusal manifestations occurred in 71.4% of cases (15/21) before and at the time of GW diagnosis. They included bilateral sinusitis (7 cases), nasal crusting (6 cases), purulent rhinorrhea (5 cases), epistaxis (4 cases), nasal ulcers (2 cases), nasal congestion with obstruction (3 cases) and 4 cases of nose deformity (saddle nose or oedema). Otologic manifestations occurred in 28.5% of cases and were never isolated. They included otitis media (3 cases), sudden hearing loss (3 cases), tinnitus (1 case), facial palsy (1 case) and 2 cases of chondritis. Pharyngolaryngotracheal manifestations occurred in 33.3% of cases (7/21). Diagnosis of GW was based on positive ANCA test (95.2% of cases), presence of biologic inflammatory parameters (76% of cases) and histological features. 29 biopsies from nasosinusal lesions on 17 patients were made. 44.8% of the biopsies were contributive with at least one histologic feature of the combination including vasculitis, necrosis and granulomatous inflammation. The best contributive site of biopsy was the paranasal sinus. CONCLUSION: We report that otorhinolaryngological manifestations occurred in 81% of cases before and at the time of GW diagnosis. These findings indicate that otorhinolaryngologists have a central role to play in early diagnosis of the disease.

[Intrapetrous aneurysms of internal carotid artery: therapeutic considerations: two cases]. / Anévrysmes de la carotide intra-pétreuse: considérations thérapeutiques: à propos de deux cas.

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.

[Is there a correlation between optimism and quality of life in upper aerodigestive tract cancer Patients? Preliminary results]. / Recherche d'une corrélation entre tempérament optimiste et qualité de vie chez le malade atteint d'un cancer des voies aérodigestives supérieures: résultats préliminaires.

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.