RESUMO
Between January 1994 and June 1995, 19 cases of nasopharyngeal carcinoma, classified N2-N3 (AJC/UICC 1987) were treated by neoadjuvant chemotherapy including cisplatin 100 mg/m2 on day 1 and epirubicin 80 mg/m2 on day 1. Following course started on day 21. A clinical and scannographic evaluation was made after 3 courses of chemotherapy. Fifty-eight percent of the patients were N3. Seventy-four percent were T3-T4. Tolerance to chemotherapy was good in 100% of the cases. A functional improvement was obtained in 14 among 16 patients who were initially symptomatic. For lymph nodes, an objective response (OR) was observed in all patients. The response was complete (CR) in 53%. A regression of primary tumor was obtained in 68% of the patients, but it was complete in 16% only. Sixty-nine percent of the patients has have a tumoral OR have a lymph node CR. Ninety percent of the patients with a complete lymph node response have a tumoral regression more than 50%. A correlation seems likely between the importance of the tumoral and the lymph node responses.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma/tratamento farmacológico , Neoplasias Nasofaríngeas/tratamento farmacológico , Adolescente , Adulto , Idoso , Carcinoma/mortalidade , Carcinoma/patologia , Quimioterapia Adjuvante , Criança , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Terapia Combinada , Epirubicina/administração & dosagem , Epirubicina/efeitos adversos , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Neoplasias Nasofaríngeas/mortalidade , Neoplasias Nasofaríngeas/patologia , Estadiamento de Neoplasias , Análise de Sobrevida , Resultado do TratamentoRESUMO
The authors report a case of a jugular bulb dehiscence extending to the tympanic cavity. They alert that the finding of a blue mass in the middle ear should evok the possibility of a vascular variant or abnormalitie. High resolution CT is extremely helpful in the correct diagnosis by showing the subtle and characteristic bone changes.
Assuntos
Veias Jugulares/patologia , Membrana Timpânica/patologia , Adolescente , Dilatação Patológica , Humanos , Veias Jugulares/diagnóstico por imagem , Masculino , Tomografia Computadorizada por Raios XRESUMO
The authors, try to establish an approach about ultrasonic pattern of capsulated peritonitis through study of four cases. The echographical semeology of this affection is based on: echoscopic signs which study the intestinal mobility and lumen, and the associated ascits: --echographic signs represented essentially by: --intestinal agglutination; --the presence of real or virtual capsula; --meso-retraction. The frequency of this affection seems to be not negligible in Tunisia. The tuberculosis is the most frequent cause, as an etiology.
Assuntos
Peritonite/diagnóstico , Ultrassonografia , Adolescente , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peritonite/diagnóstico por imagem , Peritonite/etiologia , RadiografiaRESUMO
Between 1991 and 1994, ultrasonography was used to investigate 90 consecutive children with acute osteomyelitis. Ultrasonographic findings were analyzed taking into account the time elapsed from first symptoms. Outcome in 47 children who were treated and followed for at least 6 months was also studied. Deep soft tissue swelling adjacent to the affected bone was found to be an early but nonspecific sign which persisted all along the course of the disease. Periosteal elevation smaller than 3 mm, secondary to exsudation or septic fluid, confirmed the disease in earliest stage and was the most frequent ultrasonographic sign in first three days of disease. Treated at that stage, total resolution was obtained in 66% of patients and stabilization, in 34% of cases, without any evolution toward chronicity. Acute osteomyelitis with subperiosteal abscess progressed toward stabilization in 66% of cases and toward chronic osteomyelitis in 8% of cases. 32% of subperiosteal abscess were ruptured; in such situation, progression to chronicity was observed in 26% of patients. Since ultrasonography has been used in our institution for the diagnosis of acute osteomyelitis, the rate of evolution to chronicity spectacularly dropped from 63% to 11%. The main advantage of ultrasonography is an earlier detection of subperiosteal collection that indicates surgical drainage without any delay.
Assuntos
Osteomielite/diagnóstico por imagem , Doença Aguda , Adolescente , Braço/diagnóstico por imagem , Criança , Pré-Escolar , Estudos de Avaliação como Assunto , Feminino , Humanos , Lactente , Perna (Membro)/diagnóstico por imagem , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de Tempo , UltrassonografiaRESUMO
Primitive intra-osseous meningioma is a rare benign tumor. We report a case with a temporal localization and antro-attical extension into the petrous bone.
Assuntos
Coristoma , Meningioma , Neoplasias Cranianas , Adulto , Feminino , Humanos , Imageamento por Ressonância Magnética , Neoplasias Cranianas/diagnóstico , Neoplasias Cranianas/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Histiocytosis X is an uncommon disease. Temporal bone involvement is a frequent head and neck manifestation. Most patients are under fifteen years of age. The authors report a case of a bilateral extensive temporal involvement complicated with vertigo and peripheric facial palsy. CT plays a dominant role in the diagnosis because of the ability to identify bone destruction, soft tissue involvement and intra-cranial histiocytosis more accurately.
Assuntos
Histiocitose de Células de Langerhans/complicações , Osteólise/etiologia , Crânio , Osso Temporal , Paralisia Facial/etiologia , Feminino , Histiocitose de Células de Langerhans/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Osteólise/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Ten typical cases of sideropenic dysphagia over four years reported and clinical, biological, endoscopic and radiological signs are studied. The authors stress the value of oesophagal opacification for diagnosis. The particularities of our study are the relative high frequency of the disease in Tunisia and the unusual attack in two black patients.
Assuntos
Transtornos de Deglutição/diagnóstico , Síndrome de Plummer-Vinson/diagnóstico , Adulto , Esofagoscopia , Etnicidade , Feminino , Tecnologia de Fibra Óptica , Seguimentos , Humanos , Pessoa de Meia-Idade , Síndrome de Plummer-Vinson/diagnóstico por imagem , Síndrome de Plummer-Vinson/epidemiologia , Radiografia , Tunísia/epidemiologiaRESUMO
Septic thrombosis of the cavernous sinuses most commonly follows staphylococcal infections of the middle third of the face. Orbital symptoms are constant. We report six cases diagnosed only by CT. At present, MR imaging is the diagnostic procedure of choice. Its findings are thought to reflect the septic nature of the thrombosis.
Assuntos
Seio Cavernoso , Trombose dos Seios Intracranianos/etiologia , Infecções Estafilocócicas , Adolescente , Adulto , Criança , Pré-Escolar , Face , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Trombose dos Seios Intracranianos/diagnóstico , Trombose dos Seios Intracranianos/diagnóstico por imagem , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
We report two cases of ethmoidal cephaloceles. Ethmoidal cephaloceles are very rare and most commonly present with recurrent episodes of meningitis or sometimes as a nasal mass. Diagnosis is made at MR and CT. Such imaging studies should be obtained in patients with recurrent meningitis or patients with polypoid nasal lesions prior to biopsy.
Assuntos
Encefalocele/diagnóstico , Osso Etmoide/patologia , Meningocele/diagnóstico , Adolescente , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Meningite/diagnóstico , Cavidade Nasal/patologia , Pólipos Nasais/diagnóstico , Recidiva , Tomografia Computadorizada por Raios XRESUMO
PURPOSE OF THE STUDY: Septic arthritis is frequent in Tunisia and is responsible for orthopedic sequela. The purpose of this study was to establish the indication and the viability of ultrasound scanning in the early diagnosis of septic arthritis. MATERIAL AND METHODS: 82 patients were explored by ultrasonography for suspected septic arthritis. Mean age was 7 years (range 2 months to 37 years). All sonographic studies were performed using a 7.5 MHZ transducer. 52 patients were surgically treated or had joint aspiration. Only 39 patients had septic arthritis. The hip and the knee were the most frequent localisation (respectively 20 and 12 cases). RESULTS: Statistical analysis showed that the ultrasound scanning in the diagnosis of joint effusion had a sensitivity of 93.4 per cent and a specificity of 100 per cent. Matter floating within the joint effusion was noted in 50 per cent of septic arthritis. These changes were not found in other arthritis. The thickness of synovialis and joint capsule was not specific of septic arthritis. In hip septic arthritis (51 per cent of localisation) the mean width of the anterior synovial recess was 11.7 mm (5-20 mm). In the asymptomatic opposite hip, the mean width was 3.6 mm (2.6-5 mm). Cortical irregularities had suggested osteomyelitis of femoral neck in osteoarthritis of the hip in 4 cases. Subperiosteal abscess of the femoral neck was directly visualized in another patient. DISCUSSION AND CONCLUSION: Our expense highlights that sonography may be a useful tool in the management of patient with suspect septic arthritis. Sonography allows early diagnosis of joint effusion with high accuracy. Hyperechoic or mixed aspects of the fluid joint suggest septic origin.
Assuntos
Artrite Infecciosa/diagnóstico por imagem , Articulação do Quadril , Articulação do Joelho , Articulação do Ombro , Adolescente , Adulto , Artrite Infecciosa/microbiologia , Artrite Infecciosa/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Prognóstico , UltrassonografiaAssuntos
Hemangioma/diagnóstico por imagem , Veia Porta , Adolescente , Criança , Pré-Escolar , Varizes Esofágicas e Gástricas/complicações , Feminino , Hemorragia Gastrointestinal/etiologia , Hemangioma/complicações , Humanos , Masculino , Artérias Mesentéricas/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , PortografiaAssuntos
Hipertensão Portal/cirurgia , Derivação Portocava Cirúrgica , Ascite/etiologia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Derivação Portocava Cirúrgica/instrumentação , Derivação Portocava Cirúrgica/métodos , Resultado do Tratamento , UltrassonografiaAssuntos
Hamartoma/diagnóstico , Doenças Hipotalâmicas/diagnóstico , Criança , Diagnóstico Diferencial , Feminino , Humanos , MasculinoRESUMO
The authors present a series of seven cases of hydatid cysts of the pancreas. This localization is rare since it accounts for less than 1% of the various sites of hydatid disease. The clinical signs are variable according to degree of bilio-pancreatic involvement. The preoperative diagnosis was established in three patients by ultrasonography, computed tomography and positive serology. Protruding dome was used in five patients. Distal pancreatectomy without splenectomy and Whipple resection were performed in other patients. There was no mortality and the postoperative morbidity was dominated by external biliary or pancreatic fistulae and local sepsis.
Assuntos
Equinococose/diagnóstico , Pancreatopatias/diagnóstico , Pancreatopatias/parasitologia , Adolescente , Adulto , Fístula Biliar/etiologia , Criança , Colangiografia , Drenagem/efeitos adversos , Equinococose/diagnóstico por imagem , Equinococose/patologia , Equinococose/cirurgia , Feminino , Hemorragia/etiologia , Humanos , Laparotomia , Masculino , Pessoa de Meia-Idade , Pancreatectomia/efeitos adversos , Pancreatopatias/diagnóstico por imagem , Pancreatopatias/patologia , Pancreatopatias/cirurgia , Fístula Pancreática/etiologia , Estudos RetrospectivosRESUMO
OBJECTIVE: Spinal dural arteriovenous fistulas (DAVF), the most common vascular malformations of the spine, are usually supplied by branches of the intercostal or lumbar arteries. Rarely, the DAVF are fed by branches of the hypogastric artery. Only 12 such cases have been reported. CASE REPORT: A 28 year-old man presented with a 2-month history of micturition dysfunction and progressive weakness of the legs. Physical examination showed motor deficit of the lower limbs with brisk knee jerks, absent ankle reflexes and normal plantar reflexes. Cremasteric reflexes were absent. We noted hypoesthesia of the lower limbs with complete anesthesia of the perineum. MRI of the lumbo-sacral spine demonstrated an enlargement of the conus medullaris with high T2 signal intramedullary lesion. It showed also large intradural serpentine vessels. A left iliac angiogram disclosed a nidus of arteriovenous malformation (AVM) supplied by a lateral sacral artery and draining by two enlarged ascending perimedullary veins. No clinical improvement was observed after surgical removal of the AVM. CONCLUSION: The screening examination of choice for spinal DAVF remains MRI. When selective spinal arteriography is normal, we have to search for an unusual arterial supply particularly from the hypogastric artery.
Assuntos
Fístula Arteriovenosa/complicações , Artéria Ilíaca/anormalidades , Infarto/etiologia , Meninges/irrigação sanguínea , Medula Espinal/irrigação sanguínea , Adulto , Angiografia , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/cirurgia , Humanos , Artéria Ilíaca/diagnóstico por imagem , Vértebras Lombares , Masculino , Sacro , Medula Espinal/patologiaRESUMO
The authors report a case of a thoraco-abdominal duplication of the foregut, observed in a 10-year old boy. Thoraco-abdominal duplication is an expression of notochordodysraphia, as it is frequently associated with vertebral malformations. Barium meal, ultrasonography and CT-Scan should provide a preoperative diagnosis. One-stage total excision in a single stage is mandatory in order to treat the symptoms and avoid the risks of further progression.
Assuntos
Cárdia/anormalidades , Doenças do Esôfago/diagnóstico por imagem , Esôfago/anormalidades , Gastropatias/diagnóstico por imagem , Cárdia/diagnóstico por imagem , Cárdia/cirurgia , Criança , Doenças do Esôfago/cirurgia , Esôfago/diagnóstico por imagem , Esôfago/cirurgia , Humanos , Masculino , Gastropatias/cirurgia , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Renal needle biopsy is still irreplaceable in children. The objectives of this retrospective study were to specify the technical aspects and the main nephropathies encountered. 152 children under the age of 16 years (13 +/- 3), 79 boys and 73 girls, underwent renal biopsy. The biopsy was performed after radiographic detection in 71 cases, and under continuous ultrasound guidance in 81 cases. The comparative study of these 2 techniques revealed the superiority of continuous ultrasound guidance, allowing biopsy of an essentially cortical fragment, rich in glomeruli with a limited number of punctures. Histological examination showed a predominance of glomerular nephropathy with, especially, visually normal kidney and membranoproliferative glomerulonephritis. These data encourage us to perform ultrasound-guided RNB in children and to eradicate sites of infection, particularly involving the upper respiratory tract.