ABSTRACT
Sinus histiocytosis with massive lymphadenopathy or Destombes-Rosai-Dorfman's syndrome is a rare benign disease of unknown etiology, usually seen in younger patients. The cases reported concerned a 15-month old Caucasian boy and an 8 year old black boy with unilateral cervical enlargement, occasional fever and without any extranodal involvement. Diagnosis was performed by superficial lymph node biopsy. No immunodeficiency was found. The patients received no therapy and a complete spontaneous resolution was seen after a few months in the two cases. The clinical presentation, histologic characteristics, pathogenesis and treatment of the Destombes-Rosai-Dorfman's syndrome are discussed.
Subject(s)
Histiocytosis, Sinus/pathology , Child , Histiocytosis, Sinus/physiopathology , Histiocytosis, Sinus/therapy , Humans , Infant , Lymph Nodes/pathology , Lymph Nodes/physiopathology , Male , Remission, SpontaneousABSTRACT
The authors emphasize the interest of using the fascial temporal superficial flap for the reconstruction of an oropharynx after tumoral removal. The intrinsic qualities of this aponevrotic flap (rich vascularization, plasticity, finness, absence of after effects for the doner) have made it a particularly innovative instrument in this field. They expose their experience through nine patients and specify the place of this mean of reconstruction.
Subject(s)
Oropharyngeal Neoplasms/surgery , Oropharynx/surgery , Surgical Flaps , Adult , Aged , Female , Humans , Male , Middle Aged , Surgery, PlasticABSTRACT
Eight inverted papillomas were evaluated for the presence of human papillomavirus (HPV) DNA. The techniques used were Southern Blot Hybridization in five cases and Polymerase Chain Reaction (PCR) in three cases. All eight lesions contained the characteristic features of inverted papillomas. Two lesions showed areas of dysplastic change and one lesion contained koilocytes. In three patients, invasive squamous cell carcinomas were found. The presence of HPV was noted in one of these specimen of inverted papilloma with squamous cell carcinoma. Specific testing for HPV types 6, 11, 16, 18 and 33 on this specimen was negative, thus indicating that the specimen is associated with a different HPV type. The results of this study, with only one case of positive HPV testing, leads us to question the precise role of HPV as an etiological agent in nasal inverted papillomas. The fact that this single positive case did not test positive for the HPV type 16 suggest that this is not the only "high risk" HPV type associated with the progression of inverted papilloma to a carcinoma.
Subject(s)
Nose Neoplasms/etiology , Papilloma, Inverted/etiology , Papillomaviridae/pathogenicity , Paranasal Sinus Neoplasms/etiology , Adult , Aged , Blotting, Southern , Female , Genotype , Humans , In Situ Hybridization , Male , Middle Aged , Nose Neoplasms/pathology , Papilloma, Inverted/pathology , Papillomaviridae/genetics , Paranasal Sinus Neoplasms/pathology , Polymerase Chain ReactionABSTRACT
The authors report the case of a 75 years old insulin dependent diabetic man presenting a malignant otitis externa with facial nerve paralysis. Despite prolonged, adequate parenteral antibiotic therapy, the patient's clinical status did not improve. The addition of hyperbaric oxygen as a complementary treatment was followed by the regression of clinical signs and the resolution of infection. Based upon a review of the literature, the authors discuss the indications for this therapy and the problems involved in defining the criteria of cure in malignant otitis externa.
Subject(s)
Hyperbaric Oxygenation , Otitis Externa/therapy , Aged , Anti-Bacterial Agents/therapeutic use , Diabetes Mellitus, Type 1/complications , Facial Paralysis/etiology , Gallium Radioisotopes , Humans , Magnetic Resonance Imaging , Male , Otitis Externa/diagnosis , Otitis Externa/etiologyABSTRACT
Over a 3 year period the authors have managed 12 immune competent patients with aspergillosis of the maxillary sinus by intranasal sinus surgery using only a middle meatal approach. An enlarged middle meatal window was formed by resection of the superior surface of the inferior turbinate. especially designed curve suction tubes and forceps were used to reach all areas of the maxillary sinus in order to perform a macroscopically complete resection of all lesions. On no occasion Aspergillus was the alternative use of an inferior meatal window or a Caldwell-Luc approach necessary. The authors conclude that the use of a middle meatotomy for the surgical treatment of aspergillosis of the maxillary sinus makes it possible to assure complete resection, to adapt post-operative care and to permit prolonged aeration of the sinus.
Subject(s)
Aspergillosis/surgery , Maxillary Sinus , Paranasal Sinus Diseases/surgery , Aspergillosis/diagnostic imaging , Humans , Microsurgery/methods , Nasal Cavity/surgery , Paranasal Sinus Diseases/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
The authors report about 18 cases of inverted papillomas treated between 1981 and 1991. The average age of the patients is 51 years, with a marked male predominance. The average follow-up is of 4 years. The most often noted revealing sign is unilateral nasal obstruction. A history of polypectomy and nasosinual surgery is found in 45% of the cases in our series. The treatment was surgical in all cases, including 4 De Lima's procedures, 11 procedures through a paralateronasal approach, 2 ethmoidectomies through an endonasal approach, and 1 degloving for a septal lesion. Endonasal surgery was performed for two limited tumors, for which the diagnosis of inverted papilloma never could be made preoperatively. The recurrence rate observed in our series is 5%. Out of 18 patients, 4 presented with a malignant change, either at once (2 cases) or some time after the primary exeresis of the inverted papilloma (2 cases). In the light of the results, and after analyzing the literature, the authors reassert the necessity of radical exeresis for inverted papilloma. Rhinosinual endoscopy must remain a diagnostic means and never is an indication of exeresis of inverted papilloma. The authors emphasize the difficulty of the histological diagnosis and set forth the various problems arising from the malignant degeneration of inverted papillomas. Recent discoveries on viral etiopathogenesis and on the oncogenic potential of the type-16 papilloma virus may allow characterizing the evolutive and prognostic features of inverted papillomas in the future.
Subject(s)
Nose Neoplasms/diagnosis , Papilloma/diagnosis , Paranasal Sinus Neoplasms/diagnosis , Adult , Aged , Endoscopy/methods , Ethmoid Bone/surgery , Female , Follow-Up Studies , Humans , Male , Middle Aged , Nasal Obstruction/etiology , Nose Neoplasms/complications , Nose Neoplasms/surgery , Papilloma/complications , Papilloma/surgery , Paranasal Sinus Neoplasms/complications , Paranasal Sinus Neoplasms/surgery , Retrospective StudiesABSTRACT
A prospective tubing of tracheal tubing in view of general anesthia was performed in 441 adults undergoing scheduled surgery. Before surgery, the anesthesists and ENT specialists tried to independently predict the cases of difficult tubing, according to different criteria. Tubing actually was difficult in 38 patients (8.6ù) instead of the 21 (55.2%) expected by the ENT specialists and/or the anesthesists. These difficulties were solved by bronchoscopy, which allowed tubing to be performed with a guide-probe (3 cas), by scheduled fiberendoscopy (6), tracheotomy (1), nasotracheal tubing (1), spontaneous ventilation (2), and orotracheal tubing in 25 cases. Current knowledge of the predictive criteria is incomplete: anesthesists must be aware of the assistance techniques required in case of difficult tubing in a non-ENT context.