ABSTRACT
INTRODUCTION: Recent prospective studies support the feasibility of performing sentinel lymph node biopsy following neoadjuvant chemotherapy in initially fine-needle aspiration cytology or ultrasound-guided biopsy-proven node-positive breast cancer. The main aid is to identify preoperative features that help us predict a complete axillary response to neoadjuvant chemotherapy in these patients and thus select the candidates for sentinel lymph node biopsy post-neoadjuvant chemotherapy to avoid unnecessary axillary lymphadenectomy. MATERIALS AND METHODS: A retrospective observational study with a total of 150 patients, biopsy-proven node-positive breast cancer who underwent neoadjuvant chemotherapy followed by breast surgery and axillary lymphadenectomy were included and retrospectively analysed. A predictive model was generated by a multivariate logistic regression analysis for pathological complete response-dependent variable. RESULTS: The response of the primary lesion to neoadjuvant chemotherapy according to post-treatment magnetic resonance imaging, Her2/neu overexpression and a low estrogen receptor expression are associated with a higher rate of nodal pathologically complete response. The multivariant model generated a receiver operating characteristic curve with an area under the curve of 0.79 and a confidence interval of 0.72-0.87 at a 95% level of significance. CONCLUSIONS: This model could be a helpful tool for the surgeon to help in predicting which cases have a higher likelihood of achieving a pathologically complete response and therefore selecting those who may benefit from a post-neoadjuvant chemotherapy sentinel lymph node biopsy and avoid unnecessary axillary lymphadenectomy.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/therapy , Lymphatic Metastasis/diagnosis , Mastectomy/methods , Sentinel Lymph Node/surgery , Adult , Aged , Aged, 80 and over , Axilla , Biopsy, Fine-Needle , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/pathology , Female , Humans , Lymph Node Excision/methods , Lymph Node Excision/statistics & numerical data , Lymphatic Metastasis/pathology , Magnetic Resonance Imaging , Mastectomy/statistics & numerical data , Middle Aged , Models, Biological , Neoadjuvant Therapy/methods , Neoplasm Grading , Neoplasm Staging , Patient Selection , Prognosis , Retrospective Studies , Sentinel Lymph Node/diagnostic imaging , Sentinel Lymph Node/pathology , Sentinel Lymph Node Biopsy/methods , Treatment OutcomeABSTRACT
UNLABELLED: Treatment of hyperthyroidy uses surgery as well radioactive iodine and antithyroid agents. OBJECTIVES: The study analyses the modalities of hyperthyroidy surgery, describes its complications and the population undergoing surgical treatment. POPULATION AND METHODS: It is a retrospective study on 43 patients with hyperthyroidy treated by thyroidectomy from January first 1998 until 31 January 2002. RESULTS: The mean age is 48 years. The sex ratio showed a predominance of women (with 36 women and 7 men). The most frequent aetiology is Graves' disease and toxic multinodular goiter. Total thyroidectomy is applied to Graves' disease and toxic multinodular goiter while single toxic nodules are treated by loboisthmectomy. Surgery for hyperthyroidy have a low morbidity (1/43 haematoma, 0/43 hypoparathyoidy, 1/43 palsy of recurrent nerve). CONCLUSIONS: In this conditions, the hyperthyroidy surgery is fast, effective and does not need a heavy follow-up. Surgery seems to be a good alternative to antithyroid agents, which are constraining and often ineffective in the long term, and to radioactive iodine who leads to a long follow-up because of induced hypothyroidy.
Subject(s)
Hyperthyroidism/surgery , Adult , Aged , Female , Humans , Male , Middle AgedABSTRACT
OBJECTIVE: We report a case of cricoid chondroma, underlining the difficulty in establishing a precise differential diagnosis between chondroma and low-grade chondrosarcoma of the larynx. MATERIAL AND METHODS: A 48-year-old woman developed inspiratory dyspnea. The final diagnosis was cricoid chondroma. We reviewed our case and data in the literature on these cartilaginous tumors. RESULTS: The patient was treated with conservative surgery. At 18 months follow-up, no recurrence has been detected. DISCUSSION: These tumors are rarely found in an ENT location and have similar histological features. According to many authors, the clinical course alone enables a distinction between chondroma and low-grade chondrosarcoma. Surgical treatment is indicated and provides good phonatory function in the vast majority of the cases.
Subject(s)
Chondroma , Chondrosarcoma , Laryngeal Neoplasms , Chondroma/diagnosis , Chondroma/diagnostic imaging , Chondroma/pathology , Chondroma/surgery , Chondrosarcoma/diagnosis , Chondrosarcoma/diagnostic imaging , Chondrosarcoma/pathology , Chondrosarcoma/surgery , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Laryngeal Neoplasms/diagnosis , Laryngeal Neoplasms/diagnostic imaging , Laryngeal Neoplasms/pathology , Laryngeal Neoplasms/surgery , Laryngoscopy , Larynx/pathology , Middle Aged , Prognosis , Time Factors , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Tracheobronchial aspiration of foreign bodies in children is a rare event that can be serious. We report a 10-year retrospective study of tracheobronchial foreign body aspiration in children. METHOD: This retrospective analysis involved 87 patients who underwent endoscopy at the ENT unit of the Caen University Hospital. RESULTS: Foreign bodies were found in 34 of the 87 patients. Average age was 3 years, with a male predominance. Peanuts were the most common foreign bodies observed (16/34). Most of the foreign bodies were removed via the right main bronchus (17/34). Clinical and radiological signs depended on delay to admission and were found to be normal in 15% and 37.5% of the cases respectively. Twenty-four children out of 34 had a positive history of foreign body inhalation. All foreign bodies were removed during the endoscopy procedure. CONCLUSION: This work underlines the much-debated function of chest x-ray, the need for a rigorous technically correct endoscopy procedure and the importance of close cooperation between the anesthesiologist and the endoscopist.
Subject(s)
Bronchi , Foreign Bodies/diagnosis , Child, Preschool , Endoscopy , Female , Foreign Bodies/diagnostic imaging , Foreign Bodies/surgery , Humans , Male , Radiography , Retrospective StudiesABSTRACT
We report the case of a 71-year-old woman where nasogastric tube provoked a severe laryngeal injury, revealed by acute respiratory distress. Direct laryngoscopic findings included arytenoid edema, postcricoid ulceration and bilateral vocal cord paralysis in adduction. A tracheotomy was performed. Several months later, no improvement was noted because of a cricoid necrosis. Physiopathology, prophylaxis and management are discussed.
Subject(s)
Intubation, Gastrointestinal/adverse effects , Larynx/injuries , Respiratory Distress Syndrome/etiology , Aged , Female , Humans , Respiratory Distress Syndrome/physiopathology , Tracheotomy , Treatment OutcomeABSTRACT
OBJECTIVE: The objective of this study is the evaluation of the calculation of 100% intelligibility threshold and noise resistance index as a monitoring test in populations exposed to noise in their work environment. METHOD: This is a retrospective exposed-unexposed study as the exposure to the risk factors took place before the survey. The exposed subjects were chosen in principle on sonometric criteria and the unexposed subjects among employees whom we believe were not exposed. The exploration method included history taking, clinical examination, free field audiometry and speech audiometry with background noise. RESULTS: The exposed population has a 100% intelligibility threshold on average equal to 29.69 dB, significantly higher than in the unexposed population where it is calculated at 25.30 dB (p = 0.07). The noise resistance index varies with age (p = 0.04). CONCLUSION: Our study shows the existence of a significant hearing difference between two populations with different noise exposure. It demonstrates a relationship between a hearing loss risk factor such as noise and the occurrence of the "professional hearing loss" disorder. The calculation of the 100% intelligibility index and the noise resistance index advantageously complements tonal audiometry. These procedures provide a better approach to the social impact of hearing loss but were not useful in the detection of hearing loss.
Subject(s)
Audiometry/methods , Hearing Loss, Noise-Induced/diagnosis , Noise, Occupational/adverse effects , Adult , Female , Hearing Loss, Noise-Induced/etiology , Humans , Male , Middle Aged , Risk Factors , Sensitivity and Specificity , Speech , Speech IntelligibilityABSTRACT
Two cases of parathyroid cysts are described. One cyst was symptomatic, the other was discovered while performing thyroidectomy. In both cases, the cysts were non-functional. There have been reports of functional cysts occurring in a lesser proportion and causing primary hyperthyroidism. These benign cysts are rare (300 cases reported in the literature). Surgery is the treatment of choice in most cases.
Subject(s)
Cysts , Parathyroid Diseases , Adult , Aged , Cysts/complications , Cysts/diagnosis , Cysts/surgery , Deglutition Disorders/etiology , Female , Humans , Parathyroid Diseases/complications , Parathyroid Diseases/diagnosis , Parathyroid Diseases/surgery , Parathyroidectomy , Thyroidectomy , Tomography, X-Ray ComputedABSTRACT
We report a case of extradural abscess after acute mastoiditis in an 8-years-old boy. The clinic diagnostic of an intracranial complication is difficult. The most common present symptoms are fever, otalgia and otorrhea but are not specific. Neurologic symptoms are suggestive signs of an intracranial complication. We believe that, in acute mastoiditis performance of a CT scan of the brain and temporal bones with intravenous contrast, contribues to the diagnostic of intracranial complication. The diagnostic of thrombosis sinus sigmoid is evoked with slight contrast enhanced sinus sigmoid and failure to opacify. The characterisation of an epidural empyema is a hypodense epidural collection in a contrast-enhanced CT scan. The most common isolated organism are Streptococcus Pneumoniae, Staphylococcus aureus and Pseudomonas aeuginosa. The therapeutic management includes combination of intraveinous antibiotics, mastoidectomy and surgery of the intracranial complication.
Subject(s)
Empyema, Subdural/etiology , Mastoiditis/complications , Sinus Thrombosis, Intracranial/etiology , Acute Disease , Child , Empyema, Subdural/diagnosis , Humans , Male , Sinus Thrombosis, Intracranial/diagnosisABSTRACT
We dissected 30 facial nerves in fresh cadavers after arterial casting with red latex to provide specific information about the arterial-related anatomy of the trunk of the facial nerve from the stylomastoid foramen to its bifurcation. We found that a wide anatomic variability does exist. The trunk of the facial nerve was in proximity to the stylomastoid artery, which originated from the posterior auricular artery in 70% of the specimens (21/30), from the occipital artery in 20% (6/30), and directly from the external carotid artery in 10% (3/30). The stylomastoid artery passed medially to the trunk of the facial nerve in 63 of the specimens (19/30) and laterally in 37% (11/30). Among these 11 specimens, 8 were large-caliber stylomastoid arteries. During parotid surgery, the main trunk of the facial nerve may be difficult to identify, because a large-caliber stylomastoid artery can mask it. Therefore, it is important to dissect this artery with caution.
Subject(s)
Facial Nerve/blood supply , Mastoid/blood supply , Facial Nerve/anatomy & histology , Female , Humans , Male , Mastoid/anatomy & histologyABSTRACT
We report a case of desmoid tumor in the submandibular region in an 18-month-old girl. Head and neck desmoid tumors are uncommon in children and diagnosis is a difficult task because the tumors are often classified as different types of fibromatosis. This histologically benign affection is characterized by local expansion or destruction and tends to recur. Pathology gives the positive diagnosis, showing fibroblastic monoclonal proliferation between the cellular center and the collagen periphery. Electron microscopy evidences an abundant collagen network enclosing a polymorphous cellular proliferation. Immunohistochemistry defines vimentin and actin positive desmoid tumors. Surgery is usually the therapeutic choice. Chemotherapy and radiotherapy may be used in conjunction with surgery in situations of recurrence or unsatisfactory surgical margin. There is a risk of recurrence which can be detected with regular follow-up examinations.
Subject(s)
Fibromatosis, Aggressive/diagnosis , Head and Neck Neoplasms/diagnosis , Actins/analysis , Collagen/ultrastructure , Female , Fibroblasts/pathology , Fibromatosis, Aggressive/pathology , Fibromatosis, Aggressive/surgery , Follow-Up Studies , Head and Neck Neoplasms/pathology , Head and Neck Neoplasms/surgery , Humans , Infant , Microscopy, Electron , Neoplasm Invasiveness , Neoplasm Recurrence, Local/pathology , Vimentin/analysisABSTRACT
We present a case of right sided blindness caused by a cavernous carotid artery aneurysm in a 17-year-old patient presenting with an Alagille syndrome. The diagnosis was made by magnetic resonance imaging and confirmed by angiography. This aneurysm was treated successfully with endovascular placement of detachable balloons. Cerebral vascular malformations are rarely reported in association with this syndrome. We discuss the clinical presentation, diagnosis, treatment and detection of this type of abnormality.
Subject(s)
Alagille Syndrome/complications , Carotid Artery, Internal , Intracranial Aneurysm/complications , Adolescent , Blindness/etiology , Carotid Artery, Internal/diagnostic imaging , Carotid Artery, Internal/pathology , Carotid Stenosis/diagnostic imaging , Carotid Stenosis/pathology , Carotid Stenosis/therapy , Cerebral Angiography , Embolization, Therapeutic/methods , Humans , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/pathology , Magnetic Resonance Imaging , Male , Tomography, X-Ray ComputedABSTRACT
This study was based on 34 recurrent laryngeal nerve dissections after arterial casting with red-colored latex. The aim was to provide specific information about the perineural microvasculature. This study established the following points: 1. a great anatomic variability does exist; 2. the laryngeal nerve is usually in relation to the posterior branch of the inferior thyroid artery; and 3. this vascular branch is sometimes replaced with a vascular network. In all cases, this microvascularization must be preserved during thyroid surgery.
Subject(s)
Laryngeal Nerves/anatomy & histology , Cadaver , History, 16th Century , HumansABSTRACT
Epistaxis is a common and in most cases benign event. Severe or recurrent epistaxis, however, can present therapeutic problems. Forty-five cases of supraselective embolization in intractable epistaxis are reported. The authors' success rate of 97%, similar to the success rates reported in the literature, confirms the effectiveness of this technique. Complications occurred in only 8% of the cases. One serious complication was neurologic. Percutaneous embolization is an effective option for managing intractable posterior nasal bleeding but is not recommended as an early form of treatment.
Subject(s)
Embolization, Therapeutic/methods , Epistaxis/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Treatment OutcomeABSTRACT
The endonasal approach for transsphenoidal hypophysectomy is a simple technique for exposing the floor of the sella turcica. In our institution we have operated 162 patients (64 microadenomas and 98 macroadenomas), over a ten-year period, by using that approach. The floor of the sella turcica is exposed through an incision performed posteriorly to the nostril at the junction of cartilaginous and bony septum. Postoperative rhinological complications are less frequently observed after unilateral endonasal approach than after sublabial one, and it is more comfortable for the patient. The morbidity of unilateral endonasal transsphenoidal approach is comparable to that of other series.
Subject(s)
Adenoma/surgery , Hypophysectomy/methods , Pituitary Neoplasms/surgery , Adenoma/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Nose/pathology , Nose/surgery , Pituitary Neoplasms/pathology , Sella Turcica/surgeryABSTRACT
Craniofacial fibrous dysplasia manifests clinically with dysmorphic syndrome, ophtalmologic or otologic signs. We report a case of temporal polyostotic fibrous dysplasia with vertigo and sensorineural hearing loss. Sensorineural hearing loss, with no cholesteatoma associated, as described in our case is rarely described. We review the literature concerning main clinical, diagnostic and therapeutic aspects of this disease.
Subject(s)
Fibrous Dysplasia of Bone/complications , Temporal Bone , Aged , Facial Asymmetry/etiology , Female , Fibrous Dysplasia of Bone/diagnosis , Hearing Loss/etiology , Humans , Labyrinth Diseases/etiology , Magnetic Resonance Imaging , Tomography, X-Ray ComputedABSTRACT
We report a case of Kikuchi's disease in a young man. It is a rare entity, described for the first time in 1972. It manifests clinically with cervical adenopathy and fever, often associated with other non-specific clinical signs. Laboratory tests are often normal. The diagnosis is established on the basis of histologic of lymph node excisional biopsy. Kikuchi's disease is likely to be misinterpreted as malignant lymphoma or systemic lupus erythematosus. It generally needs no treatment because it runs a spontaneously benign course with complete resolution of the symptoms within 6 months. Secondary systemic lupus erythematosus may develop. For this reason, regular follow-up of patients is recommended. The etiopathogenesis of this disease is still unknown, perhaps due to an immunologic phenomenon. It could be a hyperimmune reaction induced by various antigenic agents (infectious, neoplasic), or an autoimmune process.
Subject(s)
Lymphadenitis/pathology , Adult , Diagnosis, Differential , Humans , Lupus Erythematosus, Systemic/diagnosis , Lymph Nodes/pathology , Lymphadenitis/diagnosis , Lymphadenitis/physiopathology , Male , NecrosisABSTRACT
A case of Moebius syndrome in a premature baby is reported. After a phase of neonatal severe respiratory distress syndrome, the baby presented with a persistent facial paralysis, already present at birth and inability to close the eyes (also present in her father), without ophthalmoplegia. An unusual pharyngeal and laryngeal paralysis was also present: it led to tracheal intubation then tracheostomy and gastrostomy. CT scan at 15 months of age showed hypoplasia of brain stem. The difficulties of managing bulbar paralysis in such a premature baby are emphasized.
Subject(s)
Facial Paralysis/congenital , Pharyngeal Diseases/diagnosis , Vocal Cord Paralysis/diagnosis , Female , Humans , Infant, Newborn , Infant, Premature, Diseases/diagnosis , Ophthalmoplegia , Paralysis/diagnosis , SyndromeABSTRACT
More than three hundred and fifty cases of this ailment can be counted at the present time, an ailment coming into the wide framework of connective tissue diseases with systemic vasculitis. The auricle chondritis remains the most frequent initial localization and its almost constant throughout development. The nasal chondritis is distinguished by its evolution to the saddle-nose deformity. The tracheo-bronchial localization remains the most severe one because of a risk of stenosis. During an evolution made by bouts, the disease also involves rheumatoid, ocular, audio-vestibular, dermatological and renal symptoms. Though an immunologic mechanism seems to be the origin of the disease, the pathogenesis of polychondritis is still mysterious. The polychondritis treatment is based upon systemic steroids therapy and possibly upon immunosuppressive agents as well. Dapsone, recently brought into the polychondritis treatment have not superseded cortico-steroid therapy.
Subject(s)
Polychondritis, Relapsing , Adrenal Cortex Hormones/therapeutic use , Aged , Aortic Valve , Dapsone/therapeutic use , Eye Diseases/etiology , Female , Glomerulonephritis/etiology , Heart Valve Diseases/etiology , Humans , Male , Middle Aged , Otorhinolaryngologic Diseases/etiology , Polychondritis, Relapsing/complications , Polychondritis, Relapsing/diagnosis , Polychondritis, Relapsing/drug therapy , Skin Diseases/etiologyABSTRACT
The authors reported a case of cervical paraganglioma. Patient had a coma suggesting secretary activity of the lesion or cerebral venous thrombosis. Angiography showed an hypervascular lesion characterized by venous reflux into the contro-lateral sinus. After neurological stabilization by tumor embolization, the tumor was surgically removed.