[A rare cause of recurrent meningitis in children: cochleovestibular dysplasia]. / Une cause rare de méningite récurrente chez l'enfant: la dysplasie cochléovestibulaire.

Recurrent bacterial meningitis is an uncommon disease of childhood. It occurs most often in children who have an underlying predisposing disorder that can result from anatomic fistula or immunodeficiency. Cochleovestibular dysplasia is a rare malformation of the inner ear that is often associated with translabyrinthine cerebrospinal fistula and then can cause recurrent bacterial meningitis. We report an unusual case of recurrent meningitis revealing cochleovestibular dysplasia in a 9-year-old child. The malformation was confirmed by imaging and the child had surgery. The outcome was favourable with no recurrence of meningitis during the 3 years after the operation.

Efectividad de un protocolo consensuado para la prevención de náuseas y vómitos inducidos por quimioterapia / Effectiveness of a consensus protocol for the prevention of chemotherapy-induced nausea and vomiting

Objetivo: Evaluar la efectividad de un protocolo consensuado para la prevención de NVIQ en nuestro centro y la adherencia de las prescripciones al mismo. Método: Estudio observacional prospectivo. Se incluyeron pacientes tratados con quimioterapia (QT) en los que fue posible un seguimiento de 120 horas tras el ciclo. Se evaluó la respuesta al tratamiento, medida como: respuesta completa (RC) (ausencia de náuseas y vómitos, sin necesidad de tratamiento adicional en las 120 posteriores al ciclo), respuesta aguda (RA) (en las primeras 24 horas) y tardía (RT) (entre las 24 y las 120 horas), según si se ajustaban o no al protocolo del hospital. Se realizó un análisis estadístico descriptivo, analizando los diferentes factores riesgo y la adherencia al protocolo del hospital. Resultados: Se incluyeron un total de 167 pacientes en los que se observó una RC en el 71,9% de los casos (88,9% RA y 73,7% RT), con ausencia de vómitos en el 89,8%. El 7,2% de los casos no se ajustaron al protocolo. No se encontraron diferencias en la respuesta al tratamiento entre los pacientes que se ajustaron o no al protocolo (RC, RA o RT) pero si en la aparición de vómitos (8,3% vs 36,4%, p = 0,014). Conclusión: La efectividad de nuestro protocolo es buena especialmente en el control de los vómitos aunque las náuseas en la fase retardada siguen siendo un problema sin resolver. El control de vómitos es peor en los pacientes que no se ajustan al protocolo (AU)

Objective: To assess the effectiveness of a consensus protocol for the prevention of CINV at our institution and level of adherence to it. Method: Prospective observational study. Patients treated with chemotherapy (CT) in whom a 120-hour follow-up was made after the cycle were included. We assessed the response to the therapy, categorized as: complete response (CR) (absence of nausea and vomiting, without the need of additional treatment within the 120 hours following the cycle), acute response (AR) (within the first 24 hours) and delayed response (DR) (within 24 and 120 hours), depending on whether or not these were adjusted to the hospital protocol. A descriptive statistical analysis was performed analyzing the different risk factors and level of adherence to the hospital protocol. Results: A total of 167 patients were included in whom CR was observed in 71.9% of the cases (88.9% AR and 73.7% DR), with absence of vomiting in 89.8%. Seven point two percent of the cases did not adhere to the protocol. There were no differences in treatment response between the patients adhering and adhering to the protocol (CR, AR o DR) but yes in vomiting occurrence (8.3% vs. 36.4%, p = 0.014). Conclusion: The effectiveness of our protocol is good specially for controlling the vomiting although nausea during the delayed phase still is a not resolved matter. Vomiting control is poorer in those patients not adjusting to the protocol (AU)

[Effectiveness of a consensus protocol for the prevention of chemotherapy-induced nausea and vomiting]. / Efectividad de un protocolo consensuado para la prevención de náuseas y vómitos inducidos por quimioterapia.

OBJECTIVE: To assess the effectiveness of a consensus protocol for the prevention of CINV at our institution and level of adherence to it. METHOD: Prospective observational study. Patients treated with chemotherapy (CT) in whom a 120-hour follow-up was made after the cycle were included. We assessed the response to the therapy, categorized as: complete response (CR) (absence of nausea and vomiting, without the need of additional treatment within the 120 hours following the cycle), acute response (AR) (within the first 24 hours) and delayed response (DR) (within 24 and 120 hours), depending on whether or not these were adjusted to the hospital protocol. A descriptive statistical analysis was performed analyzing the different risk factors and level of adherence to the hospital protocol. RESULTS: A total of 167 patients were included in whom CR was observed in 71.9% of the cases (88.9% AR and 73.7% DR), with absence of vomiting in 89.8%. Seven point two percent of the cases did not adhere to the protocol. There were no differences in treatment response between the patients adhering and adhering to the protocol (CR, AR o DR) but yes in vomiting occurrence (8.3% vs. 36.4%, p = 0.014). CONCLUSION: The effectiveness of our protocol is good specially for controlling the vomiting although nausea during the delayed phase still is a not resolved matter. Vomiting control is poorer in those patients not adjusting to the protocol.

[Congenital cholesteatoma in children]. / Cholestéatome congéntial.

OBJECTIVES: To report on two cases of congenital cholesteatoma in patients aged 1 month. To review the clinical and radiological features of congenital cholesteatoma and to clarify the contribution of the CT scan in the diagnosis and the preoperative workup. PATIENTS AND METHODS: The authors report two observations of congenital cholesteatoma. These children were investigated using high-resolution CT. The treatment was surgical in both cases. RESULTS: The children were 1 month old, presenting with facial paralysis. In the otoscopic exam, the tympanic membrane was normal in both cases, with a whitish retrotympanic soft mass. The diagnosis of congenital cholesteatoma was made based on the CT data. CONCLUSION: Congenital cholesteatoma is rare. Otoscopic examination must be undertaken during the physical exam of a child at a young age to establish an early diagnosis. CT scan allows positive diagnosis and a precise preoperative workup.

Benign osteoblastoma in an unusual mastoid location.

INTRODUCTION: Benign osteoblastoma (OB) is an unusual primary bone tumor. The preferred locations are the posterior arch of vertebrae and long bones. We report herein an extremely rare location of an OB in the mastoid process of the temporal bone. CASE REPORT: A 22-year-old woman presented with painful left retro-auricular swelling. Computed tomography features were suggestive of an aggressive osteolytic lesion of the left mastoid. The pathologic examination of bone curettage material revealed a benign OB. A complete resection of the tumor was performed later, with no evidence of recurrence at 1 year. DISCUSSION/CONCLUSION: To our knowledge, this is the 14th reported case of OB confined to the mastoid process of temporal bone. Its histological diagnosis can be difficult and osteosarcoma is its principal differential diagnosis. Although generally regarded as benign, OB has potential for recurrence and local invasion. As such, complete resection, whenever possible, is preferred over conventional curettage.

[Development of murine models of ocular toxoplasmosis and preliminary results of ocular inflammatory transcriptome]. / Mise au point de modèles murins de toxoplasmose oculaire et premiers résultats de l'analyse du transcriptome inflammatoire.

BACKGROUND/PURPOSE: Toxoplasmosis is the most common cause of posterior uveitis in immunocompetent subjects. Taking into account the opposing needs of limiting parasite multiplication and minimizing tissue destruction, the infection imbalance most often involves CD4 and CD8 T lymphocytes that play the lead role in adaptive immunity to T. gondii. The aims of our study were to develop murine models of toxoplasmosis and to study the immune responses to the infection. METHODS: Two murine models were studied: (i) intravitreal injection of T. gondii (primary infection) and (ii) intraperitoneal inoculation at birth and reinfection by intravitreal injection. Clinical and histological data were determined. mRNA-cytokine levels were measured in ocular samples obtained from mice with toxoplasma chorioretinitis using RT-PCR. RESULTS: Intravitreal injection of T. gondii led to chorioretinitis. Primary infection was characterized by severe chorioretinitis when compared with reinfection. mRNA levels of IFN-gamma, TNF-alpha, and iNOS were increased in infected mice. DISCUSSION: TH1 cells may mitigate chorioretinitis by limiting T. gondii proliferation. Further studies are needed to explore ocular immune regulation. These primary results may open new in vivo therapeutic approaches.

[What are the alternative criteria for fine needle aspiration biopsy of a thyroid nodule?]. / Quels critères alternatifs à la cytoponction d'un nodule thyroïdien ?

OBJECTIVES: To identify the clinical and paraclinical factors of thyroid nodule malignancy (in absence of ultrasound-guided fine needle aspiration biopsy data). PATIENTS AND METHODS: This retrospective study was conducted on a cohort of 282 patients admitted for management of a thyroid nodule disease. All patients had undergone surgery and the specimen had been analyzed anatomically and pathologically. Forty-four patients had malignant disease. Epidemiological, clinical, and paraclinical data, as well as the anatomical and pathological characteristics of the specimen were collected for each patient. RESULTS: We showed that the epidemiological data (sex and age), the nodule's characteristics (consistency, irregularities of the edges and fixity to underlying structures, and size), the presence of adenopathies, signs of compression, and the presence of calcifications were the predictability criteria of malignant disease. However, the scintigraphic aspect, the echostructure, and the hormonal status were not significant. CONCLUSION: This study underscores that a relevant clinical and paraclinical analysis remains highly contributive in the presurgical identification of factors predictive of malignancy of a thyroid nodule, notably in countries where technological tools are not always available.

Profil ganglionnaire des micro carcinomes papillaires de la thyroide

La prise en charge des microcarcinomes papillaires de la thyroide est controversee surtout en matiere de curages ganglionnaires. Objectif : determiner le profil ganglionnaire des microcarcinomes papillaires de la thyroide afin de planifier une prise en charge adequate. Materiel et methodes : C'est une etude retrospective portant sur 20 cas de microcarcinomes papillaires de la thyroide colliges sur une periode de 14 ans (1994-2007). Resultats : il s'agissait de 18 femmes et 2 hommes d'un age moyen de 46 ans. Les micro carcinomes etaient de decouverte per-operatoire dans 50des cas. Ils etaient unifocaux dans 80des cas et non encapsules dans 40des cas. Leur taille etait superieure a 0;5cm dans 35des cas. Cinquante six pour cent des curages ganglionnaires etaient positifs. Une metastase ganglionnaire a ete retrouvee dans 83pour les tumeurs de taille superieure a 0;5cm. Conclusion : plusieurs parametres conditionnent les metastases ganglionnaires cervicales en matiere de microcarcinomes papillaires de la thyroide. La conduite therapeutique doit les prendre en consideration

Indications et resultats de la septoplastie chez l'enfant

La septoplastie chez l'enfant est un sujet de controverse jusqu'a nos jours. Notre etude est retrospective a propos de 47 cas colliges au service ORL de l'hopital Tahar Sfar de Mahdia sur une periode de 19 ans (1988-2006). L'age moyen de nos malades est de 13;8 ans. Le sexe masculin est predominant (63;8). Tous nos malades ont beneficie d'un examen rhinologique et un bilan radiologique standard. A cote de la deviation de la cloison nasale nous avons note une deviation de la pyramide nasale chez 4 malades. Tous nos malades ont beneficie d'une septoplastie sous anesthesie generale. Apres un recul moyen de 2 ans nous avons un bon resultat fonctionnel (fosses nasales permeables) chez 37 malades

Facteurs predilectifs de la malignite d'un nodule thyroidien

Buts : etudier les facteurs predictifs de malignite des nodules thyroidiens et comparer nos resultats a ceux de la litterature. Patients et methodes : Il s'agit d'une etude retrospective a propos de 282 cas de nodules thyroidiens operes a l' hopital de Mahdia entre 1988 et 2003. Resultats : L'age moyen etait de 44 ans. Le risque de malignite des nodules thyroidiens etait de 15;6 . Ce risque etait plus important chez les hommes (50) que chez les femmes (13;3). Certains facteurs etaient hautement predictifs de malignite comme l'age superieur a 60 ans; les signes de compression; les adenopathies cervicales et le caractere fixe et dure du nodule thyroidien Conclusion : Certains signes cliniques et para cliniques ont une grande valeur en matiere de benignite ou de malignite des nodules thyroidiens

[Ear myiasis. Two case reports]. / Les myiases auriculaires. A propos de deux observations.

The authors report two cases of aural myiasis. This pathology rarity induced us to search after epidemiologic, clinic and therapeutic peculiarity of this parasitical disease.