K. Ben Mahfoudh

Toxicité neurologique tardive après traitement des carcinomes nasopharyngés

PURPOSE A retrospective analysis of risk factors for late neurological toxicity after nasopharyngeal carcinoma radiotherapy. PATIENTS AND METHODS Between 1993 and 2004, 239 patients with non metastatic nasopharyngeal carcinoma were treated by radiotherapy associated or not to chemotherapy. Radiotherapy was delivered with two modalities: hyperfractionated for 82 patients and conventional fractionation for 157 patients. We evaluated the impact of tumour stage, age, gender, radiotherapy schedule and chemotherapy on neurological toxicity. RESULTS After a mean follow-up of 107 months (35-176 months), 21 patients (8.8%) developed neurological complications, such as temporal necrosis in nine cases, brain stem necrosis in five cases, optics nerve atrophy in two cases and myelitis in one case. Five- and ten-year free of toxicity survival was 95 and 84% respectively. Young patients had greater risk of temporal necrosis, and hyperfractionated radiotherapy was associated with a significantly higher risk of neurological complications (14.6% vs 5.7%, p=0.02). On multivariate analysis, hyperfractionation and age were insignificant. CONCLUSION Late neurological toxicity after radiotherapy for nasopharyngeal carcinoma was rare. Younger age and hyperfractionation were considered as risk factors of neurological toxicity in our study.

SEIN-WP-8 Approche diagnostique de la tuberculose mammaire

Objectifs Connaitre les particularites cliniques de la mastite tuberculeuse. Connaitre les differents aspects en imagerie (echo-mammographie, IRM) de la tuberculose mammaire. Connaitre la strategie diagnostique devant ses differents aspects en imagerie. Points cles La tuberculose mammaire est une entite rare meme en pays d’endemie. Elle est caracterisee par la diversite des formes cliniques. Le caractere recidivant est evocateur. Les aspects en imagerie ne sont pas specifiques. Son diagnostic est histologique.

Une cause inhabituelle de céphalées

A 64 year old woman presented to the emergency department with a history of sudden onset severe generalised headache after waking, associated with nausea. She had no medical history. On examination, the pain had not eased but she appeared alert with no other discernible features. She underwent a computed tomography scan of the head (fig 1). What is the diagnosis, and are further investigations warranted?

H-01: Une revue de 71 cas d’abcès cérébraux à pyogènes

Introduction – objectifs Etudier les caracteristiques epidemio-cliniques microbiologiques, radiologiques et therapeutiques des cas d’abces du cerveau (AC) a pyogenes. Materiels et methodes Etude retrospective des cas d’AC a pyogenes colligees dans le service de maladies infectieuses durant une periode de 24 ans (1990–2013). Resultats Soixante et onze cas (50 hommes et 21 femmes) d’âge moyen de 38,3 ans, ont ete inclus. Les tableaux cliniques les plus frequents etaient : Des troubles de l’etat de conscience febriles (40 %), des signes de focalisations neurologiques febriles (38 %) et un syndrome meninge febrile (29,5 %). Le scanner cerebral a ete pratique dans 93 % des cas et l’IRM dans 31 % des cas. Le scanner a ete normal ou a montre des lesions douteuses dans 12 cas. Dans ces cas l’IRM a permis de confirmer le diagnostic dans 83,3 % des cas. Les localisations les plus frequentes etaient : cerebelleuse (20 %) et parietale (18 %). L’AC etait secondaire a une infection oto-rhino-laryngologique (32,3 %), une septicemie (16,9 %) et une neuro-chirurgie (8 %). Une identification du germe a ete possible dans 57,7 % des cas (34 % de bacilles a Gram negatifs, 59 % de cocci a Gram positif et 7 % d’anaerobies). 60,5 % des patients ont eu un traitement medical seul. Une chirurgie a ete associee dans 38 % des cas. La guerison a ete obtenue dans 53,5 % des cas. 19,7 % des patients ont garde des sequelles et 18,3 % sont decedes. Conclusion Les AC a pyogene est une infection rare du systeme nerveux central qui demeure grave. Malgre les progres du domaine de la radiologie et la microbiologie et le raccourcissement du delai de prise en charge, la mortalite reste elevee.

Article originalTumeurs parapharyngées, apport de l’imageriePara-pharyngeal tumors, contribution of imaging

OBJECTIVES Para-pharyngeal tumors are located deeply. Imaging is mandatory for their management. We conducted a retrospective study to determine the contribution of imaging for their diagnosis and treatment. PATIENTS AND METHODS Imaging was performed for 20 cases of primary para-pharyngeal tumors between 1986 and 2008. We compared the imaging to the anatomic and histological features of these tumors. RESULTS Computed tomography and MRI confirmed the para-pharyngeal location of tumors. Tumors were located in the prestyloid compartment in eight cases, in the retrostyloid compartment in five cases, and in the retropharyngeal compartment in one case. Six tumors had filled all the para-pharyngeal space. Salivary gland tumors had filled the prestyloid space in two cases, and in two other malignant cases all para-pharyngeal space were invaded. MRI failed to differentiate the nature of tumor and its malignancy except when there was obvious bone erosion. The treatment was mainly surgical. The mean follow-up was 5 years 6 months. DISCUSSION Imaging contributes to the etiological diagnosis and assesses tumor extension, thus helping to choose the surgical approach. MRI is the most contributive examination; its resolution is more adapted to the diagnosis of deep tumors. CT scan is contributive when studying the bone structure.

Tumeurs parapharyngées, apport de l’imagerie

OBJECTIVES Para-pharyngeal tumors are located deeply. Imaging is mandatory for their management. We conducted a retrospective study to determine the contribution of imaging for their diagnosis and treatment. PATIENTS AND METHODS Imaging was performed for 20 cases of primary para-pharyngeal tumors between 1986 and 2008. We compared the imaging to the anatomic and histological features of these tumors. RESULTS Computed tomography and MRI confirmed the para-pharyngeal location of tumors. Tumors were located in the prestyloid compartment in eight cases, in the retrostyloid compartment in five cases, and in the retropharyngeal compartment in one case. Six tumors had filled all the para-pharyngeal space. Salivary gland tumors had filled the prestyloid space in two cases, and in two other malignant cases all para-pharyngeal space were invaded. MRI failed to differentiate the nature of tumor and its malignancy except when there was obvious bone erosion. The treatment was mainly surgical. The mean follow-up was 5 years 6 months. DISCUSSION Imaging contributes to the etiological diagnosis and assesses tumor extension, thus helping to choose the surgical approach. MRI is the most contributive examination; its resolution is more adapted to the diagnosis of deep tumors. CT scan is contributive when studying the bone structure.

Carcinome à cellules acineuses du septum nasal

INTRODUCTION Nasal cavity acinic carcinoma are exceptional and often of turbinal origin. We report a case of acinic carcinoma of septal origin and discuss this histological type rare in this site. OBSERVATION A 47-year-old women, with no pathologic history, consulted for right nasal obstruction and hyposmia having evolved for a year. The clinical examination revealed a right nasal cavity lesion adhesive to the septum. Tomodensitometry showed a right nasal cavity and ethmoid opacity without bone destruction. The surgical treatment was endonasal tumor resection. The histological examination revealed a nasal fossa acinic carcinoma completely resected. A postoperative radiotherapy was initiated. The evolution was uneventful without recurrence after 4 years of follow-up. DISCUSSION Acinic carcinoma is rarely located in the nasal cavity. Its septal origin is exceptional. It is usually located at the salivary gland level. Curative treatment is surgery associated or not to radiotherapy. The prognosis is related to tumor extension and quality of resection.

Cas cliniqueCarcinome à cellules acineuses du septum nasalAcinic carcinoma of the nasal septum

INTRODUCTION Nasal cavity acinic carcinoma are exceptional and often of turbinal origin. We report a case of acinic carcinoma of septal origin and discuss this histological type rare in this site. OBSERVATION A 47-year-old women, with no pathologic history, consulted for right nasal obstruction and hyposmia having evolved for a year. The clinical examination revealed a right nasal cavity lesion adhesive to the septum. Tomodensitometry showed a right nasal cavity and ethmoid opacity without bone destruction. The surgical treatment was endonasal tumor resection. The histological examination revealed a nasal fossa acinic carcinoma completely resected. A postoperative radiotherapy was initiated. The evolution was uneventful without recurrence after 4 years of follow-up. DISCUSSION Acinic carcinoma is rarely located in the nasal cavity. Its septal origin is exceptional. It is usually located at the salivary gland level. Curative treatment is surgery associated or not to radiotherapy. The prognosis is related to tumor extension and quality of resection.

ORL-WS-8 Imagerie de l’otite externe maligne : a propos de 19 cas

Objectifs Preciser l’apport de l’imagerie dans le diagnostic et dans le suivi de l’otite externe maligne (OEM). Materiels et methodes Etude retrospective de 19 cas d’OEM. Nos patients etaient âges entre 55 et 73 ans ; 11 de sexe masculin. Dix huit patients etaient diabetiques et une sous corticotherapie. Une TDM a ete pratiquee pour tous les patients. Trois ont beneficie d’une IRM. Quatre patients ont beneficie d’une TDM apres traitement. Resultats La TDM a montre un comblement du CAE dans tous les cas avec lyse de l’os tympanal dans 13 cas ; une lyse de l’ATM dans un cas ; une extension a la base du crâne dans un cas et une infiltration des espaces profonds de la face dans deux cas. L’IRM a permis le diagnostic d’une infiltration de l’espace parapharynge dans deux cas. Un pseudomonas a ete trouve dans 9 cas, aspergillus (1 cas) et candida (1 cas). La TDM de controle (3 cas) a montre une regression des signes inflammatoires dans tous les cas et de la necrose osseuse dans 2 cas. Conclusion L’OEM est une affection grave a considerer chez le sujet diabetique. L’imagerie est d’un grand apport pour poser le diagnostic et pour etudier l’extension aux espaces profonds.

CV-WS-31 Apport de l’imagerie dans le diagnostic des complications vasculaires du rein transplante

Objectifs Preciser l’apport de l’imagerie dans le diagnostic des complications vasculaires apres transplantation renale. Materiels et methodes Etude retrospective sur 13 ans (1994 – 2007) a propos de 142 greffes d’un rein de donneur vivant (114 cas) ou de donneur en etat de mort encephalique (28 cas). Au cours de cette periode, 34 complications vasculaires ont ete observees soit un taux de 22,5 %. Les manifestations cliniques etaient non specifiques. Tous les greffons ont ete explores par une echographie couplee au Doppler. Un angioscanner a ete pratique dans 8 cas et une angio-MR dans 7 cas. Une arteriographie a ete realisee dans 11 cas. Resultats La moyenne d’âge etait de 31,3 ans (8-58). Le sex ratio etait de 2,1. La stenose de l’artere du greffon etait la complication vasculaire la plus frequente (44,1 %). Dans les autres cas, il s’agissait de thrombose de l’artere du greffon (8,8 %), thrombose de la veine du greffon (8,8 %), plicature de la veine du greffon (2,9 %), infarctus segmentaire (5,8 %), necrose corticale (8,8 %), faux anevrysme (11 %) et fistule arterio-veineuse (11 %). Conclusion L’imagerie joue un role preponderant pour etablir un diagnostic precoce des complications vasculaires de la greffe renale et orienter la prise en charge therapeutique.