Cas rare de sangsue laryngée chez un homme de 70 ans

La dyspnée laryngée représente une urgence extrême en otorhinolaryngologies. Elle répond à des étiologies multiples et reste souvent graves. La dyspnée laryngée causée par une sangsue est exceptionnellement décrite dans la littérature surtout chez l’adulte. Nous rapportons une observation particulière d’infestation de l’arbre respiratoire par une sangsue ayant entraîné une dyspnée laryngée

Carcinome folliculaire de la thyroïde au Maroc: Facteurs prédictifs de métastases

Introduction: Dans la majorité des études, l’analyse des facteurs pronostics du carcinome folliculaire de la thyroïde (CFT) a été faite conjointement avec ceux du carcinome papillaire (CPT), ce qui rend leur identification difficile. Le but de cette étude était de déterminer les facteurs prédictifs de survenue de métastases chez les patients atteints de CFT dans un centre de soins tertiaires au Maroc. Méthode : L’étude incluait les patients atteints de CFT non métastatiques au moment du diagnostic suivis au service  de médecine nucléaire du CHU Ibn Rochd de Casablanca entre Janvier 2005 et Décembre 2012. Les caractéristiques clinico-pathologique, les traitements reçus et leur résultat ont été examinés en comparaison avec un échantillon de carcinome papillaire traité durant la même période. Une analyse univariée des caractéristiques des patients a été effectuée à l'aide du logiciel IBM SPSS. Résultats : Soixante-treize patients ont été inclus dans l’étude. L'âge moyen était de 51 ans (± 14), le sexe ratio (H / F) était de 0,17. Lors de l’analyse statistique, un âge supérieur à 45 ans (p=0,002) ; une taille tumorale supérieure à 5 cm (p=0,04), la multifocalité (p=0,04), les emboles vasculaires (p=0,02), un taux de thyroglobuline en défreination élevé (p=0,000) et un stade initial avancé (p=0,000) étaient retenus comme facteurs prédictifs de survenue de métastases à distance. Par rapport au CPT, le CFT était corrélé à un risque plus élevé de métastases (p = 0,000)

An unusual cause of severe dyspnea: A laryngeal live leech: Case report

Introduction: Foreign bodies in the upper airways are one of the most challenging otolaryngology emergencies, leeches present a very rare cause of airway foreign bodies around the world. Case report: A 6-year-old girl was referred to our otolaryngology department at a tertiary university hospital with a severe dyspnea and hemoptysis. Nasofibroscopy revealed a dark living leech in the supraglottic area which extends to the glottis. The patient was urgently admitted to the operating room, the leech was grasped and removed with a foreign body forceps with a full length of more than 6 cm. All symptoms were relieved post operatively and she was discharged one day later. Conclusion: Leeches should be suspected as an airway foreign body in patients with a recent history of drinking from stream water. Prevention remains the best treatment for such cases based simply on hygiene measures like not drinking stream water directly and filtering drinking water before it is used

Le cancer différencié de la thyroïde chez l’enfant et l’adolescent: à propos de 22 cas

L’obectif était de mettre en relief les particularités du cancer de la thyroïde chez l’enfant et l’adolescent, et d’évaluer nos résultats par rapport à la littérature internationale a travers une série de cas la plus représentatif au Maroc: 22 cas. C'est une étude rétrospective descriptive des patients atteints de cancer différencié de la thyroïde, hospitalisés au service d’ORL et de Chirurgie Cervico-faciale de L’hopital 20 Août de Casablanca-Maroc, sur la période qui s’étend de Janvier 1995 à Mars 2015. Nous avons recueilli les données relatives à 22 cas, qui répondaient à nos critères d’inclusion. L’âge moyen de nos patients était de 14 ans, avec une sex-ratio 3,4, la plupart de nos patients ont consulté pour un nodule thyroïdien, associé dans 22,7% des cas à une adénopathie cervicale, et dans 9,1% à des  signes de compression. L’ensemble des patients ont bénéficié d’une thyroïdectomie totale, suivie d’un curage ganglionnaire dans 31,82%. Le diagnostic de cancer thyroïdien a reposé sur l’examen anatomopathologique de la pièce opératoire, qui a objectivé un carcinome papillaire dans 95,4% des cas, et un carcinome vésiculaire dans 4,5%. Le traitement par l’iode radioactif 131 a été réalisé dans 100% des cas. Par la suite tous nos patients ont été mis sous hormonothérapie thyroïdienne. Une surveillance étroite et régulière a permis de détecter des métastases ganglionnaires chez 3 patients, et les métastases à distance chez 4 patients. Le cancer différencié de la thyroïde de l’enfant et l’adolescent est une entité rare mais agressive, son traitement se base sur la chirurgie, associée à l’irathérapie donnant un pronostic excellent

Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study.

Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours. In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186. Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78·6%] female patients and 4922 [21·4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1·4 [IQR 0·6-3·4]) compared with the prepandemic phase (2·0 [0·9-3·7]; p<0·0001) and pandemic decrease phase (2·3 [1·0-5·0]; p<0·0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69·0%] of 3704 vs 1515 [71·5%] of 2119; OR 1·1 [95% CI 1·0-1·3]; p=0·042), lymph node metastases (343 [9·3%] vs 264 [12·5%]; OR 1·4 [1·2-1·7]; p=0·0001), and tumours at high risk of structural disease recurrence (203 [5·7%] of 3584 vs 155 [7·7%] of 2006; OR 1·4 [1·1-1·7]; p=0·0039). Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation. None

Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID) : a retrospective, international, multicentre, cross-sectional study

Background: Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours. Methods: In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186. Findings: Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78·6%] female patients and 4922 [21·4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1·4 [IQR 0·6-3·4]) compared with the prepandemic phase (2·0 [0·9-3·7]; p&lt;0·0001) and pandemic decrease phase (2·3 [1·0-5·0]; p&lt;0·0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69·0%] of 3704 vs 1515 [71·5%] of 2119; OR 1·1 [95% CI 1·0-1·3]; p=0·042), lymph node metastases (343 [9·3%] vs 264 [12·5%]; OR 1·4 [1·2-1·7]; p=0·0001), and tumours at high risk of structural disease recurrence (203 [5·7%] of 3584 vs 155 [7·7%] of 2006; OR 1·4 [1·1-1·7]; p=0·0039). Interpretation: Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation.</p