178 research outputs found
Les perforations par traumatisme interne de lâoesophage
Introduction: Esophagus traumatic perforations still carries high morbidity and mortality rates. There is no consensus regarding the appropriate management of this life-threatening condition. The aim of this study is to analyse treatment of traumatic esophageal perforations.Patients and methods: This retrospective study was made with seven patients treated for traumatic perforation of the esoephagus at the ENT department of the Habib Bourguiba Hospital. All patients were men. The mean age was 24 years. One patient has a history of an idiopathic megaesophagus and another have a history of a caustic stenosis.The traumatism was by foreign body in 2 cases, at the time of an extraction of foreign body in 3 cases and at the time ofa traumatic endoscopy in 2 cases.Results: The treatment consisted on an isolated medical treatment in 1 case and associated to the surgery for the 6 other patients. The surgical treatment was conservative in 2 cases. Esophagus exclusion with replacement was made in 4 cases. After treatment, evolution was good for all patients.Conclusion: Esophageal perforations can cause death by some serious complications. The treatment is a medico-surgical urgency. The medical treatment must be founded in all the cases as of the suspicion of the diagnosis. The surgery is indicated for complications or during the monitoring in the absence of improvement under medical treatment. The majority of the authors choose conservative treatment especially if the diagnosis is made in the 48 first hours. The radical surgery is kept for the failures of the conservative treatment.Key words: Perforation, esophagus, foreign body, endoscopy, surgery, prognosis
Laryngectomie totale rĂ©sultats de lâexpĂ©rience du service dâorl de sfax
Introduction : La laryngectomie totale (LT) reste lâintervention la plus rĂ©alisĂ©e dans notre pays pour les cancers laryngĂ©s. Le but de ce travail est dâĂ©valuer les rĂ©sultats postopĂ©ratoires et Ă©volutifs des malades ayant eu une LT. MatĂ©riel et mĂ©thodes : Il sâagit dâune Ă©tude rĂ©trospective Ă propos de 187 cas de patients ayant eu une laryngectomie totale, sur une pĂ©riode de 19 ans (1987-2005). La tumeur a Ă©tĂ© classĂ©e T3T4 dans 87,8 % des cas. Lâatteinte des 3Ă©tages Ă©tait trouvĂ©e dans 56% des cas et lâextension extra laryngĂ©e dans 59 % des cas. Une trachĂ©otomie premiĂšre pour dyspnĂ©e laryngĂ©e a Ă©tĂ© rĂ©alisĂ©e dans 44 % des cas. La laryngectomie Ă©tait Ă©tendue au pharynx ou Ă la base de la langue dans 43 % des cas. RĂ©sultats : Les suites opĂ©ratoires ont Ă©tĂ© marquĂ©es par lâapparition d'un pharyngostome chez 19% des patients et par une infection dans 11% des cas. Les limites de rĂ©section ont Ă©tĂ© tumorales dans 14% des cas. Une radiothĂ©rapie postopĂ©ratoire a Ă©tĂ© rĂ©alisĂ©e dans 92,5% des cas.Une rĂ©Ă©ducation orthophonique a pu ĂȘtre rĂ©alisĂ©e chez 36% des patients. Sur un recul moyen de 40 mois (2 Ă 132 mois), une rĂ©cidive tumorale ou ganglionnaire a Ă©tĂ© retrouvĂ©e dans 8 % et 5 % des cas respectivement. Le taux de mĂ©tastase Ă distance Ă©tait de 11 % des cas. Une deuxiĂšme localisation a Ă©tĂ© objectivĂ©e dans 4 % des cas. La survie moyenne Ă 5 ans Ă©tait de 75 %. Discussion : La laryngectomie totale est une intervention mutilante, par le handicap vocal quâelle engendre mais la survie Ă 5 ans est de 75%. La perte dĂ©finitive de la fonction phonatoire du larynx en constitue lâhandicap majeur. Le diagnostic plus prĂ©coce de ces cancers dans notre pays peut permettre dâautres alternatives thĂ©rapeutiques.Mots-clĂ©s : Laryngectomie totale, pharyngostome, cancers laryngĂ©s
Tumeur maligne des gaines nerveuses périphériques révélant une neurofibromatose type 1
La Neurofibromatose type 1 (NF1) ou maladie de Von Recklinghausen est une affection Ă expression clinique variable. La transformation maligne est rare et redoutable. Le but de ce travail est dâĂ©tudier les critĂšres diagnostiques ainsi que la prise en charge thĂ©rapeutique de cette transformation maligne. Observation : A.B, ĂągĂ© de 16 ans, a consultĂ© pour une tumĂ©faction basicervicale antĂ©rieure dâapparition rĂ©cente, ayant augmentĂ© progressivement de taille sans signes de compression ni de dysthyroĂŻdie. Lâexamen clinique a trouvĂ© une masse dure, bien limitĂ©e, indolore, de 4 cm de grand axe siĂ©geant en regard du manubrium sternal, adhĂ©rente au plan profond et dĂ©bordant sur le creux sus sternal. A cette masse sâassociaient des taches cutanĂ©es cafĂ© au lait dissĂ©minĂ©es sur tout le corps, des nodules de Lish iriens et des neurofibromes occipitaux et parotidiens. AprĂšs une exĂ©rĂšse de la masse par voie cervicale, lâexamen histologique a conclu Ă une tumeur maligne de la gaine nerveuse. Le malade a eu dans un 2Ăšme temps, une exĂ©rĂšse plus large emportant le manubrium sternal et les tissus adjacents avec une reconstruction par des fragments de cĂŽtes mais avec des limites chirurgicales envahies. LâĂ©volution a Ă©tĂ© marquĂ©e par une poursuite Ă©volutive prĂ©coce imposant une exĂ©rĂšse chirurgicale plus large suivie dâune chimiothĂ©rapie et dâune radiothĂ©rapie externe (RT). Le malade Ă©tait cependant toujours en poursuite Ă©volutive et le dĂ©cĂšs est survenu dans un contexte d'envahissement mĂ©diastinal.Mots-clĂ©s : Neurofibromatose type 1, Sarcome, tissus mous, gaines nerveuses pĂ©riphĂ©riques, Chirurgie
Evaluation de la surdite professionnelle dans un departement du sud tunisien
Objectif: La surditĂ© professionnelle (SP) est une atteinte auditive acquise due Ă une exposition excessive au bruit au travail. Elle reprĂ©sente une cause frĂ©quente des surditĂ©s de lâadulte. Le but de notre travail est de rapporter les caractĂ©ristiques Ă©pidĂ©miologiques, cliniques et audiomĂ©triques des patients prĂ©sentant une SP.MĂ©thode : Il sâagit dâune Ă©tude rĂ©trospective concernant 200 patients prĂ©sentant une SP dĂ©clarĂ©e dans le gouvernorat de Sfax durant la pĂ©riode (1990-2007). Un interrogatoire, un examen ORL complet ainsi quâune audiomĂ©trie tonale ont Ă©tĂ© rĂ©alisĂ©s pour tous les malades. Nous avons Ă©tudiĂ© lâincidence annuelle, lâĂąge, le sexe, le secteur dâactivitĂ© ainsi que les donnĂ©es audiomĂ©triques de ces patients. Une Ă©tude analytique univariĂ©e a recherchĂ© une corrĂ©lation entre la perte auditive moyenne (PAM), lâĂąge, la durĂ©e dâexposition au bruit et le secteur dâactivitĂ©.RĂ©sultats : Une prĂ©dominance masculine a Ă©tĂ© notĂ©e (99%). La moyenne dâĂąge Ă©tait de 46 ans. Les secteurs dâactivitĂ© les plus incriminĂ©s Ă©taient la mĂ©tallurgie (27,5%), la menuiserie (10%) et le secteur automobile (6%). 26,5% des patients rapportaient des acouphĂšnes et 3,5% se plaignaient de troubles de lâĂ©quilibre. La surditĂ© professionnelle Ă©tait perceptionnelle, bilatĂ©rale et symĂ©trique dans 93% des cas. Lâanalyse statistique univariĂ©e nâa pas objectivĂ© de corrĂ©lation entre la PAM, lâĂąge, la durĂ©e dâexposition au bruit et le secteur dâactivitĂ©.Conclusion : A notre connaissance, il sâagit de la premiĂšre Ă©tude publiĂ©e rapportant les caractĂ©ristiques de la SP chez des travailleurs dans le sud Tunisien. Cette Ă©tude montre le manque de sensibilisation du public vis-Ă -vis de lâimportance de la prĂ©servation de lâaudition du bruit. Elle met en Ă©vidence aussi le manque dâoutils de prĂ©vention, leur inefficacitĂ© voire les deux.Mots clĂ©s : surditĂ© professionnelle ; Ă©pidĂ©miologie ; bruit ; audiomĂ©trieObjective: Occupational noise-induced hearing loss (ONIHL) describes an acquired hearing impairment attributable to excessive workplace noise exposure. ONIHL is likely to contribute to a very high proportion of the cases of hearing loss in adults. The aim of this study was to provide epidemiological profile, clinical and audiometric characteristics of patients presenting ONIHL in our department.Method : This study examined workersâ data claims accepted for hearing-related conditions in Sfax department in South Tunisia during 1990-2007. Two hundred workers were underwent audiometry and answered a clinical questionnaire. Our data were analysed to describe annual trends in ONIHL claims, claimantsâ age, gender, occupational group and audiometric features. In the univariate analysis, the ONIHL was correlated with age, duration of occupational exposure to noise and occupational group.Results : The majority of patients presenting with ONIHL was male (99%). The average age was 46 years. The most affected professional sectors were primary metal industries (27.5%), lumber and wood products manufacturing (10%) and the automobile industry (6%). Of all ONIHL patients, 26,5% had tinnitus and 3,5% had complaints related to balance disorders. ONIHL was sensorineural, bilateral and symmetrical in 93% of cases. Univariate analysis showed no significant association between hearing loss, age, occupational exposure to noise and occupational group.Conclusion : To our knowledge, it is the first published report on epidemiological profile, clinical and audiometric characteristics of ONIHL workers in south Tunisia. This work suggests the low level of public awareness regarding the importance of hearing preservation and that current strategies addressing this problem are either not effective or inadequately implemented, or both.Keywords : occupational noise-induced hearing loss; epidemiology; noise; audiometr
L'atteinte du sinus caverneux dans le carcinome adenoĂŻde systique
Introduction: Head and neck adenoid cystic carcinoma (ACC) is a malignant epithelial neoplasm, developing from salivary gland tissue. Cavernous sinus and skull base invasion by perinervous spread is a particular behavior of this tumor entity. We report two cases of cavernous sinus invasion.Cases report: The first one was originated in the parotid gland, invaded infratemporal fossa and extended to cavernous sinus through perineural infiltration along trigeminal nerve. Second case of ACC was developed in submandibular gland. An invasion of cavernous sinus was observed two years later despite a surgical resection with post operative chemoradiotherapy.Discussion: ACC is characterized by locally aggressive invasion and a strong tendency to recur. Perineural spread extension is common in ACC, as a precursor of skull base invasion and cavernous sinus involvment along the mandibular, maxillary and facial nerves. Magnetic resonance imaging (MRI) has a higher sensitivity and specificity in detecting perineural spread. Surgical therapy is the choice treatment although complete resection is not possible in all cases due to the infiltration andperineural spread. So, radiation therapy is considered effective, and has been used successfully in ACC invading cavernous sinus. The place of chemotherapy has yet to be determinate. The prognosis of these extensive tumors is bad because high frequency of local recurrence and distant metastases.Key-words: adenoid cystic carcinoma, cavernous sinus, skull base, perineural invasion
Les tumeurs myofibroblastiques inflammatoires cervico-faciales
Objectifs : Confronter les signes cliniques et paracliniques de cette entitĂ© Ă celle des cancers et Ă©tudier ses modalitĂ©s thĂ©rapeutiques.MatĂ©riel et mĂ©thodes : Etude rĂ©trospective portant sur huit cas de tumeurs myofibroblastiques inflammatoires cervico-faciales.RĂ©sultats : LâĂąge moyen Ă©tait de 37 ans sans prĂ©dominance de sexe. Le siĂšge de la pseudotumeur Ă©tait thyroĂŻdien dans un cas, ganglionnaire dans deux cas, les parties molles cervicales dans un cas, laryngĂ© dans un cas, nasosinusien dans un cas, orbito-sinusienne dans 1 cas et du cavum dans un cas. Le traitement Ă©tait chirurgical dans 6 cas. Une corticothĂ©rapie a Ă©tĂ© instaurĂ©e dans 4 cas dont 2 en post opĂ©ratoire. LâĂ©volution, aprĂšs un recul moyen de 21 mois, Ă©tait marquĂ©e par la survenue de rĂ©cidive dans 2 cas, une poursuite évolutive dans 1 cas et lâapparition dâautres localisations rĂ©nales et rĂ©tro pĂ©ritonĂ©ale chez une patiente.Discussion : Les tumeurs myofibroblastiques inflammatoires sont rares. De caractĂšre bĂ©nin, ces tumeurs prĂ©sentent gĂ©nĂ©ralement des caractĂ©ristiques cliniques dâagressivitĂ© avec un pouvoir lytique mimant une tumeur maligne. Lâatteinte des voies aĂ©rodigestives supĂ©rieures se voit dans 11 % des tumeurs extrapulmonaires. Le diagnostic prĂ©opĂ©ratoire est difficile. LâexĂ©rĂšse aussi large que possible de la tumeur est gĂ©nĂ©ralement prĂ©conisĂ©e. Lâassociation dâune corticothĂ©rapie est indiquĂ©e chez des patients demeurant symptomatiques.Mots clĂ©s : tumeur myofibroblastique inflammatoire, cervico-facial, chirurgie, corticoĂŻdesObjectives: Compare clinical, radiological and histological features of inflammatory myofibroblastic tumours with cancers and describe this entity therapeutic management.Material and methods: Retrospective study on eight cases of head and neck inflammatory myofibroblastic tumours.Results: The median age was 37 years without sex predominance. The tumor location was the thyroid (1 case), cervical lymph nodes (2 cases), neck (1 case), larynx (1 case), sinonasal tract (1case), orbit and sinosal tract (1 case) and nasopharynx (1 case). Surgical procedure was performed in 7 case. Corticosteroid therapy was established in 4 cases. The median follow-up was 21 months. Local recurrence was noted in 2 cases. A disease evolution was noted in 1 case. Occurrence of renal and retroperitoneal locations was noted in 1 case.Discussion : Inflammatory myofibroblastic tumours are uncommon. Although they are histological benign, they often show aggressive clinical behavior, with locally destructive features that mimic a neoplastic process. Head and neck involvement is seen in 11% of extrapulmonary locations. Preoperative diagnosis is difficult. A wide surgical excision of the tumor is recommended. The combination of a corticosteroid is indicated in patients who remain symptomatic.Key words: Inflammatory myofibroblastic tumour, Head and neck, surgery, corticosteroid
Unleashing the Potential : Transforming Technical and Vocational Education and Training
Technical and vocational education and training (TVET) is steadily emerging as a winner in the ârace to the topâ of global debates and government priorities for education and national development agendas. TVET also features high
in strategic and operational priorities of regional economic communities (RECs) such as the African Union, the Caribbean Community (CARICOM) and the European Union; of other multinational groups such as the G20, the Organisation for Economic Co-operation and Development (OECD), and of multilateral organizations such as the International Labour Organization (ILO) and UNESCO. This book will be of interest to the broad TVET community and beyond. It is
intended as a resource for policy-makers to analyse contextual trends and intersecting demands on education and training system
La tumeur de warthin de la parotide : A propos de 11 cas
Introduction : La tumeur de Warthin (TW) reprĂ©sente la deuxiĂšme Ă©tiologie des tumeurs parotidiennes bĂ©nignes. Le but de ce travail est dâĂ©tudier les caractĂ©ristiques Ă©pidĂ©miologiques, cliniques et radiologiques de la TW parotidienne.Patients et mĂ©thodes : 11 patients opĂ©rĂ©s pour une TW de la glande parotide ont Ă©tĂ© inclus dans une Ă©tude rĂ©trospectivesur une pĂ©riode 10 ans.RĂ©sultats : LâĂąge moyen Ă©tait de 63 ans. lesex-ratio Ă©tait 10. Le tabagisme Ă©tait notĂ© dans 82 %. il sâagissait de gros fumeurs (>30 Paquet-annĂ©e). La tumĂ©faction parotidienne Ă©tait le seul symptĂŽme prĂ©sent au moment du diagnostic chez tous les patients. Le diamĂštre tumoral moyen Ă©tait de 38 mm. A lâĂ©chographie, la tumeur Ă©tait hypoĂ©chogĂšne dans 66,6%. A lâiRM, la tumeur Ă©tait en hyposignal T1 prenant faiblement le contraste et en hypersignal T2 dans deux cas sur trois. La cytoponction Ă©tait en faveur dâune lĂ©sion maligne dans les 3 cas oĂč elle a Ă©tĂ© effectuĂ©e. Le traitement a Ă©tĂ© chirurgical dans tous les cas. Latumeur Ă©tait multifocale dans 2 cas. Aucun cas de rĂ©cidive ou de dĂ©gĂ©nĂ©rescence maligne nâa Ă©tĂ© notĂ©, avec un recul moyen de 3 ans.Conclusion : une forte corrĂ©lation entre le dĂ©veloppement dâune TW, un tabagisme et le sexe masculin a Ă©tĂ© rapportĂ©e. La cytoponction et lâiRM contribuent au diagnostic. La rĂ©cidive est faible aprĂšs parotidectomie superficielle.Mots clĂ©s : Tumeur de Warthin, parotide, tabac, iRM, parotidectomie.Objective : Warthin tumor (WT) represents the second etiology of benign parotid tumors. The aim of this work is to study the epidemiological, clinical, radiological and evolutive patterns of parotid Warthin tumor.Patients and methods : A retrospective study of 11 patients operated on for parotid gland WTfor over 10 years was conducted.Results: Mean age was 63 years. Sex ratio was. Smoking was not ted in 82 %. it was hears smoking (>30 pack years in 67 %).Parotid swelling was the only symptom present at diagnosis. The mean tumor diameter was 38 mm. On ultrasonography, the tumor was hypoechoic in 66.6% of cases. On MRi, the tumor was hypo-intense in T1, taking low contrast, and hyper-intense in T2 in two out of three cases. fine-needle aspiration (fNA) suspected malignancy in 3 cases, when it was performed. Treatment was surgical in all cases. The tumor was multifocal in 2 cases. No case of recurrence or malignant degeneration was noted after amean follow-up of 3 years.Conclusion: A strong correlation between the development of Warthin's tumor, smoking and male sex is reported. fNA and MRi contribute significantly to the diagnosis. Recurrence is low after superficial parotidectomy. Malignant degeneration is rareKeyswords : Warthin tumor, parotid, tobacco, parotidectom
Localisation rare du melanome muqueux
Purpose: Mucosal melanoma of the upper respiratory tract is rare. Nasopharyngeal involvement is extremely rare. The diagnosis and management of this tumour still remain difficult. We present a new case of mucosal nasopharyngeal melanoma, to discuss diagnosis and therapeutic modalities.Observation: A 15-year-old girl was referred to the department of otolaryngology because of bilateral cervical mass with bilateral nasal obstruction, right otalgia and chronic headache. Nasopharyngeal tumour was observed endoscopically. The histologic examination showed mucosal melanoma. No distant metastatic localisations were identified. The patientunderwent cervical lymph node dissection followed by 6 courses of chemotherapy, but she died 9 months later because of loco-regional failures.Conclusion: The primary malignant melanoma of nasopharyngeal is extremely rare disease particularly among child. Its histologic diagnosis is challenging. The treatment still remains controversial. The prognosis is poor because of anatomic localisation and high frequency of distant metastasis.Key words: Melanoma, nasopharynx, immuno-histochemistry
Many-core Branch-and-Bound for GPU accelerators and MIC coprocessors
International audienceCoprocessors are increasingly becoming key building blocks of High Performance Computing platforms. These many-core energy-efficient devices boost the performance of traditional processors. On the other hand, Branch-and-Bound (B&B) algorithms are tree-based exact methods for solving to optimality combinatorial optimization problems (COPs). Solving large COPs results in the generation of a very large pool of subproblems and the evaluation of their associated lower bounds. Generating and evaluating those subproblems on coprocessors raises several issues including processor-coprocessor data transfer optimization, vectorization, thread divergence, and so on. In this paper, we investigate the offload-based parallel design and implementation of B&B algorithms for coprocessors addressing these issues. Two major many-core architectures are considered and compared: Nvidia GPU and Intel MIC. The proposed approaches have been experimented using the Flow-Shop scheduling problem and two hardware configurations equivalent in terms of energy consumption: Nvidia Tesla K40 and Intel Xeon Phi 5110P. The reported results show that the GPU-accelerated approach outperforms the MIC offload-based one even in its vectorized version. Moreover, vectorization improves the efficiency of the MIC offload-based approach with a factor of two
- âŠ