Kyste thymique cervical

Objectifs : Le kyste thymique est une tumeur congénitale rare. Souvent asymptomatique, elle atteint généralement les enfants âgés de moins de 10 ans. Siégeant au niveau du cou, cette tumeur pose essentiellement le problème de diagnostic différentiel clinique. Son traitement est chirurgical avec un excellent pronostic et un très faible risque de récidive locale. Nous rapportons un cas de kyste thymique cervical et nous rappelons la pathogénie et les diagnostics différentiels.Mots clés : kyste thymique, cou, histologiePurpose of study: The thymic cyst is a rare congenital tumor. Usually asymptomatic, this tumor is generally seen in childhood under the age of ten. In the neck, the preoperative diagnosis of this tumor is difficult and is rarely made. The treatment of choice is surgical excision. The long-term prognosis is excellent with a low rate of local recurrence. We report a new case of cervical thymic cyst and review the pathogenesis and the differential diagnosis.Keywords: Thymic cyst, neck, histology

Metastase cervicale d’un adenome pleomorphe

Introduction : L’adénome pléomorphe est la tumeur la plus fréquente des glandes salivaires. Malgré son caractère bénin, de rares cas de métastases à distance ont été rapportés, touchant plus fréquemment l’os, les poumons et les ganglions lymphatiques. La localisation sous-cutanée, que nous rapportons dans ce travail, est exceptionnelle.Observation : Il s’agit d’une patiente de 41 ans, qui a eu une parotidectomie exofaciale gauche, par voie de lifting, pour un adénome pléomorphe, et qui a consulté, neuf ans plus tard, pour un nodule sous-cutané cervical moyen gauche. Une exérèse sous anesthésie locale a été réalisée. L’examen histologique de la pièce d’exérèse a conclu à une localisation secondaire d’un adénome pléomorphe. Aucune récidive locale ni à distance n’a été détectée, après trois ans de recul.Conclusion : L’adénome pléomorphe métastasant (APM), décrit depuis 1953, est rare. Aucune particularité clinique ni histologique ne permet de distinguer les formes métastatiques des formes classiques non métastatiques. Le mécanisme exact des métastases reste incertain mais semble être lié à une dissémination intra-vasculaire de cellules tumorales, lors de la manipulation chirurgicale de la tumeur primitive ou des récidives. Si la métastase est accessible, le pronostic est excellent après une exérèse complète.Mots-clés : adénome pléomorphe, métastase, peau, couIntroduction : Pleomorphic adenoma is the most common salivary tumor. Although clinically and histologically known as a benign tumor, there are rare reports of metastasis to distant sites, most commonly in bone, lungs, and lymph nodes. The subcutaneous site,reported in this case, is exceptional.Case-report : A 41 year-old patient, with history of left exofacial parotidectomy with a lifting incision, consulted after nine years for a left cervical subcutaneous nodule. An excision was performed under local anesthesia. The histological exam concluded in a secondary localization of pleomorphic adenoma. No local or distant recurrence was detected after three years.Conclusion : Metastasic pleomorphic adenoma, described since 1953, is uncommon. There are no known clinical or histological features that distinguish metastatic from non metastatic forms. The metastasis mechanism is uncertain, but seems to be related to vascular dissemination of tumoral cells, while surgical manipulation of the primary tumor or the recurrences. If metastasis is accessible, the prognosis is excellent after a complete excision.Keywords : pleomorphic adenoma, metastasis, skin, neck

Une etiologie rare d’une ulceration palatine : la sialometaplasie necrosante

La sialométaplasie nécrosante (SN) est une affection salivaire bénigne et rare, touchant principalement les glandes salivaires palatines et présentant des ressemblances cliniques et histologiques avec les carcinomes orales. Nous rapportons un cas de SN chez une patiente de 73 ans, non tarée, édentée, qui rapporte la notion de prothèse ancienne mal adaptée et qui présente une lésion ulcéro-végétante, bien limitée, douloureuse, palatine gauche, évoluant depuis 3 mois. Le scanner du massif facial a montré un épaississement des parties molles palatines avec un aspect aminci et irrégulier de l’os en regard. Une pathologie maligne à type de carcinome muco-épidermoide a été évoquée. Une exérèse radicale de la lésion a été réalisée et l’examen histologique a conclu à une SN.Mots clés : Sialométaplasie nécrosante; orale; palais; histologieNecrotizing sialometaplasia (NS) is a relatively uncommon benign disease of the salivary glands that most commonly occurs in the palate. It is often confused clinically and histopathologically with malignancies, such as squamous cell carcinoma or mucoepidermoid carcinoma. We report a case of NS in an edentate 73-year-old woman, with no medical history, showed up with a painful, well limited ulcerative lesion on the left palate, reporting its appearance three months ago. Reported also that she had a badly adapted removable denture. CT scan showed a thickening of the palate’s soft tissues with bone irregularity and thinning. A mucoepidermoid carcinoma was suspected. The patient underwent a radical excision of the lesion and histopathological diagnosis of NS was made.Keywords: Necrotizing sialometaplasia; oral; palate; histolog

Kyste Amygdaloïde Oropharynge A Propos D\'un Cas

Le kyste amygdaloïde est une tumeur kystique latéro-cervicale haute rare, issue de la 2ème fente branchiale. Il représente 2% des tumeurs latéro-cervicales du cou, et 6,1à 85,2% des anomalies de la deuxième fente. La forme oropharyngée est très rare. Nous rapportons une observation d\'un kyste amygdaloïde oropharyngé, chez une femme de 56 ans. Aucune symptomatologie particulière n\'a été notée. L\'examen clinique a révélé une tuméfaction de la loge amygdalienne droite, refoulant le pilier antérieur. La TDM a objectivé un processus expansif nécrosé de l\'amygdale palatine droite comblant l\'espace parapharyngé droit, en contact avec la base de la langue et le muscle ptérygoïdien médial homolatéral. Une résection complète et sans rupture du kyste a été pratiquée par voie transorale, le geste a été complété par une amygdalectomie droite. L\'histologie a confirmé le diagnostic par la co-existence d\'un revêtement épithélial et d\'une infiltration de tissu lymphoïde. Le recul est de 6 mois sans récidiveSecond branchial cleft cysts are the most common type of branchial abnormalities and usually found high in the neck. Oropharyngeal presence of branchial cleft cyst is very rare. We report a case of oropharyngeal branchial cleft cyst in 56 years women, wich had any specific symptom. Radiologic examination (TDM) revealed an expansive mass of the palatin tonsil. It was removed completely with right palatin tonsil. Cyst had a squamous epithelium-lined wall with lymphoid aggregation in histopathologic study, which was chareacteristic finding of branchial cleft cyst. There was no evidence of recurrence for 6 months for follow-up. We review reported oropharyngeal or nasopharyngeal presentation of these cases in literature and embryologic explanation. Keywords: Oropharyngeal, branchial, cysts Journal Tunisien d\'ORL et de chirurgie cervico-faciale Vol. 18 2007: pp. 49-5

Incorporating risk in field services operational planning process

© Springer Nature Switzerland AG 2018. This paper presents a model for the risk minimisation objective in the Stochastic Vehicle Routing Problem (SVRP). In the studied variant of SVRP, service times and travel times are subject to stochastic events, and a time window is constraining the start time for service task. Required skill levels and task priorities increase the complexity of this problem. Most previous research uses a chance-constrained approach to the problem and their objectives are related to traditional routing costs whilst a different approach was taken in this paper. The risk of missing a task is defined as the probability that the technician assigned to the task arrives at the customer site later than the time window. The problem studied in this paper is to generate a schedule that minimises the maximum of risks and sum of risks over all the tasks considering the effect of skill levels and task priorities. The stochastic duration of each task is supposed to follow a known normal distribution. However, the distribution of the start time of the service at a customer site will not be normally distributed due to time window constraints. A method is proposed and tested to approximate the start time distribution as normal. Moreover, a linear model can be obtained assuming identical variance of task durations. Additionally Simulated Annealing method was applied to solve the problem. Results of this work have been applied to an industrial case of SVRP where field engineering individuals drive to customer sites to provide time-constrained services. This original approach gives a robust schedule and allows organisations to pay more attention to increasing customer satisfaction and become more competitive in the market

Environmental sensing and response genes in cnidaria : the chemical defensome in the sea anemone Nematostella vectensis

Author Posting. © The Author(s), 2008. This is the author's version of the work. It is posted here by permission of Springer for personal use, not for redistribution. The definitive version was published in Cell Biology and Toxicology 24 (2008): 483-502, doi:10.1007/s10565-008-9107-5.The starlet sea anemone Nematostella vectensis has been recently established as a new model system for the study of the evolution of developmental processes, as cnidaria occupy a key evolutionary position at the base of the bilateria. Cnidaria play important roles in estuarine and reef communities, but are exposed to many environmental stressors. Here I describe the genetic components of a ‘chemical defensome’ in the genome of N. vectensis, and review cnidarian molecular toxicology. Gene families that defend against chemical stressors and the transcription factors that regulate these genes have been termed a ‘chemical defensome,’ and include the cytochromes P450 and other oxidases, various conjugating enyzymes, the ATP-dependent efflux transporters, oxidative detoxification proteins, as well as various transcription factors. These genes account for about 1% (266/27200) of the predicted genes in the sea anemone genome, similar to the proportion observed in tunicates and humans, but lower than that observed in sea urchins. While there are comparable numbers of stress-response genes, the stress sensor genes appear to be reduced in N. vectensis relative to many model protostomes and deuterostomes. Cnidarian toxicology is understudied, especially given the important ecological roles of many cnidarian species. New genomic resources should stimulate the study of chemical stress sensing and response mechanisms in cnidaria, and allow us to further illuminate the evolution of chemical defense gene networks.WHOI Ocean Life Institute and NIH R01-ES01591

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised