33 research outputs found
Esthesioneuroblastome : dilemme diagnostic et challenge therapeutique
Introduction : LâesthĂ©sioneuroblastome est une tumeur maligne rare des fosses nasales. Il sâagit dâune tumeur agressive et rĂ©cidivante dont le traitement est controversĂ©. Notre objectif est de dĂ©crire les particularitĂ©s diagnostiques et les actualitĂ©s thĂ©rapeutiques de cette tumeur.MatĂ©riels et mĂ©thode : Etude rĂ©trospective sur une pĂ©riode de 10 ans (2001-2010), ayant intĂ©ressĂ© trois cas dâesthĂ©sioneuroblastome colligĂ©s dans notre service.RĂ©sultats : Il sâagit de 3 patients ĂągĂ©s respectivement de 23, 30, 85 ans. Les signes fonctionnels sont lâobstruction nasale, lâĂ©pistaxis et les cĂ©phalĂ©es. Lâendoscopie nasale a trouvĂ© un processus tumoral endonasal dans tous les cas. Des adĂ©nopathies cervicales ont étĂ© retrouvĂ©es dans un cas. Le scanner du massif facial et la biopsie tumorale, rĂ©alisĂ©s dans les trois cas, ont permis de classer la tumeur respectivement aux stades B, C, A, selon la classification de KADISH. Lâassociation chirurgie- radiothĂ©rapie a Ă©tĂ© prĂ©conisĂ©e dans deux cas et chimio-radiothĂ©rapie dans un cas. LâĂ©volution a Ă©tĂ© favorable dans 2 cas. Le troisiĂšme patient a Ă©tĂ© perdu de vue.Discussion : le diagnostic dâesthesioneuroblastome est souvent tardif. Lâimagerie est indispensable pour lâorientation de la stratĂ©gie thĂ©rapeutique. Lâassociation chirurgie radiothĂ©rapie constitue le traitement de rĂ©fĂ©rence. La chimiothĂ©rapie gagne de plus en plus dâintĂ©rĂȘt.Mots ClĂ©s: EsthĂ©sioneuroblastome; traitement; chirurgie; radiotherapie; chimiotherapie; pronosticIntroduction : Esthesioneuroblastoma is a rare malignant tumor of the nasal cavity. It is an aggressive tumor, associated with a high level of recurrence. Treatment is still controversial. The object of our report is to describe the clinical presentations and new therapeutic approaches of this tumor.Material and methods : We retrospectively reviewed three patients with nasosinusal esthesioneuroblastoma who were managed during a period of 10 years (2001- 2010).Results : the three patients were aged respectively of 23, 30 and 85 years. Functional signs were mainly nasal obstruction, epistaxis and headache. Nasal endoscopy found an endonasal tumor process in all cases. Cervical lymph nodes were noted in one case. The CT scann and the tumor biopsy were performed in all three cases. Esthesioneuroblastoma was classified, respectively in stage B, C and A, according to KADISH classification. The association surgery-radiotherapy has been advocated in both cases and chemo-radiotherapy in one case. The outcome was favorable in two cases. The third patient was lost to view.Discussion : The ENB is a rare neuroepithelial cancer of the nasal cavity. Its diagnosis is often delayed due to its nonspecific clinical presentation. Radiography is of a great contribution for the diagnosis and for guiding the therapeutic strategy. Surgery and radiotherapy are currently the recommended treatment modality. Chimiotherapy is a new therapeutic approach.Key Words : Esthesioneuroblastoma; treatement; surgery; radiotherapy; chimiotherapy prognosis
Minimally invasive total knee replacement : techniques and results
In this review, we outlined the definition of minimally invasive surgery (MIS) in total knee replacement (TKR) and described the different surgical approaches reported in the literature. Afterwards we went through the most recent studies assessing MIS TKR. Next, we searched for potential limitations of MIS knee replacement and tried to answer the following questions: Are there selective criteria and specific patient selection for MIS knee surgery? If there are, then what are they? After all, a discussion and conclusion completed this article. There is certainly room for MIS or at least less invasive surgery (LIS) for appropriate selected patients. Nonetheless, there are differences between approaches. Mini medial parapatellar is easy to master, quick to perform and potentially extendable, whereas mini subvastus and mini midvastus are trickier and require more caution related to risk of hematoma and VMO nerve damage. Current evidence on the safety and efficacy of mini-incision surgery for TKR does not appear fully adequate for the procedure to be used without special arrangements for consent and for audit or continuing research. There is an argument that a sudden jump from standard TKR to MIS TKR, especially without computer assistance such as navigation, patient specific instrumentation (PSI) or robotic, may breach a surgeon's duty of care toward patients because it exposes patients to unnecessary risks. As a final point, more evidence is required on the long-term safety and efficacy of this procedure which will give objective shed light on real benefits of MIS TKR