Onychomycoses : de la clinique au traitement

L'onychomycose est une pathologie très fréquente dont le traitement est particulièrement long et contraignant. Les agents pathogènes sont principalement les dermatophytes et parfois les moisissures non dermatophytiques ainsi que les levures. La présentation clinique classique comporte une modification blanc jaunâtre de l'ongle. Le diagnostic différentiel avec les onychodystrophies non mycotiques n'est pas toujours aisé. L'infection fongique peut être confirmée par un examen direct (test à la potasse caustique, KOH) ou histologique (coloration au PAS) d'un prélèvement unguéal. La mise en culture permet ensuite l'identification du pathogène responsable. Plusieurs options thérapeutiques sont possibles en fonction de l'importance et du type d'onychomycose : antimycosiques topiques et/ou systémiques couplés ou non à l'avulsion chimique ou chirurgicale. De nouveaux traitements par laser, thérapie photodynaique ou iontophorèse complèteront probablement l'arsenal thérapeutique dans le futu

Carotid blowout syndrome in patients with nasopharyngeal carcinoma: three cases

Carotid blowout syndrome (CBS) is a rare complication of radiation therapy for nasopharyngeal carcinoma (NPC), for which angiography is the gold standard for diagnosis and treatment. We report three NPC cases treated with irradiation and complicated by bleeding from the internal carotid artery. The first case presented with multiple episodes of limited nosebleeding followed by massive bleeding. Bleeding was initially stopped by internal carotid artery embolisation. A few months later, meningitis related to skull base osteoradionecrosis occurred and the patient died from sceptic shock. The second case was admitted to the hospital with severe repetitive epistaxis and despite several attempts to manage the bleeding, the patient passed away. The third case presented with a massive epistaxis that resolved itself without any treatment. Spontaneous occlusion of the internal carotid artery occurred without any neurological defects. A nasopharyngeal muscle flap was constructed to prevent meningitis. CBS is a rare but life-threatening complication that requires emergency treatment. Re-irradiation and skull base radioosteonecrosis are strong predisposing factors

Post-irradiated Carotid Blowout Syndrome in patients with Nasopharyngeal Tumor: about 3 cases

Introduction Rupture of the internal carotid artery (Carotid blowout syndrome) is a rare complication of irradiated nasopharyngeal tumor. We report three cases nasopharyngeal tumors treated with radiotherapy complicated with bleeding of the internal carotid artery presenting as a massive epistaxis. Case Series The first case presented a few episodes of small nose bleeding before a massive one. Internal carotid embolisation was performed to stop the bleeding. Unfortunately, few month later, he presented a meningitis related to skull base osteoradionecrosis and died from sceptic shock. The second case was transferred to our hospital with severe repetitive epistaxis that had been occurring for hours. No endovascular treatment was possible in his case and he died in intensive care unitthe dayof his admission. The thrid case presented one massive epistaxis which stopped without any treatment or compression. A spontaneous occlusion of his internal carotid artery occured without any neurological defects. He recently benefited from a nasopharyngeal muscle flap for the coverage of the carotid artery. These three patients all presented with a history of nasopharyngeal tumor handled by radiotherapy. Pathogenesis, treatment, and outcome are discussed on the light of a comprehensive literature review. Conclusions Carotid blowout syndrome secondary to radiation therapy is rare but life-threatening. Re-irradiation and skull base osteoradionecrosis are strong predisposing factors

Olfactory Fluctuation Revisited

Many patients complain about olfactory fluctuation (OF), which is a symptom commonly attributed to sinonasal disease. Data-based evidence for its association with sinonasal disease is scarce. The aim of the study is to identify explanatory variables associated with OF and to analyze its predictive value regarding sinonasal disease