Pseudoaneurisma di origine traumatica localizzato in un seno sfenoidale fratturato

Descriviamo il caso di un pseudoaneurisma di origine traumatica dell’arteria carotide interna destra localizzato all’interno di un seno sfenoidale fratturato che si è sviluppato in un paziente che aveva riportato delle fratture dell’osso frontale e della base cranica che coinvolgevano le pareti del seno sfenoidale e il canale della carotide malgrado l’angio-TC precoce fosse negativa. Il paziente ha presentato due episodi di epistassi ritardata massiva potenzialmente letale prima di essere trattato con successo con tecniche endovascolari utilizzanti spirali metalliche e uno stent non ricoperto. Questo caso sottolinea il fatto che i pazienti con trauma cranico che presentano fratture nel seno sfenoidale con o senza epistassi massiva dovrebbero essere studiati il più presto possibile alla ricerca dello sviluppo di uno pseudoaneurisma postraumatico della carotide interna. Se la prima angio-TC è negativa, un’epistassi ricorrente dovrebbe condurre alla realizzazione di una seconda angio-TC poiché lo pseudoaneurisma richiede tempo per svilupparsi. Un trattamento endovascolare precoce con uno stent non ricoperto può impedire il decesso del paziente

Supracricoid partial laryngectomy in the management of t3 laryngeal cancer

Objective. To evaluate the oncologic results only in T3 glottic and supraglottic cancers regarding supracricoid partial laryngectomy (SCPL) not requiring total laryngectomy and to assess functional results by self-evaluation by the patient. Study Design. Case series with medical record review. Setting. Single tertiary care center. Subjects and Methods. Thirty-two patients with laryngeal squamous cell carcinoma, previously untreated, who underwent SCPL with cricohyoidopexy or cricohyoidoepiglottopexy were reviewed. Results. At 1, 3, and 5 years, the disease-free survival rates were 96.9%, 89.4%, and 78.2%; overall survival rates were 96.9%, 93.2%, and 87.3%; local control and locoregional control rates were 100%, 96.2%, and 96.2%; and distant metastasis-free survival rates were 100%, 100%, and 88.2%, respectively. Aspiration pneumonia was the most common complication observed. The 3 laryngeal functions (speech, swallowing, and breathing) were spared in 83.9% of patients. Conclusion. Supracricoid partial laryngectomy for selected glottic and supraglottic T3 tumors has excellent oncologic and functional results

Tracheal rhinoscleroma

International audienceINTRODUCTION:Tracheal rhinoscleroma is an infectious granulomatosis of the tracheobronchial tract caused by a Gram-negative bacillus. Exclusively tracheal involvement has been rarely reported in the literature. The purpose of this study was to report a case of subglottic stenosis secondary to rhinoscleroma.SUMMARY:A 46-year-old North African woman with no medical or surgical history presented with inspiratory dyspnoea that had been present for several years. Endoscopic examination under general anaesthesia revealed tracheal stenosis. Histological examination of mucosal biopsies demonstrated Mikulicz cells and culture of bacteriological samples taken during a second biopsy confirmed the diagnosis of rhinoscleroma. CO2 laser subglottic obstruction relief was performed and treatment with ofloxacin was initiated. No recurrence of tracheal stenosis was observed with a follow-up of 6 months.DISCUSSION:The diagnosis of rhinoscleroma is based on histological and bacteriological examination. Cultures are positive in 60% of cases, but negative cultures do not exclude the diagnosis of rhinoscleroma. Specific treatment consists of long-term antibiotic therapy, while surgery may be indicated for symptomatic treatment

Traumatic intra-sphenoidal pseudoaneurysm lodged inside the fractured sphenoidal sinus.

International audienceWe describe a case of traumatic intra-sphenoidal right internal carotid artery pseudoaneurysm lodged inside the fractured sphenoidal sinus that developed in a patient with a previous history of frontal and skull base fractures involving the sphenoid sinus and walls of the carotid canal, but with normal intracranial findings at early CT angiography. The patient presented two episodes of massive life-threatening delayed epistaxis before successful endovascular treatment combining the use of coils and an uncovered stent was instituted. This case report highlights that patients with head trauma who present sphenoid sinus fractures with or without massive epistaxis should be evaluated for the development of traumatic internal carotid artery pseudoaneurysm as soon as possible. If the first angiographic evaluation reveals normal findings, repeated epistaxis should prompt a second angiographic evaluation because psudoaneurysm takes time to develop. Early treatment with uncovered stent of the aneurysm can be a life-saving therapeutic approach

Interest of video-assisted minimally invasive surgery in primary hyperparathyroidism

International audienceINTRODUCTION:Surgery is the only radical and definitive treatment for primary hyperparathyroidism. Exploration of the four parathyroid sites is giving way to minimally invasive techniques. The present study sought to compare two minimally invasive parathyroidectomy techniques, by classical cervicotomy (MIP-C) and by video-assistance (MIP-VA), in terms of success rate, complications rate, operating time, and patient and community physician satisfaction.MATERIALS AND METHOD:A non-randomized retrospective comparative study included 112 patients presenting with primary hyperparathyroidism with identified parathyroid adenoma, operated on between January 2005 and October 2010. The two groups were constituted according to the surgeons' habitual practice: 54 cases of MIP-VA and 58 of MIP-C.RESULTS:Results for MIP-VA and MIP-C were respectively: success, 96.3% vs. 100% (P=0.09); mean scar size, 1.47 vs. 3.43cm (P<0.01); hypocalcemia, 2 vs. 3 cases (P=0.1); theater time, 94.25 vs. 76min (P=0.02); and postoperative stay, 1.08 vs. 1.37 days (P=0.07). Patient satisfaction was comparable between groups, while 93.3% of community physicians found MIP-VA preferable to MIP-C, although only 39.3% had known the MIP-VA technique.CONCLUSION:With efficacy, morbidity and patient satisfaction comparable to classical surgery, MIP-VA significantly reduced cervicotomy size and hospital stay. Community physicians considered it to be preferable to MIP-C