Le mal de pott sous occipital révélé par un abcès rétro pharyngien a propos d’un cas

Introduction : Pott's disease is the most frequent localisation of osteo-articular tuberculosis. The suboccipital localisation remains rare. Case report : A 12-years old boy, admitted for cervicalgy and dysphagia. His clinical exam revealed a swelling of posterior pharyngeal wall associated with a basicervical tumefaction fistulased to the skin. Cervical spine MRI and cervico-thoracic tomodensitometry show a retro-pharyngeal collection associated with necrosed mediastinal adenopathies and apical pulmonar retractile lesion. The patient underwent, in emergency, an incision of the retro-pharyngeal abscess. The biological assessment revealed an inflommatory syndrom. A tuberculine intra dermo-reaction was negative whereas the BK research were positive. The diagnosis of suboccipital Pott's disease associated with pulmonar tuberculosis was done. The anti-tuberculosis drug was mentained for 11 months with a good recovery. The follow-up was 6 years. Discussion : The sub occipital pain Pott localisation was rare. The cervicalgy was the important clinical sign of consultation. Whearas, the dysphagia and retro-pharyngeal abscess could be revealing. The MRI was necessary for an early diagnosis. The diagnosis confirmation was made by the presence of Mycobacterium Koch in the pottic lesion. The treatment was based on the anti-tuberculosis drugs for a period of 11 months completed with an orthopedic or surgical stabilisation of cervical occipital jonction.Keywords : Pott’s disease, tuberculosis, cervical spine, MRI, Mycobacterium Koch

Complications orbitaires de la polypose nasosinusienne de l’enfant

La polypose nasosinusienne (PNS) est une pathologie rare chez l’enfant. La symptomatologie clinique est habituellement celle de l’adulte. Exceptionnellement, une complication locorégionale lui est révélatrice. A travers deux observations de PNS diagnostiquées suite à une complication orbitaire, on discute les particularités cliniques de cette entité ainsi que ses implications thérapeutiques. Il s’agissait de deux enfants âgés de 13 ans ayant été hospitalisés pour une exophtalmie unilatérale d’apparition aiguë. L’examen clinique a découvert une PNS surinfectée évoquant alors le diagnostic de complication orbitaire d’origine infectieuse, confirmé par l’imagerie. Le traitement a associé un drainage chirurgical d’urgence de l’abcès orbitaire par voie externe paracanthale interne, suivi par une corticothérapie locale. L’ethmoïdectomie a été nécessaire dans un cas. L’évolution était favorable dans les deux cas avec une stabilisation de la PNS et une absence de signes de récidive de l’infection orbitaire

Les Surdites Brusques Idiopathiques Facteurs Pronostiques

Introduction : Les surdités brusques idiopathiques (SBI) constituent l\'un des sujets les plus débattus en otologie. Plusieurs problèmes d\'ordre physiopathologiques, thérapeutiques et pronostiques restent non résolus. But : Identifier les facteurs pronostiques, cliniques et audiométriques de récupération auditive après traitement d\'une SBI. Malades : Etude rétrospective portée sur 27 malades (29 cas de SBI) traités dans le service d\'ORL et chirurgie cervicofaciale du CHU Habib Bourguiba Sfax durant la période comprise entre les années 1990 et 2005. Méthodes : C\'est une étude statistique recherchant une corrélation significative entre certains facteurs cliniques et audiométriques et la récupération auditive. Les facteurs étudiés étaient : l\'âge, l\'aspect de la courbe audiométrique, la perte auditive initiale et le délai de prise en charge thérapeutique. Résultats : L\'âge inférieur à 50 ans, la courbe ascendante et la perte auditive inférieure à 70 dB étaient les facteurs de meilleur pronostic. Le délai de prise en charge thérapeutique semble avoir peu de rôle dans la récupération auditive. Discussion : La majorité des auteurs ont signalé que l\'âge jeune, les surdités légères ou moyennes, la courbe ascendante et la précocité de la prise en charge sont associés à un meilleur pronostic. Nos résultats rejoignent ceux de Tran Ba Huy qui ne trouve pas de corrélation entre le délai de prise en charge thérapeutique et le pronostic de récupération auditive.Introduction : Idiopathic Sudden Sensorineural Hearing Loss (ISSHL) remains one of the major otologic debates. Many etiopathogenic, therapeutic and prognostic problems are still unsolved. Purpose : Identify some clinical and audiometric factors influencing the recovery prognostic after treatment of ISSHL. Patients : Retrospective study of 27 patients (29 cases of ISSHL) treated in the department of Oto-Rhino-Laryngology and Head and Neck Surgery of Habib Bourguiba Hospital during the period from 1990 to 2005. Method: We underwent a statistical data to search a significant correlation between some clinical, audiometric factors and hearing recovery. The factors studied are: age of patient, the type of the tonal audiogram shape, the degree of the initial hearing loss and the therapeutic delay. Results: The age under 50 years, the ascending audiogram shape and initial hearing loss under 70dB involve a better prognostic. The therapeutic delay seems have a little role in the hearing recovery. Discussion: The majority of authors concluded that the young age, the mild and moderate hearing loss, the ascending audiogram shape and the precocity of treatment are correlated to a better prognostic. We, as Tran Ba Huy, don\'t find a significant correlation between the therapeutic delay and the quality of hearing recovery. Journal Tunisien d\'ORL et de chirurgie cervico-faciale Vol. 18 2007: pp. 7-1

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

Kyste Dermoïde Du Plancher Buccal

Le kyste dermoïde du plancher buccal est une entité rare. Il touche essentiellement le sujet jeune. Nous rapportons l\'observation d\'un nourrisson âgé de 9 mois qui a été amené par ses parents pour fistule sous mentale sans aucune gêne fonctionnelle associée. L\'examen clinique a révélé une voussure du plancher buccal antérieur. L\'IRM a montré une lésion kystique du plancher buccal en hyposignal T1 et hypersignal T2. L\'enfant a été opéré par voie endobuccale. Les suites opératoires étaient simples. L\'examen anatomopathologique a conclu à un kyste dermoïde. Nous discutons, dans ce travail, les caractéristiques cliniques, radiologiques et les volets thérapeutiques de cette entité. Keywords: kyste dermoïde, plancher buccal. Journal Tunisien d\'ORL et de chirurgie cervico-faciale Vol. 18 2007: pp. 58-6

Straight-Line and Change of Direction Intermittent Running in Professional Soccer Players

PURPOSE: The present study aimed to investigate the difference between straight-line (STL) and change of direction (COD) intermittent running exercises in soccer players. METHODS: Seventeen male professional soccer players performed the agility T-test and 6 intermittent running exercises: 10s at 130% of maximal aerobic speed (MAS) alternated with 10s of rest (10-10), 15s at 120% of MAS alternated with 15s of rest (15-15) and 30s at 110% of MAS alternated with 30s of rest (30-30) both in STL and with COD. All exercises were monitored using a global positioning system. Heart rate was measured during exercises and the rate of perceived exertion (RPE) was collected post-exercise. Delta (Δ) between covered distance in STL and COD exercises at a similar load was calculated and relationships between T-test and Δ distance were analysed. RESULTS: COD intermittent exercises showed a significantly decreased distance covered and an increased number of accelerations, heart rate peak and RPE value compared to STL intermittent exercises at a similar load. High relationships were observed between T-test performance and Δ distance in 10-10 (r = 0.72, P < 0.01) and 15-15 (r = 0.77, P < 0.01) whereas no significant relationships were observed between T-test performance and Δ distance in 30-30 (r = -0.37, P = 0.2). CONCLUSION: Intermittent COD exercises were associated with higher acceleration, heart rate peak and RPE compared to STL during 10-10 and 15-15 exercises. The ability to rapidly change direction is a crucial quality to perform intense sport-specific running in professional soccer players

Genetic variability of the P120' surface protein gene of Mycoplasma hominis isolates recovered from Tunisian patients with uro-genital and infertility disorders

<p>Abstract</p> <p>Background</p> <p>Among the surface antigens of <it>Mycoplasma hominis</it>, the P120' protein was previously shown to elicit a subtle antibody response and appears to be relatively conserved. To get better insight into the evolution of this protein, we analysed the genetic variability of its surface exposed region in 27 <it>M. hominis </it>isolates recovered from the genital tract of Tunisian patients with infertility disorders.</p> <p>Methods</p> <p>All specimens were processed for culture and PCR amplification of the N-terminal surface exposed region of p120' gene. PCR products were sequenced to evaluate the genetic variability, to test for adaptive selection, and to infer the phylogenetic relationship of the <it>M. hominis </it>isolates.</p> <p>Results</p> <p>Sequence analysis showed a total of 25 single nucleotide polymorphisms distributed through 23 polymorphic sites, yielding 13 haplotypes. All but one mutation were confined within three distinct regions. Analysis of the amino acid-based phylogenetic tree showed a predominant group of 17 closely related isolates while the remaining appear to have significantly diverged.</p> <p>Conclusion</p> <p>By analysing a larger sample of <it>M. hominis </it>recovered from patients with urogenital infections, we show here that the P120' protein undergoes substantial level of genetic variability at its surface exposed region.</p