Paragangliome nasopharynge avec extension a la base du crane: Une localisation inhabituelle des paragangliomes

Introduction : Le paragangliome est une rare tumeur neuroendocrine. La localisation nasopharyngée avec extension à la base du crâne est très rare.Présentation du cas : Il s‘agissait d‘une dame de 39 ans, prise en charge au service de neurochirurgie du CHU « Hôpital du Mali » pour un paragangliome nasopharyngé qui s‘étendait à la base du crâne. La patiente présentait une dyspnée d‘aggravation progressive associée à une épistaxis à répétition évoluant depuis 3 ans environ et une paralysie faciale périphérique gauche. Le scanner avait mis en évidence une masse volumineuse siégeant au niveau du nasopharynx obstruant partiellement les fosses nasales. La lésion était rehaussée après injection de produit de contraste. La patiente a eu une chirurgie d‘exérèse de la tumeur en 2 temps. L‘analyse anatomopathologique avec immunohistochimie a permis de confirmer le diagnostic de paragangliome. Une radiothérapie complémentaire a été réalisée sur le résidu tumoral. Les suites du traitement ont été satisfaisantes.Discussion : Les paragangliomes de la tête et du cou ne représentent que 0,6% des tumeurs de la tête et du cou et 3% de tous les  paragangliomes. Le traitement repose sur la chirurgie. La radiothérapie est indiquée si la chirurgie n‘assure pas une résection complète.Conclusion : Les paragangliomes sont une entité à prendre en compte dans les tumeurs nasopharyngées et de la base du crâne.   Englsih title: Nasopharyngeal paraganglioma with extension at the skull base: An unusual location of the paragangliomas Introduction: Paraganglioma is a rare neuroendocrine tumor. Nasopharyngeal localization with extension at the skull base is very rare.Case: A thirty-nine-year-old woman, was managed by the Neurosurgery Department of « Hôpital du Mali » for a nasopharyngeal paraganglioma that extended to the skull base. The patient had progressive dyspnea associated with repeated epistaxis for 3 years and left peripheral facial palsy. The CT scan showed a bulky mass sitting in the nasopharynx partially obstructing the nasal cavity. The lesion was enhanced after injection of contrast. The patient had surgery to remove the tumor in 2 steps. Histological analysis with  immunohistochemistry confirmed the diagnosis. Complementary radiotherapy was performed on the tumor residue. The results of the treatment were satisfactory.Discussion: Head and neck paragangliomas represent only 0.6% of head and neck tumors and 3% of all paragangliomas. The treatment is based on surgery. Radiotherapy is indicated if the surgery does not provide complete resection.Conclusion: Paragangliomas are an entity to be considered in nasopharyngeal and skull base tumors

Cleft palate caused by congenital teratoma

International audienceA cleft palate results from incomplete fusion of the lateral palatine processes, the median nasal septum and the median palatine process. This case report describes a rare case of congenital teratoma originating from the nasal septum that may have interfered with the fusion of the palatal shelves during embryonic development, resulting in a cleft palate. An infant girl was born at 40 weeks of gestation weighing 3020 g with a complete cleft palate associated with a large central nasopharyngeal tumour. Computed tomography (CT) of the head showed a well defined mass of mixed density. The tumour was attached to the nasal septum in direct contact with the cleft palate. A biopsy confirmed the teratoma. Tumour resection was performed at 5 months, soft palate reconstruction at 7 months and hard palate closure at 14 months. There was no sign of local recurrence 1 year later. Most teratomas are benign and the prognosis is usually good. However, recurrence is not rare if germ cell carcinomatous foci are present within the teratoma. For these reasons, we advocate the use of a two-stage procedure in which closure of the cleft palate is postponed until histological examination confirms complete excision of the teratoma

Management of Large Maxillomandibular Osteofibrous Dysplasia as Part of a Humanitarian Mission

International audienc

The contribution of telemedicine to humanitarian surgery

International audienc

Avenir du fleuve Niger

Le fleuve Niger constitue un véritable poumon humide pour l’Afrique de l’Ouest et plus spécialement pour la république du Mali. Dans ce pays, la gestion du fleuve constitue un enjeu majeur car on y trouve à la fois de remarquables systèmes de production traditionnels associés au phénomène naturel de crue – sources de moyens d’existence pour des centaines de milliers de personnes – mais aussi de grandes réalisations et promesses en matière d’aménagements modernes, hydroélectriques et hydroagricoles. À l’heure où de nouveaux projets d’équipement arrivent à concrétisation et où d’autres sont annoncés, il est important de faire le point sur l’état de santé de ce fleuve et de peser ce qu’il représente pour ses multiples usagers. Cette expertise collégiale, conduite par l’IRD et l’IER et réalisée avec le soutien de plusieurs institutions d’aide au développement et de défense de l’environnement, traite de ces différents aspects avec pour objectif, d’une part, la clarification des cadres institutionnels et des options de politiques publiques et, d’autre part, le renforcement des outils de suivi et d’aide à la décision.The Niger river is truly the main source of life for Western Africa, more specifically for the Republic of Mali. In the country, management of the river is a key topic, as one can find at the same time remarkable traditional production systems associated with the floods which supply hundreds thousands of people – but also great projects which promise modern installations, hydroelectrical and hydroagricultural systems. As new projects come to their end and others begin, it seems important to make a point regarding the health of the river and to evaluate what it represents for its diverse users, civil society or for the economy of Mali. This is the aim of this expert group review, led by the IRD and the IER, with the support of different development and nature protection institutes. Complementarities as well as oppositions that appear from the interactions between the river’s users are described. For the decision-makers in charge of those problems, different recommendations are made, aiming on one hand to clarify institutional frameworks and policy options, and on the other hand to reinforce management and decision-making tools

Characteristics of HIV-2 and HIV-1/HIV-2 Dually Seropositive Adults in West Africa Presenting for Care and Antiretroviral Therapy: The IeDEA-West Africa HIV-2 Cohort Study.

HIV-2 is endemic in West Africa. There is a lack of evidence-based guidelines on the diagnosis, management and antiretroviral therapy (ART) for HIV-2 or HIV-1/HIV-2 dual infections. Because of these issues, we designed a West African collaborative cohort for HIV-2 infection within the framework of the International epidemiological Databases to Evaluate AIDS (IeDEA).We collected data on all HIV-2 and HIV-1/HIV-2 dually seropositive patients (both ARV-naive and starting ART) and followed-up in clinical centres in the IeDEA-WA network including a total of 13 clinics in five countries: Benin, Burkina-Faso Côte d'Ivoire, Mali, and Senegal, in the West Africa region.Data was merged for 1,754 patients (56% female), including 1,021 HIV-2 infected patients (551 on ART) and 733 dually seropositive for both HIV-1 and HIV 2 (463 on ART). At ART initiation, the median age of HIV-2 patients was 45.3 years, IQR: (38.3-51.7) and 42.4 years, IQR (37.0-47.3) for dually seropositive patients (p = 0.048). Overall, 16.7% of HIV-2 patients on ART had an advanced clinical stage (WHO IV or CDC-C). The median CD4 count at the ART initiation is 166 cells/mm(3), IQR (83-247) among HIV-2 infected patients and 146 cells/mm(3), IQR (55-249) among dually seropositive patients. Overall, in ART-treated patients, the CD4 count increased 126 cells/mm(3) after 24 months on ART for HIV-2 patients and 169 cells/mm(3) for dually seropositive patients. Of 551 HIV-2 patients on ART, 5.8% died and 10.2% were lost to follow-up during the median time on ART of 2.4 years, IQR (0.7-4.3).This large multi-country study of HIV-2 and HIV-1/HIV-2 dual infection in West Africa suggests that routine clinical care is less than optimal and that management and treatment of HIV-2 could be further informed by ongoing studies and randomized clinical trials in this population