[Adenocarcinomas of the ethmoid sinus: retrospective analysis of prognostic factors]

OBJECTIVES

Determinate the different prognostic factors of survival in ethmoidal sinus adenocarcinomas (ADK).

MATERIAL AND METHODS

60 patients with ethmoidal sinus ADK. 59 men and one woman. Average of 62.2 years (41-82). Retrospective study between 1985 and 2005. The following data were analyzed: exposure time to wood dust, disease incidence, primary clinical symptoms and ASA score. Radiological data were recovered by tomodensitometry and magnetic resonance imaging. Histological groups were described. TNM classification according to UICC 2002 and Roux/Brasnu was established on clinical and radiological constatations. Different treatments used were analyzed. Estimate of survival rate and impact of different prognostic factors were based on Kaplan-Meier actuarial method and multivariate analysis.

RESULTS

Incidence rate was 2.86 patients a year. Exposure average time to wood dust was 25.6 years (2-44). T3/T4 stages were predominant (66.7%). the survival rate was 46.5% at 5 years. The survival rate was significantly superior respectively in T1 and T2 stages than in T3 and T4 stages, and in T4a than in T4b stages. Extension of the lesion to the sphenoid sinus was revealed as a significant bad prognostic factor. The ASA score and the exposure time to wood dust were not identified as statistically significant prognosis factors.

CONCLUSION

Survival factors of ethmoïd sinus ADK were T stage and the extension of the tumor to the sphenoid sinus. On the results of this study, we consider that extension in sphenoïd sinus could be include in TNM classification of ethmoïd sinus adenocarcinomas.

[Nasal leishmaniasis: a case report]

OBJECTIVE

To report a nasal leishmaniasis diagnosed by septal perforation biopsy.

MATERIAL AND METHODS

We report a case of septal perforation with crusty rhinosinusitis and nasal vestibulitis in a 54-year-old woman with cirrhosis.

RESULTS

Mucocartilaginous biopsy revealed a mucosal leishmaniasis. Biological and radiologic findings were normal. Clinical follow-up with anti-parasitical treatment showed a regression of the patient's muco-cutaneous lesion and regression of her hepatic insufficiency.

CONCLUSION

Biopsy of septal perforation is a useful diagnostic tool, advocated for differentiate infectious, neoplasic and inflammatory pathology. Leishmaniasis may be evoked in rhinologic pathology.

[Intrapetrous aneurysms of internal carotid artery: therapeutic considerations: two cases]

Two cases of internal carotid artery aneurysm arising within the petrous bone are described, bringing up to 56 the number of such cases reported to date in the medical literature scanned through Medline. The first case presented as a moderately bleeding tumor of the petrous apex, while the second was revealed by a massive otorrhage. In both cases a pulsatile nasopharyngeal mass was associated with otorrhage. The treatment required in both cases the aneurysm to be embolized in extreme emergency. One patient suffered transient hemiplegia and aphasia that completely recovered, while the second eventually died, although the carotid occlusion had been well tolerated in the first two weeks that followed this procedure. From their own experience and a literature review, we can emphasize the need for arterial extra-intracranial bypass before an aneurysm embolization be proposed, since the neurological issue following internal carotid occlusion cannot be predicted.

[Is there a correlation between optimism and quality of life in upper aerodigestive tract cancer Patients? Preliminary results]

The aim of this study was to test the hypothesis that optimism is a predictor of quality of life (QOL) in a sample of upper aerodigestive tract (UADT) cancer patients.

MATERIALS AND METHODS

Consenting patients with squamous cell carcinoma of the UADT were included during the week following disclosure of the diagnosis of their illness, and before the start of treatment. QOL and optimism were evaluated by questionnaires presented to the patients before the start of treatment, after the treatment, and 6 and 12 months after the end of the treatment.

PRELIMINARY RESULTS

92 patients were included. The average age was 58.7+/-11.4 years. Their QOL scores were significantly correlated, first with age (r =- 0.23, p =0.03) and second with degree of optimism (r =0.32, p =0.002). No correlation was found between QOL scores, degree of optimism, and sociodemographic and clinical data. Optimism was the sole variable significantly associated with QOL before treatment (F =4.1, p =0.002, r(2) =0.19). The difference between QOL scores before and after treatment was not significant.

CONCLUSION

Continuation of the study and analysis of survival of the patients may help pinpoint new prognostic factors, both objective and subjective, that will facilitate an overall approach to patient care by allowing for their preferences.

[Laryngo-tracheal involvement in chronic atrophic polychondritis. X-ray computed tomographic aspects]

CT patterns of a relapsing polychondritis affecting the laryngeal cartilages are reported in a 42-year-old man with a 10-year medical history of this disease, corresponding to an irregular enlargement of the cricoid, thyroid cartilages and tracheal rings, with a moderate endoluminal narrowing. CT is useful to differentiate this rare inflammatory disease from others causes of airway narrowing, and could help in certain cases of diagnosis of beginning polychondritis.

[Anatomo-radiologic diagnosis of mucoceles in the paranasal sinuses]

The diagnosis of mucoceles of the facial sinuses is essentially based on CT scans. The authors define here the main features of these benign tumours, the evolution of which is sometimes formidable.

Sequential combination of 5-fluorouracil, cis-platinum and irradiation. 1. Advanced head and neck cancers

Based on the synergistic action of 5-fluorouracil (5-FUra), cis-dichlorodiamminoplatinum(II) (cis-DDP) and gamma-rays, which was suggested in experiments on murine tumours, a sequential treatment combining irradiation and chemotherapy for human solid tumours known to be resistant to conventional treatments has been developed. A pilot study was carried out on 30 patients with recurring head and neck cancers previously treated by radiotherapy and surgery. The good tolerance and the initial results justified applying this protocol to previously untreated cases. The second study involved 40 patients with stage III and IV tumours. After 3 cycles of combined radio- and chemotherapy followed by a conventional radiotherapy, 78% were good responders (51% in complete remission). Oropharynx and oral cavity, without base of tongue, have a 51% actuarial survival at 3 years when they achieved an early complete remission.