Hypocalcémie post-thyroïdectomie

Introduction : L’hypocalcémie est la complication la plus préoccupante de la thyroïdectomie totale. Elle impose un traitement substitutif et un suivi à vie. Objectifs : Le but de cette étude est d’évaluer l’incidence de l’hypocalcémie après chirurgie et d’étudier sa corrélation avec les caractéristiques cliniques, biologiques et le type de chirurgie pratiqué. Matériels et méthodes : Etude rétrospective portant sur 488 cas de thyroïdectomies, opérées entre 1992 et 1996. L’hypocalcémie est définie par une calcémie inférieure à 80 mg/l «2 mmol/l ». Les patients, toujours dépendants d’un traitement substitutif un an après la chirurgie, ont été considérés comme ayant une hypocalcémie définitive. Résultats : Dans notre étude, 368 patients ont eu une thyroïdectomie totale et 120 ont eu une thyroïdectomie subtotale. Le goitre multinodulaire était la pathologie la plus fréquente, noté dans 359 cas, suivie des cancers thyroïdiens noté dans 83 cas. L’hypocalcémie postopératoire a été retrouvée chez 54 patients (11,06%) dont 25 étaient asymptomatique. Cette hypocalcémie s’est révélée définitive chez 14 d’entre eux (2,8%). Nous n’avons pas trouvé de corrélation statistiquement significative entre l’hypoparathyroïdie définitive et les caractéristiques cliniques biologiques et le type de chirurgie.Conclusion : Dans la plupart des cas, l’hypocalcémie est liée à un hypoparathyroïdisme transitoire, secondaire au traumatisme ou à la dévascularisation des parathyroïdes. L’hypoparathyroïdie définitive est rare, elle est toujours secondaire à une lésion irréversible des parathyroïdes. Les caractéristiques cliniques initiales des patients et les examens biologiques précoces ne permettent pas de prédire l’évolution.Mots-clés : Thyroïde, chirurgie, hypocalcémie, parathyroïde

Carcinome anaplasique de la thyroide

Objectives: Thyroid anaplasic carcinoma is a rare variety of thyroid cancer and one of the most aggressive tumors known to affect humans. It accounts for less than 2%of thyroid cancers and it is often extremelymalignant and rapidly fatal.Material and methods: It is a retrospective study of 12 cases of thyroid anaplasic carcinoma hospitalized over one 16 years period (1990-2005)Our aim is to study the clinical aspects and to discuss the therapeutic modalities of this cancer.Results: The average age of our patients was of 68 years (51-79), there are10 women and 2 men. The signs of local compression were present in 10 cases and the physical examination objectified a goiter among 11 patients with an average size of 7 cm. Lymph nodes were observed in two cases and metastases were noted among 7 patients. Two patientshad a tracheotomy in urgency with thyroid biopsy in 5 cases, total thyroidectomy in 4 cases and partial thyroidectomy in 3 cases Bilateral neck dissection was realized in two cases. The radiotherapy was palliative in one case. The survival was less than one year for all patientsConclusion: Thyroid anaplasic carcinoma is a very aggressive tumor, the prognosis is very bad with a survival exceeding rarely a year. Despite multimodality approaches, it still carries a dismal prognosis.Keywords: cancer, thyroid, anaplasic, chirurgic, radiotherapy, chemotherap

Phlegmon peri-amygdalien aspects diagnostiques et thérapeutiques

Introduction: The Peritonsillar abscesse (PTA) is a suppurated complication of the face and the neck often met as a matter of urgency ENT. He can raise diagnostic and therapeutic problems and be life-threatening. The objective of this study is to specify the epidemiological and clinical particularities of this affection and to revise the therapeutic possibilities from a review of the literature.PATIENTS AND METHODS: This retrospective study concerning 75 patients hospitalized for PTA in the Department of Otolaryngology-Head and Neck Surgery of the Hospital of Nabeul over a period of 7 years (in January 2001 to December 2007). The study of files allowed us to find all the clinical and therapeutic data. Our drop is of two years.RESULTS : The average age of our patients was of 26 years with a sex ratio of 1. The classic set of three of the PTA was complete only in 49 % of the cases. All the patients were the object of a needle aspiration, it was positive in 74 % among which 92 % benefited from a drainage under local anesthetic. A germ was identified in 16 cases with a Streptococcus â-hemolytic group A in 13 cases. The clinical and biological cure was noticed on average in the tenth day. Forty-seven patients underwent tonsillectomy at a later date after an interval from 2 to 6 months. No emergency tonsillectomy was realized.CONCLUSION : The Peritonsillar abscesses is a frequent urgency in ENT. The diagnostic is clinical. The practicable of needle aspiration in every case allows to confirm the diagnosis in the incomplete forms. The treatment is medical and surgical.KEYWORDS : Peritonsillar abscesses, diagnostic, treatmen

Carcinome spinocellulaire de la levre inferieure: Sur cicatrice de lupus erythemateux chronique

Epidermoïd carcinoma is the most common malignant tumor of the lips.They often develop on precancerous lesions. Leukoplasia is the most frequent precancerous lesion. We report a case of a 35 years old man, who suffered from discoid lupus erythematous since 20 years; and wasn't treatedfrom. He consulted for a squamous ulceration of the under lip, developed from one year. The biopsy concluded to an epidermoïd carcinoma.He was treated with surgical excision with reconstruction and homolateral triangular recovery.Keywords: Squamous cell carcinoma, epidermoïd carcinoma, discoid lupus erythematosus, precancerous lesion

Carcinome papillaire sur kyste du tractus thyreoglosse

Introduction :: Cysts of the thyroglossal duct are a congenital anomaly. they are common but the incidence of papillary carcinoma arising in a thyroglossal duct cyst (TDC) is rare. The clinical presentation of these cancers is generally nonspecific. There are usually identified only after histopathologic examinationAim: Modalities of treatment and prevention are discussed.Methods: We report 4 cases of a papillary carcinoma developed on a thyroglossal duct cyst, who underwent surgery. Two cases have been detected on préopératory and two at the definitive anatomopathology. Our therapeutic attitude has been discussed in each of our 4cases.Conclusion: there is no consensus about the modalities of treatment of papillary carcinoma in thyroglossal duct cyst.Keywords: Thyroglossal duct cyst, Thyroid, Papillary carcinoma, surgery, Total thyroidectomy

Efficacy of naloxone in reducing hypoxemia and duration of immobility following focal to bilateral tonic-clonic seizures.

Evaluating the efficacy of an opioid antagonist, naloxone (NLX), to reduce the severity of post-ictal hypoxemia and immobility after focal to bilateral tonic-clonic seizures (FBTCS). ENALEPSY is a double-blind placebo (PCB)-controlled trial conducted in patients with focal epilepsy undergoing long-term video-EEG monitoring (LTM). Patients with a FBTCS during LTM were randomized 1:1 to receive intravenous NLX or PCB within the 2 min following the end of FBTCS. After database lock, a discrepancy between the allocated arm and the received treatment was detected, resulting in a 4:1 NLX:PCB ratio. To further explore the efficacy of NLX, we used historical control (HC) data collected in patients included in the REPO <sub>2</sub> MSE study whose characteristics matched those of patients randomized in ENALEPSY. The efficacy of NLX was then assessed versus PCB and versus HC. The primary endpoint was the delay between the end of the seizure and recovery of SpO <sub>2</sub> ≥ 90%. Secondary efficacy outcomes included desaturation nadir and duration of the post-ictal immobility. 33 patients contributed to the NLX group, 7 to the PCB group, and 43 to the HC group. The proportion of FBTCS type 1 or 3 was 84% in NLX, 100% in PCB, and 84% in HC. NLX did not improve the delay of recovery of SpO <sub>2</sub> ≥ 90% or the desaturation nadir. By contrast, the duration of the post-ictal immobility differed across groups. The time to mobility recovery within the first 5 min post-ictal was very similar in the PCB (200.3 ± 215.8 s) and HC (194.4 ± 192.0 s) groups, and significantly shorter in the NLX group (128.9 ± 151.1 s) when compared to HC (Hazard Ratio, 1.84; 95% CI, 1.11-3.05; p = 0.021). NLX did not prevent post-ictal respiratory dysfunction but might reduce the duration of post-ictal immobility. Confirmation of this effect and its impact on SUDEP risk will require additional studies. Release of endogenous opioids might participate in the severity of post-ictal hypoxemia and immobility after focal to bilateral tonic-clonic seizures (FBTCS). We conducted a multicenter double-blind randomized placebo-controlled trial evaluating the efficacy of an opioid antagonist, naloxone (NLX), administered within 2 min following the end of FBTCS. The efficacy of NLX was further explored with a comparison with historical control. NLX did not improve the delay of recovery or the severity of post-ictal hypoxemia. Post-ictal immobility was significantly shorter in the NLX group when compared to historical control. The impact of these results on SUDEP prevention will require additional studies

Inhibition of protein ubiquitination by paraquat and 1-methyl-4-phenylpyridinium impairs ubiquitin-dependent protein degradation pathways

Intracytoplasmic inclusions of protein aggregates in dopaminergic cells (Lewy bodies) are the pathological hallmark of Parkinson’s disease (PD). Ubiquitin (Ub), alpha [α]-synuclein, p62/sequestosome 1 and oxidized proteins are major components of Lewy bodies. However, the mechanisms involved in the impairment of misfolded/oxidized protein degradation pathways in PD are still unclear. PD is linked to mitochondrial dysfunction and environmental pesticide exposure. In this work, we evaluated the effect of the pesticide paraquat (PQ) and the mitochondrial toxin 1-methyl-4-phenylpyridinium (MPP+) on Ub-dependent protein degradation pathways. No increase in the accumulation of Ub-bound proteins or aggregates was observed in dopaminergic cells (SK-N-SH) treated with PQ or MPP+, or in mice chronically exposed to PQ. PQ decreased Ub protein content, but not its mRNA transcription. Protein synthesis inhibition with cycloheximide depleted Ub levels and potentiated PQ–induced cell death. Inhibition of proteasomal activity by PQ was found to be a late event in cell death progression, and had no effect on either the toxicity of MPP+ or PQ, or the accumulation of oxidized sulfenylated, sulfonylated (DJ-1/PARK7 and peroxiredoxins) and carbonylated proteins induced by PQ. PQ- and MPP+-induced Ub protein depletion prompted the dimerization/inactivation of the Ub-binding protein p62 that regulates the clearance of ubiquitinated proteins by autophagic. We confirmed that PQ and MPP+ impaired autophagy flux, and that the blockage of autophagy by the overexpression of a dominant-negative form of the autophagy protein 5 (dnAtg5) stimulated their toxicity, but there was no additional effect upon inhibition of the proteasome. PQ induced an increase in the accumulation of α-synuclein in dopaminergic cells and membrane associated foci in yeast cells. Our results demonstrate that inhibition of protein ubiquitination by PQ and MPP+ is involved in the dysfunction of Ub-dependent protein degradation pathways