INTRODUCTION:Congenital dacryocystoceles are rare and often misunderstood pathologies. Their treatment varies and consists in simple follow-up, lacrimal catheterization or endoscopic surgical drainage, depending on medical teams. The aim of our study was to discuss the place of endoscopic drainage in the treatment of congenital dacryocystocele. METHODS:We conducted a retrospective review on 18 cases of congenital dacryocystoceles taken in charge in a tertiary care center between 2009 and 2012. RESULTS:Thirteen newborns, including five bilateral cases, were taken in charge. The average age was 14.6 days. Six newborns presented with an acute dacryocystitis at the time of diagnosis. No respiratory complications were observed. Spontaneous drainage of the dacryocystocele was observed in 38.8% of the cases, occurring at 22 days of life on average. Endonasal endoscopic drainage was performed in 66.6% of the cases. No recurrence or complication was observed after surgery. After spontaneous drainage, one recurrence was observed. The mean follow-up period of these patients was 8.8 months. DISCUSSION:Spontaneous drainage is common. Conservative management may therefore be considered in absence of infection. In case of infection and/or persistence of dacryocystocele after 4 weeks of life, endonasal surgical drainage should be considered. Imaging of the facial structure should be performed before any surgical treatment.

OBJECTIVE:To raise awareness of the possibility of spontaneous temporal bone cerebrospinal fistula in case of clear retrotympanic effusion. CASE REPORT:A 63-year-old man with no particular history presented with unilateral spontaneous right retrotympanic clear effusion. CT found defects in the posterior part of the right temporal bone, in contact with arachnoid granulations, with no other visible abnormalities. DISCUSSION/CONCLUSION:Unilateral clear retrotympanic effusion in an adult subject should, apart from serous otitis media, suggest possible cerebrospinal fistula. In the absence of otologic or traumatic history, arachnoid granulation is one possible etiology, inducing spontaneous cerebrospinal fluid leakage when facing the temporal bone. Diagnosis is suggested by bone defects in the tegmen tympani or posterior wall of the temporal bone on CT, with the adjacent mastoid cavities filled with fluid. Pneumococcal vaccination and early surgical repair of the fistula should be performed to avoid neuromeningeal infection.

Objective: To evaluate the nutritional status at the time of diagnosis of patients treated for head and neck cancer.Material and methods: Single-centre prospective study. Nutritional assessment comprised: clinical interview, physical examination, and a laboratory work-up. Clinical interview assessed: reference weight, diet, calorie intake, causes of weight loss, use of dietary supplements. A subjective global assessment of nutritional status (Detsky index) was established on the basis of clinical interview. The patient's height and weight were determined and serum albumin was assayed. Weight loss, body mass index, and Buzby index were then calculated. Two groups of malnourished patients were distinguished: moderately malnourished (group 1), severely malnourished (group 2). Variables were compared between the two groups by Chi(2) test.Results: One hundred and sixty-nine patients were included in the study: 145 had a history of smoking and alcohol abuse, 82 (48.5%) were malnourished and 47 of them were classified in group 1. All patients of group 1 had a normal or pureed diet. 21 (69%) patients of group 2 had a pureed or liquid diet. The mean daily calorie intake was 31 kcal/kg/24 h for group 1 and 20 kcal/kg/24 h for group 2. The main causes of weight loss were pain and dysphagia. Dietary supplements were not used by any of the patients in group 1 and by four (13%) patients in group 2. The concordance between the Detsky index and objective nutritional status was 92% for the overall population. Malnutrition was significantly more frequent among males (P = 0.01), alcohol users (P = 0.02), elderly subjects (P = 0.01), patients with pharyngeal tumour (P = 0.03), and patients with advanced tumour stage (P = 0.01).Conclusion: The prevalence of malnutrition among patients with head and neck cancer is high. Assessment of nutritional status and appropriate management must be part of the initial workup of these patients. (C) 2012 Elsevier Masson SAS. All rights reserved.

Évaluer l'état nutritionnel, lors du diagnostic, des patients traités pour un cancer des voies aérodigestives supérieures (VADS). Étude prospective monocentrique. Le bilan nutritionnel comportait : un interrogatoire, un examen clinique, un bilan biologique. L'interrogatoire portait sur : le poids de référence, l'alimentation, la quantité de calories ingérées, les causes de la perte de poids, la prise ou non de compléments alimentaires (CE). Au terme de l'interrogatoire, une évaluation globale subjective de la nutrition était établie (indice de Detsky). Les patients étaient mesurés et pesés. L'albuminémie était dosée. Ensuite étaient calculés : la perte de poids, l'indexe de masse corporelle, l'indice de Buzby. Nous avons distingué deux groupes de patients dénutris : modérément dénutris (groupe 1), sévèrement dénutris (groupe 2). La comparaison des variables a été faite grâce au test du Chi2. Cent soixante-neuf patients ont été inclus. Cent quarante-cinq étaient ethylo-tabagiques. Quatre-vingt-deux (48,5 %) étaient dénutris dont 47 appartenaient au groupe 1. Tous les patients du groupe 1 avaient une alimentation normale ou mixée. Vingt et un (69 %) patients du groupe 2 avaient une alimentation mixée-liquide. L'apport calorique moyen était de 31 kcal/kg par 24 heures pour le groupe 1 et 20 kcal/kg par 24 heures pour le groupe 2. Les principales causes de perte de poids étaient la douleur et la dysphagie. Aucun patient du groupe 1 ne prenait de CE et quatre (13 %) du groupe 2 en prenaient un. La concordance entre l'indice de Detsky et l'état nutritionnel objectif était de 92 % pour la population globale. Le nombre de patients dénutris était significativement plus élevé chez les hommes (p = 0,01), les consommateurs d'alcool (p = 0,02), les sujets âgés (p = 0,01), en cas de tumeur pharyngée (p = 0,03), en cas de stade tumoral avancé (p = 0,01). La prévalence de la dénutrition pour les cancers des VADS est élevée. L'évaluation de la dénutrition et sa prise en charge adaptée doit faire partie du bilan initial de ces cancers.

Évoquer la possibilité de brèche ostéoméningée (BOM) spontanée du rocher en cas d’épanchement rétrotympanique clair. Patient de 63 ans, sans antécédents, qui présente un comblement clair rétrotympanique unilatéral droit spontané. Une tomodensitométrie des rochers a mis en évidence des défects de la partie postérieure du rocher droit en rapport avec des granulations arachnoïdiennes (GA), sans autres anomalies visibles. Un épanchement clair rétrotympanique unilatéral chez un adulte doit faire évoquer, hormis l’otite séreuse, la présence d’une BOM. Chez des patients ne présentant aucun antécédent otologique ni traumatique, une des causes de brèches ostéoméningées spontanées est réalisée par les GA. En regard du rocher, celles-ci peuvent être responsables de fuite spontanée de liquide céphalorachidien (LCR). Une tomodensitométrie des rochers avec la présence de défects osseux au niveau du tegmen tympani ou du mur postérieur de l’os temporal et un comblement liquidien des cavités mastoïdiennes adjacentes permet d’évoquer ce diagnostic. Une vaccination antipneumococcique et un comblement chirurgical précoce de la brèche doivent être effectués afin éviter des complications infectieuses neuroméningées.

Non-Hodgkin lymphomas are lymphoid malignant neoplasms with diverse biological and clinical behavior. Patients typically present with persistent painless lymphadenopathy, but some patients may present with constitutional symptoms or with involvement of organs other than the lymphoid and hematopoietic system. An accurate diagnosis, careful staging of the disease, and identification of adverse prognostic factors form the basis of treatment selection. Patients commonly receive chemoimmunotherapy as initial treatment, and radiation therapy may be added if patients have early-stage disease. Most patients respond well to treatment, but relapses are frequent and additional therapies including stem cell transplant are often needed. Because many subtypes of lymphoma remain incurable with current management strategies, clinical trials are in progress to identify novel therapies with promising activity in this disease.