RESUMEN
BACKGROUND: When used in the French medical literature to describe a pathological state, the word "historic" normally refers to tumours of startling appearance because of their size. It is difficult to understand how a patient can allow such tumours to continue to grow. We attempt to define this concept. PATIENTS AND METHODS: Two dermatologists carried out a retrospective, independent and comparative selection of photographs taken between 1978 and 2008 of malignant cutaneous tumours of unusual size given the histological diagnosis. Socio-professional, demographic, clinical, histological psychological data, and details of treatment history and progress were collected. RESULTS: Twenty-seven patients (11 M, 16 F) of mean age 74 years (34-99 years) presented a "historic" tumour. Twelve patients lived in rural regions. Five patients were company executives. The average duration of development of the "historic" tumours was 4.5 years (6-420 months). The tumours were classed histologically as epidermoid carcinomas (nine) and melanomas (seven). The mean size was 13 cm (6-30 cm). Psychiatric problems, membership of sects or dementia were noted for 13 patients. Treatment consisted of chemotherapy, radiotherapy or, less frequently, surgery. Eighteen patients died on average 13 months after diagnosis. DISCUSSION: "Historic" malignant tumour (also described in the literature as "giant" tumour) is a real-life fact. No studies have been made of a series of such patients. Despite histological diagnosis, the size was associated with slow tumoral progress and/or late treatment, chiefly accounted for by psychiatric disorders. Socio-professional data indicate that "historic" tumours are equally common in urban and rural areas.
Asunto(s)
Carcinoma de Células Escamosas/patología , Melanoma/patología , Neoplasias Cutáneas/patología , Carga Tumoral , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/psicología , Carcinoma de Células Escamosas/terapia , Diagnóstico Tardío , Negación en Psicología , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Conducta de Enfermedad , Masculino , Melanoma/mortalidad , Melanoma/psicología , Melanoma/terapia , Trastornos Mentales/diagnóstico , Trastornos Mentales/psicología , Persona de Mediana Edad , Estudios Retrospectivos , Piel/patología , Neoplasias Cutáneas/mortalidad , Neoplasias Cutáneas/psicología , Neoplasias Cutáneas/terapia , Factores Socioeconómicos , Análisis de SupervivenciaRESUMEN
The association of voice and speech defines phonation. Phonation depends on various organs: the lungs for air, the larynx as a vibration generator, and cavities of resonance modeling articulation and tone. The role of the soft palate is important in French and for everyday conversation. Velopharyngeal incompetence is defined as a voice and articulation disruption by anatomic and/or functional deficiency between the soft palate and pharynx. Hypernasality is studied on an acoustic, phonetic, and vocal level and graded in various degrees of hypernasality. The various clinical and perceptive tests of velopharyngeal incompetence are described according to age. The difficulty to modelize hypernasality is discussed based on a recent study published in 2007. The differential diagnosis with hyper-closed nasality is discussed. The treatment for this condition is essentially speech therapy associated with pharyngoplasty in some cases. The assessment of children born with a labial-alveolar-velopalatine cleft is mainly clinical and perceptive. Therapeutic management is necessary for the child and his family. The follow-up requires a multidisciplinary approach.
Asunto(s)
Labio Leporino/complicaciones , Fisura del Paladar/complicaciones , Trastornos del Habla/etiología , Logopedia , Insuficiencia Velofaríngea/etiología , Trastornos de la Voz/etiología , Factores de Edad , Niño , Diagnóstico Diferencial , Estudios de Seguimiento , Humanos , Paladar Blando/fisiopatología , Paladar Blando/cirugía , Faringe/fisiopatología , Faringe/cirugía , Fonación/fisiología , Trastornos del Habla/diagnóstico , Trastornos del Habla/terapia , Insuficiencia Velofaríngea/diagnóstico , Insuficiencia Velofaríngea/terapia , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/terapiaRESUMEN
INTRODUCTION: The midline cervical cleft is a rare congenital anomaly of the anterior part of the neck. CASE: We report the case of a 9-year old girl, presenting a congenital midline cervical cleft who underwent corrective surgery at the age of 7 months. Currently, outome is quite satisfactory two years post-operatively; no recurrence has developed. DISCUSSION: We discuss the clinical manifestation of this anomaly, the embryology, the surgical treatment and the clinical course. In its complete form, this rare disorder presents as a subcutaneous midline vertical cervical cord, associated with a cutaneous cleft. The cutaneous cleft consists of an ulceration with an overhanging cutaneous fibromatous protuberance which prolongs downwards to a blind-ended sinus tract. The embryologic mechanism is not formally established, but the majority of the authors agree on the imperfect midline fusion of the paired branchial arch tissue by anomaly of mesodermisation. Surgical treatment is required and must be carried out in the first month of the life in order to avoid neck and mandible functional and morphological disorders. Surgery involves complete excision of the cutaneous ulceration and subjacent fibrous cord followed by site closure using multiples "Z" plasties. Long postoperative monitoring is needed due to the frequency of the recurrence.
Asunto(s)
Cuello/anomalías , Región Branquial/anomalías , Región Branquial/embriología , Fístula Cutánea/patología , Fístula Cutánea/cirugía , Femenino , Humanos , Recién Nacido , Cuello/cirugía , Úlcera Cutánea/patología , Úlcera Cutánea/cirugíaRESUMEN
INTRODUCTION: The evaluation of the bite forces coupled with EMG activity of masseter muscles allows to point out temporo-mandibular joint disorders. The intense practice of sports induces stress which may affect the mandibular statics, due to an hyperfunction of the elevator masticatory muscles, especially the masseter muscles. This concept has led us to compare the maximum isometric bite forces of sedentary and physically trained subjects. MATERIAL AND METHODS: The aim of this experimentation is to study the maximum isometric bite forces of the premolars, with a force transducer, for two groups of physically trained and sedentary volunteers (25 subjects), with distinction between male and female subjects. Subjects with normal denture and no temporo-mandibular joint disorder were retained. EMG and force recording were synchronized and recorded during 10 seconds of maximal contraction. RESULTS: The male subjects developed a maximal bite-force significantly higher (p < 0.05) compared to the female subjects. There is no significant difference between subjects practising a sport (at least 6 hours a week) and sedentary ones. The evolution of force during the contraction is different between sexes. EMG activity allowed to control that subjects developed a maximal force and an increase in muscular fatigability of physically active females compared to sedentary ones was noticed. DISCUSSION: The difference of maximal force between men and women is similar to the one found for the locomotor muscles. The analysis of the evolution of the force according to the contraction duration, might be linked to a different distribution of muscular fibers according to the sex. The practice of a sport might increase the fatigability of the masseter muscles and might be a factor inducing a muscular imbalance of the mandibular posture. But the relatively low number of subjects and the absence of well defined distinctions between different kinds of sport limit our conclusions.
Asunto(s)
Fuerza de la Mordida , Músculo Masetero/fisiología , Deportes , Adulto , Análisis de Varianza , Diente Premolar , Electromiografía , Ejercicio Físico , Femenino , Humanos , Contracción Isométrica , Estilo de Vida , Masculino , Factores SexualesRESUMEN
Gout is a frequent benign disease that rarely affects the temporomandibular joint (TMJ) alone. When it does, the disease is usually confined to the joint space and leads to pain and limitation of jaw opening (acute gout). The case described in this report is atypical in so far as it extended beyond the joint capsule into the pterygoid muscle and destroyed the head of the mandible, the temporal bone and the greater wing of the sphenoid bone. This clinical behaviour in combination with the radiographic appearance created the appearance of a benign but osteolytic lesion. The clinical, radiographic and biological features of gout in the TMJ are reviewed and treatment options are discussed.