Rheumatoid lung nodules with hydropneumothorax.
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Biomedical subjects
Publications and source records attributed to A Abid.
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Between 1988 and 2001, five patients with mycotic aneurysm of the abdominal aorta underwent surgery. Extra-anatomical reconstruction with axillo-bifemoral bypass grafting was performed in all patients. The hospital mortality rate was 20%. During the follow-up period two patients presented thrombosis of the axillo-bifemoral bypass, descending aorto-bifemoral bypass was performed in one. Extra-anatomic revascularization is a satisfactory procedure in the treatment of mycotic abdominal aortic aneurysm. The results are acceptable and the prognosis is mainly related to the underlying pathology and the severity of the infection.
We report a case of primary pulmonary Hodgkin's disease in a 20 year-old woman. The chest x-ray showed a chronic alveolar syndrome. The diagnosis was established from a pulmonary biopsy. The radiological features and the options for diagnosis of primary pulmonary Hodgkin's disease are discussed.
We report a case of a patient with intrathoracic extramedullary hematopoiesis presenting as a posterior mediastinal tumor, without associated myelofibrosis. Pathophysiology and the options for diagnosis and treatment in this condition are discussed.
We report a case of multifocal tuberculosis with the following features: - skin involvement with multiple gommes disseminated on the left upper limb, the left flank, the right hypocondrium, and the right leg; - nodal involvement including the left supraclavicular, left axillary, right laterotracheal, pre and subcarineal, ceoeliomesenteric, and liver hilus nodes; splenic involvement; right pleural involvement; - spondylodiscitis of T11-T12 and of the head of the right fibula; - peritoneal involvement leading to ascitis; - multi-organ involvement. This 43-year-old woman had not particular history: no diabetes, no renal failure, no long-term corticosteroid treatment, no immunosuppressor treatment, negative HIV-1 and HIV-2 serology. Treatment with anti-tuberculosis agents led to severe drug reactions causing death due to hepatic encephalitis.
PURPOSE OF THE STUDY: We present a minimally invasive technique for tibial valgus osteotomy using a medial wedge composed of tricalcium phosphate. MATERIAL AND METHODS: The bone substitute is composed of slowly resorbable tricalcium phosphate material shaped to the desired form and having mechanical properties allowing stable osteotomy via a short incision and staple fixation. Intraoperative fluoroscopy enables a reliable and reproducible technique. A lateral fixation staple is required because there is a risk the lateral hinge could break. This technique was used for 58 knees in 55 patients (mean age 47 years). According to the Ahlback classification of femorotibial degeneration, there were 43 grade I knees, 12 grade II, and 3 grade III. RESULTS: The implant was well tolerated in all cases. Bone healing was achieved in most cases without loss of the osteotomy angle. Complications were: rupture of the lateral hinge in four cases leading to nonunion in one, one low-grade infection. Implant resorption at mid term was significant: among the 22 patients with a follow-up of more than 5 years, the implant was barely visible in 18. DISCUSSION: This technique provides an easy way to achieve tibial valgus osteotomy without compromising future intervention. The technique can be considered to be minimally invasive because of the size of the incision, the minimal fixation required, and the bone sparing effect of the bone substitute.
Cross-talk between inducible nitric oxide synthase (NOS II) and cyclooxygenase-2 (COX-2) was investigated in rat chondrocytes. In monolayers, interleukin-1beta (IL-1beta) induced COX-2 and NOS II expression in a dose- and time-dependent manner, to produce high prostaglandin E(2) (PGE(2)) and nitrite (NO(2)(-)) levels in an apparently coordinated fashion. COX-2 mRNA was induced earlier (30 min. versus 4 hr) and less markedly (4-fold versus 12-fold at 24 hr) than NOS II, and was poorly affected by the translational inhibitor cycloheximide (CHX). IL-1beta did not stabilize COX-2 mRNA in contrast to CHX. Indomethacin and NS-398 lacked any effect on NO(2)(-) levels whereas L-NMMA and SMT reduced PGE(2) levels at concentration inhibiting NO(2)(-) production from 50 to 90%, even when added at a time allowing a complete expression of both enzymes (8 hr). Basal COX activity was unaffected by NO donors. The SOD mimetic, CuDips inhibited COX-2 activity by more than 75% whereas catalase did not. Inhibition of COX-2 by CuDips was not sensitive to catalase, consistent with a superoxide-mediated effect. In tridimensional culture, IL-1beta inhibited radiolabelled sodium sulphate incorporation while stimulating COX-2 and NOS II activities. Cartilage injury was corrected by L-NMMA or CuDips but not by NSAIDs, consistent with a peroxynitrite-mediated effect. These results show that in chondrocytes: (i) COX2 and NOS II genes are induced sequentially and distinctly by IL-1beta; (ii) COX-1 and COX-2 activity are affected differently by NO-derived species; (iii) peroxynitrite accounts likely for stimulation of COX-2 activity and inhibition of proteoglycan synthesis induced by IL-1beta.
INTRODUCTION: Subaortic stenosis is a rare congenital heart disease defined as a left ventricular outflow tract obstruction. We reviewed our surgical experience in this cardiac disease with particularly attention to the different anatomical types of the obstruction. PATIENTS AND METHODS: From January 1987 to December 1998, 56 patients with a mean age of 12.4 years underwent surgical treatment of subaortic stenosis in our Institution. The diagnosis included: subaortic membrane in 44 cases, fibromuscular process in seven and tunnel like hypertrophy in five. RESULTS: There were two hospital deaths (2/56 = 3.5%) and three patients presented postoperative heart block. The first postoperative echocardiographic control showed a mean fall in left ventricleaorta gradient of 78%. In a mean follow-up of 36 months, there were no deaths. All patients periodically controlled, showed an echocardiographic progression of the gradient and it was not related to the different anatomical types of the obstruction. There were no signs of aortic insufficiency progression. CONCLUSION: We can affirm that the surgical treatment of the subaortic obstruction is simple and safe. The medium and long-term progression toward the recurrence is independent to the anatomical type and justify the need of serial echocardiographic control.
Susceptibility to type 1 diabetes mellitus is strongly associated with particular HLA class II alleles. However, non HLA genetic factors are likely to be required for the development of disease. The candidate genes include the cytotoxic T lymphocyte associated 4 (CTLA-4) located on chromosome 2q33 and designated (IDDM12), which encodes a cell surface negative signal T molecule providing for activation. We investigated CTLA-4 exon 1 dimorphism in 74 type 1 patients and a control group of 48 healthy subjects from Tunisia using two methods PCR (polymerase chain reaction) allele specific and polymerase chain reaction restriction fragment length polymorphism (PCR RFLP). The CTLA-4/G allele was found on 68.9% in type 1 patients as compared to 51.02% in controls (p = 0.002), mostly in homozygous from 43.24% versus 22.45% (p = 0.0058). This results indicate that CTLA-4/G allele was significantly associated with predisposition to type 1 diabetes in our group from Tunisian population.
To investigate the significance of serological human T-cell lymphotropic virus type 1 (HLTV-1) Gag indeterminate Western blot (WB) patterns in the Caribbean, a 6-year (1993 to 1998) cross-sectional study was conducted with 37,724 blood donors from Guadeloupe (French West Indies), whose sera were routinely screened by enzyme immunoassay (EIA) for the presence of HTLV-1 and -2 antibodies. By using stringent WB criteria, 77 donors (0.20%) were confirmed HTLV-1 seropositive, whereas 150 (0.40%; P < 0.001) were considered HTLV seroindeterminate. Among them, 41.3% (62) exhibited a typical HTLV-1 Gag indeterminate profile (HGIP). Furthermore 76 (50.7%) out of the 150 HTLV-seroindeterminate subjects were sequentially retested, with a mean duration of follow-up of 18.3 months (range, 1 to 70 months). Of these, 55 (72.4%) were still EIA positive and maintained the same WB profile whereas the others became EIA negative. This follow-up survey included 33 persons with an HGIP. Twenty-three of them (69.7%) had profiles that did not evolve over time. Moreover, no case of HTLV-1 seroconversion could be documented over time by studying such sequential samples. HTLV-1 seroprevalence was characterized by an age-dependent curve, a uniform excess in females, a significant relation with hepatitis B core (HBc) antibodies, and a microcluster distribution along the Atlantic coast of Guadeloupe. In contrast, the persons with an HGIP were significantly younger, had a 1:1 sex ratio, did not present any association with HBc antibodies, and were not clustered along the Atlantic façade. These divergent epidemiological features, together with discordant serological screening test results for subjects with HGIP and with the lack of HTLV-1 proviral sequences detected by PCR in their peripheral blood mononuclear cell DNA, strongly suggest that an HGIP does not reflect true HTLV-1 infection. In regard to these data, healthy blood donors with HGIP should be reassured that they are unlikely to be infected with HTLV-1 or HTLV-2.
The aim of our study is to determine the ideal operative age of aortic coarctation. 30 patients (20 male and 10 female) have had surgery for coarctation of the aorta between 1990 and 1998. Mean operative age is 4.5 years (range 2 months and 13 years). Crafoord technique was performed in 23 cases, modified Crafoord technique in 3 cases, Waldhausen operation in 3 cases and coarctectomie with insertion of a prosthetic material in one case. A post-coarctectomy syndrome was noted in one case. There were no early deaths. The mean follow-up period is 4.5 years. 8 patients were noted to have late systemic hypertension (26.5%). It is more frequent in patients that have been operated after the age of 5 years (43%). One patient has had a recoarctation (3%). No late death was noted. 4 patients had to undergo a reoperation for cardiac associated anomalies.
150 patients had mitral valve repair for mitral valve incompetence. There were 57 males and 93 females with a mean age of 22 years. 60% of the patients were in Class II NYHA and 40% in Class III and IV. Type I was present in 18 patients, type II in 98 and type III in 34 cases. Mitral repair included correction of valve prolapse, valvular enlargement with pericardial patch and annuloplasty with semi-rigid ring in 128 cases and PTFE patch along the posterior leaflet in 12 cases. The perioperative mortality rate was 2.6%. All patients had early post-operative echocardiography. According to this, mitral regurgitation was absent or tiny in 135 patients, grade II in 10 cases and grade III in 2 cases. It was moderate or important in twelve patients. In the late post-operative period. All the others patients were reoperated upon for mitral dysfunction in a mean time of 37 months. The reason for reoperation was in the majority of the cases the recurrence of mitral regurgitation related to increase of valvular and sub valvular disease. The late mortality rate is 7%. Out of 126 reviewed survivors on the long run, 71 patients are asymptomatic in class I, 53 patients in class II and 2 patients in class III NYHA. The estimated mitral regurgitation by echography in those patients is absent or trivial in 96 cases. grade II in 29 cases and grade III in one case. Mitral valvuloplasty is the preferred procedure in mitral insufficiency surgical management. It is associated to a low early mortality and morbidity rate. Despite the need for reoperation in about 10% of the cases in the long follow-up, mitral repair offers a good quality of life without anticoagulant treatment.
UNLABELLED: The extra anatomical bypasses are those which do not follow the usual arterial pathway. The aim of this study is to define the indication of extra anatomical bypasses and to compare them with other revascularisation procedures. In this paper we report a retrospective study carried between January 1988 and December 1999 involving 80 patients (78 men and 2 women) who underwent extra anatomical bypasses for revascularisation of their lower limbs (83 bypasses). The mean age of the patients was 62 years. The indication for revascularisation was chronic arteritis of the lower limbs in 72 patients (90%), infected aneurysms in 6 cases (7.5%) and acute aortic dissection in 2 cases (2.5%). We performed an axillo-unifemoral bypass in 23 cases, an axillo-bifemoral in 17, a crossover ilio-femoral or femoro-femoral bypass in 41 cases, and 2 transobturator ilio popliteal bypass right and left in 1 case. Hospital mortality rate was 10%. Hospital morbidity was about 65%. Limb salvage was 78%. Sixty patients were regularly followed during a mean follow-up of 31 months. Late mortality was 10%. In the end of our study global limb salvage rate was 74%. IN CONCLUSION: extra-anatomical revascularization allows acceptable limb salvage rate along with lower operative risk even in poor state patients.
Glucuronidation of phenols (1-naphthol, 4-methylumbelliferone) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ketoprofen, naproxen and carprofen was investigated in human colon carcinoma Caco-2 cell clones. Glucuronidation of these substances was highly effective in microsomes of the clones PD-7 and TC-7, but much lower in the PF-11 clone. The activity increased up to a maximum after 21 days of culture. RT-PCR experiments indicated that the PD-7 and TC-7 clones expressed the UDP-glucuronosyltransferase (UGT) isoforms UGT1A6, UGT1A3 and UGT2B7, which could account for the glucuronidation of phenols and carboxylic acids observed. Beta-naphthoflavone stimulated by 2-fold the enzyme activity toward 1-naphthol in PD-7 and TC-7 clones, but not in PF-11 cells. This increase was parallel to that of the UGT1A6 mRNA level. Glucuronidation of ketoprofen was also sensitive to the inducing effect of beta-naphthoflavone. Actinomycin D and cycloheximide did not affect the induction of UGT1A6 by beta-naphthoflavone, but suppressed that of ketoprofen UGT. The UGT1A3 mRNA content was enhanced by beta-naphthoflavone; by contrast, that of UGT2B7 was insensitive to the inducer. In conclusion, several UGT isoforms of both families 1 and 2, which glucuronidate phenols and carboxylic NSAIDs, have been identified in Caco-2 cells. They are differently sensitive to beta-naphthoflavone.
Hydatid pulmonary embolism is an uncommon condition resulting from the rupture of a hydatid heart cyst or the opening of a visceral hydatid cyst (often in the liver) into the venous circulation. We report two cases of hydatid pulmonary embolism following rupture of a hydatic cyst in the right ventricle. One case progressed to chronic cor pulmonale. We examine the pathophysiological mechanisms as well as the clinical, therapeutic and evolutive aspects.
In this retrospective study we report 15 cases of peripheral infected aneurysms. The sex ratio was 13/2 and the mean age was 23 years. Patients presented with infection syndrome in 9 cases, vascular mass in 11 cases and limb ischemia in 2 instances. Arterial lesion was documented and confirmed by echography, tomodensitometry and angiography. The infection was recognised by different criteria the main one being micro-organism isolation. In 10 cases aneurysm was secondary to bacterial endocarditis, in 4 it was primary and in one case it was related to arterial catheter procedure. Treatment is based on antibiotics and surgical management by removing of infected aneurysm and arterial restoration whenever possible. Arterial flowerest re-establishment was done in 10 patients among whom 6 by anatomic procedures 4 by extra-anatomic ones. Hospital mortality rate was 13% (2/15), all deaths occurred after cardiac surgery for endocarditis. Two patients were readmitted for adjacent spine infection, one month and one and a half respectively after surgery. One young patient required late surgery (aorto-bifémoral bypass) 24 months after initial treatment and one patient died by intra-duodenal rupture of recurrent false aneurysm. Analysis of our results and literature review allow discussion of clinical, physiopathological and specially therapeutic aspects of infected aneurysm.
The aim of our study is to evaluate the effect of nutritional education (applied during young diabetic camps) on the nutrition knowledge acquisition and the effective application of this knowledge by young diabetics in their dietary intake composition. This study included ten volunteers pupils, aged from 12 to 15 years. Each meal provided was quantified before and after consumption to determine during three consecutive days the exact amount of food consumed. Our results showed that the young diabetic could regulate his energetic intake in accordance with his needs. He didn't modify the proposed food when it was normocaloric (2615 +/- 390 Kcal), but he increased his food intake near the recommended needs when the proposed food was hypocaloric (1766 +/- 283 Kcal) and decreased his consumption when the proposed food was hypercaloric (4271 +/- 511 Kcal). Moreover, this study showed a significant negative correlation between the total energy intake and the amount of carbohydrates (r = -0.46, p < 0.01) and proteins (r = -0.70, p < 0.01), while it was positive between the first and lipid intake (r = 0.63, p < 0.01).