[Lymphangioleiomyomatosis and tuberous sclerosis association]

The Lymphangioleiomyomatosis is a rare lung disease encountered almost exclusively in women of childbearing age. The combination with tuberous sclerosis is even more rare. Lung affection is characterized by thin walled multiple pulmonary cysts, recurrent pneumothorax, an obstructive ventilatory trouble, and an evolation to chronic respiratory failure within an average of 10 years. A patient aged 51 years old with a history of generalized seizures, hospitalized in the department for exertional dyspnea of NYHA stage III of gradual onset since 5 years, combined with a dry cough and some episodes of minimal hemoptysis leading to weakness of the general condition. Clinical examination found diffuse bilateral crepitational rale. The chest radiograph showed diffuse bilateral interstitial syndrome. The cardiovascular examination with ECG and echocardiography showed a mild PAH of 42 mmHg. The chest CT revealed multiple diffuse thin-walled cystic formations highly suggestive of lymphangioléimyomatose. Abdominal and kidney ultrasound showed no appearance of renal angiomyolipoma or uterine fibroids. Furthermore, cerebral CT showed encephalic calcifications objectified for a Tuberous sclerosis of Bourneville. Plethysmography showed a mixed ventilatory disorder predominantly obstructive. The diagnosis of pulmonary Lymphangioleiomyomatosis associated with Tuberous sclerosis of Bourneville has been retained. The patient was put on a long term oxygen therapy with good evolution. The combination Lymphangioleiomyomatosis and tuberous sclerosis of Bourneville is rare, interesting almost exclusively young women. International diagnostic criteria have been proposed for the diagnosis of these disorders. The prognosis remains reserved

[Obesity and asthma]

Asthma is a chronic disease whose prevalence continues to increase. Obesity is a comorbidity makes it difficult to support and control of asthma. A retrospective study on 39 cases of obese asthmatics, whose body mass index [BMI] exceeds 30 kg/m2, followed by allergy consultation service between January 2007 and August 2009. 31 women and 8 men aged between 23 and 79 years [average age: 48.5 years]. Diabetes is associated in 2 cases, hypertension in 5 cases and a sicca syndrome in one case. The asthma was intermittent in 17 cases [43.5%], mild persistent in 7 cases [18%], moderate persistent in 11 cases [28.25%] and severe persistent in 4 cases [10.25%]. The gastro-esophageal reflux was found in 25%, an allergic rhinitis in 41% cases, conjunctivitis in 28% of cases, eczema in 7.6% cases, food allergy in 10% of cases especially Fish and drug in 0.7% cases intolerance to aspirin. A family atopy was noted in 10% of cases. The recommended treatment based on inhaled corticosteroids and beta 2 mimetiques long duration of action in 22 cases associated with xanthine in 4 cases, antihistamines and nasal corticosteroids in 16 cases and inhibitors of proton pump in 10 cases. Asthma is well controlled in 60% of cases, partially controlled in 30% of cases and uncontrolled in 10% of cases. The flow volume curve done in all our patients had obstructive ventilatory disorder objectified in 89.7% and mixed in 10.3%. The obstructive ventilatory disorder was mild in 60% of cases, moderate in 28.6% cases and severe in 11.4%. Obesity is a bad factor in controlling asthma and a multidisciplinary care must be taken to assure the best therapeutical approach

[ bagassose: extrinxic allergic alveolite]

The extrinsic allergic alveolites are interstitial and alveolar pneumopathies of complex immunological mechanisms, related to the inhalation organic chronicles of substances. We report the observation of a 61 years old, old patient nicotinic chronicle, without particular pathological antecedents, having a concept of professional exposure to the cane with sugar during 40 years. It presents 4 months before its hospitalization a dyspnea of effort of progressive aggravation currently stage IV of the EEC associated with a productive cough mucopurulente, the whole evolving/ moving in a context of apyrexie and slimming quantified to 15 kg. The clinical examination finds a patient polypneic with 26c/mn and rails crepitants bilateral with the sounding pleuropulmonaire. Thoracic radiography shows an interstitial syndrome diffuse reticulo-micronodulaire. The thoracic TDM highlights an aspect in honeycomb evoking a pulmonary fibrosis. Washing bronchioloalveolaire objectifies a rate of polynuclear neutrophiles with 6%. Respiratory functional exploration finds a moderate restrictive syndrome with a reduction in the DLCO. In front of these clinical, radiological and functional criteria, the diagnosis of the bagassose was retained. In the light of this observation, we underline the diagnostic difficulties of the alveolite allergic extrinsic and we propose a review of the literature

[Allergic to sunflower]

The allergic to sunflower [Helianthus annuus] of the composite family is a rare, however, 13 cases of IgE-mediated anaphylactic reactions have been reported. It is most often generalized immediate reaction, with a total tolerance to the sunflower oil. This allergy manifests itself polymorphic and responds to all possible routes of exposure: ingestion, inhalation or contact. This is a boy of 18 years, followed for assessment of acute urticaria [4 episodes in 1 year]. The questioning is the notion of eating sunflower seeds before the symptoms. Skin tests were negative for aeroallergens and positive currents to extract seeds and sunflower oil. Specific IgE were increased. Allergy to sunflower seeds was used. The patient progressed well with conservative treatment [corticosteroids and oral antihistamine] with the eviction action. Through this observation, we emphasize the rarity of this form of allergy, the difficulty of the diagnostic investigation with an explanation of the pathophysiological mechanism

Proteomic technology for biomarker profiling in cancer: an update / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

The progress in the understanding of cancer progression and early detection has been slow and frustrating due to the complex multifactorial nature and heterogeneity of the cancer syndrome. To date, no effective treatment is available for advanced cancers, which remain a major cause of morbidity and mortality. Clearly, there is urgent need to unravel novel biomarkers for early detection. Most of the functional information of the cancer-associated genes resides in the proteome. The later is an exceptionally complex biological system involving several proteins that function through posttranslational modifications and dynamic intermolecular collisions with partners. These protein complexes can be regulated by signals emanating from cancer cells, their surrounding tissue microenvironment, and/or from the host. Some proteins are secreted and/or cleaved into the extracellular milieu and may represent valuable serum biomarkers for diagnosis purpose. It is estimated that the cancer proteome may include over 1.5 million proteins as a result of posttranslational processing and modifications. Such complexity clearly highlights the need for ultra-high resolution proteomic technology for robust quantitative protein measurements and data acquisition. This review is to update the current research efforts in high-resolution proteomic technology for discovery and monitoring cancer biomarkers.

[Amiodarone pneumopathy]

The frequency of which has occurred of pulmonary toxicity related to the amiodarone is variable between 1, 4 and 20% of the cases

Observation: We report the case of a 74 year old patient who has been put under amiodarone for 3 months. The patient has presented a cough and a dyspnea of effort for one month. The thoracic radiography and TDM showed an interstitial attack associated alveolar hearths. After stop of the amiodarone, the patient is put under prednisolone during 10 days. The evolution was good

Discussion: The amiodarone is responsible for various tables of pulmonary toxicity: an interstitial pneumopathy, a pneumonia with eosinophilic, an organized pneumonia,…. The positive diagnosis is based on a whole of clinical, radiological and biological criteria

Conclusion: The medicamentous knowledge of pneumopathy in general and especially to the amiodarone is important because it enables us to evoke this diagnosis and to stop the suspected drug

surgical treatment of the dilatations of the bronchi [about 48 cases]

In spite of the progress of the medical treatment of the bronchiectasies or dilations of the bronchi, a certain number of patients can benefit from a surgical treatment. The aim of our work is to value the results of the surgical treatment and to specify the moment of the surgical intervention. Our work is about 48 cases of bronchectasies operated in the service of the emergencies visceral Ibn Rochd of Casablanca between January 1994 and February 2001. It was about 30 women for 18 men, the middle age of our patients was 27 years. It was a sequelae of respiratory infections of the childhood in 22.9%, of tuberculosis in 35.42% of the cases, and 10.41% of the patients had presented a pulmonary abscess. The dilations of the bronchi were apparently primitive in 31.45% of the cases. The sits of the bronchiectasies has been specified the most often by a thoracic computed tomography in 80%, in 20% of the cases the lesion was bilateral. The type of intervention practiced was 33 cases of lobectomies, 6 cases of bilobectomies and 9 case of trisegmentectomies. The operative continuations were simple in the majority of the cases, except in 9 cases: 4 cases of pyopneumothorax, 2 case of emphysema under cutaneous and 3 case of parietal suppuration. The long-term follow-up interested 34 patients, 30 became asymptomatic, 1 patient presented a parietal pain, an obstinate cough has been noted in one patient and two patients presented occasional respiratory infections

Infections bacteriennes communautaires aux urgences

The most frequent community infections caused by bacteria that are found at medical emergencies are urinary infections and meningiti. This study's aim is to determine the type and frequency of the bacteria isolated at the emergencies, and to test their sensitivity against different antibiotics. Material and methods: We have studied in a prospective way 220 bacteriological samples of 200 patients at the medical emergencies during 7 months from the begining of June 2001 till Janury 2002. Each patient was tested according to the signs he presented and to the available technical means. We did: 100 spinal punctures [US], 82 cytological bacteriological urinary examination [ECBU], 21 blood-culture, 8 pus, 6 effusion liquids, 3 plate culture of faeces. Klebsillea and Echerichia coli are responsible for most of the urinary infections. The bacteria found showed a very high level of resistance [almost 100%] against ampicillin and [60%] against amoxicillin / calvolanic acid. However they were sensitive to fluoroquinolons and to 3 rd generation cephalosporins. Pneumococus is the most frequent germ for purulent meningitis. Isolated bacteria were all sensitive to penicillin G. The progression of resistance to antibiotics of the principal community bacteria implies to rationalize the use of antibiotics, and to monitor regularly the resistance of these bacteria, and also to make new therapeutical recommendations based on the local epidemiological data

Frequence des gastro-enterites a rotavirus chez le jeune enfant hospitalise

We evaluated at 13,5% the frequency of Rotaviruses gastroenteritis in children under 2 years old, hospitalized at the C.H.U. of Rabat. The frequency is high in children under one year old, especially in newborns under one month old. Seasonal variation of this infection was observed, with maximal frequency in automn. In the end, it appears that malnutrition and artificial feeding, have important roll in determination of this affection

[Diaphragm pathology seen by specialist in lungs disease]

38 cases of diaphragmatic pathology has been observed in the CHU Pneumology unit -Ibn Rochd hospital- between 1976 and 1989, and from 1987 to 1989 [in 20 Aout hospital]. The serie is dominated by diaphragmatic hernia and eventration divided into 22 cases of diaphragmatic eventration 11 cases of post traumatic diaphragmatic hernia and 3 cases of retro rib xyphoid hernia. The circumstances of discovery are variable: respiratory symptoms [chest aches and dyspnea] associated with abdominal pain and dyspepsia. After the analysis of the cases the authors stress the importance of following elements: Variability of radiologic anomaly is very suggestive of the hernia or eventration, so as pneumoperitoneum and gastroduodenal transit with chest photos delayed. It's useful to precise the nature of the organs intrachest. Concerning therapy repercussions only the eventration with functional re are to be proposed to a surgical, intervention. For the post traumatic hernia or retro-ribxyphoidhernia, the indication of surgical operation is formal because of the risk of a stranglement which is very important

La meningite tuberculeuse: analyse de liquides cephalo-rachidiens de 675 malades

This work is based on the retrospective analysis of the results of the search for mycobacterium tuberculosis in the C. S. F of 675 patients admitted for the other diseases than tuberculosis to the different hospitals of Rabat. The results were taken from the archives of the microbiology Laboratory of Hospital Ibn Sina during the last five years. The results of examinations after Ziehl-NeLson or auramine colorations and after culture on Loweinstein Jensen or Colletsos are compared among them and among the results from the bibliography. These results show a positive rate of 6 and 10% respectively and an interest certain for the double culture. We shoud underline the fact that repeted C. S. F examinations in the same patient when feasible clinically will increase the positivity rate

Haemophilus influenzae et resistance au antibiotiques: a propos de 25 cas de meningite

In this paper, we studied the resistance of haemophilus influenzae to the antibiotics by the production of Beta-lactamase. Among the 25 isolated strains from cephalorachidic liquid of newborn babies suffering from purulent meningitis, three are resistant to the ampicilline by producing Beta-lactamase. One of the three samples shows a multiresistance. It is particularly resistant to the chloramphenicol. In the lignt of these results and a review of the litterature, a therapeutic conduct of the H. influenze meningitis is proposed

Papillary carcinoma: a rare cancer of the biliary duct

Papillary carcinoma is rare as it represents only 5% of carcinomas of the common bile duct. The long prodromal phase is dominated by attacks of cholangitis and incomplete appearance of the jaundice when fully constituted. Its papillary structure consists of coalescent fringes producing a typical glandular appearance. Finaly, it evolves very little, therefore is of good hope of survival even after palliative treatment

Rotavirus diarrhea in childhood in Casablanca

Rotavirus have been demonstrated in 17.6% of stools of 85 children suffering from acute diarrhea. The low incidence reported here can be explained by the season and by the age of the children