Histological and chemical damage induced by microcystin-LR and microcystin-RR on land snail Helix aspersa tissues after acute exposure.

Microcystins (MCs) are the most common cyanotoxins with more than 200 variants. Among these cyanotoxins, microcystin-LR (MC-LR) and microcystin-RR (MC-RR) are the most studied congeners due to their high toxicity and frequent occurrence in surface waters. MC-LR has been detected in more than 75% of natural cyanobacteria bloom, along with other toxic and less toxic congeners. Accumulation of several microcystins variants (MC-LR and MC-RR) has been confirmed in aquatic snails exposed naturally or in the laboratory to toxic blooms. Thus, this paper aims to compare the biochemical and histological impact of both toxic variants (microcystin-LR and microcystin-RR) and their mixed form on a bioindicator, the land snail Helix aspersa. During experiments, snails were gavaged with a single acute dose (0.5 µg/g) of purified MC-LR, MC-RR, or mixed MC-LR + MC-RR (0.25 + 0.25 µg/g). After 96 h of exposure, effects on the hepatopancreas, kidney, intestine and lungs were assessed by histological observations and analysis of oxidative stress biomarkers. The results show that a small dose of MCs variants can increase the non-enzymatic antioxidant glutathione (GSH), inhibit glutathione-s-transferase (GST) level and trigger a defense system by activating glutathione peroxidase (GPx), catalase (CAT) and superoxide dismutase (SOD). Microcystin-RR causes serious anomalies in the hepatopancreas and kidney than Microcystin-LR. The organ most affected is the kidney. The damage caused by MC-LR + MC-RR is greater than that caused by single variants.

Neurotization of isolated axillary nerve palsy in a teenage patient.

BACKGROUND AND AIM: The aim of this article was to study isolated axillary nerve injury, his etiologies, symptomatology and treatment via nerve transfer or neurotization. METHODS: We describe the procedure of long head triceps radial branch transfer to the axillary nerve motor branch in adolescent patient with right deltoid muscle palsy and shoulder anesthesia following a motorcycle crush six months ago. RESULTS: Total recovery of the shoulder sensibility, abduction and extension at one-year follow-up, and patient returned progressively to his normal live and sports activities without any functional effect on the donor muscle. CONCLUSION: The advantages of the axillary nerve transfer are demonstrated through many publications. It is a good therapeutic option if it concerned a young patient and practiced at early time followed by adequate rehabilitation.

[Factors influencing the development of chondrolysis in children treated for slipped capital femoral epiphysis]. / Facteurs de risque de chondrolyse chez les enfants traités pour épiphysiolyse fémorale supérieure.

INTRODUCTION: Chondrolysis is an infrequent but serious complication of the treatment of slipped capital femoral epiphysis. The objective of this study was to identify factors influencing the development of chondrolysis. PATIENTS AND METHODS: The medical records of the patients operated on between 1989 and 2009 at the Rabat Children's Hospital for treatment of slipped capital femoral epiphysis were retrospectively evaluated. The minimum follow-up was 24 months. The risk of development of chondrolysis was correlated with various parameters. Statistical analysis was performed using a logistic regression model (binary outcome). RESULTS: A total of 140 patients were included in this study. The average age was 13 years and 4 months. The incidence of chondrolysis was 11.4% (16 patients). Chondrolysis was significantly associated with obesity (25%, P<0.001) and with a delay in the diagnosis of slipped capital femoral epiphysis exceeding 60 days (75%, P=0.01) DISCUSSION: In this series, intra-articular pin penetration is not a risk factor for chondrolysis. The association of obesity and a diagnosis delay beyond 60 days increases the risk of occurrence of chondrolysis in children operated on for slipped capital femoral epiphysis. Chondrolysis can be prevented mainly through early diagnosis of slipped capital femoral epiphysis.

Membrane-bound oxygen reductases of the anaerobic sulfate-reducing Desulfovibrio vulgaris Hildenborough: roles in oxygen defence and electron link with periplasmic hydrogen oxidation.

Cytoplasmic membranes of the strictly anaerobic sulfate-reducing bacterium Desulfovibrio vulgaris Hildenborough contain two terminal oxygen reductases, a bd quinol oxidase and a cc(b/o)o3 cytochrome oxidase (Cox). Viability assays pointed out that single Δbd, Δcox and double ΔbdΔcox deletion mutant strains were more sensitive to oxygen exposure than the WT strain, showing the involvement of these oxygen reductases in the detoxification of oxygen. The Δcox strain was slightly more sensitive than the Δbd strain, pointing to the importance of the cc(b/o)o3 cytochrome oxidase in oxygen protection. Decreased O2 reduction rates were measured in mutant cells and membranes using lactate, NADH, ubiquinol and menadiol as substrates. The affinity for oxygen measured with the bd quinol oxidase (Km, 300 nM) was higher than that of the cc(b/o)o3 cytochrome oxidase (Km, 620 nM). The total membrane activity of the bd quinol oxidase was higher than that of the cytochrome oxidase activity in line with the higher expression of the bd oxidase genes. In addition, analysis of the ΔbdΔcox mutant strain indicated the presence of at least one O2-scavenging membrane-bound system able to reduce O2 with menaquinol as electron donor with an O2 affinity that was two orders of magnitude lower than that of the bd quinol oxidase. The lower O2 reductase activity in mutant cells with hydrogen as electron donor and the use of specific inhibitors indicated an electron transfer link between periplasmic H2 oxidation and membrane-bound oxygen reduction via the menaquinol pool. This linkage is crucial in defence of the strictly anaerobic bacterium Desulfovibrio against oxygen stress.

[Glomus tumor of the finger pulp: an unusual pediatric case]. / Tumeur glomique pulpaire de l'enfant : à propos d'un cas inhabituel.

Glomus tumor is a rare benign tumor. Diagnosis is often delayed because of the absence of specific symptoms and confirmation can only be made by histological study. Treatment is always surgical. We report a clinical case of glomus tumor of the thumb pulp in a 6-year-old girl, and we discuss clinical, radiological and histological aspects of this tumor.

[Percutaneous release of trigger thumb in children: 63 cases]. / Le traitement percutané du pouce à ressaut chez l'enfant : à propos de 63 cas.

INTRODUCTION: Congenital trigger thumb is secondary to a conflict between the flexor pollicis longus tendon and its inextensible tendon sheath. Though, the exact aetiology is still unknown, its treatment is usually surgical. PATIENTS: The authors present their experience of treating 52 consecutive patients with 63 trigger thumbs, with mean age 32 months, range (12 months to five years). Twenty-nine boys and 23 girls. Right thumb 37 and left thumb 26, 11 patients had have bilateral trigger thumb. Each was exclusively treated by percutaneous release of the A1 pulley using a needle. RESULTS: Fifty-two with 50 treated trigger thumbs were available for follow-up. The mean follow-up after this procedure was 28 months (range 12-30 months). Fourty-eight thumbs had a good result without any recurrence of triggering. Two thumbs had recurrent triggering and were subsequently successfully treated by open release. No thumbs demonstrated any neurovascular deficit clinically. CONCLUSION: Percutaneous release of congenital trigger thumb can be performed safely and effectively in children by a surgeon specializing in hand surgery.

[Risk factors of osteonecrosis of the femoral head following slipped capital femoral epiphysis]. / Nécrose de la tête fémorale chez les enfants traités pour épiphysiolyse fémorale supérieure. Quels sont les facteurs de risque?

UNLABELLED: Osteonecrosis is a serious complication of the treatment of slipped capital femoral epiphysis. The purpose of this study was to identify factors predisposing to the development of this complication. We reviewed retrospectively 127 patients (150 hips) treated for slipped capital femoral epiphysis in our institution between 1980 and 2004. Clinical and radiological data were analyzed before and after treatment, and at consecutive follow-up examination. Osteonecrosis was defined in the basis of radiological criteria. The risk of development of osteonecrosis was correlated with multiple clinical and radiographic parameters. RESULTS: 12 hips in 11 patients (8%) had development of osteonecrosis. Ten of them had an unstable slip. From 130 stable hips, regardless of grade, two had development of osteonecrosis. In patients who had presented with an unstable hip, the risk of osteonecrosis increased with the grade of the slip. Osteonecrosis was more likely to develop in hips that had been treated with multiple screws than in those who had been treated with a single screw. In conclusion, partial or complete reduction of an unstable slipped capital femoral epiphysis increases the risk of development of osteonecrosis. Pinning in situ without reduction with a single screw is the method of choice of the treatment of a slipped capital femoral epiphysis.

Displaced femoral neck fractures in children: are complications predictable?

INTRODUCTION: Serious complications can occur in the management of displaced femoral neck fractures in children. Are there ways to anticipate this risk and better define eventual contributing factors? PATIENTS AND METHODS: Twenty-one children (14 boys and 7 girls) were treated between 1999 and 2006 for displaced femoral neck fractures. Nine type II, 10 type III and two type IV fractures were observed according to the Delbet's classification. Anatomical open reduction was performed in 13 patients and closed reduction in eight patients. At a mean follow-up of 26.4 months, the outcome was assessed according to the Ratliff criteria. Postoperative complications were analysed according to the age, fracture type, time-to-surgery and open or closed reduction. RESULTS: The mean age was 12.1 years. The final outcome was defined as good in 14 patients(66.66%), fair in one patient (4.76%) and poor in six patients (28.58%). Complications occurred in seven patients (33.33%), avascular necrosis (AVN) of the femoral head being the most frequent one (28.58%). In all cases, necrosis was observed in children older than 12 years (p < 0.05) and when time-to-surgery exceeded 48 h (p < 0.05). Necrosis occurred in 44.44% of type II fractures and in 20% of type III fractures (p > 0.05). Only one materialised after closed reduction (p < 0.05). DISCUSSION: Various factors may contribute to the development of complications in children with femoral neck fractures. Our study supports the hypothesis that older age, late surgery and open reduction are definite predictors of avascular necrosis occurrence. LEVEL OF EVIDENCE: Retrospective study, level IV.

[Supra and intercondylar elbow fractures in children]. / Les fractures sus- et intercondyliennes de l'humerus chez l'enfant.

Supra- and intercondylar elbow fractures are rare in children. The treatment of these fractures is controversial. The purpose of this report is to discuss diagnosis and treatment of this unusual injury. Our study looked at nine patients between six and 15 years old (average age: 11.5). In four patients, the fracture was T-condylar and in five patients, the fracture was epiphyseal-diaphyseal. Communition was noted in five cases. All fractures are secondary to high-energy trauma. All patients were treated by open reduction and internal fixation. Three patients had associated nervous lesions. Patients were reviewed at an average of 30 months follow-up and the results evaluated according to the criteria of Flynn. The results were good or excellent in six patients, fair in two patients and poor in one. Cubitus varus and limitation of elbow motion were the main complication. Supra- and intercondylar elbow fractures should be differentiated from the more common supracondylar humerus fractures. We recommended open reduction with internal fixation. Complications are due to the severity of the initial trauma and sometimes to defective treatment especially in the case of complex fracture.

Pronator teres transfer to correct pronation deformity of the forearm after an obstetrical brachial plexus injury.

A pronation deformity of the forearm following an obstetric brachial plexus injury causes functional and cosmetic disability. We evaluated the results of pronator teres transfer to correct their deformity in 14 children treated over a period of four years. The mean age at surgery was 7.6 years (5 to 15). The indication for surgery in each case was impairment of active supination in a forearm that could be passively supinated provided that there was no medial contracture of the shoulder and normal function of the hand. The median follow-up was 20.4 months (8 to 42). No patient was lost to follow-up. Qualitative results were also assessed. The median active supination improved from 5 degrees (0 degrees to 10 degrees ) to 75 degrees (70 degrees to 80 degrees ) with no loss of pronation. A passively correctible pronation contracture can be corrected safely and effectively by the transfer of pronator teres.

False aneurysm of the radial artery: Unusual complication of both-bone forearm fracture in children: A case report.

False aneurysm or pseudo aneurysm of an artery in close proximity to fractured bone is a well-recognized entity, and fewer various cases, involving different sites have been reported in the literature. We report new case of a Moroccan's patient who had 10-year-old boy presented with a right non displaced both-bone forearm fracture; the patient was placed in a long arm splint. After, six weeks, the cast was removed. And a pulsatile mass on the volar-radial aspect of the forearm was decouvred. The mass was non-tender and the patient had radial and ulnar pulse. An Ultrasound and brachial angiography showed a false aneurysm of distal radial and the radial artery was ligated.In conclusion, pseudoaneurysm of the radial artery can be associated with any bone fracture despite non displacing fractures related to the elasticity of the bone in this age and orthopedic surgeons should be aware of this potential complication.

Marked genetic differences in the regulation of blood glucose under immune and restraint stress in mice reveals a wide range of corticosensitivity.

Male and female mice from different control strains (C57BL/6, DBA/2, BALB/c) and the nonobese diabetic (NOD) strain, a spontaneous model of type 1 diabetes, were subjected to various stressors (restraint, lipopolysaccharide or interleukin-1 injection). Significant differences were measured among strains in blood glucose, insulin and corticosterone levels and, for restraint, IL-6. Addition of dexamethasone, a glucocorticoid receptor agonist, to inhibit the expression of several proteins by LPS-stimulated bone marrow-derived macrophages in vitro showed a gradient among control strains: C57BL/6>DBA/2>BALB/c corroborating the pattern of corticosensitivity suggested by their stress-induced glucose responses at the systemic level.

[Muscular tuberculosis: an unusual focus of Koch bacillus]. / La tuberculose musculaire isolée: localisation inhabituelle du bacille de Koch.

We report an exceptional case of tuberculosis in an 8-year-old girl. The focus of infection was situated in the anterior muscle compartment of the left thigh. Diagnosis was established on the basis of histological findings. A 12-month antituberculosis regimen was given. Outcome was good with no general or functional sequelae. Based on this case and data reported in the literature, we discuss the routes of dissemination of the Koch bacillus explaining this unusual sporadic localization.

[Medico-economic study of percutaneous and surgical closure of ostium secundum type interatrial communications]. / Etude médico-économique de la fermeture percutanée et chirurgicale des communications interauriculaires de type ostium secundum.

The aim of this study was the medico-economic evaluation of the closure of ostium secundum type interatrial communications in 32 patients, treated by cardiac catheterisation (group A: n = 17) or by surgery (group B: n = 15). The success rate was 100% with the 2 techniques. With national cost scale data we evaluated the overall cost of the 2 treatments using the information system medical program, starting from homogenous groups of patients: 150 catheterisation, 169 and 170 surgery. As the value for the homogenous group of 150 patients was much lower than the price of the material used for catheterisation, an adjusted group of 150 patients including the price of this material was created. An evaluation in terms of an artificial index of activity was also performed. The average duration of hospital stay for group A was reduced by 6.1 days compared to group B (p < 0.001). The overall cost was lower in group A than in group B (p < 0.001), using the real and "adjusted" homogenous group of 150 patients, with a respective reduction of 7,582 Euros and 3,731 Euros. Surgery and catheterisation scored 8,167 points (17,756 Euros) and 2,726 points (5,926 Euros) per patient respectively on the artificial activity index. In conclusion, catheterisation reduced the duration of hospital stay and brought an economic benefit for the Assurance Maladie compared to surgery. However, surgery is more profitable for the hospital than catheterisation because of the high cost of the prosthesis, which is not taken into account with a homogenous group of non-specific patients. This could hamper the development of this innovative technique in a hospital subjected to overall budgetary constraints.

[Role of laparoscopy in intra-abdominal testes in children. 35 case reports]. / Place de la laparoscopie dans les testicules impalpables de l'enfant. A propos de 35 cas.

The impalpable testicles account for approximately 10 to 20% of the total of the not descended testicles. The importance of laparoscopy is increasingly significant, because apart from its diagnostic role recently a therapeutic interest was added. Thirty-five nonpalpable testicles took advantage of laparoscopic exploration at the pediatric's emergency surgery ward at the children's hospital of Rabat within the last 2 years. In 9 cases, total testicular agenesis was found. In 6 cases the testicles were situated very high in the abdomen, so that a first time laparoscopy was performed where the testicles were lowered. In 10 cases, one laparoscopic intervention for lowering the testicles was sufficient. In 10 cases, laparoscopic surgery showed that the vas deferens and the spermatic vessels reunified in the inguinal; so that, Inguinal exploration was necessary. The time of hospitalisation was 24 h with no complications noticed. We present this work to sensitise the surgeons on the new therapeutic approach to optimise the taking care of cryptorchid boys.

[Renal hydatid cyst in children: report of 6 cases]. / Le kyste hydatique du rein chez l'enfant: a propos de 6 cas.

Echinococcosis or hydatid cyst disease of the kidney is extremely rare in children and constitutes only 2-4% of all cases of hydatid disease. We present six pediatric case of hydatid cyst of the kidney. The presentation is a cystic space occupying lesion of the kidney. Three patients have another involvement (lung, liver, and brain). Several diagnostic methods are available, ultrasonography may be sufficient. Surgical conservative treatment is still necessary, range from excision of the cyst. Significant surgical morbidity can be expected.

["Small left colon" syndrome (two case reports)]. / Le syndrome du "petit côlon gauche" (à propos de deux cas).

CASE REPORTS: Two newborns, one female and male were treated for neonatal bowel obstruction. A contrast enema led to the diagnosis of small left colon syndrome and treated those newborns successfully. CONCLUSION: Small left colon syndrome is a very rare cause of neonatal bowel obstruction. The diagnosis and treatment are assured by a simple contrast enema.

[The square pronator: an "aspirin" strip in antalgic surgery for painful neuromas of the wrist]. / Le carré pronateur: un lambeau "aspirine" dans la chirurgie antalgique des névromes douloureux au poignet.

From June 96 to January 2001, 25 patients have been operated on for painful neuromas localised at the wrist. They were between 10 and 52 years of age. These neuromas were located in at the median nerve 17 cases, at the ulnar nerve in seven cases and at the radial nerve in one case. In all cases the pain was not spontaneous but triggered off by external stimulus. All these neuromas were in continuity except 1 case at the median nerve where a total severing was present. After external neurolysis, the quadratus pronatus muscle is wrapped around the neuromas in 24 cases and around epineurial suture in one case. No internal neurolysis was done. This flap was vascularized by the anterior interosseous artery in 23 cases and by the posterior interosseous artery in two cases of distal ulnar nerve neuroma. All patients have been improved by using this method. In 21 cases (84%) (17 median, 4 ulnar nerves) the pain has completely disappeared and in four cases (3 ulnar, 1 radial), the pain has considerably decreased but without total disappearance. In the cases of median nerve neuromas the dysaesthesia has greatly decreased. No complications and no sequelae on the donor site are reported.