ABSTRACT
INTRODUCTION: Retroperitoneal fibrosis is a rare disease, typically with an insidious and various clinical course. The peak incidence is seen in patients 40 to 60 years of age and mostly in man. The characteristic finding in this disease is a periaortic fibrous mass that often surrounds the ureters. The diagnostic approach remains uncodified. We aimed to determine the different clinical, radiological and biological aspects of retroperitoneal fibrosis. PATIENTS AND METHODS: Retrospective multicenter study of 32 retroperitoneal fibrosis cases hospitalized between 1999 and 2014 in the Internal Medicine Department and Urology Department in the university hospital center Sahloul Sousse. RESULTS: There were 24 men and 8 women with a mean age of 58 years. The lumbar pain is the most common clinical signs (53.1%). An inflammatory syndrome and renal failure were the most common biological signs. The diagnosis was suspected on data from the abdominal ultrasound and confirmed by pelvic CT scan that showed a periaortic fibrous mass that often surrounds the ureters. Histological analysis of a surgical biopsy specimen was performed in only eight cases. CONCLUSION: The most common mode of presentation of retroperitoneal fibrosis remains lumbar pain with renal failure and a high sedimentation rate. Although abdominal ultrasound may contribute to the general evaluation of patients with retroperitoneal fibrosis, CT-scanner is the preferred imaging method. The imaging capability of magnetic resonance and the TEP-scan may facilitate assessment of disease extent. LEVEL OF EVIDENCE: 4.
Subject(s)
Low Back Pain/etiology , Renal Insufficiency/etiology , Retroperitoneal Fibrosis/diagnosis , Adult , Aged , Aged, 80 and over , Biopsy/methods , Female , Humans , Magnetic Resonance Imaging/methods , Male , Middle Aged , Retroperitoneal Fibrosis/physiopathology , Retrospective Studies , Tomography, X-Ray Computed/methods , Young AdultABSTRACT
Seizures are one of the most serious neuropsychiatric manifestations of systemic lupus erythematous (SLE). This descriptive and retrospective study aims at describing clinical and paraclinical features and therapeutic approach of seizures in patients with SLE. The characteristics of the seizure group was compared to those of a control group (patients with LES who had not presented seizures). A total of 177 patients were included in these analyses. Among them, 14 (8 %) developed seizures before, at or after the SLE diagnosis. The age of occurrence of seizures was younger than for other complications of the disease. There was no significant association with the antiphospholipid syndrome. Disease activity in these patients was significantly higher than in the control group. During the follow up, the subjects being under anticonvulsants and/or corticosteroids and/or immunosuppressive therapy, we observed good outcomes (n=5), re-occurence of seizures (n=4), cognitive impairment (n=3 ) and death (n=2). Our study shows that seizures tend to occur early in the course of SLE, in the context of important disease activity and other serious clinical manifestations and in younger individuals. Seizures portend a negative impact on the overall long-term prognosis and quality of life in patients with SLE.
La comitialité est une des manifestations neurologiques les plus sévères du lupus érythémateux systémique (LES). Notre objectif est de décrire les caractéristiques des épilepsies chez les patients lupiques. Dans une étude rétrospective descriptive, les données cliniques et paracliniques des patients lupiques présentant une épilepsie ont été comparées à celles des patients lupiques n'ayant pas présenté de crises convulsives. Nous avons recensé 177 patients lupiques dont 14 (8 %) avaient présenté une épilepsie avant, au moment ou après le diagnostic de LES. L'âge de survenue des épilepsies était plus jeune que celui des autres manifestations. L'association à un syndrome des antiphospholipides n'était pas significative. Les patients lupiques présentant une épilepsie avaient un score d'activité de la maladie lupique (SLEDAI) significativement plus élevé que celui du groupe contrôle. L'évolution était marquée par la disparition des crises convulsives (n=5), la récidive (n=4), l'installation de troubles cognitifs (n=3 ) et le décès (n=2). Cette étude montre que la comitialité tend à survenir de façon précoce au cours du LES, aggravant alors le pronostic fonctionnel et vital. Elle associe un SLEDAI assez élevé ainsi qu'un âge de survenue plus jeune.
Subject(s)
Lupus Erythematosus, Systemic/complications , Seizures/etiology , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
Irrigation with treated wastewater (TWW) is a vital alternative for arid and semi-arid lands but it poses pollution-risk to soil, vegetation and groundwater. Therefore, in the present study, in vitro bioassays were used to evaluate the adverse effects of TWW and irrigated-soil extract sample, on mammalian cells, with respect to heavy metal--Ni, Cd, Pb, Fe, Al-content. The heat shock protein (HSP) 47, E-screen, and transepithelial electrical resistance (TEER) assays served to investigate the stress response of treated-HSP47-transfected Chinese hamster ovary (CHO) cells, the estrogenic activity of the samples in MCF-7 breast cancer cells, and the barrier function (BF) of Caco-2 cells. Furthermore, proteomics analyses were performed to shed light on involved mechanisms and to establish pollution biomarkers. Results showed that the TWW elicited a stress response on HSP cells from 0.1% concentration while soil extract samples exhibited a stress at 1%. TWW induced an estrogenic activity at 10%; up-regulating cell proliferation and tumor-related proteins. Soil extract triggered the enhanced expression of HSP70 family proteins as survival mechanisms against their cytotoxicity toward MCF-7 cells. Moreover, depending on the concentration, 1% of soil extract from 20 cm depth (T20) resulted in a disruption of BF in Caco-2 cells involving cell metabolism, protein synthesis and tumor marker proteins, whereas, 5% of T20 induced the expression of BF-related proteins associated to heat shock, oxidative stress, cell proliferation and glycolytic metabolic pathway. These biological techniques were found to be extremely useful to evaluate the impact of wastewater reuse and to establish specific biomarkers that are common proteins for humans, other mammals and plants. Future studies should focus on exposure quantifications.