[Post-traumatic carotido-jugular fistula: Case report and review of the literature]. / Fistule carotido-jugulaire post-traumatique : à propos d'un cas opéré.

The neck, being not protected by skeleton, is vulnerable to external trauma and injury which can involve blood vessels, muscles, nerves, and trachea. Carotid injuries can be potentially life-threatening by hemorrhage and stroke. We present a case of a 26-year-old manual worker who presented a neck injury caused by a metallic projectile. The injury involved the right common carotid artery with an internal jugular vein fistula, and tracheal damage. The patient was managed with surgical repair of the tracheal lesion, reconstruction of the carotid section using a PTFE graft bypass, and ligation of the internal jugular vein. In the immediate postoperative period, the patient presented with no neurological deficits, but he did develop a pulmonary infection that resolved with antibiotic therapy. The follow-up is now 3months. The patient is doing well without any neurological disorder.

[Evaluation of stress among emergency staff: survey in a Tunisian emergency department]. / Évaluation du stress chez le personnel des urgences : enquête dans un service d'urgences tunisien.

OBJECTIVES: The objectives of this work were to make an inventory of the stress level, to detect various stressors and to describe the working conditions as perceived by staff to pinpoint the factors that might be changed. STUDY DESIGN: This survey was conducted from July to August 2012 in all sectors of the emergency department. We used the Karasek model. Collected data were demographic and professional. RESULTS: We included 107 participants, which represent 61.5% of the whole staff. The median age of participants was 30 years with a male predominance (66%). Scores found place our sample in the dial of "job strain". Only 17.8% of participants were found to be active. No significant correlation between gender, marital status, seniority and emergency risk of developing stress state was found. Age under 30 years (P=0.04) and low social support by supervisors (P=0.02) were predictive of developing stress. Job satisfaction was lower among paramedics. In multivariate analysis, they were much more sensitive to psychological demands that the doctors. CONCLUSION: This study could be used to show the importance of preventing this emotional exhaustion in order to improve the quality of health care providers but also the care given in this service.

[Creation and report of the Tunisian Fanconi Anemia Registry (TFAR)]. / Création et rapport du registre tunisien de l'anémie de Fanconi (TFAR).

INTRODUCTION: Fanconi anemia (FA) is a genetically and phenotypically heterogeneous inherited disease. Many groups have established FA registries. In Tunisia, in collaboration with the Tunisian Fanconi Anemia Study Group (TFASG), we set up the Tunisian Fanconi Anemia Registry (TFAR). PATIENTS AND METHODS: We contacted all hematology and pediatrics departments to include their FA patients diagnosed between January 1983 and December 2008. The registry is available on the TFASG web site (www.fanconi-tunisie.net). RESULTS: Sorting the files brought out 142 patients belonging to 118 families. The mean age at diagnosis was 11 years. There was consanguinity in 86%, malformative syndrome in 91%, and pancytopenia at diagnosis in 69%. Of 28 patients, 95% belonged to the FANCA group. Androgen treatment was given in 109 cases and genoidentical bone marrow transplantation (BMT) in 27 patients. The diagnosis of a myelodysplastic syndrome was retained in 4%, acute leukemia in 6%, and a solid tumor in 2%. The median overall survival time in all patients is 17 years 5 months; it is significantly better in patients having received allografts (p=0.01). CONCLUSION: FA seems frequent in Tunisia, which is in part explained by the high consanguinity and endogamy in this country. Hematologic impairment is still the most frequent revealing circumstance of the disease. It is often severe or moderate and requires androgen treatment or bone marrow transplantation. BMT should be proposed to all patients with an HLA-compatible donor.

A randomised phase II study of the efficacy, safety and cost-effectiveness of pegfilgrastim and filgrastim after autologous stem cell transplant for lymphoma and myeloma (PALM study).

AIM: To evaluate in a multicentre randomised study the effect on duration of febrile neutropenia (FN), the safety and cost-effectiveness of a single subcutaneous pegfilgrastim injection compared with daily injections of filgrastim after peripheral blood stem cell transplantation in patients receiving high dose chemotherapy for myeloma and lymphoma. METHODS: Patients were randomly assigned to a single dose of pegfilgrastim at day 5 (D5) or daily filgrastim from D5 to the recovery of absolute neutrophil count (ANC) to 0.5 G/L. Duration of FN, of neutrophil and platelet recovery, transfusion and antibiotic requirements were the main end-points of the study. Costs were calculated from D0 until transplant unit discharge. The incremental cost-effectiveness ratio was expressed as the cost per day of FN prevented. Probabilistic sensitivity analysis was performed by non-parametric bootstrap methods. RESULTS: Between October 2008 and September 2009, 10 centres enrolled 151 patients: 80 patients with lymphoma and 71 patients with myeloma. The mean duration of FN was 3.07 days (standard deviation (SD) 1.96) in the pegfilgrastin arm and 3.29 (SD 2.54) in the filgrastim one. Mean total costs were 23,256 and 25,448 euros for pegfilgrastim and filgrastim patients, respectively. There was a 62% probability that pegfilgrastim strictly dominates filgrastim. CONCLUDING STATEMENT: Pegfilgrastim after PBSC transplantation in myeloma and lymphoma is safe, effective when compared with filgrastim and could represent a cost-effective alternative in this setting.

[Acute renal failure and rhabdomyolysis secondary to prolonged hunger strike. A case report]. / Grève de la faim prolongée compliquée d'une rhabdomyolyse et d'une insuffisance rénale aiguë. A propos d'un cas.

Acute renal failure following hunger strike has been rarely reported. We report a 47-year-old man, prisoner, who developed an acute renal failure secondary to hypovolemia and major rhabdomyolysis. Failure of hydration with persistence of oliguria and secondary pulmonary edema required hemodialysis with eventually a favorable outcome.

First Report of Cercospora tripolitana Causing Leaf Spot of Emex spinosa in Tunisia.

Emex spinosa (L.) is a common weed in cereal crops and pastures in northern Tunisia. The build up of the seed bank from a cropping-grazing farming system makes chemical and cultural controls inefficient. Biological control as part of integrated weed management may improve weed control. Diseased seedlings were collected from several locations in northern Tunisia during field surveys. Symptoms were small, circular, light brown leaf spots varying in size (1.75 to 3.5 mm in diameter) with a definite dark brown border on both sides of leaves that wilted and died. Microscopic observations showed conidiophores and conidia within and around the spots. Pure cultures from single conidia were obtained on carrot leaf extract agar. The fungus was identified as Cercospora tripolitana on the basis of identification keys described by Chupp (1). Conidia, borne on unbranched, fasciculated conidiophores, were elongate, hyaline, multiseptate, 110 to 150 × 1.8 to 3.7 µm (average 130 to 2.5 µm), and had truncate bases. For pathogenicity testing, six plants were sprayed with a spore suspension of 6 × 105 conidia/ml. Controls were sprayed with sterile distilled water. Plants were placed in a growth chamber at 22°C, 95% relative humidity, and 18/6 h of light/dark and monitored for symptoms. Ten days after inoculation, symptoms identical to those observed in the field were observed on inoculated plants. Control plants did not develop any symptoms. Four weeks later, diseased leaves turned yellow and died. The fungus was reisolated from symptomatic plants according to Koch's postulates. Although C. tripolitana has been previously reported in North and South Africa, to our knowledge, this is the first report of the fungus as a pathogen on E. spinosa under Tunisian agroecological conditions, making it a promising candidate for weed control. Reference: (1) C. Chupp. A Monograph of the Fungus Genus Cercospora. C. Chupp, Ithaca, New York, 1953.

Difference in time to positivity is useful for the diagnosis of catheter-related bloodstream infection in hematopoietic stem cell transplant recipients.

Catheter-related bloodstream infections are associated with recognized morbidity and mortality. Accurate diagnosis of such infections results in proper management of patients and in reducing unnecessary removal of catheters. We carried out a prospective study in a bone marrow transplant unit to assess the validity of a test based on the earlier positivity of central venous blood cultures in comparison with peripheral blood cultures for predicting catheter-related bacteremia. Between May 2002 and June 2004, 38 bloodstream infections with positive simultaneous central venous catheter and peripheral vein blood cultures were included. A total of 22 patients had catheter-related bacteremias and 16 had noncatheter-related bacteremias, using the catheter-tip culture/clinical criteria as the criterion standard to define catheter-related bacteremia. Differential time to positivity of 120 min or more was associated with 86% sensitivity and 87% specificity. In conclusion, differential time to positivity of 120 min or more is sensitive and specific for catheter-related bacteremia in hematopoietic stem cell transplant recipients who have nontunnelled short-term catheters.

[Primary intraosseous meningioma of the vault]. / Méningiome intra-osseux primitif de la voûte.

Primitive intra-osseous meningioma is a rare benign tumor. We report a case with a temporal localization and antro-attical extension into the petrous bone.