Performance Enhancement of Kaolin/Chitosan Composite-Based Membranes by Cross-Linking with Sodium Tripolyphosphate: Preparation and Characterization.

A new family of environmentally friendly and low-cost membranes based on readily available mineral and polymeric materials has been developed from cast suspensions of kaolin and chitosan using aqueous phase separation and polyethylene glycol as a pore-forming agent. The as-fabricated membranes were further cross-linked with sodium tripolyphosphate (STPP) in order to strengthen the properties of the obtained samples. The functional groups determined by FTIR and EDX confirmed that the reaction occurred. A detailed study of the effects of cross-linking time on the physicochemical, surface and permeation properties showed that a 30-minute reaction enabled the composite membrane to be stable in acidic media (up to pH 2) and increased the mechanical strength twofold compared to the non-cross-linked membrane. A similar morphology to that generally observed in polymeric membranes was obtained, with a sponge-like surface overlaying a finger-like through structure. The top layer and cross-section thicknesses of the membranes increased during STPP post-treatment, while the pore size decreased from 160 to 15 nm. At the same time, the molecular weight cut-off and permeance decreased due to the increase in cross-linking density. These results observed in a series of kaolin/chitosan composite membranes showed that STPP reaction can provide control over the separation capability range, from microfiltration to ultrafiltration.

[Dobutamine speckle tracking imaging for evaluation of microvascular dysfunction in a patient with exertion dyspnea]. / Dysfonction microcirulatoire coronaire et 2D strain à la dobutamine chez un patient dyspnéique.

Microcirculatory dysfunction despite the absence of angiographically obvious significant coronary artery disease may potentially generate symptomatic myocardial ischemia; comprehensive assessment both noninvasive and invasive could prove to be of critical interest. We report the case of a 54-year old patient referred for an exertion dyspnea that proved to be caused by both micro and microvascular dysfunction. We present key elements for diagnosis, functional evaluation and management and demonstrate the potential role of speckle tracking imaging in that setting.

[Cardiac metastasis of a lung adenocarcinoma mimicking atrial myxoma]. / Métastase cardiaque d'un adénocarcinome pulmonaire mimant un myxome atrial.

Secondary cardiac tumors constitute a rare and severe pathology usually associated with an advanced-stage of the primary cancer and consequently correlated to dark prognosis. Clinical presentations are variable and potentially misleading. We present the case of a 76-year-old woman in whom initial echocardiographic presentation evocated left atrial myxoma though the final diagnosis was pulmonary adenocarcinoma invasion. We describe the clinical scenario, the management and we perform a brief littérature review.

[Intracoronary adenosine induced-atrial fibrillation during fractional flow reserve evaluation]. / Fibrillation atriale induite par une injection intracoronaire d'adénosine pendant une évaluation de la « fractional flow reserve ¼.

Fractional flow reserve (FFR) measurement for functional evaluation of haemodynamic relevance of coronary artery stenoses is a well established and straightforward method applied on daily basis in cardiac catheterization laboratory; it is known to be reliable, reproducible and secure associated with a low rate of adverse events. We report the case of a 68-year-old man with no history of arrhythmias in whom intracoronary injection of adenosine for FFR assessment immediately induced atrial fibrillation mandating hospitalization for pharmacological cardioversion.

[Cocaine-induced acute myocarditis]. / Myocardite aiguë induite par la cocaïne.

Cocaine is a potent sympathomimetic drug usually associated with cardiotoxicity, including ventricular arrhythmia, systemic hypertension and acute myocardial infarction. It constitutes the most frequent cause of drug-related death reported by medical examiners in the US, and these events are most often related to the cardiovascular manifestations of the drug. However; to the best of our knowledge; cocaine induced acute myocarditis has very rarely been reported. We describe the case of a 19 year-old male regular user of marijuana and cocaine who was admitted for a suspicion on an acute lateral-wall myocardial infarction and in whom the final diagnosis of acute cocaine myocarditis has been made. We report diagnosis modalities and evolution.

Functional repercussion of polyarthrosis of the elderly in tunisia.

INTRODUCTION: Osteoarthritis (OA) is the most common degenerative joint disease in the elderly. The often multifocal location at this age can be a source of pain, limitation of everyday activities, thus affecting their quality of life. AIM: To evaluate functional status of aged people with generalized OA in Tunisia, and to detect the main factors associated with a poor function in order to optimize their medical care. METHODS: A cross-sectional, descriptive study done between January and March 2017. Fifty patients were included, aged 65 years and over followed for generalized osteoarthritis. The functional repercussions of polyarthrosis was assessed by functional independence measure (FIM), the Lequesne Algofunctional Index, the Womac index for hip and knee OA, and the Oswestry questionnaire for low back pain. RESULTS: The mean age of patients was 71.94 ± 0.8 years with a sex ratio of 0.42.The functional status of patients with polyarthrosis were altered to varying degrees. The most impaired dimensions of FIM were self-care, transfers and locomotion. Activities of daily living of the Lequesne index was the most impaired section with an average of 5.28. The three dimensions of the Womac index were affected, particularly the pain section with an average of 49.18/100. The Oswestry index was altered with an average of 18.89 / 40. Factors associated with poor functional status were: Female gender (p<0,05), age of development (p<0,05), spinal arthrosis (p<0,05) and history of falls(p<0,05). CONCLUSION: Polyarthrosis is accompanied by functional impairment in the elderly. Factors associated with functional impairment should be considered in the Patient Management Program.

[Adipose epicardial tissue association with subclinical systolic dysfunction detected by longitudinal strain in diabetic patients with poor glycemic control]. / Association entre tissu adipeux epicardique et dysfonction systolique infraclinique détectée par strain longitudinal chez les diabétiques mal équilibrés.

OBJECTIVE: The aim of this study is to assess the association between epicardial adipose tissue (EAT) and infraclinical myocardial dysfunction detected by strain imaging in diabetic patients (T2DM) with poor glycemic control. METHODS: 22 patients with T2DM and 22 healthy control subjects of similar age and sex were prospectively recruited. Echocardiographic parameters were investigated. RESULTS: In comparison to controls, diabetic patients had significantly higher body mass index (27.7 vs. 24.6; P<0.01), waist perimeter (103 vs. 84; P<0.001) and usCRP level (5.4 vs. 1.5; P<0.01). On echocardiography; no differences were found in terms of ejection fraction or ventricular mass; however, patients with T2DM had significantly thicker EAT (8.7±0.7 vs. 3.0±1.0; P<0.001) and altered systolic longitudinal strain (-18.8±3.2 vs. 22.3±1.6; P<0.001). On multivariate analysis, EAT was identified as an independent contributor (ß=0,46, P=0.001) to systolic longitudinal strain. CONCLUSION: In patients with T2DM and poor glycemic control; EAT was associated with infraclinical systolic dysfunction evaluated by global longitudinal strain despite normal at rest ejection fraction and no coronary artery disease.

[Impressive extension into the right heart cavities and the inferior vena cava of renal carcinoma]. / Envahissement tumoral extensif des cavités droites et de la veine cave inférieure par un cancer rénal.

Renal carcinoma is an aggressive cancer with a high metastatic tendency. It may invade the renal vein, inferior vena cava and potentially extend in some cases to the right heart cavities. We report a case of a 71-year-old male presenting with an impressive polylobular tissular mass inside the right atrium and the right ventricle revealing an aggressive renal carcinoma extending through the inferior vena cava.

[Lead-related infective endocarditis with massive vegetation causing severe functionnal tricuspid stenosis]. / Sténose tricuspide fonctionnelle sévère occasionnée par une importante végétation suite à une endocardite sur sonde de pacemaker.

Lead-related infective endocarditis with negative hemocultures constitutes a severe condition potentially associated with a pejorative prognosis. It may induce a functional tricuspid stenosis caused by an important obstructive vegetation. We report the case of an 82 year-old woman in whom the lead-related endocarditis produced massive vegetation causing a severe functional tricuspid stenosis. We describe the medical history, diagnosis and treatment.

[Stress dobutamine echocardiography or resting strain rate imaging to unveil an early symptomatic diabetic cardiomyopathy?] / Échocardiographie à la dobutamine ou étude de la déformation longitudinale au repos pour démasquer une cardiomyopathie diabétique débutante symptomatique ?

Diabetes mellitus has been associated with changes in the structure and function of the myocardium manifesting in the early stages of the disease as subtle systolic and diastolic dysfunction; myocardial strain imaging has recently been favored over dobutamine stress echocardiography for early detection of diabetic cardiomyopathy. We report a case of an elderly diabetic patient presenting with pulmonary edema in whom at rest echocardiographic parameters including strain rate were all within normal range, while dobutamine stress echocardiography induced a deep systolic deterioration unmasking an early-stage diabetic cardiomyopathy.

[Massive intraatrial mass?] / Panique dans l'oreillette.

Posterior mediastinal hematoma in a rare and potentially lethal disease and is frequently consecutive to a traumatism. We report the original case of a 88-year-old male admitted to our department for lipothymia and syncope related to a severe compression of the left atrium by an important mediastinal hematoma mimicking in transthoracic echocardiography an obstructive intraatrial mass.

[Atypical form of cor triatrium in a 59-year-old man]. / Forme atypique de cœur triatrial chez un patient de 59ans.

Cor triatrium is a rare congenital heart disease typically diagnosed amongst very young patients. Delayed diagnosis in the elderly is much more unusual. We report the case of a 59-year-old male with unremarkable medical history in whom we have discovered, on an echocardiography performed for an exploration of transient ischemic accident with atrial fibrillation, a particular form of an isolated cor triatrium dextrum investigated with multimodality imaging.

[Prethrombus acute constitution during dobutamine stress echocardiography]. / Formation de préthrombus lors d'une échocardiographie de stress à la dobutamine.

Although generally regarded as a safe stress modality, dobutamine stress echocardiography (DSE) has been associated with several well described complications. However, to our knowledge, acute constitution of thrombi during the stress test has never been described. In this report, we present the case of a 64 year-old man with a history of ischemic heart disease who underwent a preoperative DSE; during the test, we witnessed a striking acute constitution of an intense prethrombotic state with almost a formation of a highly mobile massive thrombus adjacent to the infero-apical segment spontaneously resolving few minutes after the end of the test.

[Male sexuality after external continent urinary diversion type Mitrofanoff]. / Étude de la sexualité masculine après dérivation urinaire externe continente de type Mitrofanoff.

OBJECTIVE: To evaluate the influence of continent external urinary diversion type Mitrofanoff on male sexuality. MATERIAL AND METHODS: Between 1992 and 2011, 140 patients underwent continent urinary diversion type Mitrofanoff at an academic hospital. Among 76 men, 46 were interviewed about their sexuality after this operation. This study was performed using a set of validated questionnaires (IIEF, DAN PSS and Urolife), grouped by the model of the CTMH. Patients were divided according to their marital status: group 1: patients married before surgery (15 cases), group 2: patients married after surgery (7 cases) and group 3: singles (24 cases). RESULTS: In the first group, the functional dimension of sexuality was positive with an overall score of 81%, the sexual discomfort score was assessed at 26 % and the sexual satisfaction score was 77%. In the second group, sexual function was considered conserved in all cases with a satisfaction score estimated at 98%. These patients reported a feeling of well-being following the disappearance of urinary incontinence with integrity of their body images. In contrast, in the last group, relatively impaired sexual function was noted (65%) with a satisfaction score estimated at 59%. These disorders were multifactorial, mainly related to neurological causal pathology. CONCLUSION: To our knowledge, this is the first study about male sexuality in patients with a continent urinary diversion type Mitrofanoff. Marital status has a major role in the sexuality of these patients. A prospective study with pre- and postoperative evaluation will better clarify the factors affecting sexuality in these patients.

[Biphasic reaction to dobutamine stress echocardiography as a predictor of coronary artery spasm: Apropos of 3 cases]. / La réaction biphasique en échocardiographie de stress à la dobutamine comme facteur prédictif de spasme coronaire: à propos de 3 cas.

Dobutamine-related coronary spasm is a possible complication of dobutamine stress echocardiography potentially explaining a part of some erroneously labeled "false positive tests". Presently, there are no established echographic predictors of coronary spasm. We report 3 clinical cases in which dobutamine-induced spasm was strongly suspected on the basis of a biphasic reaction including an initial deterioration rapidly followed by a spontaneous recovery in well-defined echocardiographic territory. In all three cases, we were able to confirm spasm of angiography. The biphasic reaction may constitute a potential predictor of spasm in patients with positive dobutamine stress tests.

[Dobutamine-related coronary spasm among patients with false positive dobutamine stress echocardiography: Prevalence and predictors]. / Le spasme coronaire lié à la dobutamine chez les patients avec des échocardiographies de stress faussement positives: prévalence et facteurs prédictifs.

BACKGROUND AND OBJECTIVE: Dobutamine stress echocardiography (DSE) is being consistently used as an exercise-independent stress modality aimed at the detection of coronary artery disease (CAD) and the evaluation of myocardial ischemia. It may though occasionally induce coronary vasospasm. In this study, we aimed to evaluate the prevalence and predictors of dobutamine-related coronary spasm in patients without known CAD and false positive DSE (positive DSE but no significant coronary lesions on angiogram). METHODS: Three thousand nine hundred and fifty-two patients referred to our echocardiography laboratory for DSE between January 2010 and May 2012 were prospectively investigated. Those with positive DSE underwent coronary angiograms with systematic methylergometrine intracoronary injection in case of absence of significant coronary stenosis or spontaneous occlusive coronary spasm. Patients with spontaneous occlusive coronary spasm or positive methylergometrine test but no significant stenoses were enrolled and compared with those with positive DSE but no coronary lesions nor spontaneous or induced spasm ("true" false positive DSE). RESULTS: Twenty-nine patients with DSE-related vasospasm (19.4% of positive DES without known CAD) were compared with 56 patients with no lesions and no spasm ("true" false positive DSE). They were more frequently smokers (72.4% vs 37.5%; P=0.003); they had more frequently dyslipidemia (79.3% vs 43%; P=0.001); they also had a larger ischemic area at peak DSE (3.4 segments vs 2.7 segments; P=0.05). On multivariate analysis, dyslipidemia (HR=10.7; 95% CI=[2.7-42.1]; P=0.001) and active smoking (HR=6.1; 95% CI=[1.7-21.1]; P=0.004) were found to be independent predictors of spasm-related DSE rather than "true" false positive DSE. CONCLUSION: DSE-related coronary spasm is present in a significant proportion of patients with erroneously labelled "false" positive DSE and should systematically be ruled out. Dyslipidemia and active smoking were independent predictors of spasm rather than "true" false positive DSE.

[High pressure trap]. / Piège à haute tension.

Pheochromocytoma is a rare tumor potentially life-threatening and associated with non specific and diverse symptomatology. Cardiac symptoms may mislead diagnosis; they could manifest as myocardial sideration concomitant to a hypertensive peak or supraventricular arythmia. We report a case of pheochromocytoma associated with hypokaliemia revealed by a myocardial ischemia with acute cardiac failure and severe left ventricular depression and complete reversal after surgery.