[Morphometric analysis of the human endometrium during the implantation window. Light and transmission electron microscopy study]. / Analyse morphométrique de l'endomètre humain en période d'implantation. Étude en microscopie optique et en microscopie électronique à transmission.

OBJECTIVES: To perform a morphometric and ultrastructural analysis of the various cellular components that constitutes the endometrial epithelium during the implantation window. METHODS: Endometrial biopsies of six patients in ageing to procreate were realized during the implantation window and analyzed using light and transmission electron microscopy (TEM). RESULTS: During the implantation window, four endometrial cell types are identified in distinct proportions: microvilli-rich cells, pinopode cells, ciliated cells and others without apical differentiation. We highlighted important differences between surface and glandular epitheliums. Pinopode cells are present in all biopsies; they are more frequent in glands than surface. Their maximum expression in the glandular epithelium is at the day 20 and in the surface epithelium at the day 22. The pinopodes are present since day 19, they appeared fully developed with a maximum at day 22. Using TEM for ultrastructural analysis, we showed images of endocytosis and numerous secretory vesicles in epithelial cells of the endometrium. Their plasmic membrane present apical differentiations in the form of microvilli covered with a very developed cell coat indicating a high activity of exchange with the extracellular compartment. The endometrial cells exhibit extensive signs of communication between neighboring cells appeared to be preserved. CONCLUSION: Our data suggest each cell type and each cell structure as a very precise function in order to prepare the endometrium to be receptive.

[An exceptional localization of an intraosseous haemangioma]. / Une localisation exceptionnelle d'un hémangiome intraosseux.

The intraosseous capillary haemangioma is classified as a benign vascular bone tumor. It is extremely rare in the hand. We present the case of a carpometacarpal capillary haemangioma involving the capitate and the bases of third and fourth metacarpals. To our knowledge it is the first case reported at this site.

Bizarre Parosteal Osteochondromatous Proliferation: Nora's Lesion.

The purpose of this study was to review the imaging and anatomopathologic findings and to discuss the main differential diagnosis of bizarre parosteal osteochondromatous proliferation (BPOP) or Nora's lesion, a rare benign surface lesion of the bone. Histologically confirmed plain radiographs, ultrasound, CT and MRI images of four patients with BPOP were obtained and retrospectively reviewed. Three cases involving the hand and one involving the foot are reported. On plain radiographs, BPOP is a wellmarginated, calcified or ossified mass arising directly from the cortical surface of the underlying bone. Ultrasound images show a low echoic peripheral cap around the lesion. CT images show the wide base of the lesion. On MRI, BPOP was of a low signal on T1, enhancing following gadolinium administration. Underlying bone and adjacent surrounding soft tissues were normal.

[Intestinal and hepatic subcellular localization of aluminium and indium administered orally to rat]. / Localisation subcellulaire intestinale et hepatique de l'aluminium et de l'indium administres par voie orale chez le rat.

Aluminium and indium are two elements used in industrial and medical fields. The purpose of this work was to study the subcellular localization of these elements, after their single and simultaneous oral administration to rats. 2h after the administration of these two elements, the small intestine and the liver were removed.Ultrastructural study showed the presence of electron dense deposits in the lysosomes of apical parts of duodenal enterocytes. When the minerals were administered simultaneously, deposits were observed in lysosomes of duodenal and jejunal enterocytes. No deposits were seen in the hepatic tissue of treated and control rats. Microanalysis identification showed that the deposits are constituted of aluminium, indium as well as phosphorus. Our results suggested that the elements are concentrated, in lysosomes, under the form of insoluble phosphate salts and it seemed that there are no specific lysosomes for the concentration of minerals since the two elements were concentrated in the same lysosome when they are administered simultaneously.

[Cervicobrachial neuralgia revealing neurosarcoma]. / Névralgie cervicobrachiale révélatrice d'un neurofibrosarcome (MPNST) cervical.

Malignant peripheral nerve sheath tumor (MPNST) or neurofibrosarcoma, previously described as malignant Schwannoma or neurosarcoma, is an extremely rare cause of malignancy localized in the neck. Half of reported cases occurred in patients with neurofibromatosis in Von Recklinghausen disease type I. Typical features include high grade malignancy and a tendency to recurrence and distant metastases. We report the case of a 56-year-old woman with neurosarcoma of the neck, which was revealed by a cervicobrachial neuralgia. The physical examination found a mass on the left side of the neck. Plain radiographs showed osteoarthritis. MRI showed a well-defined paravertebral mass. Pathologic diagnosis was neurosarcoma. Radiotherapy was delivered.

[Kindler syndrome: three cases reports in three siblings]. / Syndrome de Kindler: trois cas dans une même fratrie.

INTRODUCTION: Kindler syndrome is a rare type of genetic skin condition belonging to the class of bullous poikilodermia. We report three new cases of this rare syndrome. CASE REPORTS: This condition was seen in two brothers aged 4 and 14 years and in their sister aged 6 years, born of a first-degree consanguineous marriage in a family with Kindler syndrome of varying degrees of severity. The three patients presented spontaneously regressive bullous eruptions, poikilodermia of gradual onset, major cutaneous atrophy on the back of the hands and the feet, pseudo-syndactyly and photosensitivity. The older brother presented a severe form complicated by chronic terminal renal failure with hydronephrosis secondary to urethral stenosis and hypertension as well as oesophageal stenosis requiring dilatation sessions. Electron microscopy examination of poikilodermic skin showed normal anchoring filaments and proliferation of the basal layer. Electron microscopy examination of rubbed poikilodermic skin from the other two siblings showed cleavage at both the superficial and deep intra-epidermal levels. DISCUSSION: Diagnosis of Kindler syndrome is based upon clinical evidence. Electron microscopic examination is used in particular to rule out congenital bullous epidermolysis. Detachment of layers at two or three different levels in relation to the dermal-epidermal junction described in the literature forms a specific but inconsistent feature of Kindler syndrome.

[Hereditary epidermolysis bullosa in Tunisia: an epidemio-clinical and ultrastructural study]. / Les epidermolyses bulleuses héréditaires en Tunisie: etude epidémio-clinique et ultra-structurale.

Hereditary epidermolysis bullosa (EB) are a group of genodermatoses whose common primary feature is formation of blisters following minor trauma. The aim of the present study was to assess epidemiological, clinical, genetical and histological particularities of patients with hereditary epidermolysis bullosa.

Enquete sur l'etat bucco-dentaire des enfants prescolarises a Montastir (Tunisie 2001)

Elabore en collaboration avec le Croissant Rouge; notre travail vise a etudier les affections bucco-dentaires en denture temporaire et a promouvoir la prevention par une enquete epidemiologique menee en milieu prescolaire a Monastir (Tunisie) aupres de 1991 enfants ages de 3 a 5 ans (1029 garcons et 962 filles). Les resultats revelent que 62d'entre eux possedent une brosse a dents ; cependant 50ont une hygiene insuffisante et la carie dentaire constitue chez eux l'affection la plus frequente avec un taux de 36. La malocclusion touche 31d'entre eux. Ces prevalences s'aggravent en denture permanente comme l'a montre la derniere enquete nationale en milieu scolaire. Ceci demontre l'importance de la prevention bucco-dentaire en denture temporaire chez des enfants qui constituent; par leur receptivite; une cible privilegiee

[Histology of the larynx]. / Histologie du larynx.

The mucous membrane lining the interior of the larynx was studied in autopsy specimens taken from 21 infant larynxes, with ages ranging from 1 to 15 years. Only those larynxes in which the epithelial mucosal structures were preserved were set aside for study. A standard histological technique was applied. Paraffin sections were stained with haematoxylin-eosin, PAS, Masson's triple stain and orcine. The epithelium of the ventricles, ventricular bands and subglottis was found to be of respiratory type. On the vocal folds, the lining was non-keratinising squamous epithelium. These findings are consistent with those found in the literature. Findings that differed were as follows: the laryngeal surface of the epiglottis is classically described as having a respiratory type of epithelium, whereas we found it to be of non-keratinising stratified squamous type. The literature describes the epithelium of the ventricular bands as respiratory. While in our series we found stratified squamous in 56% and respiratory in 44%. Other findings are imprecise in the literature, and need definition; the finding of taste papillae in six cases without age correlation; and the richness of follicles in the lymphoid tissue at the epiglottis and ventricles of children aged more than 3 months.

Predictive value of severity scoring systems: comparison of four models in Tunisian adult intensive care units.

OBJECTIVES: To compare the performance of four severity scoring systems: the Acute Physiology and Chronic Health Evaluation (APACHE) II, the new versions of the Mortality Prediction Model (MPM0 and MPM24), and the Simplified Acute Physiology Score (SAPS) II. DESIGN: A prospective cohort study. SETTING: Three Tunisian intensive care units (ICUs). PATIENTS: Consecutive, unselected adult patients (n = 1325). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Overall, observed death rates were higher than predicted by all models except MPM0. All the evaluated scoring systems had good discrimination power as expressed by area under the receiver operating characteristics curve, but their calibration was less perfect when compared with original validation reports. There were no major differences between the models with regard either to discrimination or calibration performance. CONCLUSION: Despite an overall good discrimination, APACHE II, MPM0, MPM24, and SAPS II showed a less satisfactory calibration in our Tunisian sample of ICU patients. Part of the models inaccuracy could be related to quality of care problems in our ICUs, but this issue needs further analysis.

Right ventricular dysfunction following severe scorpion envenomation.

OBJECTIVE: Evaluation of right ventricular (RV) performance in patients presenting with pulmonary edema following scorpion envenomation. DESIGN: Cohort study. SETTING: Medical intensive care unit of a teaching hospital. PATIENTS: Eight consecutive adult patients stung by yellow scorpion Androctonus australis and presenting with pulmonary edema at hospital admission. INTERVENTIONS: In all patients, standard hemodynamic parameters and RV volumes were measured using a pulmonary artery catheter equipped with a rapid responding thermistor enabling measurement of RV ejection fraction (RVEF). MEASUREMENTS: Hemodynamic evaluation was performed at the time of hospital admission prior to any therapeutic intervention and just before the removal of the pulmonary catheter (2.3 +/- 0.5 days after admission) in the surviving patients (n = 7). RESULTS: All patients had a decreased RVEF (24 +/- 7%) and cardiac index (2.44 +/- 0.5 L/min/m2) and increased pulmonary artery occlusion pressure (23 +/- 6 mm Hg). Right ventricular end-systolic pressure/volume ratio was decreased (.56 +/- .19 mm Hg/mL/m2), suggesting an altered RV contractility. Follow-up evaluation performed in survivors, without any inotropic support, showed hemodynamic changes reflecting a trend toward full recovery. Right ventricular ejection fraction and cardiac index improved markedly (from 24 +/- 7% to 39 +/- 10% and from 2.44 +/- 0.5 to 4 +/- .3 L/min/m2, respectively). Pulmonary artery occlusion pressure, peak systolic pulmonary artery pressure, and mean pulmonary artery pressure decreased significantly from baseline values (12 +/- 3 mm Hg, 29 +/- 5 mm Hg, and 20 +/- 4 mm Hg, respectively). Right ventricular end systolic pressure/volume ratio remained almost constant, suggesting that afterload enhancement accounted predominantly for RVEF improvement. CONCLUSION: These data show that RV function impairment is associated with left ventricular dysfunction, suggesting similarities between left ventricular and RV alterations following severe scorpion envenomation providing further arguments to the hypothesis of scorpionic myocarditis.

Bone histomorphometry in 50 normal Tunisian subjects.

Quantitative bone histomorphometry was done on undecalcified sections of iliac crest bone specimens obtained at autopsy from 50 normal subjects (24 males and 26 females). The following parameters were measured: cortical thickness (Ct.Th), trabecular bone volume (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), osteoid volume (OV/BV), osteoid surfaces (OS/BS), osteoid thickness (O.Th) and eroded surfaces (ES/BS). There was a significant age-related decrease in BV/TV in both sexes which followed a x3 polynomial regression. A significant decrease of Tb.Th was noted in males after the fifth decade. In males, bone loss was 1.5% per decade, but in females it was 0.36% before menopausal period and 2% after. Other parameters were unrelated to age and sex.

Subcellular localization of gold in suprarenal testicle and thyroid glands after injection of allochrysine in rats.

Gold injected under the form of anti-rheumatoid polyarthritis soluble solutions provokes, as observed by electron microscope, a deposit of crystalline micro-needles in different tissues, like in cells of adrenal and suprarenal glands, in Leydig cells of the testicles, in isolated thyrocytes and in thyroid endothelial cells. They are present as bundles, often of incurvated type, of high electron-density, present in lysosomes, which contain moreover a hyaline, emptied vesicle. These structures are named "aurosomes". The microanalysis, using the MS 46 (Cameca) and the Camebax (MBX) demonstrates that these crystalline structures are composed by gold associated with sulphur, and not with phosphate.

[C-reactive protein in bacterial meningitis in adults]. / La protéine c-réactive dans les méningites bactériennes de l'adulte.

In order to assess the benefits of serial assays of C-reactive protein in the course of bacterial meningitis in adults, daily blood samples were taken for CRP measurement during 10 days in 21 consecutive patients (mean age: 24 +/- 8 years) hospitalized for bacterial meningitis principally due to Neisseria meningitidis (n = 15). The highest CRP level (178 +/- 38 mg/l) was present on admission, followed by a regular decrease occurring in uncomplicated meningitis until normal level was achieved on day 9. The CRP kinetics was not influenced by the type of causative micro-organism. This study shows that CRP kinetics in adults is similar to that reported in children. The benefit of CRP assays in optimizing the duration of antibiotic treatment of meningitis needs to be more carefully assessed.

[Malignant lymphoma on a gastric stump]. / Lymphome malin sur moignon gastrique.

We report a case of lymphoplasmocytic and immunoblastic gastric remnant lymphoma occurring in a 51 year-old male. This patient had undergone subtotal gastrectomy for a gastric peptic ulcer at age 37. Histologic findings in the initial gastric specimen showed a dense lymphoid infiltrate surrounding the ulcer within the gastric mucosa. This proliferation was grouped into distinct follicles, and was compatible with pseudo-lymphoma. The progression of pseudo-lymphoma to malignant lymphoma is suggested.