Intra-articular osteolipoma of the elbow: A case report and a review of the literature.

Introduction: Lipomas are the most common benign mesenchymal tumors. The intra-articular localization is exceptional.We report the first case of an intra-articular osteolipoma at the elbow. Case report: A 36-year-old patient with no pathological history, presented to the emergency room with a two weeks history of a painless, progressively left elbow swelling in a context of apyrexia.Physical examination revealed a hot, edematous left elbow. The gentle mobilization of the joint was painless. Biologie was normal. Initial radiograph showed a well-defined lobular image. Ultrasound revealed an anechoic intra-articular collection associated to a synovium hyperaemia and the MRI shows an aspect of synovitis. An arthrotomy was done via an internal approach of the elbow. Joint fluid was red. A free ossified intraarticular mass was discovered. Bacteriological samples were sterile. Histological examination concluded to an osteolipoma with no histological signs of malignancy. At the last 3-year follow-up, the patient didn't report any pain or functional discomfort. Elbow mobility was complete, with the absence of recurrences. Discussion: Osteolipoma is defined as a histological variant of lipoma having undergone bone metaplasia. Allen found 06 cases in a series of 635 lipomas over five years. Pain has not been reported in the literature. In our case the pain was explained by the interposition of the tumoral mass between the articular surfaces. Histological examination confirms the diagnosis and recurrences are rare. Conclusion: Osteolipoma is an extremely rare entity of mesenchymal tumors whose intra-articular location, although exceptional, does not worsen the prognosis.

A new model of short acceleration-based training improves exercise performance in old mice.

In order to identify a more appealing exercise strategy for the elderly, we studied a mouse model to determine whether a less time-consuming training program would improve exercise performance, enzyme activities, mitochondrial respiration, and metabolomic parameters. We compared the effects of short-session (acceleration-based) training with those of long-session endurance training in 23-month-old mice. The short-session training consisted of five acceleration-based treadmill running sessions over 2 weeks (the acceleration group), whereas the endurance training consisted of five-one-hour treadmill sessions per week for 4 weeks (the endurance group). A control group of mice was also studied. In the acceleration group, the post-training maximum running speed and time to exhaustion were significantly improved, relative to pretraining values (+8% for speed, P<.05; +10% for time to exhaustion, P<.01). The post-training maximum running speed was higher in the acceleration group than in the endurance group (by 23%; P<.001) and in the control group (by 15%; P<.05). In skeletal muscle samples, the enzymatic activities of citrate synthase, lactate dehydrogenase, and creatine kinase were significantly higher in the acceleration group than in the endurance group. Furthermore, mitochondrial respiratory activity in the gastrocnemius was higher in the acceleration group than in the control group. A metabolomic urine analysis revealed a higher mean taurine concentration and a lower mean branched amino acid concentration in the acceleration group. In old mice, acceleration-based training appears to be an efficient way of increasing performance by improving both aerobic and anaerobic metabolism, and possibly by enhancing antioxidant defenses and maintaining muscle protein balance.

Essential oil and trichome density from Origanum majorana L. shoots affected by leaf age and salinity / Óleo essencial e densidade do tricoma dos rebentos da Origanum majorana L. afetados pela idade da folhagem e pela salinidade

Essential oil (EO) from Origanum majorana L. (Lamiaceae) shoots, extracted by hydrodistillation from plant cultivated under control and salt conditions. Essential oil composition was determined by GCMS. Plant material was harvest at three vegetative stages; early (EVS), late (LVS) and early flowering (P.F.S). Essential oil yield were 0.11% and 0.071 for E.V.S, 0.19% to 0.37% for L.V.S 0.23% and 0.47% for P.F.S, at the control and in the presence of 75 mM NaCl, respectively. Salt stress and development of vegetative stage affected the formation of the major compounds: cis-sabinene hydrate and terpinene-4-ol. Leaves were observed with scanning electron microscope (SEM), to determined trichomes number, size and distribution. Results showed that globular trichome density decrease with leaf maturity but increased with salinity.

O óleo essencial (OE) de Origanum majorana L. (Lamiaceae) foi extraído, através de hidrodestilação, de plantas cultivadas sob condições controladas e salinas. A composição do óleo essencial foi determinada por GC-MS. O material vegetal foi coletado em três estádios vegetativos: precoce (EVS), tardio (L.V.S) e floração precoce (PFS). O rendimento do óleo essencial foi de 0,11% e 0,071% para S.V.S, 0,19% e 0,37% para L.V.S, 0.23% e 0,47% para P.F.S, para o controle e na presença de NaCl 75 mM, respectivamente. O estresse salino e desenvolvimento vegetativo de rendimento afetou a formação dos principais compostos: cis-sabineno hidratado terpineno- 4-ol. As folhas foram observadas em microscópio eletrônico de varredura (MEV), para determinar o número de tricomas. Os resultados mostraram que a densidade globular do tricoma diminui com a maturidade da folha mas aumenta com a salinidade.

[Menorrhagia due to congenital factor V deficiency in an adolescent]. / Ménorragies par déficit congénital en facteur V chez une adolescente.

The frequency of menometrorrhagia in adolescence is estimated at 2-5 %. The functional origin is the most common. Hemostasis abnormalities account for 20 % of cases, and they should be sought whenever there is a personal history of known or suggestive of hemostasis disorders (epistaxis, gingival bleeding, postoperative bleeding, bruising, etc.) or there is a family history of hemostasis disorders. Organic origins are rare, but these must be sought when the characteristics of bleeding point in this direction. The workup aims to investigate the cause and assess the impact of the hemorrhage. It may include an NFS, blood group and rhesus±ß-HCG, hemostasis evaluation, determination of hemostasis factors, and a pelvic ultrasound. Whatever the cause of menometrorrhagia, the therapeutic options are the same and are oriented by the severity of bleeding. The treatment is mainly medical and hormonal. The surgical option should be a choice of last resort. We report a case of a 13-year-old girl admitted in hemorrhagic shock due to abundant metrorrhagia. Her laboratory tests showed an isolated deficiency of factor V with a 2 % rate. Congenital factor V deficiency is a rare autosomal recessive coagulation disorder. It can be diagnosed at any age when a bleeding disorder of varying severity is observed. The diagnosis is based on the hemostasis evaluation with quantitative determination of factor V. Because no FV-specific concentrate is available, fresh frozen plasma remains the mainstay of treatment. Antifibrinolytics can also be beneficial, and platelet transfusions have been successfully used, associated with hormone therapy. These patients may best be managed in cooperation with both a gynecologist and a hematologist.

[Idiopathic chylothorax in an infant: management and progression]. / Chylothorax idiopathique chez un nourrisson. Prise en charge et évolution.

Chylothorax is a rare disease (1-2 % of pleural effusions), with a prevalence between 1/8600 and 1/15,000 births. It is characterized by the presence of chyle in the pleural cavity. Three categories of chylothorax are known: congenital chylothorax, which can be either idiopathic or the result of a malformation, and traumatic chylothorax (mostly postoperative). We report the observation of a 9-month-old infant with idiopathic chylothorax revealed by respiratory symptoms, with pleural effusion and collapse of the ipsilateral lung on chest X-ray and ultrasound examination. Cytology and chemical analysis of the pleural fluid showed an exudative liquid with a chylous aspect, a high concentration of albumin (52 g/dL), triglycerides (11.42 g/L), and a high number of cells (6600 cells/mL), with lymphocyte predominance (96 %). The culture was sterile. Chylothorax is usually revealed by dyspnea, but also by nausea, vomiting, anorexia and/or malnutrition. The diagnosis is suspected when milky white fluid is obtained from thoracocentesis and is confirmed by the presence of a triglyceride level greater than 1.2 mmol/L and more than 1000 cells/mL, with lymphocyte predominance. The treatment of chylothorax can be either conservative or surgical. Conservative treatment (medical) has four goals: ensure pleural emptiness, decrease production of chyle, restore and/or maintain proper nutritional status, and treatment of the cause when identified. Surgical intervention is indicated when conservative management fails and aims to stop a radical and permanent leakage of chyle.

[Reasons for using emergency departments of major hospitals in Greater Tunis]. / Motifs du recours aux services d'urgence des principaux hôpitaux du Grand Tunis.

Tunisia, similar to many countries, has a problem of overcrowding of the emergency departments (ED). This study aimed to analyse the reasons for using EDs, and to describe the seriousness of the attendees' condition and their itinerary before their arrival at ED. This cross-sectional study in 2009 was conducted in ED of 4 hospitals in GreaterTunis and targeted 1058 patients of both sexes, aged 18 years, with stratification according to time of day of presentation to ED (morning, afternoon and evening). Information was recorded on the sociodemographic characteristics of the study participants, reasons for choosing ED, time of and reason for consultation, diagnosis and severity of illness. Over half the patients (52.5%) were male and the mean age was 46.0 (SD 18.1) years. The main reasons for choosing the ED were: speed (54.0%) and ease of access (47.7%) of ER and occurrence of an acute episode (26.4%). Patients with serious illness accounted for only 6.3% of those interviewed. Implementation of good practices and better coordination between public and private services and the ED are needed to reduce unnecessary visits to ED.

[Anterior optic pathways compression by a surgical clip mobilized by delayed chronic hydrocephalus after treatment of a ruptured anterior communicating artery aneurysm]. / Compression optochiasmatique par un clip refoulé par une hydrocéphalie chronique après traitement chirurgical d'un anévrisme rompu de l'artère communicante antérieure.

Chronic hydrocephalus is a classic and recognized complication that affects 6 to 37% of patients with aneurysmal subarachnoid haemorrhage. The diagnosis is often mentioned due to the delayed onset of gait disturbance and slower psychomotor performance. The CT-scan confirms the diagnosis by showing an enlargement of the ventricles. In case of symptomatic hydrocephalus, a ventriculo-peritoneal shunt is often required. The authors report a rare case of chronic hydrocephalus presenting with visual symptoms, due to the delayed mobilisation of a surgical clip with direct mass effect over the anterior optic pathways. The treatment of hydrocephalus led to a rapid and complete regression of symptoms.

Reasons for using emergency departments of major hospitals in Greater Tunis

Tunisia, similar to many countries, has a problem of overcrowd ing of the emergency departments [ED]. This study aimed to analyse the reasons for using EDs, and to describe the seriousness of the attendees' condition and their itinerary before their arrival at ED. This cross-sectional study in 2009 was conducted in ED of 4 hospitals in GreaterTunis and targeted 1058 patients of both sexes, aged >/= 18 years, with stratification according to time of day of presentation to ED [morning, afternoon and evening]. Information was recorded on the sociodemographic characteristics of the study participants, reasons for choosing ED, time of and reason for consultation, diagnosis and severity of illness. Over half the patients [52.5%] were male and the mean age was 46.0 [SD 18.1] years. The main reasons for choosing the ED were: speed [54.0%] and ease of access [47.7%] of ER and occurrence of an acute episode [26.4%], Patients with serious illness accounted for only 6.3% of those interviewed. Implementation of good practices and better coordination between public and private services and the ED are needed to reduce unnecessary visits to ED

Stereotactic robot-guided biopsies of brain stem lesions: Experience with 15 cases.

BACKGROUND AND PURPOSE: Biopsies of brain stem lesions are useful for histopathological analysis, which guide appropriate treatment. The frame-based stereotactic procedure is the gold standard technique for biopsies of the brain stem. For the past few years, a frameless stereotactic robot, the NeuroMate robot (Renishaw, UK) has also been used for brain biopsies. We report a retrospective study of 15 patients who underwent NeuroMate robot-guided biopsies of brain stem lesions to evaluate the efficiency and safety of the system. METHODS: From January 2004 to March 2006, 15 patients (five children and ten adults) underwent 17 biopsies of brain stem lesions. The lesions were located in the mesencephalon in two cases, in the pons in seven cases, in the pons and the medulla oblongata in five cases, and in the whole midbrain in one case. The biopsy procedure comprised four stages: image acquisition, preoperative planning, patient-to-image registration, and operative procedure. A transcerebellar approach was used in 12 cases and a double oblique anterior frontal approach in five cases. RESULTS: Two adults underwent a second procedure because the first biopsy was not contributive. There was no operative mortality. We observed two cases of transient morbidity and one case of permanent morbidity. CONCLUSIONS: The frameless NeuroMate robot is an efficient and safe instrument for biopsies of brain stem lesions. We believe that the use of frameless stereotactic techniques for brain stem biopsies could increase the number of biopsies and therefore improve the diagnostic yield and accuracy of the technique.

[Cavernous hemangioma in the orbital apex revealed by optic neuropathy]. / Hémangiome caverneux de l'apex orbitaire révélé par une neuropathie optique.

Cavernous hemangioma is the most common primary vascular neoplasm. It typically occurs in middle-aged women, causing a progressive painless proptosis as the principal symptom. It exceptionally compresses the optic nerve. We report the case of a cavernous hemangioma revealed by optic neuropathy in a 33-year-old female.

[Isolated intracranial relapse in previously treated Hodgkin's disease]. / Rechute intracérébrale isolée dans la maladie de Hodgkin.

UNLABELLED: Isolated brain relapse is uncommon in Hodgkin's lymphoma and often linked with advanced or refractory disease. CASE REPORTS: We report two patients with stage IV Hodgkin's disease, previously treated with chemotherapy, who later developed neurological symptoms. Brain MRI demonstrated two different types of lesions. Histological findings were consistent with intracranial location of Hodgkin lymphoma. Both of the patients presented only with isolated CNS relapse of the lymphoma. CONCLUSION: The two cases demonstrated the MRI appearance of intracranial involvement can be varied and mimic other disease processes in patients with a previous history of Hodgkin's lymphoma. Thus, a biopsy is necessary for diagnosis and correct treatment.

[Corneal abscess presumed to be of bacterial origin]. / Les abcès cornéens présumés d'origine bactérienne.

AIM: To assess clinical, microbiological and therapeutical characteristics of patients presenting with a clinically diagnosed corneal abscess at the Nabeul Hospital Department of Ophthalmology (Tunisia). METHODS: A retrospective study of patients presenting corneal abscess was conducted over 6 years. The clinical aspects, the microbial isolation, the treatment, and the outcome were analyzed. RESULTS: sixty-one eyes of 61 patients were hospitalized from January 2000 to October 2006. The mean age was 59.2 years old. The mean delay for referral was 8.7 days. Risk factors were noted in 90% of cases: corneal trauma (24.6%), ocular surgery (19.7%) and chronic keratopathy (14.7%). Bacteriological cultures of corneal smears isolated an organism in 39.9% of cases. Coagulase-negative Staphylococcus (16.3%), streptococcus (13.1%), Pseudomonas aeruginosa (8.1%) were the most frequent species. Poor visual outcome was correlated with anterior chamber inflammation and initial low visual acuity. CONCLUSION: Corneal trauma was the most common risk factor of corneal abcess. Early diagnosis and prompt treatment are important for successful management of bacterial keratitis to avoid corneal vision loss.

[Iridocyclitis in a patient with Behçet's disease and a familial form of retinitis pigmentosa]. / Iridocyclite chez une patiente atteinte d'une maladie de Behçet et d'une forme familiale de rétinopathie pigmentaire.

INTRODUCTION: Iridocyclitis associated with retinitis pigmentosa is rarely described in the medical literature. We report an unusual case of this association. OBSERVATION: A 55-year-old woman with a history of Behçet's disease presented with acute red and painful eyes and moderately blurred vision. Ophthalmologic examination concluded in bilateral acute hypertensive uveitis. Funduscopy and fundus fluorescein angiogram showed retinitis pigmentosa. The same fundus changes were found in the patient's siblings. Recurrences were frequent and topical steroids were always successful. CONCLUSION: This case is particular in its association of anterior uveitis as the exclusive manifestation of ocular Behçet's disease and familial retinitis pigmentosa.

Comparative exine ontogeny in some members of the family Zygophyllaceae sensu lato.

Exine ontogeny is studied in five taxa of the family Zygophyllaceae sensu lato (Peganum harmala L., Zygophyllum album L., Fagonia cretica L., Tribulus terrestris L., and Nitraria retusa [Forsk.] Asch.). In the beginning of the tetrad stage, the plasmalemma is attached to the callose wall, except in T. terrestris, where it describes crests and hollows. The primexine matrix is fibrillar, bilayered in T. terrestris and unilayered in the other taxa. In all species except P. harmala, the procolumellae are heterogeneous with clear zones and they become compact later. In T. terrestris, they are built on the crests. In Z. album and T. terrestris, a primordial nexinic lamella is set up. It is tripartite with a white line seen at some levels; on its external leaflet, the foot layer is observed, and on its internal leaflet, there is the endexine with numerous lamellae. This white line disappears often in the mature exine. In T. terrestris, there is a thick nexine that is coarsely lamellate inside. In the aperture zone, the columellae are lacking, the tectum and the foot layer get thinner; they unite and form the apertural membrane with the external part of the endexine. There is a granulolamellar endexinic zone well developed in P. harmala, whereas it is threelayered and weakly developed in T. terrestris.

[Midline tumors of the central nervous system]. / Tumeurs cranio-encéphaliques de la ligne médiane.

The anatomy of the supratentoriel midline structures of the brain is complex: corpus callosum, third ventricle, trigone, choroid plexus, pineal gland, falx cerebri. Different types of tumors can arise from these structures including tumors of the trigone and septum, tumors of the falx, third ventricular tumors and pinal region tumors. These tumors share similar features: minimal clinical symptoms despite their occasional large size, mild non-specific intracranial hypertension syndrome, value of MRI for depiction of tumor location, stereotactic biopsy, relative difficulty of surgical management.

Lipoprotein profile and prevalence of cardiovascular risk factors in urban Moroccan women.

OBJECTIVE: The study aimed to characterize the lipid and apolipoprotein profile and the prevalence of cardiovascular risk factors in a population of urban adult women of Morocco. DESIGN: A total of 213 women 25-55 y old were sampled from an agricultural province of Morocco: El Jadida. The following parameters of lipid and apolipoprotein profile were measured: plasma triglycerides (TG), plasma cholesterol (TC), triglyceride-rich lipoprotein triglycerides (TRL-TG), TRL-cholesterol (TRL-C), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and apolipoproteins A1, B, B48, CIII and E. Waist circumference (WC), body mass index (BMI) and blood pressure (BP) were also determined. RESULTS: The women studied showed the following pattern: elevated TC, LDL-C levels and TC/HDL-C in 10, 19.4 and in 43.8%, respectively; low HDL-C levels in 45.3% (<0.9 mmol/l) or in 95% (when the cutoff <1.3 mmol/l is used), elevated TG levels in 11.8%. Elevated TRL-C (>0.6 mmol/l) and TRL-TG (>0.8 mmol/l) were observed in 13.4%. Obesity and hypertension were highly prevalent in 23.9 and 16.5%, respectively. Plasma triglyceride concentrations were closely correlated with plasma concentrations of TRL-TG (R = 0.86, P = 0.0001), apoB (R = 0.50, P = 0.0001) and apoCIII (R = 0.52, P = 0.0001) and moderately correlated with HDL-C levels (R = -0.3, P = 0.0001) and BMI (R = 0.4, P = 0.0001). The association between BMI and systolic blood pressure was statistically significant (R = 0.3, P = 0.0001). Obesity, BP, TRL-C, TRL-TG, TG, apoB and apoCIII increased with age. CONCLUSION: There is a high prevalence of some risk factors for cardiovascular disease including altered lipid and lipoprotein profiles in the Moroccan urban women studied, some of these risk factors are associated with age.

Pupillary disturbances in multiple sclerosis: correlation with MRI findings.

UNLABELLED: Autonomic nervous system disturbances such as pupillary abnormalities have rarely been evaluated in multiple sclerosis (MS). However, pupillary impairment is not uncommon in MS and its origin is still unclear. The aim of this study was to investigate pupillary disturbances in MS and to try to correlate pupillary defects with spinal cord and brainstem magnetic resonance imaging (MRI) findings. We prospectively studied 45 MS patients and 30 normal subjects. METHODS: The pupillary contraction latency and the amplitude of contraction were recorded by pupillometry. We also determined afferent and efferent pathway defects by comparing the direct and consensual pupillary reflexes. We evaluated brainstem and spinal cord demyelinating lesions and spinal cord cross-sectional area on MRI. At least one pupillometric parameters were significantly impaired in 60% of patients and in none of the controls. We did not find any correlation between pupillary defect and demyelinating lesions on MRI. The most frequent abnormality was efferent pathway shift and this was correlated with spinal cord atrophy (P<0.02). These results confirm that the autonomic nervous system, and especially pupillary function, is frequently impaired in MS. The parasympathetic system is most commonly affected and this is most likely linked to axonal loss (demonstrated by spinal cord atrophy) rather than to demyelinating lesions.

Autonomic dysfunction in multiple sclerosis: cervical spinal cord atrophy correlates.

Autonomic dysfunction has rarely been studied in patients suffering from multiple sclerosis (MS). Some hypotheses have concerned the pathophysiology, especially with regard to a possible spinal cord origin. However, there have been no previous studies on autonomic dysfunction in MS and spinal cord lesions. This study assessed the frequency of autonomic dysfunction (AD) in MS and the correlation to spinal cord magnetic resonance imaging (MRI) findings. We prospectively studied 75 MS patients (25 with relapsing-remitting forms, 25 with secondary progressive forms and 25 with primary progressive forms). We performed sympathetic skin response, R-R interval variability and orthostatic hypotension testing. Spinal cord MRI was performed to detect demyelinating lesions (sagittal and axial plane) or spinal cord atrophy. Clinical and laboratory evidence of AD was found in 84% and 56% of MS patients, respectively. The correlation of the latter with disability was evaluated using the Extended Disability Status Scale. AD was more frequent in primary progressive MS than in the other two forms. AD was correlated with spinal cord cross-sectional area reduction but not with spinal cord hyperintensities. This study confirms that the frequency of AD in MS, especially in primary progressive forms, has until now been underestimated. Furthermore, AD appears to be more closely related to axonal loss, as demonstrated by spinal cord atrophy, than to demyelinating lesions.

Cardiac repolarization abnormalities in multiple sclerosis: spinal cord MRI correlates.

Ventricular repolarization dysfunction has recently been reported in multiple sclerosis (MS). We evaluated ventricular repolarization dysfunction in 52 MS patients and looked for a relationship between corrected QT (QTc) abnormalities (i.e., abnormalities of QT intervals corrected for rate) and spinal cord magnetic resonance imaging (MRI) findings. QTc intervals were increased in MS patients compared with controls (P < 0.01) and were correlated with a reduction of spinal cord area (P < 0.01). QTc abnormalities in MS were thus associated with axonal loss, reflected by spinal cord atrophy, rather than demyelination.

[Spinal cord magnetic resonance imaging in multiple sclerosis: importance of determining degree of atrophy as a marker of disease course]. / IRM médullaire et sclérose en plaques : intérêt du calcul d'atrophie comme marqueur d'évolutivité de la maladie.

Spinal cord magnetic resonance imaging (MRI) is of particular interest in the management of multiple sclerosis (MS) especially in primary progressive forms. Most of the demyelinating lesions are located in the cervical or dorsal cord. Spinal cord area reduction has been recently correlated with the progression of disability (Losseff et al., 1996, Lycklama a Nijeholt et al., 1998). The aim of this study was to confirm this first result, to assess the reproducibility of this method and to correlate demyelinating lesions with spinal cord area reduction. Fifty two patients were included and compared with 15 controls (normal subjects). T2 Sagittal and axial plane images were performed to localized hypersignal lesions. Spinal cord area was obtained by a volume acquired inversion prepared fast spoiled gradient echo acquisition (MP-Rage) sequence. We compared the mean area value with clinical parameters (age, course of the disease, expanded disability status scale ¿EDSS) and with the number and location of demyelinating lesions. Demyelinating lesions were found in 82p.100 of MS patients and in none of controls. Mean spinal cord area was closely similar to Losseff et al. (1996) results and was reduced compared with controls (p<0.001). Spinal cord reduction was correlated with disability, studied by the EDSS. Furthermore, no correlation was found between demyelinating lesions and spinal cord area reduction. This study confirms the interest of spinal cord area mesurement in MS. Spinal cord atrophy is a reliable marker for axonal loss. This method should be of particular interest for the follow-up of axonal loss in thepeutic trials especially in primary progressive MS.