Terrible triad injury of the elbow: A PROCESS-compliant surgical case series from Eastern Morocco.

Introduction: The terrible triad of the elbow (TTE) is a lesion associating a dislocation of the elbow, a fracture of the radial head, and a fracture of the coronoid process, with a high potential of complication. The treatment is based on the restoration of bone lesions and external capsular ligament repair. The systematic repair of the medial collateral ligament (MCL) is still debated in the literature. The aim of this study is to evaluate the clinical and functional results of the surgical treatment in a real-world series from Easter Morocco. Patients and methods: This was a retrospective study of 6 cases of TTE operated by isolated external approach or combined approach (internal or anterior) of the elbow in the department of Traumatology-Orthopedics of the Mohammed VI University Hospital (Oujda Morocco), over a period of 7 years from 2013 to 2020. Radial head and coronoid process fractures were classified according to the Mason and Morrey-Regan classifications, respectively. The following clinical parameters were evaluated: Mayo Clinic Elbow Performance Score (MEPS), Quick Disabilities of the Arm, Shoulder and Hand (DASH), Visual Analog Scale (VAS), and arc of mobility in flexion-extension and prono-supination. Results: 6 male patients treated between May 2013 and December 2020 were included. The median follow-up was 48 months. All patients had frontal and lateral standard X-ray of over and under joints, and computed tomography (CT)-scan was delivered for 5 cases. The elbow dislocation was posterolateral in five cases, and posteromedial in only one patient. Radial head fractures were classified as type I in one case, type II in two cases, and type III in three cases. Coronoid fractures were type I in three cases, type II in one case, and type III in two cases. At the last follow up, the mean MEPS, Quick DASH, and VAS was 81, 28, 0.8, respectively. The mean arc of mobility in flexion was 120° and it was deficient by 20° in extension. In addition, the mean arc of mobility in protonation was 80°, while in supination it was 75°. Regarding complications, we noticed an instability of the elbow on valgus in a single case, elbow stiffness with heterotopic ossification in a single case, ulnar nerve damage in a single case during medial collateral ligament anchoring, and elbow hygroma in one single case. Conclusion: The surgical management of TTE can provide good and long-term functional results after restoration of the stabilization of bone structures and the lateral ligament complex, without the need to repair the medial collateral ligament.

Denaturation process of laccase in various media by refractive index measurements.

In this work, we are interested in the denaturation process of a laccase from Tramates versicolor via the determination of the refractive index, the refractive index increment and the specific volume in various media. The measurements were carried out using an Abbe refractometer. We have shown that the refractive index increment values obtained from the slope of the variation of the refractive index vs. Concentration are outside the range refractive index increments of proteins. To correct the results, we have followed the theoretical predictions based on the knowledge of the protein refractive index from its amino acids composition. The denaturation process was studied by calculating the specific volume variation where its determination was related to the Gladstone-Dale and the Lorentz-Lorentz models.

Molecular identification of Malassezia species isolated from dermatitis affections.

The lipophilic yeast of the genus Malassezia are opportunistic microorganisms of the skin microflora but they can be agents of various dermatomycoses. The aim of this study was to perform molecular identification of the commonly isolated Malassezia species from various dermatomycoses in our region. Thirty strains of Malassezia were isolated from different dermatologic affections: pityriasis versicolor (17), dandruff (5), seborrheic dermatitis (4), onyxis (2), folliculitis (1) and blepharitis (1). These species were identified by their morphological features and biochemical characterisation. The molecular identification was achieved by amplification of the internal transcribed spacer region by simple PCR. PCR technique was used for molecular characterisation of four Malassezia species: Malassezia globosa (270 bp), Malassezia furfur (230 bp), Malassezia sympodialis (190 bp) and Malassezia restricta (320 bp). We have detected the association between M. furfur and M. sympodialis in 16% and confirmed presumptive identification in 70% of the cases. The phenotypic identification based on microscopic and physiological method is difficult and time consuming. The application of a simple PCR method provides a sensitive and rapid identification system for Malassezia species, which may be applied in epidemiological surveys and routine practice.

[Acanthamoeba keratitis: about the first two Tunisian cases]. / Les kératites amibiennes: à propos des deux premiers cas tunisiens.

Acanthamoeba keratitis is a rare but severe corneal infection which, despite improvements in diagnosis and treatment, still culminates in prolonged morbidity and significant loss of visual acuity. We present the case report of the first identification of Acanthamoeba as a causative agent of keratitis in Tunisia. Case no 1: A 20-year-old girl, nearsighted corrected with soft contact lenses, suffering from a deep corneal inflammation and poor visual acuity The ophthalmological examination showed bilateral dendritiform epithelial keratitis. The illness did not respond to topical and general antibiotic treatment and developed bilateral corneal abscess. Microscopic examination and culture of samples from cornea scraping revealed the presence of trophozoit and cysts of Acanthamoeba associated with Fusarium oxysporum. As the treatment with local Ketoconazol and antibiotherapy didn't show any result, two transfixiant keratoplasty were carried out and treatment by Désomédine, PHMB (polyhexamethylene biguanide) and Voriconazol was started. After two months, the patient felt better, vision was also improved (2/10) and infiltrates became smaller Case no 2: A 19-year-old girl, nearsighted with soft contact lenses consulted for a bilateral corneal ulceration and poor vision (1/20). Trophozoit and cysts of Acanthamoeba were found in the contact lens solution. She was treated quickly with Désomédine. Visual acuity improved to 7/10 but the corneal ulceration left a residual opacity

[Usher type I syndrome in children: genotype/phenotype correlation and cochlear implant benefits]. / Syndrome de Usher de type I chez l'enfant: corrlation génotype/phénotype et bénéfice de l'implant cochléaire.

OBJECTIVE: To assess the benefit of cochlear implant in children presenting an Usher type 1 syndrome (speech understanding, speech production intelligibility, academic performance) and to search any correlation between the phenotype and the genotype in this population. MATERIALS AND METHODS: Retrospective case series analysis about 13 implanted Usher type I children. Cochlear implantation was performed from 1995 to 2005. Our population was divided in three groups: group 1 (implantation between 1 and 3 years of age); group 2 (implantation between 4 and 7 years of age) and group 3 (implantation between 14 and 17 years of age). Postoperative speech perception, speech production intelligibility and education settings were evaluated. RESULTS: Molecular genetic analysis was performed in 11 patients and pathogenic mutations were identified in all cases: (mutation in myosin 7A gene in 5 cases; mutation in cadherin 23 gene in 6 cases). Four new mutations 2 in the MYO7A gene and 2 in the CDH23 gene never reported before were found. Walking delay and hearing level were not statistically correlated with the genotype abnormalities found. The speech discrimination skills, the speech production intelligibility and the academic performance were better in the group 1 children than the group 2 children after cochlear implantation. All the children of group 1 but one were in mainstreaming education. Specific language impairment was identified in two children of group 1. The group 3 children could not achieve open-set perceptive tasks after implantation--only closed-set word test can be done and their speech production remained unintelligible after cochlear implantation. CONCLUSION: Molecular analysis of Usher type I syndrome can ascertain the diagnosis in spite of the genetic heterogeneity. In this study, clinical symptoms weren't correlated with genotypic mutations. Speech discrimination skills, speech production quality, and academic performance were correlated with the age at implant.

[Allgrove syndrome. Report on a family]. / Syndrome d'Allgrove: à propos d'une famille.

Triple A or Allgrove syndrome is a rare autosomal recessive disease with alacrima, achalasia, and ACTH-resistant adrenal insufficiency. It is usually associated with neurological disorders. Recently, mutations in the AAAS, a candidate gene mapped to chromosome 12q13, were identified. We report a family with seven affected siblings. All of them have signs of alacrima, four were operated on for achalasia, five have neurological abnormalities including cranial nerve abnormalities, amyotrophic lateral sclerosis, pyramidal syndrome, distal motor neuropathy, and amyotrophy, and two have adrenal insufficiency. Triple A syndrome should be considered in any young patient with alacrima.

Identification of Malassezia species from Tunisian patients with pityriasis versicolor and normal subjects.

BACKGROUND: The genus Malassezia (Pityrosporum), recognized as a member of microbiological flora of the skin in humans and warm-blooded animals, has been recently revised to include 10 Malassezia species. The aim of the study was the isolation, identification and analysis of Malassezia species distribution in skin of healthy volunteers and lesions of pityriasis versicolor (PV). MATERIAL AND METHODS: Specimens were taken from 100 patients with PV and 30 healthy volunteers. Cultures were made in modified Dixon agar medium and the isolates were identified by morphological and physiological methods: macroscopy, microscopy, catalase, beta-glucosidase and lipid assimilation tests. RESULTS: Malassezia globosa was the predominant species in lesional skin of PV (65%). It was isolated alone in 47% of cases and associated in 18% with M. furfur (13%) or M. sympodialis (5%). In healthy skin M. globosa was found alone in 7.77% and associated in 15.54%, respectively, with M. furfur (4.44%), M. sympodialis (4.44%), M. restricta (3.33%) and M. slooffiae (1.11%). CONCLUSION: From these findings it was suggested that M. globosa presents the main species implicated in the pathogenicity of PV and M. furfur as the second agent of importance.

[Retinal detachment after Excimer laser (myopic LASIK or PRK). A retrospective multicentric study: 15 cases]. / Décollement de rétine post laser Excimer (Lasik/PKR myopique). Etude multicentrique rétrospective (15 cas).

INTRODUCTION: Refractive surgery by LASIK or photorefractive keratectomy (PRK) generaly aims at a myopic population that has a high probability of developing rhegmatogenous retinal detachment (RD). The authors report a multicenter study with 15 cases of RD appearing after refractive surgery by Excimer laser and discuss the role played by the techniques used. MATERIAL AND METHODS: Five centers fitted with nine Excimer laser devices took part in this study. Of 22,700 eyes undergoing refractive myopic surgery during the period 1994-2002, 15 eyes developed rhegmatogenous RD. The average age of the patients with RD was 37 years. The average myopia was 13.5 D. RD occurred a mean of 20 months after refractive laser. RESULTS: Fifteen eyes of 13 patients developed a rhegmatogenous RD, two of which were bilateral. Eight of these cases had LASIK surgery and six had photorefractive keratectomy; one of the latter patients was retreated with LASIK because of substantial regression after PRK. RD was total or subtotal in five eyes, partial superior with a temporal tear in six eyes, and nasal in three eyes. One case with inferior RD, two cases with giant retinal tear and one case with posterior tear were also repaired. Fourteen eyes were suitable for operation. The retina was reattached in 12 cases. Mean postoperative visual acuity was 7/10. DISCUSSION: The occurrence of rhegmatogenous RD in the myopic population is estimated at 2.2%. It is estimated at 0.1% in the emmetropic population. The Excimer laser, through its thermic effects, shock wave, traumatism undergone by the suction ring at the time of LASIK surgery, could increase this risk in myopic patients. A review of the literature cast doubt on the cause and effect hypothesis. Personal and multicenter studies (including ours) show that the frequency rate of rhegmatogenous RD after Excimer laser is equivalent and even lower than that estimated with an emmetropic population. The low percentage of RD after Excimer surgery found in the literature as well as in our study (<0.1%) may be explained by patient selection, the systematic monitoring of the peripheral fundus, and the prophylactic treatment of degenerative lesions by photocoagulation. In RD surgery, the cornea must be manipulated carefully, a case of flap dehiscence has been reported in the literature. CONCLUSION: Refractive surgery by LASIK or PRK for severe myopia increases the risk of RD. Systematically monitoring the peripheral fundus and preventive photocoagulation have mitigated its occurrence, and the risk incurred in the myopic population has fallen to the emmetropic population's rate. Nevertheless, candidates for LASIK or PRK surgery must be informed because severe myopia constitutes a non-negligible risk factor.

[Recurrent toxoplasmic retinochoroiditis after clindamycin treatment]. / Récurrence de la rétinochoroïdite toxoplasmique après traitement par clindamycine.

PURPOSE: To evaluate the efficacy and safety of subconjunctival injections of clindamycin associated with oral corticotherapy in the treatment of toxoplasmic retinochoroiditis (TRC) and its effect on recurrence. PATIENTS AND METHODS: This study investigated 21 patients (10 males and 11 females) who presented to an ophthalmological department from 1995 to 2000, aged 14-55 years (mean, 28 years), with unilateral TRC. They were treated with subconjunctival injections of clindamycin and systemic corticotherapy at a dose of 1 mg/kg/day. Clinical follow-up consisted of assessment of visual acuity and biomicroscopic fundus examination, completed by retinal angiography if necessary. RESULTS: We observed clinical improvement in 68.75% of patients within 4 days and in all patients healing of the chorioretinal area within 1.6 months. During the follow-up period ranging from 6 to 52 months (mean, 22 months), there have been two recurrences (9%) over the first 18 months. Tolerance of the injections was good. Serious side effects were noted in two patients: one case of conjunctival necrosis and one case of corneal and conjunctival erosion. CONCLUSION: In treating ocular toxoplasmosis, clindamycin appears to be a safe and effective substitute for the classic protocol (pyrimethamine-sulfadiazine, pyrimethamine-azithromycin), for which a 50% recurrence rate has been reported. It provides relatively good protection against recurrence and warrants testing in further controlled studies.

[Contusive retinal detachment: a retrospective review of 48 patients]. / Les décollements de rétine post contusifs.

PURPOSE: Analysis of the epidemiological, clinical and therapeutic characteristics of retinal detachment after ocular blunt trauma. MATERIAL AND METHODS: We retrospectively reviewed 48 patients with isolated retinal detachment after ocular blunt trauma, studying their epidemiological characteristics (age, sex and trauma circumstances), their clinic details and the surgical techniques used. RESULTS: The average age of our patients was 39.3 Years; most were male (75%). Assault and home accidents were the most common cause of ocular trauma (83.2%). Total retinal detachment was noted in 47.9%. Of the retinal breaks found, dialysis at the ora serrata was observed in 22%, atrophic holes in 33.9%, retinal breaks in 40.6% and giant tears in 4.2%. Most of the breaks were situated at the lower temporal quadrant. Forty one out of the 48 patients were operated on, with surgical treatment consisting in episcleral surgery in 38 cases and vitreoretinal surgery in three cases. Complete anatomical success was achieved in 92.7%. CONCLUSION: This survey shows that the prognosis of retinal detachment after ocular blunt trauma remains favorable given the young age and the absence of advanced vitreoretinal proliferation, but this should not affect the importance of prevention.

[Duplication of mouth and mandible. Apropos of a case]. / Les duplications de la bouche et de la mandibule. A propos d'un cas.

We report a case of duplication of the mouth, tongue, mandible, and cervical spine in a female neonate. Findings in this patient were somewhat different from those in previously reported cases. Clinical, radiological and therapeutic features in this localized duplication are reviewed. Embryologic hypotheses include defective midline development, such as in the split notochord syndrome, and development of totipotent cells from the first branchial arch.

[Gastric duplications in children. Apropos of a case manifested in a newborn infant]. / Les duplications gastriques chez l'enfant. A propos d'un cas à expression néonatale.

We report a case of gastric duplication with neonatal manifestations. Diagnosis of this infrequent malformation is readily established in most cases upon roentgenologic and ultrasound examinations. Etiopathogenesis is unknown. Therapy is surgical. Complete exeresis involves mutilation because the supernumerary stomach shares the vascular supply to the normal stomach, and because a cleavage plane is lacking. Therefore, incomplete resection should be performed as the condition is benign and good results are consistently achieved with this procedure.

[Hydatid cysts in children. Diagnostic and therapeutic aspects. Apropos of 1195 cases]. / Les kystes hydatiques chez l'enfant. Aspects diagnostiques et thérapeutiques. A propos de 1,195 cas.

Hydatid cysts represent a true social problem in Tunisia where 2.1% of rural inhabitants are affected. Hydatid disease is responsible for 10% of the country's surgical activity and costs approximately 800 $ per patient. From April 1967 through January 1987, 1,195 cases of hydatid cyst in children aged 2 to 15 years were treated at the Children's Hospital in Tunis. The involved organ was the lung in 643 cases, the liver in 486 cases, the spleen in 27 cases, and the kidney in 18 cases. With the exception of seven patients with malignant forms, surgery was always performed, with a 1.4% mortality rate and a 2% morbidity rate. We analyze the diagnostic and therapeutic particularities of the various locations of hydatid cyst. Diagnosis rests mainly on ultrasound findings and treatment on conservative procedures as hydatid disease in children carries a good prognosis.