Interest of surgical vascular reconstructions aiming at preserving hemodialysis access.

BACKGROUND: Vascular hemodialysis access is a very precious asset for patients with end-stage renal failure. Ideally complications in these accesses should be detected early in order to treat them in time. The aim of this study was to evaluate the effectiveness of vascular reconstructions to preserve the vascular access for hemodialysis and to examine their benefits in terms of conserving the venous network, using hemodialysis catheters, time of cannulation after surgery, patency and postoperative morbi-mortality, by comparing them to those of newly created arterio-venous fistula (AVF). METHODS: This was a retrospective, descriptive and comparative study, performed from September 2012 to February 2015. It concerned patients operated for complications of their native AVF. Two groups were compared: reconstructed AVF (group 1) and newly created AVF (group 2). Demographic characteristics, comorbidities, preoperative clinical and paraclinical data, surgical techniques and outcomes were recorded. This data was analyzed and compared between the two groups. RESULTS: We collected 151 surgical interventions divided into two groups: 55 surgical reconstructions and 96 new AVF. The average age was 59.9±1.3 years [19.1-88.9], with a male predominance (59.6%). The two groups were comparable in terms of age, gender and comorbidities. Reconstructions were mostly indicated for stenosis (47.3%) and new vascular accesses for venous thrombosis (92.7%). Reconstruction had significantly better successful exploitation rates (95.7%) and time of cannulation (26.6 days) (respectively P=0.025 and P=0.000). Its primary failure rate was null. Its primary patency and primary functional patency were respectively 94.2% and 97.7% at 1 month and 82.2% and 87.1% at 2 years. Morbidity's global rates were comparable between both groups (41.8% vs. 43.8%). The rates of early morbidity and stenosis were significantly higher for reconstructions (respectively P=0.037 and P=0.047), while late morbidity and thrombosis' rates were significantly higher for new AVF (respectively P=0.021 and P=0.023). Mid-term permeabilities were better for reconstructions, but the differences were not statistically significant. CONCLUSION: Surgical reconstructions seem to be an effective alternative for the treatment of complicated AVF. Our results appear to be comparable to those of the literature. The benefits of these surgical techniques in terms of conserving venous network, use of hemodialysis catheters, time for cannulation after surgery, patency and postoperative morbi-mortality appear to be undeniable.

A novel large deletion in CCM1 gene in a Tunisian family.

Familial CCM is a rare entity associated with the mutation of three genes: CCM1 (KRIT1), CCM2 (MGC4607), and CCM3 (PDCD10). We report here the first description of a Tunisian familial CCMs composed of six members. The father and two daughters were affected and symptomatic. The two other kindred were healthy. Surgical treatment was performed in only one affected patient. Molecular analysis of KRIT1, MGC4607 and PDCD10 genes identified a large KRIT1 deletion of the first ten exons. To the best of our knowledge, this large deletion has never been reported before.

[Beneficial effect of preferred music on cognitive functions in minimally conscious state patients]. / Effets bénéfiques de la musique préférée sur les capacités cognitives des patients en état de conscience minimale.

Several studies have shown that music can boost cognitive functions in normal and brain-damaged subjects. A few studies have suggested a beneficial effect of music in patients with a disorder of consciousness but it is difficult to conclude since they did not use quantified measures and a control condition/group. The aim of the present study was to compare the effect of music to that of a continuous sound on the relational behavior of patients in a minimally conscious state (MCS). Behavioral responses of six MCS patients were evaluated using items from the Coma Recovery Scale-Revised. Weekly evaluation sessions were carried out, over four weeks, under two conditions: following the presentation of either the patient's preferred music, or following a continuous sound (control condition). Qualitative and quantitative analyses showed that twelve of the eighteen sessions (66.6%) showed a better result for the music condition than for the control condition. This new protocol suggests that preferred music has a beneficial effect on the cognitive abilities of MCS patients. The results further suggest that cerebral plasticity may be enhanced in autobiographical (emotional and familiar) contexts. These findings should now be further extended with an increased number of patients to further validate the hypothesis of the beneficial effect of music on cognitive recovery.

[Cardiac involvement in polymyositis]. / Manifestations cardiaques au cours de la polymyosite.

Cardiovascular involvement in polymyositis constitutes a major cause of death. However, the cardiac location is rarely symptomatic and does not usually represent the principle clinical feature at the time of the initial presentation. We present here an unusual case of polymyositis with severe and polymorph cardiac disturbances that predominant the muscular signs.

Chemical composition and in vitro antimicrobial and antioxidant activities of Citrus aurantium l. flowers essential oil (Neroli oil).

Neroli essential oil is extracted from the fragrant blossoms of the bitter orange tree. It is one of the most widely used floral oils in perfumery. In this study chemical composition and in vitro antimicrobial and antioxidant activities of neroli oil are investigated. The essential oil of fresh Citrus aurantium L. Flowers (Neroli oil) cultivated in North East of Tunisia (Nabeul) were analyzed by GC-FID and GC-MS. About 33 compounds were identified, representing 99% of the total oil. Limonene (27.5%) was the main component followed by (E)-nerolidol (17.5%), alpha-terpineol (14%), alpha-terpinyl acetate (11.7%) and (E, E)-farnesol (8%). Antimicrobial activity was determined by Agar-well-diffusion method against 6 bacteria (3 Gram-positive and 3 Gram-negative), 2 yeasts and 3 fungi. Neroli oil exhibited a marked antibacterial activity especially against Pseudomonas aeruginosa. Moreover, Neroli oil exhibited a very strong antifungal activity compared with the standard antibiotic (Nystatin) as evidenced by their inhibition zones. Antioxidant activity determined by ABTS assay showed IC50 values of 672 mg L(-1). Finally, this study may be considered as the first report on the biological properties of this essential oil. The results of this study have provided a starting point for the investigations to exploit new natural substances present in the essential oil of C. aurantium L. flowers.

[Rosai-Dorfman disease: therapeutic issues in 2 cases]. / La maladie de Rosai - Dorfman : enjeux thérapeutiques à propos de 2 observations.

Rosai-Dorfman disease (RDD) is a benign lymphoproliferative disorder characterized by cervical lymph node enlargement with a consistent risk of airway compression and esthetic damage. Extranodal localizations are also described. There is no therapeutic consensus for pediatric forms of RDD. Through 2 pediatric cases with nodal involvement in 1 patient and a sinonasal and soft tissue localization in the other, we focus on the management problems of both nodal and extranodal RDD.

[Cyanobacteria and their toxic potential in dam water content in Northern Tunisia]. / Les cyanobactéries et leurs potentialités toxiques dans les retenues des barrages du Nord de la Tunisie.

In order to get data about toxic cyanobacteria and their potential sanitary risk in 12 waterbodies situated in the north of Tunisia, some taxonomic, ecological and toxicological studies were undertaken since 2001. This paper provides the first screening of the potential toxic species of cyanobacteria as well as their geographical distribution. The microscopic examination of the phytoplankton samples show 42 species of cyanobacteria; 9 are frequently quoted by the literature as being potentially toxic. Among the inventoried cyanobacteria genera there are Pseudanabaena, Planktothrix Phormidium, Lyngbya, Microcystis,... Oscillatoria constitutes the most widespread one. The content of total microcystin (MCYST) was determined by protein phosphatase inhibition assays (PP2A). The total microcystin, detected in dissolved and particulate fractions in all the examined samples is generally low and varies between 2 and 7455 ng/l microcystin-LR equivalent per liter. The highest MCYST concentration is observed in autumn and generally in particulate MCYST concentrations.

Genetic responses to metal contamination in two clams: Ruditapes decussatus and Ruditapes philippinarum.

Coastal ecosystems are subjected to a wide variety of disturbances, including those due to xenobiotics of agricultural and industrial origin. These pollutants as heavy metals can modify the genetic diversity of populations by favouring or counter-selecting certain alleles or genotypes by differential mortality. In the present study, two genetic markers (phosphoglucomutase and glucosephosphate isomerase) and a protein marker (metallothionein) were monitored in order to determine the impact of heavy metals in different clam populations. Analysis of the genetic structure of the clam populations examined reveals that those inhabiting environments contaminated by heavy metals exhibit a higher allelic diversity and possess alleles at PGM loci that could be selected by the presence of heavy metals. The evaluation of metallothionein levels using a specific polyclonal antibody developed in the Pacific oyster (Crassostrea gigas) demonstrated the existence of a relationship between metallothionein concentrations and the level of metal pollution for clam populations sampled from different sites. An inter-specific difference was also detected between Ruditapes decussatus and Ruditapes philippinarum living in sympatry at the same site, suggesting a differential response of these two species upon exposure to an identical heavy metal concentration.

[Analysis of European pharmaceutical journal diffusion: the example of the principal French document supplier]. / Analyse de la circulation des périodiques pharmaceutiques européens: l'exemple du principal fournisseur français de documents.

Our purpose was to analyse the process of providing papers, edited by european pharmaceutical journals, by the main French document supplier, "Institut National de l'Information Scientifique et Technique" linked to the "Centre National de la Recherche Scientifique" (INIST-CNRS). After having given a definition and built up a corpus of 289 journals, orders about them during 1996-1998 were analysed. Then, the possible relationships between orders to INIST-CNRS and impact of journals on scientific community (from Institute for Scientific Information (ISI) data) were examined. Finally, relationships between document orders to INIST-CNRS and, on the one hand european pharmaceutical journals indexation in bibliographic databases and, on the other hand their possible indexation in the French National Collective Catalogue were studied.

[Contraception with Depo-Provera. Report of a series of 930 women]. / Contraception par Dépo-Provéra. A Propos d'une serie de 930 femmes.

In this study, Dépo-Provéra was evaluated in 930 women. It is a retrospective longitudinal bicentric study: We revealed the following results: The average age is 30.8 years. 66.6% the women have between 1 and 3 children. The nulliparous represent 17%. In 84.3%, it is the first used contraceptive method. The first injection was done in the post abortion in 65.3% of the cases. Pearl index is 0.46. Thus, the efficacy level is 99.54%. Amenorrhea is the most frequent trouble; its incidence within a year is 52.3%. It the first cause of abandon. The other troubles of the cycle disappear within 12 months. The acceptability is 34.8% year women.

[Cystic renal cancers. Review of 6 cases]. / Les cancers du rein d'aspect kystique. A propos de 6 observations.

The authors present six cases of cystic renal cancers which raised preoperative and intraoperative diagnostic difficulties. Computed tomography is currently the most reliable diagnostic examination. The diagnosis of complicated benign cyst must be made cautiously and persistence of doubtful images must lead to surgical exploration. The authors try to up-date the diagnostic strategy for atypical cysts based on recent progress in medical imaging and propose a practical approach to treatment.

[Isolated kidney lymphoma. Case report]. / Le lymphome isolé du rein. A propos d'une observation.

Renal lymphomas, essentially secondary, are the commonest site of lymphoma in the urinary tract: 68% of cases. Apparently primary renal lymphoma is very rare and difficult to diagnose. The authors report the case of a 55-year-old patient admitted with solid tumour of the right kidney. Radical nephrectomy was performed. Histological examination revealed renal lymphoma. Postoperative assessment looking for other sites was negative. Based on a review of the literature, the authors analyse the epidemiological and diagnostic aspects of isolated lymphomas of the kidney.

A comparative study of local sensors of power ultrasound effects: electrochemical, thermoelectrical and chemical probes.

In order to propose standard methods for the local measurement of the effects of power ultrasound inside a reactor, we compare three methods: a chemical dosimeter (Weissler reaction), a thermal sensor (embedded thermocouple) and an electrochemical probe (developed in our laboratory). The same emission device, i.e. the resonant tube (Sonitube-Sodeva), was used for all these methods. Similar trends were observed using various measurements: ultrasound effects vary significantly along the tube axis (due to standing waves in the resonant tubular emitter), but only slightly from the tube axis to the wall. More reliable and reproducible results were obtained with the thermal and electrochemical probes than with the chemical dosimeter.

Experimental study of the ultrasound attenuation in chemical reactors.

Ultrasound is used in different domains, and in sonochemistry particularly, for different purposes and in various flow configurations: monophasic, two-phase and polyphasic reactors. In order to optimize and to design sonochemical reactors, it is important to describe the ultrasonic intensity space and time distribution. In addition, it is important to study the different parameters influencing the intensity profiles of the ultrasonic wave. In this work, a thermoelectric probe has been used to measure the ultrasonic intensity. This procedure has shown that the ultrasound propagation is influenced by the presence of cavitation bubbles, the flow regime and the presence of solid particles.