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Adolescence is defined as the period extending from puberty to adulthood, the limit of which is difficult to determine. It is a delicate period, in which the distancing from one's own body image can have deleterious consequences on psychological development and social-emotional life. Breast hypertrophy and the correction of hypertrophic tuberous breasts in adolescents raise some questions that we will attempt to answer in this article. There are specificities to manage, in relation to surgical indications, resection volume, postoperative follow-up and cutaneous healing. [ABSTRACT FROM AUTHOR]

Introduction: malignant arterial hypertension (MAH) is a nosologic disorder which has not been described in Nephrology. The purpose of this study was to describe the profile of patients with MAH in the Division of Nephrology and to identify prognostic factors. Methods: we conducted a retrospective, descriptive and analytical study from January 2013 to December 2018 in the Unit of Nephrology of the University Hospital Center in Treichville. The diagnosis of MAH was retained in patients with diastolic blood pressure (DBP) ≥ 130 mmHg, Keith Wegener grade III/IV hypertensive retinopathy, one or multiple visceral, cardiac and/or brain and/or renal diseases. Results: we collected data from 168 patients. The average age of patients was 41.10 ± 14.86 years, with male predominance (sex ratio 1.54). Cardiovascular risk factors were AH (79.20%), alcohol (32.10%), tobacco (19.60%), chronic kidney disease (15.30%) and diabetes (11.30%). They were admitted with dyspnea (39.29%), hypertensive crisis (26.16%), consciousness disorders (10.12%). Clinical examination showed anemia (82.10%), lower limb edema (63.10%), acute pulmonary edema (37.50%). Arterial hypertension resulted in renal failure (95,9%), left ventricular hypertrophy (92.81%), stroke (16,67%), and cardiac and renal involvement (85%). Renal failure was chronic in 78% of cases. The causes of MAH were essential AH (56,8%), chronic glomerulonephritis (29.8%), and diabetes (6%). Outcome was favorable in 66,7% of cases and overall mortality rate was 25.6%. In multivariate analysis uremia ≥ 2g/l [OR=5,07; 95%CI = 2,39-10.75; p = 0.0001], hperkalaemia [OR = 3.50; 95% CI = 1.70 - 7.19; p = 0.001], hyponatremia [OR = 2.90; 95% CI= 1.40 - 6.03; p = 0.004], haemoglobin level < 12g/dl [OR=5,91; 95% CI=1,34-26,00; p=0,019] and end-stage renal disease [OR = 6.06; 95% CI = 2.04 - 18.18; p = 0.001] were factors associated with the occurrence of death. Conclusion: MAH is a consequence of poorly treated or untreated AH. It mainly affects young adults with multivisceral complications. In our Hospital, these were dominated by end-stage chronic renal disease. Hence the importance of early diagnosis and adequate management in patients with AH. [ABSTRACT FROM AUTHOR]

Introduction: cardiovascular complications have become the 3th cause of death and the 4th reason for hospitalization in HIV-infected patients. The purpose of this study was to determine the frequency of asymptomatic myocardial ischemia in HIV-infected patients on antiretroviral therapy. Methods: we conducted a descriptive crosssectional study in November 2015. Asymptomatic HIV-1-infected patients on ARV treatment and followed up in the Day Hospital Unit of the Department of Infectious Diseases of the University Hospital Sanon Sourou of Bobo-Dioulasso were included in the study. Among enrolled patients data on cardiovascular risk factors were collected as well as two sitting blood pressure measurements after 10 minutes of rest were taken during consultations and resting 12-lead electrocardiogram (ECG) was performed. Results: a total of 123 HIV-1-infected patients with a median age of 42 years (IQR: 36-50), among whom 79% were female subjects, were included in the study. Cardiovascular risk factors included: PAH (31.7%), obesity (33%), dyslipidemia (10.57%), active smoking (0.8%) and diabetes (0.8%). All patients with hypertension (5.7%) were insufficiently treated. The median duration of ARV treatment was 5.3 years (IQR: 3-7.7). Repolarization disorders were found in 26 cases (21.13%). They were divided into subepicardial ischaemia in 20 cases (16.26%), subendocardial damage in 2 cases (1.63%) and sequelae of necrosis in 4 cases (3.25%). Left ventricular hypertrophy (LVH) was found in 12 cases (9.76%) and, in particular, in hypertensive patients. Prolonged QTc interval was found in 7 patients (5.69%) regardless of the ARV drugs given. Conclusion: this study of HIV-1-infected patients highlights that asymptomatic myocardial ischemia is common. Screening programmes should be improved through more effective ischemia tests in order to better determine its severity in this subpopulation with increased cardiovascular risk. [ABSTRACT FROM AUTHOR]

Erythrophagocytosis by blast cells is due to hyperactivation of blast cells. Erythrophagocytosis is associated with T cell myeloid hemopathies (8;16). This study shows an exceptional case of erythrophagocytosis by blast cells in a patient with acute T-lymphoblastic leukemia without cytogenetic abnormalities. We here report the case of A.Z, aged 19 years presenting with febrile syndrome with dizziness and phosphenes, tumor syndrome with amygdala and gingival hypertrophy. Blood count revealed hyperleukocytosis (399.5 G/L), with aregenerative anemia (Hb: 9,3 g/dl) and thrombocytopenia (platelet count: 40 g/L). Myelogram showed 90% of blast cells (MPO-negative) with erythrophagocytosis by blast cells images. Immunophenotyping confirmed T-cell LAL. Cytogenetic analysis was normal. Erythrophagocytosis by blast cells in patients with T-cell LAL appears to be a separate entity, hence the importance of images on diagnosis, prognosis and treatment of T-cell LAL. [ABSTRACT FROM AUTHOR]

Intensive and prolonged practice of sport can lead to cardiovascular and electrocardiographic changes. The purpose of this study was to describe the electrocardiographic changes in some young black Senegalese players practicing competitive basketball. We conducted a prospective descriptive analysis of surface electrocardiogram (ECG) findings related to young Senegalese Black players practicing competitive basketball. The study involved 40 young basketball players, 20 girls and 20 boys, whose average age was 17 ± 0.86 years (ranging from 17 to 19 years) and 15 ± 1.56 years (ranging from 13 to 18 years) respectively. Heart rate was lower among boys, 59 beats ± 9 beats (ranging from 42 to 85) than among girls 73 beats/min ± 11 beats (ranging from 50 to 95) (p = 0.0004). The following features have been observed: repolarization abnormalities such as T-wave inversion V1-V4 in 3 cases (7.5%), right ventricular hypertrophy in 1 case (2.5%), right axis deviation (QRS axis) in 1 case (2.5%). Intensive and prolonged practice of basketball leads to electrocardiographic changes in the young black Senegalese players [ABSTRACT FROM AUTHOR]

Brain abscesses can cause significant morbidity in patients with cyanogen heart disease. In countries with limited resources treatment, it is difficult and prognosis is guarded. Here we report a case of brain abscesses revealing a rare form of cyanogen heart disease, the trilogy of Fallot, in Parakou in the north of Benin. The study involved a 9-year old boy, referred to a primary hospital for left hemiparesis. Interview and physical examination revealed symptoms evolving for two months including intense headaches, fever, vomiting and functional impairment of the left hemicorps, altered general state, generalized cyanosis, left hemiparesis, pulmonary systolic murmur. Brain CT scan showed abscesses in the right parietal region and in the left temporal region as well as hydrocephalus. Doppler echocardiography showed stiff pulmonary stenosis, atrial septal defects and right ventricular hypertrophy. Antibiotic therapy including ceftriaxone, gentamicin and metronidazole was started in emergency. Indication for surgical intervention included trepano-puncture but this could not be performed due to rapid unfavorable outcome. Brain abscesses are a common complication of cyanogen heart disease. Outcome is fatal in the absence of adequate management, hence the role of diagnosis and early treatment of these heart diseases. [ABSTRACT FROM AUTHOR]

Introduction: sudden death that occurs during sporting activity affects patients with ignored heart disease. Black athlete's ECG has been little studied and the features of this ethnic group have been discussed. This study aims to study the epidemiological profile and the peculiarities of repolarization of black athletes. Methods: we conducted a descriptive study of black athletes selected among all the athletes followed in the sectoral Center of Sports Science and Medicine in Sousse over a period of 8 months from March to October 2014. Data were collected using a medical questionnaire. Results: data on 35 athletes were collected, with a male predominance (94,28%), with an average age of 24,34 years. Four athletes had left ventricular hypertrophy on cardiac ultrasound. There were 8 athletes with atrioventricular block degree I and 8 athletes with electrical type of left ventricular hypertrophy (LVH). ST segment changes were more marked at the level of precordial leads. Five athletes (14.2%) had inverted T waves in V2 and V3. These were the same athletes who ST-segment depression in these same leads. Early repolarization was found in 3 athletes. All these cases had notch signaling. Conclusion: black athletes have quite specific electrical modifications which are important to know. However, our sample is not sufficiently large to certify these results. A comparative study of white athletes would be very interesting. [ABSTRACT FROM AUTHOR]

Diabetes is a powerful independent cardiovascular risk factor. The aim of this study is to describe the electrocardiographic and echocardiographic abnormalities observed in patients with type 2 diabetes treated in the Department of Medicine at the University Hospital in Bobo-Dioulasso. We conducted a descriptive cross-sectional study of all patients with type 2 diabetes who gave consent from April to September 2014. We gathered clinical data from all the patients. They, moreover, underwent electrocardiography and doppler echocardiography. A total of 155 diabetics were investigated. The average age of patients was 55 years (IQR: 47-64) with a female predominance (sex ratio 0.5). Electrocardiographic abnormalities included repolarization abnormalities (31%) and atrial rhythm disorders (16,12%). Echocardiographic examination showed left ventricular hypertrophy (LVH) in 20,64% of cases. Left atrium was dilated in 14.19% of cases, LV was dilated in 1.3% of cases. Abnormal left ventricular ejection fraction was detected in 3.87% of cases. Nosological entities included hypertensive heart disease in 27 cases (54%), ischemic heart disease in 19 cases (38%), dilated cardiomyopathy in 2 cases (4%) and diabetic cardiomyopathy in 2 cases (4%). Heart failure was detected in 22 cases (44%) independently from cardiac impairment. Electrocardiographic and echocardiographic abnormalities are frequent in type 2 diabetes population at the University Hospital in Bobo-Dioulasso. Improved cooperation between cardiologists and diabetologists as well as the establishment of adequate technical screening equipment would be prerequisite for better cardiac risk stratification in this population. [ABSTRACT FROM AUTHOR]

This study aims to contribute to the improvement of treatment protocols for patients with dilated cardiomyopathies (DCMs) in Brazzaville. We conducted a prospective analytical study at the University Hospital in Brazzaville between 1 January 2014 and 30 June 2015. All patients hospitalized with heart failure (HF) associated with DCM in the Department of Cardiology were included in the study. The study involved 100 patients. Hospitalization rate for DCM was 32.1%: 38 men (38%) and 62 women (62%) with an average age of 52.9 ± 17.1 years. Seventy two patients had comprehensive heart failure (72%). ECG showing normal sinus rhythm (95%) objectified left ventricular hypertrophy (40%), left bundle-branch block (16%), atrial fibrillation (5%). Mean left ventricular ejection fraction (EF) was 33.4 ± 6.8% and left ventricle end-diastolic diameter was 65.5 ± 7.0 mm. Treatment was based on loop diuretic (100%), ACE Inhibitors, Angiotensin II Receptor Blockers (ARBs) (100%), beta blocker (38%), digitalis (30%), anti-aldosterone (16%) and anti-vitamin K (11%). After 12-month follow-up period, overall case-fatality rate was 9%, readmission rate was 12% and the rate of patient lost-to-follow-up was 41%. This study shows that DCM is frequent and it is one of the leading causes of heart failure. The short follow-up period and the high rate of people lost to follow up do not enable assessment of survival rate of patients at our Department. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Évaluer la prévalence de l’hypertrophie ventriculaire gauche (HVG) électrocardiographique et échographique ainsi que ses corollaires dans une population d’hypertendus vivant en milieu semi-rural au Sénégal. Patients et méthode Selon l’approche STEPS de l’organisation mondiale de la santé, nous avons mené, en novembre 2012, une enquête transversale et exhaustive chez les sujets âgés d’au moins 35 ans et vivant depuis au moins 6 mois, dans la zone semi-rurale de Guéoul. Les facteurs de risque cardiovasculaire ont été dépistés et l’hypertrophie ventriculaire gauche recherchée à l’électrocardiogramme et à l’échocardiographie chez les hypertendus. Les données étaient analysées grâce au logiciel SPSS 18.0 et le seuil de significativité fixé pour une valeur de p < 0,05. Résultats Nous avons examiné 1411 sujets âgés en moyenne de 48,5 ± 12,7 ans. Au total, 654 sujets étaient hypertendus et une hypertrophie ventriculaire gauche a été la recherche chez 515 sujets parmi eux. Selon l’indice de Sokolow-Lyon, 86 sujets (16,7 %) présentaient une HVG électrocardiographique, plus fréquemment chez les hommes ( p = 0,002). Selon l’indice de Cornell et le produit de Cornell, elle était retrouvée respectivement chez 66 (12,8 %) et 52 sujets (10,1 %), avec une prédominant féminine ( p = 0,0001 ; p = 0,004). Elle était plus fréquente chez les hypertendus en grade 3 quel que soit l’indice. À l’échocardiographie, la prévalence de l’HVG selon la masse ventriculaire gauche était de 2,5 % (13 cas), de 9,3 % (48 cas) selon la masse ventriculaire gauche indexée à la surface corporelle et de 8,2 % (42 cas) selon la masse ventriculaire gauche indexée à la taille 2,7 . L’HVG selon la masse ventriculaire gauche indexée à la surface corporelle était significativement corrélée à l’HVG électrocardiographique selon l’indice de Sokolow-Lyon ( p < 0,0001) et à l’hypertension artérielle de grade 3 ( p = 0,003). Conclusion Bien que rare chez l’hypertendu sénégalais vivant en milieu semi-rural, l’hypertrophie ventriculaire gauche est corrélée à la sévérité de l’hypertension artérielle. Un dépistage par l’électrocardiogramme permettra un meilleur suivi de ces hypertendus. Objectives To assess the prevalence of left ventricular hypertrophy according to electrocardiographic and echocardiographic criteria among hypertensive patients living in semi-rural Senegalese area. Patients and methods According to the World Health Organization STEPSwise approach, we conducted, in November 2012, a cross-sectional and exhaustive study in the population aged at least 35 years old and living for at least six months in the semi-rural area of Guéoul. We researched electrocardiographic and echocardiographic left ventricular hypertrophy in hypertensive subjects. Data were analyzed with SPSS 18.0 software version. The significance level was agreed for a value of P < 0.05. Results We examined 1411 subjects aged on average of 48.5 ± 12.7 years. In total, 654 subjects were hypertensive and screening of left ventricular hypertrophy (LVH) was effective in 515 of them. According to Sokolow-Lyon index, 86 subjects (16.7%) presented electrocardiographic LVH, more frequently in men ( P = 0.002). According to Cornell index and Cornell product, LVH was founded respectively in 66 (12.8%) and 52 subjects (10.1%), more frequently in female ( P = 0.0001; P = 0.004). It was more common in grade 3 of hypertension however criteria. In echocardiography, prevalence of LVH was 2.2% (13 cases) according to the left ventricular mass, 9.3% (48 cases) according to the left ventricular mass indexed to body surface area and 8.2% (42 cases) according to the left ventricular mass indexed to height 2.7 . LVH was significantly correlated with the electrocardiographic LVH according to Sokolow-Lyon index ( P < 0.0001) and the grade 3 of hypertension ( P = 0.003). Conclusion Although rare in hypertensive Senegalese living in semi-rural area, left ventricular hypertrophy is correlated with severity of grade of hypertension. Screening by electrocardiogram will allow better follow-up of these hypertensive subjects. [ABSTRACT FROM AUTHOR]

We here report the case of a 60-year old patient with congestive heart failure due to Fabry disease-related cardiopathy. This study has offered the opportunity to perform a literature review on cardiopathy related to this disease as well as to highlight the features of cardiac manifestation in Fabry disease. [ABSTRACT FROM AUTHOR]

Résumé Les oreilles décollées constituent une disgrâce qui est un motif fréquent de consultation en chirurgie plastique en particulier chez l’enfant. En effet, elle est souvent l’objet de moqueries et de remarques désobligeantes qui engendrent dans certains cas des difficultés psychologiques ou des conflits scolaires. Les oreilles décollées sont la résultante d’une ou plusieurs anomalies congénitales qui peuvent s’associer entre elles à des degrés divers. Le défaut de plicature de l’anthélix, l’ouverture de l’angle céphaloconchal et l’hypertrophie de conque sont les plus fréquentes. La chirurgie vise à corriger ces anomalies, en remodelant le cartilage de façon à obtenir des oreilles bien plicaturées, normalement positionnées et orientées, symétriques, de taille et d’aspect naturels. Elle combine différents gestes qui doivent être simples et rapides. L’incision est rétro-auriculaire, la dissection jusqu’au plan mastoïdien permet de repérer le muscle rétro-auriculaire qui est ôté. Le modelage de l’anthélix vise à lui redonner un relief naturel par fermeture de l’angle scaphoconchal. La conque est ensuite enfouie et est amarrée solidement au périoste pré-mastoïdien, ce qui a pour conséquence de fermer l’angle céphaloconchal. Le résultat doit être harmonieux et durable. Chaque chirurgien adopte une technique qui lui est propre en s’adaptant au cas par cas pour obtenir le meilleur résultat, en évitant les complications dominées par le risque d’infection heureusement exceptionnelle. Summary Prominent ears can have a significant psychological impact especially in children. It is often the subject of negative remarks among classmates. Prominent ears are the result of one or more congenital anomalies that may be associated together in various degrees. Absence of antihelical fold, opening the cephalo-conchal angle and conchal hypertrophy are the most common. The surgery aims to correct these anomalies, by reshaping the cartilage in order to obtain well-shaped ears that is normally positioned and oriented with natural size and appearance. It combines different steps that need to be simple and fast. Retro-auricular incision, and dissection posteriorly allows to expose and remove the post-auricular muscle. Modeling of antihelical fold aims to restore a natural relief by closing the scapha-conchal angle. The concha is then buried and is securely attached to the pre-mastoid periosteum, which by consequence closes cephalo-conchal angle. The result must be harmonious and sustainable. Each surgeon adopts a suitable technique for him to obtain best results, by avoiding complications mainly infection, which is fortunately exceptional. [ABSTRACT FROM AUTHOR]

In removable full prosthesis, prosthetic rehabilitation can be difficult, especially in the presence of an unfavorable ostéomuqueux environment, preventing the establishment of the prosthesis. Indeed, a significant hypertrophy and crestal tuberosity requires surgical planning of the prosthetic space useful because these anatomical obstacles forcing the practitioner to harmful to compromise the stability of the prostheses, in terms of the extent of the base at the level occlusion and aesthetics. Through this work, we will try to illustrate the difficulties inherent in the lack of prosthetic space in the horizontal direction and propose a course of action adequately address this problem for optimal prosthetic balance. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Très peu d’études se sont intéressées au suivi gynécologique des femmes présentant un spina bifida et ce sujet est rarement évoqué tant dans les associations de patients que dans les milieux médicaux. Pourtant, ces patientes sont demandeuses de conseils et d’une prise en charge adaptée à leur pathologie. Méthodes Nous avons mené, dans le cadre du centre de référence spina bifida du CHU de Rennes, une étude rétrospective, observationnelle, sur 4 ans, afin d’étudier les éventuelles particularités du suivi gynécologique de ces patientes et de pouvoir adapter notre pratique à leurs besoins. Résultats Quarante-huit patientes ont été incluses. Nous avons mis en évidence, de façon significative, un sur-risque de puberté précoce, d’hypertrophie des petites lèvres et de prolapsus pelvien. Conclusion Le suivi gynécologique des patientes ayant un spina bifida présente quelques particularités intéressantes à connaître. Une étude sur une plus grande série de patientes est nécessaire pour analyser plus précisément les problématiques gynéco-obstétricales et sexologiques de ces femmes. Objectives Few studies have focused on reproductive health care for women with spina bifida. This subject is rarely discussed, whether in patient groups or in the medical community. However, these patients need advice and a care that is appropriate to their condition. Methods In association with the spina bifida reference center of the University Hospital of Rennes, we have conducted a four-year retrospective, observational study. Its aim was to analyze the characteristics of the patients’ gynecological care and to adapt our practice to their needs. Results Forty-eight patients were included. We demonstrated an increased risk of precocious puberty, labia minora hypertrophy and genital prolapse. Conclusion Some specific characteristics of the reproductive health care of patients with spina bifida are interesting to know. A study on a larger series of patients is needed to further analyze the obstetric, gynecological and sexological issues of these women. [ABSTRACT FROM AUTHOR]

Résumé La reconstruction du fourreau cutané de la verge impose un résultat fonctionnel et esthétique parfait, associant un haut degré d’élasticité cutanée pour permettre des érections régulières à un aspect cosmétique satisfaisant. La demande de chirurgie esthétique d’augmentation pénienne ne cesse de s’accroître depuis plusieurs années. La technique chirurgicale la plus communément utilisée est désormais la lipopénosculpture (LPS) d’épaississement et d’élargissement, associant une greffe adipocytaire à une section du ligament suspenseur de la verge. Un patient ayant bénéficié d’une LPS a présenté plusieurs années après une hypertrophie majeure du greffon adipocytaire, rendant impossible tout rapport sexuel, imposant de réaliser une lipoaspiration. Cette lipoaspiration s’étant compliquée d’une nécrose du fourreau cutané de la verge, une reconstruction était nécessaire et a consisté en une greffe de peau mince non expansée associée à du derme artificiel. Grâce à la technique de l’adaptation de la greffe de peau sur le pénis en érection, l’utilisation de derme artificiel et la stabilisation externe par thérapie à pression négative, la reconstruction du fourreau cutané de la verge permet d’obtenir d’excellents résultats esthétique et fonctionnel. Enfin, il n’est que rarement rapporté dans la littérature de complication du lipomodelage à type d’altération du résultat esthétique après prise de poids. Summary Reconstruction of the penile skin requires a functional and esthetically perfect result, combining a high degree of skin elasticity to allow regular erections and a satisfactory cosmetic appearance. Demand for cosmetic surgery penile augmentation continues to increase for several years. The surgical technique most commonly used is now widening and lengthening lipopenisculpture (LPS), combining an adipocyte graft to a section of the suspensory ligament of the penis. A patient who underwent LPS presented several years after a major hypertrophy of the adipocyte graft, making it impossible to have sexual activities, imposing to perform liposuction. This liposuction was being complicated by necrosis of the penile skin. Reconstruction was required and consisted of an unexpanded thin skin graft associated with artificial dermis. Through technical adaptation of the skin graft on the erect penis, the use of artificial dermis and external stabilization by negative pressure therapy, reconstruction of the penile skin provides excellent aesthetic and functional results. Finally, it is rarely reported in the literature complications of lipofilling like alteration of the aesthetic result after weight gain. [ABSTRACT FROM AUTHOR]

Résumé: L’adénomyose est fréquente, souvent asymptomatique. Une hypertrophie réactionnelle des cellules musculaires lisses autour des glandes endométriales ectopiques peut entraîner des phénomènes compressifs. Nous rapportons la prise en charge par embolisation d’un volumineux utérus adénomyosique avec compression veineuse iliaque chez une patiente réfutant l’hystérectomie. Ce traitement a permis une réduction du volume utérin et l’absence de récidive à 3ans. L’IRM est la technique d’imagerie de choix dans les incertitudes échographiques, permettant une évaluation non invasive, précise et le suivi après traitement. L’embolisation n’est pas actuellement recommandée. Cependant, elle est une alternative conservatrice évaluée efficace, permettant la préservation de la fertilité. [ABSTRACT FROM AUTHOR]

Résumé: Objectif: Évaluer par échographie la fréquence des épanchements articulaires, de l’hypertrophie synoviale, de la synovite et du signe du double contour des articulations habituellement atteintes par la goutte et savoir si ces caractéristiques diffèrent suivant l’uricémie, la durée de la maladie et l’utilisation d’hypo-uricémiants. Méthodes: Les goutteux participants furent recrutés dans des services de rhumatologie. Une évaluation clinique détaillée de l’histoire de la maladie, des comorbidités, des traitements médicamenteux, de la consommation d’alcool, de la taille, du poids, des synovites, des tophus et de l’uricémie fut entreprise. Une échographie des articulations métatarsophalangiennes, chevilles, genoux, métacarpophalangiennes, poignets, coudes à la recherche d’épanchement articulaire, d’une hypertrophie synoviale, d’une synovite ou du signe du double contour fut effectuée. Le nombre moyen d’articulations atteintes fut comparé à l’uricémie (<360μmol/L contre>360μmol/L), le traitement ou l’absence de traitement par hypo-uricémiant et la durée d’évolution de la maladie (≤5ans contre>5ans). Résultats: Quarante patients participèrent à l’étude. Un épanchement articulaire, une hypertrophie synoviale et un signe du double contour furent respectivement identifiés chez 36 (90 %), 38 (95 %) et 37 (93 %) des participants. Un épanchement articulaire fut observé le plus fréquemment au genou (droit : 70 %, gauche : 68 %) suivi par l’articulation métatarsophalangienne du gros orteil (droite : 48 %, gauche : 40 %) et moins souvent des articulations métatarsophalangiennes (droites : 45 %, gauches : 35 %). L’hypertrophie synoviale, la synovite et le signe du double contour furent observés plus fréquemment à l’articulation métatarsophalangienne du gros orteil (hypertrophie : droite 65 %, gauche 60 % ; synovite : droite 18 %, gauche 18 % ; double contour droit 60 %, gauche 68 %). Ces résultats ne différaient pas suivant l’uricémie, la durée d’évolution de la maladie ou l’utilisation d’hypo-uricémiants. Conclusion: L’échographique polyarticulaire identifie fréquemment les épanchements articulaires, l’hypertrophie synoviale, la synovite et le signe du double contour chez les goutteux particulièrement aux articulations métatarsophalangiennes et au genou. [ABSTRACT FROM AUTHOR]

Résumé: But de l’étude: L’objectif de ce travail était d’évaluer l’influence de la restriction de l’apport alimentaire en sodium sur les changements de la morphologie cardiaque et vasculaire associés à une insulinorésistance. Animaux et protocoles: À huit semaines d’âge, les rats reçoivent soit un régime contenant 60 % de fructose avec (0,64 %) ou sans (<0,01 %) sodium, soit une alimentation standard (0,64 % de NaCl) pendant 12 semaines. Résultats: L’augmentation de l’HOMA index et de l’insulinémie à jeun confirme l’installation d’une insulinorésistance. Le régime fructose s’accompagne d’une hypertrophie cardiaque et vasculaire ainsi que d’une augmentation de la proportion de collagène indiquant une fibrose cardiaque. Aucune variation significative de la pression artérielle ou de l’expression de l’ARNm de l’aldostérone synthétase n’est notée. En revanche, on observe une augmentation du stress oxydant, évalué par la fluorescence du dihydroéthidium (DHE), dans le tissu cardiaque. Le régime désodé prévient l’insulinorésistance, l’augmentation de la masse cardiaque et la fibrose cardiaque de même que l’élévation de l’aire de section de la carotide. Parallèlement, le marquage du DHE est normalisé dans le tissu cardiaque des rats nourris par le régime fructose sans sodium. Conclusion: La prévention de l’élévation du stress oxydant est très probablement l’un des mécanismes impliqués dans l’effet favorable de la réduction de la consommation de sodium sur les altérations cardiovasculaires associées à une insulinorésistance d’origine alimentaire. [ABSTRACT FROM AUTHOR]

Résumé: Nous rapportons deux accouchements, à l’issue de deux grossesses successives, chez une patiente atteinte d’un syndrome de Parkes-Weber. Cette parturiente présentait une angiodysplasie complexe, associant une hypertrophie des parties molles d’un membre inférieur, un angiome plan cutané et des malformations vasculaires artérioveineuses. L’existence de malformations artérioveineuses médullaires a été éliminée par une angiographie médullaire par résonance magnétique nucléaire. Nous décrivons également d’autres aspects de la prise en charge, notamment l’évaluation cardiovasculaire prépartum, la voie d’accouchement, l’emploi de l’analgésie périmédullaire et la prévention des risques hémorragique et thromboembolique. [ABSTRACT FROM AUTHOR]

Résumé: Objectif: Les techniques chirurgicales décrites de nymphoplastie de réduction sont multiples et variées. À travers une revue de la littérature, nous avons essayé de déterminer quelle est la technique à privilégier afin de traiter les hypertrophies des petites lèvres. Matériel et méthodes: Une revue de la littérature a été effectuée en consultant la base de données Medline (entre 1980 et 2012). Les articles ont été sélectionnés en croisant les mots clés ű hypertrophy of labia minora Ƈ et ű surgical reduction of labia minora Ƈ. Résultats: Aucun essai randomisé n’a été retrouvé. Seules deux techniques (de résection sectorielle triangulaire) ont fait l’objet de séries rétrospectives portant sur des effectifs importants avec un suivi à long terme détaillé. Discussion et conclusion: Les techniques de nymphoplastie de réduction décrites sont multiples. La technique de résection triangulaire est la seule ayant fait l’objet d’une évaluation sur de grands effectifs, avec des résultats satisfaisants sur le plan esthétique et fonctionnel (90 à 95 % des patientes) et peu de complications (2 à 7 %). Les autres techniques, évaluées sur des nombres plus restreints de patientes, rapportent également des résultats satisfaisants. Par conséquent, la technique de résection est à choisir principalement en fonction de l’expérience du chirurgien, des particularités anatomiques et des souhaits de la patiente. [ABSTRACT FROM AUTHOR]

Abstract: We report a unique and previously unreported case of motor paralysis of the posterior interosseous nerve of rapid onset in a context of hypertrophy of the short supinator muscle, occurring 2years after a distal rupture of the biceps in a 62year-old man. The ruptured tendon had received functional treatment due to the patient''s age and low functional requirements. Operatively, the deep branch of the radial nerve was released within the arcade of Frohse with complete recovery from symptoms at 5months. The unrepaired rupture of the distal portion of the biceps could be a risk factor for posterior interosseous nerve compression in active subjects. [Copyright &y& Elsevier]

Abstract: In western Europe, the techno-economic changes that affected human societies during the 16th millennium BC suggest a deep reformulation of social relations that led to the emergence of Magdalenian features, thanks to a powerful cultural acceleration process. In central France, these mutations, contemporary with the Heinrich 1 climatic event, took place in a paleohistorical framework whose structure was less distended than in other regions: the cultural answers seem to disappear behind social “waves” (hypertrophy of the circulation of lithic raw materials, the sudden resurgence of blade debitage) expressed in this area since the early Upper Paleolithic. They allow us to discern, in the long term, how the original experiments of the Middle Magdalenian materialized. In the short term, some limited geological episodes, such as the recovery of the volcanic activity of the Massif Central around 16 ka cal BC, offer some possible stimuli of the rapid changes that affected technical systems. Their variations reveal the conditions, the aspects and the rhythms of the emergence of new ideological attributes that formed the traditional basis of Magdalenian societies. [Copyright &y& Elsevier]

Abstract: Objectives: To evaluate results, complications and the satisfaction of patients after labia minora, reduction. Patients and methods: It was a retrospective study. Twenty-six patients underwent a labia minora reduction by longitudinal resection in the service of gynecological surgery of the hospital Tenon during a two-year period. Patients were 14 to 64 years old (median=25 years old). The motivations were aesthetic or functional, with entry dyspareunia, discomfort with exercise, and discomfort in clothing. The anatomical result was estimated at the postoperative consultation, one month later. Patient satisfaction was estimated in the long term by a phone questionnaire. Results: There was no complication to type haematoma or wound dehiscence. The anatomical result was satisfactory for 95% of the patients. Twenty questionnaires were completed. All the patients having answered were satisfied with the aesthetic result. Only one patient was dissatisfied of the functional result with a loss of clitoral “flexibility”. Discussion and conclusion: Reduction of labia minoria according to the amputation technique of is simple, safe, with few complications and high patient satisfaction. However, the size of the sample is low and further studies are warranted. [Copyright &y& Elsevier]

Summary: Introduction: Hypertrophy of the masticatory muscles most commonly affects the masseter. Less common cases of isolated or associated temporalis hypertrophy are also reported. Parafunctional habits, and more precisely bruxism, can favor the onset of the hypertrophy. This condition is generally idiopathic and can require both medical and/or surgical management. Observation: A 29-year-old patient was referred to our department for an asymmetric swelling of the masticatory muscles. Physical examination revealed a bilateral hypertrophy of the masticatory muscles, predominantly affecting the right temporalis and the left masseter. Major bruxism was assessed by premature dental wearing. The additional examinations confirmed the isolated muscle hypertrophy. Benign asymmetric hypertrophy of the masticatory muscles promoted by bruxism was diagnosed. Treatment with injections of type A botulinum toxin was conducted in association with a splint and relaxation. Its effectiveness has been observed at six months. Discussion: Few cases of unilateral or bilateral temporalis hypertrophy have been reported, added to the more common isolated masseter muscles hypertrophy. The diagnosis requires to rule out secondary hypertrophies and tumors using Magnetic Resonance Imaging. The condition is thought to be favoured by parafunctional habits such as bruxism. The conservative treatment consists in reducing the volume of the masticatory muscles using intramuscular injections of type A botulinum toxin. Other potential conservative treatments are wearing splints and muscle relaxant drugs. Surgical procedures aiming to reduce the muscle volume and/or the bone volume (mandibular gonioplasty) can be proposed. [ABSTRACT FROM AUTHOR]

Summary: Introduction: Patients desiring breast reduction are often in overweight, and describe interferences with their daily life and minor psychological problems. We undertook this study to establish the pre- and postoperative weight pattern by age and histological breast type. Patients and methods: A retrospective review was performed on 100 consecutive patients who underwent bilateral reduction mammaplasty for macromastia (>300g per breast) in 2007. The patients were categorized by age in two groups: group 1 (G1) comprising the 50 younger patients (mean age: 35.5 years) and group 2 (G2) comprising the 50 older (mean age: 47.2 years). We obtained data points including: preoperative and postoperative weight pattern according to age and histological subtypes, calculation of body mass index (BMI), data from surgery including amount of resection, postoperative course and complications. Results: Patients consulting for breast reduction are moderately overweight (mean BMI: 28.22 confounded all ages). Preoperative weight loss is low despite systematic surgeon request (<0.5 % on average waiting time of 6.45 months). The postoperative weight loss is higher in young patients with glandular form of HTM (respectively −4.76 kg for glandulofibrous type and −3kg for fibrous, which corresponds to a loss of 6.5 and 4.1 % of their body weight). The impact of surgery on the patient''s psychological condition is better in young patients. Conclusion: This study demonstrated that postoperative weight diminution after breast reduction are significant only in young patients with a constitutional type of macromastia (glandular or mixed forms). We believe that in addition to the functional improvement associated with surgery, these young patients lose weight they initially take to harmonize their silhouette. [Copyright &y& Elsevier]

Summary: Introduction: The Turner''s syndrome encompassed several conditions, of which monosomy X (absence of the entire sex chromosome X) is most common. It is a chromosomal abnormality in which all or part of the sex chromosomes X is absent. Typical females have two X chromosomes, but in Turner''s syndrome, one of those sex chromosomes is missing or presents abnormalities. Patients show a shield shaped thorax with thick and bulging chest, breast hypotrophy and widely spaced nipples. The objective of this study was to characterize the breast abnormalities observed in Turnerian. Patients and methods: We describe a prospective multicentric study (August 2007–March 2008) on 21 nullipar patients, ranging from 16 to 35 years old. Six were monosomic and 14 were Turner mosaic (in this case the chromosome is missing in some cells but not others), 19 were treated with estrogens and progestatives. This study was achieved through the use of clinical examinations including body, waist, hips (BWH) measurements and photography. The statistical method involved a descriptive analysis, linear correlation calculations and student test. Results: The breast morphology appears to be quite closed to that of the general woman population, but with average thorax volume more bulky mainly in the anteroposterior zone, and with more reduced breast volumes. No specific abnormalities in the chest development were observed. No differences in the hypotrophy, hypertrophy, and normal breast volume repartition were observed between monosomic and mosaic patients. The self-satisfaction index on the breast look is quite low, patients mainly complain about breast hypotrophy. Nevertheless, these results are not representative of the whole turnerians, since this study address only to volunteer patients and we cannot exclude possible distortions. Conclusions: In contrast to common beliefs, we don’t have observed any increase of the average of the internipple space; this observation is in good agreement with the most recent published literature works, which report only an apparent increase of this intermamelonary distance versus the thoracic width (in front view), probably caused to an optical distortion effect. [Copyright &y& Elsevier]

Summary: Obstructive sleep apnea (OSA) is common in childhood obesity and is mainly due to adenoid and tonsillar hypertrophy. Surgical management with adenotonsillectomy will be the first line of treatment for obese children with OSA in addition to weight loss. In addition, recent data suggested that sleep deprivation in infancy may be associated with obesity later in life, probably due to hypothalamic dysregulation with modifications in hormones involved in food intake regulation. It confirms that it is crucial to evaluate sleep for all obese children with questionnaire in order to improve their management and their quality of life. [ABSTRACT FROM AUTHOR]

Summary: We report the case of a 9-year-old boy with progressive thoracic scoliosis and crossed hemihypertrophy who was discovered with a Chiari 1 malformation and syringomyelia. These disorders are connected by complex physiopathological mechanisms; their association deserves attention. This observation reviews the importance of the clinical examination, particularly the neurological exam, in childhood scoliosis. The features suggesting a neurogenic background of spine deformation should be sought. Scoliosis with hemihypertrophy can be the sign of an underlying neurological abnormality. [ABSTRACT FROM AUTHOR]

Summary: Pulmonary atresia and critical pulmonary stenosis with intact ventricular septum includes a wide spectrum of cardiopathies with great morphological heterogeneity. The pulmonary valve may be completely atretic or may contain a puncture hole if stenosis is present. The obstruction may be membranous and/or musclar. All components of the right ventricle can be affected, even the coronary circulation with ventriculocoronary connections and stenosis or atresia of the pulmonary arteries. Prenatal diagnosis is made when the right ventricle is hypoplastic and hypertrophic. The pulmonary valve is thickened and the pulmonary artery is perfused retrogradely through the ductus arteriosus. Right ventriculocoronary connections may sometimes be seen with fetal echocardiography. Postnatal survival depends on the patency of the ductus arteriosus, requiring prostaglandin E1 infusion. When hypoplastic right ventricle and/or ventricle-dependent coronary circulation exists, biventricular circulation is not possible. In these cases, surgical treatment is palliative. In cases with well-developed right ventricle, transcatheter therapy is usually provided with perforation and balloon dilation of the pulmonary valve. In cases of muscular obstruction of the right ventricle outflow tract, surgery may be considered as first-line therapy. In case of prenatal diagnosis, the medical termination of pregnancy is possible when severe right ventricular hypoplasia exists, precluding biventricular circulation. Postnatally, the prognosis of the patients is highly variable, mainly related to the size of the right cavities and the presence of coronary anomalies. [Copyright &y& Elsevier]

Summary: If the etiological diagnosis of left ventricular hypertrophy in an athlete is often easy, even obvious, it can conversely be sometimes very complex. The clinical case that we describe here is an illustration that allows us to develop the clinical reasoning should then follow steps. [Copyright &y& Elsevier]

Summary: Introduction: A new medical device based on a concept of the reconstruction of the extracellular matrix by a molecule belonging to the family of the ReGeneraTing Agents (RGTA®) has just been available to treat skin lesions. RGTA® are biodegradable polymers engineered to mimic heparan-sulfate in the extracellular matrix of damaged tissue. RGTA® improves tissue healing in several animal models, by stabilizing and protecting heparin-binding growth factors (HBGFs) and matrix proteins. We have evaluated the effects of this device containing RGTA® on cutaneous cicatrisation in a group of patients treated by reduction mammoplasty and in a group operated by a centrofacial lifting. Patients and methods: Seventeen patients who underwent mammoplasty for breast hypertrophy received cutaneous application of the device at D1, D4, D8 and D11 on one breast. Quality, color, inflammation of the scar and eventual complications have been evaluated by photography and at the third postoperative month by the Vancouver Scar Scale. Another group of 50 patients that underwent a centrofacial lifting received a bilateral deposition of drops of RGTA® in the operating plane at the end of the surgical procedure. Discomfort, oedema, ecchymosis and inflammation of the scars have been evaluated at 1-month postoperative and compared with an identical group of 50 other patients, operated by the same surgeon without RGTA®. Results: In the group of mammoplasties, inflammation, prurit and hypertrophic scars were less frequent for the breast treated by RGTA®. The mean Vancouver Scar Scale has been lower in the treated group than in the control group. In some patients the pain, related probably to the local inflammation, has been less important for the treated breast. In the sequence of centrofacial lift at 1-month postoperative, scar inflammation, oedema and bruises were much less frequent in the treated group (10 %) than in the non-treated group (90 %). Conclusion: Topical application of RGTA® seems to improve cutaneous healing in a group of patients operated for breast reduction and to reduce discomfort, ecchymosis and oedema in the group of centrofacial lifting. These results are concordant to the experimental results obtained and pilot studies results. [Copyright &y& Elsevier]

Abstract: Introduction: The Niemann Pick disease type B is a rare deficiency in sphingomyelinase activity, autosomal recessively inherited. Case reports: We report three patients (two men, one woman) of the same family, who showed pulmonary and hepatosplenic lesions, usually present in the disease but also adrenal gland lesions confirmed by tomodensitometry. Conclusion: The current treatment of Niemann Pick disease is purely symptomatic awaiting the use of enzymatic replacement therapy which has been successfully experimented in animal model. [ABSTRACT FROM AUTHOR]

Summary: A retrospective study was made to assess complications of superior pedicle breast reduction, in the Besançon hospital plastic surgery ward. One hunderd patients operated between 2003 and 2007 were reexamined. In every case, the intervention was performed by the same operator (Pr Tropet) using the same technique. The average postoperation time range was 2 years (from 8 months to 5 years). The interview''s minutes were formalized via a revisions sheet, including medical files, photos, and pre- and postoperative measures. Complications (hematoma, infection, necrosis, suture disunion, thromboembolic disease) were reported in 16 % of the cases. These lead to three emergency reoperations for drainage, and six delayed reoperations. Result imperfections were related to aerola and nipple, and to scars. Two patients requested a scar revision. The results match reported data. Technical modifications are suggested to reduce complications or imperfections. [Copyright &y& Elsevier]

Résumé: La sténose hypertrophique du pylore est une cause fréquente de vomissements chez le nourrisson, surtout le garçon. Sa pathogénie a donné lieu à de très nombreuses hypothèses et aucune d’entre elle n’est confirmée à ce jour. C’est une hypertrophie acquise de la musculeuse du canal pylorique, de type tumoral, globale, myomateuse qui entraîne une sténose centrée de la lumière du pylore. Cette hypertrophie s’étend à la paroi de l’antre prépylorique, créant un rétrécissement progressif serré, antropylorique étendu sur plusieurs centimètres. L’hypertrophie est sténosante, de consistance dure, presque calcaire, construisant sous la séreuse une masse ovalaire dont le pôle distal est saillant dans la lumière du bulbe duodénal alors que le pôle proximal est moins bien défini, n’apparaissant de façon nette que lorsque les ondes péristaltiques gastriques viennent buter sur sa rigidité en l’englobant. Les examens de pièces anatomiques ont permis d’observer constamment l’hypertrophie du muscle pylorique associée à un œdème de la muqueuse pylorique et, occasionnellement, des ulcérations. [Copyright &y& Elsevier]

Résumé: Nous rapportons un cas d’hypertrophie des muscles tibiaux et, de façon moins importante, des muscles du mollet précédé d’un syndrome lombaire et d’une sciatique. La myélographie lombaire a révélé une compression d’origine discale au niveau de la racine nerveuse L5. La biopsie musculaire des muscles péroniers a montré une prédominance des fibres de type I et une hypertrophie sans infiltration inflammatoire. Nous considérons la possibilité qu’une radiculopathie, pas uniquement au niveau de la racine nerveuse S1 mais également en L5, puisse déclencher une hypertrophie musculaire et qu’elle doit être prise en compte dans le diagnostic différentiel de l’hypertrophie unilatérale localisée du membre inférieur. [Copyright &y& Elsevier]

Summary: HIV-related facial atrophy is a common complication due to antiretroviral treatment. The social handicap due to this lipodystrophy increase the demand of surgical correction. The usual treatment is the Lipostructure® described by Coleman. The hypertrophy is one of the complications which can occur after a correction by Lipostructure®. This complication is different from the overcorrection by the free time before his appearance. The treatment by liposuction is possible but there is a high risk of recurrence. The best treatment, after the literature review, seems to be the direct excision. [Copyright &y& Elsevier]

Summary: Aim: The internal breast pedicle flap is not a well-known technique yet. Anyway, it is effective for some of breast reconstructions and partial thoracic defects. This technique is applied to patients presenting breast hypertrophy. In this article, we present the experience of our department in this technique, considering its indications, surgery details, complications that may occur and subsisting interrogations about this surgical approach. Material and methods: Two patients were treated with internal breast pedicle flap, one for controlateral breast reconstruction and one for coverage of partial thoracic defect. Results: Patients were followed; flap survival and aesthetic results were analyzed during consultations. Results were good and similar to other well-spread reconstruction techniques. Conclusion: The internal breast pedicle flap is a relevant, reproducible and easy technique. Overall results are satisfying and allow the possibility of applying other techniques in case of failure. You have to keep in mind the risk of making a transfer of a potentially carcinogenic tissue for a patient having already presented a breast cancer. [Copyright &y& Elsevier]

Summary: The authors present a retrospective study about 20 patients operated for important breast hypertrophy and gigantomastia by the postero-inferior reduction technique. They compare the results obtained by this technique on the breast (projection, breast-feeding) and on the nipple–areola complex (sensibility, pigmentation, nipple projection), with those obtained by the Thorek technique (free nipple grafting). The authors show that this technique is reliable for such breasts hypertrophies, with good esthetics results, and avoid free nipple grafting. [Copyright &y& Elsevier]

Résumé: Objectifs: Le but de notre étude a été de décrire les anomalies échographiques des articulations interphalangiennes proximales (IPP) et interphalangiennes distales (IPD) chez des sujets sains. Méthodes: Des sujets témoins, volontaires asymptomatiques, âgés de moins de 40 ans, ont été inclus dans l’étude. L’échographie a été réalisée sur les IPP et les IPD no  2 à 5 par deux opérateurs. En mode-B, une hypertrophie synoviale et un épanchement ont été définis selon les critères de l’Omeract. L’activité inflammatoire a été évaluée en mode Doppler énergie. Résultats: Les 46 sujets inclus dans l’étude étaient âgés de 25,5 ans en moyenne et 89 % étaient droitiers. Nous avons étudié 368 articulations IPP et IPD. Un épanchement articulaire a été mis en évidence dans 19,6 % des IPP du côté dominant et 22,3 % du côté non dominant (p >0,05). L’épanchement pouvait être unilatéral ou bilatéral. L’épanchement était plus rare (3 %) dans les IPD. La taille de l’épanchement était de 0,83±0,25mm pour les IPP et 0,72±0,16mm pour les IPD. Conclusion: Notre étude permet une analyse descriptive des articulations IPP et IPD. Elle confirme, sur un plus grand nombre d’articulations étudiées, l’existence possible à l’état physiologique d’un épanchement dans une articulation IPP chez le sujet sain. Pour les articulations IPD du sujet sain, il s’agit de la première étude descriptive et l’épanchement y est très rare. [Copyright &y& Elsevier]

Summary: Aim: The aim of this study is to appreciate the hypertrophy of labia minora, its psychological and functional effects and the different techniques of reduction available. Patients and methods: From August 2004 to June 2007, 14patients have been operated with a posterior wedge resection technique associated with a Z plasty. A questionnaire has been sent to each patient in order to make a retrospective study of the different reasons of consultation and their degree of satisfaction after surgery. Results: Among the 12 patients who answered the questionnaire, main part of them was satisfied or very satisfied of the morphologic and functional results. All of them were satisfied to have decided on this surgery. Discussion: We can notice an increase of the requests concerning the vulvar morphologic changing, either due to aesthetics preoccupations or functional disorders. Technically, the wedge resection brings the most satisfactory results. The addition of a Z plasty and the posterior location of the scar should prevent dyspareunia and perpartum tears. Conclusion: This preliminary clinical study focuses on the different techniques, enables a better knowledge of these women expectations and confirms our technique. [Copyright &y& Elsevier]

Summary: Rhinophyma is an hypertrophy of the nose occurring primarily in man, as from 40 years, secondary of an hyperplasy and a fibrosis of sebaceous glands. This pathology is particularly unesthetic and sometimes responsible of nasal obstruction. The treatment of this pathology is primarily surgical and the purpose of all techniques is to carry out a decortication. The authors describe one case of surgical treatment of rhinophyma by hydrodissection using Versajet®. After having presented the other possibilities of surgical technics for the treatment of this pathology, the authors compare the advantages and drawbacks of this new technique compared to those described in the international literature. [Copyright &y& Elsevier]

Summary: Bilateral hypertrophy of the palatine tonsils can be either an acute or chronic a condition. Chronic hypertrophy is now more and more frequent, and it usually affects children of less than five years of age who otherwise may not have pharyngitis often. The etiology and pathogenesis of tonsillar hypertrophy are not clear. Two hypotheses are currently the most accepted: the first, the deleterious effects of pollution, and the second, inflammation in the upper airways. When ventilation is affected, particularly during sleep, corticoids are the recommended treatment for the acute form and tonsillectomy for the chronic form. It should be noted that the intervention has no immuno-allergic consequence, even in very young infants. [Copyright &y& Elsevier]

Abstract: Introduction: Light chain deposition disease is a systemic disorder characterised by tissue deposition of monoclonal immunoglobulin light chains without tinctorial properties. It has been exceptionally reported with salivary involvement mimicking Sjögren''s syndrome and peripheral neuropathy. Case report: We report a case of light chain deposition disease associated with plasma cell dyscrasia presenting as sicca syndrome with salivary glands hypertrophy and polyneuropathy successfully treated by high dose melphalan and autologous blood stem transplantation. Conclusion: Light chain deposition disease should be recognized as an aetiology of sicca syndrome and peripheral neuropathy. Further studies should assess the prevalence of sicca syndrome in light chain deposition disease and better characterise the neurological manifestations. [Copyright &y& Elsevier]

Summary: Pompe disease is an autosomal recessive glycogen storage disorder caused by acid-α-glucosidase deficiency. The infantile form is usually fatal by 1year of age in the absence of specific therapy. We report the cardiac follow-up of a 4-month-old boy treated with enzyme replacement therapy (ERT) for 8months. The patient had no cardiac failure at the age of 1year. Before starting ERT, ECG showed a shortened PR interval, with huge QRS complexes and biventricular hypertrophy; echocardiography demonstrated major hypertrophic cardiomyopathy. The QRS voltage (SV1+RV6) decreased from 13 to 2.9mV after 32weeks of ERT, suggesting a progressive reduction of cardiac hypertrophy and intracellular glycogen excess. The PR interval increased from 60 to 90ms. A block of the right bundle branch appeared after 13weeks of treatment. The indexed left ventricular mass decreased from 240 to 90g/m2 after 30weeks of ERT. The left ventricular ejection fraction decreased transitorily between the 5th and the 15thweeks of treatment. In summary, ERT is an efficient therapeutic approach for the cardiomyopathy of infantile Pompe disease. However, the possible occurrence of a right bundle branch block and a transitory alteration in the ejection fraction highlight the importance of cardiac follow-up. [Copyright &y& Elsevier]

Summary: Our retrospective study done on 184 cases of hypertrophic mammary gland and ptosis on little, medium, and high grade confirms that we have approached an original technique, giving an inversed T scar, reducing the horizontal part of our scar instead of the original Pitanguy scar. [Copyright &y& Elsevier]

Abstract: Bilateral hypertrophy of the palatine tonsils can be either an acute or chronic a condition. Chronic hypertrophy is now more and more frequent, and it usually affects children of less than five years of age who otherwise may not have pharyngitis often. The etiology and pathogenesis of tonsillar hypertrophy are not clear. Two hypotheses are currently the most accepted: the first, the deleterious effects of pollution, and the second, inflammation in the upper airways. When ventilation is affected, particularly during sleep, corticoids are the recommended treatment for the acute form and tonsillectomy for the chronic form. It should be noted that that intervention has no immunoallergic consequence, even in very young infants. [Copyright &y& Elsevier]

Abstract: The incidence of insulin-dependent diabetes mellitus increase permanently, with early diagnosis. Insulin is the treatment of this pathology. Insulin therapy is associated with complication such as lipodystrophies at injection sites leading functional and aesthetics disorders (pain, reduction of treatment efficiency, haematomas and oedemas). Our report two cases to illustrate the effectiveness of the suction-assisted lipectomy (SAL) on these lipodystrophies. We present two cases of insulin dependent diabetics patients with lipodystrophies of thighs, abdomen, and shoulders treated by SAL. The various analyzed parameters are: aesthetic aspect, efficiency of insulin treatment, ease injection, and pain reduction. We observe a significant reduction of insulin dose necessary to obtain a normoglycema half time. This treatment allow a better control of pain, control of haematomas and oedemas at the injection sites and an aesthetic improvement. The lipoaspiration is thus a simple and effective treatment of lipodystrophies due to insulin. [Copyright &y& Elsevier]

Abstract: Objectives: The aim of our work was to determine the frequency of various cardiovascular abnormalities and atypical aspects observed in Tunisian competitive athletes. Material and methods: Our population was constituted of 181 professional football players (average age 23.1±3.9 years) consulted in “Centre National de la Médecine et des Sciences de Sport” of Tunis with to obtain medical certificate authorizing professional football practice. Results: Electrocardiogram was strictly normal in 67 players (37%). Twenty-nine players had conduction abnormalities. Repolarisation abnormalities were noted in 20 players. Echocardiography was normal in 129 players (71.3%). Ten cases of valvular heart disease were found. The mean left ventricular end-diastolic diameter was 53±4 mm and the mean left ventricular mass was 202.6±42.7 g. The mean relative wall thickness was 0.380. The left ventricular hypertrophy was present in 42 players. Conclusion: Cardiovascular abnormalities found in electrocardiogram and echocardiography in the Tunisian professional football players are comparable with those usually observed in elite athletes. [Copyright &y& Elsevier]

Abstract: Venous malformations (VM) are localized defects of blood vessels that are due to vascular dysmorphogenesis. These slow-flow lesions can affect any tissue or organ. Clinically, a cutaneous VM is characterized by a bluish mass that is compressible on palpation. Phleboliths are commonly present. Symptoms depend on location and size. VM are often sporadic and isolated, however, they can be associated with other malformations and be part of a syndrome; Klippel-Trenaunay (capillary-lymphatico-venous malformation with limb hypertrophy) is the most common. Glomuvenous malformation (GVM) is another type of venous anomaly. In contrast to VM, GVM is often painful on palpation and not compressible. Clinical diagnosis of VM is often made in the presence of a bluish cutaneous lesion: however, other lesions can mimick VM. The most frequent anomalies are a blue naevus, a hemorrhagic lymphatic malformation, a sub-cutaneous hemangioma or even the presence of dilated superficial normal veins due to underlying venous stenoses. This chapter will detail the clinical characteristics of venous anomalies and their differential diagnosis. [Copyright &y& Elsevier]

Abstract: Lymphatic malformations (LM) are the most frequent vascular malformations. There are three types of lesions involving lymphatic development that must be included in LM: vascular anomalies and knots (truncal malformations [TLM]); cystic anomalies, superficial or deep, uni- or multicystic (extratruncal malformations [ETLM]) and hemolymphatic anomalies which combine venous, arterial, or capillary malformations with LM. ETLM can be ubiquitously distributed but most are located in the cervical or axillary regions. Most ETLM are diagnosed at birth and in 80–90% of the cases before the age of 2. The clinical aspects are extremely variable: superficial ETLM (vesicular) and deep ETLM, localised or diffuse, mono- or multicystic. TLM are generally located on a lower limb with neonatal lymphatic oedema (often in a polymalformation context). All forms of the hemolymphatic combination can be identified. They are generally located on the limbs and are often unilateral. They are usually sporadic but can also be can be found in polymalformation syndromes (Klippel-Trénaunay, Parkes-Weber, Protée, Maffucci). ETLM generally tend to increase in volume and spread with age with stabilisation at puberty. They do not tend to spontaneously regress. Specific local complications can have serious consequences. They are linked to haemorrhaging, infections and compression phenomena. There can also be complications such as skeletal and soft tissue hypertrophy. [Copyright &y& Elsevier]