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Abstract: Introduction: Wounds on the palmar side of the wrist affecting the median or ulnar nerves are responsible for motor and sensory sequelae, severe pain and cold intolerance. Materials and methods: Thirty-nine patients with 40nerve sections were retrospectively reviewed with a mean follow up of 23months. The median nerve alone was affected 20times, the ulnar nerve seven times and both nerves simultaneously 13times. In 75% of the cases, there was an associated vascular injury (radial artery and/or ulnar artery). The average number of tendons cut was 4.25. Results: After repair of the median nerve, 71% of patients recovered antepulsion and opposition that was normal or possible against resistance. The strength was approximately 70% of the opposite side. The sensitive recovery was good (S3 in≥50% of cases) but it was accompanied by cold intolerance one out of two patients. After repair of the ulnar nerve, 29% of the cases had an ulnar claw hand, 71% of patients recovered sensitivity greater or equal to S3 but with cold intolerance in 42% of the cases. The combined median and ulnar sections had a poorer sensory-motor prognosis. Revision surgery was necessary in 12 of these cases. Conclusion: Sensory recovery after an isolated ulnar nerve lesion at the wrist is better than after an isolated median nerve lesion but there is no difference in the motor recovery. Combined median and ulnar lesions have an especially bad prognosis and may require secondary palliative surgery. The existence of nerve contusion and a high number of tendon injuries were factors associated with a poorer prognosis. [Copyright &y& Elsevier]

Nodular lymphoid hyperplasia (NLH) of the gastrointestinal tract is a rare disease usually reported in patients with congenital or acquired immunodeficiency and chronic gastrointestinal infections. However, no case of NLH in a patient receiving immunosuppressive therapy has been reported to date. We describe the case of a woman who developed chronic diarrhea related to NLH 9 years after liver transplantation. Other causes of diarrhea and NLH were excluded. Her immunosuppressive regimen consisted on mycophenolate mofetil (MMF) and tacrolimus. Reduction of MMF dose improved symptoms but led to a rising aminotransferase level. Given the risk of graft rejection, MMF at full dose was resumed and she was started on symptomatic treatment for diarrhea. The role of immunosuppressive drugs in the pathogenesis of NLH may be related to the reduction of T- and B-lymphocyte proliferation and decreasing antibody production. NLH will further develop to compensate functionally inadequate lymphoid tissue, as reported in congenital immunodeficiency states. [ABSTRACT FROM AUTHOR]

Abstract: Tracheobronchomegaly (TBM) (Mounier–Kuhn syndrome) is dilatation of the trachea and major bronchi because of atrophy or absence of elastic fibers and smooth muscle cells. We present a case of TBM with refractory lower respiratory infection and haemoptysis. The patient was a 53-year-old man with recurrent haemoptysis and without fever, wheezes, chest pain, weight loss or any respiratory disease. Chest helical computed tomography (CT) scan showed tracheomegaly with transversal diameters of the trachea of 50mm. A bronchoscopy was performed and revealed markedly enlarged airways and traces of bleeding arising from the right airways. The haemoptysis was stopped only after bronchial artery embolization. [Copyright &y& Elsevier]

Background Hypertension is the first cause of atrial fibrillation. Its onset is explained by intricate mechanisms such as atrial conduction impairment. The aim of our study was to evaluate atrial conduction by tissue Doppler imaging in hypertensive patients compared to a control group. Methods This is a comparative prospective study performed in the cardiology department of the FSI hospital enrolling 55 patients with hypertension and 55 controls. All of them underwent a complete echocardiography exam with Doppler tissue imaging. We measured inter-atrial and intra-atrial electromechanical delay by Pulsed Tissue Doppler. Results Left ventricular mass and septal thickness were more important in the hypertensive group. Mitral A wave was greater in hypertensive group compared to controls (7.1 cm/s vs. 5.6 cm/s; P < 0.001; respectively). Left atrial volume was of 32.7mL ± 6.8 mL/m 2 in hypertensive vs. 29.5 ± 4.3 mL/m 2 in controls ( P = 0.006). Doppler Tissue study showed homogeneous statistically significant elongation of atrial conduction times in hypertensive patients compared to controls: inter-atrial time (16.8 ± 7.8 ms vs. 12.7 ± 4.2 ms, P < 0.0003) and left intra-atrial (27.6 ± 8.6 ms vs. 19.0 ± 4.3 ms, P < 0.0001) and right intra-atrial time (10.6 ± 6 ms vs. 6.6 ± 2.9 ms, P < 0.0001) respectively for hypertensive and control subjects. There was a significant correlation between measured intra-atrial and inter-atrial electromechanical delays and duration of hypertension, indexed left atrial volume and indexed left ventricular mass ( r : 0.27–0.47, P < 0.001). Conclusion Atrial conduction time is significantly longer in hypertensive patients. Impairment of atrial conduction may be predictive of atrial fibrillation and should prompt closer follow-up to detect this arrhythmia in these patients. [ABSTRACT FROM AUTHOR]

Abstract: The digestive metastases of uterine leiomyosarcoma are rare. We report a case of a duodenal tumor detected in a 50 year-old woman, 3 years after she underwent a total hysterectomy for uterine leiomyosarcoma. The stenosing duodenal mass was thought to be a mesenchymal tumor. A pancreaticoduodenectomy was performed. The resected lesion was morphologically similar to the uterine leiomyosarcoma. In fact, the histopathological study confirmed a submucosal tumor with typical features of the uterine leiomyosarcoma. Immunohistochemistry was performed and it showed negative CD117 and CD 34. Markers displayed positivity for actin smooth muscle and desmin. Considering the patient history and the immunohistochemical observations, we diagnosed a duodenal metastasis of uterine leiomysarcoma. Through this exceptional observation we want to emphasize the epidemiological and the pathological features of the metastatic uterine leiomyosarcoma. We will also point out the progress of tumoral cells and the histopathological distinctive criteria with a primitive digestive mesenchymal tumor. [Copyright &y& Elsevier]

Abstract: Long term haemodialysis patient is subject to several complications such as generalised amyloidosis which is the result of deposits of β2-microglobuline not depurated by haemodialysis. Digestive location causes ischemic accidents such as ulcer, infarctus, digestive haemorrhage, pseudo-obstruction and perforation manifested by a surgical emergency. Our observation is the 6th case of intestinal perforation caused by amyloidosis deposit reported in the literature. [Copyright &y& Elsevier]

Au centre national de transfusion sanguine de Tunis, le prélèvement des concentrés unitaires de plaquettes (CUP) se fait en deux étapes ; la première consiste à faire une sérologie infectieuse pré-don (conformément à la réglementation relative à la sécurité transfusionnelle), si le résultat de cette dernière est négatif, le donneur peut réaliser son don. La sérologie infectieuse pré-don nous évite l’utilisation des kits de plaquettes pour les donneurs ayant une sérologie infectieuse positive. La problématique réside dans le fait que certains donneurs de CUP qui se présentent pour faire la sérologie pré-don ne reviennent pas pour le don proprement dit. Dans le présent travail, nous avons suivi les sérologies pré-dons sur une période de 20 mois allant de mai 2013 à décembre 2014 et nous avons trouvé qu’uniquement 1604 dons ont été réalisés pour 2266 donneurs qui ont bénéficié d’une sérologie infectieuse pré-don. Le but de ce travail est de comparer le coût global d’un CUP prélevé avec ou sans sérologie infectieuse pré-don et d’en déduire s’il serait plus rentable de procéder directement au prélèvement du don pour tous les donneurs. [ABSTRACT FROM AUTHOR]