Involvement of the IL23/Th17 Pathway in the Pathogenesis of Tunisian Pemphigus Foliaceus.

Pemphigus foliaceus (PF) is a rare autoimmune skin disease caused by anti-Dsg1 pathogenic autoantibodies. It is considered as a Th2-mediated disease. Likewise, Th17 cells were recently described in the pathogenesis of the disease but their role is still unclear. We aimed to unravel the eventual implication of the IL23/Th17 pathway in the development of PF. A case-control study was conducted on 115 PF patients and 201 healthy controls using PCR-RFLP and AS-PCR methods. SNPs in IL23R, RORγt, IL17A, IL17F, IL17AR, TNFa, and STAT3 genes were genotyped. mRNA expression of IL23R and RORγt was evaluated using Q-PCR. The frequency of circulating Th17 cells was analyzed by flow cytometry. Genetic associations between IL23R>rs11209026, IL17A>rs3748067, IL17F>rs763780, and TNFa>rs1800629 and the susceptibility to PF were reported. Moreover, we revealed a significant increased frequency of circulating CD4+IL17+ cells as well as higher mRNA levels of RORγt and IL23R in PBMCs of patients. However, no significant increase of RORγt and IL23R mRNA expression was observed in lesional skin biopsies. In spite of the little size of specimens, our results provide converging arguments for the contribution of the IL23/Th17 pathway in the pathogenesis of PF.

[Aesthetic reconstructive surgery of the lip]. / Chirurgie réparatrice et esthétique labiale.

Lip reconstruction can be performed with numerous surgical techniques. The aim was here to present these usual techniques and to focus on the details that can be used to obtain the most favourable results. The goal of this surgery, that represents a compromise between function and aesthetic, has to be kept in mind to prevent mistakes that decrease the quality of the result.

[Maxillary sinusitis of odontogenic origin: surgical treatment]. / Sinusites maxillaires d'origine dentaire : traitement chirurgical.

PURPOSE: The frequency of maxillary sinusitis of dental origin (MSDO) is under estimated. The medical and surgical treatment has improved thanks to endoscopic guidance. We report our experience and strategy in the treatment of MSDO. PATIENTS AND METHODS: Twenty-two patients presenting with MSDO were treated between 1998 and 2008. The results were evaluated on clinical, functional, sinusal, and odontologic signs. RESULTS: MSDO accounted for 16% of surgically managed sinusitis. CT was performed in 95% of cases. The etiologies were apical leakage in seven patients, migration of a tooth or root during extraction, or presence of ectopic tooth in the sinus in nine patients, a cyst in three patients, and oroantral communication in three patients. Surgery was performed after antibiotic and NSAID treatment. The first surgical step was the treatment of the odontogenic source. The second step was sinus drainage by endoscopic treatment in 64%, Caldwell-Luc in 23%, and drainage by oroantral communication enlarged then closed in the same operative time in 13%. The follow up ranged from 3 months to 10 years. Early postoperative superinfection was observed in two patients. Two patients presented with recurrent sinusitis. The postoperative sequels were hyposmia in three patients, dental pulpotomy, and trigeminal neuralgia in five patients treated by Caldwell-Luc surgery. DISCUSSION: Nasal endoscopy has improved the surgical management of MSDO. It makes curettage and exclusion of sinus cavities obsolete. It is reliable and has a low rate of complications. The best treatment remains prevention.

[Nasal dermoïd cyst with intracranial extension: which approach?]. / Kyste dermoïde nasal avec extension intracrânienne: quelle voie d'abord?

Dermoïd cyst is the most common midline congenital nasal tumor. Intracranial extension is rare but possible, must be suspected and confirmed by a cerebral magnetic resonance imagining (MRI). Only total surgical removal via a combined intracranial/extracranial approach appears to provide a complete resolution and effective protection against late recurrence. We report a case of a 2 years old patient who was operated for a nasal congenital cyst extending to the nasal septum. Anatomopathology showed a dermoïd cyst. Five years later, he presented local recurrence of the dermoïd cyst with intracranial extension through a bifid crista galli. We conclude that to avoid recurrence, the removal of the nasal cyst and sinus tract must be followed to its dural attachment. A transfacial approach can be associated with frontal craniotomy, which can provide adequate exposure for complete removal of the intracranial component of the cyst and sinus tract. A literature review was performed.

HoCoS: Home Companion Software. A service oriented solution for elderly home accompanying and remote healthcare monitoring.

The age of the population in all societies around the world is increasing. Elderly people prefer to maintain their independence, their autonomy and live at home as long as possible. We propose as a solution to this issue a Home Companion Software baptized HoCoS. This solution aims to help the elderly with daily life by providing an ergonomic and familiar interface. The second purpose is to integrate transparent remote healthcare monitoring service that ensures elderly security without disturbing the ergonomics of the application. We present service oriented architecture that offers extensibility and interoperability between heterogonous systems in order to combine several technologies and operators. We carried out ergonomic tests on this solution to evaluate its comfort and ease of use.

[Risk factors for recurrence of maxillary odontogenic keratocysts]. / Les facteurs de risque de récidive des kératokystes odontogéniques des maxillaires.

PURPOSE: The odontogenic keratocyst is a benign tumor with a high recurrence rate and aggressive behavior. We analyzed the risk factors for recurrence of odontogenic keratocysts and compared our results to published ones. PATIENTS AND METHODS: Thirty-two patients (36 odontogenic keratocysts) were treated in our department between 1996 and 2006. We retrospectively analyzed recurrence according to anatomoclinic, histopathological, and prognostic parameters. RESULTS: The patients' mean age was 41 years. The sex ratio was 1.28 with male predominance. The mandible was the most common site (30 cases). The most common radiological finding was a unilocular cyst in 75 % of cases. The primary treatment was conservative surgery for all patients. Twelve recurrences were observed in eight patients between 2 and 10 years of follow-up. All recurrences occurred in the mandible with 41 % in the angle and ramus. Multilocular cysts recurred in 55 % of cases, unilocular in 11 %. The recurrence rate of orthokeratocysts was 40 %. The presence of satellite cysts and extension to soft tissues were associated with a high rate of recurrence (60 %). Sixty-six percent of infected cysts recurred and among these, eight were enucleated in several fragments. DISCUSSION: The recurrence rate of odontogenic keratocysts is higher in case of mandibular posterior region localization and multilocular keratocysts. This might be explained by the difficult surgical accessibility. Some histological findings including the presence of satellite cysts and orthokeratocysts are associated with a higher recurrence rate. Cyst infection and treatment modalities influence the recurrence rate.

[Mandibular desmoplastic fibroma: diagnosis and therapeutics difficulties]. / Fibrome desmoïde mandibulaire : difficultés diagnostiques et thérapeutiques.

INTRODUCTION: The desmoplastic fibroma is a rare bone tumor, characterized by aggressive local infiltration, with frequent recurrence. The most common site is the mandible. Radioclinical signs are not specific and the histological diagnosis may be difficult. CASE: A 16 year-old male patient consulted for a painless and hard left mandibular swelling, without inferior alveolar nerve disorders. The tumor extended from tooth 31 to tooth 35, the mucosa was healthy. The panoramic view showed a multilocular osteolytic lesion with dental root resorption. CT scan showed expansion of bony cortex with rupture of the outer cortical. The biopsy indicated a desmoplastic fibroma or a fibrosarcoma. A second histological analysis combined with an immuno-histochemical study proved the diagnosis of desmoplastic fibroma. DISCUSSION: The desmoplastic fibroma has a polymorphous symptomatology. Radiological signs are unspecific. Anatomopathology combined with immuno-histochemistry can prove the diagnosis and guide the treatment.

[Retroauricular dermatofibroma in a child simulating a malignant tumour]. / Dermatofibrome rétro-auriculaire chez un enfant simulant une tumeur maligne.

BACKGROUND: Dermatofibroma represents one of the commonest benign soft tissue tumours, and its diagnosis is usually straightforward if classical clinicopathologic features are evident. It occurs frequently on the extremities and trunk, often in young adults during the 3(rd) and 4(th) decades. We report a peculiar case of an aggressive cellular dermatofibroma in a child that simulated a malignant tumour. Our aim is to discuss the differential diagnosis. CASE REPORT: An 8-year-old boy presented with a retroauricular tumour. Clinically, the lesion, 2 cm in diameter, was located in the left retroauricular region. It was nodular, erythematous, infiltrating the underlying tissue with an anterior spread leading to an amputation of the auricular lobule and a retraction of the tragus. Computerized axial tomography revealed a local tissular thickening extending in soft tissues without any bone involvement. A malignant lesion was initially suspected. A biopsy was performed. It was followed by a surgical resection. The lesion had the full microscopic characteristics of a cellular dermatofibroma. CONCLUSION: Dermatofibroma is one of the major differential diagnosis of nodular cutaneous tumours in children that simulate malignancy. Histologic examination with immunohistochemical study is essential for diagnosis.

[Pediatric mandibular myofibromatosis]. / Myofibromatose infantile de la mandibule.

INTRODUCTION: Pediatric myofibromatosis is a rare tumor in neonates and children. Two forms are described, solitary and multicentric, the solitary type is more common and is localized mainly on the head and the neck, mandible involvement is rare. The aim of this article was to report the anatomoclinical and therapeutic features of this pediatric tumor in a case as well as its follow-up. CASE REPORT: A 10-year-old girl was brought to consultation for a lower left gingival swelling 5 cm in diameter, forming a unit with the mandibular bone. The volume had gradually increased over the last 12 months. Imagery revealed the presence of an osteolytic tumor benign in aspect, but locally aggressive. Conservative surgery was performed. The diagnosis of pediatric myofibromatosis was confirmed. Evolution was excellent and after three years of follow-up, there was no evidence of relapse. DISCUSSION: Pediatric myofibromatosis often presents as a painless, well-circumscribed, solid nodule. Imagery is very useful to assess lesion extension and for the therapeutic follow-up. The diagnosis is made on anatomopathological findings and immunohistochemical assessment. The treatment of the solitary myofibromatosis is primarily surgical and its prognosis is excellent contrary to the multicentric form.

[Melanotic schwannoma of the temporozygomatic region]. / Schwannome mélanocytique de la région temporozygomatique.

INTRODUCTION: Melanotic schwannoma is a rare benign tumor, which arises from nerve sheath cells. Melanotic differentiation is its most histologic characteristic. CASE REPORT: We report a case of melanotic schwannoma arising in the temporozygomatic region for a man of 38-year-old. Outcome was favourable after tumor resection. DISCUSSION: This benign neoplasm occurs pronominally in spinal nerve roots. Craniofacial locations are rare. Most melanotic schwannomas are slow growing tumors, but prognosis can be poor because of local recurrence or malign behavior, especially when multiple lesions are present and/or involve the Carney complex.

[Mandibular Langerhans cell histiocytosis]. / Histiocytose langerhansienne mandibulaire.

INTRODUCTION: Langerhan's cell histiocytosis is defined as an abnormal proliferation of Langerhans cells in various organs and tissues (bone, skin, lymph nodes...). Among facial locations, mandibular involvement is the most frequent and occurs in young people less than 20 years. The aim of this report is to review the characteristic features of this disease, the current means of diagnosis and treatment through two case reports. CASES: Two male patients aged 10 and 55 years respectively presented with single mandibular location of Langerhans cell histiocytosis. The diagnosis was confirmed by histological examination of the biopsy specimen. The first patient underwent surgical resection of the tumor. No recurrence was observed. In the second patient, the postoperative course was marked by the appearance of an inflammatory phenomenon in the adjacent skin and mucosa, successfully treated by intralesional corticosteroid therapy. DISCUSSION: Langerhan's cell histiocytosis is a rare disease. The mandibular location has variable clinical expressions which can vary from dental mobility to tumor development in the gingiva. The radiological appearance is also variable; histological proof is required for diagnosis. Treatment depends on the number and locations of the lesions. In case of a single location, the treatment options may vary from a "wait and see" attitude to a non aggressive surgery, with a possible local corticosteroid therapy or radiothe-rapy. For multiples locations, chemotherapy is indicated.

[Lethal osteogenesis imperfecta. Prenatal diagnosis]. / Ostéogénèse imparfaite létale. Diagnostic anténatal.

INTRODUCTION: Osteogenesis imparfecta (OI) comprises a group of disorders principally affecting type I collagen, which result in increased bone fragility. Lethal forms are rare and are characterised by micromelia with malformation of the limbs. CASE REPORT: A prenatal diagnosis of lethal OI was made by ultrasonography at 18 weeks of gestation and therapeutic abortion was indicated. COMMENTS: Molecular biology and genetic studies offer new possibilities of prenatal diagnosis, but ultrasonography remains the investigation of choice. It confirms the diagnosis by revealing an increase in bone transparency.

Nitric oxide synthase inhibition by haem oxygenase decreases macrophage nitric-oxide-dependent cytotoxicity: a negative feedback mechanism for the regulation of nitric oxide production.

Nitric oxide (NO) production in macrophages by inducible nitric oxide synthase (NOS2) has multiple tissue damaging effects and is involved in the pathogenesis of inflammation and graft rejection. Haem oxygenase (HmOx) is the enzyme which degrades haem. Its inducible isoform, HmOx1, was recently shown to increase cellular resistance against oxidative stress and to decrease inflammation and graft rejection. Since haem is an essential cofactor for NOS2 activity, we investigated the effects of HmOx1-induction upon NO secretion in macrophages. We induced HmOx1 in BALB/c bone-marrow-derived macrophages by short-term exposure to haemin (20 micromol/l, 30 min); then we incubated them for 24 h to allow maximal expression of HmOx1 activity. Next, we activated the macrophages with lipopolysaccharide (LPS) and measured their NO production and their NO-dependent cytotoxicity against P815 cells. We found that HmOx induction 24 h before LPS activation in mouse macrophages suppresses their production of NO, while HmOx inhibition (with zinc protoporphyrin) increases NO secretion. NOS2 inhibition is reflected by the decrease of macrophage NO-dependent cytotoxicity against the P815 targets. We therefore propose that HmOx1 is a physiological inhibitor of NOS2 in activated macrophages because it decreases haem availability for NOS2 synthesis. NOS2 inhibition may explain the antinflammatory effects of HmOx induction which could also be used therapeutically in situations when NO hyperproduction leads to cytotoxic effects such as inflammation or transplant rejection.

Carbon monoxide induces murine thymocyte apoptosis by a free radical-mediated mechanism.

Carbon monoxide (CO) induces acute or chronic toxicity, according to the level and duration of the exposure. Since chronic CO exposure was shown to have immunosuppressive effects (as it decreases the frequency of rat splenic immunocompetent cells and immunoglobulin production), we investigated the effect of CO on thymocytes, since these are the most sensitive cells to oxidative damage from the lymphoid lineage. We exposed thymocytes to CO, then determined their apoptotic index after 6 h of incubation at 37 degrees C using the fluorochrome Hoechst 33342 and electron microscopy and found an increase of apoptosis in CO-exposed thymocytes. Trolox (6-hydroxy-2,5,7,8-tetramethylchroman-2-carboxylic acid), an antioxidant vitamin E analog, decreased CO-induced thymocyte apoptosis unlike methylene blue, L-nitroarginine methyl ester or pyrrolidine dithiocarbamate. We also observed that lipid peroxidation was increased in the CO-exposed thymocytes and that it was inhibited by Trolox. Our results suggest that CO induces thymocyte apoptosis by a free radical-mediated mechanism which can be inhibited by Trolox but which does not involve the activation of the guanylyl cyclase-cGMP pathway.

Induction of nitric oxide synthase by chlorinated pesticides (p,p'-DDT, chlordane, endosulfan) in rat liver.

The aim of this study is to investigate the effect of certain polychlorinated pesticides on the induction of rat liver Ca(2+)-independent nitric oxide synthase (NOS) and compare it with the effect of bacterial lipopolysaccharide. Our results show that endosulfan and p, p'-DDT treatment significantly increases the NOS activity while no significant induction by any route of administration was observed in the case of chlordane. Our results show therefore that a wide variety of chlorinated pesticides, which are considered as hepatic tumor promotors, can stimulate the expression of NO synthase in vivo.

Rapid method for analysis of chloroacetanilide and chloronitrophenoxyaniline herbicides by gas chromatography.

The herbicides Alachlor and Alclonifen are recently used in France for pre-emergent weed control in corn, essentially in association. For this reason, an improved method has been developed by gas chromatography for simultaneously characterising and quantifying the two herbicides. The best conditions were obtained by using a gas chromatograph equipped with an ion trap detector, and a 30 m x 0.25 mm DB-1701 fused silica capillary column. Retention times of Alachlor and Aclonifen were 12.8 and 23.2 min respectively. The limit of detection was of 2.0 ppb for each herbicide.