Oxidised cellulose-based reaction mimicking a suspicious ovarian mass: a case report and a systematic review.

Oxidised regenerated cellulose was introduced 60 years ago to control diffuse bleeding from large surfaces. Although considered safe and effective, foreign body reactions can mimic suspicious masses in several organs. We describe the third case, reported in PubMed, of an oxidised regenerated cellulose-based granuloma mimicking a suspicious ovarian tumour on MRI. During surgery, the diagnosis was suspected by granulomatous tissue and confirmed by pathology. The follow-up after the excision was uneventful. Although a rare complication, physicians should be aware of this presentation and of the recommendation to remove excess Surgicel after the bleeding has stopped.

Omalizumab in patients with chronic spontaneous urticaria nonresponsive to H1-antihistamine treatment: results of the phase IV open-label SUNRISE study.

BACKGROUND: Omalizumab is approved as an add-on therapy for the treatment of chronic spontaneous urticaria (CSU) in patients with inadequate response to H1-antihistamine treatment. The urticaria control test (UCT) is a reliable, concise tool developed as an alternative to the 7-day urticaria activity score (UAS7) - the standard for CSU disease activity assessment. OBJECTIVES: This prospective, open-label, phase IV study evaluated the efficacy and safety of omalizumab in French adult patients with CSU nonresponsive to H1-antihistamine treatment. MATERIALS AND METHODS: Patients [n = 136; stratified 1 : 2 (with angio-oedema : without angioedema)] received omalizumab 300 mg subcutaneously every 4 weeks for 12 weeks. Study assessments included UCT, UAS7, angio-oedema activity score and d-dimer levels (exploratory objective). RESULTS: At Week 12, 74·6% of the patients achieved disease control [UCT score ≥ 12 (primary endpoint)] and 67·7% of patients showed well-controlled disease (UAS7 ≤ 6). There was a strong negative correlation between UCT score and UAS7 at Week 12 (Spearman's correlation coefficient -0·839). Mean plasma d-dimer concentration was elevated at baseline (1002·1 ng mL-1 ) and decreased notably at Week 8 (455 ng mL-1 ). Among the nine patients with a very high baseline d-dimer concentration (> 3000 ng mL-1 ), eight were responders (UAS7 ≤ 6) at Week 12. CONCLUSIONS: Omalizumab was efficacious in patients with CSU nonresponsive to H1-antihistamines. The UCT was a reliable tool for disease assessment and the scores correlated well with UAS7. This study does not support the usefulness of d-dimer to monitor long-term disease prognosis in adult urticaria; however, it may indicate patients who respond to omalizumab.

Pilocytic astrocytoma mimicking cavernous angioma: Imaging features and histological characteristics.

Pilocytic astrocytoma (PA) commonly occurs during the first two decades of life. Typical locations include cerebellum, optic nerve, optic chiasm/hypothalamus and brainstem. PA should be considered in the differential diagnosis of patients with brain tumors manifesting with hemorrhagic onset. We report a case of a hemorrhagic onset of cerebellar PA in a young adult with imaging findings mimicking cavernous angioma. We also discuss imaging features and histological characteristics with a focus on the etiology of the hemorrhagic onset.

Hepatitis E virus genotypes 1 and 3 in wastewater samples in Tunisia.

Hepatitis E represents an important public-health concern throughout the world. It is one of the leading causes of hepatitis in North Africa, Asia and the Middle East. In Tunisia, the true burden of HEV infection is still unknown. The objectives of the present study were to assess the occurrence of hepatitis E virus in Tunisia through the monitoring of urban sewage and to characterize the strains identified using molecular assays. A total of 150 sewage samples (raw and treated) were collected from three wastewater treatment plants located in the regions of Monastir and Mahdia and analyzed by nested RT-PCR using a qualitative assay targeting the methyltransferase gene in ORF1. Of these, only three samples (2 %) were found to be positive for HEV, one belonging to genotype 1 and two to genotype 3. The results of the present study indicate a low level of virus excretion among the Tunisian population. Both genotypes 1 and 3 are circulating in this country, however, possibly causing sporadic infections. The presence of the zoonotic genotype 3, known to be transmitted to humans mainly by swine and demonstrated in Tunisia for the first time in this work, raises the question of possible reservoir species, since pork products are not consumed in this country, pigs are not bred, and wild boar is not endemic. Further studies will be needed to gather information on the occurrence and diversity of HEV strains circulating among humans and animals in Tunisia, and on possible animal reservoirs.

Qualitative and Quantitative Assessment of Hepatitis A Virus in Wastewaters in Tunisia.

Hepatitis A causes substantial morbidity in both industrialized and non-industrialized countries and represents an important health problem in several southern Mediterranean countries. The objectives of the study were as follows: (a) to assess the occurrence of hepatitis A virus (HAV) in Tunisia through the monitoring of urban wastewaters collected at wastewater treatment plants (WTPs); (b) to characterize environmental strains; and (c) to estimate the viral load in raw and treated sewages, in order to evaluate the potential impact on superficial waters receiving discharges. A total of 150 raw and treated wastewaters were collected from three WTPs and analyzed by both qualitative (RT-PCR/nested) and quantitative (qRT-PCR) methods. Of these, 100 (66%) were found to be positive for HAV by the qualitative assay: 68.3% in influents and 64.7% in effluents. The vast majority of HAV sequences belonged to sub-genotype IA, with 11 different strains detected found to be identical to clinical strains isolated from Tunisian patients with acute hepatitis. Five unique variants were also detected, not previously reported in clinical cases. Only two IB strains were found, confirming the rarity of this sub-genotype in this country. The results of the present study indicate a wide circulation of the pathogen in the population, most probably in the form of asymptomatic infections, a finding consistent with the classification of the country as having intermediate/high endemicity. Quantitative data showed high viral loads in influents (3.5E+05 genome copies/liter, mean value) as well as effluents (2.5E+05 genome copies/liter, mean value), suggesting that contaminated water could be a critical element in transmission.

The value of sonohysterography in the diagnosis of tubal patency among infertile patients.

BACKGROUND: Tubal pathology is one of the main causes of infertility. In the routine fertility work-up, our ability to evaluate tubal function is limited to tubal patency and peritubal adhesions. AIMS: To assess the value of sonohysteroography (SHG) in evaluation of tubal patency in infertile patients and to compare its results with hysterosalpingography and laparoscopy. methods: In this prospective study, 40 consecutive women were underwent three methods of exploration of tubal patency: hysterosalpingography, sonohysteroography and laparoscopy with dye test, within a period of 6 months. RESULTS: The Mean age of our patients was 32 ± 5 years. Of the 40 women who were recruited, 30 had primary and 10 had secondary infertility. Altogether 80 tubes were exanimated by these 3 methods. Sonosalpingography showed patency in 51(63.7%) tubes, hysterosalpingography in 47 (58.7%) tubes, and laparoscopy in 52 (65%) tubes. Sonosalpingography and laparoscopy agreed in 70 out of 80 tubes (concordance, 87.5%). As regards the appearance of the right and left tubes, the results of sonohysterography agreed with laparoscopy in 75% and 87.5%, respectively, while HSG agreed with laparoscopy in 64% and 54% respectively. CONCLUSION: SHG is useful in the assessment of tubal patency and its implication in the fertility workup as a simple and fast procedure can minimize costes and abus of sophisticated techniques.

Robinow syndrome: report of two cases and review of the literature.

We report two patients with Robinow syndrome, review the published literature and stress the importance and limitations of radiographic examination in the diagnosis of this disorder, which shows extreme clinical and radiographic variability. The radiographic differential diagnosis of Robinow syndrome is discussed.

Ultrasonographic screening for cystic echinococcosis in sheep in Tunisia.

Sheep from the areas of Fondouk-Jeddid, Bir Mchergua and El Fahs, located in the Northeast of Tunisia, were examined by ultrasonography between 2001 and 2004 in order to assess their infection with Echinococcus granulosus, the agent of hydatid disease, and to evaluate this method as an efficient aire for hydatid cysts. A total of 1039 sheep, aged between 1 and 14 years was examined. The highest prevalence was found in sheep aged more than 8 years. The least infected animals were aged between 1 and 2 years. All hydatid cysts detected by ultrasound were located in the liver. In all age-groups, the dead cysts were more numerous than viable cysts. Eighteen positive sheep were autopsied and a comparison between ultrasound and autopsy results was performed. The results showed a prevalence of about 40% for the three areas. Ultrasonography allowed the cysts, deep or superficial to localize in the central or left part in relation to the caudal vena cava of the animals. Consequently, all the cysts were not detected with this technique. This work shows that ultrasonography confirms the importance of ovine hydatid cyst in Tunisia and that its use as a mass screening approach for cystic echinococcosis in sheep could be helpful for the monitoring of this disease in a hydatid control program without great stress for the animals.

[Imaging of acute cerebellitis in children. Report of 4 cases]. / Imagerie des cérébellites aiguës chez l'enfant. A propos de 4 observations.

Acute cerebellitis is one of the main causes of acute cerebellar dysfunction in children. It is either infectious, usually viral, post-infectious or post vaccinal in etiology. Diagnosing acute cerebellitis may be difficult in patients with only subtle cerebellar signs and when cerebro-spinal fluid examination is normal. MRI is the most adequate imaging technique to demonstrate cerebellar involvement. The authors report the clinical and neuro-imaging findings in 4 paediatric cases. Patient's age varied from 2 to 7 years and predominant clinical symptoms were fever, headache and vomiting; ataxia was noted only in 2 cases. Viral serologic tests were negative in 3 cases and demonstrated Epstein-Barr virus in 1. Initial MRI examination (2 cases) demonstrated increased intensity on T2W and Flair sequences of the cerebellar gray matter with pial enhancement. Clinical outcome was good with complete resolution of symptoms in 3 cases and persistent mild right upper limb paresis in one. The resolution of the signal abnormality was well demonstrated on MRI in one case, suggesting an inflammatory etiology with moderate residual cerebellar atrophy.

[MR imaging in spinal cord injury]. / Apport de l'imagerie par résonance magnétique dans les traumatismes médullaires.

PURPOSE: To describe MR features of spinal trauma and assess the value of MR imaging in the prognosis. MATERIAL AND METHODS: Retrospective confrontation between initial and follow up MRI findings and clinical features in 7 young patients with spinal cord injury. RESULTS: Five lesions were due to motor vehicle accidents and 2 lesions were secondary to falls. Five patients had multiple associated injuries, 1 patient had associated spinal vertebrae injury, the last had Spinal Cord injury Without Radiological Abnormalities (SCIWRA). A motor deficit was noted in 5 cases of paraplegia, a case of monoplegia and a case of tetraparesia. The initial MRI showed in 3 cases intramedullary hemorrhage, cord edema in 2 cases and spinal cord compression and contusion in 1 case. Initial MRI was not done in the remaining case. No cord transection was noted. Outcomes were marked by lack of significant neurological recovery with complications due to bed confinement in 5 cases, and complete neurolgical recovery in two cases. In follow up, MR findings included post traumatic cystic lesion (2 cases), "ad integrum" restitution (1 case), segmental atrophy with gliosis (2 cases) and myelomalacia in the 2 other cases. CONCLUSION: MR may offer new possibilities in establishing the prognosis for neurological recovery. Our study demonstrated a good correlation between imaging findings, clinical features and outcomes. A hemorrhagic contusion in the acute stage indicated a poor prognosis while a focal hyperintense area on T2-weighted images may resolve.

Cystic hydatic disease in sheep: treatment with percutaneous aspiration and injection with dipeptide methyl ester.

An in vitro and in vivo study was conducted to show the effect of dipeptide methyl ester on the protoscolices of Echinococcus granulosus and in naturally infected sheep. Easily punctured cysts were located by ultrasonography. A PAIR and PAI method were performed by the injection of dipeptide methyl ester into these cysts at a final concentration of 110 mmol/L. Follow-up was conducted monthly by ultrasonography. After injection of the compound, the sheep were sacrificed at different times from 6 to 17 weeks. The size and the morphological aspect of treated cysts were noted. Samples were collected for histology and electron microscopy. In conclusion, these studies revealed significant and rapid detachment of the membrane of the treated cyst and alteration of the inner membrane in less than 5 min after injection of the drug, confirming the effect of the compound on the laminated layer of the parasite.

[Pseudotumoral form of abdominal tuberculosis: report of four cases]. / La tuberculose abdominale pseudo-tumorale.

PURPOSE: To report the imaging features of four cases of pseudo-tumoral abdominal tuberculosis in order to demonstrate diagnostic difficulties, even in endemic areas, despite expanding imaging modalities. MATERIAL AND METHODS: We have retrospectively reviewed four cases investigated in our hospital between 1998 and 2002. The first case concerned a 2 year and 6 month old boy admitted for a right iliac fossa mass. The other patients were 43 and 48 year old women admitted for epigastric mass and persistent epigastric pain with past history of treated tuberculosis respectively. The last was an 86 year old man investigated because progressive worsening of general health. Sonography (US) and computed tomography (CT) were performed in all four cases. RESULTS: Involvement of the ileocaecal region was noted in three cases. Large intestinal hypervascular mass in the pediatric case, heterogeneous mass with porta hepatis lymph node in the patient with past history of treated tuberculosis, pseudotumoral caecal wall thickening in the third case. The multiloculated pattern of the epigastric mass and its location initially suggested a diagnosis of pancreatic tumor. CONCLUSION: Abdominal tuberculosis is rare even in endemic areas. This diagnosis must be considered when imaging modalities depict a hypervascular soft tissue mass on Doppler examination with peripheral enhancement on CT scan.

[Hydatid cyst of soft tissues: MR imaging findings (Report of three cases)]. / Kyste hydatique des tissus mous: apport de l'IRM (A propos de trois observations).

Three cases of hydatid disease of the soft tissues are reported. All presented as soft tissue lesions in the neck and lower extremities. All three cases were studied with ultrasound (US) and magnetic resonance (MR) imaging techniques. Two patients presented with multivesicular lesions, which were considered diagnostic for hydatid disease. The third showed a lesion with hypoechoic solid and lobulated pattern mimicking lymph node. MR outlined the cystic pattern with intense peripheral enhancement and was suggestive of an infected cystic lesion. Surgery was performed in all three cases. Hydatid disease presenting in the soft tissues can be diagnosed with confidence, when US and/or MR shows multivesicular lesions. MR appears to be the most useful imaging technique when a complex or solid pattern is present. Enhancement of the peri-cystic soft tissues can be considered as a suggestive MR feature of soft tissue hydatid disease.

[Magnetic resonance imaging features of cystic meningiomas. Report of four cases]. / Aspects en imagerie par resonance magnetique des méningiomes kystiques. A propos de quatre cas.

Four cases of cystic meningioma are reported, and the imaging features and diagnostic pitfalls of cystic meningiomas are reviewed. Cystic meningiomas are infrequent tumors and remain difficult to diagnose in spite of advanced imaging techniques. Our patients were between 15 and 58 years of age, and underwent CT and MR imaging. In all the four cases, the meningiomas were supratentorial and included Nauta type I, type II and type III tumors.

[Computed tomography features in aorto-digestive fistula after abdominal aortic surgery. Report of two cases]. / Apport de la tomodensitométrie dans les fistules aorto-digestives compliquant la chirurgie de l'aorte abdominale. A propos de deux cas.

Aorto-enteric fistula is an uncommon late complication of aortic reconstructive surgery. Morbidity and mortality remain high despite progress in diagnosis and therapeutic procedures. We report two cases of complications of aortic interventions and present the diagnosis contribution of the CT scans. Our patients were two men aged 62 and 68 years. Both presented with abdominal pain and gastrointestinal bleeding. Endoscopy and CT scan with contrast enhancement were performed providing the diagnosis of aorto-enteric fistula before surgery. Both patients died after surgery. The fundamental principle in the management of late complications of abdominal aortic surgery is early and aggressive surgery. Cross sectional imaging and particularly CT scan plays an important role in diagnosis and in determining the extent of these complications. CT must be performed for life-long follow-up of these patients to allow assessment of early diagnosis of aortic reconstruction surgery complications.

[Radioclinical profile of cardiopericardial hydatid: report of 17 cases]. / Profil radioclinique du kyste hydatique cardiopéricardique: à propos de 17 cas.

Hydatid cysts concerning the heart are rare, accounting for 0.5 to 2% of all hydatic sites. The risk of serious complications in this location makes rapid diagnosis and surgical treatment essential. The aim of our study is to clarify the role of imaging in the diagnosis of the disease and to propose an adequate strategy. We report on 17 patients who underwent surgery for cardiopericardial hydatid cyst in the cardiovascular and thoracic unit of Sahloul hospital in Sousse from January 1988 to December 1998. Clinical investigation included in all cases chest X ray, ECG and ultrasonography (US). A computed tomography (CT) scan was performed in 14 cases, magnetic resonance imaging in three cases, transesophageal US in five cases, and coronary angiography in fsix cases. Examination for other hydatic sites was realized in all cases, and brain CT was performed in four cases. The hydatid cyst was variably localized in the left ventricle wall (five cases), the right ventricle (five cases), the pericardium (five cases), the interventricular septum (four cases), the right auricle (one case) and the left auricle (one case). The existence of other cardiac hydatid sites was found in 12 cases. All patients underwent surgery. Outcome was favorable in 14 cases, with a mean of 3 years and 5 months survey. Three patients died. The combination US-CT scan allowed a precise topographical inventory, reducing the need for MRI to the complicated cases and to the rare cases of inconclusive results by US-CT scan.