[Intestinal and hepatic subcellular localization of aluminium and indium administered orally to rat]. / Localisation subcellulaire intestinale et hepatique de l'aluminium et de l'indium administres par voie orale chez le rat.

Aluminium and indium are two elements used in industrial and medical fields. The purpose of this work was to study the subcellular localization of these elements, after their single and simultaneous oral administration to rats. 2h after the administration of these two elements, the small intestine and the liver were removed.Ultrastructural study showed the presence of electron dense deposits in the lysosomes of apical parts of duodenal enterocytes. When the minerals were administered simultaneously, deposits were observed in lysosomes of duodenal and jejunal enterocytes. No deposits were seen in the hepatic tissue of treated and control rats. Microanalysis identification showed that the deposits are constituted of aluminium, indium as well as phosphorus. Our results suggested that the elements are concentrated, in lysosomes, under the form of insoluble phosphate salts and it seemed that there are no specific lysosomes for the concentration of minerals since the two elements were concentrated in the same lysosome when they are administered simultaneously.

[Experimental and pathological changes of the neuromuscular junction]. / Remaniements expérimentaux et pathologiques de la jonction neuromusculaire.

The objective of our study was to investigate the cellular communication between the axon and its postsynaptic targets in the synapse. We used the neuromuscular junction (NMJ) model, which is a highly specialized structure between the nerve, the muscle, and the Schwann cell terminal where the motor neuron orders the muscle to contract. We used experimental models of motor nerve reimplantation in a denervated muscle to determine whether 1) the formation of new NMJ could participate in reinnervation of the muscle necessary to contraction or 2) the blockage of neurotransmitter release using botulinum toxin could be compensated by the formation of new NMJ. We also studied human genetic diseases that affect neuromuscular transmission--congenital myasthenic syndromes--to identify the mutations in the genes coding for synaptic molecules and to analyze the compensatory processes involved in NMJ dysfunction so that muscle contraction can occur in these conditions.

Celiac disease in adult patients with type 1 diabetes mellitus in Tunisia.

OBJECTIVE: Type1 diabetes mellitus may be associated with celiac disease. The prevalence of celiac disease as determined by screening among adult patients with type 1 diabetes is high with rates of 1.07.8% in Europe and U.S.A. The aims of the study are to determine the prevalence of celiac disease in adults with type 1 diabetes in Tunisia. METHODS: 348 consecutive adult patients with type1 diabetes were investigated prospectively and screened for celiac disease. The mean age was 28.45+/-10.74 years old. There were 176 females and 172 males. For the screening of celiac disease, we used immunoglobulin A (IgA) anti-endomysium (EMA) antibodies determined by an indirect immunofluorescence method. Anti-transglutaminase (tTG) antibodies were determined by an ELISA method. Those patients with positive results for anti EMA and or tTG were proposed for duodenal biopsy. RESULTS: 14 patients were positive for anti EMA and had high or a weak positive level of tTG antibodies. One patient from this group was already known to have celiac disease. Only 8 patients consented to biopsy and morphological changes were consistent with celiac disease in all cases. Prevalence of biopsy-proven celiac disease was 2.3% (95% CI=1.0-4.5%). CONCLUSION: The present study confirms that celiac disease of adults is prevalent in type 1 diabetic patients in Tunisia. Serological screening for celiac disease in type 1 diabetes is important because many patients are asymptomatic and most are detected by the screening.

[Giant retroperitoneal liposarcoma. One case report]. / Liposarcome rétropéritonéal géant. A propos d'un cas.

INTRODUCTION: Retroperitoneal Liposarcoma is a rare and primary malignancy developed from mesenchymal tissue. It's generally unique and shows an only one histologic component. We report a case of multicentric and synchronous liposarcoma (intraperitoneal and retroperitoneal) and with different histologic types. EXEGESES: A 53-year old man presented with abdominal pain, increased abdominal girth and weight loss. Physical examination revealed two abdominal masses. Computed tomography scan showed a very large retroperitoneal mass displacing the left kidney, digestive loops and vessels. The patient underwent surgery. One enormous mass of the left renal lodge measuring 50 cm, a retroduodenal mass measuring 15 cm and a nodule of the coecum were removed. Histological examination of the mass of the left renal lodge revealed mixed type liposarcoma (dedifferentiated and myxoid). Histological examination of the retroduodenal mass and of the nodule of the coecum revealed well-differentiated liposarcoma. CONCLUSION: Pathological, therapeutic and prognostic aspects of abdominal liposarcoma will be reviewed in this article.

[Study of malabsorption of lactose by the hydrogen breath test in a population of 70 Tunisian adults]. / Etude de la malabsorption du lactose par le test respiratoire à l'hydrogène dans une population de 70 adultes tunisiens.

Lactose malabsorption was studied by the hydrogen breath-test in 23 adults suffering from irritable bowel syndrome (group A) and in 47 healthy subjects (group B). The concentration of hydrogen in end-expired alveolar samples was measured after ingestion of 25 g of lactose. Among the 70 subjects, 6 (8.5 p. 100) were not hydrogen producers and were excluded from the study. Lactose malabsorption was shown in 51 of the remaining 64 subjects (79.6 p. 100). Among these 51 patients, 36 were healthy and 15 had an irritable bowel syndrome. The frequency of lactose malabsorption among the 43 healthy hydrogen producers was 83 p. 100. This value is similar to those observed in other studies (greek and italian). Our results suggest that lactose malabsorption is frequent among the tunisian adult population.

[Malignant lymphoma on a gastric stump]. / Lymphome malin sur moignon gastrique.

We report a case of lymphoplasmocytic and immunoblastic gastric remnant lymphoma occurring in a 51 year-old male. This patient had undergone subtotal gastrectomy for a gastric peptic ulcer at age 37. Histologic findings in the initial gastric specimen showed a dense lymphoid infiltrate surrounding the ulcer within the gastric mucosa. This proliferation was grouped into distinct follicles, and was compatible with pseudo-lymphoma. The progression of pseudo-lymphoma to malignant lymphoma is suggested.

[Pregnancy-related liver diseases]. / Les hepatopathies gravidiques.

The liver diseases of pregnancy are specific liver disorders during the pregnancy. The principal hepatic anomaly during hyperemesis gravidarum is a reversible augmentation of liver enzymes under reanimation. Intrahepatic cholestasis of pregnancy occur during the last 2 trimesters of pregnancy, manifested usually by pruritus preceeding a jaundice. The liver enzymes and the serum biliary acids are augmented. The acute fatty liver of pregnancy occur during the last trimester of pregnancy leading to early interruption of pregnancy which would help to diminish the elevated level of maternal and fetal mortality. The HELLP syndrome usually observed during the toxemia of pregnancy, associate an hemolysis elevation of liver enzymes and low platelets.

[Intestinal metaplasia at the gastroesophageal junction - epidemiologic and histologic aspects. Report of 164 cases]. / Metaplasie intestinale de la jonction oeso-gastrique aspects epidemiologiques et histologiques. A propos de 164 cas.

Adenocarcinoma of the gastric cardia is increasing in incidence. The purpose of this study was to determine whether intestinal metaplasia of the esophagogastric and having a malignant potential junction can be considered as an ultra-short segment Barrett's esophagus. To study the epidemiologic and histological features of the intestinal metaplasia of esophagogastric junction two groups of patients were compared for the prevalence of this condition. Group 1 included 82 patients with gastroesophageal reflux symptoms et group 2 consisted of 82 healthy individuals. Both groups had two biopsy specimens taken from the esophagogastric junction. Histological evidence of intestinal metaplasia was defined as specialized columnar epithelium containing goblet cells staining with alcian blue at pH 2.5. Intestinal metaplasia of the esophagogastric junction was present in 12 patients in group 1 and 9 individuals in group 2. The global prevalence of this condition was 12.8% and there was not a statistically significant difference in the prevalence of this condition between the two groups. A significant difference could not be found when sex was considered. There was a significant association between this condition and older age (p = 0.01). Intestinal metaplasia of the esophagogastric junction and Barrett's esophagus do not have the same epidemiologic features. Therefore, we suggest that screening biopsy specimens of the esophagogastric junction be limited to study protocols at this time.

Gastric MALT lymphoma. A clinico-pathological study of 65 cases. Relationship to Helicobacter pylori.

We report 65 cases of MALT gastric lymphomas. HP was looked for with Giemsa and Whartin Starry stains. Immunohistochemistry was done with PAP method. Anti-HP treatment was used in 9 cases. 38 were of low grade of malignancy, 23 were high grade, 4 were high grade with a low grade component. The mean age was 51.5 years, the sex ratio 1.5. Epigastric pain was the most frequent feature (87.7% of cases). Endoscopically, low grade lymphomas presented as unique or multiple ulcerations (55.3% of cases) with antral localisation (52.6% of cases). 60% of our patients were stage IE, of which 61% had low grade lymphoma, 18% were at stage II2E, 10% at stage III and 10% at stage IV. From 23 operated patients, 29% had early lymphoma which was low grade malignant in 71.5% of cases, and 71% had lymphomas which were widely spread beyond the submucosa. HP was found in 63% of cases. Histologic regression of two early lymphomas of low grade malignancy was achieved after HP eradication.

[Morphometric analysis of the human endometrium during the implantation window. Light and transmission electron microscopy study]. / Analyse morphométrique de l'endomètre humain en période d'implantation. Étude en microscopie optique et en microscopie électronique à transmission.

OBJECTIVES: To perform a morphometric and ultrastructural analysis of the various cellular components that constitutes the endometrial epithelium during the implantation window. METHODS: Endometrial biopsies of six patients in ageing to procreate were realized during the implantation window and analyzed using light and transmission electron microscopy (TEM). RESULTS: During the implantation window, four endometrial cell types are identified in distinct proportions: microvilli-rich cells, pinopode cells, ciliated cells and others without apical differentiation. We highlighted important differences between surface and glandular epitheliums. Pinopode cells are present in all biopsies; they are more frequent in glands than surface. Their maximum expression in the glandular epithelium is at the day 20 and in the surface epithelium at the day 22. The pinopodes are present since day 19, they appeared fully developed with a maximum at day 22. Using TEM for ultrastructural analysis, we showed images of endocytosis and numerous secretory vesicles in epithelial cells of the endometrium. Their plasmic membrane present apical differentiations in the form of microvilli covered with a very developed cell coat indicating a high activity of exchange with the extracellular compartment. The endometrial cells exhibit extensive signs of communication between neighboring cells appeared to be preserved. CONCLUSION: Our data suggest each cell type and each cell structure as a very precise function in order to prepare the endometrium to be receptive.

[Influence of open chest conditions on pulse pressure variations]. / Influence de l'ouverture du thorax par sternotomie sur les variations respiratoires de la pression pulsée.

OBJECTIVES: Pulse pressure variations are used to assess fluid responsiveness in mechanically ventilated patients. The accuracy of this index in open chest conditions remained unclear. The aim of the study was to evaluate the effect of open chest conditions on pulse pressure variations. STUDY DESIGN: Non-interventional prospective study. METHODS AND PATIENTS: Twenty-eight mechanically ventilated patients scheduled for open-heart surgery were included. Pulse pressure variations, peak aortic velocity, and stroke volume were measured before and after thoracotomy with pericardotomy. Measurements were made at each step and compared. RESULTS: Neither pulse pressure variation nor peak aortic velocity and nor stroke volume variation were modified by open chest conditions (median=5% [interquartile range=6] vs 4% [6], p=NS), (20% [11] vs 17% [12], p=NS and 11% [7] vs 10% [3], p=NS) respectively. Pulse pressure variations were correlated to stroke volume before thoracotomy (r'=-0.432; p=0.02) and after thorocatomy (r'=-0.433, p=0.02). CONCLUSION: In these studied patients, preload dependancy indices were not modified by open chest conditions. Pulse pressure variations remained correlated to stroke volume even after thoracotomy.

Phenotype genotype analysis in 15 patients presenting a congenital myasthenic syndrome due to mutations in DOK7.

Congenital myasthenic syndromes (CMSs) are a heterogeneous group of diseases caused by genetic defects affecting neuromuscular transmission. Mutations of DOK7 have recently been described in recessive forms of CMS. Dok-7 is a cytoplasmic post-synaptic protein co-activator of the muscle-specific receptor-tyrosine kinase (MuSK) involved in neuromuscular synaptogenesis and maintenance. We report clinical, morphological and molecular data on 15 patients with mutations in DOK7. Eleven different mutations (5 novel) were identified and all patients but one were found to carry at least the common c.1124_1127dupTGCC mutation. Patients with DOK7 mutations have a particular limb-girdle pattern, without tubular aggregates but a frequent lipidosis on the muscle biopsy. Changes in pre- and post-synaptic compartments of the neuromuscular junction were also observed in muscle biopsies: terminal axons showed defective branching which resulted in a unique terminal axon contacting en passant postsynaptic cups. Clinical features, muscle biopsy findings or response to therapy were confusing in several patients. Characterization of this distinct phenotype is essential to provide clues for targeted genetic screening and to predict the therapeutic response to anticholinesterase treatments or ephedrine as has been suggested.