[Predictive factors for recurrence after surgery of nasal polyposis].

Introduction: Endoscopic sinus surgery has become the treatment of choice in the surgical management of patients with nasal polyposis. The aim of our study is to identify the role of some epidemiological, clinical and therapeutic factors in recurrence after surgery of nasal polyposis. Materials and methods: We conducted a retrospective study over a period of 11 years (between 2000 and 2010) including 184 patients operated for nasal polyposis after failure of prolonged medical treatment. We evaluated the impact of epidemiological and clinical factors (age, sex, asthma, Widal disease, allergy and stage of nasal polyposis at the time of surgery) and treatment (surgical technique, observance of postoperative topical steroids ) on postoperative recurrence. Results: Nasal poly­posis recurred in 26.6% of patients after an average period of 23 months. Widal disease, asthma and bad observance of the intranasal steroid therapy were significantly associated with postoperative recurrence in the univariate analysis. In multi­variate analysis the bad observance of the intranasal steroid therapy was the only factor significantly associated with recurren­ce. Conclusion: Postoperative steroids prescribed routi­nely in our practice can effectively prevent recurrence after endonasal surgery and this result was found in both uni­variate and multivariate analysis.

Genetic differentiation in Pyrenophora teres f. teres populations from Syria and Tunisia as assessed by AFLP markers.

UNLABELLED: To investigate the level of genetic differentiation and diversity among Pyrenophora teres isolate populations originating from different agro-ecological areas of Syria and Tunisia and to determine the potential of AFLP profiling in genotyping Pyrenophora teres f. teres. In this study, AFLP markers have been employed to identify patterns of population structure in 20 Pyrenophora teres f. teres populations from Syria and Tunisia. Ninety-four isolates were studied by the use of a protocol that involved stringent PCR amplification of fragments derived from digestion of genomic DNA with restriction enzymes EcoRI and MesI. Based on 401 amplified polymorphic DNA markers (AFLP), variance analyses indicated that most of the variation was partitioned within rather than between populations. Genotypic diversity (GD) was high for populations from Rihane, local landraces and different agro-ecological zones (GD = 0·75-0·86). There was high genetic differentiation among pathogen populations from different host populations in Syria (Gst  = 0·31, ht = 0·190) and Tunisia (Gst  = 0·39, ht = 0·263), which may be partly explained by the low gene flow around the areas sampled. A phenetic tree revealed three groups with high bootstrap values (55, 68, 76) and reflected the grouping of isolates based on host, or agro-ecological areas. AFLP profiling is an effective method for typing the genetically diverse pathogen Pyrenophora teres f. teres. SIGNIFICANCE AND IMPACT OF THE STUDY: The study represents a comparative analysis of the genetic diversity in P. teres isolates from two countries spanning two continents and also shows that several distinct P. teres genotypes may be found in a given environment. The implications of these findings for Pyrenophora teres f. teres evolutionary potential and net blotch-resistance breeding in Syria and Tunisia were also discussed.

[Computerized three-dimensional reconstruction of the retrohepatic segment of inferior vena cava of a 20 mm human embryo]. / Reconstruction tridimensionnelle informatisée du segment rétrohépatique de la veine cave inférieure d'un embryon humain de 20mm.

The subdiaphragmatic venous drainage of the embryo is provided by the two caudal cardinal veins to which is added the subcardinal vein system, draining the mesonephros, the perispinal supracardinal veins and the umbilical and vitelline venous system. The anastomosis of certain segments of the embryonic venous structures and the disappearance of others are at the origin of the inferior vena cava. Since the 19th century, three-dimensional reconstruction of solid models from histological sections were developed. At present, the development of computerized three-dimensional reconstruction techniques allowed to operate a multitude of techniques of image processing and modeling in space. Three-dimensional reconstruction is a tool for teaching and research very useful in embryological studies because of the obvious difficulty of dissection and the necessity of introducing time as the fourth dimension in the study of organogenesis. This method represents a promising alternative compared to previous three-dimensional reconstruction techniques including Born technique. The aim of our work was to create a three-dimensional computer reconstruction of the retrohepatic segment of the inferior vena cava of a 20mm embryo from the embryo collection of Saints-Pères institute of anatomy (Paris Descartes university, Paris, France) to specify the path relative to the liver and initiate a series of computerized three-dimensional reconstruction that will follow the evolution of this segment of the inferior vena cava and this in a pedagogical and morphological research introducing the time as the fourth dimension.

Influence of the drying mode of support on the properties of Pd/Al2O3-ZrO2 materials used for methane combustion.

This work constitutes a new trial to enhance the properties of palladium supported on alumina modified with zirconium used as catalysts for methane combustion. The effect of the support drying mode is studied. For this aim, Al2O3-ZrO2 binary oxides with zirconium loading of 2 and 5% in weight were prepared using sol-gel process then dried under ordinary or supercritical conditions. Palladium with a loading of 0.5% was deposited on the support by wet impregnation. Several techniques have been used to investigate differences between the two types of the derived catalysts.

Growth and ochratoxin A production by Aspergillus carbonarius at different pHs and grape maturation stages.

AIMS: The objective of this work was to study the effect of some factors, linked to grape composition during ripeness process, on the growth and ochratoxin A (OTA) production of Aspergillus carbonarius isolated from grapes. METHODS AND RESULTS: Aspergillus carbonarius isolates were tested (i) in vitro, in Czapek yeast autolysate agar (CYA) at different pHs (2·5-4·5) and incubation times (2-6 days), and (ii) in situ, in fresh grapes collected at different maturation stages. Aspergillus carbonarius was able to grow with the same intensity at the different maturation stages and pH levels tested. In general, a similar trend of OTA production by A. carbonarius in response to acidity in media and in grape was observed. Low pH level seemed optimal for maximum OTA production. CONCLUSIONS: Aspergillus carbonarius strains can strongly grow and produce OTA on grape from the early stages of maturation. Extrinsic environmental conditions at the harvest period and skin thickness are, probably, the mains factors contributing to OTA contamination of grapes at the end of maturation. SIGNIFICANCE AND IMPACT OF THE STUDY: The results lead to a better understanding of the critical point during grape maturation for the growth of ochratoxigenic fungi and the toxin production.

[Para-pharyngeal tumors, contribution of imaging]. / Tumeurs parapharyngées, apport de l'imagerie.

OBJECTIVES: Para-pharyngeal tumors are located deeply. Imaging is mandatory for their management. We conducted a retrospective study to determine the contribution of imaging for their diagnosis and treatment. PATIENTS AND METHODS: Imaging was performed for 20 cases of primary para-pharyngeal tumors between 1986 and 2008. We compared the imaging to the anatomic and histological features of these tumors. RESULTS: Computed tomography and MRI confirmed the para-pharyngeal location of tumors. Tumors were located in the prestyloid compartment in eight cases, in the retrostyloid compartment in five cases, and in the retropharyngeal compartment in one case. Six tumors had filled all the para-pharyngeal space. Salivary gland tumors had filled the prestyloid space in two cases, and in two other malignant cases all para-pharyngeal space were invaded. MRI failed to differentiate the nature of tumor and its malignancy except when there was obvious bone erosion. The treatment was mainly surgical. The mean follow-up was 5 years 6 months. DISCUSSION: Imaging contributes to the etiological diagnosis and assesses tumor extension, thus helping to choose the surgical approach. MRI is the most contributive examination; its resolution is more adapted to the diagnosis of deep tumors. CT scan is contributive when studying the bone structure.

[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.

Comparative virulence of Pyrenophora teres f. teres from Syria and Tunisia and screening for resistance sources in barley: implications for breeding.

AIMS: The aim of this study is to investigate the pathogenic diversity and virulence groups among Pyrenophora teres f. teres isolates, sampled from Syria and Tunisia, and to identify the most effective source of resistance in barley that could be used in breeding programmes to control net blotch in both countries. METHODS AND RESULTS: One hundred and four isolates of P. teres f. teres were collected from barley in different agroecological zones of Tunisia and Syria. Their virulence was evaluated using 14 barley genotypes as differential hosts. The UPGMA clustering identified high pathogenic variability; the isolates were clustered onto 20 pathotypes that were sheltered under three virulence groups, with high, intermediate and low disease scores. According to susceptibility/resistance frequencies and mean disease ratings, CI05401 cultivar ranked as the best differential when inoculated with the Syrian isolates. However, CI09214 cultivar was classified as the best effective source of resistance in Tunisia. CONCLUSIONS: All P. teres f. teres isolates were differentially pathogenic. CI09214 and CI05401 cultivars were released as the most effective sources of resistance in Syria and Tunisia. SIGNIFICANCE AND IMPACT OF THE STUDY: National and international barley breeding programmes that seek to develop resistance against P. teres f. teres in barley should strongly benefit from this study. This resistance cannot be achieved without the proper knowledge of the pathogen virulence spectrum and the sources of host resistance.

Predictive factors associated with complete pathological response after neoadjuvant treatment for rectal cancer.

PURPOSE: A proportion of 10 to 30% of patients treated by chemoradiotherapy followed by total mesorectal excision surgery for a locally advanced rectal cancer can achieve a complete pathological response. We aimed to identify predictive factors associated with complete pathological response or no response and to assess the impact of each response on survival rates. PATIENTS AND METHODS: Patients treated with long course chemoradiotherapy for locally advanced and/or node positive rectal cancer from 2010 to 2016 were retrospectively reviewed. Statistical analysis was carried out to determine predictors of tumor regression and treatment outcomes. RESULTS: Records were available on 70 patients. In the univariate analysis, clinical factors associated with complete tumor response were tumor mobility in digital rectal examination (P=0.047), a limited parietal invasion (P=0.001), clinically negative lymph node (P<0.001) and a circumferential extent greater than 50% (P=0.001). On the other hand, a T4 classification and an endoscopic tumor size greater than 6cm were associated with no response to treatment (P=0.049 and P=0.017 respectively). On multivariate analysis, T2 clinical classification and N0 statement before treatment were independent predictive factors of pathologic complete response (P<0.001 and P=0.001) and a delayed surgery after 12 weeks was associated with no response to treatment (P=0.001). CONCLUSION: The identification of predictive factors of histological response may help clinicians to predict the prognosis and to propose organ preservation for good responders.

Two missense mutations in SLC26A4 gene: a molecular and functional study.

Mutations in the SLC26A4 gene encoding pendrin, an anion transporter, are responsible for non-syndromic hearing loss (HL) (DFNB4) and Pendred syndrome (PS). PS is a genetic disorder that causes early HL and affects the thyroid gland. Here, we report eight Tunisian families affected with profound HL. Clinical investigations revealed goiter in few patients. Genotyping using microsatellite makers showed linkage to SLC26A4, and missense mutations p.L445W and p.M147T were identified by sequencing and polymerase chain reaction-restriction fragment length polymorphism. The p.L445W mutation segregated in seven families and haplotype analysis suggested its founder effect. In order to understand the molecular pathogenic mechanisms of p.L445W and p.M147T mutations, SLC26A4 wild-type and mutant cDNA constructs were transiently expressed in COS7 cells and several human cell lines including Thyroid 8305C cells. Reverse transcription-PCR, western blot and immunofluorescence demonstrated that these two mutations abolished complex glycosylation of pendrin and prevented its targeting to the plasma membrane.

[Xanthogranuloma of the parotid gland in adults]. / Xanthogranulome parotidien de l'adulte.

UNLABELLED: Juvenile xanthogranuloma (JXG) is a cutaneous non-Langerhans cell histiocytosis affecting infants. We report the first case of JXG in the parotid gland of an adult. CLINICAL CASE: A 52 year-old man consulted for a painful swelling of the left parotid region, progressively increasing. On physical examination, the mass was 4 cm in diameter. A second 1.5 cm diameter tumor was found in the right parotid region. MRI revealed masses with heterogeneous hypodense on T1-weighted images and with hyper dense on T2 weighted images associated with heterogeneous enhancement after gadolinium injection. The superficial and deep lobes of the parotid gland were involved. Per-operative left-side exploration revealed a lipomatous degeneration of the parotid gland and facial nerve. A lower polar parotidectomy was performed. The histological examination identified a parotid xanthogranuloma. DISCUSSION: The JXG is usually revealed by cutaneous lesions. In fact, the morphological, immunohistochemical, and ultrastructural features of this affection lead to its diagnosis. Extra-cutaneous localizations are less frequent. The differential diagnosis is X histiocytosis.

[Acinic cell carcinoma of the nasal septum]. / Carcinome à cellules acineuses du septum nasal.

INTRODUCTION: Nasal cavity acinic carcinoma are exceptional and often of turbinal origin. We report a case of acinic carcinoma of septal origin and discuss this histological type rare in this site. OBSERVATION: A 47-year-old women, with no pathologic history, consulted for right nasal obstruction and hyposmia having evolved for a year. The clinical examination revealed a right nasal cavity lesion adhesive to the septum. Tomodensitometry showed a right nasal cavity and ethmoid opacity without bone destruction. The surgical treatment was endonasal tumor resection. The histological examination revealed a nasal fossa acinic carcinoma completely resected. A postoperative radiotherapy was initiated. The evolution was uneventful without recurrence after 4 years of follow-up. DISCUSSION: Acinic carcinoma is rarely located in the nasal cavity. Its septal origin is exceptional. It is usually located at the salivary gland level. Curative treatment is surgery associated or not to radiotherapy. The prognosis is related to tumor extension and quality of resection.

[A case of thyroid metastasis of an unusual cancer]. / Un cas de métastase intrathyroïdienne d'un primitif inhabituel.

Nasopharyngeal carcinoma affects preferentially young adults and is characterized by a high rate of node and visceral metastases that explains a part of therapeutic failure. We report a case of thyroid metastasis of a nasopharyngeal carcinoma. A 50-year-old patient had been treated of a nasopharyngeal carcinoma (T4 N2M0). Four years after a concomitant chemoradiotherapy, he presented with a compressive mass in the thyroid loge associated to cervical nodes. He underwent a total thyroidectomy and the definitive result concluded to an carcinome indifférencié de type nasopharyngé (UCNT) thyroid metastasis. A new concomitant chemoradiotherapy was delivered and consequently the tumor disappeared. Secondly, several node recurrences occurred. Metastasis of UCNT in thyroid gland is exceptional. Several problems are related to its aetiopathogenesis and to its treatment that is not systematized in the literature. The prognosis like for all metastatic forms of nasopharyngeal cancer is unfavorable.

[Monoclonal gammopathy and primary colonic mantle cell lymphoma]. / Une gammapathie monoclonale associée à un lymphome colique primitif à cellules du manteau.

The association of a monoclonal gammopathy (MG) with a B cell non-Hodgkin's lymphoma (NHL) is a well-known phenomenon. It has been recognized in many subtypes of primary gastrointestinal lymphoma but its association with primary colonic mantle cell lymphoma has never been yet described. We report a 65-year-old man who presented with an exudative ascites and constipation. Serum electrophoresis showed a monoclonal peak in the gamma region of 45g/L and immunoelectrophoresis confirmed the presence of monoclonal gammopathy of IgM kappa type. Bone marrow aspirate was normal. Radiologic and endoscopic investigations evidenced a primary colonic mantle cell lymphoma. Although the association of an MG with an NHL and, in particular, to a primitive digestive location appears a rare phenomenon, endoscopic investigations in patients with MG appears legitimate in the presence of any digestive sign.

[Cutaneous basosquamous carcinoma]. / Carcinome basocellulaire métatypique.

INTRODUCTION: Basosquamous carcinoma is a rare entity that essentially affects the head and neck region in male patients. The authors present the clinical signs and progression as well as the therapeutic consequences of this disease through two observations. CASE REPORT 1: A 41-year-old man presented with basosquamous carcinoma of the right temporoparietal region treated initially with surgery alone. Five years later, he was operated on for a local and lymph node recurrence followed by radiation therapy, stabilizing the disease for 4 years; subsequently a second recurrence with metastasis to the chest area occurred. The patient died 10 years after the onset of his disease of diffuse pneumopathy with severe septicemia. CASE REPORT 2: A 71-year-old man presented retroauricular basosquamous carcinoma at first treated with wide resection, but the surgical limits were invaded. He developed local recurrences treated with surgical resection until total petrosectomy, but the surgical limits were always invaded. Radiotherapy was delivered. Seven years after the end of treatment, he developed a local recurrence invading the brain, which was deemed untreatable. DISCUSSION: Basosquamous carcinoma is characterized by its severe aggression and its tendency to recur. Treatment is essentially surgical. Radiotherapy is an adjuvant for the cases with high risk of recurrence. The role of chemotherapy is not yet proved.

[Cervical spondylodiskitis revealed by retropharyngeal abscess]. / Spondylodiscite cervicale révélée par un abcès rétropharyngé.

INTRODUCTION: Spondylodiskitis is rare in the cervical vertebrae. We report a case of cervical spondylodiskitis revealed by a retropharyngeal abscess caused by a pyogen agent. The aim of our work was to shed light on the diagnosis and therapeutic difficulties of spondylodiskitis associated with a retropharyngeal abscess. CASE REPORT: A 70-year-old patient was admitted to the emergency department for a progressive laryngeal dyspnoea of 3 months duration. Clinical examination showed severe dyspnoea. Oropharynx and pulmonary exams were unremarkable. Failure of medical treatment led to the performance of an emergency tracheotomy after which the patient developed a flaccid quadriparesis. Medullar MRI revealed a spondylodiskitis with medullary compression and a retropharyngeal abscess. Surgical biopsy concluded to a pyogen osteitis. Treatment in the form of antibiotics and cervical immobilisation was instituted. Evolution was marked with septicaemia, multiple organ failure and ionic disturbance leading to death. COMMENTS: Cervical spondylodiskitis is rare. Its revelation by retropharyngeal abscess is also rare. MRI is the tool of choice for diagnosing discovertebral infections and its prevertebral extensions. Treatment is medical and surgical.

[Neurofibromatosis type 1 revealed by malignant peripheral nerve sheath tumor]. / Tumeur maligne des gaines nerveuses périphériques révélant une neurofibromatose type 1.

UNLABELLED: Neurofibromatosis type 1 or Von Recklinghausen's disease is an affection with variable clinical expression. Malignant transformation is rare and dangerous. OBJECTIVE: The aim of this work is to study diagnostic criterias as well as treatment of this malignant transformation. CASE REPORT: Sixteen years old patient presented with gradually progressive basicervical mass without compression nor dysthyroidy signs. Physical examination revealed a painless, hard and well limited mass measuring 4 cm. It was located in front of sternal manuhrium and associated to multiples "café au lait" spots, iris Lisch nodules and generalized neurofibromas. This mass was excised by cervical surgery. The histological exam concluded to a low grade malignant peripheral nerve sheath tumour Unfortunately despite a larger reoperation including resection of the manubrium, the limit of this excision were not safe. Early recurrence was observed, although treated by surgery, chemotherapy and radiotherapy, the patient died by mediastinal invasion.

Comparative analyses of albumin/globulin grain proteome fraction in differentially salt-tolerant Tunisian barley landraces reveals genotype-specific and defined abundant proteins.

Salinity is one of the major abiotic stresses threatening crop production and yield worldwide. Breeding programmes are therefore needed to improve yield under cultivation in soil. Traits from locally adopted landraces provide a resource to assist breeding of novel elite genotypes. Here, we examine differentially expressed proteins by performing comparative proteomic profiling of the albumin/globulin grain fraction of Tunisian barley genotype landraces with contrasting salinity tolerance. Tunisian barley Boulifa (B, tolerant) and Testour (T, sensitive) mature grains were assessed in 2-DE profiles. Differentially expressed spots, with an abundance enhanced 1.5-fold in the grain, were subjected to MALDI TOF/TOF MS for identification. Distinctiveness between tolerant and sensitive genotypes was proved in the albumin/globulin fraction using PCA; 64 spots showed significant differential abundance. Increased accumulation of 40 spots was confirmed in Boulifa with, interestingly, four genotype-specific spots. Two of these four spots were sHSP. Proteins with highest abundance were serpin Z7, 16.9 KDa Class I HSP and phosphogluconolactonase 2. Proteins such as expansin, kiwellin, kinesin and succinyl-CoA ligase were identified for the first time in barley grain. Moreover, ß-amylase, LEA family and others were identified as abundant in Boulifa. On the other hand, proteins more accumulated in Testour are implicated mainly in ROS scavenging and protease inhibition. Our results clearly indicate proteomic contrast between the two selected genotypes. With identification of specific HSP, high abundant stress-protective and other defined proteins, we provide biochemical traits that will support breeding programmes to address the threat of salinity in agricultural production.

[Contribution and limits of intensity-modulated reirradiation of nasopharyngeal carcinomas]. / Apports et limites de la réirradiation conformationnelle avec modulation d'intensité des carcinomes nasopharyngés.

PURPOSE: We report in this study, the dosimetric and carcinologic results of intensity-modulated technique for the reirradiation of nasopharyngeal carcinomas. PATIENTS AND METHODS: Eight patients reirradiated with intensity-modulation technique between January 2015 and December 2017 were included. We noted for each patient: the minimum, maximum and average doses, the dose received by 95% (D95%), 98% (D98%) and 2% (D2%) of the volume to be irradiated, the homogeneity and conformity indices and doses to the organs at risk. RESULTS: Target volume coverage was satisfactory with a median of D95% greater than 57Gy (95% of the prescribed dose). The median maximum dose received by the spinal cord and brainstem were 8.2Gy and 18.25Gy, respectively. After a median follow-up of 14.5 months [1-29 months], five patients were in complete remission of their disease. Overall survival at 2 years was 66.7%. An increase in preexisting late toxicity after the first irradiation (now grade 2 or above) was found in four patients (50% of cases). CONCLUSION: Intensity-modulation is an attractive technique for reirradiation of the nasopharynx. It allows a better conformity of the dose to the target and a reduction of the doses on the already irradiated critical organs. This offers good control of the disease with fewer severe late toxicities.

[Frontal pneumosinus dilatans associated with multiple cerebral meningioma]. / Pneumosinus dilatans frontal associé à des méningiomes cérébraux multiples.

UNLABELLED: Pneumosinus dilatans is rare. It is defined as an expansion of one of paranasal sinuses. We discuss the etiopathogenic hypothesis of pneumosinus dilatans, its epidemiologic and clinical characteristics, and its therapeutic approaches. OBSERVATION: A man, 50 years old, presented frontal pneumosinus dilatans associated with multiple cerebral meningiomas, one of which was appended in the nasal cavity revealed by frontal deformation and nasal obstruction. CT and MRI confirmed the diagnosis. The patient was operated in the neurosurgery department, via the bicoronal approach, allowing the removal of meningioma and osteodural repair of the skull base. DISCUSSION: Pneumosinus dilatans is a rare pathology with an unknown etiology. It mainly affects the frontal sinus. Its association with cerebral meningioma has been described in the medical literature. Treatment is surgical and is recommended for cases with aesthetic problems.