[Paradoxical reaction following antituberculosis therapy in immunocompetent patient]. / Réaction paradoxale à la fin du traitement antituberculeux chez le sujet immunocompétent.

INTRODUCTION: The features of paradoxical reactions (PR) that occurred in non-HIV infected patients are rare and not well known. CASE REPORT: The authors reported the case of a 21years old, non-immunocompromised, and HIV negative patient treated for disseminated tuberculosis. PR occurred after 8months after initiation of antituberculous treatment. PR presented as left cervical lymphadenopathy, pulmonary, pleural, costal and spinal location of the tuberculosis. The antituberculous drugs were prolonged. Patient's clinical symptoms improved initially. However, left inguinal lymphadenopathy appeared after 20months of antituberculous therapy. Inguinal lymph node biopsy revealed tuberculous lymphadenitis. The patient has a good compliance to the treatment. The patient was continued on same antituberculous treatment for a total of 28months. The cervical and inguinal lymphadenopathy disappeared and CT scan showed regression of thoracic, abdominal, costal and spinal lesions. CONCLUSION: PR during antituberculous treatment must be considered after exclusion of other causes. No consensus on the therapeutic management of this entity has been developed to date.

[Unusual location of an intrathoracic mesothelial cyst in the posterior and upper mediastinum]. / Une masse inhabituelle du médiastin supérieur et postérieur : le kyste cœlomique.

BACKGROUND: Intrathoracic mesothelial cysts are congenital lesions due to an abnormal development of the pericardial coelom. They are usually asymptomatic and found incidentally on chest radiography or computed tomography. As their classic anatomical location is in the cardiophrenic angle, they are also referred to pleuropericardial cysts. CASE REPORT: A 50-year-old male presented with a history of chest pain. Physical examination and chest X-ray were normal. Computed tomography (CT) scan revealed a cystic lesion in the posterior and upper mediastinum. The cyst was surgically removed through a posterolateral thoracotomy. Histopathological examination confirmed that it was a mesothelial cyst. The surgical resection of the cyst lead to relief of the thoracic pain over a three-year follow-up period. CT-scan showed an aberrant right subclavian artery or arteria lusoria, which is an anomaly of the aortic arch secondary to abnormal embryogenesis. We know no other report of concurrent ectopic coelomic cyst and aberrant right subclavian artery. CONCLUSION: Although the majority of coelomic cysts needs only radiological and clinical follow-up, surgical resection should be performed when the patient is symptomatic or when the diagnosis is uncertain.

[Malignant peripheral sheath nerve tumor: An exceptional mass of the anterior and middle mediastinum]. / Tumeur maligne des gaines des nerfs périphériques : masse exceptionnelle du médiastin antérieur et moyen.

Malignant peripheral nerve sheath tumors (MPNST) are rare nervous tumors usually located in the posterior mediastinum in the paravertebral gutters. We report the case of a non-smoking 62-year-old man who was admitted with a 4 months history of cough, hoarseness and shortness of breath. Physical examination noted a superior vena cava syndrome. CT scan of the chest revealed a right anterior and middle mediastinal mass compressing the superior vena cava, the ascending aorta, the right pulmonary artery, invading the superior root of the pulmonary vein and the right auricle. Flexible bronchoscopy showed extrinsic compression of the right main bronchus, the right upper lobe bronchus and intermedius bronchus. The patient underwent surgical biopsy of the mass by mediastinoscopy. Histological examination revealed a malignant peripheral nerve sheath tumor. The patient received a single cycle of chemotherapy (ifosfamid-adriamycin). Clinical course was marked by the fast worsening of the dyspnea and the general state. Patient died three weeks after the cure of the chemotherapy. This case is original by the exceptional clinical presentation of MPSNT with a superior vena cava syndrome and the very rare location of this tumor in the anterior and middle mediastinum.

[Management of spontaneous pneumomediastinum in the adult: 14 cases and a review of the literature]. / Prise en charge du pneumomédiastin spontané chez l'adulte: à propos de 14 cas avec revue de la littérature.

The authors report a series of 14 patients hospitalized for spontaneous pneumomediastinium between 1992 and 2006. They included 10 men and four women with an average age of 27.84 years. Dyspnoea dominated the symptoms. The pneumomediastinum was idiopathic in five patients and secondary in the other nine patients, involving an attack of severe asthma in half of the patients, polymyositis in one patient and idiopathic pulmonary fibrosis in one patient, respectively. The patients presenting polymyositis and pulmonary fibrosis died due to respiratory distress. The other patients benefited from asthma treatment or thoracic drainage, and were kept at rest. Their outcome was good. No cases of relapse were observed after an average follow up of 2.11 years.

Passivity-based current controller design for a permanent-magnet synchronous motor.

The control of a permanent-magnet synchronous motor is a nontrivial issue in AC drives, because of its nonlinear dynamics and time-varying parameters. Within this paper, a new passivity-based controller designed to force the motor to track time-varying speed and torque trajectories is presented. Its design avoids the use of the Euler-Lagrange model and destructuring since it uses a flux-based dq modelling, independent of the rotor angular position. This dq model is obtained through the three-phase abc model of the motor, using a Park transform. The proposed control law does not compensate the model's workless force terms which appear in the machine's dq model, as they have no effect on the system's energy balance and they do not influence the system's stability properties. Another feature is that the cancellation of the plant's primary dynamics and nonlinearities is not done by exact zeroing, but by imposing a desired damped transient. The effectiveness of the proposed control is illustrated by numerical simulation results.

[Characterization of RET proto-oncogene C634Y mutation in a Moroccan family with multiple endocrine neoplasia type 2A]. / Caractérisation de la mutation C634Y du proto-oncogène RET dans une famille marocaine de néoplasie endocrinienne multiple de type 2A.

Medullary thyroid carcinoma (MTC) is a rare cancer which originates from the calcitonin producing "C" cells of thyroid gland. It presents in as isolated form or as part of the multiple endocrine neoplasia type 2 (MEN 2). The familial form of MTC which frequency remains underestimated, account for 25 to 40% of all MTC presentations. All hereditary forms are transmitted in an autosomal dominant manner and are due to proto-oncogene RET germ line mutations. Although MCT is relatively rare, preclinical or prebiological diagnosis can be achieved with genetic screening with high specificity and sensitivity. Early diagnosis is crucial for disease prevention. In this study we identified the first RET mutation underlying NEM 2A in Morocco. The C634Y mutation was present in the heterozygous state in a Moroccan family with MEN 2A. Genetic screening showed that six asymptomatic members of this family were not C364Y carriers. This report should contribute to the development of genetic screening for NEM 2 and F-MTC in Morocco.

Mastication in the oral myofunctional disorders.

The aim of this article is to show two ways of clinical work with mastication in Oral Myofunctional Disorders. Consideration is given to limitations that make direct treatment impossible: symptoms/signs of temporo-mandibular joint, occlusions alterations, types of orthodontics or orthopedics appliances and loosing teeth. The procedures suggested are named procedures WITH and WITHOUT LIMITATIONS.

[Per os desensitization in nickel contact eczema: a double-blind placebo-controlled clinico-biological study]. / Désensibilisation per os dans l'eczéma de contact au nickel: étude clinico-biologique en double insu contre placebo.

BACKGROUND: Ingestion of nickel (Ni) has been demonstrated to induce a specific state of tolerance in the guinea pig and mouse. In a pilot study conducted in 10 patients, we demonstrated that per os administration of Ni leads to reduced proliferation of specific lymphocytes and a lower number of responding lymphocytes in blood. The aim of this study was to evaluate the clinical and biological changes induced by the ingestion of Ni in a double-blinded placebo-controlled study. PATIENTS AND METHODS: Patients with nickel contact hypersensitivity were given a capsule of nickel sulfate containing 5 mg Ni (group A) or an identical placebo (group B) once a week for 7 weeks. Clinical criteria were assessed 49 days after study onset: objective measurement of lesion extent and intensity and quantitative patch tests at concentrations 2.4-0.8-0.2 and 0.05 p. 100. Likewise stimulation of specific lymphocyte proliferation and the number of circulating lymphocytes responding to Ni at limit dilutions were determined. RESULTS: Thirty patients with nickel contact eczema were included in the study, 28 women and 2 men. There was no statistical difference between the two groups for the intensity of skin lesions or their clinical course, quantitative patch tests and lymphocyte stimulation tests. Conversely, the number of circulating lymphocytes responding to Ni was significantly lower in group A than in group B at study end (p < 0.05). DISCUSSION: This double-blind placebo-controlled study confirmed that per os nickel can induce a significant reduction in the number of circulating lymphocytes responding to Ni. No other effect could be demonstrated for the clinical and biological parameters studied. These preliminary results should prompt a multicentric controlled trial including a larger number of patients with more severe lesions at inclusion and with a longer treatment duration.

Dysembryoplastic neuroepithelial tumors: nonspecific histological forms -- a study of 40 cases.

OBJECTIVE: To demonstrate that DNTs include a large morphological spectrum of tumors that cannot be histologically distinguished from conventional categories of gliomas. METHODS: All tumors from patients who underwent epilepsy surgery in Sainte-Anne hospital (Paris) that histologically resembled gliomas and did not conform to current histological criteria for DNTs or gangliogliomas were entered in the study. RESULTS: According to the WHO histological classification, the 40 tumors resembled: pilocytic astrocytomas (4 cases), astrocytomas (16 cases), anaplastic astrocytoma (1 case), oligodendrogliomas (10 cases), oligo-astrocytomas (8 cases) or anaplastic oligo-astrocytomas (1 case). However foci of cortical dysplasia could be observed in 47% of the cases. Clinical presentation and imaging features were strikingly similar to that observed in typical DNTs. Although surgical removal was incomplete in 28% of the cases and none of the patients underwent chemo or radiotherapy, none of the tumors recurred (mean follow-up: 7 years). Moreover, serial preoperative imaging in 26 patients (mean follow-up: 4.5 years) demonstrated that these lesions were perfectly stable. CONCLUSIONS: Whatever the histological appearance of a glial tumor, the diagnosis of DNT must be considered when all the following criteria are associated: (1) partial seizures, with or without secondary generalization, beginning before the age 20 years, (2) no neurological deficit or stable congenital deficit, (3) cortical topography of the lesion as better demonstrated by MRI and (4) no mass effect on imaging.

Myofunctional therapy: brief intervention.

This study addresses speech-language therapy in orofacial myology utilizing a Brief Intervention (in Portuguese: IntervenAão Fonoaudiológica Breve) (IFB). IFB is applied to patient groups between the ages of 8 and 15 years with orthodontic/orthopedic appliances in 1997. Results are presented indicating the advantages of using IFB for breathing, feeding, oral-facial habits, buccal hygiene and corporal posture/physical activity. It concludes that Brief Intervention can be accomplished in 8 sessions, is economically advantageous for use in group therapy, and may be used before or in conjunction with Myofunctional Therapy/Myotherapy.

[Iatrogenic air embolism]. / Les embolies gazeuses iatrogènes.

The incidence of iatrogenic air embolism can only be estimated since many accidents are not recognized. Clinical manifestations, essentially neurological or cardiovascular disorders vary greatly. Air embolism may occur during coronary or cerebral arteriography, cardiopulmonary bypass, venous catheterism, various types of surgery or blood transfusion among other situations. Once air has entered the arterial circulation, the bubble of gas follows the blood flow until it is blocked by a smaller calibre vessel. The progressive diffusion of the air reduces the size of the embolus which then migrates on to smaller and smaller vessels. Subsequent pathological manifestations of air embolism result from mechanical obstruction leading to ischemia and inflammatory reactions to air acting as a foreign body. The sudden onset signs of neurological impairment with or without a cardiopulmonary component in patients in a high-risk situation leads to clinical diagnosis. Treatment must be started immediately although brain CT scan or echocardiography may help confirm the diagnosis. The source of the air must be immediately identified and removed and the vital functions controlled. Mechanical or facial mask ventilation with pure oxygen is indicated. Hyperbaric oxygen therapy should be instituted. Morbidity and mortality after iatrogenic air embolism is high but major improvements have been achieved with oxygen therapy. Neurological sequellae have been estimated to reach 19 to 50% of the patients. A personal controlled prospective study revealed 14% mortality after hyperbaric oxygen therapy given within 12 hours of the accident.