[Rhinitis and asthma related to cotton dust exposure in apprentices in the clothing industry]. / Rhinite et asthme liés à l'exposition aux poussières de coton chez des apprentis en habillement.

OBJECTIVE: Respiratory allergies are the most common occupational diseases in the world. The aim of this study was to determine the prevalence of rhinitis and asthma among apprentices exposed to cotton dust in the clothing industry and to describe their epidemiologic and clinical profiles. SUBJECTS AND METHODS: We carried out a descriptive study of 600 apprentices in a textile and clothing vocational training centre in the Monastir area. The investigation comprised a questionnaire exploring risk factors and symptoms appearing during their training. Subjects who developed allergic respiratory symptoms at the work-place underwent a clinical examination, rhinomanometry and investigation of their allergic status and respiratory function. RESULTS: One hundred twenty apprentices (20%) developed allergic respiratory reactions due to exposure to textile dust (exclusively cotton) during their training, with a positive withdrawal-re-exposure test. Conjunctivitis (14.3%) and rhinitis (8.5%) were the most frequent allergic symptoms. Twenty eight apprentices (4.6%) presented symptoms of asthma. Rhinitis was associated with asthma in 45% of cases. Two cases of asthma were diagnosed clinically at the work-place following their exposure to textile dust. The prick test performed in 120 symptomatic apprentices was positive in 41.6% of cases. There was sensitization to pollens in 29 cases and to dermatophagoides in 13 cases. Cotton and wool allergy was noted in two cases. Allergic symptoms developing during the training were significantly more frequent in the atopic group, and they varied according to the intensity of textile dust exposure. CONCLUSION: In the textile and clothing industry the frequency of respiratory disorders caused by allergens remains high, especially in atopic apprentices who constitute a population at high risk.

[Mercury impregnation in dentists and dental assistants in Monastir city, Tunisia]. / L'imprégnation mercurielle des dentistes et de leurs assistants dans la ville de Monastir, Tunisie.

INTRODUCTION: The property of mercury to amalgamate with other metals is used to create a material for filling teeth. This material remains the cheapest and most efficient in tooth restoration. Mercurial toxicity has been documented since Antiquity but the metal remains widely used in some countries. This study compared mercury impregnation in dentists and dental assistants in Monastir (Tunisia) to another population not exposed professionally. SUBJECTS AND METHODS: A cross-sectional study was made on 52 dentists and dental assistants working in private offices and in the stomatology unit of the Monastir teaching hospital, with a control group of 52 physicians and nurses working in the Monastir Fattouma Bourguiba hospital. The groups were paired according to age and gender. The study lasted three months. A questionnaire investigated the socioprofessional features of the study population, non professional mercury exposure, work environment, the various amalgam handling and preparation techniques, and preventive hygiene measures. Urinary and salivary sampling was performed so as to prevent any accidental mercurial contamination. Mercury level was assessed by atomic absorption spectroscopy in an automatic sampler, urine creatinine with Jaffé's colorimetric reaction. The results of mercury level assessment were expressed in microg/g of creatinine, salivary mercury in mug/l. The statistical analysis was made with the Epi.info 6 software. Khi(2) and Fisher tests were used to compare qualitative variables. The ANOVA test was used to compare averages with a statistic significance threshold at 0.05. RESULTS: Sixty-one percent of individuals with risk exposure worked in a dental clinic. Bruxism and onychophagia were more important in the control group with a significant statistical difference (respectively, p=0.01 and p<0.0001). The urinary and salivary mercury levels were significantly increased in the exposed group, with respective values of 20.4+/-42.4microg/g of creatinine and 10.6+/-13.02microg/l versus 0.04+/-0.3microg/g of creatinine and 0microg/l in the control group. Disposing of amalgam waste was inadequate in 94% of the cases. The variation of mercury in urine was significantly influenced by the presence of fabric curtains (p=0.04). Eating lunch at meals at the work place was also linked to a significant increase of mercury levels in urine (p=0.04). The storage mode of mercury in open containers was a significant factor for variation of mercury level (p=0.03). DISCUSSION: Most dentists' private offices in Monastir do not comply or comply weakly with prevention measures linked to risk of mercury poisoning. Awareness campaigns were launched as well as actions for the improvement of work conditions: efficient aspiration of offices containing fixed sources of mercury, adequate storage of mercury and waste, and compliance to occupational hygiene rules.

Traumatic isolated perforation of lower oesophagus.

One of the rarest cases of non-iatrogenic oesophageal perforation is falling from height. We report a case of a 26 year old man with oesophageal perforation resulting from a fall of 12 meter height. A pneumomediastinum in the absence of a pneumothorax and contrast extravasation from the oesophagus on CT evoked a perforation of the aerodigestive tract. No other injuries were seen. A non-operative management was pursued with good outcomes.

Jejunal lymphangioma: an unusual cause of intussusception in an adult patient.

Adult intussusception is a relatively rare clinical entity. Almost 90% of cases of intussusception in adults are secondary to a pathologic condition that serves as a lead point. Lymphangioma of the small bowel is an unusual tumour that has been rarely reported to cause intussusception. In this paper, we present a rare case of adult intussusception due to jejunal lymphangioma. A 22-year-old female patient with a medical history significant for anaemia presented with intermittent colicky abdominal pain, diarrhoea and oedema of the inferior limbs for the past three months. Ultrasonography and CT scan revealed a typical target sign with dilated intestinal loops. At laparotomy, a jejuno-jejunal intussusception was found. Partial resection of the jejunum was performed. Macroscopic examination of the surgical specimen revealed a pedunculated polyp measuring 2 cm in diameter. Histological sections of the polyp revealed in the lamina propria and submucosal layer of the jejunum several markedly dilated thin-walled lymphatic spaces lined with single layers of flat endothelial cells. The final pathologic diagnosis was submucosal lymphangioma. This case report indicates that intussusception, although rare in adults, should be considered in the differential diagnosis of abdominal pain. Moreover, it should be taken into consideration that lymphangioma is one of the possible lesions that can cause intussusception.

Omentoplasty in the prevention of deep abdominal complications after surgery for hydatid disease of the liver: a multicenter, prospective, randomized trial. French Associations for Surgical Research.

BACKGROUND: Omentoplasty (OP) is thought to fill residual cavity, to assist healing of raw surfaces, and to promote resorption of serosal fluid and macrophagic migration in septic foci. Results published to date, whether retrospective or prospective, are not controlled and are discordant. STUDY DESIGN: The authors investigated whether OP, either filling the residual cavity after unroofing, or covering the hepatic raw surface after pericystectomy, could reduce the rate or severity of deep abdominal complications (DAC) after surgical treatment of hydatid disease of the liver. Between January 1993 and December 1996, 115 consecutive patients (51 males and 64 females, mean age 42+/-16 years [range 10 to 80 years]) with previously unoperated uni- or multilocular hydatid disease of the liver, complicated or not, without other abdominal hydatid disease, were randomly allotted to OP (n = 58) or not (NO) (n = 57) after unroofing, total, or partial pericystectomy. Patients were divided into 2 strata according to the site of the cyst with respect to the diaphragm: a) posterosuperior segments II, VII, and VIII or b) anterior segments III, IV, V, and VI. Main outcomes measures included deep bleeding, hematoma, infection, or bile leakage. Subsidiary measures included wound complications, extraabdominal complications, duration of operation, and length of hospital stay. RESULTS: Both groups were comparable regarding patient demographics, cyst characteristics, intraoperative procedures, search for bile leaks, and intraoperative transfusion requirements. On the other hand, more patients (86%) in NO had associated drainage of the abdominal cavity than in OP (64%) and the duration of operation was 9 minutes longer in OP, but neither of these differences was statistically significant. Less DAC occurred in OP (10%) than in NO (23%) (a posteriori gamma risk < 0.05) and fewer deep abdominal abscesses (0 versus 11%) (p < 0.03). Median duration of hospital stay, however, was similar. CONCLUSIONS: OP decreases the rate of DAC and especially deep abdominal abscess after surgical treatment (unroofing or pericystectomy) for hydatid disease of the liver and should be recommended in this setting.

[Gastroduodenal intussusception on gastric tumor]. / Invagination gastro-duodénale sur tumeur gastrique.

Gastroduodenal intussusception is a rarely documented condition. A distinction has to be made between complete gastroduodenal intussusception (CGDI) and either prolapse of a pedunculated tumor through the pylorus or mucosal prolapse through the pylorus. CGDI usually occurs secondary to a pedunculated benign gastric tumor. More rarely the tumor is malignant. We report a case of CGDI associated with gastric adenocarcinoma. We emphasize diagnostic difficulties that can be generated by CGDI.

[Anterior anal sphincter approach in the management of urethral-rectal fistulas: a case report]. / La voie antérieure trans-ano-sphinctérienne dans la prise en charge des fistules uréthro-rectales: à propos d'un cas.

Urethrorectal fistula is a rare disease which is easy to diagnose, but which essentially raises a problem of the choice of the most appropriate surgical technique. A review of the literature on the subject shows that, over the last decade, various teams have developed the anterior and posterior trans-anp-sphincteric approaches. We report a case of an acquired urethrorectal fistula associated with anal incontinence treated via an anterior trans-ano-rectal perineal incision. The exposure provided by this incision facilitates simultaneous cure of the fistula and repair of the anal sphincter.

Association of a p73 exon 2 GC/AT polymorphism with colorectal cancer risk and survival in Tunisian patients.

We examined the association of one linked GC/AT polymorphism at p73 with the risk of colorectal cancer. In the present study, we investigated whether this polymorphism was related to the risk of colorectal cancer, and whether there were relationships between the polymorphism and LOH, protein expression or clinicopathological variables. The p73 genotypes were determined by PCR-restriction fragment length polymorphism in 150 Tunisians patients with colorectal cancer and in 204 healthy control subjects. Immunohistochemistry was performed on normal mucosa, primary tumour and metastasis. The frequencies of the genotypes were 52% for wild-type (GC/GC), 31% for heterozygotes (GC/AT) and 17% for variants (AT/AT) in patients, and 54%, 35% and 11% in controls, respectively. There were no significant differences of the frequencies of the three genotypes between the patients and controls (p = 0.11). We did not find any relationship of the genotypes with clinicopathological features of patients. We found that patients with the AT/AT genotype had a significantly worse clinical outcome than those with the GC/AT and GC/GC genotype. There were no significant differences between tumoural immunostaining of the total p73 and p73 polymorphism (p = 0.16). However, we found a significant difference between the expression profile of DeltaNp73 isoform and frequencies of the three genotypes (p = 0.0001). No LOH was observed at p73 locus. Our results suggest that the AT/AT genotype is significantly associated with poor prognosis in colorectal cancer. All these findings suggest that p73 polymorphism analysis may provide useful prognostic information for colorectal cancer patients.

[Acute phlegmonous gastritis. Apropos of a case]. / La gastrite aiguë phlegmoneuse. A propos d'un cas.

Phlegmonous gastritis is a rare bacterial infection of the stomach. Its diagnosis is difficult and has a poor prognosis. The authors report a case of phlegmonous gastritis occurring in a 50 year-old woman in whom the diagnosis was made by microscopic examination after surgery for intestinal occlusion. The patient died a few hours after the operation.