Spontaneous uterine rupture during the first trimester of a partial molar pregnancy in a scar uterus: A rare case report.

INTRODUCTION: Spontaneous uterine rupture in the first trimester is a redoubtable obstetric emergency that carries a high risk for both mother and fetus. CASES PRESENTATION: We present the case of a spontaneous uterine rupture in a patient with a scarred uterus at 9 weeks' gestation treated by laparotomy in emergency obstetrical department of Ibn Rochd University Hospital of Casablanca; whose histological examination of the removed material found a partial mole. CLINICAL DISCUSSION: Spontaneous uterine rupture in the first trimester is rare and usually occurs in a scarred or malformed uterus. Clinicians should consider this diagnosis in the presence of an acute abdominal pain in early pregnancy with or without first trimester metrorrhagia. CONCLUSION: Since the rate of uterine surgeries is increasing, it is necessary to highlight the risk of uterine rupture occurring early in order to improve their management. Molar pregnancy is a factor of fragility of the uterine wall and uterine rupture must be suspected in any molar pregnancy associated with a hemoperitoneum.

Theoretical study of the effects of modifying the structures of organic dyes based on N,N-alkylamine on their efficiencies as DSSC sensitizers.

In this work, we carried out a theoretical study in which DFT and TD-DFT calculations of a series of six new organic dyes that incorporate N,N-alkylamine as an electron donor and a cyanoacrylic acid group as an electron acceptor and anchoring group were performed. In each dye, the donor and the acceptor were bridged by six different π-conjugated spacers consisting of an auxiliary donor group (3,4-ethylenedioxythiophene, EDOT) or an auxiliary acceptor group (benzothiadiazole, BTZ or diketopyrrolopyrrole, DPP) that was linked to either thiophene or phenyl. EHOMO, ELUMO, Egap, λmax, Eex, the open-circuit photovoltage (Voc), the light-harvesting efficiency (LHE), and the free injection energy (ΔGinject) were calculated for all of the dyes to compare their photovoltaic performance. The effects of the incorporation of an additional acceptor group (DPP or BTZ) or an additional donor group (EDOT) into the π-bridge on the geometry, electronic structure, and photovoltaic performance of each designed dye were explored. The study shows that modifying the dye skeleton can greatly improve the performance of the dye and increase its power conversion efficiency. It also reveals that all of the studied dyes are promising candidates for an effective DSSC sensitizer, especially those that include the acceptor group DPP in the π-bridge.

West Nile Disease Epidemiology in North-West Africa: Bibliographical Review.

West Nile fever (WNF) or West Nile disease (WND) is a mosquito-borne viral disease that can affect birds, humans and horses. West Nile virus (WNV) is a member of the genus Flavivirus in the family Flaviviridae. WNV is maintained in a mosquito-bird-mosquito transmission cycle, whereas humans and horses are considered dead-end hosts. In human and horses, symptoms range from unapparent infection to mild febrile illness, meningitis, encephalitis or death. WNV has a wide geographical range that includes portions of Europe, Asia, Africa, Australia (Kunjin virus), and in North, Central and South America. Migratory birds are thought to be primarily responsible for virus dispersal, including reintroduction of WNV from endemic areas into regions that experience sporadic outbreaks (Fields Virology, 2001, Lippincott Williams and Wilkins, Philadelphia, Pennsylvania, USA, 1043-1125). The occurrence of disease in humans and animals along with birds and mosquitoes surveillance for WNV activity demonstrates that the virus range has dramatically expanded including North, Central and South America as well as Europe and countries facing the Mediterranean Basin. WND infection in humans has been reported in Morocco in 1996 (Virologie, 1, 1997, 248), in Tunisia in 2007 (Ann. N. Y. Acad., 951, 2001, 117) (Med. Trop., 61, 2001, 487) and 2003 (Epidémiologie de la fièvre West Nile, 2012, Thèse de doctorat, Université Montpellier II, Sciences et techniques du Langueduc, Montpellier, France), and in Algeria in 1994 (Rev. Sci. Tech., 31, 2012, 829). Outbreaks of equine encephalitis have been also reported in Morocco in 1996 (Bull. OIE, 11, 1996, 867), in 2003 (Emerg. Infect. Dis., 11, 2005, 306) and in 2010 (World Animal Health Information Database. WAHID, 2010). Serological evidence of WNV has been demonstrated in the three countries in many species. The aim of this review was to assess the epidemiological situation of WND in north-west Africa comprising Morocco, Algeria and Tunisia, with an updated literature review based on of human cases and equine outbreaks reports as well as serological studies in these countries.

Characterization of gas phase WC²âº: a thermodynamically stable carbide dication.

Using an ab initio methodology, we performed a detailed theoretical study of the gas phase WC(2+) dication. These calculations were done using a multiconfigurational method in connection with a large basis set, where relativistic effects were taken into account. This dication is identified here as the first thermochemically stable doubly charged diatomic carbide in the gas phase. Our work hence confirms the stability of this dication in the gas phase and its earlier observations by atom probe mass spectrometry. Our calculations show that the shape of the potential energy curves of its lowest electronic states changes drastically upon consideration of relativistic effects. For instance, the electronic ground state possesses a Morse-like potential without spin-orbit that evolves to the usual volcanic behavior, and with a columbic 1/R evolution at large internuclear separation after inclusion of spin-orbit. We predict a set of thermochemical and spectroscopic data for this molecular species.

The multilayer flow modulator stent for the treatment of arterial aneurysms.

AIM: The purpose of this manuscript was to: 1) report our experience with the Multilayer Flow Modulator (MFM) for the treatment of peripheral, visceral and aortic aneurysms; 2) review the published literature regarding the outcomes of patients treated with the MFM; and 3) develop initial treatment guidelines regarding the MFM. METHODS: We reviewed our clinical experience with the MFM in 58 high surgical risk patients. Thirty-one peripheral (PAAs), 9 visceral (VAAs) and 18 aortic aneurysms (10 thoracoabdominal [TAAA]; 8 abdominal) were treated. In addition, the PubMed database through April 2013, along with relevant websites and scientific presentations at international meetings, were quered regarding the MFM. Seventeen articles and 3 presentations were identified. Data regarding 178 patients treated with the MFM were included for analysis including 57 PAAs, 31 VAAs and 90 complex degenerative aortic lesions. Outcomes including technical success, 30-day mortality, endoleak rate and aneurysm-related survival were studied. RESULTS: In our experience, there were 47 males and the mean age was 62 years (16-80). In patients with PAAs and VAAs, technical success with the MFM was 100%. At 30 days, there were no deaths. Initial MFM patency was 97.5% (39/40) with patency of the thrombosed MFM successfully restored. Longer-term follow-up (mean 16 ± 8 months) demonstrated progressive thrombosis and shrinkage of the aneurysm sacs and all side-branches were patent. In patients with aortic aneurysms, technical success was 100%, with no complications and no deaths at 30 days. Longer-term follow-up (8 ± 7 months) demonstrated aneurysm-related survival of 100%, all-cause survival of 83.3%, intervention-free survival of 100% and 100% patency of the side branches. The longest duration for aneurysm sac thrombosis was 18 months. A significant mean diameter reduction was observed at 6 months (17.3 mm for the transversal maximal diameter and 13.83 mm for the antero-posterior diameter) in the TAAA group. In the literature review, there was 100% technical success and a 97.7% 30-day survival rate in patients with PAAs and VAAs treated with the MFM. In follow-up (range 5-26 months), there were no aneurysm-related deaths or aneurysm ruptures and the overall survival was 95.5%. Complete aneurysm exclusion was observed in 94.3% of the patients with significant aneurysm shrinkage in 83% of the patients. Nine (10%) MFMs occluded with most occlusions resulting from pre-existing conditions. Patency of 5 occluded MFMs were restored and 4 occluded MFMs were not treated and were asymptomatic. All covered side branches were patent except in a patient with thrombophilia who also had an occluded MFM. The treatment of complex aortic degenerative lesions with MFM demonstrates a 95.5% 30-day survival with 2 aneurysm ruptures for contrindicated use (previously ruptured aneurysm; mycotic aneurysm). Over the follow-up (range 3-28 months), all-cause survival was 87.8% and aneurysm-related survival was 96.7% (1 late rupture due to a type 1 endoleak). Side branches were patent for 97.7% of the treated cases and a 13.3% endoleak rate was reported. There were no neurological, renal or respiratory complications. Complete exclusion and size stability were achieved for most of the cases. CONCLUSION: Clinical experience with the MFM is increasing. The MFM has been used to treat many types of aneurysms including peripheral, visceral and aortic. Early results suggest that use of the MFM can help prevent aneurysm-related mortalities while maintining branch vessel patency. Additional study and investigation is needed.

[Digital ulcers revealing lung carcinoma]. / Ulcérations digitales révélant un carcinome bronchique.

Digital ulcers usually reflect focal ischemia due to a microangiopathy, its causes are diverse. In women, it first suggests a connective tissue disease whereas in men, a diffuse arteriopathy. Acral ischemia till necrosis is a rare form of a paraneoplasia. We report about a man with a metastatic lung cancer revealed by digital ulcers. In front of digital necrosis, haemopathy or cancer must be searched in the absence of iatrogenic cause, occupational diseases, atherosclerosis or systemic disease.

[Möbius syndrome]. / Le syndrome de Möbius.

Möbius syndrome is a rare congenital disease characterized by facial and abducens nerve palsy. Children are unable to smile, frown, suck, grimace, blink their eyes, and to move their eyes laterally. The aim of this study was to analyze the diagnosis and treatment of this disease. Maxillofacial examination reveals: facial diplegia, retrognathism, palatine and dental malformations. Möbius syndrome is usually associated with multiple cranial nerve involvement, limb or orofacial malformation, and Poland syndrome. Although the pathogenesis of the syndrome is unclear, a number of mechanisms have been suggested including vascular and genetic hypotheses. Symptomatic treatment is used to manage this syndrome. The diagnosis of Möbius syndrome may be difficult in some patients with atypical signs of facial diplegia and other cranial nerve palsies, it requires a multidisciplinary approach.

Renal angioplasty and stenting: is it still indicated after ASTRAL and STAR studies?

A renal artery stenosis (RAS) is common among patients with atherosclerosis, up to a third of patients undergoing cardiac catheterization. Fibromuscular dysplasia is the next cause of RAS, commonly found in young women. Atherosclerosis RAS generally progresses overtime and is often associated with loss of renal mass and worsening renal function (RF). Percutaneous renal artery stent placement is the preferred method of revascularization for hemodynamically significant RAS according to ACC and AHA guidelines. Several randomized trials have shown the superiority of endovascular procedures to medical therapy alone. However, two studies ASTRAL and STAR studies were recently published and did not find any difference between renal stenting and medical therapy. But these studies have a lot of limitations and flaws as we will discuss (poor indications, poor results, numerous complications, failures, poor technique, inexperienced operators, ecc.). Despite these questionable studies, renal stenting keeps indications in patients with: uncontrolled hypertension; ischemic nephropathy; cardiac disturbance syndrome (e.g. "flash" pulmonary edema, uncontrolled heart failure or uncontrolled angina pectoris); solitary kidney. To improve the clinical response rates, a better selection of the patients and lesions is mandatory with: good non-invasive or invasive imaging; physiologic lesion assessment using transluminal pressure gradients; measurements of biomarkers (e.g., BNP); fractional flow reserve study. A problem remains after renal angioplasty stenting, the deterioration of the RF in 20-30% of the patients. Atheroembolism seems to play an important role and is probably the main cause of this R.F deterioration. The use of protection devices alone or in combination with IIb IIa inhibitors has been proposed and seems promising as shown in different recent reports. Renal angioplasty and stenting is still indicated but we need: a better patient and lesion selection; improvements in techniques and maybe the use of protection devices to reduce the risk of RF deterioration after renal stenting.

[An unusual foreign body in the orbit]. / Un corps étranger orbitaire insolite.

INTRODUCTION: Foreign bodies in the orbit are rare. They can generate more or less serious complications depending on their nature and size. We report an exceptional case of a bulky foreign body in the orbit (the tip of a pen), which did not lead to any complication. OBSERVATION: A 13-year-old child presented with a right orbital trauma caused by a pen. He consulted 3 months later when a small palpebral swelling appeared. The CT scan showed the presence of a foreign body on the orbital floor. Wound debridement allowed extracting the tip of a pen measuring 3.5cm without any complication. There were no postoperative complications. DISCUSSION: The originality of this observation is two-fold; the singularity of the foreign body and its total harmlessness in spite of its large size. However, orbital trauma and a secondary orbital syndrome must lead to emergency imaging.

[Maxillary cementoblastoma. A case report]. / Cémentoblastome maxillaire. A propos d'un cas.

Cementoblastoma is a rare benign odontogenic neoplasm. Its cause is unknown. It represents less 6 % of all odontogenic tumors. The aim of our work is to present a rare case of maxillary cementoblastoma involving an included central incisor. A 32-year old man consulted for a left maxillary swelling to projection under nostril. A panoramic radiographic examination revealed an included tooth 21 with a radiopaque lesion around its root. The computed tomography revealed the included tooth 21 with a process around its root. This process is well-defined, high-dense and is surrounded by a radiolucent halo. The treatment should consist of complete removal of the lesion with the tooth 21. Histological examination concluded to the diagnosis of a cementoblastoma. The cementoblastoma occurs most frequently in young persons and predominantly among men. The mandibular premolar and molar are the more frequently reached. The maxillary localization remains rare. This tumor occurs around the roots of the posterior and lower teeth. Radiographically, the lesion is well-defined and attached to the root of the tooth, radiopaque dense and surrounded by a radiolucent halo. The cementoblastoma evolves slowly and has the tendency to blow the cortical. The prognosis is good.

[A maxillary lip bumper used to manage labial self-mutilation]. / Utilisation du lip bumper ou pare-choc labial dans la prise en charge d'une autophagie labiale.

INTRODUCTION: The repair of facial self-mutilation often fails if the reconstruction is not protected. The authors report a case of a lip self-mutilation treated by an orthodontic device: the "lip bumper". OBSERVATION: A four-year-old patient presented with self-mutilation of the lower lip in a context of multiple malformations. The defect concerned two third of the lower lip. The treatment combined antibiotics, local care, psychiatric management and a lip bumper. The evolution was favorable without need for secondary reconstruction. DISCUSSION: The lip bumper is a simple orthodontic device. It pushes the lower lip away from the dental arch. It is used to stop the pattern "agitation-mutilation-infection".

[Cheek paraganglioma: a rare location]. / Paragangliome jugal: une localisation rare.

OBSERVATION: A 29 year-old-woman presented with a massive painless slow-growing tumor of the right cheek, with a benign aspect on clinical examination. The CT scan with injection, showed a solid-cystic mass, well defined, and partially enhanced. The mass was easily removed with a complete endobuccal excision. The histological examination and immunohistochemical study revealed a paraganglioma. There was no postoperative complication. No recurrence was noted after six months of follow-up. DISCUSSION: The paraganglioma is a rare neuroendocrine tumor and its location in the cheek has never been reported.

Hydatid cyst of the rib: a new case and review of the literature.

The hydatid cyst is not rare in our country, but bone lesions are less common. The disease often takes the appearance of abscess or malignant lesion. We report a case of a 35-year-old man with a hydatid cyst of the rib complicated with cutaneous fistula. The surgery allowed both diagnosis and treatment. Albendazole was then administered to prevent relapse.

[Primary palpebral tuberculosis]. / La tuberculose palpébrale primaire.

INTRODUCTION: Isolated-eyelid tuberculosis is exceptional. Its clinical polymorphism explains the delayed diagnosis. OBSERVATION: A 36-year-old male nurse, with no specific history, presented with a lower-eyelid nodule. The treatment was not effective and the lesion-exeresis biopsy proved the diagnosis of tuberculosis. Follow-up did not reveal any other tuberculosis focus and the patient's evolution was good under antibacilli treatment. DISCUSSION: Eyelid tuberculosis is exceptional. Unlike in our case, it is usually secondary to pulmonary tuberculosis. The eyelid contamination may be hematogenic or secondary to trauma.

[Cerebral revascularisation in Takayasu's arteritis]. / Revascularisation cérébrale dans la maladie de Takayasu.

SUBJECT: Supraaortic angioplasty is often not feasible in patients with Takayasu's arteritis because of involvement of long segment of arteries. Consequently, the role of surgical treatment in the management of cerebral ischemia is important in this disease. The objective of this work is to specify the indications and surgical techniques in lesions of arteries to the head in this disease and to report our experience. METHODS: Seven patients with cervical arterial lesions due to Takayasu's arteritis were treated by bypass surgery in the department of vascular surgery, Ibn-Sina hospital on one period of 11 years. RESULTS: It is about 6 women and one man of middle age at the time of the diagnosis of 33,8 years. The revealing signs were essentially of neurological and ocular order. Six of our patients were in inflammatory thrust at the time of the diagnosis, and required a medical treatment first to basis of corticosteroids. Bypasses from the ascending aorta to the carotid artery were performed in six cases. In one case, the bypass was performed between the brachiocephalic artery and common carotid artery. A death in relation with a cerebral hemorrhage occurred 2 days after the revascularisation. A clean improvement of the functional signs was noted among 3 patients, whereas the improvement was partial at two other. A secondary thrombosis of the bypass surgery occurred in 3 cases. CONCLUSION: The natural history of Takayasu's arteritis and its evolution is badly known. The operative indications must not rest solely on the only anatomical balance, but based on a bundle of arguments in which, the assessment of the cerebral blood flow would be useful. Cerebral hyperperfusion syndrom constitutes a major risk that can be reduced by staged revascularisations.

[Bilateral congenital macrostomia]. / Macrostomie congénitale bilatérale.

INTRODUCTION: Congenital macrostomia, a transverse facial cleft, is a rare deformity of the mouth, which can occur alone or in association with other deformities. We report a case of congenital bilateral macrostomia. We discuss the difficulties of plastic surgery in this pathology. OBSERVATION: Congenital macrostomia in a one-year-old girl compromised feeding. The patient presented an isolated bilateral transverse facial cleft. Surgery associated a suture of the orbicularis oris muscle and a cutaneous W plasty. At twelve months, follow-up has been uneventful. DISCUSSION: Congenital macrostomia is most commonly associated with others anomalies. Many procedures are described regarding surgical correction of macrostomia. Reconstruction of the integrity of the oral sphincter associated with W plasty usually gives the best results.

[Hydrocarbon pneumonitis. A case report]. / Pneumopathie aux hydrocarbures. A propos d'un cas.

Hydrocarbon pneumonitis has become rare in industrialized countries. However, it remains one of the most frequent emergencies in African dispensaries, especially within children, by accidental ingestion. The case reported here is about a diesel aspiration after siphoning. As in most cases, the healing occurred without any complication.

[Bilateral carotid aneurysm revealing Takayasu disease]. / Anévrisme carotidien bilatéral révélant une maladie de Takayasu.

Extracranial carotid aneurysms caused by Takayasu's arteritis is extremely rare. Their evolutionary risk is dominated by rupture and cerebral ischemia. We report a case of a 23 years old woman presenting bilateral common carotid aneurysm secondary to Takayasu's arteritis. Surgical treatment with the patient under steroid coverage was performed to prevent the risque of rupture. The aneurysm was resected, reconstruction was performed with prothetic aortocarotid bypass. She was discharged without major complications. The graft have remanied patent during the four years follow-up periods. A biologic inflammatory syndrome and a parietal thickening of the aneurysm in a young woman must provoke diagnosis. The surgery must be appropriate every time that the diagnosis is carried considering the evolutionary risk of these aneurysms.