Coalescence of Macroscopic Flux Ropes at the Subsolar Magnetopause: Magnetospheric Multiscale Observations.

We report unambiguous in situ observation of the coalescence of macroscopic flux ropes by the magnetospheric multiscale (MMS) mission. Two coalescing flux ropes with sizes of ∼1 R_{E} were identified at the subsolar magnetopause by the occurrence of an asymmetric quadrupolar signature in the normal component of the magnetic field measured by the MMS spacecraft. An electron diffusion region (EDR) with a width of four local electron inertial lengths was embedded within the merging current sheet. The EDR was characterized by an intense parallel electric field, significant energy dissipation, and suprathermal electrons. Although the electrons were organized by a large guide field, the small observed electron pressure nongyrotropy may be sufficient to support a significant fraction of the parallel electric field within the EDR. Since the flux ropes are observed in the exhaust region, we suggest that secondary EDRs are formed further downstream of the primary reconnection line between the magnetosheath and magnetospheric fields.

Syndrome of inappropriate anti-diuresis induces volume-dependent hypercalciuria.

Hyponatremia is associated with bone demineralization. We hypothesized that, during hyponatremia, calciuria and calcium balance depend on volemic status. We evaluated calciuria in patients with hyponatremia, secondary to SIAD or hypovolemia. Patients with SIAD exhibited a volemic expansion that was associated with hypercalciuria. Calciuria was proportional to markers of volemia. INTRODUCTION: Chronic mild hyponatremia has been associated with bone demineralization of unknown mechanisms. During chronic hyponatremia, arginine-vasopressin secretion can result from hypovolemia or from syndrome of inappropriate anti-diuresis (SIAD) that leads to a slightly volemic expansion. Since volemia determines renal calcium excretion and balance, we evaluated calcium homeostasis in patients with chronic hyponatremia, related to SIAD or to hypovolemia. METHODS: We retrospectively included all patients referred to our Department between May 2006 and May 2014 for hyponatremia, resulting from SIAD or chronic hypovolemia. None had edema, cirrhosis, cardiac, or renal insufficiency. Exploration included estimation of volemia, extracellular fluid volume (ECFV) measurement with inulin, and calcium homeostasis. RESULTS: In total, the SIAD and hypovolemic groups included 22 and 7 patients, respectively. The SIAD group exhibited signs of increased volemia: higher glomerular filtration rate, higher fractional excretion of uric acid, and lower plasma renin. ECFV exceeded that of the hypovolemic group and was above usual values. There was no difference between the two groups regarding plasma calcium, PTH, and vitamin D. However, in the SIAD group, calciuria was higher than in the hypovolemic group, reaching levels of hypercalciuria. Furthermore, there was a positive correlation between calciuria and markers of volemia. CONCLUSIONS: Our results show that SIAD results in a volemic expansion tendency that is associated with a decrease in renal calcium reabsorption and thus hypercalciuria, whereas in the hypovolemic group, calciuria was not increased. Therefore, renal loss of calcium and bone demineralization in SIAD patients could be partly induced by volemic expansion.

[Fusarioses to Fusarium solani in an immunocompetent and immunocompromised diagnosed in military hospital of Rabat]. / Fusarioses superficielles à Fusarium solani chez un immunocompétent et un immunodéprimé diagnostiquées à l'Hôpital militaire de Rabat.

Fusarium are ubiquitous hyalohyphomycoses, usually encountered in the soil. They are the second unusual fungal pathogens after the Trichosporon. Intertrigo Fusarium sp. is a rare achievement. We report a case of intertrigos interorteils in an immunocompetent 45years old and a same case associated with a total onychodystrophy in an immunocompromised 75year-old. Laboratory diagnosis has found Fusarium solani confirmed with the positivity of a pure culture twice. Good progress was noted with terbinafine treatment. One or more aggravating factors must always be sought. These cases are in addition to cases increasingly frequent intertrigo due to Fusarium sp.

Compression of the peroneal nerve by a neurofibroma originating from collaterals of the peroneal nerve: a case report.

BACKGROUND: Paralysis of the external popliteal sciatic nerve is a frequent pathological condition that occurs after trauma. However, etiologies other than trauma, such as tumors, are also possible. The sensory collaterals of the external popliteal sciatic nerve have a small territory of innervation at the knee, and tumors involving these nerves become symptomatic after compression of the motor nerves. We here describe the first reported case of this phenomenon. CASE PRESENTATION: This case involved a lesion compressing the origin of the external popliteal sciatic nerve of a 13-year-old Moroccan boy diagnosed with a neurofibroma. He developed functional impairment of his left lower limb during a football game, and examination revealed a steppage gait. The initial diagnosis was stretching of the peroneal nerve. The definitive diagnosis of a neurofibroma was revealed by imaging and confirmed by surgery and pathology. Treatment involved total removal of the tumor; however, our patient's steppage gait persisted. CONCLUSIONS: Our patient developed compression of the external popliteal sciatic nerve from a tumor growing on a collateral nerve. Early diagnosis is an absolute necessity in such cases. Trauma and tumors of sensory nerves can distort the diagnosis, as in this case. Ultrasound and magnetic resonance imaging can contribute to an accurate diagnosis in patients with neuropathy in the absence trauma or tomacula.

Thyroid disorders during interferon alpha therapy in 625 patients with chronic hepatitis C: a prospective cohort study.

AIM: to report the prevalence, risk factors, management and long-term outcome of thyroid disorders caused by INFalpha in patients with chronic hepatitis C. PATIENTS AND METHODS: From January 1991 to December 2004, 625 patients with chronic hepatitis C underwent INFalpha therapy. TSH assay was normal and antithyroperoxidase antibodies (anti-TPO) was performed before onset antiviral treatment; then TSH was performed every 2 months in all patients during therapy, and every 3 months after treatment. RESULTS: 58 patients developed thyroid disorder (8.9%). Mean age was 50.6+/-13 years; sex ratio: 1 M/2 F; the anti-TPO antibodies were positive before onset antiviral treatment in 9 patients (13.8%). 26 patients developed hypothyroidism (44.8%), 9 patients developed hyperthyroidism (15.5%) and among them 3 cases of Grave's disease. Biphasic thyroiditis occurred in 21 patients (36.2%), anti-TPO increase during treatment in 2 patients (3.5%) without hypothyroidism. The dysthyroidism was more frequent in risk in female gender (p<0.05) and in the group with positive antiTPO antibodies before treatment (p<0.02). CONCLUSION: Female gender and positive antiTPO antibodies are the predictive factors of development of the thyroid dysfunction during INFalpha therapy.

Low rectal volumes in patients suffering from fecal incontinence: what does it mean?

BACKGROUND: Rectal perception and adaptation to distension are widely heterogeneous in subjects with faecal incontinence. AIM: To quantify rectal physiology in patients with incontinence and low maximum rectal volume, according to AGA guidelines on anorectal testing techniques. PATIENTS AND METHODS: 148 patients (12 men, 136 female) with incontinence to liquid and/or solid stools were investigated. Distending isobaric procedures were carried out using an electronic barostat in order to analyse perception and adaptation of the rectum. RESULTS: Pain during isovolumic rectal distension at a level of 100 mL or less was experienced in 21 subjects (14.2%). As defined by isobaric distensions, incontinent patients with low MTV had more frequently a hypocompliant rectum (62%) when compared with those with higher MTV (31%, P = 0.046). Perception scores tended to be higher at each step of distending rectal pressure: incontinent patients with low MTV had more frequently a hypersensitive rectum (48%) when compared with those with normal or high MTV (24%, P = 0.035). Only four of 21 incontinent subjects with low MTV had an isolated hypersensitive rectum. CONCLUSION: Both sensitivity and compliance are altered in patients with low MTV. A more extensive study of the role of sensory and compliance aspects of subjects with incontinence is warranted.

[Large ossifying fibroma of the jaws and hyperparathyroidism in a chronic hemodialyzed patient]. / Fibrome ossifiant géant des maxillaires et hyperparathyroïdisme chez un hémodialysé chronique.

OBJECTIVE: Describe the exceptional and fortuitous character of the association of ossifying fibroma and hyperparathyroidism in a chronic hemodialyzed patient. CASE REPORT: A twenty-year-old man who had undergone dialysis for ten years as the result of an indeterminate nephropathy was admitted for a functional disability in the standing position and a serious dysmorphic syndrome with swelling of the jaws that hindered proper closure of the mouth. RESULTS: Medical imagery revealed a polyostotic attack pleading in favor of renal osteodystrophy or a fibrous dysplasia. The surgical reduction of the tumor of the jaws shown, from the histological viewpoint, a large aggressive ossifying fibroma of the jaws. CONCLUSION: The association of ossifying fibroma and hyperparathyroidism in a chronic hemodialyzed patient is exceptional and fortuitous. The difficult treatment points out the need for early rigorous prevention of hyperparathyroidism in a chronic hemodialyzed patient.

[Inflammatory pseudotumor of the spleen]. / Pseudotumeur inflammatoire de la rate.

Inflammatory pseudotumor of the spleen is a very rare benign lesion of unknown etiology. Splenectomy is recommended to obtain histological diagnosis and to eliminate a malignant tumor.

[A rare cause of lower digestive tract bleeding: angiodysplasia of the small bowel]. / Une cause rare d'hémorragie digestive basse: l'angiodysplasie du grêle.

Angiodysplasia of the small bowel is an uncommon condition which causes lower digestive tract bleeding. The aim of this report was to clear up some of the particular problems and to stree the difficulty of diagnosis in low digestive bleeding. We report the case of a 34-year-old patient who had melena for ten years. Explorations performed, mostly endoscopy, had not given the diagnosis. Angiodysplasia was diagnosed on selective angiogram performed during a hemorrhagic episode. The literature emphasizes the difficulty of diagnosis. Selective angiography allows topographic diagnosis and simplifies surgical cure which should be as elective as possible with segmental enterectomy. Different studies on small bowel angiodysplasia have found the disease in both sexes at equivalent frequencies by age. Low digestive hemorrhage is a constant sign. Pathogenesis remains a question of debate: acquired or congenital histology shows an essentially submucosal vessel pastes ectasia. We emphasize the importance of selective angiography for exploring bleeding of the lower digestive tract of unknown cause.

[Ulcero-hemorrhagic rectocolitis: operative morbidity and mortality. Apropos of 100 cases]. / La recto-colite ulcéro-hémorragique morbidité et mortalité opératoires. A propos de 100 cas.

We performed a retrospective analysis of morbidity and mortality in 100 cases of ulcerative colitis treated at the surgical care unit of the Ibn Sina hospital over a 10 year period from 1984 to 1994. One major complication, usually infection, was observed in 40% of the cases. Overall mortality was 22%, a rate higher than the larger published series. The main factor incriminated in our study ; besides surgical circumstances, was the delay in care, including in the intensive care unit. It must be concluded that medical and surgical management must be initiated as soon as a flare up is diagnosed.

[Cancer of the gastric stump]. / Le cancer du moignon gastrique.

Among a series of 266 cases of gastric cancer operated on between 1981 and 1991, 8 cases were developed on gastric stump after gastro-duodenal surgery. A post operative delay of 10 years has been insisted upon. We note an exclusive masculine series. The main age was 61 years. Clinical aspects were univoque and treatment was always surgical with a resecability rate of 37%. Pathological analysis of operatory specimen and biopsies has shown everywhere an adenocarcinoma. The only way to improve the prognosis and to lay the live based on the yearly histoendoscopic supervision since the tenth year after initial intervention of these operated patients of the stomach with high neoplastic risk.

[Our experience of surgery for common bile duct lithiasis. Apropos of 370 cases]. / Notre expérience de la chirurgie de la lithiase de la voie biliaire principale. A propos de 370 observations.

We report a series of 370 common bile duct stones in which the diagnosis was made preoperatively in 56% of cases. We performed: choledochotomy with Kehr drainage in 70% of cases, biblio-intestinal anastomosis in 20%, transcystic extraction with drainage via the same route in 7%, surgical sphincterotomy in 2%. The global mortality was 2.7% related to preexisting deficiency states. The residual stone rate was 5.6%.

[For a conservative treatment of hydatid cyst of the spleen]. / Pour un traitement conservateur du kyste hydatique de la rate.

A retrospective study of 45 cases of spleen hydatic cyst. Operated on between January 1980, and December 1989 permitted the following commentary. Splenic hydatic cyst is characterized by its rarity and latency. It's diagnosis gives no rise to any problems. Echography data are essential in asymptomatic froms associated to other localisations. Surgical treatment can not be summarised to splenectomy; conservative methods are used as long as possible.

[Peritoneal echinococcosis. Diagnostic and therapeutic problems. Apropos of 34 cases]. / L'échinococcose péritonéale. Problèmes diagnostiques. et thérapeutiques. A propos de 34 cas.

By the light of retrospective study of a series of 34 cases of peritoneal echinococcosis the authors are reminding epidemiological, etiopathologenical, diagnostic difficulties and treatment of this endemic affection in their country. In their study they noted a frequency of 4.5%. With a female predominance (73.5%), the main age was 47 years 80% of the patients were noted to have a rural origin. The treatment was conservative for the primitive kyste as for the peritoneal locations. The post operative course was uneventful in 76% of cases and complicated in 24% (subphrenic abscess in 5 cases and cholerragy in 2 cases). They deplored 3 deaths the follow up was assured clinically; echographically and biologically; they have reoperated 9 relapses.

[Surgical treatment of primary hyperparathyroidism. Apropos of 11 cases]. / Traitement chirurgical de l'hyperparathyroïdie primaire. A propos de 11 cas.

Over a period of 10 years, 11 cases of primary hyperparathyroidism were operated on and identified as 7 adenomas and 4 hyperplasias. One post-operative death was noted in a 80 year woman with advanced disease. Three hypocalcemias and one temporary unilateral recurrent nerve plasy were observed. After the results of this series, various clinical forms were identified and surgical modalities were altered according to the intra operative findings.