Forensic aspects of trauma to the male external genitalia (TMEG), analysis of a series of 84 cases.

Objectives: Describe the medico-legal aspects of trauma to the male external genitalia by specifying their epidemiological, clinical, paraclinical, therapeutic and evolutionary characteristics. Materials and methods: Retrospective study spread over a period of 3 years (2017-2019) concerning adult patients with trauma to the male external genitalia consulting in the surgical emergency and forensic medicine departments of the Ibn Rochd University Hospital Center in Casablanca. Results: We collected 84 cases of TMEG within the framework of evaluation of bodily injury aimed at fixing the duration of Total Temporary Incapacity (TTI) and the rate of Permanent Partial Incapacity (PPI). There was a predominance of bursa trauma (85.7%) followed by penis trauma (14.5%). The average age of the patients was 39 years (17-61 years). Road accidents are the cause of 42% of cases. Regarding bursa trauma, the clinical symptomatology was dominated by pain (100%) and increased scrotal volume (50%). Scrotal ultrasound found the main lesion to be scrotal hematomas (35.71%) followed by ruptures of the tunica albuginea (9.5%). Surgical exploration was indicated in 45.23% of cases, of which (38%) was conservative treatment.For trauma to the penis, the clinical examination revealed 1 case of fracture of the cavernous body, a hematoma of the penis in only 1 patient, a superficial wound of the penis in 1 patient and the rest of the patients (9 cases) showed no lesions. Surgical treatment was indicated in only one patient. The average duration of temporary total incapacity was 17.5 days and the average rate of partial permanent incapacity was 4%. Conclusion: Physicians who are experts in the evaluation of bodily injury are frequently confronted with the evaluation of the damage resulting from the TMEG. The medico-legal evaluation of these traumas remains difficult and very varied requiring a perfect knowledge of the mechanisms of these traumas, of the therapeutic and evolutionary principles helping in the judicial decision.

Obstructive oligo-anuria revealing pelvic gynecological cancers, analysis of a series of 102 cases.

INTRODUCTION: Obstructive Anuria (OA) constitutes a diagnostic and therapeutic emergency involving the vital prognosis of the patient requiring an emergency and multidisciplinary care. The etiologies are multiple and the pelvic gynecological cancers represent one of the main causes of OA. OBJECTIVES: Describing the epidemiological, clinical, paraclinical, etiological, therapeutic and progressive aspects of obstructive anuria of the gynecological origin, in the urology department in the University Hospital Center. MATERIALS AND METHODS: This is a descriptive and retrospective study spread over a period of 4 years (2016-2019) including all the patients admitted for management of OA secondary to the pelvic gynecological cancers. RESULTS: 102 patients were included in the study whose the mean age was 60 years old (36-84). The main etiologies were cervical cancer (93%), followed by endometrial cancer (5%) and ovarian cancer (2%). The mean time to consultation was 4.5 days (1-8). The main circumstances of discovery were anuria (67%), oligoanuria (21.5%), low back pain (17%) and hematuria (9%). Clinical examination found an altered general condition (Performans Status> 2) in 37.5% of the patients and an advanced local state in 96% of the patients. The means of serum creatinine and blood urea were 122 mg/l and 2.4 g/l respectively. The hemodialysis (HD) was indicated in 29.5% of patients with life-threatening hyperkalemia (Kalemia> 6.4meq/l) with cardiac distress (20.5%), hydro-sodium overload (6%) and metabolic acidosis (3%). The ultrasound-guided percutaneous nephrostomy was the main method of diversion (92%) followed by the placement of the double J stent (8%). The outcome was favorable in the majority of patients with normalization of the kidney function (88%) while 7% of cases kept chronic kidney disease. The main complication was an obstruction syndrome (41%), followed by infections of the percutaneous nephrostomy tubes (13%) and venous thrombosis of the lower limbs (3%). In addition, the mortality was estimated at 5%. CONCLUSION: The obstructive anuria constitutes a medico-surgical emergency involving the patient's vital prognosis. Our study notes the frequent association between the pelvic gynecological tumors and the obstructive anuria, which can be explained by the advanced stage of these tumors. This work underlines the fundamental interest of early diagnosis of these tumors to enable the prevention of the OA.

Acute orchiepididymitis: Epidemiological and clinical aspects: An analysis of 152 cases.

INTRODUCTION: Orchiepididymitis is an inflammation of the testis and epididymis. Epididymitis, orchitis, and true orchiepididymitis are all examples of orchiepididymites. They are the most frequent cause of adult acute scrotal pain. OBJECTIVES: to investigate the epidemiological, clinical, paraclinical, therapeutic, and evolutionary characteristics of acute orchiepididymitis in the urology department of University Hospital Center. MATERIALS AND METHODS: This is a three-year retrospective, descriptive study of 152 patients who consulted the urology department at the university hospital center for treatment of orchiepididymitis (2017-2019). RESULTS: In our study, 152 patients were included. The average age was 49,5 years (17-82 years). The average of consultation delay was 7 days. Prostatic pathology was found to be the main medical antecedent in 18.5% of patients, and transurethral resection of the prostate was found to be the main surgical antecedent in 8.5% of cases. Clinical examination revealed that the predominant clinical symptom was painful inflammatory bursa in 94% of cases, followed by lower urinary tract disorders in 57.5% of cases, and fever in 10% of cases.A germ was isolated in 26 cases after a systematic cytobacteriological examination of the urine (CBEU) (17%). All patients received medical treatment, and 21% of them were received urgical treatment. In 84.5% of cases, the outcome was favorable. CONCLUSION: Acute orchiépididymitis is a common cause for a consultation to the emergency room. Diagnosis is based on clinical examination and ultrasound. Because of the frequency of complications and sequelae that might influence fertility in the long term, it is a diagnostic and therapeutic emergence.

Investigate the Presence of HBV Surface Antigen in Pregnant Women, Cairo City in Egypt.

Hepatitis means inflammation of the liver, and hepatitis B is a common and dangerous liver disease caused by the Hepatitis B Virus (HBV) of the DNA hepadnavirus family. In 2010, the World Health Organization (WHO) considered hepatitis B infection a major health problem worldwide. One way of transmitting this disease is a transmission from a carrier mother to a child. This study aimed to investigate the presence of HBV surface antigen in pregnant women referred to Kasra Al-Aini Hospital in Cairo. This study was a cross-sectional descriptive study that was performed on pregnant women. One thousand pregnant women were selected with their consent to participate in this study, and after preparing a blood sample, an Enzyme-linked Immunosorbent Assay kit, used for Hepatitis B Virus surface antigen detection, a questionnaire containing questions about socio-individual characteristics. Among 1000 samples, 13 samples were equal to 1.3% had HBsAg positive. No significant relationship was found between the prevalence of HBs Ag in the city and rural location, education, occupation, age, and history of abortion in pregnant women. History of dialysis in pregnant women, tattooing, and type of job of the pregnant woman was not considered risk factors. However, injection drug users, history of previous surgery, and blood transfusion can be considered suspicious factors (P≤0.05). The prevalence of hepatitis B infection in pregnant women in Cairo was 1.3, which is lower than the study statistics in most parts of the world. However, to evaluate this amount more accurately, there is a need to conduct a study with a higher sample size.

[The role of electromagnetic navigation bronchoscopy in the diagnosis of peripheral pulmonary lesions]. / Place de la navigation électromagnétique endobronchique pour le diagnostic de lésions pulmonaires périphériques.

INTRODUCTION: Electromagnetic navigation bronchoscopy (ENB) is a recent, minimally invasive procedure utilized to guide endoscopic diagnostic tools to peripheral pulmonary nodules. The place of this technology among other diagnostic procedures remains uncertain. METHOD: We analyzed our 30 first months of ENB used in the diagnosis of 106 lesions in 101 patients, from June 2016 to December 2018. Follow-up and final diagnosis was completed for 95 lesions (90%). RESULTS: ENB was performed for 3.5% of all patients referred for abnormal findings on pulmonary imaging, and represented 19% of second line procedures for peripheral pulmonary lesions. Procedures were performed under general anesthesia, with a mean duration of 35min. The sensitivity of ENB was 64% (95%CI: 52-74%) for lesions with a mean diameter of 21mm, with an improvement over time (sensitivity 69% in the last 18 months). The presence of a bronchus within the lesion (bronchus sign) was associated with an increased sensitivity of 74%. Pneumothorax occurred in 5 patients (5%) of which 4 required drainage. There was no hemoptysis, and no death related to the procedure. CONCLUSION: ENB is a minimally invasive procedure reaching acceptable sensitivity in the most difficult patients. ENB can be recommended for the diagnosis of peripheral pulmonary nodules when no other procedure is successful or possible. Its use as a first choice procedure is, for the moment, limited by the cost, but must be weighed against that of non-diagnostic procedures, and the cost of complications of trans-thoracic lung biopsies.

[Choroid metastases revealing pulmonary adenocarcioma resolved with chemotherapy]. / Métastases choroïdiennes révélatrices d'un adénocarcinome bronchique et involuant sous chimiothérapie.

Lung cancer is the leading cause of choroidal metastasis in men, but choroidal metastasis is rarely inaugural. With the advent of new generations of chemotherapy molecules non-small-cell lung cancer (NSCLC) has become more chemosensitive. Choroidal metastasis may respond to chemotherapy. We report a case of a 52-year-old men who developed choroidal metastasis revealing pulmonary adenocarcinoma confirmed by the bronchial biopsy. Systemic chemotherapy using gemcitabine-cisplatin led to total involution of the choroidal metastasis with improvement of the visual acuity in one eye and stabilization in the other. Systematic search for lung cancer is required in patients presenting choroidal metastasis. If compatible with the patient's general status, histologically-adapted chemotherapy must be instituted. This approach can avoid the use of radiotherapy and therefore deterioration of visual acuity after radiation.

Tissue distribution and processing of proSAAS by proprotein convertases.

The conversion of inactive precursor proteins into bioactive neuropeptides and peptide hormones involves regulated secretory proteins such as prohormone convertases PC1 and PC2. The neuroendocrine protein 7B2 represents a specific binding protein for PC2, and the protein proSAAS, which interacts with PC1, exhibits certain structural and functional homologies with 7B2. With the intention of better understanding the physiological role of proSAAS and its derived peptides, we investigated its tissue localization using a new radioimmunoassay (RIA) to a C-terminal proSAAS-derived peptide. Immunoreactivity corresponding to this SAAS-derived peptide is mostly localized to the brain and gut. Analysis of the brain distribution of the proSAAS-derived peptides indicates that the hypothalamus and pituitary are the two richest areas, consistent with the previously described high expression of PC1 in these two areas. In order to investigate the cleavage of proSAAS by prohormone convertases, we incubated recombinant His-tagged proSAAS with recombinant mouse proPC2 or furin, separated the cleavage products using high-pressure gel permeation chromatography and analyzed the products by RIA. Our results indicate that either PC2 or furin can accomplish in vitro rapid removal and efficient internal processing of the C-terminal peptide, exposing the inhibitory hexapeptide to possible further digestion by carboxypeptidases. Finally, we also studied proSAAS processing in the brains of wild-type and PC2 null mice and found that proSAAS is efficiently processed in vivo. Whereas the C-terminal peptide is mostly internally cleaved in wild-type mouse brain, it is not processed as efficiently in the brain of PC2 null mice, suggesting that PC2 is partially responsible for this cleavage in vivo.

Action of polygodial on agonist-induced contractions of the rat portal vein in vitro.

This study investigated the vasorelaxant action of the sesquiterpene polygodial, isolated from the bark of Drymis winteri, on rat portal vein in vitro, contracted by various agonists. Polygodial (21-342 microM) preincubated 20 min before, produced graded antagonism of the contractile responses caused by bradykinin, endothelin-1, noradrenaline, the stable analogue of thromboxane A2 U46619, substance P, neurokinin B, and senktide (an NK3-selective agonist). Polygodial, at the same concentration, also produced graded inhibition of the contractile response induced by potassium chloride and by phorbol ester. At the median inhibitory concentration (IC50) level, polygodial was approximately 114- to 177-fold more active in inhibiting mediated contractions to senktide and phorbol ester. When assessed in the tonic contraction induced by endothelin-1 (0.5 nM) or by phorbol (3 microM), polygodial (0.1-100 microM) produced concentration-dependent relaxation, with maximal inhibition (E(max)) of 62 +/- 2% and 100%, respectively. Finally, polygodial (0.1-100 microM) inhibited the rhythmic spontaneous contractions of the rat portal vein (E(max) of 75 +/- 2%). Taken together, these results suggest that the vasorelaxant actions caused by polygodial in rat portal vein are, at least in part, associated with inhibition of calcium influx through voltage-sensitive channels and interaction with protein kinase C-dependent mechanisms. In addition, these data confirm and extend our previous suggestion that polygodial preferentially antagonizes tachykinin-mediated contraction, especially the NK3-mediated responses.

In vitro effect of the extract and the 1,7-dihydroxy-2,3-dimethoxy xanthone from Polygala cyparissias on the contractions induced by inflammatory mediators and ovalbumin in normal and actively sensitised trachea from guinea pig.

OBJECTIVE: This study describes the in vitro action of the hydroalcoholic extract and the 1,7-dihydroxy-2,3-dimethoxy xanthone isolated from P. cyparissias on agonist and ovalbumin induced contractions in trachea, from normal and actively sensitised guinea pigs. RESULTS: The hydroalcoholic extract of P. cyparissias (0.125 to 1 mg/ml), incubated with the guinea-pig trachea for 20 min, had no effect on the resting tone of the preparations, but caused a concentration-dependent, reversible and non competitive inhibition of contractions induced by acetylcholine, histamine, compound 48/80, bradykinin, substance P, prostaglandin E2 and the stable analogue of thromboxane A2 mimetic U 46619. The calculated mean IC50 values for the hydroalcoholic extract were: 0.37, 0.51, 0.06, 0.32, 0.48, 0.3 and 0.17 mg/ml, respectively. Also, the extract of P. cyparissias (0.125 to 0.5 mg/ml) antagonised, in a graded manner (IC50 of 0.46 mg/ml) ovalbumin-induced contractions in guinea-pig trachea obtained from animals which had been actively sensitised to this antigen. Pre-incubation of the preparations with the purifed xanthone isolated from P. cyparssias (2.5 to 80 microg/ml; 10.0 to 310.0 microM) caused significant and concentration-dependent, reversible and noncompetitive inhibition of the contractile responses elicited by acetylcholine, histamine, bradykinin, substance P, U 46619 and prostaglandin E2. The calculated mean IC50 values for these effects were: 132.0, 73.0, 9.2, 32.0, 110.6 and 66.0 microM, respectively. At very high concentrations (I55.0-620.0 microM) the xanthone also antagonised contraction induced by KCl in guinea-pig trachea (IC50 of 190.0 microM). CONCLUSIONS: Taken together these and our previous in vivo results are consistent with the view that the active principles present in P. cyparissias, including the 1,7-dihydroxy-2,3-dimethoxy xanthone, antagonise, in a non competitive but, reversible manner the contractions induced by chemical inflammatory mediators in the guinea pig trachea in vitro. Thus, these results might explain at least in part, the medicinal use of this plant in the management of inflammation, asthma and allergy.

Action of polygodial, a sesquiterpene isolated from Drymis winteri, in the guinea-pig ileum and trachea 'in vitro'.

This study describes the action of the sesquiterpene polygodial, the major constituent isolated from the bark of Drymis winteri in the guinea pig ileum and trachea in vitro. Polygodial (5 to 128 microM), added for 20 min, did not affect the resting tone of the preparations, but caused graded inhibition, associated in some cases with rightward displacement of the acetylcholine, histamine (1 nM to 10 microM), bradykinin (0.1 nM to 1 microM) and KCl (1 to 100 mM)-contraction response curves. When assessed in the guinea-pig trachea, polygodial (5 to 342 microM) caused significant inhibition of bradykinin (10 pM to 1 microM), 9,11-dideoxy-9alpha,11alpha-methano-epoxy prostaglandin F2alpha (0.1 to 1000 nM) and KCl (1 to 100 mM)-induced contractions, although the action against bradykinin was not concentration-dependent. Polygodial (5 to 80 microM) caused a small but significant shift to the right of substance P and also the selective agonist of tachykinin NK2 receptor [beta-Ala8]neurokinin A-(4-10)-induced contractions in guinea pig trachea. This action of polygodial seems to be quite selective towards tachykinin NK2 receptors since up to 432 microM, polygodial had no effect against contraction caused by tachykinin NK1 receptor agonist, substance P methyl ester. When tested in the guinea-pig trachea from animals which had been actively sensitised to ovalbumin, polygodial (30 to 40 microM) caused time and concentration-dependent inhibition of ovalbumin-mediated contraction. In addition, polygodial (85 to 342 microM) inhibited contraction induced by compound 48/80 (1 to 1000 microg/ml), in the guinea-pig trachea from non-sensitised animals. These findings and those from our previous study are consistent with the notion that the main sesquiterpene polygodial isolated from the bark of D. winteri is responsible for most, if not all, of the relevant pharmacological action reported previously for the extract of this plant. Thus, polygodial could be of potential value in the development of a new drug for the treatment of asthma, allergy and other inflammatory processes.

Action of the extract of Drymis winteri on contraction induced by inflammatory mediators, compound 48/80 and ovalbumin of the guinea-pig trachea in vitro.

1. We examined the effect of hydroalcoholic extract (HE), obtained from the barks of Drymis winteri J.R. et Forster (Winteraceae), against contraction caused by several mediators involved in asthma and allergy, and also that caused by ovalbumin and compound 48/80 in guinea-pig trachea. 2. HE (0.5-2 mg/ml) added to the bath 20 min earlier antagonized the contractions elicited by bradykinin, prostaglandin E2 and capsaicin in a concentration-dependent and noncompetitive manner. 3. HE antagonized, in a graded but apparently competitive fashion, contractions induced by substance P, [beta-ala8]neurokinin A-(4-10), a selective NK2 agonist, and the stable analog of thromboxane A2 (U 46619). However, HE had only a slight effect against contractions induced by histamine and had no effect against responses induced by acetylcholine and the selective NK1 agonist, substance P-methylester. 4. In guinea-pig trachea (GPT) from animals that had been previously sensitized actively to ovalbumin, HE antagonized ovalbumin-mediated contraction in a time- and concentration-dependent manner. In addition, HE caused graded displacement to the right of contraction evoked by compound 48/ 80 in GPT from nonsensitized animals. 5. It is concluded that HE contains active principle(s) which interact via distinct mechanisms with several mediators known to participate in asthma and allergy. Furthermore, HE concentration dependently attenuated ovalbumin and compound 48/80-mediated contractions in GPT from sensitized and nonsensitized animals, respectively.