Les corps etrangers tracheobronchiques a propos de 107 cas

Introduction : L'inhalation du corps etranger (Ce) est un accident domestique grave survenant surtout chez le petit enfant et peut occasionner une detresse respiratoire aigue necessitant une prise en charge therapeutique urgente. Le but de notre travail est d'analyser les aspects cliniques et therapeutique des Ce tracheo-bronchiques vus en urgence. Patients et methode ; etude retrospective regroupant 107 enfants ages de moins de 15 ans; presentant une symptomatologie respiratoire aigue (= 3 jours); admis au service d'OrL; CHU Farhat Hached Sousse; pour bronchoscopie rigide devant la suspicion d'inhalation d'un Ce; entre janvier 2000 et Decembre 2011. Resultats : nous avons retrouve en moyenne 9 cas de Ce par an. L'age moyen de nos patients etait de 30 mois avec des extremes allant de 6 mois a 15 ans. Parmi ces enfants; 70 avaient un age compris entre 1 et 3 ans. Le syndrome de penetration a ete retrouve dans 77;6 des cas. Le symptome le plus frequent etait une toux dans 74;8 des cas. Deux patients ont presente un etat d'asphyxie aigue. La diminution du murmure vesiculaire a ete retrouvee dans 39;2 des cas. L'examen clinique et la radiographie pulmonaire etaient normaux dans 24;3 des cas. Un Ce radio-opaque a ete retrouve dans 5 cas. L'emphyseme obstructif unilateral a ete retrouve dans 39;2 des cas. Les grains de tournesol etaient les plus frequents; notes dans 26;2 des cas; suivis par les cacahuetes dans 15 des cas. Le Ce etait bronchique dans la majorite des cas avec une predominance du cote droit; 62;6 contre 33;7 du cote gauche. La bronchoscopie rigide a ete pratiquee pour l'extraction des Ce chez tous nos patients. Il n'y avait pas de deces dans notre serie. Conclusion : L'inhalation d'un Ce chez l'enfant est une pathologie grave qui engage le pronostic vital. Il faut l'evoquer devant meme des anomalies non specifiques et une endoscopie bronchique doit etre faite au moindre doute

Pott's puffy tumor. A case report.

Pott's puffy tumor is an infrequent entity characterized by a subperiosteal abscess associated with frontal bone osteomyelitis. It is usually seen as a complication of frontal sinusitis. This common condition is usually not diagnosed initially and is easily confused with neoplasms, skin and soft-tissue infection, and infected haematoma. Although Pott's puffy tumor is more commonly described in children, it should also be included in the differential diagnosis of swelling on the forehead in adults. This report describes the case of a 25-year-old man with Pott's puffy tumor resulting from frontal sinusitis, complicated by frontal brain abscess, and a subdural empyema. It was successfully treated with abscess drainage and prolonged use of antibiotics. To the best of our knowledge, only 13 cases of Pott's puffy tumor have been previously reported in adults. Particularities of this disease are reported here.

Unusual nucleotide conformations in GNRA and UNCG type tetraloop hairpins: evidence from Raman markers assignments.

High resolution NMR data on UNCG and GNRA tetraloops (where N is any of the four nucleotides and R is a purine) have shown that they contain ribonucleosides with unusual 2'-endo/anti and 3'-endo/syn conformations, in addition to the 3'-endo/anti ones which are regularly encountered in RNA chains. In the current study, Raman spectroscopy has been used to probe these nucleoside conformations and follow the order (hairpin) to disorder (random chain) structural transitions in aqueous phase in the 5-80 degreesC temperature range. Spectral evolution of GCAA and GAAA tetraloops, as formed in very short hairpins with only three G.C base pairs in their stems (T m >60 degreesC), are reported and compared with those previously published on UUCG and UACG tetraloops, for which the syn orientation of the terminal guanine as well as the 2'-endo/anti conformation of the third rC residue have been confirmed by means of vibrational marker bands. Raman data obtained as a function of temperature show that the first uracil in the UUCG tetraloop is stacked and the two middle residues (rU and rC) are in the 2'-endo/anti conformation, in agreement with the previously published NMR results. As far as the new data concerning the GNRA type tetraloops are concerned, they lead us to conclude that: (i) in both cases (GCAA and GAAA tetraloops) the adenine bases are stacked; (ii) the second rC residue in the GCAA tetraloop has a 3'-endo/anti conformation; (iii) the sugar pucker associated with the third rA residue in both tetraloops possibly undergoes a 3'-endo/2'-endo interconversion as predicted by NMR results; (iv) the stem adopts a regular A-form structure; (v) all other nucleosides of these two GNRA tetraloops possess the usual 3'-endo/anti conformation.

Structural features of the UCCG and UGCG tetraloops in very short hairpins as evidenced by optical spectroscopy.

Structures of the UCCG and UGCG tetraloops formed in octamer ribonucleotidic hairpin sequences, i.e., 5'-r[GC(UCCG)GC]-3' and 5'-r[GC(UGCG)GC]-3', have been studied in aqueous solution by methods of optical spectroscopy. UV absorption melting profiles of these short hairpins, containing only two closing GC base pairs in the stem, are consistent with a monophasic, completely reversible order-to-disorder transition and clearly confirm their unusual structural stability (with Tm congruent with 50 degrees C). To establish structural characteristics of these tetraloops, Raman and FTIR spectroscopies have been used and vibrational conformation markers arising from the phosphate backbone and various nucleosides have been analyzed. They have been assigned on the basis of known unambiguous vibrational markers established for DNA and RNA chains. Surprisingly, they are easily transferable to short oligonucleotidic sequences. Intensities and wavenumbers of these conformation markers have been monitored in the 0-70 degrees C temperature range, i.e., in going from an ordered to a disordered structure. The main structural features of the UCCG and UGCG tetraloops are similar to those previously found in the UUCG and UACG tetraloops by means of NMR and vibrational spectroscopies, except those of the second nucleosides of the tetraloops (rC and rG, respectively) which adopt a 3'-endo/anti rather than a 2'-endo/anti conformation.

Common structural features of UUCG and UACG tetraloops in very short hairpins determined by UV absorption, Raman, IR and NMR spectroscopies.

Thermodynamic and structural properties of two UNCG tetraloops in very short hairpin octamers, 5'-r(GCUUCGGC)-3' and 5'-r(GCUACGGC)-3', have been studied by means of various physical techniques. Melting profiles of both octamers, obtained from UV absorption spectra taken as a function of temperature, are consistent with a monophasic, progressive and completely reversible order-to-disorder transition and confirm their unusual structural stability (Tm > 51 degrees C). The 1H, 13C and 31P NMR chemical shifts and coupling constants of the UACG loop nucleotides are comparable with those reported previously for UUCG loops, i.e. 2'-endo/anti conformation of the second and third nucleotide of the loop as well as the syn orientation of the ultimate guanine base and the A-type double helical conformation of the hairpin stem. Simulation of quantitative NOESY volumes shows that the UACG octamer adopts a very rigid compact structure which is well represented by an average order parameter of 0.9. Three base-pairs and four additional strong hydrogen bonds are undoubtedly responsible for such limited flexibility. Raman and infrared spectra as a function of temperature reflect the order-to-disorder transition, as well. Vibrational conformational markers in low temperature spectra of both octamers indicate the hairpin structure as the major conformer in aqueous phase. These spectra further support the structural features of most of the nucleotides involved in the tetraloops and clearly demonstrate the structural similarities of the phosphodiester backbone in both hairpins. Consequently, on the basis of all present results, one can deduce that the conformational features of the UUCG and UACG tetraloops seem to be inherent to the UNCG type tetraloops, regardless of either the nature of the tetraloop second base or the stem length.