Interest of surgical vascular reconstructions aiming at preserving hemodialysis access.

BACKGROUND: Vascular hemodialysis access is a very precious asset for patients with end-stage renal failure. Ideally complications in these accesses should be detected early in order to treat them in time. The aim of this study was to evaluate the effectiveness of vascular reconstructions to preserve the vascular access for hemodialysis and to examine their benefits in terms of conserving the venous network, using hemodialysis catheters, time of cannulation after surgery, patency and postoperative morbi-mortality, by comparing them to those of newly created arterio-venous fistula (AVF). METHODS: This was a retrospective, descriptive and comparative study, performed from September 2012 to February 2015. It concerned patients operated for complications of their native AVF. Two groups were compared: reconstructed AVF (group 1) and newly created AVF (group 2). Demographic characteristics, comorbidities, preoperative clinical and paraclinical data, surgical techniques and outcomes were recorded. This data was analyzed and compared between the two groups. RESULTS: We collected 151 surgical interventions divided into two groups: 55 surgical reconstructions and 96 new AVF. The average age was 59.9±1.3 years [19.1-88.9], with a male predominance (59.6%). The two groups were comparable in terms of age, gender and comorbidities. Reconstructions were mostly indicated for stenosis (47.3%) and new vascular accesses for venous thrombosis (92.7%). Reconstruction had significantly better successful exploitation rates (95.7%) and time of cannulation (26.6 days) (respectively P=0.025 and P=0.000). Its primary failure rate was null. Its primary patency and primary functional patency were respectively 94.2% and 97.7% at 1 month and 82.2% and 87.1% at 2 years. Morbidity's global rates were comparable between both groups (41.8% vs. 43.8%). The rates of early morbidity and stenosis were significantly higher for reconstructions (respectively P=0.037 and P=0.047), while late morbidity and thrombosis' rates were significantly higher for new AVF (respectively P=0.021 and P=0.023). Mid-term permeabilities were better for reconstructions, but the differences were not statistically significant. CONCLUSION: Surgical reconstructions seem to be an effective alternative for the treatment of complicated AVF. Our results appear to be comparable to those of the literature. The benefits of these surgical techniques in terms of conserving venous network, use of hemodialysis catheters, time for cannulation after surgery, patency and postoperative morbi-mortality appear to be undeniable.

A novel large deletion in CCM1 gene in a Tunisian family.

Familial CCM is a rare entity associated with the mutation of three genes: CCM1 (KRIT1), CCM2 (MGC4607), and CCM3 (PDCD10). We report here the first description of a Tunisian familial CCMs composed of six members. The father and two daughters were affected and symptomatic. The two other kindred were healthy. Surgical treatment was performed in only one affected patient. Molecular analysis of KRIT1, MGC4607 and PDCD10 genes identified a large KRIT1 deletion of the first ten exons. To the best of our knowledge, this large deletion has never been reported before.

[Beneficial effect of preferred music on cognitive functions in minimally conscious state patients]. / Effets bénéfiques de la musique préférée sur les capacités cognitives des patients en état de conscience minimale.

Several studies have shown that music can boost cognitive functions in normal and brain-damaged subjects. A few studies have suggested a beneficial effect of music in patients with a disorder of consciousness but it is difficult to conclude since they did not use quantified measures and a control condition/group. The aim of the present study was to compare the effect of music to that of a continuous sound on the relational behavior of patients in a minimally conscious state (MCS). Behavioral responses of six MCS patients were evaluated using items from the Coma Recovery Scale-Revised. Weekly evaluation sessions were carried out, over four weeks, under two conditions: following the presentation of either the patient's preferred music, or following a continuous sound (control condition). Qualitative and quantitative analyses showed that twelve of the eighteen sessions (66.6%) showed a better result for the music condition than for the control condition. This new protocol suggests that preferred music has a beneficial effect on the cognitive abilities of MCS patients. The results further suggest that cerebral plasticity may be enhanced in autobiographical (emotional and familiar) contexts. These findings should now be further extended with an increased number of patients to further validate the hypothesis of the beneficial effect of music on cognitive recovery.

[Rosai-Dorfman disease: therapeutic issues in 2 cases]. / La maladie de Rosai - Dorfman : enjeux thérapeutiques à propos de 2 observations.

Rosai-Dorfman disease (RDD) is a benign lymphoproliferative disorder characterized by cervical lymph node enlargement with a consistent risk of airway compression and esthetic damage. Extranodal localizations are also described. There is no therapeutic consensus for pediatric forms of RDD. Through 2 pediatric cases with nodal involvement in 1 patient and a sinonasal and soft tissue localization in the other, we focus on the management problems of both nodal and extranodal RDD.

[Analysis of European pharmaceutical journal diffusion: the example of the principal French document supplier]. / Analyse de la circulation des périodiques pharmaceutiques européens: l'exemple du principal fournisseur français de documents.

Our purpose was to analyse the process of providing papers, edited by european pharmaceutical journals, by the main French document supplier, "Institut National de l'Information Scientifique et Technique" linked to the "Centre National de la Recherche Scientifique" (INIST-CNRS). After having given a definition and built up a corpus of 289 journals, orders about them during 1996-1998 were analysed. Then, the possible relationships between orders to INIST-CNRS and impact of journals on scientific community (from Institute for Scientific Information (ISI) data) were examined. Finally, relationships between document orders to INIST-CNRS and, on the one hand european pharmaceutical journals indexation in bibliographic databases and, on the other hand their possible indexation in the French National Collective Catalogue were studied.

[Contraception with Depo-Provera. Report of a series of 930 women]. / Contraception par Dépo-Provéra. A Propos d'une serie de 930 femmes.

In this study, Dépo-Provéra was evaluated in 930 women. It is a retrospective longitudinal bicentric study: We revealed the following results: The average age is 30.8 years. 66.6% the women have between 1 and 3 children. The nulliparous represent 17%. In 84.3%, it is the first used contraceptive method. The first injection was done in the post abortion in 65.3% of the cases. Pearl index is 0.46. Thus, the efficacy level is 99.54%. Amenorrhea is the most frequent trouble; its incidence within a year is 52.3%. It the first cause of abandon. The other troubles of the cycle disappear within 12 months. The acceptability is 34.8% year women.

[Lipoma of the corpus callosum. 3 case reports and review of the literature]. / Lipome du corps calleux. A propos de trois cas et revue de la littérature.

Lipoma of the corpus callosum is a rare congenital intracranial tumor. Although only 153 cases had been reported as of March 1992, the incidence of this tumor is underestimated (some cases are unpublished and others are asymptomatic). Three cases of lipoma of the corpus callosum diagnosed in children are reported herein. These tumors may be either discovered fortuitously in an asymptomatic patient or responsible for manifestations of which the most common are seizures, headache, and mental disorders. Diagnosis rests on imaging techniques. The main investigation is computed tomography which discloses a mass composed of fat, with or without peripheral calcifications, and also identifies any other malformations such as dysgenesis of the corpus callosum.

[Cerebral miliary tuberculosis. Apropos of 5 cases and review of the literature]. / Miliaire tuberculeuse cérébrale. A propos de 5 cas et revue de la littérature.

The authors report 5 cases of cerebral miliary tuberculosis studied by computerized tomography and review 5 cases of the literature. Computerized tomography can see very small tuberculomas, of several millimeters. Chest miliary tuberculosis is found in all their cases, and 3 of the 5 cases of the other authors. Because of the discretion of neurological signs and the association with chest miliary, we suggest to make a computed tomography of brain of all patients who have chest miliary tuberculosis despite the absence of neurological signs and we think that we will find out other cases of brain miliary tuberculosis.

[Cutaneous-mucosal hyalinosis with cerebral sites. 3 new cases]. / Hyalinose cutanéo-muqueuse avec localisations cérébrales. Trois nouveaux cas.

The authors report about 3 new cases of cutaneous-mucosal hyalinosis, or Urbach-Wiethe disease, with cerebral sites. The intracranial calcifications were detected without any neurological presenting features, and were discovered incidentally on radiographs of the skull. The CT examination allows specifying the site of these calcifications, in the gyri of the hippocampus.

Ureteral valves: report of a case diagnosed by antegrade pyelography.

Ureteral valves are an uncommon cause of upper urinary tract obstruction. The majority of cases are discovered only at surgery or autopsy. We report a case diagnosed by antegrade pyelography under sonographic guidance and we review the literature.

[Cavitary tumor lesions of the small intestine. Radio-ultrasonic diagnosis. Apropos of 4 cases]. / Les lésions tumorales cavitaires du grêle. Diagnostic radio-échographique. A propos de 4 observations.

Excavated lesions of small intestine are rare and generally of a malignant nature, the must frequent cause being metastases. In Tunisia these lesions are usually the aneurysmal type of lymphoma. The etiology in a series of four cases of excavated lesion of small intestine was not always lymphomatous. Radiologic and ultrasound semeiology are outlined and etiologies discussed. Scan images are not available since whole-body scanners are not in use in Tunisia.