Femoral tripod arteries: Surgical anatomic variants.

AIM: To describe the surgical anatomy of the femoral tripod arteries and their anatomical variants. MATERIALS AND METHODS: Patients who underwent vascular surgery by external arciform approach of the Scarpa between May 2022 and July 2022 were selected. The surgical anatomy was assessed by direct observation. The origin and the course of major branches of the femoral artery (FA) were studied. Diameters and the distance of the origin of the femoral profunda artery (FPA) from the midpoint of the inguinal ligament was measured in millimeters and recorded. The observed anatomical variations were photographed and compared to those in the literature. RESULTS: A total of 40 patients (34 men, 85%) were included. The median diameter of the common femoral artery (CFA) was 9mm (IQR: 7-12mm). The Modal bifurcation was noted in 95% of cases. The collateral branches of the CFA were found to be distributed as follows: the superficial circumflex iliac artery (SCIA) in 34 cases (85%), the superficial epigastric artery (SEA) in 22 cases (55%), the deep external pudic artery in 16 cases (40%), and the superficial external pudic artery in 18 cases (45%). The median diameter of the FPA was 5mm (IQR: 4-6mm). The FPA originated from the posterolateral side of the CFA in 90% of cases, from the posterior side in 5% of cases and from the medial side in 5% of cases. The median diameter of the SFA was 6mm (IQR: 4-9mm). CONCLUSION: The anatomic variants of the femoral tripod arteries are extremely frequent. Therefore, it is important to recognize the anatomy in order to avoid possible diagnostic errors and to minimize the risk of per and post procedural complications.

Familial lupus in Tunisia: a series of 14 families.

The relatively high prevalence of systemic lupus erythematosus (SLE) in familial cases supports genetic susceptibility to this disease. Although many advances have been made in the identification of new genes implicated in lupus pathogenesis, to date, there has been no large study of familial SLE. We report what we believe to be the first study of familial SLE in the North African population. The objectives of this study were to determine the main clinical and laboratory features of familial lupus and to compare them to sporadic lupus in a population of Tunisian patients. Fourteen families in which the diagnosis of lupus could be verified in at least two relatives were included in the study. All patients fulfilled four or more criteria defined by the American College of Rheumatology. Twenty-seven patients (23 females and 4 males) with familial SLE among a cohort of 253 SLE patients were found, resulting in a frequency of 10.67%. No significant differences were found between familial SLE cases and their controls in terms of sex ratio, mean age at onset and clinical and serological manifestations, which is consistent with the results of other series reported in the literature. Our results support the importance of carrying out more genetic studies within families of SLE in order to have a better understanding of the genetic and molecular mechanisms of the disease.

[Tocilizumab for refractory Takayasu arteritis with aortic aneurysm]. / Traitement par tocilizumab d'une artérite de Takayasu réfractaire avec anévrysme aortique.

Takayasu arteritis (TA) is a form of large vessel vasculitis (LVV) which affects the aorta and the main arteries. Many reports showed efficacy of biologic drugs (TNF α inhibitors and interleukin 6 inhibitors) in refractory TA cases. We report the case of a 46-year-old woman with refractory TA complicated by giant aortic aneurysm (AA) and severe hypertension, treated efficacy with tocilizumab (anti-interleukin 6 receptor monoclonal antibody).

[Rendu-Osler disease and recurrent thromboembolic venous disease]. / Maladie de Rendu-Osler et maladie veineuse thromboembolique récidivante.

Rendu-Osler-Weber syndrome is a rare systemic fibrovascular dysplasia, recognized by mucocutaneous telangiectasias, arteriovenous malformations, epistaxis and family history. Venous thromboembolic disease is a poor prognostic factor in this disease given the risk of increased bleeding caused by anticoagulant therapy. We report a new case of a 56-year-old patient with Osler disease who developed recurrent thromboembolic venous disease when anticoagulants were discontinued. According to a review of the literature, this association does not appear to be fortuitous and is a factor of disease severity.

Free-sodium salts mixture and AlgySalt® use as NaCl substitutes in fresh and cooked meat products intended for the hypertensive population.

This work aims at reducing the use of added NaCl in processed meat products because of its negative effects on hypertensive population by replacing it by sodium-free salts mixture (SM: KCl, MgCl2 and CaCl2) in fresh and cooked sausages. The technological, sensory, and microbiological effects of SM were compared with a commercial replacer based on seaweed extracts (AlgySalt®). A total substitution of NaCl with the latter and a partial one with SM (80% and 50%) were studied in cooked sausages and a total NaCl substitution with both substitutes was performed in fresh sausages. As a result, hardness increased in AlgySalt® reformulated samples, while it decreased when 80% SM were used. Whereas, AlgySalt® induced less cooking loses than SM. To some extent, microbiological counts showed a similarity between reformulated and control samples for both sausage types, whereas reformulated products containing SM revealed better sensory properties for both meat products. Therefore, using SM as NaCl replacer is adequate for processed meat products.

Effect of a probiotic Lactobacillus plantarum TN8 strain on trinitrobenzene sulphonic acid-induced colitis in rats.

This study aimed to investigate the potential effects of an oral treatment by a newly isolated probiotic Lactobacillus plantarum TN8 strain on trinitrobenzene sulphonic acid (TNBS)-induced colitis in Wistar rats. Thus, 18 rats were divided into three groups (n = 6 per group): group 1 (control) - rats not receiving TNBS application; group 2 - rats receiving an intrarectal TNBS infusion (100 mg/kg TNBS dissolved in ethanol); and group 3 - rats treated with intragastrical TN8 strain once per day (for 5 days before TNBS induction). The performance and the effects of the probiotic treatment were evaluated using a series of histological, biophysical and biochemical analyses. The results have shown that the treatment with the L. plantarum TN8 strain improves the body weight and reduces the diarrhoea, colonic mucosal inflammation and colon shortening. TN8-treated rats showed a significant decrease in the total cholesterol content from 1.86 (for group 2) to 1.32 mmol/l and in triglyceride (TG) content from 2.09 (for group 2) to 1.23 mmol/l. Furthermore, the findings revealed that the high-density lipoprotein (HDL) cholesterol contents increased from 0.95 to 1.02 mmol/l. The histological studies have confirmed that the architecture of the liver and kidney tissues of the TN8-treated rats were found to be improved. Overall, the results suggest that the L. plantarum TN8 presents promising perspectives for the development of safe and cost-effective agents for the prevention or alleviation of several intestinal pathologies.

Causes and outcome of hospitalisations in Tunisian patients with systemic lupus erythematosus.

OBJECTIVE: To describe the most common reasons of admission of Tunisian patients with systemic lupus erythematosus (SLE) and the outcomes of these hospitalisations. METHOD: The charts of patients with SLE who were hospitalised at our Department of Internal Medicine during a 2-year period from January 2011 to December 2012 were retrospectively reviewed, and the demographic characteristics, clinical and laboratory features, as well as all comorbidities, were collected. RESULTS: There were 128 episodes of hospitalisation of 87 patients with SLE. 25 patients (28.7%) were admitted twice or more. The median length of stay for all admissions was 11 days (2-76). The total number of days of hospitalisation was 1896 days, which represent 10.7% of the total number of days of hospitalisation in our department. The most common overall reason for hospitalisation was active SLE (55 events, 43%). In 29 patients, SLE was newly diagnosed during hospitalisation. Other causes of hospitalisation included assessment of the disease, infections (9.4%) and associated autoimmune disease (6.25%). Adverse drug reaction (3.1%) and thromboembolic events (1.25%) were uncommon causes of hospitalisations. There was a significant difference in length of stay between patients admitted with SLE flare and those admitted for non-SLE flare reasons (p<0.01). Four hospitalisations (3%) resulted in death. The principal cause of death was active SLE. CONCLUSIONS: Hospitalisation of patients with SLE is common in our department. Our study of this North African SLE population confirms the findings of previous studies suggesting that active SLE and infection remain the most common causes of hospitalisation of patients with SLE.

Bilateral ptosis as a presenting feature of primary hypertrophic osteoarthropathy (pachydermoperiostosis): a case report.

Pachydermoperiostosis is a rare hereditary disorder, which affects both bones and skin. It is characterized by a combination of dermatologic changes (pachydermia or thickening of the skin) and rheumatologic manifestations (periostosis and finger clubbing). Eyelid ptosis which is caused by thickened eyelids (blepharoptosis) is a less common symptom. We report the case of a patient with a complete form of pachydermoperiostosis with bilateral ptosis as presenting feature.

Efficient role of BacTN635 on the safety properties, sensory attributes, and texture profile of raw minced meat beef and chicken breast.

Bacteriocin BacTN635, produced by Lactobacillus plantarum sp. TN635, was purified and characterised in previous work. In this study we report the biotechnological application of this bacteriocin as a biopreservative during storage at 4°C of raw minced meat beef and chicken breast. Overall, the results obtained showed that the addition of the semi-purified BacTN635 at 500 or 1000 AU g(-1) in raw minced meat beef and chicken breast can delay the proliferation of spoilage microorganisms, suppress the growth of the pathogenic microorganism Listeria monocytogenes, improve sensory quality, texture attributes, and extend the shelf-life of these two meat products during refrigerated storage. BacTN635 at 1000 AU g(-1) could extend the shelf-life, and the meat showed good sensory characteristics. Therefore, treatment with semi-purified BacTN635 can be used as a safe method for preservation of raw minced meat beef and chicken breast.

[Risk factor for deep venous thrombosis in internal medicine: A retrospective study of 318 cases]. / Profil étiologiques des thromboses veineuses profondes en milieu de médecine interne : une étude rétrospective de 318 cas.

OBJECTIVE: Venous thromboembolic disease is a common condition. Deep vein thrombosis (DVT) and pulmonary embolism are the most common manifestation but other locations may also occur. The objectives of the study were to estimate the incidence and determine the epidemiologic, topographic and associated conditions of venous thromboembolic disease in a department of internal medicine. METHODS: A retrospective study of a series of 318 cases of DVT was conducted in Internal Medicine CHU Hedi Chaker, Sfax, during a period of 15 years (1996-2010). RESULTS: DVT of the lower limbs was the most common location (87%). Other sites of DVT was noted in 16.35% of cases including upper limbs (19 cases), vena cava (16 cases), cerebral veins (10 cases), portal vein (10 cases) and hepatic vein (3 cases). A risk factor of VTE was found in 274 patients (86.1%). A state of thrombophilia was retained in 203 patients (63.5%). It was a hereditary thrombophilia (22.6%), an antiphospholipids syndrome (19.1%), Behçet's disease (16.4%) and neoplasia (7.2%). The study of the distribution of venous thrombosis as the seat and etiology showed that: the antiphospholipid syndrome was the most associated conditions with the upper extremity DVT (31.7%) whereas Behçet's disease was the most frequent etiology of vena cava thrombosis (7 cases) and the cerebral vein thrombosis especially in young males.

Multiple cranial nerve palsy revealing hypertrophic pachymeningitis with positive myeloperoxidase-antineutrophil cytoplasmic antibody.

Pachymeningitis is a progressive disease resulting in a diffuse thickening of dura mater due to inflammation, tumor or autoimmune diseases, but most cases are idiopathic. Here, we report the case of a 60-year old man who had a progressive sensorineural hearing loss, visual disturbance and others cranial nerve involvement with an accompanying headache over several months. Brain magnetic resonance imaging showed diffusely thickened dura mater, highly enhanced after gadolinium administration, which was consistent with pachymeningitis. It was assumed to be related to autoimmune pathogenesis on the basis of elevated serum myeloperoxidase-antineutrophil cytoplasmic antibody titers. After empirical steroid and cyclophosphamide therapy, the neurological problems were partially improved. Therefore, in the case of atypical sensorineural hearing loss accompanied by cranial nerve palsy or headache, pachymeningitis should be considered in the differential diagnosis.

[Antisynthetase syndrome: a report of four cases and literature review]. / Le syndrome des antisynthétases : à propos de quatre observations et revue de la littérature.

The antisynthetase syndrome (ASS) includes inflammatory myopathy (polymyositis or dermatomyositis), interstitial lung disease (ILD), arthritis, Raynaud's phenomenon, and mechanic's hands, associated with antibodies against aminoacyl-tRNA-synthetases, the most well-recognized being the anti-Jo1 antibody (anti-histidyl-tRNAsynthetase). We report four cases of antisynthetase syndrome and review the clinical characteristics and prognosis factors dominated by ILD. We report the cases of four women with a mean age of 42 years (28-62 years). The interstitial lung disease was found in four cases and was objectified by CT-scan in all cases. The pulmonary symptoms were consisted of dyspnea (one case) and respiratory distress (one case). The anti-Jo1 antibodies were present in the four patients. The myopathy was concomitant with pulmonary involvement (two cases), preceded it in 6 months (one case) and in the course of evolution and after 1 month (one case). All patients received corticosteroid treatment. The immunosuppressive treatment was necessary for two patients because of the severity of the pulmonary involvement. The outcome was favorable in two patients, partially favorable in a patient who presented pulmonary fibrosis. However, one patient died after developing brain abscesses.

Computational laser spectroscopy in a biological tissue.

We present a numerical spectroscopic study of visible and infrared laser radiation in a biological tissue. We derive a solution of a general two-dimensional time dependent radiative transfer equation in a tissue-like medium. The used model is suitable for many situations especially when the external source is time-dependent or continuous. We use a control volume-discrete ordinate method associated with an implicit three-level second-order time differencing scheme. We consider a very thin rectangular biological-tissue-like medium submitted to a visible or a near infrared light sources. The RTE is solved for a set of different wavelength source. All sources are assumed to be monochromatic and collimated. The energetic fluence rate is computed at a set of detector points on the boundaries. According to the source type, we investigate either the steady-state or transient response of the medium. The used model is validated in the case of a heterogeneous tissue-like medium using referencing experimental results from the literature. Also, the developed model is used to study changes on transmitted light in a rat-liver tissue-like medium. Optical properties depend on the source wavelength and they are taken from the literature. In particular, light-transmission in the medium is studied for continuous wave and for short pulse.

A new view of a stationarity of the RR series for sinusal variability analysis.

The influence of ANS in sinusal variability is studied through analysis of RR series, and particularly RR interval variations during time. Different kinds of RR series signal analysis are applied to clinical situations found in cardiology. However, some of the RR series may be stationary as well as non-stationary. Statistical tests applied to the RR series will establish determinism and stationarity of these signals. The aim of this article is to characterize the statistical behaviour pattern of RR series in order to identify precautions that should be observed when time-frequency transform techniques are used in sinusal clinical investigations. Eight kinds of RR series concerning sinusal variability were submitted to the statistical tests. The results showed the uncertain character of the RR series and their non-stationarity. This result is consequently a warning against using several techniques of time-frequency transform for sinusal variability analysis. Some of the techniques studied are adapted to non-stationary signals under some conditions.