[Chest wall tuberculosis: report of 3 cases]. / Tuberculose de la paroi thoracique: à propos de trois cas.

Despite the dramatic decline in the incidence of tuberculosis during the last decades, the disease remains a significant public health problem especially in developing countries. Chest wall tuberculosis is a very rare location. Clinically, it can present as a pyogenic abscess or soft tumor, making diagnosis difficult, particularly in the absence of warning signs. Optimal therapeutic management is controversial. Medical treatment alone in often insufficient and must be associated with a surgical excision or debridement.

A solitary fibrous tumor of the pleura revealed by hiccups.

Solitary fibrous tumors of the pleura are rare and benign primary localized tumors; they possess a malignant potential and thus should be excised. We report a case of a 43-year-old woman, who had suffered for 5 years from right basithoracic pain associated with progressive dyspnea and persistent hiccups during the last 6 months. We have not found any similar case in the literature. Further testing after excision by thoracotomy revealed a solitary fibrous pleural tumor. A brief discussion of the clinical presentation and incidence of these tumors is included.

[Tracheotomy complications in resuscitation patients]. / Complications de la tracheotomie chez les malades de reanimation.

Many statistics on what concerned the tracheotomy complications are old, dating from 1960-1970, and discouraging to practise this kind of gesture. Moreover, it is unfeasible to objectively evaluate this technique from these huge sets where it is often difficult to separate the dramatic complications (massive haemorrhage, suffocating pneumothorax,...) and those more benign. The authors analyze through a retrospective study of 32 tracheotomised patients, the index of these complications in distinguishing those of the early stage and the late stage can occur even after decannulation. In the acute phase, haemorrhages 9.3 p 100) per inadequate haematosis, the pneumothorax (3.1 p 100) and the infection of the stoma (12.5 p 100) are the most frequent. The opening tracheotomy infection can support pulmonary infections (28.1 p 100) which cause serious problems at tracheotomised. After decannulation, the principal complication is the tracheobronchial stenosis (3.1 p 100). Its diagnosis is difficult and should be done by systematic endoscopic control of the trachea and radiological explorations at the time of the decannulation. The authors insist on the use of proper equipments, protocols of rigorous care and strict post-operative monitoring.

Mutations in the protamine locus: association with spermatogenic failure?

The protamine locus consists of a 28.5 kb region with a linear array of the protamine (PRM)1, PRM2, PRM3 and transition nuclear protein (TNP)2 genes. Several studies indicate an abnormal expression pattern of protamine genes associated with male infertility, although the molecular mechanism underlying this observation is unclear. Here, we determined the spectrum of DNA variants present in all four genes in men with unexplained infertility compared with an ancestry-matched fertile/normospermic population. A total of 160 control individuals and at least 125 infertile men with either idiopathic azoospermia or oligozoospermia were sequenced for the open reading frame of PRM1, PRM2, PRM3 and TNP2 genes. All individuals carried an apparently intact Y chromosome. Of the 28 variants identified, 21 were previously described in the literature. The novel variants that were observed only in the infertile cohort included the SNP c.65G>A mutation which resulted in an amino acid change at the codon 22 (p.Ser22Asn) in the PRM1 gene, a mutation in the promoter region of PRM2 (-67C>T) and a nonsense mutation in the PRM3 gene. These data are consistent with that of previous studies which have indicated that mutations in the protamine locus may be an infrequent cause of male infertility.

Hydatid cyst of the rib: a new case and review of the literature.

The hydatid cyst is not rare in our country, but bone lesions are less common. The disease often takes the appearance of abscess or malignant lesion. We report a case of a 35-year-old man with a hydatid cyst of the rib complicated with cutaneous fistula. The surgery allowed both diagnosis and treatment. Albendazole was then administered to prevent relapse.

Metal concentrations in sediments and clams in four Moroccan estuaries.

Metals (Cd, Cu, Ni, Zn, Mn and Fe) were analyzed seasonally over three years in sediments and in tissues of the clam Scrobicularia plana in four Moroccan Atlantic estuaries: Loukkos, Sebou, Bou Regreg and Oum er Rbia. Of these metals, Cd was at the lowest concentrations in sediment. Concentrations of Cu, Zn, and to a lesser extent Ni, in sediments suggest greater contamination in Sebou and Bou Regreg than in the other estuaries. The fluctuations of Mn and Fe concentrations in the fine surface sediments reflect their continental origin and show seasonal variations that indicate soil run-off following rain events. Concentrations of Cu, Zn, and especially Ni in clam tissues in these estuaries were generally higher than in some other common bioindicator bivalve species. The seasonal variations in S. plana's tissue metal concentrations are linked to patterns of reproductive activity for all metals except Cd and possibly Zn, whose tissue concentrations may be regulated. Mn and Fe concentrations in S. plana were positively correlated to sediment levels of these metals.

[Mature teratoma of the posterior mediastinum]. / Tératome mature du médiastin postérieur. A propos d'un cas.

Mature teratoma is the most frequent primary germ-cell occurring in the anterior mediastinum. We report a case of a 67-year-old man with mature teratoma of the posterior mediastinum. Computed tomography was helpful in suggesting a diagnosis of mature teratoma by demonstrating the presence of fat and calcification.

[Pyothorax in pneumonectomy cavity. Apropos of 24 cases]. / Les pyothorax sur cavité de pneumonectomie. A propos de 24 cas.

AIM OF THE STUDY: Describe as series of post-pneumonectomy empyema episodes, with or without bronchial fistula treated at the department of Thoracic Surgery, University of Ibn Sina, Rabat, Morocco. PATIENTS, METHOD AND RESULTS: Twenty-four patients with post-pneumonectomy pyothorax cared for between 1991 and 2000 were reviewed retrospectively. There were 15 men and 9 women, mean age 34 years. Pneumonectomy was indicated for tuberculous pyothorax and destroyed lung (n = 8), 8 destroyed lung (n = 8), pulmonary aspergilloma (n = 2), pulmonary hydatidosis (n = 2), bronchial dilatation (n = 2), lung cancer (n = 1), and bullet wound (n = 1). The patients were divided into two groups according to presence or absence of bronchial fistula: group 1, 19 patients with without bronchial fistula, and group 2 5 with bronchial fistula. Fourteen patients in group 1 (73.7%) achieved definitive cure, 12 after drainage and washout (63%) at mean delay of 45 days and 2 after drainage and washout with thoracoplasty. Five patients did not respond to hospital drainage and washout and remained under definitive ambulatory drainage as they declined further surgical treatment. One death occurred in this group. Two patients in group 2 (40%) achieved definitive cure, one after daily aspiration, and the other after thoracoplasty. Two fistulae in one patient were treated with nitratage. For this patient, we also attempted revision of the bronchial stube via posterior throacotomy, the closure of the bronchial fistula using an intercostal muscle flap associated with thoracoplasty. All these methods failed. There were two deaths in this group. CONCLUSION: Sixteen patients were definitively cured (66.6%). Eight patients (33.3%) remain in a chronic condition. Patients with pyothorax on a pneumonectomy cavity should be managed in specialized centers before reaching the chronic stage. Thoracomyoplasty with preparation of the cavity by thoracostomy should be proposed.

Classical polymorphisms in Berbers from Moyen Atlas (Morocco): genetics, geography, and historical evidence in the Mediterranean peoples.

BACKGROUND: Mediterranean population relationships have recently been reviewed through the analysis of classical and DNA markers. The differentiation between Berbers and Arabic-speakers to the south, and the genetic impact of the seven centuries of Muslim domination in the Iberian Peninsula have been among the most interesting questions posed in these studies. AIM: The present study seeks to assess the degree of genetic affinity between the two main population groups of Morocco: Berbers and Arabic-speakers. Data from the Berber study population were also compared with published information on 20 circum-Mediterranean groups. SUBJECTS AND METHODS: A Berber sample of 140 individuals from Moyen Atlas (Morocco) has been characterized using 15 classical markers (ABO, Duffy, MNSs, Rh, ACPl, AKl, ESD, GLOI, 6-PGD, PGMl, GC, HP, PI, PLG and TF). RESULTS: Allele frequencies in the Berbers fit well into the general southern Mediterranean ranges, albeit with some peculiarities, such as the high FY*A, ACPl*C, and PI*S values. The general pattern of relationships among Mediterranean peoples tested by genetic variance analysis was compatible with a north-south geographical differentiation. Spatial auto-correlation analysis in the different geographical regions of the Mediterranean reveals that the highest degree of association between allele frequencies and geographical distances corresponds to the western (41% of significant correlograms) and northern Mediterranean populations (33%). When only southern Mediterranean groups were considered, the degree of geographical structure considerably decreases (11% of significant correlograms). CONCLUSIONS: The different loci studied revealed close similarity between the Berbers and other north African groups, mainly with Moroccan Arabic-speakers, which is in accord with the hypothesis that the current Moroccan population has a strong Berber background. Differences in the spatial pattern of allele frequencies also are compatible with specific population histories in distinct Mediterranean areas, rather than general population movements across the whole region.

Apolipoprotein molecular variation in Moroccan Berbers: pentanucleotide (TTTTA)n repeat in the LPA gene and APOE-C1-C2 gene cluster.

Apolipoprotein LPA, APOE, APOC1, and APOC2 genotype frequencies have been determined for the first time in a North African population. A sample of 140 Berber individuals from the Moroccan Moyen Atlas region has been analyzed. Allelic and haplotypic data have been used to compare our sample with other world populations and the results clearly differentiate Berbers from Europeans and Sub-Saharans, suggesting several distinctive features of Moroccan Berbers as the extreme high values of LPA PNR*11 pentanucleotide allele (10.5%) and the relatively high and low values of APOE*E4 (15.7%) and *E2 (4.5%) in comparison to other Mediterraneans. Another remarkable result is the frequency distribution of the two APOC2 alleles (70% vs 30%) in comparison with the European pattern (50% of each allele). The high values of APOE*E4 and LPA PNR*7 together with the intermediate linkage disequilibrium values between APOE and APOC1 alleles in comparison with Europeans and Africans suggest a certain degree of Sub-Saharan influence in the current Moroccan population.

Dermatoglyphic characterization of Berbers from Morocco: qualitative and quantitative digital and palm data.

BACKGROUND: The demographic impact of the Arabization in the Berber genetic background has been extensively studied by means of different classical and DNA genetic markers. Information from other biological traits as dermatoglyphics could be of interest in order to gain an insight into the relationship between these two North African groups. AIM: The Moroccan Berber population is characterized by means of digital and palm dermatoglyphics to determine the degree of genetic affinities among Berber and other Mediterraneans, especially the Moroccan Arab-speakers. SUBJECTS AND METHODS: Finger patterns, pattern intensity, finger total ridge counts, pattern frequencies in the five configuration areas of the palm, mainline D terminations, and a-b ridge count were analysed in a sample of 120 males and 103 females of Moyen Atlas (Morocco). RESULTS: Bilateral asymmetry was more pronounced than sexual differences in the overall distribution of the analysed traits. Our two series (males and females) exhibit high values of total ridge count (TRC) and mainline D terminations in comparison with other Mediterranean series. Several pattern frequencies in fingers and palm areas also differentiate the Berbers of Moyen Atlas from North Africans. CONCLUSION: The picture obtained by principal components based on qualitative digital and palm data revealed that Berber males were within the variation range of North African groups while Berber females clustered with some Iberian samples. The population pattern obtained in a bivariate plot of quantitative finger data showed the Berbers (males and females) as the most differentiated population in the Mediterranean context. Dermatoglyphic data failed to indicate any particular proximity between Berbers and Arab-speakers from Morocco.

Metals in sediments and the edible cockle Cerastoderma edule from two Moroccan Atlantic lagoons: Moulay Bou Selham and Sidi Moussa.

Metals (Cd, Cu, Pb and Zn) were determined over a 3-year period in sediments and bivales Cerastoderma edule from two lagoon ecosystems on the Moroccan Atlantic coastline, Moulay Bou Selham and Sidi Moussa. Sediment metal concentrations were seasonally influenced, and were highest, generally, in winter--possibly signifying an increased contribution from run-off from adjacent arable land and roads. Neither site can be considered highly contaminated; however, Cd was enriched at Sidi Moussa, probably as a result of waste discharge from phosphate industries 20 km along the coast to the northeast. This ability to act as a sink for metals at distance from sources demonstrates the need for surveillance in these sensitive environments. Copper and Zn concentrations in edible cockles C. edule appear to be regulated over the concentration ranges currently found in lagoon sediments. In contrast, body burdens of Pb and, to a lesser extent Cd, reflect sediment levels and might be useful in future risk assessments. Metal concentrations Cerastoderma edule are seasonally related to the reproductive cycle, however, and sample timing will need to be standardised in future monitoring exercises.

[Treatment of hydatid bilio-bronchial and bilio-pleuro-bronchial fistulas by thoracotomy]. / Traitement des fistules biliobronchiques et bilio-pleuro-bronchiques d'origine hydatique par thoracotomie.

STUDY AIM: The aim of this study was to report the results of surgical treatment of hydatid bilio-bronchial et bilio-pleuro-bronchial fistulas via thoracotomy. MATERIAL AND METHODS: From 1990 to 1998, 63 cases were observed in the same center. Biliptysis was the main symptom in 72% of cases. The diagnosis was based on chest radiography and abdominal ultrasonography; both examinations visualised the cyst, intrathoracic collections, a diaphragmatic breach and biliary lesions. All patients were treated by one-stage thoracotomy. The procedures consisted of lung resection (lobectomy and/or segmentectomy) (n = 47) and decortication (n = 16) in the chest, cyst dome resection (n = 61) or partial pericystectomy (n = 12) in the abdomen and suture of the diaphragmatic defect in all cases after hepato-diaphragmatic disconnection. An additional laparotomy was necessary in 4 cases. RESULTS: There were 8 deaths (12.7%): one intraoperative death due to haemorrhage and seven postoperative deaths, mostly related to pulmonary complications. Postoperative complications (14.3%) were mainly respiratory. Clinical and radiological results were good with a one-year follow-up. CONCLUSION: Bilio-bronchial and bilio-pleurobronchial fistulas due to hydatid cyst are rare, but severe diseases. They are responsible for lesions at three levels: abdominal, diaphragmatic and thoracic. A high perioperative mortality rate was observed. Thoracotomy is the best approach for surgical treatment at all three levels.

[Mature teratome of the mediastinum]. / Tératome mature du médiastin.

STUDY AIM: The aim of this retrospective study was to report a series of 12 cases of mature teratoma of the mediastinum operated during a 10-year period in the same center. PATIENTS AND METHOD: From 1990 to 2000, 12 patients (7 females and 5 males with a mean age of 32 years) were operated for mature mediastinal teratoma. Chest pain was present in 10 cases; cough, dyspnea and septic episodes were present in 5 cases and X-ray detected the mediastinal tumor in 10 cases. CT scan showed a tumor with liquid and fatty components and calcifications in 5 out of 9 cases. Tumors were resected via a posterolateral thoracotomy in 11 cases and an anterior thoracotomy in one case, associated with pneumonectomy in 1 case, basal segmentectomy in 1 case and thymectomy in 1 case. RESULTS: There were no postoperative deaths. Morbidity included 2 phrenic nerve palsies, 1 pyothorax after pneumonectomy, 1 case of bleeding and 1 pleural effusion. No recurrences have been observed with a follow-up of 5 to 87 months. Nine of the 10 tumors reviewed by pathologist contained multiple tissue components and one only contained a single tissue. CONCLUSION: Mature teratomas are usually detected in young patients: they are usually located in the middle part of the anterior mediastinum and are only diagnosed by pathologic examination of the specimen. They have an excellent prognosis when tumor resection is complete and in the absence of immature tissue in the tumor.

Digital dermatoglyphic patterns of Moroccan Arabs: relationships with Mediterranean populations.

Dermatoglyphic finger patterns and pattern intensity were examined in a sample of 204 (105 males and 99 females) adults from the authochthonous Arab population of south central Morocco. No significant sex differences were found for the overall finger pattern incidence or for the pattern intensity index. A high incidence of arches is the most remarkable characteristic of this population as compared to other Mediterranean groups. The significant differences from two previous sets of Moroccan data indicate a remarkable heterogeneity within the present day Moroccan population. Also important is the differentiation of this sample from other north African ethnic groups such as Berbers and Tuaregs. An analysis of the dermatoglyphic relationships using R-matrix analysis, shows a relative proximity between this Moroccan series and other southwest European groups as compared to north African populations.