DERIVATION OF LOCAL DIAGNOSTIC REFERENCE LEVELS FOR COMMON ADULT COMPUTED TOMOGRAPHY EXAMINATIONS IN MOROCCAN HOSPITAL.

The purpose was to derive local diagnostic reference levels (LDRLs) for adults common computed tomography (CT) examinations in Moroccan hospital. The data of patients were collected retrospectively from one facility for 2 months period. The proposed LDRLs were defined as 75th percentile of spreads for CT dose index-volume (CTDIvol) and dose length product (DLP). Findings were compared with diagnostic reference levels (DRLs) of France, Australia and Egypt. A total of 259 cases were enrolled including 53% of male and 47% of female. The corresponding LDRLs in terms of CTDIvol (mGy) were 58, 15, 15 and 14 for head, chest, abdomen-pelvis and chest-abdomen-pelvis CT examinations, respectively. For DLP (mGy.cm) were 1298, 944, 1874 and 2026, respectively. The proposed LDRLs for CTDIvol were almost similar to DRLs of Australia, higher than those of France and lower than Egyptian DRLs. In terms of DLP, LDRLs were higher than compared studies with exception of head CT, which were lower and higher for CTDIvol than Egyptian DRLs. The results highlight higher radiation doses during adult CT scans, indicating the need to spread the same investigation regarding other imaging procedures including different radiological examinations across Moroccan hospitals.

Assessment of hemodialysis impact by Polysulfone membrane on brain plasticity using BOLD-fMRI.

PURPOSE: Hemodialysis (HD) is considered the most common alternative for overcoming renal failure. Studies have shown the involvement of HD membrane in the genesis of oxidative stress (OS) which has a direct impact on the brain tissue and is expected to be involved in brain plasticity and also reorganization of brain function control. The goal of this paper was to demonstrate the sensitivity of the blood oxygenation level-dependent functional magnetic resonance imaging (BOLD-fMRI) to characterize the OS before and after the HD session. PATIENTS, MATERIALS AND METHODS: Twelve male patient-volunteers following chronic HD for more than 6months were recruited among 86 HD-patients. All patients underwent identical assessment immediately before and after the full HD-session. This consisted of full biological assessment, including malondialdehyde (MDA) and total antioxidant activity (TAOA); and brain BOLD-fMRI using the motor paradigm in block-design. RESULTS: Functional BOLD-fMRI maps of motor area M1 were obtained from the HD patient before and after the hemodialysis session, important decrease in the intensity of brain activation of the motor area after HD, and important increase of the size of the volume of brain activation were observed, these changes are reflecting brain plasticity that is well correlated to OS levels. Individual patients MDA and TAOA before and after the hemodialysis sessions demonstrated a clear and systematic increase of the OS after HD (P-value=0.03). Correlation of BOLD-fMRI maximal signal intensity and volume of activated cortical brain area behaviors to MDA and total TAOA were close to 1. CONCLUSION: OS is systematically increased in HD-patients after the HD-process. Indeed, the BOLD-fMRI shows a remarkable sensitivity to brain plasticity studied cortical areas. Our results confirm the superiority of the BOLD-fMRI quantities compared to the biological method used for assessing the OS while not being specific, and reflect the increase in OS generated by the HD. BOLD-fMRI is expected to be a suitable tool for evaluating the plasticity process evolution in hemodialysis brain patients.

[Vascular complications of infective endocarditis: a retrospective analysis of 18 cases]. / Les complications vasculaires de l'endocardite infectieuse.

OBJECTIVES: Among 82 patients hospitalized for infective endocarditis between June 1995 and June 2001 at the cardiology B unit of the Rabat University Hospital Morocco, 18 (22%) had one or more vascular complications. We present here a retrospective analysis. PATIENTS AND METHODS: The cohort included 12 men and 6 women, mean age 22 years. Infective endocarditis had grafted on a pre-existing cardiopathy among 17 patients: rheumatic heart disease (n=14), mechanical prosthetic valve (n=2), congenital heart disease (n=1). RESULTS: For 12 patients, vascular disease was the only complication, 1 had two complications and 4 three complications. This gave 26 lesions: 11 neurological complications, 10 arterial diseases involving the limbs including 5 mycotic aneurysms, 2 acute myocardial infarcts, 2 splenic infarcts, and 1 recurrent septic pulmonary embolism. Vascular disease was the inaugural manifestation in 9 patients and 54% of the complications occurred before the end of the second week of antibiotic treatment. Blood cultures were positive in 7 patients (40%). Oral streptococcus was isolated in 5 cases, Gram-negative bacillus in 1 case and Staphylococcus aureus in 1. Echography revealed valvular vegetations in the 16 cases of infective endocarditis on native valves: mitral (n=9), aortic (n=5), mitroaortic (n=1), tricuspid (n=1). Short term outcome was marked by 4 deaths including 3 directly related to the vascular complication. DISCUSSION: We emphasize the variable and diverse features of vascular complications of infective endocarditis. Prevention and early diagnosis are essential to institute optimal management of infective endocarditis.

[Heart involvement in carcinoid syndrome: report of a case]. / Atteinte cardiaque au cours du syndrome carcinoïde: à propos d'un cas.

The authors report the case of tricuspid and pulmonary disease, revealing a carcinoid syndrome in a 32 years-old young man who was admitted for asthenia and an effort hepatology. The carcinoid syndrome was confirmed by hormonal proportioning, and by an anatomopathologic and immunohistochimic study of a hepatic metastatic biopsy. The check-up to search the primitive tumor was negative. The clinicals, paraclinicals and therapeutics aspects of the carcinoid heart were reported in this work.