Evaluation of a Modified Version of the United Kingdom Working Party Diagnostic Criteria for Atopic Dermatitis in Tunisia.

BACKGROUND: For many years, the United Kingdom (UK) Working Party diagnostic criteria for atopic dermatitis (AD) have represented the criteria of choice for epidemiological studies. A recent study has reported a low sensitivity of these criteria among Tunisian patients, probably because of some epidemiologic characteristics of AD in our country. OBJECTIVE: Our objective was to validate a modified version of the UK Working Party criteria for AD in Tunisia by establishing their sensitivity, specificity, and positive predictive value and negative predictive value. MATERIALS AND METHODS: This case-control study was performed over a period of 18 months in our dermatology department in Tunisia. The diagnosis of AD was established clinically by 2 dermatologists who specialized in dermatoallergology. Based on the UK Working Party diagnostic criteria and respecting the epidemiological peculiarities of AD in Tunisia, we proposed a modified version of diagnostic criteria adapted to Tunisian AD. The modifications concerned the first, fourth, and fifth minor criteria of the UK Working Party diagnostic criteria list. RESULTS: We collected 156 patients and 156 controls. The mean age of AD onset was 7 years and 9 months. The inverted topography of lesions was found in 67.9% of cases. The sensitivity, specificity, positive predictive, value and negative predictive value were, respectively, 56.4%, 97.4%, 95.65%, and 69.09% for the UK Working Party diagnostic criteria and 89.1%, 95.5%, 95.1%, and 89.7% for the modified version. CONCLUSIONS: This modified version of the UK criteria seems to be a practical diagnosis tool for AD in Tunisia.

[Nonketotic hyperglycemia-induced hemiballism]. / Hémiballisme secondaire à une hyperglycémie sans cétose.

Nonketotic hyperglycemia-induced hemichorea or hemiballism is a well-recognized entity that is rarely encountered. Particular computed tomography and magnetic resonance imaging findings have been described. The pathophysiological mechanism of this disease remains uncertain. We report here on two female patients that presented with hemiballism secondary to nonketotic hyperglycemia and underwent brain computed tomography and magnetic resonance imaging.

[Central neurocytoma: Study of 32 cases and review of the literature]. / Le neurocytome central : étude de 32 cas et revue de la littérature.

Central neurocytoma is a rare benign neoplasm of the central nervous system. The intraventricular location close to the Monro foramina and the attachment to the septum pellucidum are characteristic for the diagnosis. However, atypical appearances may be encountered and confused with other neoplasms. The authors report the radiological findings of 32 surgically treated and pathologically confirmed neurocytomas.

Wild ostrich (Struthio camelus australis) reproduction in Orbata, a nature reserve in Tunisia.

The aim of the current investigation was to determine wild ostrich reproductive behaviour in Orbata Nature Reserve by observing 16 hens and 28 cocks over a seven-year period. Intense laying commenced in January, one month after the cessation of the rainy season, and 92% of the eggs were produced during the dry season (January to May, peaking in March). Over the seven years, 1,322 eggs were laid in 69 nests, which corresponded to an annual average production of 19.2 +/- 9.1 eggs/nest and 11.8 eggs/hen. 24 nests (34.78%) were non-brooded, 17 nests (24.64%) were deserted in the course of incubation, and 28 nests (40.58%) possessed hatched eggs. All the non-incubated nests had egg losses equivalent to 46.6 +/- 12.6%. Hatchability success of incubated eggs was 41.9 +/- 12.0%. Ostriches tended to dig their nests adjacent to the reserve enclosure which had direct access by road and track, the latter subjecting them to human disturbance and predation. The systematic obstruction of these nests stimulated ostriches to build additional nests within the reserve perimeter. The authors discussed the results recorded in an ostrich flock in relation to the environmental factors (climatic factors, food disponibility and predation) and suggested possibilities for improved wildlife management.

[Cerebromediastinal tuberculosis in a child with a probable Say-Barber-Miller syndrome: a causative link?]. / Tuberculose cérébromédiastinale chez un enfant atteint de syndrome de Say-Barber-Miller probable : un lien de causalité ?

INTRODUCTION: Tuberculosis continues to be a public health problem in emerging countries with a recent evidence of increased incidence of extrapulmonary localization in developed countries probably linked to HIV. To our knowledge the occurrence of cerebro-mediastinal tuberculosis in an immuno-competent child has not been previously described; moreover the child we describe has a probable Say-Barber-Miller syndrome. We discuss a putative causative link between this syndrome and the occurrence of tuberculosis. CASE REPORT: A seven-year-old girl presented to our department with a history of infantile encephalopathy since birth characterized by a facial dysmorphy (evocative of a bird face), microcephaly, and mental retardation, and with recurrent infections. The child had complained of back pain for several months; the parents reported anorexia, loss of weight. Spinal and cerebral MRI showed a mediastinal mass involving the spine and cerebral lesions evocative of tuberculomas. The tuberculin interdermal reaction was positive. Culture of a vertebral biopsy was positive for Koch bacillus. Anti-tuberculosis treatment improved general and local status. An extensive immunological work-up was normal. CONCLUSION: [corrected] This observation is exceptional in many aspects: very early age of onset of extrapulmonary tuberculosis, no immune deficit, association with a rare congenital neurological syndrome. We discuss the possible link between this entity and the occurrence of tuberculosis.

[Transarterial embolization of intracranial dural arteriovenous malformations with ethylene vinyl alcohol copolymer (Onyx18): report of three cases]. / Embolisation par voie artérielle de malformations artérioveineuses durales intracrâniennes à l'aide d'éthylvinyl alcool copolymère (Onyx((R))18) : à propos de trois observations.

BACKGROUND: This is a report of the endovascular treatment of three intracranial dural arteriovenous malformations (DAVM) using Onyx. PATIENTS AND METHODS: We analyzed the clinical and angiographic results in three patients with intracranial DAVM, revealed by a hemorrhagic event and treated by endovascular way by the use Onyx. Angiographic investigation showed the DAVM to be located in the lateral sinus in two cases and in the tentorium region in the third. RESULTS: In all three cases, embolization was performed by selective catheterization of the meningeal arterial feeder of the DAVM. The injection of Onyx resulted in complete anatomical exclusion of the DAVM, as demonstrated by posttreatment angiography. Clinically, the patients recovered partially or completely their neurological deficit. CONCLUSION: Onyx is a liquid embolization agent recently introduced for the treatment of DAVM. When used under optimal conditions, it offers a feasible alternative option in the treatment of such vascular malformations.

Reversible metronidazole-induced encephalopathy.

We report the neuroimaging findings of a case of reversible metronidazole-induced encephalopathy. Magnetic resonance imaging (MRI) demonstrated lesions in highly suggestive locations. Follow-up imaging performed 1 month after cessation of metronidazole therapy demonstrated resolution of imaging findings.

Atypical CT and MRI aspects of an epidermoid cyst.

We report a case of an unusual epidermoid cyst (EC) of the cerebellopontine angle that appeared hyperdense on computed tomography (CT) scanning, hyperintense on T1-weighted MR images and hypointense on T2-weighted magnetic resonance (MR) images. Diffusion-weighted imaging showed a hypointense lesion. We discuss imaging characteristics of ECs, explain the atypical findings in our case and confirm that the signal seen on diffusion-weighted images in the EC is related to a T2 effect.

Insect growth regulator activity of Cestrum parqui saponins: an interaction with cholesterol metabolism.

Cestrum parqui is an ornamental shrub known for its insecticidal activity against some insect pests; this activity comes from the crude saponic extract of the leaves of this plant, the saponins cause insect growth regulator symptoms (development and moulting perturbation). In this work we try to demonstrate the hypothesis that saponins interact with ecdysone (moulting hormone) synthesis mechanisms by reducing diet cholesterol absorption (cholesterol forms the skeleton of ecdysone and of other ecdysteroids). To show the cholesterol/saponin interaction we used a stored product pest insect (Tribolium confuisurn), the larva of this insect are affected by saponins added in their diet, but the addition of cholesterol permits to reduce significatively this insecticidal propriety. Using Spodoptera littoralis larva model the tentative to detect a cholesterol rate reduction on the level of hemolymph is also unsuccessful. All these experiments shows that this type of reaction can't occur in the diet or in the digestive system but probably in insect cells. It is clear that Cestrurn parqui saponins affect the cholesterol metabolism but the exactly mechanism is still unknown. More investigations are necessary to develop this hypothesis and to envisage the use of Cestrum saponins as insect growth regulator bioinsecticide.

[The effect of food containing Cestrum paquii (Solanaceae) extract on various damaging Lepidoptera]. / L'impact de l'alimentation contenant du broyât de Cestrum paquii (Solanacées) sur des lépidoptères dommageables.

The repulsive activity of Cestrum parquii on the feeding behaviour of Pieris brassicae L. and Spodoptera littoralis Boisduval was studied. Antifeedant effect was observed at regular intervals during a week. Meal uptake was stopped after the first day, showing a strongly antifeedant effect of C. parquii extract on these two species. The impact of C. parquii with different concentrations of dry extract (2, 4, 8, 16, 32%) delayed the larval growth of Spodoptera littoralis Boisduval compared to untreated insects. Abnormal metamorphosis was observed with concentrations of 8 and 16% leading to death and abnormal morphogenesis. The antifeedant activity of C. parquii was also observed in S. littoralis and measured by the evolution of food uptake and the weight of larva. Effect seemed to be proportional to extract concentration in the diet. High concentration (32%) stopped growth in the earlier instar.

[Septic arthritis of posterior lumbar facet joint]. / Arthrite septique interapophysaire postérieure lombaire.

Septic arthritis of the posterior lumbar joints is extremely rare. The clinical picture of this unusual site of infection can easily lead to confusion with spondylodiscitis which is more common. We report a case of a 50-year-old woman with Staphylococcus aureus septic arthritis of the left L5-S1 lumbar facet joint. CT scan was helpful to establish the diagnosis and to guide the percutaneous needle biopsy.

[Cerebral venous thrombosis and arterial infarction in pregnancy and puerperium. A series of 60 cases]. / Thromboses veineuses et infacrctus artériels cérébraux au cours de la grossesse et du post-partum. Une série de 60 cas.

We report a retrospective study of 60 patients aged from 18 to 46 years, pregnant or parturient, with ischemic cerebrovascular accident. The hospital incidence was 3.6 cases per year. The prevalence was 0.70 per 1,000 childbirth in Tunis area. 3/4 of these cerebrovascular accidents occurred in the post partum period and 1/4 in the pregnancy. Gravidic toxemia and sepsis were the most frequent risk factors. The cerebral venous thrombosis (CVT) (55%) were almost as frequent as cerebral ischemic accidents (CIA) 45). We individualized 3 groups of CVT: septic, aseptic, mixed. Among CIA etiologies we noted two cases of cerebral angiopathy of toxemia and one case of peripartum angiography. The mortality rate nul for CIA, was 36% for CVT. The functional sequelae were more severe for CIA.

[Mondini's malformation. Apropos of a case]. / La malformation de Mondini. A propos d'un cas.

Mondini's malformation is a rare internal ear malformation. It's often discovered in childhood in the course of perception deafness check up, or repetitive meningitis in some other cases. The authors report a case of complex Mondini's malformation with fistulas of cerebro-spinal-fluid in oval and round windows, and stress the interest of high resolution computed tomography.