Influence des facteurs épidémio-cliniques dans le résultat fonctionnel de la septoplastie: étude de 250 cas / Epidemiological and clinical predictive factors of success in septoplasty: Study of 250 patients

to describe the epidemiological and clinical aspects, to evaluate the surgical result and to identify the prognostic factors for the success of septoplasty. Methods: It was a retrospective study including 250 patients operated on for a septoplasty collected over a 6-yearperiod. The evaluation of our results was made using 2 tools: NOSE scale and the visual satisfaction scale. Results: In our series, there was a male predominance with a sex ratio of 1.4. The mean age of the patients was 32.7 years. The medical history was dominated by allergic rhinitis in 38.4% of cases. Nasal trauma was noted in 45.2% of cases. A subjective quantification of respiratory discomfort by the NOSE score made it possible to divide them into 3 groups:Group 1: Severe ON: 65.2% of cases; Group 2: Moderate ON: 31.6% of cases; Group 3: Mild ON: 3.2% of cases. Our analytical study of the epidemiological and clinical factors that may influence the functional results showed that: Severe or moderate overall discomfort, severe ON (NOSE scale> 50) or moderate (NOSE scale between 26 and 50), DS classified zone I, II, III according to the Cottle classification, a quasi-obstructive deviation were considered as a predictor of the success of septoplasty. Conclusion: Several factors can influence the results of a septoplasty that must be considered before any surgical indication.

[Acute cholestatic hepatitis associated with olanzapine in a patient with bipolar disorder]. / Cas clinique du mois. Hépatite cholestatique aiguë associée à l'olanzapine chez une patiente bipolaire.

INTRODUCTION: Transient elevation of liver enzymes is reported in 9 % of patients on olanzapine. However, rare cases of symptomatic hepatotoxicity associated with olanzapine use have been reported in the literature. This case report describes a woman who presented acute hepatitis linked to the use of olanzapine. Similar reports in the literature are also analyzed. OBSERVATION: A 43-year-old female patient, treated for bipolar disorder type I by sodium valproate 1500 mg/d, was admitted to hospital for management of a manic episode. Her liver tests at admission were normal. As soon as she was admitted to hospital, the patient was treated by olanzapine 10 mg/day, which was increased to 20 mg/day over 2 weeks, and diazepam, in addition to the sodium valproate 1500 mg/d. Three days after the increase of olanzapine to 20 mg, the patient pre- sented with mucocutaneous jaundice, dark urine with pruritus and vomiting, and a marked alteration of liver enzymes. No etiology was found to explain this hepatotoxicity other than drug origin. CONCLUSION: This case report emphasizes the need for a baseline hepatic evaluation before starting olanzapine therapy and regular monitoring of liver enzyme levels, especially among at risk patients.

INTRODUCTION: Une élévation transitoire des enzymes hépatiques est rapportée chez 9 % des patients sous olanzapine, Cependant, de rares cas d'hépatotoxicité symptomatique associée à l'utilisation de l'olanzapine ont été rapportés dans la littérature. Le but de ce rapport de cas est de présenter un cas d'hépatite aiguë induite par l'utilisation de l'olanzapine et de comparer ce cas avec les données de la littérature. OBSERVATION: Patiente âgée de 43 ans, suivie pour trouble bipolaire type I sous valproate de sodium 1.500 mg/j, hospitalisée pour prise en charge d'un accès maniaque. Son bilan hépatique à l'admission était sans particularité. Dès son hospitalisation, la patiente a été mise, en plus du valproate de sodium 1.500 mg/j, sous olanzapine 10 mg/j, dose qui a été augmentée à 20 mg/j en 2 semaines et ajout de diazépam. Trois jours après l'augmentation d'olanzapine à 20 mg, la patiente a présenté un ictère cutanéo-muqueux, des urines foncées avec un prurit et des vomissements, avec une perturbation du bilan hépatique. Aucune étiologie n'a été trouvée pour expliquer cette hépatotoxicité, à part l'origine médicamenteuse. CONCLUSION: Nous soulignons la nécessité de faire un bilan hépatique de base avant de commencer le traitement par olanzapine et de surveiller régulièrement les taux d'enzymes hépatiques, en particulier chez les patients à risque.

Facteurs pronostiques des carcinomes épidermoïdes non métastatiques du larynx

Etudier les facteurs influençant le pronostic des carcinomes épidermoïdes du larynx. Méthodes: Etude rétrospective analytique menée sur 100 patients présentant un carcinome épidermoïde primitif du larynx, durant une période de 24 ans (1992­2015). Résultats: La survie globale à 1 an, à 3 ans et à 5 ans a été respectivement de 99 %, de 77 % et de 63 %. La survie sans maladie à 1 an, à 3 ans et à 5 ans a été respectivement de 88 %, de 76 % et de 63 %. L'étude univariée de la survie globale et la survie sans maladie a montré un impact péjoratif de l'atteinte ganglionnaire histologique, de l'engainement péri-nerveux et des limites chirurgicales tumorales (facteurs histo-pronostiques). Dans l'étude multivariée, seuls le stade T, le stade N, l'atteinte sous-glottique, l'atteinte du cartilage thyroïde et le délai de la radiothérapie postopératoire ont présenté un impact significatif sur la survie sans maladie. Aucun facteur n'a présenté d'impact significatif sur la survie globale, en analyse multivariée. L'étude statistique de la récidive n'a montré aucun facteur prédictif. Conclusion: Le stade tumoral et les facteurs histo-pronostiques sont les 2 facteurs pronostiques majeurs. Dans la littérature, Les principaux facteurs prédictifs de récidive sont: le stade tumoral, les limites chirurgicales tumorales et l'extension extra-nodale. Dans notre étude, aucun facteur prédictif n'a été trouvé.

Les surdites brusques idiopathiques facteurs pronostiques / Sudden idiopathic deafness prognostic factors

Les surdités brusques idiopathiques (SBI) constituent l'un des sujets les plus débattus en otologie. Plusieurs problèmes d'ordre physiopathologiques, thérapeutiques et pronostiques restent non résolus. But : Identifier les facteurs pronostiques, cliniques et audiométriques de récupération auditive après traitement d'une SBI. Malades : Etude rétrospective portée sur 27 malades (29 cas de SBI) traités dans le service d'ORL et chirurgie cervicofaciale du CHU Habib Bourguiba Sfax durant la période comprise entre les années 1990 et 2005. Méthodes : C'est une étude statistique recherchant une corrélation significative entre certains facteurs cliniques et audiométriques et la récupération auditive. Les facteurs étudiés étaient : l'âge, l'aspect de la courbe audiométrique, la perte auditive initiale et le délai de prise en charge thérapeutique. Résultats : L'âge inférieur à 50 ans, la courbe ascendante et la perte auditive inférieure à 70 dB étaient les facteurs de meilleur pronostic. Le délai de prise en charge thérapeutique semble avoir peu de rôle dans la récupération auditive. Discussion : La majorité des auteurs ont signalé que l'âge jeune, les surdités légères ou moyennes, la courbe ascendante et la précocité de la prise en charge sont associés à un meilleur pronostic. Nos résultats rejoignent ceux de Tran Ba Huy qui ne trouve pas de corrélation entre le délai de prise en charge thérapeutique et le pronostic de récupération auditive.

Facteurs pronostiques des carcinomes épidermoïdes non métastatiques du larynx / Prognostic factors in laryngeal non-metastatic squamous cell carcinomas

But: Etudier les facteurs influençant le pronostic des carcinomes épidermoïdes du larynx. Méthodes: Etude rétrospective analytique menée sur 100 patients présentant un carcinome épidermoïde primitif du larynx, durant une période de 24 ans (1992­2015). Résultats: La survie globale à 1 an, à 3 ans et à 5 ans a été respectivement de 99 %, de 77 % et de 63 %. La survie sans maladie à 1 an, à 3 ans et à 5 ans a été respectivement de 88 %, de 76 % et de 63 %. L'étude univariée de la survie globale et la survie sans maladie a montré un impact péjoratif de l'atteinte ganglionnaire histologique, de l'engainement péri-nerveux et des limites chirurgicales tumorales (facteurs histo-pronostiques). Dans l'étude multivariée, seuls le stade T, le stade N, l'atteinte sous-glottique, l'atteinte du cartilage thyroïde et le délai de la radiothérapie postopératoire ont présenté un impact significatif sur la survie sans maladie. Aucun facteur n'a présenté d'impact significatif sur la survie globale, en analyse multivariée. L'étude statistique de la récidive n'a montré aucun facteur prédictif. Conclusion: Le stade tumoral et les facteurs histo-pronostiques sont les 2 facteurs pronostiques majeurs. Dans la littérature, Les principaux facteurs prédictifs de récidive sont: le stade tumoral, les limites chirurgicales tumorales et l'extension extra-nodale. Dans notre étude, aucun facteur prédictif n'a été trouvé.

L'actinomycose en ORL : à propos de 7 cas

Objectif :L'actinomycose est une infection rare due à une bactérie anaérobie à Gram positif saprophyte des cavités naturelles de l'homme. Le but de ce travail est d'illustrer les difficultés diagnostiques de cette pathologie et de montrer l'importance de l'examen anatomopathologique dans ce cadre.Matériel et méthodes :Il s'agit d'une étude rétrospective de 7 cas d'actinomycose colligés entre les années 1998 et 2015.Résultats :L'étude a intéressé 4 femmes et 3 hommes d'âge moyen de 42 ans (16 à 70 ans). Tous les patients n'avaient pas d'antécédents odontogéniques ni traumatiques. Les localisations étaient nasopharyngées dans 4 cas et sub-mandibulaires dans 3 cas. La symptomatologie était peu spécifique. Une rhinorrhée purulente était notée dans 3 cas, une obstruction nasale bilatérale dans 2 cas, une haleine fétide dans 1 cas et une anosmie dans 1 cas. Le motif de consultation était une tuméfaction submandibulaire dans 3 cas. L'échographie et le scanner n'ont pas aidé au diagnostic positif d'actinomycose. L'examen bactériologique était négatif dans tous les cas. Le diagnostic préliminaire d'actinomycose n'a été évoqué par notre équipe dans aucun cas. Le diagnostic était confirmé en postopératoire par l'examen anatomopathologique d'un prélèvement biopsique dans tous les cas. Il avait mis en évidence des grains actinomycosiques. L'évolution était dans tous les cas favorable après un traitement à base de pénicilline G associé à la chirurgie.Conclusion :L'actinomycose peut prendre des aspects trompeurs prêtant à confusion avec des affections tumorales ou infectieuses à pyogènes. Aucune imagerie ne peut fournir des informations spécifiques pour le diagnostic. Les résultats négatifs des examens bactériologiques doivent être interprétés avec prudence. L'examen anatomopathologique est d'un grand apport pour poser le diagnostic

Limited beneficial effects of piceatannol supplementation on obesity complications in the obese Zucker rat: gut microbiota, metabolic, endocrine, and cardiac aspects

Resveratrol is beneficial in obese and diabetic rodents. However, its low bioavailability raises questions about its therapeutic relevance for treating or preventing obesity complications. In this context, many related natural polyphenols are being tested for their putative antidiabetic and anti-obesity effects. This prompted us to study the influence of piceatannol, a polyhydroxylated stilbene, on the prevention of obesity complications in Zucker obese rats. A 6-week supplementation was followed by the determination of various markers in plasma, liver, adipose tissue and heart, together with a large-scale analysis of gut microbiota composition. When given in doses of 15 or 45 mg/kg body weight/day, piceatannol did not reduce either hyperphagia or fat accumulation. It did not modify the profusion of the most abundant phyla in gut, though slight changes were observed in the abundance of several Lactobacillus, Clostridium, and Bacteroides species belonging to Firmicutes and Bacteroidetes. This was accompanied by a tendency to reduce plasma lipopolysaccharides by 30 %, and by a decrease of circulating non-esterified fatty acids, LDL-cholesterol, and lactate. While piceatannol tended to improve lipid handling, it did not mitigate hyperinsulinemia and cardiac hypertrophy. However, it increased cardiac expression of ephrin-B1, a membrane protein that contributes to maintaining cardiomyocyte architecture. Lastly, ascorbyl radical plasma levels and hydrogen peroxide release by adipose tissue were similar in control and treated groups. Thus, piceatannol did not exhibit strong slimming capacities but did limit several obesity complications (AU)

No disponible

Limited beneficial effects of piceatannol supplementation on obesity complications in the obese Zucker rat: gut microbiota, metabolic, endocrine, and cardiac aspects.

Resveratrol is beneficial in obese and diabetic rodents. However, its low bioavailability raises questions about its therapeutic relevance for treating or preventing obesity complications. In this context, many related natural polyphenols are being tested for their putative antidiabetic and anti-obesity effects. This prompted us to study the influence of piceatannol, a polyhydroxylated stilbene, on the prevention of obesity complications in Zucker obese rats. A 6-week supplementation was followed by the determination of various markers in plasma, liver, adipose tissue and heart, together with a large-scale analysis of gut microbiota composition. When given in doses of 15 or 45 mg/kg body weight/day, piceatannol did not reduce either hyperphagia or fat accumulation. It did not modify the profusion of the most abundant phyla in gut, though slight changes were observed in the abundance of several Lactobacillus, Clostridium, and Bacteroides species belonging to Firmicutes and Bacteroidetes. This was accompanied by a tendency to reduce plasma lipopolysaccharides by 30 %, and by a decrease of circulating non-esterified fatty acids, LDL-cholesterol, and lactate. While piceatannol tended to improve lipid handling, it did not mitigate hyperinsulinemia and cardiac hypertrophy. However, it increased cardiac expression of ephrin-B1, a membrane protein that contributes to maintaining cardiomyocyte architecture. Lastly, ascorbyl radical plasma levels and hydrogen peroxide release by adipose tissue were similar in control and treated groups. Thus, piceatannol did not exhibit strong slimming capacities but did limit several obesity complications.

[Neurofibromatosis type 1 revealed by malignant peripheral nerve sheath tumor]. / Tumeur maligne des gaines nerveuses périphériques révélant une neurofibromatose type 1.

UNLABELLED: Neurofibromatosis type 1 or Von Recklinghausen's disease is an affection with variable clinical expression. Malignant transformation is rare and dangerous. OBJECTIVE: The aim of this work is to study diagnostic criterias as well as treatment of this malignant transformation. CASE REPORT: Sixteen years old patient presented with gradually progressive basicervical mass without compression nor dysthyroidy signs. Physical examination revealed a painless, hard and well limited mass measuring 4 cm. It was located in front of sternal manuhrium and associated to multiples "café au lait" spots, iris Lisch nodules and generalized neurofibromas. This mass was excised by cervical surgery. The histological exam concluded to a low grade malignant peripheral nerve sheath tumour Unfortunately despite a larger reoperation including resection of the manubrium, the limit of this excision were not safe. Early recurrence was observed, although treated by surgery, chemotherapy and radiotherapy, the patient died by mediastinal invasion.

[Frontal pneumosinus dilatans associated with multiple cerebral meningioma]. / Pneumosinus dilatans frontal associé à des méningiomes cérébraux multiples.

UNLABELLED: Pneumosinus dilatans is rare. It is defined as an expansion of one of paranasal sinuses. We discuss the etiopathogenic hypothesis of pneumosinus dilatans, its epidemiologic and clinical characteristics, and its therapeutic approaches. OBSERVATION: A man, 50 years old, presented frontal pneumosinus dilatans associated with multiple cerebral meningiomas, one of which was appended in the nasal cavity revealed by frontal deformation and nasal obstruction. CT and MRI confirmed the diagnosis. The patient was operated in the neurosurgery department, via the bicoronal approach, allowing the removal of meningioma and osteodural repair of the skull base. DISCUSSION: Pneumosinus dilatans is a rare pathology with an unknown etiology. It mainly affects the frontal sinus. Its association with cerebral meningioma has been described in the medical literature. Treatment is surgical and is recommended for cases with aesthetic problems.

Cardiac contractile dysfunction in insulin-resistant rats fed a high-fat diet is associated with elevated CD36-mediated fatty acid uptake and esterification.

AIMS/HYPOTHESIS: Changes in cardiac substrate utilisation leading to altered energy metabolism may underlie the development of diabetic cardiomyopathy. We studied cardiomyocyte substrate uptake and utilisation and the role of the fatty acid translocase CD36 in relation to in vivo cardiac function in rats fed a high-fat diet (HFD). METHODS: Rats were exposed to an HFD or a low-fat diet (LFD). In vivo cardiac function was monitored by echocardiography. Substrate uptake and utilisation were determined in isolated cardiomyocytes. RESULTS: Feeding an HFD for 8 weeks induced left ventricular dilation in the systolic phase and decreased fractional shortening and the ejection fraction. Insulin-stimulated glucose uptake and proline-rich Akt substrate 40 phosphorylation were 41% (p < 0.001) and 45% (p < 0.05) lower, respectively, in cardiomyocytes from rats on the HFD. However, long-chain fatty acid (LCFA) uptake was 1.4-fold increased (p < 0.001) and LCFA esterification into triacylglycerols and phospholipids was increased 1.4- and 1.5-fold, respectively (both p < 0.05), in cardiomyocytes from HFD compared with LFD hearts. In the presence of the CD36 inhibitor sulfo-N-succinimidyloleate, LCFA uptake and esterification were similar in LFD and HFD cardiomyocytes. In HFD hearts CD36 was relocated to the sarcolemma, and basal phosphorylation of a mediator of CD36-trafficking, i.e. protein kinase B (PKB/Akt), was increased. CONCLUSIONS/INTERPRETATION: Feeding rats an HFD induced cardiac contractile dysfunction, which was accompanied by the relocation of CD36 to the sarcolemma, and elevated basal levels of phosphorylated PKB/Akt. The permanent presence of CD36 at the sarcolemma resulted in enhanced rates of LCFA uptake and myocardial triacylglycerol accumulation, and may contribute to the development of insulin resistance and diabetic cardiomyopathy.

Les surdites brusques idiopathiques : facteurs pronostiques

Introduction : Les surdites brusques idiopathiques (SBI) constituent l'un des sujets les plus debattus en otologie. Plusieurs problemes d'ordre physiopathologiques; therapeutiques et pronostiques restent non resolus. But : Identifier les facteurs pronostiques; cliniques et audiometriques de recuperation auditive apres traitement d'une SBI. Malades : Etude retrospective portee sur 27 malades (29 cas de SBI) traites dans le service d'ORL et chirurgie cervicofaciale du CHU Habib Bourguiba Sfax durant la periode comprise entre les annees 1990 et 2005. Methodes : C'est une etude statistique recherchant une correlation significative entre certains facteurs cliniques et audiometriques et la recuperation auditive. Les facteurs etudies etaient : l'age; l'aspect de la courbe audiometrique; la perte auditive initiale et le delai de prise en charge therapeutique. Resultats : L'age inferieur a 50 ans; la courbe ascendante et la perte auditive inferieure a 70 dB etaient les facteurs de meilleur pronostic. Le delai de prise en charge therapeutique semble avoir peu de role dans la recuperation auditive. Discussion : La majorite des auteurs ont signale que l'age jeune; les surdites legeres ou moyennes; la courbe ascendante et la precocite de la prise en charge sont associes a un meilleur pronostic. Nos resultats rejoignent ceux de Tran Ba Huy qui ne trouve pas de correlation entre le delai de prise en charge therapeutique et le pronostic de recuperation auditive

[Survey of the cycle of reproduction of red algae Gelidium sesquipedale (Turner) Thuret (case of the maritime zone of El Jadida-Jarf lasfer of Morocco)]. / Etude du cycle de reproduction de l'algue rouge Gelidium sesquipedale (Turner) Thuret (cas de la zone maritime d'el Jadida-Jarf lasfer du Maroc).

The industrial exploitation of the agarophyte, Gelidium sesquipedale, is an important part of the economy of Morocco, however the species is in danger of being overexploited. The development of research on the biological cycle of the species enbles a better understanding of environmental influencies on its reproduction periods and of the effect of pulling up on the growth of the thalli. This should assist in helping to avoid excessive collection of the species and to reinforce a period of rest where no collection takes place. The major are of collection supplying industries is the maritime sector of El Jadida - Jarf Lasfar. In order to study the methods of reproduction of G sesquipedale, a first series of experimentation was carried out by the INRH. Studies relating to biology and the effect of pulling up on the biometrics of the thalli of this species were carried out at two stations of the maritime zone El Jadida - Jarf lasfar: Moulay Abdellah and Sidi Bouzid during the period 2000-2002. The results obtained show that the fertile thalli are present all the year with a maximum reproductive activity in winter. The recruitment of the young slings takes place before the winter and occurs more in Sidi Bouzid. The regeneration and the growth of the thalli are carried out in spring and summer. To preserve this resource, it is necessary to put in place a system whereby one zone or area is allowed to rest whilst another area is cultivated for a year; whilst in the following year the rercise occurs.

Cystic echinococcosis in the Berber of the Mid Atlas mountains, Morocco: new insights into the natural history of the disease in humans.

Precise knowledge of the natural history of cystic echinococcosis (CE) in humans remains somewhat arcane. The aim of the present study was to determine whether aspects of the natural history of established human infection with Echinococcus granulosus could be investigated by using a cross-sectional approach, in a community where CE was endemic. A mass ultrasound-screening survey, coupled with a questionnaire to record all previous surgical histories related to CE, was carried out amongst the primarily transhumant Berber people of the Mid Atlas mountains in Morocco. During two periods of intensive screening, of 10 days in May 2000 and 11 days in May 2001, 11,612 people, representing > 98% of the local population, were checked. One hundred and twenty six (1.1%) of the subjects--75 (59.5%) of the 6864 females investigated and 51 (40.5%) of the 4748 males--were found ultrasound-positive for CE. Overall, 14.1% of the CE cases detected were children aged 1-15 years (who made up 44% of the study population). Most (77.4%) of the ultrasound-positive subjects investigated were also found seropositive for CE. The frequency of a past history of surgery for CE increased with subject age (P = 0.024), 125 (1.1%) of the subjects being recorded as having had such surgery. The frequency of surgery for pulmonary CE was relatively constant in all age-groups, indicating that infection can occur at any time. The frequency of abdominal CE increased with age (R2 = 0.8102). Assuming that the incidence of infection remains fairly constant over time and that the longer a person spends in this endemic area the more likely it is that he or she will develop CE, then a progression from active through transitional to inactive CE should occur. The cysts observed by ultrasound in the present study were categorized, as type 1, 2, 3, 4 or 5, according to the new, standardized, ultrasound classification of CE developed by the World Health Organization (WHO). There was a clear exponential decline in the frequency of the various cyst types, from type 1 (the most frequent) to type 5 (the rarest). This decline validates the assumptions made, about the natural history of established CE, by those who developed the WHO's classification. The classification should therefore be invaluable to surgeons and clinicians, when they have to consider treatment options for patients with the various types of CE, and to policy makers trying to establish the economic costs of treating CE in endemic settings.

Public health education/importance and experience from the field. Educational impact of community-based ultrasound screening surveys.

The public health educational impact of community-based ultrasound (US) surveys for cystic echinococcosis (CE) can form an important part of the development about the awareness of the importance of the disease in an endemic area. In addition to identifying asymptomatic carriers and thereby facilitating early diagnosis and treatment, such surveys can be used to impart important educational messages at the individual, household, community, regional and national levels. US surveys are usually appealing to rural communities where such services are not available but where the technique is generally appreciated by its application in a wide field of medical applications. The qualities of the test (painless, non-invasive and gives instant recordable results) are also attractive to participants during such surveys and the majority of the population in a selected study area choose to be screened. Two such surveys were carried out amongst the Berber people of the mid-Atlas mountains in central Morocco in May 2000 and 2001. Over 11,000 people were screened in the two 10-day surveys. Informed consent had been obtained through community meetings and with the chiefs of villages prior to the surveys being conducted. Individuals who volunteered to be screened entered the study and as far as is known there were no refusals. The concept of voluntary participation, the explanation of the life cycle and clinical manifestations of the disease and its prevention are all-important educational messages. The occurrence of CE is almost always known in an endemic community but is usually very poorly understood leading in many cases to a fear of the disease, especially amongst families with an infected individual who has previously undergone surgery. During the US survey considerable attention was paid to provide educational input before, during and after the survey. Information was provided at the start of the survey to local leaders, doctors, veterinarians and school teachers on the aims of the study and to obtain informed consent. At the start of the study everyone was individually schooled about the route of transmission of the parasite and how this may be best prevented. The knowledge level of those screened was assessed by showing hydatid cysts, either freshly obtained from the abattoir of from photographs. Animal cysts were recognised by almost everyone but its transmission and link to human disease was invariably unknown. Patients found to be infected with CE were always confidentially counselled and followed up for treatment, if required. Treatment options were explained to the individual or to parents in the case of a child. Local physicians participated in discussions on the WHO guidelines for the treatment of CE and all cases were fully discussed providing an educational element for the local doctors. The 1% US prevalence found sent an important message to the local politicians and the perceived importance of the disease had an impact at the leadership level. Local leaders made calls for a control programme. The long term educational impact remains to be evaluated as does the role such surveys play in the future collaboration of communities with the implementation of a control programme.

Screening of a large number of dyes for the separation of human immunoglobulin G2 from the other immunoglobulin G subclasses immunoglobulin G2 enrichment on immobilized Procion Yellow HE-4R.

Human immunoglobulins (IgG) are produced on a multi-ton scale for therapeutic applications. There is presently no available method to manufacture IgG preparations enriched with immunoglobulins from the IgG2 subclass although they might be useful for therapeutic purposes. By frontal chromatography, we have screened 69 immobilized dyes, among which, six display a different affinity for IgG2 and other subclasses. One (Procion Yellow HE-4R) was studied further. The screening of various mobile phase conditions allowed us to devise a procedure to prepare IgG2 enriched IgG solutions: The cumulative yield for IgG2 was 43% and IgG2/total IgG ratio in the final product was 67%.

Production and properties of monoclonal antibodies against human IgG isotypes.

Several monoclonal antibodies (MAbs) against human IgG isotypes were obtained by the fusion of myeloma cells with splenocytes from mice immunized with IgG fractions extracted from human plasma. Four MAbs (F7H7, D4F8, B12A8, and E7E10) were selected by an ELISA technique on the basis of their ability to detect one of the four IgG subclasses. Their specificity was checked using a panel of pure myeloma proteins representative of the main allotypes present on IgG isotypes. In addition, two other MAbs (F3E12 and E6D6) were found able to detect specifically kappa or lambda light chains. The immunochemical properties of these MAbs were analyzed mainly in respect to their capacity to detect and to purify the different human IgG isotypes. The following data were obtained: (1) The ability of the MAbs F7H7, D4F8, B12A8, and E7E10 to measure the concentration of each IgG subclass in serum was estimated by an immunocapture ELISA. Results obtained with the new antibodies were compared with several other MAbs recommended by the IUIS/WHO human Immunoglobulins subcommittee. Similar or better results were obtained with the new anti-IgG1, anti-IgG3, and anti-IgG4, MAbs. (2) The same MAbs were tested for their ability to purify a single IgG subclass from IgG preparations and from normal and pathological sera. Fractions containing about 80% of purified IgG1, IgG3, and IgG4 were obtained after one-step immunoaffinity purification. Consequently, these MAbs proved to be useful to detect, to measure and to purify IgG subclasses.

[Laparoscopic surgery of an intraperitoneal intrauterine device]. / Traitement coelio-chirurgical du stérilet intrapéritonéal.

This study involved 13 cases of patients fitted with intra-uterine contraceptive devices which migrated in the abdominal cavity. Laparoscopy enabled localization of the IUCD and full lesion assessment. It was removed by celio-surgery in all 13 cases. Difficulties encountered were due to parietoepiploic adhesions and IUCD impacted in the wall of the rectum.

Chromatography of human immunoglobulin G on immobilized drimarene rubine R/K-5BL. Study of mild, efficient elution procedures.

A range of substances were screened to find eluents for human immunoglobulin G (IgG) which are retained with a strong affinity by immobilized Drimarene Rubine R/K-5BL. The strong affinity of IgG for the dye is partly due to the presence of copper in the dye. This was suggested by the effect of substances able to make coordination bonds with metals that elute the IgG and also the effect of metal stripping from the immobilized dye. Several mobile phase conditions were found that allowed desorption of retained IgG on immobilized Drimarene Rubine R/K-5BL without using a protein denaturant. A procedure was also devised for separating IgG2 from other IgG subclasses using chromatography on immobilized Rubine R/K-5BL and column development with an AMP gradient.