Retropharyngeal course of the internal carotid artery.

A 77-year-old male patient presented with dysphonia. Endoscopic examination demonstrated a distortion of the posterior pharyngeal wall, which was pulsatile. The axial CT showed left internal carotid artery in a retropharyngeal location. An anomalous course of the carotid artery in the retropharyngeal space is an unusual finding that poses a risk of vascular injury during pharyngeal surgery and intubation. Such an anomaly may be congenital (incomplete descent of the third aortic arch) and may be more pronounced in older patients secondary to atherosclerosis and hypertension as occurred in our case noted here.

Ten years of barcoding at the African Centre for DNA Barcoding.

The African Centre for DNA Barcoding (ACDB) was established in 2005 as part of a global initiative to accurately and rapidly survey biodiversity using short DNA sequences. The mitochondrial cytochrome c oxidase 1 gene (CO1) was rapidly adopted as the de facto barcode for animals. Following the evaluation of several candidate loci for plants, the Plant Working Group of the Consortium for the Barcoding of Life in 2009 recommended that two plastid genes, rbcLa and matK, be adopted as core DNA barcodes for terrestrial plants. To date, numerous studies continue to test the discriminatory power of these markers across various plant lineages. Over the past decade, we at the ACDB have used these core DNA barcodes to generate a barcode library for southern Africa. To date, the ACDB has contributed more than 21 000 plant barcodes and over 3000 CO1 barcodes for animals to the Barcode of Life Database (BOLD). Building upon this effort, we at the ACDB have addressed questions related to community assembly, biogeography, phylogenetic diversification, and invasion biology. Collectively, our work demonstrates the diverse applications of DNA barcoding in ecology, systematics, evolutionary biology, and conservation.

Blast injury of the ear by massive explosion: a review of 41 cases.

BACKGROUND: Blast injuries in modern warfare are common, and the ear is often affected as it is an effective pressure transducer. This study aimed to evaluate military blast injuries of the ear. METHODS: From May 2002 to October 2014, all patients referred to two military hospitals near Paris, France following exposure to massive explosions were analysed. RESULTS: Among the 41 patients (82 ears), 36 of them reported tinnitus, 25 hearing loss, 14 earache and 8 vertigo. It was noted that 44% of the patients had tympanic membrane perforations and that this was bilateral in two-thirds of the cases. The hearing loss in 29% of the cases was pure sensorineural, in 55% it was mixed and in 15% it was a pure conductive hearing loss. There was no correlation between the impact of middle ear lesions and the severity of the inner ear injury. Three patients had a pharyngolaryngeal blast injury detected on the battlefield associated with blast lung injury, but only two of them had tympanic perforations. Nine tympanoplasty procedures were performed, of which 44% succeeded in sealing the perforation. CONCLUSIONS: Blast injuries of the ear are characterised by significant functional signs and are not correlated to otoscopic examinations. Sensorineural hearing loss is almost immediately final. When deciding on initial management, the status of the tympanic membrane does not provide any information about the risk of a primary blast injury of the lung; laryngeal nasofibroscopy seems a more relevant screening test.

Exposing the illegal trade in cycad species (Cycadophyta: Encephalartos) at two traditional medicine markets in South Africa using DNA barcoding.

Species in the cycad genus Encephalartos are listed in CITES Appendix I and as Threatened or Protected Species in terms of South Africa's National Environmental Management: Biodiversity Act (NEM:BA) of 2004. Despite regulations, illegal plant harvesting for medicinal trade has continued in South Africa and resulted in declines in cycad populations and even complete loss of sub-populations. Encephalartos is traded at traditional medicine markets in South Africa in the form of bark strips and stem sections; thus, determining the species traded presents a major challenge due to a lack of characteristic plant parts. Here, a case study is presented on the use of DNA barcoding to identify cycads sold at the Faraday and Warwick traditional medicine markets in Johannesburg and Durban, respectively. Market samples were sequenced for the core DNA barcodes (rbcLa and matK) as well as two additional regions: nrITS and trnH-psbA. The barcoding database for cycads at the University of Johannesburg was utilized to assign query samples to known species. Three approaches were followed: tree-based, similarity-based, and character-based (BRONX) methods. Market samples identified were Encephalartos ferox (Near Threatened), Encephalartos lebomboensis (Endangered), Encephalartos natalensis (Near Threatened), Encephalartos senticosus (Vulnerable), and Encephalartos villosus (Least Concern). Results from this study are crucial for making appropriate assessments and decisions on how to manage these markets.

Endoscopic septoplasty: Learning curve.

AIMS: The aim of the current study was to report the learning curve for endoscopic septoplasty for a senior surgeon already trained in endonasal sinus surgery. MATERIAL AND METHODS: From November 2011 to September 2012, 100 patients were prospectively included and grouped in 5 consecutive groups of 20 by date of surgery. The primary endpoint was operative time. Intra- and postoperative complications and functional assessment were also analyzed. RESULTS: Operative time decreased with the surgeon's experience and became stable after 60 procedures. Operative time saving was about 10min per 20 procedures. Mean operative time was stable between groups 4 (21.1±9.6min) and 5 (19.2±8.2min). There was a 2% rate of conversion to conventional surgery for technical problems. The number of procedures free of accidental mucosal lesion increased and became stable after 40 procedures. There was a 4% rate of residual postoperative perforation. Nasal Obstruction and Septoplasty Effectiveness (NOSE) score improved postoperatively in each group (P<0.05). CONCLUSION: After 60 endoscopic septoplasty procedures, a senior surgeon masters the surgical technique with satisfactory operative times, and a decreasing rate of intra- and postoperative complications.

Endoscopic vs. conventional septoplasty: A review of the literature.

The aim of this review of literature was to compare conventional and endoscopic septoplasty in terms of operating time, functional efficacy and perioperative morbidity. A systematic review of the scientific literature was performed on the PubMed database, Google and Google Scholar, searching for randomized prospective trials comparing endoscopic and conventional septoplasty. The primary endpoint was operating time, and the secondary endpoints were intra- and postoperative complications, postoperative pain, hospital stay and functional result. Twenty-nine articles published between 1991 and 2012 compared conventional and endoscopic septoplasty, five of which were prospective randomized trials. Operating time was shorter with endoscopic surgery (P<0.001), with less mucosal damage (P<0.01); there was less synechia (P<0.01) and residual deformity (P<0.05); and postoperative pain was milder. Endoscopic septoplasty thus shortened surgery time and reduced perioperative complications, but the functional result was the same as with conventional septoplasty.

[Leg ischemia complicating the intraosseous infusion of epinephrine for a Djiboutian child]. / Ischémie de jambe secondaire à une perfusion intra-osseuse d'adrénaline chez une enfant djiboutienne.

Intraosseous infusion is increasingly used as an alternative to intravenous infusion. It is recommended for the cardiac arrest of a child in the first instance and after two failed attempts of intravenous infusion in the cardiac arrest of adults. Its rapid use and its low failure rate justify its use in all life-threatening emergencies. It can be used to administer the same treatments as intravenous infusion. It does, nonetheless, present some rare complications, such as acute leg ischemia by extravasation of epinephrine, as we report here. Awareness of these complications is necessary to ensure compliance with the rules of placing this type of infusion.

[Traumatic neurogenic shock]. / Choc neurogénique traumatique.

Traumatic neurogenic shock is a rare but serious complication of spinal cord injury. It associates bradycardia and hypotension caused by a medullary trauma. It is life-threatening for the patient and it aggravates the neurological deficit. Strict immobilization and a quick assessment of the gravity of cord injury are necessary as soon as prehospital care has begun. Initial treatment requires vasopressors associated with fluid resuscitation. Steroids are not recommended. Early decompression is recommended for incomplete deficit seen in the first 6 hours. We relate the case of secondary spinal shock to a luxation C6/C7 treated in prehospital care.

[Acute myocardial infarction in Djibouti: 2-year prospective study]. / Infarctus du myocarde en phase aiguë à Djibouti : étude prospective sur deux ans.

OBJECTIVES: Acute myocardial infarction (AMI) is a life-threatening emergency. In Africa, the increasing prevalence of cardiovascular risk factors is leading to an epidemiological transition. No data have yet been reported about AMI in Djibouti. PATIENTS AND METHODS: This study prospectively included all patients with acute coronary syndrome and persistent ST segment elevation admitted to the emergency department of Bouffard Military Hospital in Djibouti from January 2009 through December 2010. It analyzed their clinical data and management. RESULTS: The study included 35 patients. Their mean age was 52 ± 11 years [range: 29-76]. The sex ratio was 7.7 (men/women). Cardiovascular risk factors were: hypercholesterolemia (83%), tobacco use (60%), khat chewing (57%), diabetes (49%), hypertension (46%), and heredity (20%). AMI was anterior in 40% of cases. Fifteen patients (43%) arrived within 12 hours after the onset of symptoms (average 5 hours); thrombolysis was successful for 11 of them (73%). Seven patients (20%) died over the entire follow-up (11.3 ± 9 months), 5 within the first month. Mortality was significantly associated with diabetes (p<0.01), initial severe clinical complications (p<0.01) and initial low left ventricular ejection fraction (p<10(-6)). CONCLUSION: Patients with AMI in Djibouti are 10 to 15 years younger than in Western countries. Their high level of cardiovascular risk is remarkable. Khat use did not significantly affect prognosis. The high mortality rate was similar to rates reported before the percutaneous coronary angioplasty era.

[Macroscopic hematuria in an adolescent in Chad]. / Une hématurie macroscopique chez un adolescent au Tchad.

We report the case of a 16-year-old Chadian boy referred for chronic macroscopic hematuria and dysuria, diagnosed as urinary schistosomiasis, contracted while bathing in contaminated fresh water. The diagnostic approach and treatment in light of the limited resources available in Africa are described in detail.

Management of exsanguinating pelvic trauma: Do we still need the radiologist?

BACKGROUND: The hemodynamically unstable pelvic fracture are a diagnostic and therapeutic challenge. The current management is based on the control of pelvic bleeding by combining pelvic ring stabilization and embolization of pelvic arteries. The mortality of these patients, however, exceeds 30%. Recently the preperitoneal packing, based on the hemostatic tamponade of the pelvic cavity has been described. The objective of this study was to evaluate the interest of this new surgical procedure. The effectiveness of the standard algorithm is evaluated by analysis of pelvic injuries in 200 severe trauma treated at the Sainte-Anne Hospital. The results are then compared with literature data on the preperitoneal packing. PATIENTS AND METHODS: The profile injury, management and morbidity and mortality was evaluated in 200 polytrauma. After an initial phase of resuscitation, unstable pelvic fractures were treated with a circumferential belt followed by the application of an external fixator. Arteriography was performed for all patients with persistent hemodynamic instability. RESULTS: The mean injury severity score (ISS) was 31 (4-75). The mean trauma-related injury severity score (TRISS) was 74% (3-99). The proportion of hemodynamically unstable patients was 47%. Fifteen patients (41%) had severe bleeding. The median number of blood transfusion was 10 (4-42); eight patients (22%) underwent embolization. For two patients, reducing the pelvic fracture with an external fixator resulted in permanent hemostasis. Two patients underwent a laparotomy first, for the control of a hemoperitoneum. The mortality rate of the group of patients with hemorrhage was 33% (5/15). DISCUSSION: This high mortality leads to reconsider the place of pelvic embolization as firstline treatment. Some major drawbacks are noted: its effectiveness in treating venous bleeding, availability and duration of the procedure. The preperitoneal packing is a fast and effective surgical alternative. It seems to improve hemodynamic status of patients and significantly reduce the use of embolization and massive transfusion. Embolization is still indicated for patients not responding to surgery. However survival is not significantly improved.

[Obstructive syndrome apnea. Practice study in general medicine]. / Syndrome d'apnées obstructives du sommeil. Étude de pratiques en médecine générale. Une enquête descriptive auprès de 108 praticiens militaires.

INTRODUCTION: The obstructive sleep apnea syndrome (OSA) is a frequently occurring condition, which is becoming a major public health problem because it can be responsible for accidents due to excessive daytime drowsiness and because of associated cardiovascular complications. This study was aimed at testing the practice and knowledge of general practitioners relating to OSA. METHODS: Three hundred and thirty-four French military practitioners were surveyed using a questionnaire sent to them by post. Their results were analysed and compared to previously published data. RESULTS: Hundred and eight (32%) practitioners answered our questionnaire. About half of them (the younger practitioners) were comfortable with the management of this condition. Their knowledge about the risk factors and the symptoms of OSA was good but their knowledge about the physiology and the possible complications of OSA was insufficient. CONCLUSIONS: The results of this study are on the whole better than those previously published, and show that education has had some effect in this area. However, it remains the case that OSA is under diagnosed and a further intensification of efforts are needed to address this.

Prevalence of and risk factors for obstructive syndrome apnea.

INTRODUCTION: Obstructive Sleep Apnea Syndrome (OSAS) is becoming an important public health problem because of its frequency and adverse health consequences. The objective of this prospective study was to evaluate the prevalence of and risk factors for OSA in a cohort of subjects working for the french Army. SUBJECTS AND METHODS: This prospective study was carried out on a sample of volunteers working for the French army. The subjects were recruited at their annual work visit between November 2008 and September 2009. Subjects were asked to complete 2 screening questionnaires (Epworth and Berlin) and were given a medical examination. Subjects suspected of having OSAS (based on high questionnaire scores) were monitored by nocturnal ventilatory polygraphy. OSAS was diagnosed if the subject was found to have an apnea/hypopnea index (AHI) greater than or equal to 5. RESULTS: In this healthy, young and active population (n = 1054), 4.20% of subjects were diagnosed with OSA. Comparing our two groups of subjects (OSA and non-OSA), several statistically significant (p < .05) differences emerged that may be associated with OSA: the individuals with OSA were older by an average of 7 years, they presented with an average BMI greater than 4.5 kg/m2, an average abdominal girth greater than 12.2 cm and an average cervical circumference greater than 2.6 cm. In addition, they consumed more tobacco when they were smokers and were more likely to present with permanent nasal obstruction. They were also more likely to suffer from gastroesophageal reflux and present with skeletal class II. Finally, they presented with a longer average soft palate as determined by the Mallampati scoring system. CONCLUSION: We found that the major risk factors for OSAS were age, BMI, abdominal girth and cervical circumference (linear correlations determined by bi-variate analysis).