A patient with a "good nose".

We report on a 33-year-old man who underwent an odyssey of doctors for investigation of dysphagia. Eventually, a nasopharyngeal mass was found by several otorhinolaryngologists who repeatedly recommended biopsy or excision, because a polyp or fibroma was assumed on nasal endoscopy and MR imaging. However, we finally diagnosed the nasopharyngeal mass to be an ectopic pituitary gland after thorough clinical (cleft lip and palate) and radiological re-examination. Literally, the patient had a "good nose", since he refused manipulations on the nasopharyngeal tumour and assumably prevented inadvertent hypopituitarism. We conclude that biopsy or excision of nasopharyngeal masses should always be considered carefully, especially in patients with facial anomalies.

[Factors associated with the satisfaction of prescribers of blood products in Burkina Faso]. / Facteurs associés à la satisfaction des prescripteurs de produits sanguins labiles au Burkina Faso.

BACKGROUND: The National Blood Transfusion Centre, unique operator of blood transfusion in Burkina Faso is engaged into the quality process according to ISO 9001. Therefore, the assessment of customer satisfaction is a main part of its system. Our study conceives "customer satisfaction" as dependant to the perceived service quality based on SERVQUAL model. OBJECTIVES: To identify factors associated with the satisfaction of blood products prescribers in order to help decision-makers for continuous improvement of services. MATERIAL AND METHODS: We conducted a cross-sectional survey among prescribers of blood components in Ouagadougou, between February 27 and April 30, 2015. We used an anonymous self-administered questionnaire, including 13 items associated to the 5 dimensions of SERVQUAL model. The different satisfaction gaps were calculated and linear regression was used to determine statistical associations with a significance level of 5%. RESULTS: The return rate was 94.5% about the 256 questionnaires distributed. A total of 30% of respondents were satisfied to very satisfied. The overall global gap of satisfaction was -5.74. The product delivery time, the efficacy and safety of blood products, the medical and clinical support, the pro-activity of the communication, the management of blood products reservation and the satisfaction of needs in blood products were the factors associated with the prescribers' satisfaction. CONCLUSION: This first study in blood transfusion services in our context was been useful to assess customer satisfaction and identify the main axes on which targeting priority actions in order to effectively use available resources.

[Role of quality control for improvement of blood components in the Regional Blood Centre of Ouagadougou in Burkina Faso, 2014]. / Apports du contrôle qualité produits finis dans l'amélioration de la qualité des produits sanguins labiles au Centre régional de transfusion sanguine de Ouagadougou (Burkina Faso), 2014.

OBJECTIVES: In Burkina Faso, blood components must comply with national standards. Then, all Transfusion services must implement a quality control process to ensure compliance. Our study aims to establish the main characteristics of blood components of the regional transfusion center of Ouagadougou, and evaluate the capability of this center to improve its manufacturing process. METHODS: We conducted from marsh to December 2014 a pre-post study, assessing blood components' characteristics before and after the implementation of a six months' improvement plan. The assessed parameters were: volume, hematocrit (Ht) and hemoglobin (Hb) levels in RBCs; volume and the number of platelets in PPCs; and volume and concentration of clotting factor VIII in fresh frozen plasma (FFP), respectively. Three hundred and twelve RBCs and 280 PCs were randomly selected for the first series of controls, and 215 RBCs, 54 PCs and 60 FFP were selected for the second series of controls. We compared the mean values of the components parameters and the overall non-compliance rates for each series. RESULTS: The average Hb level of RBCs was respectively 47.8±8.9g and 54.7±7.2g in the first and second series compare to a standard of≥40g. Non-compliance rates of Hb level decreased significantly from 17.6% to 1.4%. For PCs units, the mean number of platelets was 0.14±0.10×1011 and 0.30±0.15×1011 in the first and second period compare to a standard of 0.5×1011. Non-compliance rates for platelets number were high 97.1% and 72.2%. CONCLUSION: The study demonstrates that only RBCs complied with national standards. The study also demonstrates the capability of CRTSO to improve blood components' processing even if for PCs and FFP, NC rates remain high. QC must be maintained and expanded to the others regional blood centers of the country.

Residual risk of HIV, HVB and HCV transmission by blood transfusion between 2002 and 2004 at the Abidjan National Blood Transfusion Center.

The assessment of the viral residual risk from blood products is an assessment indicator of the quality management system and of the availability process of these products. Assessments of HIV, HBV and HCV viruses transmission risks through blood transfusion are calculated after the setting of a quality approach at the Abidjan NBTC. The method used estimates the risk of a donation made during a period immunologically silent. The residual risks for HIV, HBV, and HCV viruses have been estimated by multiplying the incidence rate for 100,000 people per year by the respective durations of the serological windows. The data received from the Abidjan Center's information processing system (Progesa 4.4d of MAK SYSTEM) go from 2002 to 2004 period. The residual risks are 1/5780 donations for HIV and 1/406 donations for the HCV, then 1/383 donations for the HBV. The residual risk for the HIV is almost four times reduced compared to that of 1997. The results show not only the importance of the transmission risk of HIV, HBV and HCV viruses through blood products, but also the necessity to set a quality management system in endemic countries of Sub-Saharan Africa.

Liver dysfunction in allogeneic bone marrow transplantation recipients.

Liver dysfunction is common in allogeneic bone marrow graft recipients, but no systematic studies of pre- and posttransplantation liver biopsies have been performed to identify and compare hepatic lesions. This study involved 25 consecutive patients who had undergone serial viral screening tests, liver tests, and pre- and posttransplantation liver biopsy. The aims were to ascertain the origin of liver disorders prior to bone marrow transplantation, to determine the mechanism and severity of liver dysfunction occurring early after transplantation, and to identify a possible relationship between pre-existing liver lesions and the frequency and nature of early liver dysfunction after transplantation. Pretransplantation biochemical liver tests were abnormal in 72% of patients, despite the absence of clinical liver disease. Eleven patients had chronic viral hepatitis B or C. Mild or moderate histological lesions were present in all the patients, with bile duct abnormalities in 48%, central vein abnormalities in 24%, sinusoidal fibrosis in 52%, portal fibrosis in 88%, portal necrosis in 52%, and parenchymal siderosis in 76%. After transplantation, fatal veno-occlusive disease occurred in two patients and biochemical abnormalities occurred in 24. Coded review of needle biopsy specimens failed to provide a single diagnosis. Histological lesions differed between pre- and posttransplantation biopsy specimens only by increased iron overload (96%, P<0.01). We conclude that pretransplant liver lesions contribute to hepatic dysfunction early after bone marrow transplantation, being very similar in nature and degree to lesions observed posttransplantation.

In vitro evaluation of a mechanical injector for infusion of magnetic resonance contrast media.

The authors evaluated the performance of a prototype mechanical injector developed for infusion of magnetic resonance (MR) contrast media. The injector was installed in a 0.6-T clinical MR scanner, and evaluation was made using saline (viscosity: 1.0 cP) and gadopentetate dimeglumine (viscosity: 4.9 cP) with 16-, 21-, and 25-gauge needles, and 244- and 366-cm connecting tubing. At a fixed flow rate of 1 mL/second, volume infused was within 10% of the desired volume except for infusions less than 1 mL. Reproduction of flow rates was less reliable. With saline, maximal flow rates were 5.5 mL/second, 4.2 mL/second, and 1.1 mL/second for the 16-, 21-, and 25-gauge needles, respectively, and 3.7 mL/second, 2.4 mL/second, and 0.9 mL/second, respectively, for gadopentetate dimeglumine. Needle size was identified as the major factor limiting flow rate. The magnet was reshimmed after the injector was installed, and no deleterious effects were identified on gradient echo (TR: 250/TE:18/flip angle 60 degrees) MR images.

A case of Erdheim-Chester disease with orbital involvement.

The Erdheim-Chester disease is a rare idiopathic, systemic, histiocytic disorder. To our knowledge, ocular involvement has been reported in only 16 cases. We describe a 55-year-old man who had symmetrical exophthalmos and several skin nodules on the arms and trunk. A magnetic resonance imaging scan confirmed the presence of bilateral, intraconal, retrobulbar tumors. An examination of the histopathologic features of orbital and skin biopsy specimens revealed xanthogranulomatous infiltrate with Touton giant cells. Further systemic investigations showed bone and retroperitoneal involvement. Three years later, multiple eyelid xanthelasmas developed in the patient. These findings are consistent with the diagnosis of the Erdheim-Chester disease. The patient's condition is stable under therapy with low-dose corticosteroids. His survival is longer than usually described in the literature.

Neuroimaging findings in a patient recovering from global alexia to spelling dyslexia.

The authors report findings in a 67-year-old right-handed man who had an ischemic infarct in the territory of the left posterior cerebral artery. The clinical manifestation consisted mainly of total alexia without agraphia. The patient gradually recovered, subsequently showing the syndrome of spelling dyslexia. Cerebral MR-images revealed a circumscript infarction of medial and basal parts of left temporal lobe. In the acute stage [99mTc]HM-PAO SPECT was characterized by a diminished uptake in the definitely infarcted area and hyperfixation in the region of the left forceps major. Because high retention of HM-PAO indicates potentially salvageable tissue after an ischemic event, the depicted area might be correlated with the recovery of function. Thus, the authors' neuroimaging data give further support to the assumption that the left forceps major is a critical area for global alexia, whereas spelling dyslexia is due to involvement of the left medio-basal temporal lobe.

Screening blood donations for hepatitis C in Central Africa: analysis of a risk- and cost-based decision tree.

Four screening strategies (no testing, HC Abbott, HC Pasteur, and a combined test) for the detection of hepatitis C virus (HCV) antibody in donated blood were considered in a formal decision tree. Decision criteria included residual risk of infection and overall monetary cost. Tree parameters were determined using data from the Central African Republic. The prevalences observed among blood donors for HIV infection, hepatitis B, syphilis, and hepatitis C varied between 6% and 15%. The current residual risk of transfusion-transmitted infections is very high (8.4%). Screening for HCV would bring that risk down to about 3% with either the HC Pasteur, the HC Abbott, or the combined test. Even though baseline analysis gives preference to the HC Abbott test (the combined test coming out last), Monte Carlo sensitivity and uncertainty analyses showed that Abbott's and Pasteur's tests are interchangeable, on the basis or either risk or cost considerations.

[The computer tomographic diagnosis of echinococcosis (author's transl)]. / Zur computertomographischen Diagnostik der Echinokokkose.

The computer tomographic appearances and differential diagnosis in 22 patients with echinococcosis are described; of these, twelve were of the cystic and ten of the alveolar type. The computer tomographic appearances are characterised by the presence of daughter cysts (66%) within the sharply demarkated parasitic cyst of water density. In the absence of daughter cysts, a definite aetiological diagnosis cannot be made, although there is a tendency to calcification of the occasionally multiple echinococcus cysts. The computer tomographic appearances of advanced alveolar echinococcosis are characterised by partial collequative necrosis, with calcification around the necrotic areas (90%). The absence of CT evidence of partial necrosis and calcification of the pseudotumour makes it difficult to establish a specific diagnosis. The conclusive and non-invasive character of the procedure and its reproducability makes computer tomography the method of choice for the diagnosis and follow-up of echinococcosis.

[Self assessment tools]. / Grilles d'auto-évaluation.

Self assessment tools are an integral part of quality process and are involved in developing a quality assurance program. Improvements is becoming a necessity for the new international standards Iso 9001. After the evaluation of the situation and the measure of the results, the improvement developing program results from self assessment. This article intends to provide a better understanding of self assessment processing. The first part presents the technique used for the elaboration of the questionnaire in relation with 'good transfusion practices' and the tools used to identify opportunities for quality improvement. The involvement of the whole staff is the key for the efficiency of appropriate action. The second part presents how these tools can be applied in blood transfusion organisation and in some specific applications.

[Why remove leukocytes from labile blood products in 1995?]. / Pourquoi déleucocyter les produits sanguins labiles en 1995?

During the last 15 years, the techniques to prepare leukocyte-poor cellular blood components greatly improved, as well as our knowledge about the role of leukocytes in many adverse effects of transfusion. These two facts favor the extension of indication of leukocyte-poor blood components. Leukocytes in blood components may be detrimental to their storage, due to their metabolic needs and to their progressive lysis, leading to the release of cytokines. Leukocytes are the exclusive vector in blood of CMV and HTLV viruses. Leukocytes are a key element of the immune modifications induced by transfusion. HLA alloimmunization is favored by the transfusion of large quantities of leukocytes HLA different from the recipient whose immune functions are intact. Conversely, the risk of transfusion associated graft versus host disease is dependent of the transfusion of mature T lymphocytes sharing a partial identity with the recipient, and/or an immune deficient status of the recipient. Between these two extremes, many other effects related to the presence of leukocytes in cellular blood components, as are the transfusion effect observed in transplant recipients, the increased risk for bacterial infection after transfusion, the increased risk for tumor recurrence or the reactivation of virus infections, remain to be fully understood. Despite recent significant improvements, further studies, experimental as well as clinical, will be needed to expand the indications of leukocyte-poor blood components.

[Labile blood products from donors immunized against the HLA system. Apropos of a case of transfusional pulmonary edema]. / Produits sanguins labiles provenant de donneurs immunisés dans le système HLA. A propos d'un cas d'oedème pulmonaire lésionnel.

A case of transfusion-related acute lung injury (TRALI) due to HLA antibodies present in one unit of packed red blood cells led us to discuss the screening of HLA antibodies for female donors having been pregnant, and the use of labile blood products.

[Acquired disorder of thirst perception with intact osmoregulation of vasopressin]. / Erworbene Störung des Durstempfindens bei intakter Osmoregulation des Vasopressins.

We report a 45 y old male patient with severe hypodipsia, but intact vasopressin secretion and maximal renal response to vasopressin. The patient presented during hot summer days, 18 months after a frontal lobe hemorrhage due to a ruptured aneurysm, with severe hypernatremia (171 mmol/L) and a plasma osmolality of 348 mosm/kg. He was awake and had no interest in fluid intake. After initial correction, a thirst test for 36 hours was performed. Plasma osmolality rose from 295 to 320, urine osmolality rose from 220 to 700 mosm/kg, while plasma vasopressin levels increased more than 3-fold. Throughout the test the patient did not exhibit appreciable thirst. The intact osmoregulation of vasopressin as evidenced by the plasma levels and the elicited renal response, indicates that a selective acquired disturbance of thirst is present. Whether the thirst center is destroyed or/and thirst recognition (frontal lobe affection) is disturbed primarily, can not be decided.

[Rectal pocket syndrome after stapled haemorrhoidopexy]. / Rectal-Pocket-Syndrom nach Stapler-Hämorrhoidopexie.

We report the case of a 41-year-old female patient who presented in the emergency department with recurrent pain in the lower abdomen 3 years after haemorrhoidopexy (Longo's procedure). At clinical examination a space-occupying mass between the rectum and the vagina was present which was identified as a stool-loaded diverticulum of the rectum by magnetic resonance imaging. Using a perineal approach the diverticulum could be excised at its base and the defect of the mucosa was closed transanally with sutures. A diverticulum of the rectum is a rare complication (2.5%) after stapled haemorrhoidopexy. In the diagnostic of complications after Longo's haemorroidopexy the MRI constitutes an excellent auxiliary modality.