[Management and follow-up of antenatally diagnosed primary megaureters]. / Prise en charge et évolution des méga-uretères primitifs de découverte anténatale.

INTRODUCTION AND OBJECTIVES: To study the diagnostic and outcome aspects of antenatally diagnosed primary megaureters and analyse the results of the postnatal medicochirurgical management. PATIENTS AND METHODS: The authors report a retrospective analysis of 12 patients been born between 1998 and 2009 with primary megaureter antenatally diagnosed between 20 and 32weeks of gestation. A postnatal radiological assessment comprising urinary tract ultrasound, DTPA or MAG3 renal scintigraphy, retrograde cystography, DMSA renal scintigraphy and intravenous urography was performed. All the patients were put under urinary antiseptic treatment and followed since the birth. RESULTS: This study comprised nine boys and three girls, all been born at term with normal trophicity. Mean age of antenatal diagnosis of hydronephrosis was 26weeks of gestation. Mean age of definitive postnatal diagnosis was ten months. Left megaureter was seen in five children, right in two cases and five patients had bilateral megaureter comprising a total of 17 renal units of which eight units were non-obstructed/non-refluxing, three units were refluxing, five units were obstructed and one unit was obstructed and refluxing. Megaureter was associated to controlateral ureteropelvic junction obstruction syndrome in one patient and to ipsilateral ureteral duplicity with a superior polar kidney in another case. Renal function was less than 20% in four renal units. The mean follow-up was four years (range : 10months to 11years). Outcome was marked by urinary infections in seven cases of which four patients had non-obstructed/non-refluxing megaureter. Six patients required surgical correction, two for non-obstructed/non-refluxing megaureter complicated with urinary recurring infections, three for obstructed megaureter with severe renal functional deterioration and one patient for bilateral refluxing megaureter grade V. Two other patients required surgical treatment, one for controlateral ureteropelvic junction obstruction syndrome and the other for ipsilateral ureteral duplicity with destroyed superior polar kidney. Mean age at surgery was 22,6months (range : 6 months to 7 years). CONCLUSION: Half of our patients with antenatal diagnosis of primary megaureter required surgical correction. Urinary recurring infections, renal functional deterioration less than 20% and importance of ureteral dilatation with vesico-ureteric reflux grade V were predictive factors for surgery.

[Imaging features of Takayasu's arteritis]. / Imagerie de l'artérite de Takayasu.

Takayasu's arteritis is the most frequent inflammatory arteritis in young patients. It is characterized by the presence of giant cells and typically involves specific vascular sites: aorta and its main branches and pulmonary arteries. Inflammatory arterial involvements leads to stenosis, aneurysm, occlusion and arterial wall thickening. Diagnosis relies mainly on imaging, namely Doppler US, CT, and MRI. The imaging features of this disease are reviewed based on a retrospective review of 36 patients imaged over a 13 year period.

Prenatal diagnosis and prognosis of triple X syndrome: 47, XXX.

Triple X syndrome is a relatively common sex chromosomal abnormality occurring in 0,1% of live-born female infants. Most of these infants have a normal phenotype and only a few cases with 47, XXX karyotype have congenital malformations. We report three cases of triple X syndrome that were diagnosed prenatally by genetic amniocentesis for advanced maternal age and have been observed from birth to age of 3 to 12 years. A description of their growth and development is presented. The birth weight was normal in all patients and one of them had facial dysmorphism with right microphtalmia and auricular septal defect. During the first 2 years of life, the neuromotor development of these infants was not distinguishable from chromosomally normal children. By 3 years of age, two patients have a moderate developmental delay in speech and language. One girl 12-year-old had normal schooling. The diagnosis of the triple X syndrome can be never made because clinical demonstrations are not rather important to arouse the demand of a karyotype. Prenatal diagnosis is often made in front of the advanced maternal age. Expectant parents must be counseled as to the significance of this 47, XXX karyotype and prognostic information must be given.

Robust sensorless vector control of an induction machine using Multiobjective Adaptive Fuzzy Luenberger Observer.

This paper presents an inherent speed estimation scheme associated to the Indirect Field Oriented Control in case of Induction motor sensorless control. Indeed, through the design of a Multiobjective Adaptive Fuzzy Luenberger Observer, the speed sensorless control issue even at low speed, the observer poles' assignment issues and the speed estimation's sensitivity to rotor resistance uncertainties issue are treated concurrently. First of all, the structure of the proposed Takagi-Sugeno adaptive observer is described. Secondly, based on Lyapunov theory, observer gains are designed and a fuzzy speed estimation scheme is provided. The design's objectives consist of minimizing the sensitivity of the proposed observer to rotor resistance uncertainties (using the L2 techniques) and to guarantee a specified observer dynamic performances through a D-stability analysis. The design conditions are formulated into Linear Matrix Inequalities terms. Finally, experiments are conducted to demonstrate the effectiveness of the proposed results regardless of uncertainties in the rotor resistance.

Apolipoprotein B signal peptide polymorphism: distribution and influence on lipid parameters in Tunisian population.

Apolipoprotein B (apo B) is the major protein component of LDL, VLDL and chylomicrons. Numerous polymorphisms of the apolipoprotein B gene have been described. Particularly, the insertion/deletion polymorphism located in the coding part of the signal peptide of apo B, associated with modification of lipid concentrations and the risk of cardiovascular disease, has been reported in the general population. No such study in the Tunisian population has been performed. The aim of our study was to assess the effect of insertion/deletion polymorphism of the apolipoprotein B gene on lipid levels in a sample of the Tunisian population. A total of 458 unrelated subjects (321 men and 137 women) were included. The insertion/deletion polymorphism was determined by electrophoresis on polyacrylamide gels after PCR amplification. The relative frequencies of the Ins and Del alleles were 0.74 and 0.26, respectively. These frequencies were similar to those found in other Caucasian populations. There was no significant difference in serum TC, TG, and HDL-C levels due to the influence of the genotypes. However, significant variation among the three genotypes was seen for LDL-cholesterol (p<0.001) and apo B (p<0.001) levels. Individuals homozygous for the Del allele had higher levels than individuals homozygous for the Ins allele, while individuals heterozygous for both alleles exhibited intermediate levels. When the data were analyzed in men and women separately, a similar effect was seen in both groups. Our results show that distribution of apo B insertion/deletion polymorphism in Tunisians is similar to other Caucasian population and confirm the reported association with serum LDL-cholesterol and apo B concentrations.

[XbaI polymorphism of apolipoprotein B gene in a Tunisian population: alleles frequencies and relationship with plasma lipid parameters]. / Polymorphisme XbaI du gène de l'apolipoprotéine B dans une population tunisienne: fréquences alléliques et relation avec les paramètres lipidiques plasmatiques.

Apolipoprotein B (Apo B) is a component of chylomicrons, low-density lipoproteins (LDL), very low density lipoproteins (VLDL), and intermediate-density lipoproteins (IDL) and is the ligand for the LDL receptor. Thereby, Apo B plays a central role in lipoprotein metabolism and in maintaining the normal homeostasis of serum cholesterol levels. Several Apo B restriction fragment length polymorphisms (XbaI, EcoRI, MspI) have been reported to be associated with variation in lipid levels, obesity and/or coronary artery disease. To date, no data are available on relationship between XbaI Apo B polymorphism and lipid levels in Tunisian population. Here, we report frequencies of the XbaI polymorphism of the Apo B gene and we assess the effect of this polymorphism on lipid and lipoprotein concentrations in Tunisian population. Blood samples from 296 Tunisian individuals (112 women and 184 men, aged 51.4+/-9.6 years), were analysed for total cholesterol, triglycerides, HDL-cholesterol and apolipoproteins A1 and B. In parallel, genotyping by means of polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) was performed. The XbaI polymorphism was associated with differences in plasma cholesterol (p=0.04), triglyceride (p=0.02) and apolipoprotein A1 (p=0.004), individuals with the genotype X1X1 have the lowest mean levels and those with the genotype X2X2 have the highest, with the individuals heterozygous for the polymorphism having intermediate levels. According to sex, the XbaI polymorphism effect was only observed for triglyceride in men. Thus, the results demonstrate an influence of XbaI polymorphism of Apo B gene on serum total-cholesterol, triglycerides and apolipoprotein A1 concentrations among Tunisian population.

Apolipoprotein E polymorphism in the Tunisian population: frequency and effect on lipid parameters.

OBJECTIVES: We determined the frequencies of apolipoprotein E (apo E) gene alleles and examined the association between apo E polymorphism and lipid parameters in a sample of the Tunisian population. DESIGN AND METHODS: Apo E polymorphism was investigated using PCR, and plasma lipid parameters were measured in 122 men and 111 women aged 35 to 87 years. RESULTS: The allele frequencies were epsilon2: 7.3%, epsilon3: 84.6%, and epsilon4: 8.1%. Apo E polymorphism was associated with significant differences (P<0.001) in total cholesterol, apo B and LDL cholesterol in both men and women. epsilon2 carriers had the lowest mean total cholesterol, apo B and LDL-C concentrations, and subjects with the epsilon4 allele had the highest levels. Triglycerides levels increased with the epsilon4 allele, but this did not reach statistical significance. These results remained unchanged after adjustment for age, body mass index, sex, hypertension, diabetes and smoking. However, in obese subjects (BMI>30 kg/m2), TG concentrations were significantly lower in individuals homozygous for the epsilon3 allele compared to those with the alleles epsilon2 or epsilon4. CONCLUSION: In this sample of the Tunisian population, the distribution of apo E gene alleles is similar to that observed in Southern European populations with low prevalence of the epsilon4 allele. Variations in the apo E gene play a role in determining plasma lipid levels. These data also suggest that effects of apo E alleles on lipids levels are partly dependent on environmental variables such as BMI. These findings highlight the importance of the gene/environment interaction on the deleterious effect of obesity on cardiovascular risk factors.

[Homocysteinemia and coronary artery disease: a case-control study in a Tunisian population]. / Homocystéinémie et maladie coronaire: etude cas-témoins dans une population tunisienne.

We have determined the prevalence of hyperhomocysteinemia and tested its relationship with coronary heart disease in Tunisian patients. The study included 70 angiogrphically proven coronary patients and 140 age- and sex-matched healthy subjects. Plasma homocysteine folate and vitamin B12 were analyzed by immunoenzymatic methods. Hyperhomocysteinemia was considered for plasma homocysteine concentration >17 micromol/L. Mean plasma homocysteine concentration and hyperhomocysteinemia prevalence were significantly (p<0.001) higher in patients (16.3 +/- 7.9 micromol/L and 29%) than controls (12.6 +/- 4.0 micromol/L and 10%). The association between hyperhomocysteinemia and coronary heart disease persisted after adjusting on main cardiovascular risk factors (multi adjusted odds ratio, 2.99; 95% CI, 1.18-7.59; p=0.02). No association was observed between hyperhomocysteinemia and coronary disease severity and extent. This study showed an independent association between hyperhomocysteinemia and coronary heart disease, suggesting a role of hyperhomocysteinemia in atherothrombogenesis. However, causal relationship is not yet established. Until results of homocysteine-lowering therapy trials become available, hyperhomocysteinemia should be researched and treated in coronary heart disease patients.

Hellp syndrome: incidence and maternal-fetal outcome--a prospective study.

OBJECTIVE: To determine the incidence of Hellp syndrome (HS) and the maternal fetal outcome associated with its occurrence. DESIGN: A prospective study during a 6-month period. SETTING: The department of obstetrics and gynecology and the Intensive Care Unit of a 700 bed teaching hospital. PATIENTS: Sixty-two consecutive preeclamptic and eclamptic women. MEASUREMENTS AND RESULTS: All patients were systematically investigated for the biological markers of HS. The effects of the occurrence of HS on maternal and fetal prognosis were evaluated by comparing for prognosis indicators usually assessed in gravidic hypertension, pre-eclamptic and eclamptic woman who exhibited HS (HS+ subgroup) with HS free patients (HS- subgroup). HS was found in 12 out of the 62 pre-eclamptic and eclamptic women (19.3%). Its occurrence was associated with higher maternal mortality (16.7% vs 0%; p = 0.03), a greater incidence of eclamptic crisis (50% vs 20%; p = 0.03), severe hypertension (33% vs 8%; p = 0.03) and episodes of acute renal failure (66% vs 30%; p = 0.02). Mean proteinuria was also higher in HS+ patients (4.6 +/- 3.3 vs 2.2 +/- 2.5 g/day; p = 0.001). However, fetal outcome was not significantly altered. CONCLUSION: Pre-eclampsia and eclampsia may be more severe in the presence of HS with a worsening of maternal prognosis while fetal outcome seems not altered.

[Desmoid tumor of the mesentery. An uncommon cause of ureteral obstruction]. / La tumeur desmoïde du mésentère. Une cause exceptionnelle d'obstruction urétérale.

Desmoid tumors are rare lesions with a local invasive potential and a risk of recurrence considered as benign due to the absence of metastases. They are included in fibromatoses and may be associated with Gardner's syndrome. The authors report an unusual case, in a 26 year old man, of a desmoid tumor invading ileon, right colon, appendix and the right ureter and responsible of a ureteral obstruction. Etiologic factors (traumatic, hormonal, auto-immune...) are discussed. The treatment of choice to lower the risk of recurrence is the complete surgical removal of the tumor.

[Color and pulsed Doppler of renal masses. Angiographic and anatomo-pathological correlation]. / Doppler pulsé et couleur des masses rénales. Corrélation angiographique et anatomo-pathologique.

We report the results of a prospective study about the detection of tumoral neovascularization, the renal vein involvement and the characterization of renal tumors by color and pulsed doppler. Twenty-six renal tumors including 19 renal carcinomas and 7 benign tumors (2 angiomyolipomas, 2 oncocytomas, 2 complex cysts and one adenoma) were prospectively explored. Benign cysts were excluded from the study. The results were correlated to pathologic (24/26) and angiographic datas (24/26). Doppler ultrasonography seems to be an accurate method for the detection of a neovascularization (19 true-positives/19 vascularised tumors, no false-positive) but pulsed doppler (no false-negative) is more sensitive than color doppler imaging (3 false-negatives), the results of color doppler were improved by using a new software for the color detection of very low flow. Spectral analysis found 3 different types of doppler curves inside the masses, but all of them were observed in benign and malignant tumors. We did not find any correlation between the size of the tumor and the peak systolic velocity. The specificity of Doppler regarding the renal vein and inferior vena cava involvement seems to be good (no false-positive). But as, in our series, we do not have any case of main renal vein involvement, the sensitivity of this technique cannot be assessed.

[Ultrasonic study of the soft tissues of the hand. I. Study technic and normal anatomy of the palm]. / Exploration ultrasonographique des parties molles de la main. I. Technique d'examen et anatomie normale de la paume de la main.

Ultrasound enables a worthwhile static and dynamic study of the soft tissues of the hand, provided that a high-resolution real-time is used. Accurate examinations are feasible after a several months of training because of the difficulty of the anatomy. The authors, studying 200 normal hands, describe their technique based upon the use of a 7.5 MHz multifocused linear phased-array real-time transducer and the normal ultrasonic anatomy.

[Ultrasonic study of the soft tissues of the hand. II. Tumors and pseudotumors of soft tissues. Preliminary results apropos of 12 surgically treated cases]. / Exploration ultrasonographique des parties molles de la main. II. Tumeurs et pseudo-tumeurs des parties molles. Résultats préliminaires à propos de 12 cas opérés.

Thirty patients underwent a sonographic examination of the hand because of nodular masses. In 12 out of these, the surgical removal exhibited 5 benign tumors (2 giant cell tumors, 1 angioma, 1 lipoma, 1 myoma), 5 pseudo-tumors (1 granulomatous tenosynovitis, 1 nodular tendinitis, 2 sebaceous cysts, 1 synovial cyst) and 2 congenital abnormalities of the lumbrical muscles. Except the lipoma and the nodular tendinitis, all the masses were hypoechoic or anechoic. The major interest of sonography in such a disease is a precise localization of the mass and the description of its connections with the surrounding anatomical structures.

[Ultrasonic study of the soft tissues of the hand. III. Traumatic and inflammatory pathology of the flexor tendons of the fingers]. / Exploration ultrasonographique des parties molles de la main. III. Pathologie traumatique et inflammatoire des tendons fléchisseurs des doigts de la main.

The accuracy of the high-resolution real-time ultrasonic examination of the flexor tendons of the fingers of the hand has been tested on the retrospective study of 27 patients treated surgically. The method is sensitive and specific in the rupture of the tendons (8 cases), except when the latter is partial. Ultrasound enables the discrimination between palmar masses developed extrinsically (8 cases) and those involving the tendons (4 cases). A fluid collection inside the tendon's sheath has been detected in all the 5 cases of tenosynovitis, without false positive. The post-operative follow-up of operated tendons is easier by ultrasound.

[Renal Doppler ultrasonography in the diagnosis of acute obstructions of the upper urinary tract]. / Apport du Doppler rénal dans le diagnostic des obstructions aiguës du haut appareil urinaire.

A comparative study of the resistivity indices (RI) obtained in both kidneys has been carried out in 30 controls and 60 patients with suspected unilateral acute obstruction of the upper urinary tract. Doppler findings (difference in the mean RI of both kidneys, delta RI) in the pathologic population have been systematically correlated to the data yielded by intravenous pyelography (IVP). In the control population delta RI was always < or = 0.03 (mean delta RI = 0.01, SD = 0.01). Considering that an increase in delta RI > or = 0.05 (> mean RI + 3 SD) is significant, 93% sensitivity and 100% specificity are obtained for the diagnosis of unilateral acute obstruction. Comparison of the resistivity indices of both kidneys is more specific and more sensitive than the assessment of the index on the obstructed side only; it improves the performance of ultrasonography in the initial diagnosis of acute urinary tract obstruction.

[Role of MRI in the diagnosis of kidney cancer]. / Place de l'IRM dans le diagnostic du cancer du rein.

The recent technical developments in magnetic resonance imaging (MRI) and the use of paramagnetic contrast media (gadolinium compounds) have considerably improved the performances of MRI for the detection and characterization of renal tumors. MRI does not have specific merits for the diagnosis of the typical form of cancer, nor for the detection of small kidney tumors, both being mainly based on computed tomography (CT). On the other hand, it can be used for the diagnosis of atypical forms of cancers (small, hypovascular, cystic or hemorrhagic cancers) which raise problems of differential diagnosis with some pseudotumoral lesions, complex cysts and benign tumors. Its complementarity to CT for the characterization of an atypical mass results from the signal information it provides, from a better contrast resolution, and from the possibility to make sections in all planes of space. Except for angiomyolipoma, which has a fatty content, there is no really specific MR criterion as present to evidence benign renal tumors. Concerning regional extension, CT remains the primary technique of choice, as it allows studying the limits of the tumor, the renal compartment ans its walls, the renal vein and the inferior vena cava, the neighboring organs and the contralateral kidney all together. Its findings allow defining the indications of MRI, which, as a complementary exploration, is often decisive to assess venous invasion.

[Echography of the flexor tendons of the fingers]. / Exploration échographique des tendons fléchisseurs des doigts de la main.

The accuracy of high-resolution real-time ultrasonic examination of the flexor tendons of the fingers was tested in a retrospective study of 27 patients treated surgically. In ruptured tendons (8 cases) the method proved sensitive and specific, except in cases of partial rupture. Ultrasound made it possible to distinguish between extrinsically developed palmar masses (8 cases) and masses involving the tendons (4 cases). A fluid collection inside the tendon sheath was detected in 5 cases of tenosynovitis, without false-positive results. The post-operative follow-up of surgically treated tendons (2 cases) was easier with ultrasound.

[Prenatal surveillance and determinants of prenatal follow-up in the Monastir health district]. / Surveillance prénatale et déterminants du suivi prénatal dans la circonscription sanitaire de Monastir.

Prenatal monitoring is a prime strategy to improve the end of pregnancy. To estimate the prevalence rate and the conditions determining such a monitoring, the authors carried out a survey on 1190 pregnant women in the Monastir district (Tunisia). The rate of satisfactory monitoring (4 check-up and more) is 45.8 p.c. Age and high parity have a negative influence, but instruction, occupation and a bad out come of the last pregnancy favour a satisfactory prenatal monitoring.

PIP: In Tunisia, a survey was conducted of 1190 women who delivered at the maternity ward of the Fattouma Bourguiba University Hospital Center in Monastir during September 1988 to August 1989 to evaluate, in an Arab-Moslem context, the coverage rate of prenatal care and to identify the determinants of correct prenatal follow-up among users of the central maternity ward. 45.8% of the women received adequate prenatal care (i.e., 4 prenatal visits). 14.4% received no prenatal care. The frequency of adequate prenatal care decreased with age (51.78% for 15-24 years, 45.29% for 25-34 years, and 35.51% for 35 and over; relative risk [RR] = 1.34). Based on occupation, mothers who did not work received the least amount of prenatal care (40.47% vs. 55.63% for moderate profession and 51.76% for superior profession; RR = 1.36). Women who received the least amount of prenatal care were illiterate women (39.89% vs. 53.18% for secondary education and 67.69% for higher education; RR = 1.86). Women whose last pregnancy had a poor outcome (fetal death or miscarriage) were more likely to receive adequate prenatal care than those whose last pregnancy had a good outcome (54.7% vs. 33.6%; RR = 1.47). Women who experienced a medical condition during pregnancy were more likely to receive adequate prenatal care than those who had no such problem (53.7% vs. 45.2%). Primiparous women were more likely to receive adequate prenatal care than multiparous women (55.7% vs. 38.7% for parity 2-4 and 21.7% for parity 5; RR = 1.77). The influence of parity continued even when the researchers controlled for age (p 0.0003).

[Color doppler echography in the exploration of vasculogenic impotence]. / Echographie-doppler couleur dans l'exploration de l'impuissance d'origine vasculaire.

102 patients with suspected vasculogenic impotence were evaluated with color doppler sonography. Measurement of normal systolic and diastolic velocities were obtained from the cavernosal arteries of patients responding by a full erection after intra-cavernosal injection of 20 mg of Papaverine. A correlation with cavernosometry was obtained in 61 patients and with selective internal pudendal arteriography in 11. The 10 patients with abnormal arteriograms had a systolic velocity < 25 cm/sec. 13 out of the 15 patients with an end diastolic velocity > 5 cm/sec had a venous leak defined by a maintenance flow rate of erection during cavernosometry > 25 ml/mn. End diastolic velocity is an excellent index of the function of the veno-occlusive system, provided the systolic velocity remains at a normal value. In case of arterial insufficiency, a diastolic flow < 5 cm/sec is of no value and cavernometry is mandatory to detect a mixed arterio-venous impotence. The addition of color doppler sonography permitted a more rapid detection of vessels and an easily reproducible measurement of velocities which makes color doppler sonography an excellent screening test for examining patients with potential vasculogenic impotence.

[Imaging of renal cancer in adults]. / Imagerie du cancer du rein de l'adulte.

In its typical form renal carcinoma shows at imaging as a solid, heterogeneous and vascularized mass deforming the kidney; its CT scan appearance is usually very suggestive. Atypical forms (small or cystic carcinomas, large carcinomas with exorenal extension, haemorrhagic carcinomas) mainly raise problems of characterization; the lesional image is always suspicious at CT or combined US, CT and MRI examinations. The detection of small tumours primarily rests on CT with contrast injection, a technique which is more sensitive (94%) than all other techniques. Among non-tumoral lesions which may look like renal carcinomas, some pseudotumoral inflammatory lesions and suspicious atypical cysts often require histological examination. With the exception of angiomyolipoma with its fat content detectable at CT or MRI, there is no truly specific criterion to differentiate benign tumour from cancer. The diagnosis of renal carcinoma extension primarily rests on MRI. In a number of cases the results are so inadequate for the study of renal veins and caval vein that a complementary exploration of these veins by Doppler ultrasonography or MRI must be requested.