Diverticule de Zenker à propos de 6 observations

Introduction : Le diverticule de Zenker est une pathologie acquise rare qui touche surtout le sujet âgé. Il peut être à l’origine de sérieuses complications pulmonaires.Matériel et méthodes : il s’agit d’une étude rétrospective à propos de 6 patients opérés pour diverticule de Zenker au service d’ORL Farhat Hached de Sousse sur une période de 15 ans (1996-2010).Résultats : Le symptôme majeur était la dysphagie. L’âge moyen était de 64 ans. Les six patients étaient opérés par voie de cervicotomie. Les suites opératoires immédiates étaient bonnes. Un seul patient a  développé une sténose oesophagienne.Conclusion : Le diverticule de Zenker est une pathologie rare qui touche le sujet âgé. Le tableau clinique est peu spécifique. Son diagnostic positif est confirmé par le transit pharyngo-oesophagien. La cervicotomie ainsi que l’endoscopie représentent les deux modalités thérapeutiques possibles. La diverticulectomie avec myotomie trans-muqueuse reste le traitement de choix pour le sujet jeune. Cependant le traitement endoscopique reste une bonne alternative chez le sujet âgé à haut risque chirurgical.Mots clés : diverticule de Zenker, dysphagie, myotomie

Adenome pleomorphe des glandes salivaires accessoires

Objective : Pleomorphic adenoma (PA) is the most common benign neoplasm of the minor salivary glands. Clinical behavior,diagnosis, treatment modalities and evolution of nine cases of pleomorphic adenoma were discussed.Materials and methods : This is a descriptive and retrospective study about 9 cases of pleomorphic adenoma conductedover a period of 20 years (1990 à 2009) at the ENT department of Sousse (Tunisia).Results : There were 5 men and 4 women having a mean age of 40 years. The main site of this adenoma was the hard palate. The others 3 tumors were seen in the nasal cavity, in the parapharyngeal space and in cervical soft tissues. Clinical examination showed a swelling at the level of the interested region. Computed tomography (CT) was made in 5 cases,associated to the magnetic resonance imaging (MRI) in 2 cases. The treatment was based in surgical excision of the tumors. Histologically, the tumor showed features of a benign PA in 8 cases and of malignant PA in 1 case. Two patients had a documented local recurrence. The evolution was good for the first patient after secondary excision of the tumor.The patient presenting a carcinoma ex pleomorphic adenoma developed quickly pulmonary and cerebral metastases.Conclusion : Pleomorphic adenoma of minor salivary gland is generally known to be a slow-growing tumour. They must be evoked before all painless swelling in the upper aerodigestive tract developed under a healthy mucosa. The surgical management is basically total resection of the tumor with a safety margin of 5 mm. Longer follow-up was needed due to the possibility of recurrences and malignancy transformation.Keywords : Pleomorphic adenoma, Minor salivary gland, Imaging

Mucormycose Otocerebrale: À Propos D\'un Cas

La mucormycose est une affection mycosique rare mais souvent fatale, survenant sur des terrains débilités. Elle est due à la prolifération de champignons cosmopolites de la famille de mucorales. Elle entraîne des lésions délabrantes et extensives des parties molles avec risque de thromboses vasculaires. Observation : nous rapportons l\'observation d\'une petite fille, âgée de 3 ans , issue d\'un mariage consanguin, hypotrophe, hospitalisée pour otite externe évoluant depuis 3 semaines. La patiente a bénéficié d\'une antromastoidectomie et a été mise sous antibiotiques. Devant une aggravation de l\'état local, avec extension de la nécrose et destruction du conduit auditif externe, une infection mycosique est fortement suspectée, sur un terrain particulier de déficit immunitaire probable. L\'examen parasitologique d\'un prélèvement local a mis en évidence la présence de filaments mycéliens dont la culture a isolé un Rhizopus oryzae, confirmé aussi par l\'étude anatomopathologique. L\'exploration de l\'immunité a mis en évidence un déficit de l\'immunitaire céllulaire.Un traitement par amphotéricine B était mal toléré (choc anaphylactique), l\'évolution spontanée était rapidement défavorable avec une extension locorégionale importante et une thrombophlébite du sinus latéral homolatéral, aboutissement au décés. Conclusion : la localisation oto cérebrale de la mucormycose est exeptionnelle, on doit y penser devant une otite externe maligne sur un terrain particulier. La prise en charge doit être urgente afin d\'augmenter les chances de survie.Mucormycosis is a relatively rare, potentially life-threatening, fungal infection. It occurs predominately in immunocompromised hosts. Vascular invasion, thrombosis and rapid ischemic necrosis of infected tissue are the most characteristic features of this pathology. Early diagnosis and consequently effective treatment are needed to save life in this fatal condition. Report: We report a case of otocerebral mucormycosis occurring in an hypotrophic 3-years old girl suffering from language retardation and chronic diarrhea. Immune system\'s exploration revealed a profound cell-mediated immunity defect. The diagnosis was suspected because of the rapidly extensive necrosis of the external ear conduct, the existence of lateral sinus thrombosis and the resistance to an aggressive antibiotic therapy.The diagnosis was confirmed by identifying Rhizopus oryzae by pathological examination of the necrotic tissue. Treatment by intravenous amphotericin B was certainly lately begun and unfortunately complicated by anaphylactic shock. Because no alternative drug was possible, such as liposomal amphotericin B, the girl rapidly died. Conclusion: Otocerebral mucormycosis is extremely rare.It must be considered when ear lesions are necrotic and rapidly extensive mainly in patients with predisposing conditions. Successful treatment requires tissue excision and early injection of amphotericin B, preferably in its liposomal presentation. Journal Tunisien d\'ORL et de chirurgie cervico-faciale Vol. 16 2006: pp. 42-4

Improving sustainability performance of the Italian professional printers supply chain

Because of excessive use, resources are becoming scarcer and more expensive. This calls for a shift from our current economic model, based on the linear approach of “take, make, consume, dispose”, to the paradigm of circular economy, which maintains the value of products, materials and resources in the economy while eliminating waste. Printers for professional use, which are printers that are sold to public or private organizations, are perfect candidates for the application of circular business models. Since decades, these printers have been rented with a “pay-per-use” business model, where customers do not own the printers but pay depending on utilization. Professional printers’ supply chains are, however, scarcely studied in literature, and little is known on how to reap the full potential of circular business models. Therefore, this research sheds light on the supply chain of these products, discusses strengths and weaknesses of the current situation, and derives suggestions to the sector how to move towards a wider application of circular economy, while reaching higher environmental sustainability performance. To this aim, we conducted 14 interviews with all types of actors in the professional printer supply chain. With the collected data, we could map the whole supply chain and draw conclusions on how to improve circular economy and sustainability performance. Although retailers are key actors in the Italian second-hand market, as they contribute to the collection of products at the end of their lifecycle, the shift to circular economy requires the active involvement of all supply chain actors. Moreover, given that many printers are exported, we advocate high attention to how printers are disposed at the end of their life at global level

Molecular and structural characterizations of lipases from Chlorella by functional genomics

International audienc

Potential of three local marine microalgae from Tunisian coasts for cadmium, lead and chromium removals

International audienc

Isolation, identification and characterization of a new lipolytic Pseudomonas sp., strain AHD-1, from Tunisian soil

International audienc

Zinc biosorption by Dunaliella sp. AL-1: Mechanism and effects on cell metabolism

International audienc

Characterization and Biotechnological Potential of Two Native Marine Microalgae Isolated from the Tunisian Coast

International audienc