ANEVRISMES GEANTS DE L’ARTERE HYPOGASTRIQUE : DIFFICULTES DE PRISE EN CHARGE THERAPEUTIQUE

The isolated aneurysms of internal iliac artery are rare and present several difficulties of care. Their treatment is often difficult and contains relatively high rates of morbidity and mortality. The giant character complicates the methods of assessment and surgical dissection due in the complexity of the anatomical region and the modifications of marks engendered by the aneurismal mass. Bringing back us to two observations of giants’ aneurisms of the internal iliac artery discovered incidentally on an atypical symptomatology. Both patients were surgically handled with a good evolution. We evoke the variety of the aetiologies of these aneurysms and we discuss the difficulties of their surgical treatment.Les anévrismes isolés de l’artère iliaque interne sont rares et présentent plusieurs difficultés de prise en charge. Leur traitement est souvent difficile et comportent des taux de morbidité et de mortalité relativement élevés. Leur caractère géant complique les modalités de contrôle et de dissection chirurgicale du à la complexité de la région anatomique et les modifications des repères engendrées par la masse anévrismale. Nous rapportons deux observations d’anévrismes géants de l’artère iliaque interne découverts fortuitement sur une symptomatologie atypique. Les deux malades ont été traités chirurgicalement avec une bonne évolution. Nous évoquons la diversité des étiologies de ces anévrismes et nous discutons les difficultés de leur traitement chirurgical

SYNDROME DE L’ARTERE POPLITEE PIEGEE : UNE CAUSE RARE DE CLAUDICATION INTERMITTENTE DU SUJET JEUNE

The syndrome of the trapped pop1ity artery appears in the young adult like a limping of the calf and or foot. Anatomical anomalies relating to insertions of the internai Twin muscle primarily. The diagnosis is suspect on Doppler echography, showing positional compression, change of direction of the poplitée artery, or only the existence of an abnormal fascicule of muscle fibres between artery and poplity vein. Angio IRM can replace the conventional assessment arteriographic. The treatment of extrinsic compression must avoid the constitution of parietal lesions and thromboses if they are installed, the suppression of the anatomical anomaly must be associated a segmentary revascularisation in autogenous venous material. Our patient is a young patient who consulted for an intermittent limping of effort of the right calf. The peripheral pulses were present, just as arterial the Doppler echo and the angio scanner of the hollow poplity showed the insertion of a beam of the internal  twin between the artery and the vein poplity. The arterial échodoppler and the IRM are according to certain authors the only essential examinations with the positive and differential diagnosis of the syndrome of the trapped pop1ity artery and will make it possible to eliminate from other differential diagnoses: pop1ity athéromating and the early athérome, disease of Burger or thromboangéite obliterating, the aneurisms poplities and the cysts adventitiels of the poplity artery. The treatment is always surgical and must be early. It includes/understands the lifting of the trap associated with the need with an arterial gesture of revascularisation. For the authors, the permeability to short and long-term was better for the patients among whom one practised a section of the musculo-tendineux beam being wrong compared to the patient which profited from a gesture of  vascular restoration.Le syndrome de l’artère poplitée piégée se manifeste chez l’adulte jeune comme une claudication du mollet et ou du pied. Les anomalies anatomiques concernant essentiellement les insertions du muscle Jumeau interne. Le diagnostic est suspecté sur l’échographie doppler, montrant la compression positionnelle, le changement de direction de l’artère poplitée, ou seulement l’existence d’un faisceau musculaire anormal entre artère et veine poplitée. L’angio IRM peut remplacer le bilan artériographique conventionnel. Le traitement de la compression extrinsèque doit éviter la constitution de lésions pariétales et de thromboses si elles sont installées, la suppression de l’anomalie anatomique doit être associée à une revascularisation segmentaire en matériel veineux autogène. Notre patient est un malade jeune qui a consulté pour une claudication intermittente d’effort du mollet droit. Les pouls périphérique étaient présents, de même que l’écho doppler artériel et l’angio scanner du creux poplité montraient l’insertion d’un faisceau du jumeau interne entre l’artère et la veine poplité. L’échodoppler artériel et l’IRM sont selon certains auteurs les seuls examens indispensables au diagnostic positif et différentiel du syndrome de l’artère poplitée piégée et vont permettre d’éliminer d’autres diagnostics différentiels : poplitée athéromateuse et l’athérome précoce, maladie de Buerger ou thromboangéite oblitérante, les anévrysmes poplités et les kystes adventitiels de l’artère poplitée. . Le traitement est toujours chirurgical et doit être précoce. Il comprend la levée du piège associé au besoin à un geste de revascularisation artériel. Pour les auteurs, la perméabilité a court et à long terme était meilleure pour les malades chez qui on a pratiqué une section du faisceau musculo-tendineux aberrant par rapport au patient qui ont bénéficié d’un geste de restauration vasculaire

ANEVRISME ROMPU DE L’ARTERE GASTRODUODENALE : HEMOSTASE PAR EMBOLISATION

Aneurysms of the gastroduodenal artery are rare vascular lesions with significantly higher risk of rupture, given the predominance of inflammatory causes. Rupture is frequently the initial symptom, and intraoperative isolation and control of the aneurysm can be difficult, it worsens the prognosis and increases mortality. The endovascular approach with embolization of the aneurysm offers in these cases the possibility of a primary hemostasis and allows secondly evacuation of the hemoperitoine on a stable and a well-prepared patient.We report a 72 year-old women, having benefited of an urgent haemostasis by embolisation of a ruptured gastroduodenal artery aneurysm and a secondary evacuation of her hemopéritoine 48 hours later. It was an embolization in a ruptured digestive artery aneurysm with an anatomic variant, the hepatic artery was arising from the superior mesenteric artery, and it makes all the particularity of this observation. In this paper we recall the diagnostical and etiological aspects of gastroduodenal artery aneurysms, we discuss the difficulties of their treatment and we emphasis the advantages of embolization in management of this type of complication.Les anévrismes de l'artère gastroduodénale sont des lésions vasculaires rares, la rupture en est un risque réel, il est significativement augmenté par la nature inflammatoire dominante de leurs étiologies. La rupture est un mode de révélation fréquent et souvent inaugurale, elle rend le contrôle chirurgical de l’artère gastroduodénale difficile, aggravant ainsi le pronostic et augmentant le taux de mortalité. L’approche endovasculaire par embolisation offre la possibilité d’une hémostase primaire en urgence et permet de reporter l’évacuation de l’hemopéritoine dans un deuxième temps sur un malade stable et bien préparé.Nous rapportons l'observation d'une femme de 72 ans, ayant bénéficiée d’une hémostase par embolisation d’un anévrisme rompu de l‘artère gastroduodénale en urgence et d’une évacuation secondaire de son hemopéritoine 48 heures après. Cette observation rapporte le cas d’une embolisation sur un anévrisme rompu d’une artère digestive avec une variante anatomique réalisée par l’artère hépatique qui nait de l’artère mésentérique supérieure, cela fait toute la particularité de cette observation. Dans ce travail nous rappelons les aspects diagnostic et étiologiques des anévrismes de l’artère gastroduodénale, nous discutons les difficultés de leur prise en charge en cas de rupture et nous mettant le point sur les avantages de l’embolisation primaire à visée hémostatique

Implantable Cardioverter-Defibrillator Implantation in a Patient with Atrial Standstill

We report a 55-year-old female patient who presented with no P waves but with a wide QRS complex escape rhythm at 44 beats/min and prolonged QTc of 0.55 seconds on ECG. The patient had recurrence of ventricular fibrillations and loss of consciousness, and underwent defibrillation and cardiopulmonary resuscitation (CPR) several times because of cardiac arrest. The transthoracic echocardiography showed dilated cardiomyopathy and enlargement of both atria. The Doppler echocardiography documented the absence of A wave in the tricuspid and mitral valve flow. An electrophysiologic study demonstrated electrical inactivity in the right and left atria. Atrial pacing with maximum output did not capture the atria. These findings together with her electrocardiographic finding indicated atrial standstill. Sudden cardiac death was her first clinical manifestation of ventricular arrhythmia. The patient remained asymptomatic after receiving a single chamber implantable cardioverter-defibrillator (ICD) with VVI pacemaker function

Concentration-dependent organization of DNA by the dinoflagellate histone-like protein HCc3

The liquid crystalline chromosomes of dinoflagellates are the alternative to the nucleosome-based organization of chromosomes in the eukaryotes. These nucleosome-less chromosomes have to devise novel ways to maintain active parts of the genome. The dinoflagellate histone-like protein HCc3 has significant sequence identity with the bacterial DNA-binding protein HU. HCc3 also has a secondary structure resembling HU in silico. We have examined HCc3 in its recombinant form. Experiments on DNA-cellulose revealed its DNA-binding activity is on the C-terminal domain. The N-terminal domain is responsible for intermolecular oligomerization as demonstrated by cross-linking studies. However, HCc3 could not complement Escherichia coli HU-deficient mutants, suggesting functional differences. In ligation assays, HCc3-induced DNA concatenation but not ring closure as the DNA-bending HU does. The basic HCc3 was an efficient DNA condensing agent, but it did not behave like an ordinary polycationic compound. HCc3 also induced specific structures with DNA in a concentration-dependent manner, as demonstrated by atomic force microscopy (AFM). At moderate concentration of HCc3, DNA bridging and bundling were observed; at high concentrations, the complexes were even more condensed. These results are consistent with a biophysical role for HCc3 in maintaining extended DNA loops at the periphery of liquid crystalline chromosomes

Concentration-dependent organization of DNA by the dinoflagellate histone-like protein HCc3

The liquid crystalline chromosomes of dinoflagellates are the alternative to the nucleosome-based organization of chromosomes in the eukaryotes. These nucleosome-less chromosomes have to devise novel ways to maintain active parts of the genome. The dinoflagellate histone-like protein HCc3 has significant sequence identity with the bacterial DNA-binding protein HU. HCc3 also has a secondary structure resembling HU in silico. We have examined HCc3 in its recombinant form. Experiments on DNA-cellulose revealed its DNA-binding activity is on the C-terminal domain. The N-terminal domain is responsible for intermolecular oligomerization as demonstrated by cross-linking studies. However, HCc3 could not complement Escherichia coli HU-deficient mutants, suggesting functional differences. In ligation assays, HCc3-induced DNA concatenation but not ring closure as the DNA-bending HU does. The basic HCc3 was an efficient DNA condensing agent, but it did not behave like an ordinary polycationic compound. HCc3 also induced specific structures with DNA in a concentration-dependent manner, as demonstrated by atomic force microscopy (AFM). At moderate concentration of HCc3, DNA bridging and bundling were observed; at high concentrations, the complexes were even more condensed. These results are consistent with a biophysical role for HCc3 in maintaining extended DNA loops at the periphery of liquid crystalline chromosomes

Link between Intestinal CD36 Ligand Binding and Satiety Induced by a High Protein Diet in Mice

CD36 is a ubiquitous membrane glycoprotein that binds long-chain fatty acids. The presence of a functional CD36 is required for the induction of satiety by a lipid load and its role as a lipid receptor driving cellular signal has recently been demonstrated. Our project aimed to further explore the role of intestinal CD36 in the regulation of food intake. Duodenal infusions of vehicle or sulfo-N-succinimidyl-oleate (SSO) was performed prior to acute infusions of saline or Intralipid (IL) in mice. Infusion of minute quantities of IL induced a decrease in food intake (FI) compared to saline. Infusion of SSO had the same effect but no additive inhibitory effect was observed in presence of IL. No IL- or SSO-mediated satiety occurred in CD36-null mice. To determine whether the CD36-mediated hypophagic effect of lipids was maintained in animals fed a satietogen diet, mice were subjected to a High-Protein diet (HPD). Concomitantly with the satiety effect, a rise in intestinal CD36 gene expression was observed. No satiety effect occurred in CD36-null mice. HPD-fed WT mice showed a diminished FI compared to control mice, after saline duodenal infusion. But there was no further decrease after lipid infusion. The lipid-induced decrease in FI observed on control mice was accompanied by a rise in jejunal oleylethanolamide (OEA). Its level was higher in HPD-fed mice than in controls after saline infusion and was not changed by lipids. Overall, we demonstrate that lipid binding to intestinal CD36 is sufficient to produce a satiety effect. Moreover, it could participate in the satiety effect induced by HPD. Intestine can modulate FI by several mechanisms including an increase in OEA production and CD36 gene expression. Furthermore, intestine of mice adapted to HPD have a diminished capacity to modulate their food intake in response to dietary lipids

A Combined Synthetic-Fibrin Scaffold Supports Growth and Cardiomyogenic Commitment of Human Placental Derived Stem Cells

Aims: A potential therapy for myocardial infarction is to deliver isolated stem cells to the infarcted site. A key issue with this therapy is to have at one\u27s disposal a suitable cell delivery system which, besides being able to support cell proliferation and differentiation, may also provide handling and elastic properties which do not affect cardiac contractile function. In this study an elastic scaffold, obtained combining a poly(ether)urethane-polydimethylsiloxane (PEtU-PDMS) semi-interpenetrating polymeric network (s-IPN) with fibrin, was used as a substrate for in vitro studies of human amniotic mesenchymal stromal cells (hAMSC) growth and differentiation. Methodology/Principal Findings: After hAMSC seeding on the fibrin side of the scaffold, cell metabolic activity and proliferation were evaluated by WST-1 and bromodeoxyuridine assays. Morphological changes and mRNAs expression for cardiac differentiation markers in the hAMSCs were examined using immunofluorescence and RT-PCR analysis. The beginning of cardiomyogenic commitment of hAMSCs grown on the scaffold was induced, for the first time in this cell population, by a nitric oxide (NO) treatment. Following NO treatment hAMSCs show morphological changes, an increase of the messenger cardiac differentiation markers [troponin I (TnI) and NK2 transcription factor related locus 5 (Nkx2.5)] and a modulation of the endothelial markers [vascular endothelial growth factor (VEGF) and kinase insert domain receptor (KDR)]. Conclusions/Significance: The results of this study suggest that the s-IPN PEtU-PDMS/fibrin combined scaffold allows a better proliferation and metabolic activity of hAMSCs cultured up to 14 days, compared to the ones grown on plastic dishes. In addition, the combined scaffold sustains the beginning of hAMSCs differentiation process towards a cardiomyogenic lineage