An Uncommon Cause of Acute Bowel Obstruction: The Left Para.Duodenal Hernia

Internal hernias of the abdomen are uncommon. They represent less than 1% of bowel obstruction cases. The left Paraduodenal hernia (PH) is the most frequent type of internal hernias. We report a case of 77 year- old woman consulting for bowel obstruction evolving since two days. The abdominal computed tomography revealed a retroperitoneal small bowel contained in a peritoneal sac. The surgical exploration confirmed the diagnosis of a left internal PH by showing incarcerated jejunal loops in a PH through a narrow opening to the left of the angle of Treitz. A surgical reduction of the hernia and closure of the hernia neck were performed. The follow-ups were uncomplicated. Through this observation and a literature review, we try to recall the clinical and radiological characteristics of this disease and toclarify the therapeutic modalities.Keywords: Computed tomography, internal hernia, paraduodenal hernia, small bowel obstructio

A long survival of a patient with brain metastasis of unknown site of the primary tumor

Eighty percent of brain metastases (BM) are diagnosed in patients with known primary site of cancer. BM of unknown primary represents a difficult diagnosis. In up to 15% of patients with BM, the site of the primary tumor will not be detected despite investigations. The prognosis of this entity is very poor. We report here a case of a long survival of a patient with brain metastasis of unknown primary. The conclusion that can be drawn is that within BM of unknown primary exist patients with a very good prognosis that must be collected and published in order to base recommendations

A prospective, randomised comparison of continuous paravertebral block and continuous intercostal nerve block for post-thoracotomy pain

Background: This study aimed to compare paravertebral block and continuous intercostal nerve block after thoracotomy.Methods: Forty-six adult patients undergoing elective posterolateral thoracotomy were randomised to receive either a continuous intercostal nerve blockade or a paravertebral block. Opioid consumption and postoperative pain were assessed for 48 hours .Pulmonary function was assessed by forced expiratory volume in 1 s (FEV1) recorded at 4 hours intervals.Results: With respect to the objective visual assessment (VAS), both techniques were effective for post thoracotomy pain. The average VAS score at rest was 29±10mm for paravertebral block and 31.5±11mm for continuous intercostal nerve block. The average VAS score on coughing was 36±14mm for the first one and 4 ±14mm for the second group. Pain at rest was similar in both groups. Pain scores on coughing were lower in paravertebral block group at 42 and 48 hours. Post-thoracotomy function was better preserved with paravertebral block. No difference was found among the two groups for side effects related to technique, major morbidity or duration of hospitalisation.Conclusion: We found that continuous intercostal nerve block and paravertebral block were effective and safe methods for post-thoracotomy pain.

Defending with Errors: Approximate Computing for Robustness of Deep Neural Networks

Machine-learning architectures, such as Convolutional Neural Networks (CNNs) are vulnerable to adversarial attacks: inputs crafted carefully to force the system output to a wrong label. Since machine-learning is being deployed in safety-critical and security-sensitive domains, such attacks may have catastrophic security and safety consequences. In this paper, we propose for the first time to use hardware-supported approximate computing to improve the robustness of machine-learning classifiers. We show that successful adversarial attacks against the exact classifier have poor transferability to the approximate implementation. Surprisingly, the robustness advantages also apply to white-box attacks where the attacker has unrestricted access to the approximate classifier implementation: in this case, we show that substantially higher levels of adversarial noise are needed to produce adversarial examples. Furthermore, our approximate computing model maintains the same level in terms of classification accuracy, does not require retraining, and reduces resource utilization and energy consumption of the CNN. We conducted extensive experiments on a set of strong adversarial attacks; We empirically show that the proposed implementation increases the robustness of a LeNet-5, Alexnet and VGG-11 CNNs considerably with up to 50% by-product saving in energy consumption due to the simpler nature of the approximate logic.Comment: arXiv admin note: substantial text overlap with arXiv:2006.0770

Facteurs predictifs de survenue de pharyngostome après laryngectomie totale

Objectif : Déterminer l’incidence de survenue de la fistule pharyngo-cutanée ou pharyngostome après laryngectomie totale ainsi que les facteurs prédisposants.Matériel et méthodes: C’est une étude rétrospective qui a porté sur 187 malades ayant eu une laryngectomie totale à notre département (Janvier 1985-Décembre 2007). Nous avons étudié les facteurs cliniques, histologiques, les modalités thérapeutiques ainsi que évolutives à la recherche de corrélation avec la survenue de pharyngostome après laryngectomie totale. -Résultats : Les pharyngostomes ont été observé dans14,4% des cas. La chimioradiothérapie préopératoire était significativement corrélée à l’apparition de pharyngostome (p=0,008). L’infection postopératoire est un facteur hautement significatif de survenue de pharyngostome (p=0,000). De même que l’hémorragie postopératoire (p=0,016), les troubles de ladéglutition (p=0,037), et les bronchopneumopathies (p=0,032). La rupture capsulaire lors d’un envahissement ganglionnaire était très  significativement corrélée à la survenue d’un pharyngostome (p = 0,001).Conclusion : en présence de facteurs de risque significatifs de  pharyngostome, cette complication peut ainsi être prévue même si sa prévention demeure encore difficile.Mots-clés : Pharyngostome, Laryngectomie totale, Incidence, facteurs prédisposants

Efecto de la edad y el nivel de vitamina E en dietas de pollos broiler sobre la modulación de la respuesta inmune.

La vitamina E pertenece al grupo de nutrientes con capacidad reguladora del sistema inmune (Koutsos y Klasing, 2008). En aves, la vitamina E induce cambios tanto en el sistema inmune innato como en el específico, mejora la función fagocítica de los macrófagos, amortigua la respuesta en fase aguda, disminuye la proporción de heterófilos y potencia la síntesis de anticuerpos (Koutsos y Klasing, 2008; Khan et al., 2012). Recientemente se ha demostrado que parte del efecto de la vitamina E está ligado a su capacidad de actuar directamente sobre factores de transcripción nuclear que modulan la expresión de citoquinas, tales como el factor-Kappa B o el PPAR γ (Koutsos y Klasing, 2008; Nakamura y Omaye, 2009). Por otro lado, el impacto de la vitamina E sobre la modulación del sistema inmune viene definido por factores tales como la edad y la relación dosis-respuesta. En broiler la inclusión en la dieta de niveles moderadamente superiores (25-50 UI/kg dieta) al recomendado por el National Research Council (NRC, 1994; 10 UI/kg) aumenta los títulos de anticuerpos tras la vacunación (Friedman et al., 1998; Leshchinsky y Klasing, 2001; Lin y Chang, 2006). Sin embargo, niveles superiores a 150 UI/kg tienen un efecto supresor sobre la producción de anticuerpos (Koutsos y Klasing, 2008). En relación a la edad es importante determinar aquellos periodos o “ventanas” en los que es necesario estimular el sistema inmune (Kogut, 2009). Un periodo a considerar sería el de las dos primeras semanas de vida del pollo debido a la menor funcionalidad de macrófagos y heterófilos (Kogut, 2009). El presente trabajo tiene como objetivo evaluar el efecto del nivel de Vitamina E y la edad sobre la modulación de la respuesta inmune en pollos. Para ello se estudió el efecto de la inclusión de 40 y 160 ppm de vitamina E en la dieta sobre la expresión de la interleuquina 2 (IL 2), el interferón gamma (IFN γ) y el factor de crecimiento mielomonocítico (MGF) en el bazo de los animales a los 7 y 21 días de edad

Quel bilan d’extension faut-il faire pour les carcinomes indifferencies du nasopharynx ?

Introduction: Nasopharyngeal carcinoma prognosis is often correlated with its local extension but especially lymphatic node and metastatic.The aimof our work was to study sensitivity and the specificity of clinical and paraclinic explorations in the initial assessmentPatients and methods : It .s about a retrospective study of 366 patients having nasopharyngeal carcinoma, diagnosed over eleven years period between 1993 and 2003 in Sfax hospital. Into pretherapeutic, all the patients had a complementary assessment including:- Nasopharyngeal tomodensitometry (TDM), in all the cases, extended to the cervical area in 112 cases and a magnetic resonnance Imagery (MRI) of the nasopharynx and cerebral in 18 cases.- Metastatic assessment: comprising systematically a chest radiography, an abdominal ultrasonography and an osseous scintiscanning. The statistical study comprised a descriptive study and an analytical study.Results : The metastasis diagnosis was retained in 39 cases (10,7%): osseous in 82%, hepatic in 23% and pulmonary in 12,8% of the cases. The tumour was associated to lymph node N3 in 25 cases (64%). At univariate study, we retained the presence of significant difference between the groups of the metastatic and lack metastatic patients for : the male sex, reason for consultation (cervical node, rhinologic signs and otologic signs) and cervical node at the examination.The multivariate analysis for all the factors was without interest. We choose the parameters according to the result of the univariate study, the literature and parameters' found among all patients with discovered CNP. It comes out from this study that the following elements are providers of metastases: age between 40 and 45years, male sex and cervical node N3a stage.Discussion : The assessment of extension is not standardized for all the authors. Indeed, for the study of the pulmonary extension (AJCC)/ (UICC) recommends the systematic practice of the chest radiography. For (NCCN), the practice of chest radiography is only for patients classified at the stage 2 and 3 in WHO classification. For KUMAR, LEUNG and our results, it is recommended systematically to practice the chest radiography . This radiography would be supplemented by a thoracic tomodensitometry with the least suspect lesion. For the hepatic assessment, some recommend the systematic practice of abdominal echography for the advanced nodestages (N3). For others, it will be indicated only for the symptomatic patients. For (AJCC)/ (UICC) abdominal echography is systematic.For the osseous assessment, KRAIPHIBUL recommends the practice of the osseous scintiscanning only for patients having signs of osseous call but LEUNG and SHAM recommend the practice of the osseous scintiscanning only for the patients having cervical node N3.Key words: Nasopharyngeal carcinoma/ extension assessment/ metastasis

Gastric signet-ring cell carcinoma with hypersecretion of β-Human chorionic gonadotropin and review of the literature

β-Human chorionic gonadotropin (β-HCG) is an embryonic protein secreted by the syncytiotrophoblast of the placenta. The determination of the plasma β-HCG level is routinely used for the diagnosis and the follow-up of germ cell tumors. Some adenocarcinomas have been described as being rarely associated with β-HCG hypersecretion. We report a case of gastric signet-ring cell carcinoma with β-HCG hypersecretion and propose hypotheses to explain the pathogenesis of such hypersecretion. Key Words: β-Human chorionic gonadotropin, gastric signet-ring cell carcinoma

Unilateral aplasia of both cruciate ligaments

Aplasia of both cruciate ligaments is a rare congenital disorder. A 28-year-old male presented with pain and the feeling of instability of his right knee after trauma. The provided MRI and previous arthroscopy reports did not indicate any abnormalities except cruciate ligament tears. He was referred to us for reconstruction of both cruciate ligaments. The patient again underwent arthroscopy which revealed a hypoplasia of the medial trochlea and an extremely narrow intercondylar notch. The tibia revealed a missing anterior cruciate ligament (ACL) footprint and a single bump with a complete coverage with articular cartilage. There was no room for an ACL graft. A posterior cruciate ligament could not be identified. The procedure was ended since a ligament reconstruction did not appear reasonable. A significant notch plasty if not a partial resection of the condyles would have been necessary to implant a ligament graft. It is most likely that this would not lead to good knee stability. If the surgeon would have retrieved the contralateral hamstrings at the beginning of the planned ligament reconstruction a significant damage would have occurred to the patient. Even in seemingly clear diagnostic findings the arthroscopic surgeon should take this rare abdnormality into consideration and be familiar with the respective radiological findings. We refer the abnormal finding of only one tibial spine to as the "dromedar-sign" as opposed to the two (medial and a lateral) tibial spines in a normal knee. This may be used as a hint for aplasia of the cruciate ligaments