Dacryocystorhinostomie par voie endoscopique endonasale

Introduction : La dacryocystorhinostomie (DCR) endoscopique endonasale est une chirurgie mini invasive du sac lacrymal. Le but de notre travail est d’analyser et d'évaluer prospectivement nos patients opérés pour DCR endoscopique endonasale utilisant une sonde de trans-illumination, durant 2010.Patients et méthode : étude prospective de 20 DCR endoscopique (18 patients) utilisant la sonde de transillumination. Ce travail consiste en une analyse des données épidémiologiques, des indications opératoires, des données cliniques et radiologiques, des constatations per opératoires et des résultats fonctionnels et anatomiques postopératoires.Résultats : Cette étude a concerné 16 femmes (88,9%) et 2 hommes. L'âge médian est de 34 ans. Les indications chirurgicales sont réparties entre échec de DCR par voie externe (6 cas), pathologie rhino-sinusienne associée (13 cas), dacryocèle (1 cas). Notre taux de succès est de 85,7% (12 cas/14) dans les DCR de première intention. Il est de 83,3%(5cas/6) dans les reprises des voies externes. A 6 mois du post opératoire l’orifice de la stomie est identifiable dans 14 cas soit 70%. Aucune complication majeure n’est colligée.Discussion et conclusion : La DCR endoscopique endonasale est une technique physiologique et esthétique. Elle reste tout aussi efficace et fiable que la voie externe avec un taux de succès pratiquement  comparable (85% à 90%). Le succès d'une DCR par voie endoscopique endonasale est conditionné par une collaboration multidisciplinaire étroite(ORL/Ophtalmologistes/Radiologues), par une maitrise des impératifs techniques et enfin, par des soins postopératoires de qualité.Mots clés : dacryocystorhinostomie endoscopique, traitement

Management of pregnant women infected with Ebola virus in a treatment centre in Guinea, June 2014

We report two cases of confirmed Ebola virus disease in pregnant women, who presented at the Médecins Sans Frontières Ebola treatment centre in Guéckédou. Despite the very high risk of death, both pregnant women survived. In both cases the critical decision was made to induce vaginal delivery. We raise a number of considerations regarding the management of Ebola virus-infected pregnant women, including the place of amniocentesis and induced delivery, and whether certain invasive medical acts are justified

Environmental regulation of carbon isotope composition and crassulacean acid metabolism in three plant communities along a water availability gradient

Expression of crassulacean acid metabolism (CAM) is characterized by extreme variability within and between taxa and its sensitivity to environmental variation. In this study, we determined seasonal fluctuations in CAM photosynthesis with measurements of nocturnal tissue acidification and carbon isotopic composition (δ13C) of bulk tissue and extracted sugars in three plant communities along a precipitation gradient (500, 700, and 1,000 mm year−1) on the Yucatan Peninsula. We also related the degree of CAM to light habitat and relative abundance of species in the three sites. For all species, the greatest tissue acid accumulation occurred during the rainy season. In the 500 mm site, tissue acidification was greater for the species growing at 30% of daily total photon flux density (PFD) than species growing at 80% PFD. Whereas in the two wetter sites, the species growing at 80% total PFD had greater tissue acidification. All species had values of bulk tissue δ13C less negative than −20‰, indicating strong CAM activity. The bulk tissue δ13C values in plants from the 500 mm site were 2‰ less negative than in plants from the wetter sites, and the only species growing in the three communities, Acanthocereus tetragonus (Cactaceae), showed a significant negative relationship between both bulk tissue and sugar δ13C values and annual rainfall, consistent with greater CO2 assimilation through the CAM pathway with decreasing water availability. Overall, variation in the use of CAM photosynthesis was related to water and light availability and CAM appeared to be more ecologically important in the tropical dry forests than in the coastal dune