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

Resultats du traitement chirurgical de l’otospongiose notre experience a propos de 310 cas

Introduction : Le traitement de l’otospongiose est chirurgical. Plusieurs facteurs peuvent intervenir dans l’indication opératoire ou influencer les résultats fonctionnels. L’objectif de notre étude est d’évaluer nos résultats audiométriques et d’étudier les facteurs prédictifs de l’échec fonctionnel. Matériel et méthodes : Il s’agit d’une étude rétrospective à propos de 310 oreilles opérées pour otospongiose, sur une période de 21 ans (1985-2005). On a effectué une analyse des résultats audiométriques à partir des audiogrammes postopératoires faits à 3 mois, à 1an et au dernier contrôle. Nous avons ensuite étudié 8 facteurs pouvant être prédictifs de l’échec fonctionnel. Ce dernier était défini par un Rinne résiduel post-opératoire (RRPO) > 10 dB.Résultats : Le RRPO était en moyenne de 7,9 dB avec des extrêmes de 5 dB à 33 dB. La fermeture du Rinne a été obtenue dans 87,3% des cas. Après étude multivariée avec régression logistique, nous avons retenu 2 facteurs indépendants significativement prédictifs de l’échec fonctionnel : un stade audiométrique III ou IV d’Aubry (OR : 19,06/p : 0,0001) et un Rinne post-opératoire précoce supérieur à 35 dB (OR : 4 ,01/p : 0,0025). Conclusion : Une audiométrie post-opératoire précoce serait intéressante pour dépister précocement un échec chirurgical d’une part et pour préjuger du résultat fonctionnel définitif d’autre part. Un stade audiométrique III ou IV d’ Aubry, prédictif certes d’un moins bon résultat fonctionnel, ne contre-indique pas la chirurgie qui permettra entre autres une meilleure adaptation audio- prothétique.Mots-clés : otospongiose - chirurgie - résultats – facteurs prédictif

Synthesis of α-glucan in mycobacteria involves a hetero-octameric complex of trehalose synthase TreS and Maltokinase Pep2

Recent evidence established that the cell envelope of Mycobacterium tuberculosis, the bacillus causing tuberculosis (TB), is coated by an α-glucan-containing capsule that has been implicated in persistence in a mouse infection model. As one of three known metabolic routes to α-glucan in mycobacteria, the cytoplasmic GlgE-pathway converts trehalose to α(1 → 4),α(1 → 6)-linked glucan in 4 steps. Whether individual reaction steps, catalyzed by trehalose synthase TreS, maltokinase Pep2, and glycosyltransferases GlgE and GlgB, occur independently or in a coordinated fashion is not known. Here, we report the crystal structure of M. tuberculosis TreS, and show by small-angle X-ray scattering and analytical ultracentrifugation that TreS forms tetramers in solution. Together with Pep2, TreS forms a hetero-octameric complex, and we demonstrate that complex formation markedly accelerates maltokinase activity of Pep2. Thus, complex formation may act as part of a regulatory mechanism of the GlgE pathway, which overall must avoid accumulation of toxic pathway intermediates, such as maltose-1-phosphate, and optimize the use of scarce nutrients

Stenose tracheale post-intubation

Objective : Remind the main post-intubation tracheal stenosis etiopathogenic characteristics, specify the preoperative assessment and discuss the different therapeutic modalities.Materials and methods : This retrospective study includes 28 cases of scarring tracheal stenosis treated between 1987 and 2003.Results : They are acquired, secondary to intubation and / or tracheotomy. The results of our study highlight the important role of medical and endoscopic treatment. However, the best treatment of tracheal stenosis remains the surgical treatment based on tracheal resection anastomosis, 89% of good results in our study.Conclusion : Our results indicate that the endoscopic treatment of post-intubation tracheal stenoses can be considered a safe first-line therapy, leaving the complex and relapsing stenoses, for surgical resection.Keywords : Tracheal stenosis, tracheal intubation, tracheotomy

Aberrant innate immune sensing leads to the rapid progression of idiopathic pulmonary fibrosis

Novel approaches are needed to define subgroups of patients with Idiopathic pulmonary fibrosis (IPF) at risk for acute exacerbations and/or accelerated progression of this generally fatal disease. Progression of disease is an integral component of IPF with a median survival of 3 to 5 years. Conversely, a high degree of variability in disease progression has been reported among series. The characteristics of patients at risk of earlier death predominantly rely on baseline HRCT appearance, but this concept that has been challenged. Disparate physiological approaches have also been taken to identify patients at risk of mortality, with varying results. We hypothesized that the rapid decline in lung function in IPF may be a consequence of an abnormal host response to pathogen-associated molecular patterns (PAMPs), leading to aberrant activation in fibroblasts and fibrosis. Analysis of upper and lower lobe surgical lung biopsies (SLBs) indicated that TLR9, a hypomethylated CpG DNA receptor, is prominently expressed at the transcript and protein level, most notably in biopsies from rapidly progressive IPF patients. Surprisingly, fibroblasts appeared to be a major cellular source of TLR9 expression in IPF biopsies from this group of progressors. Further, CpG DNA promoted profibrotic cytokine and chemokine synthesis in isolated human IPF fibroblasts, most markedly again in cells from patients with the rapidly progressive IPF phenotype, in a TLR9-dependent manner. Finally, CpG DNA exacerbated fibrosis in an in vivo model initiated by the adoptive transfer of primary fibroblasts derived from patients who exhibited rapidly progressing fibrosis. Together, these data suggested that TLR9 activation via hypomethylated DNA might be an important mechanism in promoting fibrosis particularly in patients prone to rapidly progressing IPF

Les lymphomes de l’anneau de Waldeyer traitement et pronostic

Les lymphomes non Hodgkiniens (LNH) qui prennent naissance au niveau de l’anneau de Waldeyer constituent une entité bien particulière tant sur le plan clinique, thérapeutique que pronostique. Les auteurs rapportent une étude rétrospective de 44 observations de LNH de l’anneau de Waldeyer colligées entre 1995 et 2002. Une chimiothérapie exclusive aété indiquée chez 80,6% des malades et une association chimio-radiothérapie a été réalisée chez 19,4%. Le taux de survie globale était de 42% à 5 ans. Dans notre étude quatre facteurs de mauvais pronostic ont été individualisés : un âge ≥ à 40 ans, les stades d’Ann Arbor II, III et IV, un taux de LDH ≥ 1,5 fois la normale et la survenue de rechute.Mots-clés : Lymphome, anneau de Waldeyer, chimiothérapie, radiothérapie, pronosti

COVID-19 outbreak and increased risk of amblyopia and epidemic myopia: Insights from EUROCOVCAT group

The most common cause of vision impairment in children is amblyopia. It is defined as impaired visual acuity in one or both eyes that is present with no demonstrable abnormality of the visual pathway and is not immediately resolved by wearing glasses. After the World Health Organization (WHO) recognized COVID-19 as a global pandemic on March 11, 2020, widespread changes and restrictions to social and sanitary practices have presented significant issues in access to eye care during the COVID-19 pandemic. A reduction of more than 80% in pediatric eye care volume up to its total cessation has been observed in different departments. In this scenario, reduced or absent eyesight, due to delay in timely treatment of amblyopic conditions, could create major, long-lasting effects on all aspects of life, including daily personal activities, interacting with the community, school and work opportunities and the ability to access public services. Processes coming out of lockdown should be gradually easing restrictions giving priority to ophthalmology and eye care facilities so that amblyopia does not remain unattended and irreversible as in adults due to lack of timely treatments. If not reversible, this process could lead to a dramatic increase in disability and unsustainable social costs for many governments