Prise en charge des complications de la chirurgie partielle du larynx

Introduction : Le cancer du larynx est un cancer fréquent occupant la première place des cancers des voies aéro-digestives chez l’homme en Tunisie. Le tabac est le principal facteur favorisant surtout s’il est associé à l’éthylisme chronique. Il s’agit le plus souvent d’un carcinome épidermoïde plus ou moins différencié. Son pronostic est généralement bon, en raison de son développement dans un tube rigide bien limité et d’un traitement chirurgical actuellement bien codifié. La chirurgie partielle du cancer du larynx est une chirurgie à risque de complications postopératoires nécessitant une prise en charge adéquate.Patients et méthodes : Notre série comprend 54 patients ayant bénéficié d’une chirurgie partielle du larynx au sein du service de chirurgie carcinologique de l’institut Salah Azaiez sur une période de 15 ans (1997-2011).But : Présenter notre expérience en matière de prise en charge des complications de la chirurgie partielle du larynx.Résultats : La moyenne d’âge de nos patients était de 54,9 ans avec des extrêmes allant de 33 à 69 ans. La prédominance masculine était nette avec un sex-ratio de 26. La consommation tabagique était notée dans 92,6% des cas et la dysphonie était présente chez 40 patients porteurs d’une tumeur à localisation glottique. Six types d’interventions ont été pratiqués: cordectomie (9 cas), laryngectomie fronto-latérale (4 cas), laryngectomie frontale antérieure reconstructive type Tucker (10 cas), laryngectomie partielle supra-cricoïdienne avec crico-hyoïdopexie (CHP) (4 cas), laryngectomie partielle supra-cricoïdienne avec crico-hyoïdo-épiglottopexie (CHEP) (24 cas) et laryngectomie horizontale supra-glottique (3 cas). Une antibioprophylaxie était administrée chez 79,6% des patients pour une durée moyenne de 7 jours. Les complications postopératoires ont été analysées et discutées en fonction du type de la chirurgie partielle pratiquée et du type d’antibiothérapie utilisée. Ces complications étaient les suivantes: infection du trachéostome (20,4%), infection de paroi (5 cas), complications respiratoires (29,6%), emphysème sous cutané (7,4%), fistule salivaire (1 cas) et pancréatite aigüe (1 cas).Conclusion : Cette étude montre dans l’ensemble des bons résultats tant sur le plan infectieux que respiratoires, justifiant ainsi l’importance de la prise en charge des complications de la chirurgie partielle du cancer du larynx.Introduction : Laryngeal cancer is a common cancer occurring mainly in men. Smoking is the main risk factor especially if associated with chronic alcoholism. Squamous cell carcinoma is the most common histologic type. Prognosis is generally good, due to the development of the tumor in a very limited rigid tube and to a well-codified surgical treatment. Partial surgery of laryngeal cancer is characterized by postoperative complications requiring an adequate management.Methods : Our series includes 54 cases of laryngeal cancer treated with partial laryngectomy in the ENT department of Salah Azaiez Institute over a period of 15 years from 1997 to 2011.Objective : To present our experience in the management of partial laryngeal surgery complications.Results : Average age of our patients was 54.9 years ranging from 33 to 69 years. Male predominance was marked with a sex ratio of 26. Tobacco abuse was found in 92.6%. Dysphonia was the most common symptom found in 40 patients with glottic cancer. Six varieties of partial laryngectomy were performed: cordectomy (9 cases), fronto-lateral laryngectomy (4 cases), fronto-anterior reconstructive laryngectomy (10 cases), partial supra-cricoid laryngectomy with CHP (4 cases), partial supra-cricoid laryngectomy with CHEP (24 cases) and supra glottic horizontal laryngectomy (3 cases). 79.6 % of our patients received prophylactic antibiotics for an average of 7 days. Postoperative complications were analyzed and discussed in terms of the type of surgery performed and the antibiotic used. Complications observed were: infection of the tracheostoma (20.4%), parietal infection (5 cases), respiratory complications (29.6%), subcutaneous emphysema (7.4%), salivary fistula (1 case) and acute pancreatitis (1 case).Conclusion : This study shows overall good results for partial laryngeal cancer surgery with minimal post-operative complications and oncologic failure justifying the importance of an early management of these complications

Genetic diversity in Tunisian horse breeds

This study aimed at screening genetic diversity and differentiation in four horse breeds raised in Tunisia, the Barb, Arab-Barb, Arabian, and English Thoroughbred breeds. A total of 200 blood samples (50 for each breed) were collected from the jugular veins of animals, and genomic DNA was extracted. The analysis of the genetic structure was carried out using a panel of 16 microsatellite loci. Results showed that all studied microsatellite markers were highly polymorphic in all breeds. Overall, a total of 147 alleles were detected using the 16 microsatellite loci. The average number of alleles per locus was 7.52 (0.49), 7.35 (0.54), 6.3 (0.44), and 6 (0.38) for the Arab-Barb, Barb, Arabian, and English Thoroughbred breeds, respectively. The observed heterozygosities ranged from 0.63 (0.03) in the English Thoroughbred to 0.72 in the Arab-Barb breeds, whereas the expected heterozygosities were between 0.68 (0.02) in the English Thoroughbred and 0.73 in the Barb breeds. All FST values calculated by pairwise breed combinations were significantly different from zero (p  <  0.05) and an important genetic differentiation among breeds was revealed. Genetic distances, the factorial correspondence, and principal coordinate analyses showed that the important amount of genetic variation was within population. These results may facilitate conservation programs for the studied breeds and enhance preserve their genetic diversity

Lrp4 Modulates Extracellular Integration of Cell Signaling Pathways in Development

The extent to which cell signaling is integrated outside the cell is not currently appreciated. We show that a member of the low-density receptor-related protein family, Lrp4 modulates and integrates Bmp and canonical Wnt signalling during tooth morphogenesis by binding the secreted Bmp antagonist protein Wise. Mouse mutants of Lrp4 and Wise exhibit identical tooth phenotypes that include supernumerary incisors and molars, and fused molars. We propose that the Lrp4/Wise interaction acts as an extracellular integrator of epithelial-mesenchymal cell signaling. Wise, secreted from mesenchyme cells binds to BMP's and also to Lrp4 that is expressed on epithelial cells. This binding then results in the modulation of Wnt activity in the epithelial cells. Thus in this context Wise acts as an extracellular signaling molecule linking two signaling pathways. We further show that a downstream mediator of this integration is the Shh signaling pathway

Dental cell type atlas reveals stem and differentiated cell types in mouse and human teeth

Understanding cell types and mechanisms of dental growth is essential for reconstruction and engineering of teeth. Therefore, we investigated cellular composition of growing and non-growing mouse and human teeth. As a result, we report an unappreciated cellular complexity of the continuously-growing mouse incisor, which suggests a coherent model of cell dynamics enabling unarrested growth. This model relies on spatially-restricted stem, progenitor and differentiated populations in the epithelial and mesenchymal compartments underlying the coordinated expansion of two major branches of pulpal cells and diverse epithelial subtypes. Further comparisons of human and mouse teeth yield both parallelisms and differences in tissue heterogeneity and highlight the specifics behind growing and non-growing modes. Despite being similar at a coarse level, mouse and human teeth reveal molecular differences and species-specific cell subtypes suggesting possible evolutionary divergence. Overall, here we provide an atlas of human and mouse teeth with a focus on growth and differentiation. Unlike human teeth, mouse incisors grow throughout life, based on stem and progenitor cell activity. Here the authors generate single cell RNA-seq comparative maps of continuously-growing mouse incisor, non-growing mouse molar and human teeth, combined with lineage tracing to reveal dental cell complexity.Peer reviewe

The MSX1 allele 4 homozygous child exposed to smoking at periconception is most sensitive in developing nonsyndromic orofacial clefts

Nonsyndromic orofacial clefts (OFC) are common birth defects caused by certain genes interacting with environmental factors. Mutations and association studies indicate that the homeobox gene MSX1 plays a role in human clefting. In a Dutch case-control triad study (mother, father, and child), we investigated interactions between MSX1 and the parents' periconceptional lifestyle in relation to the risk of OFC in their offspring. We s

Transcriptome analysis of embryonic mammary cells reveals insights into mammary lineage establishment

Introduction: The mammary primordium forms during embryogenesis as a result of inductive interactions between its constitutive tissues, the mesenchyme and epithelium, and represents the earliest evidence of commitment to the mammary lineage. Previous studies of embryonic mouse mammary epithelium indicated that, by mid-gestation, these cells are determined to a mammary cell fate and that a stem cell population has been delimited. Mammary mesenchyme can induce mammary development from simple epithelium even across species and classes, and can partially restore features of differentiated tissue to mouse mammary tumours in co-culture experiments. Despite these exciting properties, the molecular identity of embryonic mammary cells remains to be fully characterised. Methods: Here, we define the transcriptome of the mammary primordium and the two distinct cellular compartments that comprise it, the mammary primordial bud epithelium and mammary mesenchyme. Pathway and network analysis was performed and comparisons of embryonic mammary gene expression profiles to those of both postnatal mouse and human mammary epithelial cell sub-populations and stroma were made. Results: Several of the genes we have detected in our embryonic mammary cell signatures were previously shown to regulate mammary cell fate and development, but we also identified a large number of novel candidates. Additionally, we determined genes that were expressed by both embryonic and postnatal mammary cells, which represent candidate regulators of mammary cell fate, differentiation and progenitor cell function that could signal from mammary lineage inception during embryogenesis through postnatal development. Comparison of embryonic mammary cell signatures with those of human breast cells identified potential regulators of mammary progenitor cell functions conserved across species. Conclusions: These results provide new insights into genetic regulatory mechanisms of mammary development, particularly identification of novel potential regulators of mammary fate and mesenchymal-epithelial cross-talk. Since cancers may represent diseases of mesenchymal-epithelial communications, we anticipate these results will provide foundations for further studies into the fundamental links between developmental, stem cell and breast cancer biology

A Novel Role for Dbx1-Derived Cajal-Retzius Cells in Early Regionalization of the Cerebral Cortical Neuroepithelium

Patterning of the cerebral cortex during embryogenesis depends not only on passive diffusion of morphogens but also on signal delivery by Cajal-Retzius neurons that migrate over long distances

Cerebral venous thrombosis associated with homozygous factor V Leiden mutation in a 15-year-old girl of Tunisian origin

Cerebral venous thrombosis (CVT) is a rare disease. It has numerous and complex etiologies. Inherited or acquired prothrombotic states play a key role in the development of this disease, such as factor V G1691A mutation (FV Leiden). A 15-year-old girl presented to the Department of Neurology with a complaint of severe headache with visual blurring. The diagnosis of CVT was not initially suspected because of the patient's condition on presentation. An MRI showed thrombosis in the superior sagittal sinus, confirming venous stroke. Anticardiolipin and antiphospholipid antibodies were assessed. In addition, inherited prothrombotic defects, such as protein C, protein S, and antithrombin deficiencies, and genetic mutations for FV Leiden, prothrombin gene G20210A (FII G20210A), and methyltetrahydrofolate reductase C677T (MTHFR C677T) were studied. All results were unremarkable except for the unique homozygous FV Leiden mutation, which likely contributed to this prothrombotic situation. This study highlights the fact that FV Leiden may play a significant role in the onset of CVT in young patients