92 research outputs found
Diagnostic et prise en charge de lâhyperparathyroĂŻdie primaire
Objectif : LâhyperparathyroĂŻdie primaire (hPTP) est dĂ©finie par la production excessive et inappropriĂ©e de parathormone (PTh). Les formes asymptomatiques et modĂ©rĂ©es sont devenues de plus en plus frĂ©quentes. Le but de ce travail est dâĂ©tudier les caractĂ©ristiques cliniques et paracliniques de lâhPTP, de prĂ©ciser les indications thĂ©rapeutiques et de les discuter en comparant nos rĂ©sultats avec ceux de la littĂ©rature.MatĂ©riel et mĂ©thodes: Il sâagit dâune Ă©tude rĂ©trospective Ă propos de 86 patients colligĂ©s entre Janvier 2005 et DĂ©cembre 2010. Tous les patients ont bĂ©nĂ©ficiĂ© dâun examen ORL et dâun bilan biologique comportant une calcĂ©mie et un dosage de la PTh. Le bilan radiologique comportait une Ă©chographie cervicale, une scintigraphie au MIBI et/ou une IRM cervicale.Tous les patients ont Ă©tĂ© opĂ©rĂ©s sous anesthĂ©sie gĂ©nĂ©rale et ont eu une cervicotomie par approche classique. La surveillance a Ă©tĂ© clinique et biologique avec un recul moyen de 16 mois (4-36 mois).RĂ©sultats : La calcĂ©mie Ă©tait Ă©levĂ©e chez 77 patients (89,5%) et la PTh chez tous les patients. Une Ă©chographie cervicale a Ă©tĂ© rĂ©alisĂ©e chez 79 patients et a montrĂ© une image en faveur dâun adĂ©nome parathyroĂŻdien chez 37 dâentre eux (46,8%). La scintigraphie au MIBI, pratiquĂ©e chez 46 patients, a montrĂ© une hyperfixation dans 31 cas (67,4%). LâIRM aĂ©tĂ© pratiquĂ©e chez 5 patients et a rĂ©vĂ©lĂ© un adĂ©nome dans 3 cas.Lâexploration chirurgicale avec examen extemporanĂ© a rĂ©vĂ©lĂ© un adĂ©nome unique chez 65 patients deux adĂ©nomes chez 12 patients, et une hypertrophie des 4 PTh chez 9 autres. Une exĂ©rĂšse des adĂ©nomes a Ă©tĂ© ainsi rĂ©alisĂ©e chez 77 patients et une parathyroĂŻdectomie subtotale dans 9 cas. en post-opĂ©ratoire, 12 patients (14%) ont prĂ©sentĂ© une hypocalcĂ©mietransitoire. Aucune hypocalcĂ©mie dĂ©finitive ni paralysie rĂ©currentielle nâont Ă©tĂ© notĂ©es. Lâexamen anatomopathologique dĂ©finitif a rĂ©vĂ©lĂ© un adĂ©nome unique, un adĂ©nome double, une hyperplasie et PTh normale respectivement chez 58, 3, 24 et 1 patients. LâĂ©volution Ă long terme a Ă©tĂ© marquĂ©e par lâamĂ©lioration clinique et biologique chez 81 patients (94,2%). Une non-amĂ©lioration clinique et biologique a Ă©tĂ© notĂ©e chez 5 patients. Ils ont Ă©tĂ© rĂ©opĂ©rĂ©s et ont eu une parathyroĂŻdectomie subtotale. Lâanatomopathologie confirmait lâhyperplasie dans tous les cas.Conclusion : Le traitement de lâhPTP symptomatique est chirurgical. Lâapproche classique a fait preuve de son efficacitĂ©. Les progrĂšs rĂ©cents des explorations prĂ©opĂ©ratoires et le dosage peropĂ©ratoire de la PTh ont rendu possible une approche mini-invasive. Des controverses persistent quant Ă la prise en charge de lâhPTP asymptomatique dont lâindicationthĂ©rapeutique doit ĂȘtre bien Ă©tudiĂ©e.Mots-clĂ©s : hyperparathyroĂŻdie primaire, adĂ©nome, glande parathyroĂŻde, parathormone, scintigraphie, parathyroĂŻdectomi
Lâectopie des glandes parathyroides dans la chirurgie de lâhyperparathyroidie
Introduction : Lâectopie parathyroĂŻdienne est la cause dâĂ©chec la plus frĂ©quente de la chirurgie de lâhyperparathyroĂŻdie, entrainant le plus souvent des reprises chirurgicales. Son diagnostic topographique prĂ©-opĂ©ratoire reste difficile malgrĂ© le progrĂšs dans les diffĂ©rentes explorations radiologiques. Le diagnostic per-opĂ©ratoire doit ĂȘtre guidĂ© par une stratĂ©gie de dissection de rĂ©fĂ©rence. Le but de travail est dâĂ©tudier la stratĂ©gie de recherche des parathyroides lors de leur chirurgie.MatĂ©riels et mĂ©thodes : Il sâagit dâune Ă©tude rĂ©trospective Ă propos de 137 patients (162 glandes parathyroĂŻdes ectopiques) parmi 572 patients opĂ©rĂ©s dâune hyperparathyroĂŻdie, colligĂ©s sur une pĂ©riode de 11 ans (Janvier 2001-DĂ©cembre 2011). Tous les patients ont bĂ©nĂ©ficiĂ© dâune imagerie prĂ©-opĂ©ratoire et ont Ă©tĂ© opĂ©rĂ©s sous anesthĂ©sie gĂ©nĂ©rale.RĂ©sultats : LâĂąge moyen Ă©tait de 49 ans (11-71 ans) et le sex-ratio de 1,04. Une hyperparathyroĂŻdie primaire Ă©tait prĂ©sente chez 26 patients (18,98%) et une hyperparathyroĂŻdie secondaire Ă une insuffisance rĂ©nale chronique chez 111 patients (81,02%).Une cervicotomie par voie classique avec exploration des 2 loges thyroĂŻdiennes a Ă©tĂ© rĂ©alisĂ©e dans 136 cas. Dans les cas oĂč la parathyroĂŻde nâa pas Ă©tĂ© retrouvĂ©e, un geste opĂ©ratoire a Ă©tĂ© associĂ©. Ce geste consistait en un curage mĂ©diastino-rĂ©currentiel (15 cas), une thymectomie (12 cas) et une lobectomie thyroĂŻdienne (9 cas). Un seul patient a eu une thoracotomie en chirurgie thoracique, sans abord cervical classique. Sur les 162 glandes parathyroĂŻdes ectopiques retenues dans lâĂ©tude, 68 Ă©taient des glandes parathyroĂŻdes infĂ©rieures. Les localisations de celles-ci Ă©taient par ordre de frĂ©quence le thymus (26 cas), le ligament thyro-thymique (14 cas), le mĂ©diastin antĂ©ro-supĂ©rieur (5 cas) et la gaine carotidienne (3 cas). Vingt glandes parathyroĂŻdes infĂ©rieures nâont pas Ă©tĂ© retrouvĂ©es sur les 68 (29,41%). Le nombre des glandes parathyroĂŻdes supĂ©rieures ectopiques Ă©tait de 94 sur 162. Leurs localisations Ă©taient par ordre de frĂ©quence le pĂŽle supĂ©rieur (33 cas), le pĂ©dicule supĂ©rieur (20 cas), la rĂ©gion rĂ©tro-oesophagienne (15 cas), la gaine carotidienne (11 cas), intra-thyroĂŻdienne (5 cas) et le mĂ©diastin postĂ©ro-supĂ©rieur (2 cas). Huit glandes parathyroĂŻdes supĂ©rieures nâont pas Ă©tĂ© trouvĂ©es sur les 94 (8,51%). Au total, sur les 162 glandes parathyroĂŻdes ectopiques, 28 nâont pas Ă©tĂ© retrouvĂ©es (17,28%).Conclusion : Lâimagerie est un moyen incontournable Ă la recherche dâune glande parathyroĂŻde ectopique. Lorsquâelle nâest pas retrouvĂ©e dans sa localisation habituelle, la stratĂ©gie de dissection chirurgicale doit ĂȘtre mĂ©thodique.Mots-clĂ©s : glande parathyroĂŻde, ectopie, hyperparathyroĂŻdie, imagerie, parathyroĂŻdectomieIntroduction: The ectopic parathyroid is the most common cause of failure of hyperparathyroidism surgery, resulting often in reoperations. Its preoperative topographic diagnosis remains difficult despite advances in various imaging studies. The intraoperative diagnosis should be guided by a reference strategy of dissection.Materials and Methods: This is a retrospective study of 137 patients (162 ectopic parathyroid glands) among 572 patients undergoing hyperparathyroidism surgery, collected over a 11-year period (January 2001-December 2011). All patients underwent preoperative imaging and were operated under general anesthesia.Results: The mean age was 49 years (11-71 years) and the sex-ratio 1.04. Primary hyperparathyroidism was present in 26 patients (18.98%) and hyperparathyroidism secondary to chronic renal failure in 111 patients (81.02%). Cervicotomy through traditional approach with bilateral exploration was performed in 136 cases. In cases where the parathyroid was not found, a surgical procedure was performed. This act consisted in mediastinal-recurrential lymphadenectomy (15 cases), thymectomy (12 cases) and thyroid lobectomy (9 cases). One patient had a thoracotomy in thoracic surgery department without conventional cervical approach. Among the 162 ectopic parathyroid glands included in the study, 68 were inferior parathyroid glands. The locations of these were in order of frequency the thymus (26 cases), the thyro-thymic ligament (14 cases), the antero-superior mediastinum (5 cases) and the carotid sheath (3 cases). Twenty inferior parathyroid glands were not found among the 68 (29,41%). The number of ectopic superior parathyroid glands was 94 of 162. Their locations were in order of frequency the upper pole (33 cases), the superior pedicle (20 cases), the retro-esophageal region (15 cases), the carotid sheath (11 cases), intra-thyroid (5 cases) and the postero-superior mediastinum (2 cases). Eight superior parathyroid glands were not found among the 94 (8.51%). In total, among 162 ectopic parathyroid glands, 28 were not found (17,28%).Conclusion: Imaging is essential to search an ectopic parathyroid gland. When not found in its usual location, the strategy of surgical dissection should be methodical.Keywords: parathyroid gland, ectopia, hyperparathyroidism, imaging, parathyroidectom
Jellyfish stings trigger gill disorders and increased mortality in farmed sparus aurata (linnaeus, 1758) in the mediterranean sea
Jellyfish are of particular concern for marine finfish aquaculture. In recent years repeated mass mortality episodes of farmed fish were caused by blooms of gelatinous cnidarian stingers, as a consequence of a wide range of hemolytic, cytotoxic, and neurotoxic properties of associated cnidocytes venoms. The mauve stinger jellyfish Pelagia noctiluca (Scyphozoa) has been identified as direct causative agent for several documented fish mortality events both in Northern Europe and the Mediterranean Sea aquaculture farms. We investigated the effects of P. noctiluca envenomations on the gilthead sea bream Sparus aurata by in vivo laboratory assays. Fish were incubated for 8 hours with jellyfish at 3 different densities in 300 l experimental tanks. Gill disorders were assessed by histological analyses and histopathological scoring of samples collected at time intervals from 3 hours to 4 weeks after initial exposure. Fish gills showed different extent and severity of gill lesions according to jellyfish density and incubation time, and long after the removal of jellyfish from tanks. Jellyfish envenomation elicits local and systemic inflammation reactions, histopathology and gill cell toxicity, with severe impacts on fish health. Altogether, these results shows P. noctiluca swarms may represent a high risk for Mediterranean finfish aquaculture farms, generating significant gill damage after only a few hours of contact with farmed S. aurata. Due to the growth of the aquaculture sector and the increased frequency of jellyfish blooms in the coastal waters, negative interactions between stinging jellyfish and farmed fish are likely to increase with the potential for significant economic losses
An Improvement of Speed Control Performances of a Two-Mass System using a Universal Approximator
Comparative Analysis of Tunisian wild Crataegus azarolus (yellow azarole) and Crataegus monogyna (red azarole) leaf, fruit and traditionally derived syrup: phenolic profiles, antioxidant and antimicrobial activities of the aqueous-acetone extracts
Quantitative and qualitative analyses of the yellow and red azarole phenolic extracts prepared from leaf, fruit peel/pulp, and syrup were comparatively investigated. The yellow azarole was found significantly richer in polyphenols than the redfruit
species. Hyperoside was the main phenolic in both yellow and red azarole leaves and only in yellow fruits, whereas
procyanidin B2 was the major compound in red fruits. Yellow azarole leaf and fruit peel extracts exhibited the strongest antioxidant activities using DPPH (â168 and 79 ÎŒmol TEAC/g fw, respectively) and FRAP (â378 and 161 ÎŒmol Fe2+/g fw,
respectively) assays. The highest antibacterial activities were recorded for the yellow azarole leaf and fruit peel extracts, especially against Staphylococcus aureus and Streptococcus faecalis. The low phenolic content of the syrups contrasted with their significant antioxidant and antimicrobial potentials, which were correlated to their hydroxymethylfurfural (HMF) (furan derivative
amounts) content
Protective effects of azarole polyphenolic extracts against oxidative damage using in vitro biomolecular and cellular models
The antioxidant activity of the different polyphenolic extracts prepared from Tunisian azarole, Crataegus azarolus and Crataegus monogyna (Rosaceae family) leaves, fruit peel, pulp and syrup was evaluated using cholesterol, liposome and rat liver-homogenate oxidation assays and cytotoxic activity in differentiated Caco-2, undifferentiated Caco-2, and B16F10 melanoma cells. Protective effects were observed against thermal-cholesterol degradation at 140 °C for 1 h, which depended on the concentration and the type of the extract. Moreover, the pre-treatment with the phenolic extracts preserved liposomes and rat liver-homogenate from oxidative induced damage by Cu2+ and Fe2+ at 37 °C for 24 h and 2 h, respectively. Azarole phenolics inhibited the oxidation of polyunsaturated fatty acids (PUFA) and limited the production of oxidized compounds. Furthermore, within tested concentrations (0.24-4.8 mg/mL), all extracts did not show any toxic effect on differentiated Caco-2 cells; while, they were found cytotoxic to cancer Caco-2 cells, except, extracts of pulp and syrup of C. monogyna. Using B16F10 melanoma cell model, only azarole pulp and syrup extracts were found toxic and induced the production of melanin in a dose-dependent manne
Essential Oil Composition, Antioxidant, Cytotoxic and Antiviral Activities of Teucrium pseudochamaepitys Growing Spontaneously in Tunisia
The chemical composition, antioxidant, cytotoxic and antiviral activities of the essential oil obtained by hydrodistillation from the aerial parts of Teucrium pseudochamaepitys (Lamiaceae) collected from Zaghouan province of Tunisia are reported. The essential oil was analyzed by gas chromatography equipped with a flame ionization detector (GC-FID) and gas chromatography coupled with mass spectrometry (GC/MS). Thirty-one compounds were identified representing 88.6% of the total essential oil. Hexadecanoic acid was found to be the most abundant component (26.1%) followed by caryophyllene oxide (6.3%), myristicin (4.9%) and α-cubebene (3.9%). The antioxidant capacity of the oil was measured on the basis of the scavenging activity to the stable 2,2-diphenyl-1-picrylhydrazyl (DPPH). The IC50 value of the oil was evaluated as 0.77 mg·mLâ1. In addition, the essential oil was found to possess moderate cytotoxic effects on the HEp-2 cell line (50% cytotoxic concentration (CC50) = 653.6 ”g·mLâ1). The potential antiviral effect was tested against Coxsackievirus B (CV-B), a significant human and mouse pathogen that causes pediatric central nervous system disease, commonly with acute syndromes. The reduction of viral infectivity by the essential oil was measured using a cytopathic (CPE) reduction assay
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