Pulmonary sequestration: a review of 26 cases

Objectives: Pulmonary sequestration is a continuum of lung anomalies for which no single embryonic hypothesis is yet available. The aim of this study was to assess the diagnostic tools and treatment for the rare condition, pulmonary sequestration, in an unspecialised centre. Methods: We performed an analysis of 26 cases of pulmonary sequestration (paediatric and adult) operated at the Centre Hospitalier Universitaire Vaudois between May 1959 and May 1997. A review of the extralobar and intralobar types of sequestrations is discussed. Angiography is compared to other diagnostic tools in this condition, and treatment is discussed. Results: Twenty-six cases of pulmonary sequestrations, a rare congenital pulmonary malformation, were operated on in the defined time period. Seventy-three percent (19) of the cases were intralobar and 27% (seven) extralobar. Extralobar localisation was basal in 71% and situated between the upper and the lower lobe in 29%. In six cases, the diagnosis was made by exploratory thoracotomy. In the other 20 cases, diagnosis was evoked on chest X-ray and confirmed by angiography. Lobectomy (46%) was the most common treatment procedure. Segmental resection was performed in 30% of the cases and bilobectomy in 4%. Post-operative morbidity was low. The most significant complications were pleural empyema, haemothorax and haemopneumoperitoneum in case of extralobar sequestration. There was no evidence of metaplasia or pre-neoplastic changes. Conclusions: Despite its rarity, some radiological features are sufficiently suggestive of diagnosis of pulmonary sequestration. Investigations are necessary in order to avoid unexpected pathology at the time of operation. Resection of the involved lung leads to excellent results and the long-term outcome is highly favourabl

Impact of water stress on plant water relations, growth and mycorhization of Acacia tortilis ssp. raddiana: Interactions of the stress severity and duration, and the AM fungal species.

Mycorrhizae are commonly reported to improve drought resistance of the host plant. Investigating factors controlling the plant-resistance strategy to water stress can however lead to a suitable management of mycorrhizal plants under drought. Here, we focused on the impact of interactions of the AM fungal species and water stress severity and duration on mycorrhizal Acacia tortilis ssp. raddiana in terms of plant growth, mycorhization and water relations. We used three Glomus species, which were G. mosseae, G. deserticola and G. intraradices. We applied three watering regimes that were maximum water holding non-stress regime, mild-severe water stress and severe water stress. Measurements were performed at four stage durations named pre-drought (one day before applying water stress), early-drought (30 days after applying water stress), mid-drought (60 days after applying water stress), and late-drought (90 days after applying water stress). Under maximum water holding regime, G. mosseae was more infective than G. deserticola and G. intraradices, but differences were not significantly different (P < 0.05). Predawn water potential was analogous for both mycorrhizal and control treatments whilst midday water potential was lower for control than for AMF treatments. Under mild and late drought, G. deserticola and G. intraradices were more infective than G. mosseae. Plants inoculated with G. intraradices had the highest predawn water potential and MWP. Mid-morning and midday stomatal conductance were similar and higher in seedlings inoculated with G. deserticola and G. intraradices. Under severe and late drought, infectivity was comparable and higher for both G. deserticola and G. intraradices. However, plants inoculated with G. intraradices displayed the highest growth, midday water potential, stomatal conductance and relative water content. Seedlings inoculated with G. mosseae and the controls had lost their leaves at -4 MPa water potential. Difference between Glomus species in the host response to water stress seemed to be related to the severity and duration of the stress. On the whole, inoculation of A. tortilis ssp. raddiana with G. intraradices resulted in increased plant growth and improved water status under severe and long-lasting drought, relative to G. deserticola and G. mosseae

Phenols, essential oils and carotenoids of Rosa canina from Tunisia and their antioxidant activities

The antioxidant activity of leaf extracts of Rosa canina from diverse localities of Tunisia were evaluated by ABTS and DPPH methods, whereas in those of essential oils and carotenoids extracts such activity was determined only by the ABTS method. Total phenols determined by the Folin method revealed that at Aindraham, samples showed a great variability of phenol content in contrast to those from Feija. After chemical analysis of the essential oils by gas chromatography (GC) and gas chromatography coupled to mass spectra (GC-MS), revealed that the oils of Feija were predominantly composed of palmitic acid, vitispirane, linoleic acid, lauric acid, myristic acid and phytol acetate, while in thosesamples from Aindraham predominated vitispirane, palmitic acid, linoleic acid and phytol acetate. Higher concentrations of b-carotene and lycopene were found in the samples from Aindraham after determination by high performance liquid chromatography (HPLC). All samples possess antioxidant activity, nevertheless much more significant in phenol extracts in contrast to the carotenoid extracts, which possess the lowest activity

Phenols, essential oils and carotenoids of Rosa canina from Tunisia and their antioxidant activities

The antioxidant activity of leaf extracts of Rosa canina from diverse localities of Tunisia were evaluated by ABTS and DPPH methods, whereas in those of essential oils and carotenoids extracts such activity was determined only by the ABTS method. Total phenols determined by the Folin method revealed that at Aindraham, samples showed a great variability of phenol content in contrast to those from Feija. After chemical analysis of the essential oils by gas chromatography (GC) and gas chromatography coupled to mass spectra (GC-MS), revealed that the oils of Feija were predominantly composed of palmitic acid, vitispirane, linoleic acid, lauric acid, myristic acid and phytol acetate, while in those samples from Aindraham predominated vitispirane, palmitic acid, linoleic acid and phytol acetate. Higher concentrations of beta-carotene and lycopene were found in the samples from Aindraham after determination by high performance liquid chromatography (HPLC). All samples possess antioxidant activity, nevertheless much more significant in phenol extracts in contrast to the carotenoid extracts, which possess the lowest activity

Pulmonary sequestration: a review of 26 cases

OBJECTIVES: Pulmonary sequestration is a continuum of lung anomalies for which no single embryonic hypothesis is yet available. The aim of this study was to assess the diagnostic tools and treatment for the rare condition, pulmonary sequestration, in an unspecialised centre. METHODS: We performed an analysis of 26 cases of pulmonary sequestration (paediatric and adult) operated at the Centre Hospitalier Universitaire Vaudois between May 1959 and May 1997. A review of the extralobar and intralobar types of sequestrations is discussed. Angiography is compared to other diagnostic tools in this condition, and treatment is discussed. RESULTS: Twenty-six cases of pulmonary sequestrations, a rare congenital pulmonary malformation, were operated on in the defined time period. Seventy-three percent (19) of the cases were intralobar and 27% (seven) extralobar. Extralobar localisation was basal in 71% and situated between the upper and the lower lobe in 29%. In six cases, the diagnosis was made by exploratory thoracotomy. In the other 20 cases, diagnosis was evoked on chest X-ray and confirmed by angiography. Lobectomy (46%) was the most common treatment procedure. Segmental resection was performed in 30% of the cases and bilobectomy in 4%. Post-operative morbidity was low. The most significant complications were pleural empyema, haemothorax and haemopneumoperitoneum in case of extralobar sequestration. There was no evidence of metaplasia or pre-neoplastic changes. CONCLUSIONS: Despite its rarity, some radiological features are sufficiently suggestive of diagnosis of pulmonary sequestration. Investigations are necessary in order to avoid unexpected pathology at the time of operation. Resection of the involved lung leads to excellent results and the long-term outcome is highly favourabl

Cancer de la prostate résistant à la castration (CRPC). Revue de la littérature en 2016

Introduction : Le cancer de la prostate en Tunisie est la troisième cause de mortalité par cancer après le cancer du poumon et les cancers colorectaux. L'avènement récent des hormonothérapies de nouvelle génération a révolutionné la prise en charge du cancer de la prostate résistant à la castration (CPRC). Plusieurs options thérapeutiques sont désormais disponibles en pré et en post Docetaxel. L’objectif de notre travail était d’étudier les différentes stratégies thérapeutiques dans le CPRC. Méthodes : Nous avons effectué une recherche bibliographique sur Pubmed, Medline, Cochrane   et en se référant aux recommandations internationales des sociétés savantes : AFU, EAU, ESMO, NCCN concernant les protocoles thérapeutiques des CPRC. Résultats : De nombreuses nouvelles classes thérapeutiques sont à différents stades de leur développement pour le CPRC. La connaissance de la biologie tumorale a mis en évidence l’implication de nouvelles cibles thérapeutiques comme le récepteur aux androgènes. Selon cette revue de la littérature, des immunothérapies, de nouvelles hormonothérapies, de nouveaux anti-androgènes, des thérapies ciblées et de nouveaux traitements ciblant l’os métastatique ont enrichis-la prise en charge thérapeutique des CPRC. Conclusion : Les progrès dans la prise en charge médicale du patient atteint de CPRC sont en nette progression et ce depuis 2004. L’année 2010 a été particulièrement riche en nouvelles thérapies, avec notamment les hormonothérapies de deuxième génération utilisées en pré et post Docetaxel. Tout le challenge actuel est de proposer la séquence thérapeutique optimale pour chaque patient, d’où le concept de médecine personnalisée.

Tumeur neuro-ectodermique primitive du rein avec insuffisance rénale

Introduction : Les Tumeurs neuroectodermiques périphériques (PNET) ou le sarcome d'Ewing est un cancer qui se développe habituellement dans les os et la localisation extrasquelettique est rare. Les PNET de localisation rénale sont rares et se caractérisent par une évolution clinique agressive et un mauvais pronostic. Seuls quelques cas de PNET rénaux avec insuffisance rénale ont été rapportés dans la littérature à ce jour.  Cas clinique : Nous présentons un cas de PNET rénal chez un homme de 48 ans sans antécédents médicaux, qui présentait une douleur au flanc droit, imitant des coliques nephretiques. Une échographie abdominale a montré une masse rénale droite.  La tomodensitométrie a montré une masse du rein droit de 23x9 cm associée à une carcinose péritonéale, la tumeur été localement avancé avec invasion vasculaire et des structures adjacentes. L'analyse histologique a trouvé de petites cellules rondes monomorphes qui forment des rosettes. à l’immunohistochimie, les cellules tumorales sont fortement positifs pour le CD99 et la vimentine confirmant le diagnostic de PNET. Le patient a développé une insuffisance rénale au début de l'évolution de la maladie qui nous a empêchés de réaliser le bilan d’extension de la maladie et de prescrire une chimiothérapie. Le patient est décédé de sa maladie trois mois plus tard.Discussion : Les Tumeur neuroectodermique périphérique (PNET) de localisation rénale surviennent généralement pendant l'enfance, l'adolescence ou chez le jeune adulte ce qui n’est pas le cas de notre patient (48 ans). L’insuffisance rénale en association avec les PNET rénaux a été rapportée précédemment dans seulement quelques cas pédiatriques, mais pas dans la population adulte. cette insuffisance rénale peut être expliquer par: d'une part le thrombus direct qui envahit la veine rénale (20 à 30% des cas en pédiatrie), d'autre part l'étendue de la tumeur elle-même dans le rein et enfin la compression  par les adénopathies régionales. La présence d'une fonction rénale altérée complique encore la gestion de ces patients à risque élevé avant le traitement et également après le début de la chimiothérapie. Et ceci est un obstacle à l'utilisation d’une chimiothérapie potentiellement néphrotoxiques et de produit de contraste pour l'imagerie. Devrions-nous utiliser l'échographie, la tomodensitométrie sans produit de contraste ou l’imagerie par résonance magnétique pour la stadification et le suivi ? D'autres recherches peuvent répondre à ces questions.Conclusion : Les PNET de localisation rénale doivent être envisagées dans les tumeurs rénales de tous âges, mais plus particulièrement chez les enfants et les jeunes adultes. Cette tumeur a de nombreuses similitudes avec d'autres tumeurs rénales, il est important de diagnostiquer cette entité tôt avant l’apparition des complications et principalement l’insuffisance rénale

Laparoscopic management of appendicitis and symptomatic cholelithiasis during pregnancy

BACKGROUND: Laparoscopic surgery during pregnancy is a challenging procedure that most surgeons are reluctant to perform. The objective of this study was to evaluate whether laparoscopic appendectomy and cholecystectomy is safe in pregnant women. The management of these situations remains controversial. We report a single center study describing the successful management of 16 patients during pregnancy. METHODS: More than 3,356 laparoscopic procedures were performed in our institutions between May 1990 and June 2005. Sixteen of these patients were operated on in the second and third trimester between 22 and 32 weeks of estimated gestational age. We performed 11 laparoscopic appendectomies and 5 laparoscopic cholecystectomies. We also reviewed the management and operative technique used in these patients. RESULTS: In this study, the laparoscopic appendectomy or cholecystectomy was performed successfully in all patients. Three patients were in their second trimester, weeks 22, 23, and 25, and 13 were in the third trimester, weeks 27 (three patients), 28 (five patients), 31 (three patients), and 32 (two patients). No maternal or fetal morbidity occurred. Open laparoscopy was performed safely in all patients and all patients delivered healthy babies. CONCLUSION: From our experience laparoscopic management of appendicitis and biliary colic during pregnancy is safe, however the second trimester is preferable for laparoscopic cholecystectomy. Pregnancy is not a contraindication to the laparoscopic approach to appendicitis or symptomatic cholelithiasis. We believe that laparoscopic operations, when performed by experienced surgeons, are safe and even preferable for the mother and the fetu