Experience du service de medecine nucleaire sahloul sousse dans la prise en charge des carcinomes differencies de la thyroïde a thyroglobuline elevee.

But : L’objectif de notre travail est de présenter notre expérience dans la prise en charge des cancer différencié de la thyroïde (CDT) à Thyroglobuline (Tg) élevée, tout en identifiant les paramètres modifiant l’efficacité de l’Irathérapie et la valeur seuil de la Tg permettant avec un balayage post thérapeutique négatif de conclure à une rémission.Matériels et méthodes : Il s’agit d’une étude rétrospective portant sur 150 patients opérés pour CDT, suivis entre 1990 et 2006 et présentant une Tg>2ng/ml.Résultats : Il s’agit de 122 femmes et 28 hommes. L’âge moyen était de 52 ans. La Tg ne dépendait pas du type histologique mais il existait une relation statistiquement significative entre la Tg et la taille tumorale, l’atteinte ganglionnaire, l’extension locorégionale, la présence de métastases et le stade TNM. La réponse thérapeutique des CDT avec une Tg élevée dépendait de l’âge des patients, des caractéristiques anatomopathologiques de la tumeur et des valeurs de la Tg.Conclusion : L’efficacité ablative est optimisée par des cures d’iode 131 qui doivent être prolongées tant que la Tg reste élevée. La surveillance à vie, au cours de la quelle on exige des seuils de Tg infèrieurs à 2ng/ml, est nécessaire. Mots clés : Cancers différenciés de la thyroide, Thyroglobuline, Irathérapie, Pronostic, Surveillance.Purpose: The aim of our work is to present our experience in the management of differentiated thyroid cancer (DTC) with high thyroglobulin (Tg) , to identify parameters changing iodine effectiveness and Tg threshold with negative post treatment scan conclude to remission.Materials and Methods: This is a retrospective study of 150 patients undergoing CDT, followed between 1990 and 2006 and having a Tg > 2ng/ml .Results: Our study concerns 122 women and 28 men. The average age was 52 years . Tg value does not depend on the histological type but there was a statistically significant relationship between Tg and tumor size, lymph node involvement, locoregional , metastasis and TNM stage . The therapeutic response of CDT with a high Tg was dependent on the age of patients, the pathological characteristics of the tumor and the Tg values ofConclusion: The ablative efficiency is optimized by 131 cures iodine should be extended until the Tg remains high. Monitoring life is necessary and the thresholds Tg below 2ng/ml is required.Keywords: Differentiated thyroid Cancers, Thyroglobulin, Iodine 131, Prediction, Monitoring

Primary pelvic hydatid cyst with sciatic compression

Hydatid cysts are endemic in certain regions of the world and particulary in North Africa. They are usually located in the liver, lung, and spleen, though many uncommon locations have been reported. This is the first report of a child with primary pelvic hydatid disease causing a sciatic compression

A first assessment of genetic variability in the Eurasian Stone-curlew Burhinus oedicnemus

The Eurasian Stone-curlew is a species of conservation concern in Europe. We investigate for the first time the extent of population structure among populations sampled from six geographical areas, representing four subspecies inhabiting the western part of the species’ distribution. Neither mitochondrial nor nuclear markers fully supported current subspecies boundaries. However, both markers support significant differentiation of the Canary Island populations from those sampled from the Mediterranean. Further work is needed to establish the taxonomic status of this potentially distinct Macaronesian taxon. More broadly, further genetic research is required to design and implement an effective conservation plan for this species

Giant primary adrenal hydatid cyst presenting with arterial hypertension: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>A primary hydatid cyst of the adrenal gland is still an exceptional localization. The adrenal gland is an uncommon site even in Morocco, where echinococcal disease is endemic.</p> <p>Case presentation</p> <p>We report the case of a 64-year-old Moroccan man who presented with the unusual symptom of arterial hypertension associated with left flank pain. Computed tomography showed a cystic mass of his left adrenal gland with daughter cysts filing the lesion (Type III). Despite his negative serology tests, the diagnosis of a hydatid cyst was confirmed on surgical examination. Our patient underwent surgical excision of his left adrenal gland with normalization of blood pressure. No recurrence has occurred after 36 months of follow-up.</p> <p>Conclusion</p> <p>There are two remarkable characteristics of this case report; the first is the unusual location of the cyst, the second is the association of an adrenal hydatid cyst with arterial hypertension, which has rarely been reported in the literature.</p

Exacerbations of chronic obstructive pulmonary disease: when are antibiotics indicated? A systematic review

BACKGROUND: For decades, there is an unresolved debate about adequate prescription of antibiotics for patients suffering from exacerbations of chronic obstructive pulmonary disease (COPD). The aim of this systematic review was to analyse randomised controlled trials investigating the clinical benefit of antibiotics for COPD exacerbations. METHODS: We conducted a systematic review of randomised, placebo-controlled trials assessing the effects of antibiotics on clinically relevant outcomes in patients with an exacerbation. We searched bibliographic databases, scrutinized reference lists and conference proceedings and asked the pharmaceutical industry for unpublished data. We used fixed-effects models to pool results. The primary outcome was treatment failure of COPD exacerbation treatment. RESULTS: We included 13 trials (1557 patients) of moderate to good quality. For the effects of antibiotics on treatment failure there was much heterogeneity across all trials (I(2 )= 82%). Meta-regression revealed severity of exacerbation as significant explanation for this heterogeneity (p = 0.016): Antibiotics did not reduce treatment failures in outpatients with mild to moderate exacerbations (pooled odds ratio 1.09, 95% CI 0.75–1.59, I(2 )= 18%). Inpatients with severe exacerbations had a substantial benefit on treatment failure rates (pooled odds ratio of 0.25, 95% CI 0.16–0.39, I(2 )= 0%; number-needed to treat of 4, 95% CI 3–5) and on mortality (pooled odds ratio of 0.20, 95% CI 0.06–0.62, I(2 )= 0%; number-needed to treat of 14, 95% CI 12–30). CONCLUSION: Antibiotics effectively reduce treatment failure and mortality rates in COPD patients with severe exacerbations. For patients with mild to moderate exacerbations, antibiotics may not be generally indicated and further research is needed to guide antibiotic prescription in these patients

Characterization of Coastal Urban Watershed Bacterial Communities Leads to Alternative Community-Based Indicators

BACKGROUND: Microbial communities in aquatic environments are spatially and temporally dynamic due to environmental fluctuations and varied external input sources. A large percentage of the urban watersheds in the United States are affected by fecal pollution, including human pathogens, thus warranting comprehensive monitoring. METHODOLOGY/PRINCIPAL FINDINGS: Using a high-density microarray (PhyloChip), we examined water column bacterial community DNA extracted from two connecting urban watersheds, elucidating variable and stable bacterial subpopulations over a 3-day period and community composition profiles that were distinct to fecal and non-fecal sources. Two approaches were used for indication of fecal influence. The first approach utilized similarity of 503 operational taxonomic units (OTUs) common to all fecal samples analyzed in this study with the watershed samples as an index of fecal pollution. A majority of the 503 OTUs were found in the phyla Firmicutes, Proteobacteria, Bacteroidetes, and Actinobacteria. The second approach incorporated relative richness of 4 bacterial classes (Bacilli, Bacteroidetes, Clostridia and alpha-proteobacteria) found to have the highest variance in fecal and non-fecal samples. The ratio of these 4 classes (BBC:A) from the watershed samples demonstrated a trend where bacterial communities from gut and sewage sources had higher ratios than from sources not impacted by fecal material. This trend was also observed in the 124 bacterial communities from previously published and unpublished sequencing or PhyloChip- analyzed studies. CONCLUSIONS/SIGNIFICANCE: This study provided a detailed characterization of bacterial community variability during dry weather across a 3-day period in two urban watersheds. The comparative analysis of watershed community composition resulted in alternative community-based indicators that could be useful for assessing ecosystem health

Systematic Review of Potential Health Risks Posed by Pharmaceutical, Occupational and Consumer Exposures to Metallic and Nanoscale Aluminum, Aluminum Oxides, Aluminum Hydroxide and Its Soluble Salts

Aluminum (Al) is a ubiquitous substance encountered both naturally (as the third most abundant element) and intentionally (used in water, foods, pharmaceuticals, and vaccines); it is also present in ambient and occupational airborne particulates. Existing data underscore the importance of Al physical and chemical forms in relation to its uptake, accumulation, and systemic bioavailability. The present review represents a systematic examination of the peer-reviewed literature on the adverse health effects of Al materials published since a previous critical evaluation compiled by Krewski et al. (2007). Challenges encountered in carrying out the present review reflected the experimental use of different physical and chemical Al forms, different routes of administration, and different target organs in relation to the magnitude, frequency, and duration of exposure. Wide variations in diet can result in Al intakes that are often higher than the World Health Organization provisional tolerable weekly intake (PTWI), which is based on studies with Al citrate. Comparing daily dietary Al exposures on the basis of “total Al”assumes that gastrointestinal bioavailability for all dietary Al forms is equivalent to that for Al citrate, an approach that requires validation. Current occupational exposure limits (OELs) for identical Al substances vary as much as 15-fold. The toxicity of different Al forms depends in large measure on their physical behavior and relative solubility in water. The toxicity of soluble Al forms depends upon the delivered dose of Al+ 3 to target tissues. Trivalent Al reacts with water to produce bidentate superoxide coordination spheres [Al(O2)(H2O4)+ 2 and Al(H2O)6 + 3] that after complexation with O2•−, generate Al superoxides [Al(O2•)](H2O5)]+ 2. Semireduced AlO2• radicals deplete mitochondrial Fe and promote generation of H2O2, O2 • − and OH•. Thus, it is the Al+ 3-induced formation of oxygen radicals that accounts for the oxidative damage that leads to intrinsic apoptosis. In contrast, the toxicity of the insoluble Al oxides depends primarily on their behavior as particulates. Aluminum has been held responsible for human morbidity and mortality, but there is no consistent and convincing evidence to associate the Al found in food and drinking water at the doses and chemical forms presently consumed by people living in North America and Western Europe with increased risk for Alzheimer\u27s disease (AD). Neither is there clear evidence to show use of Al-containing underarm antiperspirants or cosmetics increases the risk of AD or breast cancer. Metallic Al, its oxides, and common Al salts have not been shown to be either genotoxic or carcinogenic. Aluminum exposures during neonatal and pediatric parenteral nutrition (PN) can impair bone mineralization and delay neurological development. Adverse effects to vaccines with Al adjuvants have occurred; however, recent controlled trials found that the immunologic response to certain vaccines with Al adjuvants was no greater, and in some cases less than, that after identical vaccination without Al adjuvants. The scientific literature on the adverse health effects of Al is extensive. Health risk assessments for Al must take into account individual co-factors (e.g., age, renal function, diet, gastric pH). Conclusions from the current review point to the need for refinement of the PTWI, reduction of Al contamination in PN solutions, justification for routine addition of Al to vaccines, and harmonization of OELs for Al substances