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

Fibromatose desmoïde à localisation nasale

Introduction : Les fibromatoses desmoïdes sont des lésions histologiquement bénignes infiltrant les muscles et les aponévroses. Ces tumeurs siègent le plus souvent au niveau de la paroi abdominale et thoracique. La localisation cervicofaciale est rare. Observation : Nous rapportons le cas d’un nourrisson âgé de 1 an 9 mois qui a présenté une fibromatose desmoïde à localisation nasale. Le patient a été opéré par voie endonasale sous guidage endoscopique avec exérèse tumorale en monobloc. L’évolution a été favorable sans récidive pour un recul de 24 mois. Conclusion : Les fibromatoses desmoïdes correspondent à des proliférations fibreuses infiltrantes mais non métastasiantes. La chirurgie est le traitement de choix, toutefois ces tumeurs sont caractérisées par un risque de récidive imposant un suivi à long terme. Mots clés : Fibromatose desmoïde, cavité nasale, chirurgie

Facteurs predictifs de l’efficacite ablative de l’iode 131 dans les cancers differencies de la thyroïde

La prise en charge des cancers différenciés de la thyroïde (CDT) comporte souvent une radiothérapie métabolique à l’iode131 (IRA-thérapie). Le but de ce travail est d’évaluer le caractère prédictif des différents éléments anatomopathologiques, de la classification pTNM et de la stadification pronostique sur l’activité ablative requise d’iode131. Notre travail est une étude analytique rétrospective portant sur 275 cas de CDT ayant subit une thyroïdectomie totale. Tous ces patients ont eu une ou plusieurs activités ablatives. Nous avons cherché – au moyen d’une analyse statistique par test de Khi2 ou test Anova – toute corrélation entre les éléments de l’examen anatomopathologique de la tumeur, la classe pTNM, le stade pronostique correspondant d’une part  et l’efficacité de l’irathérapie ablative d’autre part. Dans notre série, une activité ablative plus élevée est nécessaire lorsque la taille du foyer tumoral dépasse les 6 cm (p=0,012), en cas de dépassement de la graisse péri thyroïdienne (

Hematome organise du sinus maxillaire a propos d’un cas

L’hématome organisé du sinus maxillaire est une entité rare. Son étiopathogénie reste incertaine. Nous rapportons le cas d’une patiente âgée de 16 ans présentant une épistaxis unilatérale droite de grande abondance avec une endoscopie nasale strictement normale. L’imagerie était en faveur d’une tumeur vasculaire du sinus maxillaire. Une exérèse chirurgicale complète a été réalisée par voie combinée avec des suites simples. L’examen anatomopathologique a conclu à un hématome organisé du sinus maxillaire. Nous discutons, dans ce travail, l’étiopathogénie, les caractéristiques cliniques, radiologiques et les volets thérapeutiques de cette entité.Mots clés : Hématome organisé, sinus maxillaire, tomodensitométrie, chirurgie

Los esfuerzos para dirección de bosque de alcornoque y sus efectos sobre conservación de suelo, la meseta Shoul, región de Rabat, Marruecos

The Shoul oak grove is a forested ecosystem inherited from a Holocene phase of ecological optimum; its evolution, through the double geologic and human temporality, and in relation with several processes of degradation, led to the progressive loss of its environmental equilibrium and further to the reduction of its economic contributions. The fragility of these forests is the consequence of the convergence of two main factors, i) the intrinsic fragility of the forested environment based on an unstable balance between the tree, the leached soils and their moisture content ; ii) the anthropological action on the forest environment and its degradation with the change of its floristic composition. During the colonization the new context was at the origin of the new social and economic relation between the forest and the surrounding populations. The current use of this oak grove is in a classic scheme of the reports society / forest in Morocco. The population is especially of pastoral main activity in the bordering communes. But the oak groves of Mamora-Sehoul are integrated into the area of influence of several cities, what exposes the forest to the risks of uncontrolled urbanization. These oak groves are thus in the centre of interest of several stakeholders with opposite behaviour and a new paradigm of relation rural/urban. Through a double approach, environmental and socio-economic, this paper will try to bring elements of answer by analyzing the interactions between a forest which reached an alarming threshold of degradation and a society affected by important changes in its modes of intervention and exploitation.La arboleda de roble Shoul es un ecosistema arbolado heredado de una fase de Holocene de grado óptimo ecológico; su evolución, por la doble temporalidad geológica y humana, y en relación con varios procesos de degradación, conducida a la pérdida progresiva de su equilibrio ambiental y con relación a la reducción de sus contribuciones económicas. La fragilidad de estos bosques es la consecuencia de la convergencia de dos factores principales, i) la fragilidad intrínseca del ambiente arbolado basado en un equilibrio(saldo) inestable entre el árbol, los suelos leached y su contenido de humedad; ii) la acción antropológica sobre el ambiente forestal y su degradación con el cambio de su composición floristic. Durante la colonización el nuevo contexto estaba en el origen de la nueva relación social y económica entre el bosque y las poblaciones circundantes. El empleo corriente de esta arboleda de roble está en un esquema clásico de la sociedad de informes / el bosque en Marruecos. La población es sobre todo de actividad pastoral principal en las comunas de lindar. Pero las arboledas de roble de Mamora-Sehoul son integradas en el área de influencia de varias ciudades, que expone el bosque a los riesgos de urbanización incontrolada. Estas arboledas de roble son así en el centro de interés de varios tenedores de apuestas con el comportamiento de enfrente y un nuevo paradigma de relación rural/urbana. Por un doble acercamiento, ambiental y socioeconómico, este papel(periódico) tratará de traer los elementos de respuesta por analizando las interacciones entre un bosque que alcanzó un umbral alarmante de degradación y una sociedad afectada por cambios importantes de sus modos de intervención y explotación

Year in review in Intensive Care Medicine 2011: III. ARDS and ECMO, weaning, mechanical ventilation, noninvasive ventilation, pediatrics and miscellanea

SCOPUS: re.jinfo:eu-repo/semantics/publishe

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