The Dirichlet problem for superdegenerate differential operators

Let $L$ be an infinitely degenerate second-order linear operator defined on a bounded smooth Euclidean domain. Under weaker conditions than those of H\"ormander, we show that the Dirichlet problem associated with $L$ has a unique smooth classical solution. The proof uses the Malliavin calculus. At present, there appears to be no proof of this result using classical analytic techniques

Computational Laser Spectroscopy in a Biological Tissue

We present a numerical spectroscopic study of visible and infrared laser radiation in a biological tissue. We derive a solution of a general two-dimensional time dependent radiative transfer equation in a tissue-like medium. The used model is suitable for many situations especially when the external source is time-dependent or continuous. We use a control volume-discrete ordinate method associated with an implicit three-level second-order time differencing scheme. We consider a very thin rectangular biological-tissue-like medium submitted to a visible or a near infrared light sources. The RTE is solved for a set of different wavelength source. All sources are assumed to be monochromatic and collimated. The energetic fluence rate is computed at a set of detector points on the boundaries. According to the source type, we investigate either the steady-state or transient response of the medium. The used model is validated in the case of a heterogeneous tissue-like medium using referencing experimental results from the literature. Also, the developed model is used to study changes on transmitted light in a rat-liver tissue-like medium. Optical properties depend on the source wavelength and they are taken from the literature. In particular, light-transmission in the medium is studied for continuous wave and for short pulse

Neurocognitive outcome after preterm birth: Interest of the follow-up and the systematic evaluation

ObjectivePreterm children can experience cognitive and behavioral difficulties being able to be responsible for school difficulties going to the academic failure. The aim of this study was to assess the cognitive process while insisting on the early screening from the preschool age.MethodsThe data arise from the study of files and from the neuropsychological evaluations realized with the premature children followed in a regular way to the service. The premature children with or without motor disabilities more 4 and a half-years, old deficit integrated pre-school and ordinary school were included. The children with severe disabilities in upper limbs and the children having a mental deficiency were excluded.Results30 middle-aged children 7 years 5 months have been included. The prematurity is between 27–34. The born term has an effect on the performances in particular on attention and visuo-spatial capacities.ConclusionThe prematurity is a risk factor of the school future of the child. There is specially a negative impact on visuo-spatial and visuo-motor processes and those children present social and behavioral difficulties. It is mandatory to include the neuropsychological evaluation in any follow-up of premature child thanks to tests validated in the Tunisian context. It remains of great importance to identify effective interventions to improve the long-term neurocognitive outcomes

PHYSICO-CHEMICAL AND MICROBIOLOGICAL CHARACTERIZATION OF NATURAL FERMENTING OLIVE BRINES

The main objective of this work is to study the characterization of physico-chemical and microbiological of fermenting green olive brines at different times of fermentation. The technological and probiotic properties of lactic acid bacteria strains isolated from brines were also characterized, 24 brine samples were sampled from Triffa conserves entreprise, an industrial zone of Oujda city in eastern Morocco, during 2014-2015 and 2015-2016 campaigns, 240 isolates of lactic acid bacteria have been isolated, and they have undergone a series of tests to finally select the so-called probiotic bacteria. 41 strains were resistant to low pH (3, 2.5, 2), bile salts (0.3 and 1%, w/v) and 7 strains among the 41 were resistant to saline stress (8%, w/v) and endowed with acidification capacity and have a good enzymatic activity and a broad spectrum of antibacterial activity against pathogenic and non-pathogenic bacteria such as (Escherichia coli, Staphylococcus aureus, Listeria innocua, Pseudomonas aeruginosa and Micrococcus luteus). These results show the ability of these strains to dominate and grow in the digestive tract.These potential probiotic strains will be used as concentrated ferments in the fermentation and bioconservation of foods

L’ectopie des glandes parathyroides dans la chirurgie de l’hyperparathyroidie

Introduction : L’ectopie parathyroïdienne est la cause d’échec la plus fréquente de la chirurgie de l’hyperparathyroïdie, entrainant le plus souvent des reprises chirurgicales. Son diagnostic topographique pré-opératoire reste difficile malgré le progrès dans les différentes explorations radiologiques. Le diagnostic per-opératoire doit être guidé par une stratégie de dissection de référence. Le but de travail est d’étudier la stratégie de recherche des parathyroides lors de leur chirurgie.Matériels et méthodes : Il s’agit d’une étude rétrospective à propos de 137 patients (162 glandes parathyroïdes ectopiques) parmi 572 patients opérés d’une hyperparathyroïdie, colligés sur une période de 11 ans (Janvier 2001-Décembre 2011). Tous les patients ont bénéficié d’une imagerie pré-opératoire et ont été opérés sous anesthésie générale.Résultats : L’âge moyen était de 49 ans (11-71 ans) et le sex-ratio de 1,04. Une hyperparathyroïdie primaire était présente chez 26 patients (18,98%) et une hyperparathyroïdie secondaire à une insuffisance rénale chronique chez 111 patients (81,02%).Une cervicotomie par voie classique avec exploration des 2 loges thyroïdiennes a été réalisée dans 136 cas. Dans les cas où la parathyroïde n’a pas été retrouvée, un geste opératoire a été associé. Ce geste consistait en un curage médiastino-récurrentiel (15 cas), une thymectomie (12 cas) et une lobectomie thyroïdienne (9 cas). Un seul patient a eu une thoracotomie en chirurgie thoracique, sans abord cervical classique. Sur les 162 glandes parathyroïdes ectopiques retenues dans l’étude, 68 étaient des glandes parathyroïdes inférieures. Les localisations de celles-ci étaient par ordre de fréquence le thymus (26 cas), le ligament thyro-thymique (14 cas), le médiastin antéro-supérieur (5 cas) et la gaine carotidienne (3 cas). Vingt glandes parathyroïdes inférieures n’ont pas été retrouvées sur les 68 (29,41%). Le nombre des glandes parathyroïdes supérieures ectopiques était de 94 sur 162. Leurs localisations étaient par ordre de fréquence le pôle supérieur (33 cas), le pédicule supérieur (20 cas), la région rétro-oesophagienne (15 cas), la gaine carotidienne (11 cas), intra-thyroïdienne (5 cas) et le médiastin postéro-supérieur (2 cas). Huit glandes parathyroïdes supérieures n’ont pas été trouvées sur les 94 (8,51%). Au total, sur les 162 glandes parathyroïdes ectopiques, 28 n’ont pas été retrouvées (17,28%).Conclusion : L’imagerie est un moyen incontournable à la recherche d’une glande parathyroïde ectopique. Lorsqu’elle n’est pas retrouvée dans sa localisation habituelle, la stratégie de dissection chirurgicale doit être méthodique.Mots-clés : glande parathyroïde, ectopie, hyperparathyroïdie, imagerie, parathyroïdectomieIntroduction: 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

Osteite frontale post-sinusitique: Etude rétrospective à propos de 31 cas

Objective : Post-sinusitic frontal osteitis is defined as an extension of frontal sinus infection to the adjacent bony structures. It is an emergency that should rapidly be diagnosed and treated. The aim of this study is to analyze epidemiologic, clinical and paraclinical features, and to review different therapeutic modalities of this disease.Materials and methods : We carry a retrospective study about 31 patients diagnosed and treated between 1996 and 2010. All patients underwent complete ENT and neurological examination, biological investigations, sino-nasal and cerebral CT scan. Antibiotherapy was administrated intravenously. Surgical drainage of the frontal sinus was performed eitherby trephination, by osteoplastic flap confection, or by Lemoyne drain placement. Endonasal drainage consisted of middle meatotomy with anterior ethmoidectomy. Frontal sinus cranialisation was performed with coronal approach. Evolution was assessed on clinical, biological and radiological criteria.Results : Mean age was 24,4 years (8-62 years) and sex-ratio 4,16. Frontal headache (10 cases) and intracranial hypertension signs (8 cases) were the most frequent functional symptoms. Frontal tumefaction was noted in 9 patients, associated in 5 cases with orbital tumefaction of the internal eye angle. Rhinological signs were essentially purulent rhinorrhea(9 cases) and nasal obstruction (5 cases). Nasal endoscopy showed purulent secretions at themiddlemeatus in 12 cases. CT scan revealed a typical aspect of frontal osteitis with bony lysis. A sub-periostal abscess was associated in 7 patients. Intracranial extension was noted in 15 cases and orbital extension in 7 cases. Bacteriological examination was positivein 8 cases. Most frequent bacteria were streptococcus and staphylococcus aureus (3 cases each). Antibiotic therapy was initially administrated in all cases. Concerning initial surgical treatment, 9 patients underwent frontaldrainage and 2 others orbital drainage. On the other hand, 4 patients underwent only sub-periostal abscess drainage. This one was associated with cranialisation in another case. For patients having endocranial complications, empyema drainage was realized in 14 cases, associed in 6 of them with cranialisation. Cerebral abscess drainage was performedin one other patient. Clinical and radiological evolution was favourable in 24 patients (77,4%). The seven other patients were reoperated because of persistence or aggravation of clinical symptoms. Later evolution was favourable.Conclusion : Post-sinusitic frontal osteitis a rare and serious affection. Diagnosis, based on clinical and radiological features, should be early made. Adequate treatment have to be instituted to prevent life-threatening complications.Keywords : osteitis, frontal sinus, sinusitis, computed tomography, drainage, cranialisatio

Temporal Dynamics and Impact of Climate Factors on the Incidence of Zoonotic Cutaneous Leishmaniasis in Central Tunisia

Old world cutaneous leishmaniasis is a vector-borne disease occurring in rural areas of developing countries. The main reservoirs are the rodents Psammomys obesus and Meriones shawi. Zoonotic Leishmania transmission cycle is maintained in the burrows of rodents where the sand fly Phlebotomus papatasi finds the ideal environment and source of blood meals. In the present study we showed seasonality of the incidence of disease during the same cycle with an inter-epidemic period ranging from 4 to 7 years. We evaluated the impact of climate variables (rainfall, humidity and temperature) on the incidence of zoonotic cutaneous leishmaniais in central Tunisia. We confirmed that the risk of disease is mainly influenced by the humidity related to the months of July to September during the same season and mean rainfall lagged by 12 to 14 months

Fistules perilymphatiques post-traumatiques a propos de 13 cas

Introduction : La fistule péri-lymphatique (fPL) post-traumatique réalise une communication anormale entre le compartiment liquidien périlymphatique et l’oreille moyenne. Son diagnostic est souvent difficile du fait du tableau clinique parfois incomplet. L’imagerie est indispensable afin d’étayer le diagnostic. Le traitement repose sur la chirurgie.Patients et méthode : : il s’agit d’une étude rétrospective à propos de 13 patients colligés sur une période de 13 ans (1996-2008). un examen ORL complet, une audiométrie et une imagerie (tomodensitométrie des rochers) ont été réalisés dans tous les cas. Tous les patients ont bénéficié d’un traitement médical et ont été opérés sous anesthésie générale. Le contrôle ultérieur était clinique, audiométrique et radiologique avec un recul moyen de 22 mois.Résultats :L’âge moyen était de 29 ans (20-47 ans) et le sex-ratio 3,33. Les signes fonctionnels étaient essentiellement représentés par l’hypoacousie dans 12 cas (92,3%), les vertiges dans 11 cas (84,6%) et les acouphènes dans 4 cas (30,8%). L’écoulement d’un liquide eau de roche par l’oreille a été rapporté par 2 patients (15,4%). L’examen clinique trouvait un nystagmus spontané battant du côté controlatéral au traumatisme chez un seul patient, et un signe de la fistule positif chez 2 patients (15,4%). A l’audiométrie, 9 patients (69,3%) avaient une surdité de perception ou mixte dont 6 cas de cophose. une surdité de transmission a été objectivée dans 3 cas. un patient avait une audition subnormale. La TdM des rochers a montré une fracture extra-labyrinthique dans 5 cas (38,5%) et une fracture trans-labyrinthique ou mixte dans 6 cas (46,2%). un pneumolabyrinthe a été constaté chez 5 patients (38,5%). une exploration chirurgicale a été indiquée chez tous les patients. En per-opératoire, une fPL a été mise en évidence dans tous les cas. Le siège de la fistule était au niveau du promontoire et/ou au niveau des fenêtres. un colmatage de la fistule a été réalisé dans tous les cas. Les matériaux utilisés étaient essentiellement de l’aponévrose temporale superficielle, du périchondre tragal et de la graisse. En post-opératoire, les vertiges se sont améliorés chez  patients parmi les 11 vertigineux (81,8%). L’audition était améliorée chez 2 patients parmi les 9 ayant une surdité de perception ou mixte (18,2%).Conclusion : La fistule périlymphatique post-traumatique est de diagnostic difficile. Celui-ci est étayé par un faisceau d’arguments cliniques et paracliniques et n’est confirmé qu’en per-opératoire. L’indication d’une exploration chirurgicale et son délai dépendent essentiellement de la symptomatologie clinique et de son évolution dans le temps.Mots clés : fistule périlymphatique, traumatisme, vertige, surdité, tomodensitométrie, chirurgieObjective : Post-traumatic perilymphatic fistula (PLf) realises an abnormal communication between the perilymphatic fluid compartment and the middle ear. its diagnosis is often difficult because the clinical presentation is sometimes incomplete. imaging is essential in order to support the diagnosis. Treatment is based on surgery.Patients and methods : We carry a retrospective study about 13 patients collected over a period of 13 years (1996- 2008). A complete ENT examination, audiometry and imaging (petrous CT scan) were performed in all cases. All patients received medical treatment and were operated under general anaesthesia. Subsequent control was clinical, radiological and audiometric with a mean period of 22 months.Mean age was 29 years (20-47 years) and sex ratio 3.33. Symptoms were mainly hearing loss in 12 cases (92.3%), vertigo in 11 cases (84.6%) and tinnitus in 4 cases (30.8%). flow of liquid from the ear was reported by 2 patients (15.4%). Clinical examination showed spontaneous nystagmus beating to the contralateral side of the trauma in one patient, and a positive sign of the fistula in 2 patients (15.4%). At audiometry, 9 patients (69.3%) had sensorineural or mixed deafness, of which 6 cases of cophosis. Transmission deafness was found in 3 cases. One patient had a subnormal hearing. Petrous CT scan showed extra-labyrinthic fracture in 5 cases (38.5%) and trans-labyrinthic or mixed fracture in 6 cases (46.2%). A pneumolabyrinth was found in 5 patients (38.5%). Surgical exploration was indicated in all patients. PLf was found in all cases. The localization of the fistula was at the promontory and / or at the windows. Blockage of the fistula was achieved in all cases. Materials used were essentially superficial temporal fascia, tragal perichondrium and fat. Postoperatively, vertigo improved in 9 patients among 11 (81.8%). Hearing was improved in 2 patients among the 9 having sensorineural or mixed deafness (18.2%).Conclusion: TPost-traumatic perilymphatic fistula trauma is difficult to diagnose. This is supported by a beam of clinical and paraclinical arguments, and is confirmed intraoperatively. The indication for surgical exploration and its delay depend mainly on clinical symptomatology and its evolution over time.Keywords : perilymphatic fistula, trauma, vertigo, deafness, CT scan, surger

Fistules perilymphatiques post-traumatiques

Introduction : La fistule péri-lymphatique (FPL) post-traumatique réalise une communication anormale entre le compartiment liquidien périlymphatique et l’oreille moyenne. Son diagnostic est souvent difficile du fait du tableau clinique parfois incomplet. L’imagerie est indispensable afin d’étayer le diagnostic. Le traitement repose sur la chirurgie.Matériel et méthodes : Il s’agit d’une étude rétrospective à propos de 13 patients colligés sur une période de 13 ans (1996-2008). Un examen ORL complet, une audiométrie et une imagerie (tomodensitométrie des rochers) ont été réalisés dans tous les cas. Tous les patients ont bénéficié d’un traitement médical et ont été opérés sous anesthésie générale. Le contrôle ultérieur était clinique, audiométrique et radiologique avec un recul moyen de 22 mois.Résultats : L’âge moyen était de 29 ans (20-47 ans) et le sex-ratio 3,33. Les signes fonctionnels étaient essentiellement représentés par l’hypoacousie dans 12 cas (92,3%), les vertiges dans 11 cas (84,6%) et les acouphènes dans 4 cas (30,8%). L’écoulement d’un liquide eau de roche par l’oreille a été rapporté par 2 patients (15,4%). L’examen clinique trouvait un nystagmus spontané battant du côté controlatéral au traumatisme chez un seul patient, et un signe de la fistule positif chez 2 patients (15,4%). A l’audiométrie, 9 patients (69,3%) avaient une surdité de perception ou mixte dont 6 cas de cophose. Une surdité de transmission a été objectivée dans 3 cas. Un patient avait une audition subnormale. La TDM des rochers a montré une fracture extra-labyrinthique dans 5 cas (38,5%) et une fracture trans-labyrinthique ou mixte dans 6 cas (46,2%). Un pneumolabyrinthe a été constaté chez 5 patients (38,5%). Une exploration chirurgicale a été indiquée chez tous les patients. En per-opératoire, une FPL a été mise en évidence dans tous les cas. Le siège de la fistule était au niveau du promontoire et/ou au niveau des fenêtres. Un colmatage de la fistule a été réalisé dans tous les cas. Les matériaux utilisés étaient essentiellement de l’aponévrose temporale superficielle, du périchondre tragal et de la graisse. En post-opératoire, les vertiges se sont améliorés chez 9 patients parmi les 11 vertigineux (81,8%). L’audition était améliorée chez 2 patients parmi les 9 ayant une surdité de perception ou mixte (18,2%).Conclusion : La fistule périlymphatique post-traumatique est de diagnostic difficile. Celui-ci est étayé par un faisceau d’arguments cliniques et paracliniques et n’est confirmé qu’en per-opératoire. L’indication d’une exploration chirurgicale et son délai dépendent essentiellement de la symptomatologie clinique et de son évolution dans le temps.Mots-clés : fistule périlymphatique, traumatisme, vertige, surdité, tomodensitométrie, chirurgieIntroduction: Post-traumatic perilymphatic fistula (PLF) realises an abnormal communication between the perilymphatic fluid compartment and the middle ear. Its diagnosis is often difficult because the clinical presentation is sometimes incomplete. Imaging is essential in order to support the diagnosis. Treatment is based on surgery.Materials and Methods: We carry a retrospective study about 13 patients collected over a period of 13 years (1996-2008). A complete ENT examination, audiometry and imaging (petrous CT scan) were performed in all cases. All patients received medical treatment and were operated under general anaesthesia. Subsequent control was clinical, radiological and audiometric with a mean period of 22 months.Results: Mean age was 29 years (20-47 years) and sex ratio 3.33. Symptoms were mainly hearing loss in 12 cases (92.3%), vertigo in 11 cases (84.6%) and tinnitus in 4 cases (30.8%). Flow of liquid from the ear was reported by 2 patients (15.4%). Clinical examination showed spontaneous nystagmus beating to the contralateral side of the trauma in one patient, and a positive sign of the fistula in 2 patients (15.4%). At audiometry, 9 patients (69.3%) had sensorineural or mixed deafness, of which 6 cases of cophosis. Transmission deafness was found in 3 cases. One patient had a subnormal hearing. Petrous CT scan showed extra-labyrinthic fracture in 5 cases (38.5%) and trans-labyrinthic or mixed fracture in 6 cases (46.2%). A pneumolabyrinth was found in 5 patients (38.5%). Surgical exploration was indicated in all patients. PLF was found in all cases. The localization of the fistula was at the promontory and / or at the windows. Blockage of the fistula was achieved in all cases. Materials used were essentially superficial temporal fascia, tragal perichondrium and fat. Postoperatively, vertigo improved in 9 patients among 11 (81.8%). Hearing was improved in 2 patients among the 9 having sensorineural or mixed deafness (18.2%).Conclusion: Post-traumatic perilymphatic fistula trauma is difficult to diagnose. This is supported by a beam of clinical and paraclinical arguments, and is confirmed intraoperatively. The indication for surgical exploration and its delay depend mainly on clinical symptomatology and its evolution over time.Keywords: perilymphatic fistula, trauma, vertigo, deafness, CT scan, surger