Acute lower limb ischemia following surgical management of postpartum hemorrhage: about a case and review of the literature

This is a 30-year-old patient, without history, primigravida, with a full-term pregnancy, who consulted in the obstetric emergency department for treatment of heavy metrorrhagia. After conditioning, the ultrasound showed a completely covering placenta, hence the indication for an emergency caesarean giving birth to an Apgar boy 5/10th then 9/10th. The patient presented with uterine atony resistant to medical treatment. Uterine padding and triple vascular ligation were performed. With the persistence of uterine atony, ligation of the hypogastric arteries was attempted with accidental lesion of the right external iliac artery requiring its ligation to ensure haemostasis. The patient was transferred to our training for additional care. On admission, the patient was intubated, hemodynamically stable with coldness of the right lower limb and absence of the right femoral pulse. CT angiography of the aorta and both lower limbs revealed partial occlusion of the right external iliac artery with downstream patency. Revascularization by bypass using the great saphenous vein of the contralateral limb was performed. The post-operative follow-up was simple. Postpartum hemorrhage is a serious complication in obstetrics. Hypogastric artery ligation is one of the means for the surgical management of postpartum hemorrhage. It is a standardized and effective technique, but complications are not uncommon

Medical treatment of ectopic pregnancy: case report

Ectopic pregnancy occurs when the embryo implants outside the uterine cavity. It is a leading source of morbidity and mortality within pregnancy. Methotrexate, a folic acid antagonist, has been widely used to treat appropriately selected ectopic pregnancies. We report the case of a 20-year-old woman, married, G2P0, having as antecedent a right tubal ectopic pregnancy benefiting from a right salpingectomy two years ago, who presents actually a paucisymptomatic ectopic pregnancy. Medical treatment with methotrexate was chosen with monitoring of the patient's hemodynamic status and hCG level

Splenic artery aneurysm revealed by digestive bleeding

Introduction : Les anévrismes de l’artère splénique sont les plus fréquents des anévrismes des artères viscérales et sont le plus souvent asymptomatiques. Un anévrisme de l’artère splénique fistulisé dans l’estomac est une cause rare mais potentiellement grave d’hémorragies digestives. Observation : Nous rapportons le cas d’un patient de 60 ans, qui a été admis pour des hématémèses, méléna et rectorragies, sans pouvoir déterminer l’origine du saignement à la fibroscopie digestive haute, puis son tableau s’est compliqué d’un abdomen aigu avec un état de choc. Le diagnostic d’un anévrisme de l’artère splénique, fistulisé en intragastrique et rompu dans l’abdomen a été révélé à la TDM abdominale. Le traitement était chirurgical avec bonne évolution. Conclusion : Bien que rare, devant la possibilité d’une hémostase spontanée retardant le diagnostic et devant l’engagement du pronostic vital, un anévrisme de l’artère splénique, fistulisé dans la lumière digestive doit être recherché en cas de saignement gastro-intestinal d’origine inconnue.Introduction: Splenic artery aneurysm is the most common visceral artery aneurysms and is often asymptomatic. A splenic artery aneurysm fistulized in the stomach is a rare but serious cause of gastrointestinal bleeding

Inhibiting astrocyte connexin-43 hemichannels blocks radiation-induced vesicular VEGF-A release and blood-brain barrier dysfunction

Therapeutic brain irradiation with ionizing radiation exerts multiple side effects including barrier leakage that disturbs glial-neuronal functioning and may affect cognition. Astrocytes contribute to barrier leakage by endfeet release of various vasoactive substances acting on capillary endothelial cells forming the barrier. Here, we investigated X-ray effects on astrocytic vesicular transport in mice and determined whether interfering with astrocyte connexins affects radiation-induced barrier leakage. We found that astrocytic VEGF-A-loaded VAMP3 vesicles drastically reorganize starting from 6 h post-irradiation and move in a calcium- and Cx43-dependent manner towards endfeet where VEGF-A is released, provoking barrier leakage. Vesicular transport activation, VEGF-A release and leakage 24 h post-irradiation were all potently inhibited by astrocytic Cx43 KO, Cx43S255/262/279/282A (MK4) mutant mice and TATGap19 inhibition of Cx43 hemichannel opening. Astrocyte VEGF release is a major player in complications of brain irradiation, which can be mitigated by anti-VEGF treatments. Targeting Cx43 hemichannels allows to prevent astrocyte VEGF release at an early stage after brain irradiation

Targeting gliovascular connexins prevents inflammatory blood-brain barrier leakage and astrogliosis

The blood-brain barrier is formed by capillary endothelial cells expressing connexin 37 (Cx37), Cx40, and Cx43 and is joined by closely apposed astrocytes expressing Cx43 and Cx30. We investigated whether connexin-targeting peptides could limit barrier leakage triggered by LPS-induced systemic inflammation in mice. Intraperitoneal LPS administration increased endothelial and astrocytic Cx43 expression; elevated TNF-alpha, IL-1 beta, IFN-gamma, and IL-6 in plasma and IL-6 in the brain; and induced barrier leakage recorded over 24 hours. Barrier leakage was largely prevented by global Cx43 knockdown and Cx43/Cx30 double knockout in astrocytes, slightly diminished by endothelial Cx43 knockout, and not protected by global Cx30 knockout. Intravenous administration of Gap27 or Tat-Gap19 peptides just before LPS also prevented barrier leakage, and intravenously administered BAPTA-AM to chelate intracellular calcium was equally effective. Patch-clamp experiments demonstrated LPS-induced Cx43 hemichannel opening in endothelial cells, which was suppressed by Gap27, Gap19, and BAPTA. LPS additionally triggered astrogliosis that was prevented by intravenous Tat-Gap19 or BAPTA-AM. Cortically applied Tat-Gap19 or BAPTA-AM to primarily target astrocytes also strongly diminished barrier leakage. In vivo dye uptake and in vitro patch-clamp showed Cx43 hemichannel opening in astrocytes that was induced by IL-6 in a calcium-dependent manner. We conclude that targeting endothelial and astrocytic connexins is a powerful approach to limit barrier failure and astrogliosis

GIS preprocessing for rainfall-runoff modeling using HEC-HMS in Nekkor watershed (Al-Hoceima, Northern Morocco)

All Discharge data are among the most critical factors that must be considered when evaluating the management of water resources in a watershed. Simulation of rainfall-runoff is therefore an important element in assessing the impacts of serious flooding. In the present study, rainfall-runoff in the Nekkor watershed in Al Hoceima province was simulated using GIS, remote sensing and the Hydrologic Engineering Center Hydrologic Modeling System (HEC-HMS) model. The applicability, capacity and suitability of this model for rainfall runoff in the watershed were examined. The watershed parameters were generated using (HEC-GeoHMS) and ArcGIS. The model was calibrated using a daily data set that occurred in the watershed between 2003 and 2007, the validation period was from 2009 to 2012. Model performance was evaluated using a variety of different statistical indices to study the response and impact of rainfall-runoff. Model parameters were changed and calibration was performed using the Soil Conservation Service Curve Number loss method. Consistent and satisfactory performance in terms of peak discharge, total flood volume, timing of peak discharge and overall hydrograph adjustment effect was found. The determination coefficient (R2) for the validation period reached 0.73 versus 0.71 for the calibration period. The root mean square error (RMSE) is within the acceptable range. The relative bias (RE) demonstrates an overestimation in the calibration period and an underestimation in the validation period in the peak flows. These results will help decision makers to better manage water resources in this watershed and mitigate flood risks

Control of progression towards liver fibrosis and hepatocellular carcinoma by SOCS3 polymorphisms in chronic HCV-infected patients

International audienceChronic Hepatitis C is one of the most important risk factors of liver cirrhosis and hepatocellular carcinoma. Before reaching these ultimate steps, insulin resistance triggered by hepatitis C virus infection is known to participate in the progression of liver disease. The present study aims to investigate the influence of two functional polymorphisms on SOCS3 mRNA expression and on the outcomes of CHC progression in a North African context