Psoas abscess of the adult: study of 38 cases

OBJECTIVE: Our aim is to report the clinical aspects, the etiologies, the treatment and the evolution of the psoas abscess in the adult. METHODS: Our retrospective study concerns 38 cases of psoas abscesses collected in the Department of Infectious Diseases of Sfax (Tunisia), over a period of 16 years (January 1990 - December 2005). RESULTS: The average age is 44 years (extremes: 16-76 years). The sex-ratio is 1.4. Six patients were diabetics and one had a chronic renal injury at the stage of hemodialysis. The clinical manifestations were: a fever (76.4%), an abdomino-pelvic ache (84.2%) and a psoitis (34.2%). All patients had a biologic inflammatory syndrome with a hyperleucocytosis in 28 cases. The abscess was one-sided in 29 cases and bilateral in 9 cases. After microbiological study and/or histological study, pathogens were identified in 31 patients, they were Staphylococcus aureus (10 cases), Staphylococcus lugdunensis (1 case), Streptococci (3 cases), Escherichia coli (2 cases), Bacteroides fragilis (1 case), Actinomyces (2 cases), Brucella (3 cases), Mycobacterium tuberculosis (8 cases) and Candida glabrata (1 case). The psoas abscess was primary in 10 cases and secondary in 28 cases. All the patients received an antibiotherapy or an antifungal therapy adapted to the micro-organism in cause, with a drainage of the abscess in 25 cases (surgical in 9 cases and percutaneous in 16 cases). The evolution was favourable in 36 cases. One patient presented recurrences and one patient died. CONCLUSION: The psoas abscess of the adult is characterized by a polymorphe clinical presentation. Germs in cause are very variable.     

Regression of a Large Congenital Hepatic Arteriovenous Malformation

Congenital hepatic arteriovenous malformations are rarely seen in association with persistent neonatal pulmonary hypertension. We report the case of a full-term female newborn who presented with heart failure and respiratory distress soon after birth. Echocardiographic investigation revealed severe persistent pulmonary hypertension and patent ductus arteriosus. Here we report spontaneous regression in size of both the feeder vessel and the vascular bed of the congenital hepatic arteriovenous malformation. We postulate that our conservative use of oral heart failure therapy, in the form of diuretic agents and captopril, decreased the congestion and diameter of the affected vessels.     

Vascular and cellular changes accompany altered expression of angiopoietins in placenta of non-complicated ART pregnancies

Background: ART is steadily performed for infertility cases and most of the previous researches have focused on complicated pregnancies. Nonetheless, few ones have concerned with placenta of ART in non-complicated pregnancies.Objectives: To investigate the expression of angiopoietins (ANG) and their receptor, TIE-2, in placenta of full-term non-complicated pregnancies having ART (n = 28) versus those with spontaneous conception (n = 28) together with the histological as well as morphometric analysis.Results: While no prominent changes were noticed in the histological structure of the placenta ART pregnancies, it showed a significant decrease (p < 0.05) in the percentage of syncytial area and numbers of syncytial knots with insignificant reduction in the placental villous area. Vascular changes in the form of significant decrease (p < 0.05) in the chorionic vessel diameter and significant increase (p < 0.05) in percentage of vessel area were detected in the ART placenta. In addition, the levels ANG-1, ANG-2 and TIE-2 were significantly increased (p < 0.05) in the ART placentas compared with those of SC.Conclusions: We demonstrated that there is an altered expression of angiopoietins accompanying the morphometric changes occurring in placenta of ART pregnancies. These changes may indicate vascular and cellular adaptation mechanism for a potential subclinical hypoxia in placenta of ART even in non-complicated pregnancies.     

The hepatitis C virus (HCV)-Trimera mouse: a model for evaluation of agents against HCV.

The lack of small-animal models that are suitable for evaluation of agents used to treat infection with hepatitis C virus (HCV) severely hinders the assessment of potential new therapies for the disease. This study created such a model, termed the "HCV-Trimera" model. The HCV-Trimera model was developed by using lethally irradiated mice, reconstituted with SCID mouse bone marrow cells, in which human liver fragments infected ex vivo with HCV had been transplanted. Viremia (positive-strand HCV RNA levels) in HCV-Trimera mice peaked at approximately day 18 after liver transplantation, and an infection rate of 85% was reached. Viral replication in liver grafts was evidenced by the presence of specific negative-strand HCV RNA. The usefulness of this model for evaluation of anti-HCV agents was demonstrated by the ability of a small molecule (an HCV internal ribosomal entry site inhibitor) and an anti-HCV human monoclonal antibody (HCV AB(XTL)68) to reduce virus loads in HCV-Trimera mice in a dose-dependent manner.     

Osteonecrosis

Formerly referred to as avascular necrosis, the term osteonecrosis is now preferred. Simply defined, osteonecrosis means ‘dead bone’. The ‘avascular’ state of the necrotic bone is the result of a loss of circulation from numerous potential causes together with multiple risk factors. The resultant state is a sequelae of repair processes leading finally to gross deformation of the bony structural architecture and joint incongruity. Among the commonest sites are the femoral head, talus, lunate, knee and humeral head. In addition to normal radiography, bone scan and MRI have provided early diagnosis of subtle changes in the osteo-histology. Intervention depends upon the phase of disease progression; in the form of a series of preservation and/or salvage procedures.     

The relationship between job stress and body mass index using longitudinal data from Canada

Objective

This paper examines the effect of job stress, as measured by the job strain model (high job demands and low job control) on an individual’s body mass index (BMI) using data from the Canadian National Population Health Survey.

Methods

We use panel data estimation methods to account for unobserved individual-level heterogeneity to better examine the relationship between job-related stress and BMI.

Results

Results from the fixed effects and random effects models show no statistically significant difference in BMI levels between individuals in jobs with high/medium strain compared to jobs with low strain. However, in the cross-sectional OLS model, job stress has a positive and significant effect on BMI. These analyses control for socio-demographic factors, lifestyle behavior, workplace social support, occupational and provincial fixed effects. The results suggest that the mixed findings in the previous studies may in part be due to unobserved characteristics that cannot be controlled for using standard cross-sectional analysis.

Conclusion

This study results suggest the need for further longitudinal evidence in order to have a better understanding of the relationship between job stress and body weight.