Hydatic pulmonary embolism complicating a cardiac hydatic cyst. A case report

Hydatic pulmonary embolism: complication of a cardiac hydatic cyst:a case report hydatic cardiac cyst is a rare condition and represents only 0.5 to 2% of all visceral localisations of the hydatid disease. We reported a 28 year old patient with a multiple hydatic pulmonary embolism caused by the rupture of a hydatic cyst of the interventricular septum. The diagnosis was established by transthoracic echocardiography and CT Scan. Surgery was performed without delay and the outcome was good after a five month follow-up. This case illustrates the diagnostic value of the non invasive imaging means in hydatic cyst of the heart and underlines the importance of surgery realized before complications occur.     

Development of a clinical prediction rule for classifying patients with patellofemoral pain syndrome who respond to patellar taping

STUDY DESIGN: Predictive validity/diagnostic test study. OBJECTIVE: To determine the predictive validity and interrater reliability of selected clinical exam items and to develop a clinical prediction rule (CPR) to determine which patients respond successfully to patellar taping. BACKGROUND: Patellar taping is often used to treat patients with PFPS. However, the characteristics of the patients who respond best to patellar taping intervention have not been identified. METHODS AND MEASURES: Fifty volunteers (27 males, 23 females) with PFPS underwent a standardized clinical examination. Diagnosis of PFPS was based on the complaint of retropatellar pain that was provoked by a partial squat or stair ascent/descent. Subjects performed 3 functional activities and rated their pain during each activity on a numerical rating scale (NPRS). All subjects received treatment with a medial glide patellar-taping technique and repeated the functional activities and pain ratings. An immediate 50% reduction in pain or moderate improvement on a global rating of change (GRC) questionnaire was considered a treatment success. Likelihood ratios (LRs) were calculated to determine which examination items were most predictive of treatment outcome. Logistic regression analysis identified items included in the CPR. RESULTS: Twenty-six subjects (52%) had an immediate successful response to the intervention. Two examination items (positive patellar tilt test or tibial varum greater than 5 degrees, +LR = 4.4) comprised the CPR. Application of the CPR improved the probability of a successful outcome from 52% to 83%. Fifty-eight percent of the lower extremity measures were associated with moderate to good reliability (reliability coefficient range, 0.52-0.84). The reliability coefficients for the items that comprised the CPR were 0.49 (patellar tilt) and 0.66 (tibial varum). CONCLUSION: A CPR was developed to predict an immediate successful response to a medial glide patellar taping technique. Validation of the CPR in an independent sample is necessary before widespread clinical use can be recommended.     

Syphilitic aortic aneurysm. A case report

The incidence of tertiary syphilis has declined in recent years owing to the early recognition of the disease and use of antibiotics. As a result, syphilitic aortic aneurysms are rarely encountered nowadays. We report the case of a 65 years old man, who was admitted to our hospital in June 2004 for dyspnea, cough and chest discomfort. On physical examination, blood pressure was 130/80 mmHg with no significant laterality, pulse rate was 70 per minute and there was a decrease of breath sounds over the right lung. Laboratory findings revealed a slight elevation of the erythrocyte sedimentation rate. Serological studies for syphilis showed a positive venereal disease laboratory test (VDRL) at 1/32 and a positive Treponema pallidum hemagglutination test (TPHA) at 1/2560. The chest radiography showed a right para cardiac opacity measuring 16 x 12 cm. Fiber optic bronchoscopy showed an extrinsic compression of the right upper lobar bronchus. Gadolinium-enhanced magnetic resonance angiography and 16 multidetector-row spiral computed aortography showed a huge partially thrombosed saccular aneurysm of the ascending aorta measuring 132 mm in diameter. The circulating lumen measured 53 mm in its largest diameter. This aneurysm involved the innominate artery. There was no other arterial involvement. The patient was given a three week course of intravenous penicillin followed by a successful surgical procedure in September 2004 with ascending aortic replacement and innominate artery reimplantation. This case illustrates well a formerly common, but now extremely rare disease.     

Acute intratubular obstructive renal failure after ampicillin treatment

Sir, Hospital acquired renal insufficiency has been increasing infrequency in recent years and now accounts for 7.2% of patientsadmitted to the hospital for renal failure [1]. Its most commoncause is a decrease in renal perfusion. Medications (mainlyantibiotics) that variously produce nephrotoxicity also frequentlycause renal failure during hospitalization [1]. We present apatient with Listeria monocytogenes meningitis treated withhigh     

Hypertension and nephrotoxicity in the rate of decline in kidney function in diabetic nephropathy

Serum creatinine levels were determined prospectively every 2 to 3 months in 40 patients with diabetic nephropathy for a global observation period of 864 months. The monthly creatinine increasing rate was significantly lower in normotensive periods, mean arterial pressure (MAP) less than 115 mmHg, when compared with hypertensive periods, MAP greater than 125 mmHg. No significant difference was shown in periods with borderline hypertension (MAP between 115-124 mmHg). The mean creatinine increases were of 0.036 mg/dl/month, 0.3 mg/dl/month and 0.046 mg/dl/month respectively. Normotension was associated with a slowing down of the rate of decline in renal function in this group of moderate kidney failure with an initial mean serum creatinine of 2.26 mg/dl. The exposure of patients to nephrotoxics (aminoglycosides, and possibly anesthesia) significantly accelerated the decline in renal function: 0.39 mg/dl/month and 0.17 mg/dl/month respectively according to the concomitance or not of toxics and hypertension. The reported protective effect of diabetes against aminoglycosides nephrotoxicity in experimental conditions was not reflected in our clinical results. On the contrary, we suggest a possible enhanced sensibility of the diabetic patient with diabetic nephropathy to aminoglycosides leading to an acceleration of the progression of renal failure.     

L'TABLISSEMENT D'UN MODLE CELLULAIRE DE L'OLIGONUCLOTIDE MUTANT

Objectif Pour etablir un modele cellulaire de I'oligonucleotide mutant. Methodes Par rap- port la prise du gene de la proteine de fluorescence verte et agrandisse (EGFP) , nous induissons une mutation par la technique du point mutant de PCR pour changer du codon de 98eme position du gene egfp GAA au codon d'arret TAA, formant le gene egfp-D de mutant, donc on construit deux vecteurs de plasmides : pcDNA3-egfp et pcDNA3-egfp-D. Puis les plasmides sont transferes dans les cellules NIH-3T3 par le calcium de phosphate. Resultats Sous le microscope de fluorescence, on n'a pas vu I 'expression de la EGFP dans tous les cellules transferees par l'egfp-D de mutant, et en meme temps, les cellules transferees par l'egfp normal peuvent exprimer la EGFP. Ensuite on obtient les cellules stables par le criblage de G418. PCR confirme I'integration du gene egfp-D dedans le genome ADN des cellules. RT-PCR et Northern blot analysent les genes egfp et egfp-D peuvent transcrire normalement, il montre les cellules transferees par le gene egfp-D de mutant n'exprimant pas la fluorescence verte est parce que la traduction est terminee en avant. Conclusion Le modele cellulaire de I'oligonucleotide mutant rapporte par le gene egfp est etabli avec succes, ce modele peut employer en recherche du systeme reparant therapeutique via le chi-meric ARN /ADN oligonucleotide(RDOs).     

UNE COLORATION SIMPLE ET RAPIDE DU FROTTIS DU SPERME

Objective To introduce a rapid simple staining method for sperm morphology.Methods Liquifiedsemen was on the glass, fixed by methanol, treated with phosphonic acid buffer, stained by A, B staining solution separately, and rinsed by running water. Results After staining, the whole sper-matozoid was very clear. The cephalic zone of spermatozoid head , acrosome area , was colored pink; its caudal zone colored violet red or violet blue. The body and tail of spermatozoid colored pink or light blue. Normal and abnormal morphology of spermatozoid could be differentiated easily. The sloughed spermatogenic cells and white blood cells could be differentiated also. Conclusion This rapid staining method of semen smear can produce the same effect of other usual staining method , but the staining time is shorter and the procedure is simpler.     

Severity of Acute Respiratory Distress Syndrome in haematology patients: long‐term impact and early predictive factors

Severe forms of acute respiratory distress syndrome in patients with haematological diseases expose clinicians to specific medical and ethical considerations. We prospectively followed 143 patients with haematological malignancies, and whose lungs were mechanically ventilated for more than 24 h, over a 5‐y period. We sought to identify prognostic factors of long‐term outcome, and in particular to evaluate the impact of the severity of acute respiratory distress syndrome in these patients. A secondary objective was to identify the early (first 48 h from ICU admission) predictive factors for acute respiratory distress syndrome severity. An evolutive haematological disease (HR 1.71; 95% CI 1.13–2.58), moderate to severe acute respiratory distress syndrome (HR 1.81; 95% CI 1.13–2.69) and need for renal replacement therapy (HR 2.24; 95% CI 1.52–3.31) were associated with long‐term mortality. Resolution of neutropaenia during ICU stay (HR 0.63; 95% CI 0.42–0.94) and early microbiological documentation (HR 0.62; 95% CI 0.42–0.91) were associated with survival. The extent of pulmonary infiltration observed on the first chest X‐ray and the diagnosis of invasive fungal infection were the most relevant early predictive factors of the severity of acute respiratory distress syndrome.