Concomitant coexistence of ACTH‐dependent and independent Cushing syndrome

We report a case of a patient who presented for ACTH‐dependent Cushing after a confirmed hypercortisolism and an inadequate normal ACTH. A transsphenoidal surgery of a pituitary picoadenoma has been done. After surgery, the patient showed the persistence of hypercortisolism. CT scan revealed adrenal adenomas removed surgically and improved the patient.     

Effect of the oral antibilharzial niridazole (ambilhar) on patients with concomitant schistosomiasis and HBs antigenaemia

Twenty-three patients received oral antibilharzial therapy in the form of niridazole tablets (10 mg/kg body weight for 20 days), and 10 patients served as controls. Three months post-therapy, 14 out of 23 treated patients (61%) had cleared the HBsAg. This was found to be statistically significant. In contrast, 2 of the controls (20%) had eliminated the HBsAg from the serum. It is concluded that patients suffering from concomitant schistosomiasis and HBs antigenaemia are enabled to eliminate the HBsAg after niridazole therapy.     

3D dento-maxillary osteolytic lesion and active contour segmentation pilot study in CBCT: semi-automatic vs manual methods

Objectives:

This study was designed to evaluate the reliability of a semi-automatic segmentation tool for dento-maxillary osteolytic image analysis compared with manually defined segmentation in CBCT scans.

Methods:

Five CBCT scans were selected from patients for whom periapical radiolucency images were available. All images were obtained using a ProMax® 3D Mid Planmeca (Planmeca Oy, Helsinki, Finland) and were acquired with 200-μm voxel size. Two clinicians performed the manual segmentations. Four operators applied three different semi-automatic procedures. The volumes of the lesions were measured. An analysis of dispersion was made for each procedure and each case. An ANOVA was used to evaluate the operator effect. Non-paired t-tests were used to compare semi-automatic procedures with the manual procedure. Statistical significance was set at α = 0.01.

Results:

The coefficients of variation for the manual procedure were 2.5–3.5% on average. There was no statistical difference between the two operators. The results of manual procedures can be used as a reference. For the semi-automatic procedures, the dispersion around the mean can be elevated depending on the operator and case. ANOVA revealed significant differences between the operators for the three techniques according to cases.

Conclusions:

Region-based segmentation was only comparable with the manual procedure for delineating a circumscribed osteolytic dento-maxillary lesion. The semi-automatic segmentations tested are interesting but are limited to complex surface structures. A methodology that combines the strengths of both methods could be of interest and should be tested. The improvement in the image analysis that is possible through the segmentation procedure and CBCT image quality could be of value.     

Cholangite tuberculeuse simulant une maladie de Caroli : difficultés diagnostiques

Abstract

The liver and the bile ducts represent an exceptional location of tuberculosis. The clinical symptomatology is not specific.We describe three aspects macronodular, micronodular and canalicular which are the rarest.

Purpose

Precise the diagnostic difficulties of this entity insisting on the clinical, biological and morphological signs.

Case report

We report the case of 70 year old man without medical history, admitted for a clinicobiological cholangitis syndrome evolving in a context of impaired general condition. Acute cholecystitis was documented by ultrasound with a moderate dilatationof the common hepatic duct. The bili-MRI showed a dilation of the left intrahepatic bile ducts suggestive of Caroli’s disease. A bi-segmentectomy were performed. Histological examination finds a hepatic tuberculosis and infirm the diagnosis of Caroli’s disease.

Conclusion

Tuberculous cholangitis is rare and poses a diagnostic problem. It can simulate a Caroli disease leading to an unnecessary liver resection. Percutaneous liver biopsy can help to rectify the diagnosis for TBC.     

The QT interval: standardization, limits and interpretation

Despite clinical importance of ventricular repolarisation, it remains difficult to analyse. Conventionally, quantification of the electrocardiographic ventricular repolarization is usually performed with reference to axis of the T wave and QT interval duration. A variety of factors can prolong the QT interval, such as drug effects, electrolyte imbalances, and myocardial ischemia. The biggest risk with prolongation of the QT interval is the development of torsades de pointes. Commonly accepted reference ranges for the electrocardiogram (ECG) have been in use, with little change, for many years. Populations throughout the world present several differences: age, ethnic compositions, and are exposed to different environmental factors. Recent studies have reported reference data for QT interval in healthy population and have evaluated the influence of age, gender, QRS duration and heart rate on this interval. In this review, we address several issues relative to the measurement, and interpretation of QT interval and its adjustment for rate, age, gender and QRS duration.     

Screening of SLC26A4 gene in autoimmune thyroid diseases

The Pendred syndrome (PS) gene, SLC26A4, was involved in the genetic susceptibility of autoimmune thyroid disease (AITD) in Tunisian population. Recently, functional assays have shown a differential expression of SLC26A4 gene between Graves’ disease (GD) and Hashimoto's thyroiditis (HT). Here, by the mean of DHPLC and HRM, we explored the 21 exons and their flanking intronic sequences of 128 patients affected with GD (n = 64) or HT (n = 64). The pathogenic effect of identified variations on splice was investigated using the web server HSF. Eighteen allelic variations were identified and ranged on missense, sens and splice variations. Nine identified variations (c.‐66C>G, c.898A>C, c.1002‐9A>C, c.1061T>C, c.1544 + 9G>T, c.1545‐5T>G, c.1790T>C, c.1826T>G, c.2139T>G) were previously reported in hearing impairment studies. Forty‐seven per cent (30/64) of GD patients and 37,5% (24/64) of HT patients present at least one variant in the explored sequences. Moreover, the analysis of the variant distribution between HT (9 (5′UTR), 12 exonic and 13 intronic) and GD (18 (5′UTR), 13 exonic and 5 intronic) patients showed a significant difference (χ² = 6.54, 2df, P = 0.03). Interestingly, missense changes (I300L, p.M283I, F354S and p.L597S) affected conserved residues of pendrin. On the other hand, the HSF analyses ascertain that some variants identified in HT disease are predicted to have a pathogenic effect on splice. In conclusion, our analysis of SLC26A4 sequence variations suggested a distinct genetics basis between HT and GD patients, which should be confirmed on a large cohort.