From diagnosis to treatment of gluteus medius tendon tear of the hip: a case report]

OBJECTIVE: To report a case of spontaneous gluteus medius tear repaired surgically in a 42-year-old woman patient without any other antecedent other than diabetes. PATIENT AND METHODS-RESULTS: Trochanteric pain evolving for 7 months led to scintigraphy objectifying a hyperfixation of the trochanter and ultrasonography showing an inflammatory gluteus medius tendon. These examinations were supplemented by magnetic resonance imaging and tomodensitometry visualising the tendon rupture but no marked fat degeneration of the muscle despite atrophy of this one. Surgical exploration confirmed the presence of a major rupture of the gluteus medius tendon, which was reinserted through an osseous trench. Rehabilitation involved protecting the tendon, by an installation of the member in abduction and passive mobilization from the third postoperative day, with a move to partial support on day 45. The result after 16 months was excellent, the patient returning to work 8 months after the surgery without any residual pain. CONCLUSION: The spontaneous rupture of the gluteus medius, often ignored, can occur in young subjects and induce limited function, often well corrected by reinsertion surgery.     

Artificial neural networks assessing adolescent idiopathic scoliosis: comparison with Lenke classification

Background contextVariability in classifying and selecting levels of fusion in adolescent idiopathic scoliosis (AIS) has been repeatedly documented. Several computer algorithms have been used to classify AIS based on the geometrical features, but none have attempted to analyze its treatment patterns.PurposeTo use self-organizing maps (SOM), a kind of artificial neural networks, to reliably classify AIS cases from a large database. To analyze surgeon's treatment pattern in selecting curve regions to fuse in AIS using Lenke classification and SOM.Study designThis is a technical concept article on the possibility and benefits of using neural networks to classify AIS and a retrospective analysis of AIS curve regions selected for fusion.Patient sampleA total of 1,776 patients surgically treated for AIS were prospectively enrolled in a multicentric database. Cobb angles were measured on AIS patient spine radiographies, and patients were classified according to Lenke classification.Outcome measuresFor each patient in the database, surgical approach and levels of fusion selected by the treating surgeon were recorded.MethodsA Kohonen SOM was generated using 1,776 surgically treated AIS cases. The quality of the SOM was tested using topological error. Percentages of prediction of fusion based on Lenke classification for each patient in the database and for each node in the SOM were calculated. Lenke curve types, treatment pattern, and kappa statistics for agreement between fusion realized and fusion recommended by Lenke classification were plotted on each node of the map.ResultsThe topographic error for the SOM generated was 0.02, which demonstrates high accuracy. The SOM differentiates clear clusters of curve type nodes on the map. The SOM also shows epicenters for main thoracic, double thoracic, and thoracolumbar/lumbar curve types and transition zones between clusters. When cases are taken individually, Lenke classification predicted curve regions fused by the surgeon in 46% of cases. When those cases are reorganized by the SOM into nodes, Lenke classification predicted the curve regions to fuse in 82% of the nodes. Agreement with Lenke classification principles was high in epicenters for curve types 1, 2, and 5, moderate in cluster for curve types 3, 4, and 6, and low in transition zones between curve types.ConclusionsAn AIS SOM with high accuracy was successfully generated. Lenke classification principles are followed in 46% of the cases but in 82% of the nodes on the SOM. The SOM highlights the tendency of surgeons to follow Lenke classification principles for similar curves on the SOM. Self-organizing map classification of AIS could be valuable to surgeons because it bypasses the limitations imposed by rigid classification such as cutoff values on Cobb angle to define curve types. It can extract similar cases from large databases to analyze and guide treatment.     

Pustular drug hypersensitivity syndrome due to allopurinol

Allopurinol hypersensitivity syndrome (AHS) is a severe drug reaction. It is characterized by rash, fever, and internal organ involvement. It may present in different clinical forms. We present a case of acute generalized exanthematous pustulosis occurring as a manifestation of AHS.KEY WORDS: Allopurinol, hypersensitivity syndrome, pustulosis     

Effect of Paraffin and Silica Matrix Phase Change Materials on Properties of Portland Cement Mortars

In the search for methods to incorporate Phase Change Materials (PCM) into Portland cement mortar mixtures, PCM based on paraffins adhered to a silica-based matrix appear as a suitable option. However, paraffin particles have been observed to escape from the silica matrix when water is added. There are only limited data on how the use of such PCM affects the behaviour of mortars. To evaluate the effect of this PCM addition, Portland mortar mixtures were elaborated with 5%, 10% and 15% of PCM content, and using CEM 42.5 I R and CEM I 52.5 R cement types. Physical properties such as density, open porosity, air content and water absorption were analysed for fresh and dry samples. The results obtained show that the PCM-added mixtures require greater water and cement amounts than the standard mortar mixtures to achieve similar compressive strengths. Compared to non-PCM mixtures the PCM-added mortars present a density lowering of 37% for fresh mixtures and near 45% for dry state forms. A maximum compressive strength of 15.9 MPa was reached for 15% PCM mixtures, while values beyond 40 MPa were achieved for 5% PCM mixtures. Thus, the proposed study contributes to broad the available knowledge of PCM cement mortar mixtures behaviour and their mix design.     

A mitochondrial implication in a Tunisian patient with Friedreich's ataxia-like

Genes encoding the DNA helicase TWINKLE (C10orf2) or the two subunits of mtDNA polymerase γ (POLγ) (POLG1 and POLG2) have a direct effect on the mitochondrial DNA replication machinery and were reported in many mitochondrial disorders. Friedreich's ataxia (FRDA) is the common cause of ataxia often associated with the expansion of a GAA repeat in intron 1 of the frataxin gene (FXN). Mitochondrial DNA could be considered as a candidate modi?er factor for FRDA disease, since mitochondrial oxidative stress is thought to be involved in the pathogenesis of this disease. We screened the FXN, POLG1 and C10orf2 genes in a Tunisian patient with clinical features of Friedreich's ataxia-like. The results showed the absence of the expansion of a GAA triplet repeat in intron 1 of the FXN gene. Besides, the sequencing of all the exons and their flanking regions of the FXN, POLG1 and C10orf2 genes revealed the presence of intronic polymorphisms. In addition, screening of the mtDNA revealed the presence of several mitochondrial known variations and the absence of mitochondrial deletions in this patient. The detected m.16187C>T and the m.16189T>C change the order of the homopolymeric tract of cytosines between 16184 and 16193 in the mitochondrial D-loop and could lead to a mitochondrial dysfunction by inhibiting replication and affecting protein involved in the replication process of the mtDNA which could be responsible for the clinical features of Friedreich ataxia observed in the studied patient.     

Skin test reactivity to seven aeroallergens in a Sousse area population sample

INTRODUCTION: Allergy skin tests are an important tool in the diagnosis of allergy diseases. They are useful in epidemiologic studies. OBJECTIVES: The aim of our study is to estimate the prevalence of the skin sensitivity in a sample of unselected population and to study the relationship between skin test reactivity and clinical manifestations. PATIENTS AND METHODS: During 9 months, we undertake skin prick-test in 500 subjects. Our population was recruited in the blood sample room of the biochemistry laboratory of the University Hospital of Sousse. Seven aeroallergen was tested: Dermatophago?des pteronyssinus (DPT), Dermatophago?des farinae (DF), Pollens of Graminees, Olive-tree, Partetaure, Cockroach and Candidine. A positive and a negative control tests were made. RESULTS: 34% of the population was sensitized to one or more aeroallergens. In the litterature this prevalence vary from 9 to 55.5% according to the methodology applied. In our study the skin reactivity does not change with sex (p = 0.26) but was high in subjects aged between 15 and 35 years. 21.8% were sensitized to house dust mites (DPT, DF) and 18.2% to pollens (Olive-tree, Graminees, Parietaire). Skin reactivity was more common when subjects had personal atopic history (p < 0.003) and/or had actual allergic symptoms particularyrhinitis and asthma (p < 0.006). CONCLUSION: Skin reactivity to common aeroallergens is frequent in the general population, particularly in symptomatic subjects affected by rhinitis and/or allergic asthma. This skin sensitization is the result of genetic and environmental interaction, but skin sensitization does not mean allergy.     

Enhanced schistosomicidal efficacy of tartar emetic encapsulated in pegylated liposomes

The aim of the present study was to evaluate the ability of liposomes to improve the efficacy of tartar emetic (TA) against established Schistosoma mansoni infection. TA was used as a schistosomicidal drug model and both conventional liposomes (CL) and long-circulating pegylated liposomes (LCL) were evaluated. In the first experiment, TA, either free or encapsulated within CL or LCL, was given intraperitoneally (i.p.) as a single dose of 11 mg Sb/kg to mice experimentally infected with S. mansoni. Only the group treated with LCL showed a significant (55%) reduction in the worm burden, compared to the control groups (untreated or treated with empty LCL). In the second experiment, the efficacy of TA-containing LCL was evaluated at a higher dose (27 mg Sb/kg) by both subcutaneous (s.c.) and i.p. routes. Reduction levels of 67 and 82% were achieved by s.c. and i.p. routes, respectively. Strikingly, all mice survived to this high dose of antimony. This is in contrast with free TA that was lethal in 100% of mice at the same dose. The present work demonstrates that LCL reduce the acute toxicity of TA and effectively deliver this drug to S. mansoni during the late stages of parasite infection.