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The pheochromocytome is a localized tumor at the level of the medullosurrenale in 85% of the cases. The clinical presentation is very variable. Severe Heart failure presentation can be the mode of revelation in 2% of the cases. We present the case of a patient admitted for refractory cardiogenic shock correlated to pheochromocytome tumor. The difficulty of this rare clinical presentation was to confirm rapidly and in emergency this diagnosis in the same time when the patient presents a persistante and severe cardiogenic chock after finding a sub-occluded and thrombotic LAD coronary artery and which was treated by thrombectomy and coronary revascularization. The surgical treatment of this tumor is considered to be a quickly saving treatment. It allows a fast recovery of the cardiac function., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Fabry disease is a lysosomal disease caused by the accumulation of glycosphingolipids, mainly the globotriaosylceromid (Gb3) in different body tissues, mostly the kidney, the heart and the brain. Occuring most frequently during childhood, the first signs of the disease (hypohidrosis, ocroporesthesia, GI tract signs, and ongiokeratoma) are often unrecognized and the diagnosis is delayed. Even though Fabry disease is on x-linked disorder, the carrier females can also be symptomatic, and can even present sometimes with a pattern similar to that of the males. The availability of enzyme replacement therapy, which can potentially prevent the occurrence of renal, cardiac and neurological life threatening manifestations, underlines the importance of having an early diagnosis. The indications to start enzyme replacement therapy in childhood are currently the subject of specialists discussion in France.

We have analysed the result of 17,173 pap smears screened in the national research center in reproductive health of Ariana from 1 may 1993 to 30 april 1997. Among these pap smears, 613 colposcopy and 380 biopsy have been performed. The results show that: 1.9% of pap smears present cytological anomalies with 0.79% of low Squamous Intraepithelial lesions and 0.66% high Squamous Intraepithelial lesions. The incidence of CIN III is 1.8% and 0.9% for invasive cancer. The age interval 35-44 years is at high risk of CIN III and invasive cancer of the cervix. evaluation of our diagnostic approach shows that: positive predictive value of pap smears with low SLI is 43.2% positive predictive value of pap smears with high SLI is 37.3%.

Objectives: We report our experience in Tunisia with contraception by subdermal levonogestrel implants., Methods: From January 1, 1990 through June 30, 1994 we inserted 1021 implants at our family planning center in Ariana., Results: Our experience with this pure progesterone implant showed that this method provides effective long-duration contraception. There was only one case of ectopic pregnancy among our 1021 patients. The most frequent undesirable effect and the first cause of discontinuing treatment was disturbed menstrual cycle with irregular discharge., Conclusion: Our results underline the importance of counselling before implant insertion. A 10-day estrogen regimen may provide a solution for menstrual disorders.

Serotonergic neurons have their perikaraya concentrated in the raphe nuclei. In the present experiment, pieces of raphe nuclei containing serotonergic neuroblasts were dissected from 14 days rat embryos, mechanically dissociated, and 1 microliter of a cell suspension containing 30,000 cells was injected slowly under stereotaxic control in the olfactory bulb of adult rats. Three weeks after transplantation, the brain of the rats were processed for immunocytochemical detection of 5-HT. In all of the grafted animals, 5-HT neurons were found in the olfactory bulb. They exhibited the morphology of adult neurons, with well developed axon and dendrites, extending far from the injection site. Ultrastructural immunocytochemistry disclosed afferent and efferent synapses to the grafted neurons. Three preliminary results indicates that the transplanted neurons have been integrated in the host's neuronal circuitry. Ongoing electrophysiological studies are now directed at investigating the functional status of these grafted neurons.

The thoracic discal hernia is a rare affection whose prognosis has been transformed by the present diagnostic means and the technical progress of surgery. A case history has been reported of a thoracic discal hernia, T9-T10, with Brown-Sequard Syndrome and vertebral CT Scanning showed a left lateral localization. A posterior access remains indicated in lateral localization of those hernias, and it confirms clinical and neuroradiological findings showing a direct compression of the Adamkiewicz artery in the intervertebral foramen.

Cerebral ultrasound imaging by a transfontanelle approach is now a common investigation during the first year of life. This exploratory procedure is non-invasive, non-irradiating, requires no sedation and can be carried out at the infant's bedside. In addition, the classical apparatus can be completed by deep Doppler allowing deep cerebral vessels to be studied. Three cases are reported of aneurysm of Galen's ampulla detected by ultrasound imaging during the neonatal period. Images demonstrated the presence of an abnormal fluid mass in the region of Galen's ampulla, confirmed as of vascular origin by Doppler, and allowed assessment of degree of subjacent ventricular dilatation and possible secondary ischemic lesions. In massive neonatal forms this exploration may be sufficient since prognosis is poor, but in lesions of moderate size CT scan and angiographic examinations and perhaps MR imaging are required. This technique allows detection of this malformation in the fetus and could therefore influence therapy.

Inducers of cytochrome P450-linked mono-oxygenases increase the normobaric oxygen tolerance of the adult rat. Pulmonary inducers, as 3-methylcholanthrene and beta-naphthoflavone permit the rat survival and simultaneously a decrease of pulmonary edema. Phenobarbital, an hepatic inducer had lesser effects both on survival rate and on pulmonary and lymphoïd oxygen toxicity.

Radical surgery of pain is destined for chronic and intolerable pain, resistant to causal treatment, and rebellious to the various medicinal therapeutics. Conventional neuro surgery by selective section of nociceptive fibers is very valuable for cancerous subjects with a limited life span. On the other hand, there has been skepticism concerning the real efficiency of neuro stimulation. The advance made in the knowledge of neurophysiologic and neurochemical mechanism of pain will allow a radical transformation as substitute for this invasive type surgery.

Already advocated by Cushing to complement surgery of pituitary adenomas, radiotherapy remains useful in these benign tumours despite controversies concerning long-term results, pituitary cell resistance and potential harmful effects on the optic nerve, glands and skin. Radiotherapy was applied to 36.6 p. 100 of 150 patients with pituitary tumours operated upon by the same surgical team. Some very good results were obtained, notably in invasive and recurrent tumours. In a case of chromophobe adenoma operated twice at 1 year interval, radiotherapy (4,500 rads) after the second operation resulted in complete cure confirmed by computerized tomography 15 years later. Similarly, in an 8-year old girl reoperated upon for severe recurrent suprasellar craniopharyngioma 3 years after the initial excision, post-operative radiotherapy (5,000 rads) produced excellent remission which persists after 19 years. Thus, even with the modern diagnostic and microneurosurgical procedures, radiotherapy remains, for many authors, a useful and safe method to improve the prognosis of pituitary tumours.

The evoked compound action potential of lumbar nerve roots after posterior tibial nerve stimulation at the ankle during operation were studied in 10 patients with lumbar disc herniation. The recording needle electrode was inserted into compressed the nerve root before and after excision of disc herniation. The evoked nerve root action potentials consisted of a positive-negative complex. Before excision, this predominant positive complex was recorded in every patient with a mean peak latency of P1 at 16.64 +/- 1.69 msec, and a mean peak to peak amplitude of P1-N1 of 1.94 +/- 0.52 microv. In three cases with migratory disc herniation, the P1-N1 complex was followed by smaller negative component. After excision of disc herniation, the amplitude of the P1-N1 complex decreased significantly with no significant latency modification. The second negative component was not recorded in the three cases with migratory disc herniation. The recording of nerve root evoked potential during operation is of interest for diagnostic purposes. In addition, it allows electrophysiological monitoring of nerve root traumatism during operation procedures.

The transection of spinal cord can be seen as an interruption of the continuity in between the control command and the peripheral reception. The consequence is an anarchic reorganization of the distal spinal cord often responsible of spasticity and painful rigidity. We have, in a first step, sectioned the spinal cord at lower thoracic level in adult rats. Knowing the modulatory role of aminergic neurotransmitters, we have then one week later transplanted foetal 5-HT neurons into the distal segment of the cord, in half of the transsected animals. Functional results suggest the constitution of sphincteral autonomy in the grafted animals whereas the controls showed either an acute urine retention leading to death within two to three weeks after the section, or an absence of sphincteral control. Immunocytochemical study with specific 5-HT antibodies showed adult-looking neurons extending processes towards the intermediolateral nucleus and the anterior horn. Ultrastructural immunocytochemistry disclosed afferent and efferent synapses to the grafted neurons.