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La fistule omphalo-mésentérique est une affection très rare. Nous rappelons à travers une observation ses aspects physiopathologiques, cliniques et radiologiques. Un nourrisson de deux mois présentait depuis la naissance un écoulement de liquide intestinal par l’ombilic. L’examen local montrait une tuméfaction ombilicale inflammatoire au sein de laquelle existait un petit pertuis facilement cathétérisable. L’opacification par un produit iodé a objectivé une communication avec l’intestin, ce qui a permis de poser le diagnostic de fistule omphalo-mésentérique. La fistule omphalo-mésentérique correspond à la persistance du canal omphalo-mésentérique sur tout son trajet. Le diagnostic repose généralement sur les données cliniques et la fistulographie. Parfois le tableau est atypique, constitué d’un simple bourgeon ombilical suintant qui ne répond pas à l’application de nitrate. Les complications, prolapsus, occlusion, ulcère, hémorragie ou perforation sont redoutables. Le diagnostic de la fistule omphalo-mésentérique doit être fait le plus précocement possible afin d’éviter ces complications. [Copyright 2004 Elsevier]

Abstract: Primary hydatid disease of the pancreas is very rare. We report about the case of a 38-year-old man who presented with jaundice, abdominal pain and epigastric mass. Abdominal ultrasound and computed tomography (CT) scan demonstrated a large, thick-walled pancreatic cystic mass compressing the common bile duct and causing obstructive jaundice. The treatment involved eccentration and the resection of the protruding mass by cystogastrostomy. The procedure was successful and no recurrence or complication occurred postoperatively. Hydatid disease should be considered in the differential diagnosis of all cystic masses in the pancreas, especially in the geographical regions where the disease is endemic. [Copyright &y& Elsevier]

Purpose: Hemodialysis (HD) is considered the most common alternative for overcoming renal failure. Studies have shown the involvement of HD membrane in the genesis of oxidative stress (OS) which has a direct impact on the brain tissue and is expected to be involved in brain plasticity and also reorganization of brain function control. The goal of this paper was to demonstrate the sensitivity of the blood oxygenation level-dependent functional magnetic resonance imaging (BOLD-fMRI) to characterize the OS before and after the HD session. Patients, materials and methods: Twelve male patient-volunteers following chronic HD for more than 6 months were recruited among 86 HD-patients. All patients underwent identical assessment immediately before and after the full HD-session. This consisted of full biological assessment, including malondialdehyde (MDA) and total antioxidant activity (TAOA); and brain BOLD-fMRI using the motor paradigm in block-design. Results: Functional BOLD-fMRI maps of motor area M1 were obtained from the HD patient before and after the hemodialysis session, important decrease in the intensity of brain activation of the motor area after HD, and important increase of the size of the volume of brain activation were observed, these changes are reflecting brain plasticity that is well correlated to OS levels. Individual patients MDA and TAOA before and after the hemodialysis sessions demonstrated a clear and systematic increase of the OS after HD ( P -value = 0.03). Correlation of BOLD-fMRI maximal signal intensity and volume of activated cortical brain area behaviors to MDA and total TAOA were close to 1. Conclusion: OS is systematically increased in HD-patients after the HD-process. Indeed, the BOLD-fMRI shows a remarkable sensitivity to brain plasticity studied cortical areas. Our results confirm the superiority of the BOLD-fMRI quantities compared to the biological method used for assessing the OS while not being specific, and reflect the increase in OS generated by the HD. BOLD-fMRI is expected to be a suitable tool for evaluating the plasticity process evolution in hemodialysis brain patients. [ABSTRACT FROM AUTHOR]

Résumé Les infections invasives à streptocoque A peuvent être graves. La survenue à la période néonatale et la localisation méningée sont deux situations inhabituelles. Les complications rapportées sont diverses et nous y ajoutons le risque thrombo-embolique. Nous rapportons en effet l’observation d’un nouveau-né, de sexe masculin, hospitalisé à 22 jours de vie pour une méningite néonatale tardive à streptocoque A et des lésions d’ischémie-hémorragie cérébrales diffuses. L’échographie abdominale avec doppler et l’angioscanner abdominal ont objectivé une thrombose avec cavernome porte. L’échographie cardiaque, l’électrocardiogramme, le bilan d’hémostase et de thrombophilie étaient normaux. Après un recul de 18 mois, il s’était installé une atrophie cérébrale avec dilatation ventriculaire séquellaire mais pas de signes d’hypertension portale. Nous avons conclu à une méningite néonatale à streptocoque A compliquée de thromboses multiples qu’on peut expliquer par les propriétés invasives et l’hypercoagulabilité caractérisant le streptocoque bêta-hémolytique du groupe A. Cependant, les particularités de la circulation fœtale peuvent expliquer la survenue d’une embolie cérébrale paradoxale à partir d’une thrombose porte. Summary Invasive group A streptococcal infections are potentially serious. The occurrence in the neonatal period and meningeal location are two unusual situations. The complications reported in the literature vary; we add the risk of thromboembolic events. We report the case of a newborn, admitted to our department at 22 days of life for late neonatal group A streptococcal meningitis and diffuse cerebral infarction lesions. Ultrasound and abdominal CT scan objectified the presence of portal vein thrombosis and cavernoma. Echocardiography, electrocardiogram, as well as coagulation and thrombophilia tests were normal. Progression was marked by the installation of cerebral atrophy and ventricular dilation without the appearance of signs of portal hypertension over 18 months. We therefore concluded in neonatal group A streptococcal meningitis complicated by multiple thrombosis that can be explained by the invasive properties and hypercoagulability characterizing group A beta-hemolytic streptococcus. However, the characteristics of the fetal circulation may explain the possibility of paradoxical cerebral embolism from portal thrombosis. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To describe the neuroimaging findings in eclamptic patients still symptomatic after 24 hours. Patients and methods: All parturients consecutively admitted over a 12-month period for eclampsia and presenting with neurological disorders (coma, focal neurological abnormalities, and eyesight disturbance) underwent cerebral CT-scan and/or MRI. Results: Nineteen women were studied, and all had abnormal neuroradiological findings. The CT-scan was normal in three cases. Cerebral œdema was the predominant lesion (14 cases). It was localized in the parietal or occipital area (12 cases), paraventricular area (1 case), or was diffuse (1 case). Diffusion weighted MRI was performed in four cases and showed cytotoxic cerebral oedema in one case. There were three cases of cerebral venous thrombosis and two cases of intracerebral haemorrhage. Conclusion: Various neuroradiological lesions can be observed in eclamptic patients. A localized cerebral oedema is the most frequent. Diffusion weighted MRI should be systematically done when neurological disorders persist. [Copyright &y& Elsevier]

Résumé La dysostéosclérose est une affection génétique rare, de pronostic sévère. C’est une ostéochondrodysplasie similaire à l’ostéopétrose mais typiquement caractérisée par une platyspondylie et des métaphyses très élargies. Elle se manifeste habituellement par des atteintes des nerfs crâniens et notamment du nerf optique, des complications hématologiques, des fractures lors de traumatismes minimes, un retard des acquisitions motrices avec une dentition anormale mais aussi par une ostéomyélite du maxillaire inférieur. Nous rapportons un cas de dysostéosclérose compliqué d’une ostéomyélite chronique de la mandibule. Summary Dysosteosclerosis is a rare genetic disorder with a poor prognosis. It is an osteochondrodysplasia similar to osteopetrosis but it is typically characterized by platyspondyly and expanded metaphyses. It shows complications such as compression of cranial nerves, especially the optic nerve, hematologic complications, fractures following mild injury, abnormal dentition, neurological and psychological deterioration, in addition to osteomyelitis of the mandible. We report a new case of dysosteosclerosis complicated by osteomyelitis of the lower maxilla. [ABSTRACT FROM AUTHOR]