Search

Introduction: Hydatid disease remains a real public health problem in many traditional pastoral farming countries. Its prevention is the most effective solution. Aim: Our study aimed to assess the knowledge of patients managed for a lung hydatid cyst concerning their pathology. Methods: Between November 2018 and July 2019, we carried out a descriptive cross-sectional study, in a thoracic surgery department, about the knowledge and information that patients with hydatid cyst had about the disease. Results: Thirty-four patients responded to our survey. The mean age was 37.18 ± 18.43 years old. Most of our patients came from rural areas. Among the 30 patients under the age of 60, 12 (40%) were housewives. Three patients (8.8%) had already been operated on for a cyst. Thirty patients (88.3%) reported having contact with dogs and sheep. If a cyst was suspected in the sheep’s offal, 20.6% (7 cases) threw them in the trash and 14.8% gave them to the dog (5 women). Among the respondents, 50% (17 cases) did not know the modes of human contamination. Knowledge of clinical signs suggestive of the disease and modes of contamination were correlated with the level of education. Fourteen patients (41.2%) raised the possibility of disease recurrence. Among the means of prevention, thorough washing of fruits and vegetables was cited in 3 cases (21.4%) and incineration of soiled offal in 1 case (7.2%). Conclusion: Assessment of patients9 knowledge about hydatid disease must be systematic in countries with high endemicity of hydatidosis, in order to identify false practices and correct them, to break the parasitic cycle. Educational messages should target the rural population and be adapted to their level of education.

Synovial sarcoma is a soft tissue sarcoma. Its occurrence as a primary mediastinal neoplasm is very rare. We report a case of mediastinal synovial sarcoma in a 14‐year‐old girl with exertive dyspnoea at presentation. On physical examination, there was a superior vena cava syndrome and café‐au‐lait spots. Chest X‐ray revealed a white left hemithorax with mediastinal deviation to the opposite side. Thoraco‐abdomino‐pelvic scanner showed a voluminous posterior cervico‐mediastinal tissue mass. Computed tomography (CT)‐guided biopsy of the mediastino‐pleural mass was performed. Histological examination reported fusocellular malignant mesenchymal proliferation. A complementary immunohistological study with a broad range of antibodies was performed with a high‐grade single‐phase spindle cell synovial sarcoma of the mediastinum. She presented a respiratory distress, did not respond to resuscitation, and died. Mediastinal synovial sarcoma is a rare tumour that is difficult to diagnose. Its slow progression and delay in diagnosis may lead to a fatal evolution., Synovial sarcoma is a soft tissue sarcoma. Its occurrence as a primary mediastinal neoplasm is very rare. We report a fatal case of mediastinal synovial sarcoma in a 14‐year‐old girl with exertive dyspnoea at presentation. We highlight the role of imaging, the means of diagnosis, and the importance of the speed of therapeutic management. Mediastinal synovial sarcoma is a rare tumour that is difficult to diagnose. Its slow progression and delay in diagnosis may lead to a fatal evolution.

Introduction: Primary tracheal tumors are rare. They represent less than 1% of primary tumors of the chest. However, they are diagnostic and therapeutic challenges. Our aim was to study the characteristics and management of primary tracheal tumors Methods: We retrospectively reviewed the clinical data from patients who were operated for primary tracheal tumors within 17 years at the thoracic surgery department of Abderrahmen Mami Hospital Ariana – Tunisia Results: There were 5 women and 4 men.The main symptom was dyspnea, accompanied with dysphonia in 1 case and dysphagia in another case. Bronchoscopy showed the lesion within the lumen in all cases. The median size of the tumor was 32.5 mm.The tumor was located in the upper third of the trachea (2 cases), the middle third (4 cases) and the lower third (3 cases). A tissue diagnosis was obtained in all patients by direct biopsy at bronchoscopy. Pathological study revealed : adenoid cystic carcinoma (4 cases), mucoepidermoid carcinoma (1 case), carcinoma with lymphoid stroma (1 case), schwannoma (1 case), glomus tumor (1 case) and cylindroma (1 case). All patients were managed by resection with reconstruction by primary anastomosis. Neck-collar incision was used in 4 cases, median sternotomy in 3 cases and posterolateral thoracotomy in 2 cases. Negative margin resection was achieved in 6 cases. The postoperative course was complicated in 3 cases. Two weeks postoperatively, bronchoscopy showed satisfactory lumen (6 cases), a lesion in the carina (1 case) and a reduced lumen (2 cases) Conclusion: Primary tracheal tumors are the least common neoplasic lesions of the airways. Non specific symptoms delay diagnosis. Resection with primary reconstruction should be preferred in initial treatment

Introduction: Cystic echinococcosis, which is commonly contracted during childhood or adolescence, is still a serious health problem in many countries. Pulmonary hydatid location is more frequent than hepatic, in children. Material and Methods: The records of 75 children managed for LHC between 2010 and 2019 in a thoracic surgery department were retrospectively reviewed. Results: There were 47 boys and 28 girls, with a mean age of 11.31 years (2–15 years). Parasitic exposure was found in 80% of the cases. The most common signs were: cough (62%), chest pain (49%), hemoptysis (42%) and fever (36%). Imaging tools showed a single LHC in 74 cases and bilateral in one case. It was right seated in 33 cases (45.3%) and left in 42 (56%). Mean size of LHC was 7 cm. Associated hydatic lesions were seen in the liver in 11 cases and in the spleen in one case. All the patients were operated. The most used approach was a video-assisted mini-thoracotomy. LHC was complicated in 34 cases and non-complicated in 41 cases. For the treatment of the residual cavity, parenchyma-saving procedures were performed most of the time: cystectomy in 64 cases (85.3%) and pericystectomy in 6 cases (8%). Anatomical resection was performed in 5 cases (6.6%): 4 complicated cysts and one simple cyst. The postoperative course was uneventful in 97% of the cases. Complications were seen in 2 patients: fever (1 case) and hemothorax (1 case). Secondary pleural hydatidosis was reported in one case during follow-up. conclusion: LHC are often asymptomatic and diagnosed at a later stage in children. Intact cysts should be operated rapidly to avoid rupture and parasitic dissemination. Parenchyma-saving procedures should be performed whenever possible, even in infected cysts.

Cyriax syndrome is a rare entity of the chest wall, which mainly affects young people. It can manifest as abdominal pain in the right or left hypochondriac region, which may be very intense, and often causes problems in the differential diagnosis. We report the case of a 36-year-old man who presented with intense left hypochondrial pain, worsening on exercise. After multiple specialized consultations and several unnecessary and expensive investigations, a diagnosis of Cyriax syndrome was obtained. A thorough physical examination might have been sufficient to evoke the diagnosis.

Introduction Les tumeurs desmoides sont des tumeurs rares des tissus mous. Elles correspondent a une proliferation fibroblastique infiltrante. Il s’agit de lesions benignes, possedant toutefois un potentiel invasif locoregional avec un risque de recidive locale. Le diagnostic est difficile, suspecte sur la base de signes cliniques et radiologiques et confirme par l’etude histologique de la piece d’exerese. Le but etait d’etudier l’interet de la chirurgie dans la prise en charge diagnostique et therapeutique de ces lesions. Methodes Etude retrospective portant sur 8 cas de tumeurs desmoides thoraciques operes dans le service de chirurgie thoracique de l’hopital Abderrahman Mami sur une periode de 14 ans entre 2006 et 2020. Resultats Il s’agissait de 3 femmes et de 5 hommes. L’âge variait de 6 a 67 ans. L’atteinte etait parietale dans 6 cas et intrathoracique chez deux cas. Pour les cas de la paroi thoracique, deux etaient de localisation parasternale, 4 cas etaient thoracique anterieure. Une resection complete a ete faite dans tous les cas emportant en moyenne deux cotes avec limites de resection saines. Une reconstruction de la paroi thoracique anterieure a ete faite dans un cas par mise en place d’une plaque de mersylene avec cimentoplastie. Pour les deux cas de tumeur desmoide intra thoracique, il s’agissait d’un processus mediastino-pulmonaire gauche de 6 cm symptomatique de toux seche pour le premier cas. Il a eu une resection de la masse par thoracotomie posterolaterale gauche. Le deuxieme cas presentait un processus tissulaire de la cavite pleurale gauche comblant l’orifice thoracique superieur gauche, il a eu une resection complete par voie de Cormier–Dartevelle–Grunenwald. La confirmation diagnostique a ete apportee par l’etude histologique de la piece operatoire. Les suites operatoires immediates etaient marquees par un chylothorax pour un cas. Un seul patient a presente une recidive locale apres 1 an, pour laquelle il a eu une radiotherapie. Conclusion Les tumeurs desmoides sont des fibromatoses agressives du fait de leur caractere infiltrant avec un haut potentiel de recidive. Le diagnostic est difficile et peut etre evoque devant toute masse parietale thoracique. La chirurgie peut apporter une aide diagnostique et therapeutique. L’exerese de ces tumeurs doit etre aussi large que possible afin d’eviter le risque de recidive.

Introduction L’infection des bulles d’emphyseme est une complication courante de la maladie obstructive chronique des voies respiratoires. Le diagnostic peut etre fait radiologiquement par la presence d’un niveau hydroaerique au niveau d’une bulle. Le traitement de reference reste la chirurgie associe a l’antibiotherapie. Methodes Sur une periode de 7 ans entre 2007 et 2014, 7 patients ont ete traites pour bulles d’emphysemes infectees dans le service de chirurgie thoracique et cardiovasculaire de l’hopital Abderrahmane Mami Ariana. Resultats Il s’agissait de 7 hommes, avec un âge moyen de 46,8 ans [38–58]. Six patients etaient tabagiques a 27,4 PA [10–90]. La bulle d’emphyseme etait a droite dans 5 cas et a gauche dans 2 cas. La symptomatologie principale etait une douleur thoracique avec dyspnee. Tous les patients ont eu un scanner thoracique objectivant une bulle d’emphyseme qui est le siege d’un niveau hydroaerique. Cinq patients ont eu une bullectomie avec avivement pleural mecanique et chimique, un patient a eu une lobectomie superieure droite et un patient a eu une lobectomie superieure gauche. La voie d’abord principale etait la thoracotomie posterolaterale pour 5 patients et thoracotomie video-assiste pour 2 patients. Les suites etaient simples pour 4 patients, 2 patients ont eu un drainage prolonge necessitant une symphyse a la betadine pour un patient et un symphyse au nitrate d’argent apres la betadine pour un patient, et une atelectasie en postoperatoire chez un patient bien evolue apres fibroaspiration. La duree de drainage moyenne etait 16,1 jours [6–57]. Le resultat etait satisfaisant avec amelioration du syndrome inflammatoire biologique et de la dyspnee. Conclusion Le traitement chirurgical reste le traitement de reference des bulles d’emphysemes compliquees par suppuration, hemorragie,compression ou rupture. La bullectomie est le plus souvent suffisante mais parfois un geste d’exerese reglee est necessaire.

Introduction L’actinomycose thoracique est une maladie infectieuse rare. Son tableau clinique est le plus souvent trompeur et les aspects radiologiques ne sont pas specifiques, pouvant simuler un cancer ou une tuberculose. Par consequent, le diagnostic est difficile a confirmer et de nombreux cas sont decouverts a l’examen anatomopathologique, apres un geste de resection. Methodes Determiner les specificites des cas d’actinomycose a localisation thoracique decouverts apres resection chirurgicale. Resultats La moyenne d’âge etait de 39,5 ans avec un sex-ratio (H/F) de 5. Les comorbidites associees etaient le diabete (3 cas) et l’HTA (2 cas). Les signes revelateurs etaient: douleur thoracique (12 cas), hemoptysie recurrente (5 cas) et un etat general altere (2 cas). Une pneumonie a ete rapportee dans 4 cas et un abces parietal dans 2 cas. En raison de la probabilite d’une lesion neoplasique (4 patients) ou d’une pneumonie chronique (6 patients) avec hemoptysie recurrente, la chirurgie a ete decidee a but diagnostique et therapeutique. Une thoracotomie posterolaterale a ete realisee chez 8 patients et une thoracotomie laterale chez 2 patients. Les gestes pratiques etaient une lobectomie chez 6 patients, une bilobectomie chez un 1 patient, une resection partielle chez 2 patients, une mise a plat chez 2 patients et une biopsie pulmonaire dans 1 cas. L’examen anatomopathologique definitif a revele une actinomycose dans tous les cas. Les suites operatoires etaient simples avec une duree moyenne d’hospitalisation de 5 jours. Un traitement antibiotique postoperatoire a ete introduit pendant une moyenne de 3 mois chez tous les patients. Conclusion L’actinomycose dans sa localisation thoracique est une pathologie infectieuse rare, de diagnostic difficile. L’evolution est souvent favorable sous traitement antibiotique precoce et adequat. Le diagnostic doit etre evoque chez un sujet immunodeprime, presentant une condensation parenchymateuse trainante. Le recours a la chirurgie devrait etre limite aux cas compliques, en l’absence d’autres alternatives diagnostiques ou therapeutiques.

Background: Bronchogenic cysts (BC) result from a congenital abnormality in the development of the tracheobronchial tree. BC remain asymptomatic for a long time and the occurrence of clinical signs points towards complication. The aim of our study was to assess the clinical and therapeutic characteristics of BC discovered in adulthood. Methods: We retrospectively reviewed the records of 106 patients managed between 1985 and 2018 in the thoracic and cardiovascular surgery department of Abderrahmen Mami Hospital Ariana - Tunisia. Results: There were 47 women and 59 men, with a mean age of 42 years [18-83 years]. The most common signs were chest pain (51 cases), cough (44 cases) and dyspnea (31 cases). Dysphagia was reported in 3 cases, dysphonia in 1 case and 11 patients were asymptomatic. Chest X-ray showed a homogeneous opacity (37 cases), an air-fluid level (23 cases), a suspicious opacity (14 cases) and was normal in 16 cases. Fiberoptic bronchoscopy showed: inflammation (26 cases), signs of extrinsic bronchial compression (8 cases) and an endobronchial bud (3 cases). CT-scan revealed 67 intra-parenchymal BC and 37 mediastinal BC, mainly at the subcarinal level (28 cases). All patients were operated. The most common surgical approach was thoracotomy (82 cases). Cystectomy was total in 68 cases and subtotal in 13 cases. Lobectomy was required in 23 cases and segmentectomy in 2 cases. The postoperative course was uneventful in 102 cases (96.2%). Reported complications were pulmonary infection and pneumothorax. Conclusion: Because of the risk of complications, which make surgical management more difficult, surgical resection of BC is recommended, whatever the age of discovery.

Background: Liver Hydatid cyst with intrathoracic rupture is a rare complication, which may be life-threatening. Currently there is a lack of consensus about the best way of management. The aim of our study was to assess the characteristics and outcomes of patients presenting with liver hydatid cyst ruptured into the thorax and managed through a thoracic approach. Methods: The records of 113 patients managed between 1994 and 2018, in the thoracic and cardiovascular surgery department of Abderrahmen Mami Hospital Ariana - Tunisia, were retrospectively analyzed. Results: There were 64 women and 49 men. The mean age was 48 years [13-86 years]. Reported signs were: chest pain in 68 cases (60.1%), fever in 49 cases (43.3%), dyspnea in 41 cases (36.2%), cough in 30 cases (26.5%), or pain in the right upper quadrant of the abdomen in 5 cases (4.4%), and 21 patients (18.5%) were admitted in emergency. The cysts were assessed with abdominal ultrasonography, CT-scan or both. Surgery was performed in 106 cases. The main procedure was cystectomy through thoraco-phrenotomy and ‘Lagrot’ on the liver in 57 cases (53.7%). Lung resections were performed in 17 cases: segmentectomy (2 cases), bilobectomy (2 cases), lobectomy (12 cases) and right pneumonectomy (1 case). Twenty three patients had a decortication. Mortality rate was 2.6% and morbidity rate was 23.5%. Conclusion: Intrathoracic rupture of liver hydatid cyst may be managed through an abdominal or a thoracic approach. The thoracic approach should be preferred whenever the lung or the pleura are involved. In some cases, a combined thoracic and abdominal approach should be considered in order to prevent recurrences.

In this paper, we describe a simulation system of myopathicsurface electromyography (sEMG) signals. The architecture of the proposed system consists of two cascading modules. SEMG signals of three pathological skeletal muscles (Biceps Brachii, InterosseursDorsalis, TibalisAnterior) were generated. Root Mean Square (RMS Envelope) and Power Spectral Density (PSD) were used to validate our system.

Introduction En chirurgie thoracique, le saignement perioperatoire est responsable d’une augmentation de la morbi-mortalite. L’effet de l’acide tranexamique sur l’epargne sanguine a ete prouve dans plusieurs types de chirurgies. L’objectif de cette etude est d’evaluer son efficacite dans la reduction du saignement perioperatoire. Methodes Apres accord du comite d’ethique et le consentement des patients, une etude prospective randomisee en double aveugle a ete menee dans le service de chirurgie thoracique, incluant des patients âges de plus de 18 ans proposes pour chirurgie thoracique a haut risque hemorragique : resection pulmonaire pour aspergillose, chirurgie de la tuberculose lobectomie avec parietectomie, decortication pleurale, chirurgie pour hemoptysie pathologies inflammatoires thoraciques et redux. Nous avons releve : les criteres demographiques, biologiques et cliniques ainsi que les besoins transfusionnels, les pertes sanguines peroperatoires et les complications. Les patients ont ete randomises en deux groupes : TA groupe : a recu 25 mg/kg d’acide tranexamique en bolus a l’induction suivi de 2 mg/kg/h en perfusion jusqu’a la fin de l’acte SSI groupe : a recu les memes volumes en serum physiologique. Les donnees ont ete analysees au moyen du logiciel SPSS version 20.0. Resultats Nous avons inclus 60 patients repartis en deux groupes. Les deux groupes etaient comparables en ce qui concerne les parametres demographiques, le taux d’hemoglobine et la duree de l’intervention. Le saignement estime en peroperatoire etait significativement moins important dans le groupe TA. L’acide tranexamique a aussi reduit le saignement post operatoire a H24 H48 et H72. Nous avons note une difference significative du deltaHB (Hb preop − hb post-op) entre les deux groupes (p = 0,048). Onze patients ont ete transfuses : deux du TA groupe (7 %) et neuf du SSI groupe 30 % (p = 0,02). Les patients transfuses dans le groupe TA ont recu 4 culots globulaires versus 13 dans le groupe SSI (p = 0,003). Nous n’avons pas note de complications. Conclusion L’utilisation de l’acide tranexamique dans la chirurgie thoracique a permis de reduire le saignement perioperatoire et le recours a la transfusion sans complications ce qui est en accord avec la litterature. D’autres etudes multicentriques devraient etre menees pour confirmer ces resultats.

Iatrogenic tracheal stenosis is a severe late complication of tracheal intubation and tracheotomy. Its features have a strong impact on the therapeutic strategy. The records of 73 patients managed for iatrogenic tracheal stenosis in the department of thoracic surgery ofAbderrahmenMami hospital, between January 1995 and December 2015, were reviewed in order to study the clinical, radiological and therapeutic features of this disease. The mean age of the patients was 31years (10 to 64 years). All the patients reported a past history of intubation, associated with tracheotomy in 34%of the cases. Mean intubation time was 12days. The mean interval between extubation and the diagnosis was 106days. Fiberoptic bronchoscopywas performed in 67cases(92%). It showed a circumferentialstenosis in87.6% of the cases and a complex stenosis in12%. Chest CT scan or MRI was performed in95.5% of the cases. The mean distance between the stenosis and vocal cords was 3.17 cm[1-7.5cm]. The mean length of the stenosis was 2.2 cm. Thirteen patients(17.8%) underwent endoscopic treatment before surgery(dilatation 8cases, laser treatment 5 cases)with good immediate results in 53%of the cases. In our study, all the patients underwent tracheal resection and reconstruction. Postoperative complications were observed in 10.9%of cases. One patient died in the immediate postoperative period secondary to hemorrhage. The follow-up periods ranged from 2 to 69 months and showed a recurrence in one patient. Tracheal stenosis is a serious cause of morbidity and mortality in patients who underwent intubation, tracheotomy, or both. Its management is challenging and requires a multidisciplinary team. Its features have to be well analyzed in order to adopt the suitable therapeutic choice.

In Tunisia substantial economic and financial vulnerability are mainly caused by the civil unrest and the subsequent regime change after the Tunisian revolution in 2011. In order to quantify this fragility, in this paper, we use reverse stress testing (RST) based on combination of relevant risk factors that lead to the worst case in which the bank becomes unviable and insolvent. Given the financial stress testing scenarios shortcomings (i.e. plausibility, subjectivity), the use of RST methodology is explained by the fact that it identify the probability of realization of such scenarios. We apply this new methodology on Tunisian banks which are the core for financial stability; more specifically, we focus on credit risk RST. We choose the upper bound for value at risk (VaR) in order to identify worst VaR at probability of realization a. Our proposed framework relies on the logistic regression to identify stress probability and the linear regression of financial stress index output gap versus macroeconomic risk factors in order to search for scenarios at 1%, 3% and 5% levels of plausibility. Empirical results show that Tunisian banks have likely to reach the WVaR in 2012 at 5% level. Besides the more extreme the scenarios which are considered the less plausible they become. Our reverse FST is a complement, and never a substitute for risk manager and what matters most is the mindset of those employing it.

This work describes a model which is able to simulate the surface electromyography (sEMG) of different muscles. The model assumes that each muscle is controlled by many motor units (MU). Therefore, the motor unit action potential (MUAP) can be mathematically formulated as the spatiotemporal sum of divers potential actions produced by its fiber muscles. We evaluate the sEMG of four different muscles: soleus, tibialis anterior, dorsal interossei and platysma muscles.

Financial stress index (FSI) is considered to be an important risk management tool to quantify financial vulnerabilities. This paper proposes a new framework based on a hybrid classifier model that integrates rough set theory (RST), FSI, support vector regression (SVR) and a control chart to identify stressed periods. First, the RST method is applied to select variables. The outputs are used as input data for FSI–SVR computation. Empirical analysis is conducted based on monthly FSI of the Federal Reserve Bank of Saint Louis from January 1992 to June 2011. A comparison study is performed between FSI based on the principal component analysis and FSI–SVR. A control chart based on FSI–SVR and extreme value theory is proposed to identify the extremely stressed periods. Our approach identified different stressed periods including internet bubble, subprime crisis and actual financial stress episodes, along with the calmest periods, agreeing with those given by Federal Reserve System reports.

Introduction Malgre l’endemicite de la maladie hydatique dans certains pays du bassin mediterraneen, l’atteinte costo-vertebrale est rare. Toutefois, elle reste la plus frequente et la plus grave des localisations osseuses. Le but de notre etude etait de preciser, les caracteristiques cliniques et therapeutiques de cette localisation hydatique. Methodes Entre 2000 et 2018, 14 patients ont ete pris en charge pour une hydatidose costo-vertebrale dans le service de chirurgie thoracique et cardiovasculaire de l’hopital Abderrahmane Mami de l’Ariana en Tunisie. Resultats Notre etude comportait 9 hommes et 5 femmes, avec un âge moyen de 48 ± 15,4 ans [27–76 ans]. Des antecedents de kystes hydatiques (KH) etaient retrouves dans 5 cas (2 KH hepatiques, 2 KH de la paroi thoracique et un KH pulmonaire). La symptomatologie clinique etait faite de douleurs rachidiennes (7 cas), d’hemoptysie (2 cas), de tumefaction cutanee (5 cas), de deficit neurologique (3 cas ; paraplegie, paraparesie et compression medullaire, chacune dans 1 cas). L’atteinte du rachis dorsal etait plus frequente (9 cas). La 7e cote etait la plus souvent touchee (5 cas), suivie par la 8e (3 cas). L’atteinte etait lateralisee a droite dans 7 cas, a gauche dans 5 cas et bilaterale dans 1 cas. La tomodensitometrie (TDM) et l’imagerie par resonance magnetique (IRM) avaient montre : une lyse osseuse (7 cas), une extension intracanalaire (6 cas), une extension aux parties molles (5 cas) et une compression medullaire (1 cas). L’imagerie avait permis de retrouver d’autres localisations hydatiques concomitantes : pleurale (2 cas) et hepatique (1 cas). Le traitement etait chirurgical dans tous les cas. Une exerese costo-vertebrale large a ete realisee dans 12 cas. Les suites operatoires etaient compliquees dans 3 cas (un cas de paraplegie associee a une embolie pulmonaire, un cas d’hematome dorsal non compressif et un cas de detresse respiratoire). La duree moyenne d’hospitalisation etait de 9,4 ± 8 jours [4–33 jours]. L’evolution etait favorable chez 9 patients et 3 patients ont presente une recidive. Conclusion La presentation clinique de l’hydatidose costo-vertebrale est souvent insidieuse et non specifique. Toute symptomatologie parietale ou rachidienne dans un contexte d’endemie hydatique, doit faire penser au diagnostic. L’IRM occupe une place importante dans l’etude de l’extension hydatique. La prise en charge chirurgicale est difficile, necessitant souvent plusieurs intervenants (chirurgien thoracique, orthopediste et neurochirurgien).

This work aims to describe a model which is able to simulate the action potential (AP) of a single muscle fiber. The model assumes muscle fibers have a cylindrical structure and are uniformly parallel distributed in an isotropic media. This model is based on a mathematical formulation of the relationship between the observation electrode and the extracellular longitudinal currents produced by the fiber muscle. The AP of a single muscle fiber is estimated by including parameters values related to the AP such as the dipoles length, radial and longitudinal conductivity in the presented model. The parameters related to the position of electrode, the inter-electrode distance and the electrode sizes are investigated on the presented simulation model.

The use of Cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenator (ECMO) in patients suffering from Sickle cell disease (SCD) needs specific precautions. Whereas, no consensual protocols have been established to clarify therapeutic management. CASE REPORT A 7-year-old boy was admitted to the hospital for surgery of advanced endocarditis. Major dyspnea, hemodynamic distress and fever were noted on physical examination. Biological tests exploring anaemia revealed Haemoglobin (Hb) S levels of 39.1%. Echocardiography showed important right heart cavities dilation with multiple aortic vegetations. The child was accepted for emergent surgery. Ten minutes after anesthetic induction, serious hemodynamic distress was established. The patient was put on normothermic CPB when he received four packed red-blood-cell. After surgery, he was placed on ECMO support for 2 days than he succumbed. CONCLUSION Urgent cardiac surgery in patients suffering from SCD poses a major therapeutic dilemma. Multiplying case reports and encouraging prospective studies are necessary to define the right place of cardio-pulmonary assistance in treatment protocols for better management.

Banking activities have become more complex and diverse in recent years. This increasing complexity has been accompanied by a process of innovation in how banking institutions measure and monitor t...

The Duffy blood group system, besides its relevance in transfusion medicine, is of major interest for population genetics. In fact, the Duffy molecule is the only red cell receptor for Plasmodium vivax, thus the fixation of FY*silent allele in western south-Saharan Africa resulted in the absence of this type of malaria in that area (for a review see Kwiatowski, Am J Hum Genet 77:171-192, 2005). For the Duffy functional role see, for example, Daniels (Vox Sanguinis 93:331-340, 2007).Duffy blood group distribution in 115 unrelated Tunisians was determined using the polymerase chain reaction with sequence specific primer (PCR-SSP) method detecting the five allelic versions of the FY gene. The red cell antigenic FY phenotype, for each donor, was deduced through DNA analysis. The blood samples of the positive FY*X alleles were investigated by serological methods, mainly the fixation-elution technique.The following allele frequencies were found (after having excluded FY*X, which had frequency of 0.0174): FY*1 = 0.291 (expressed 0.260; silent 0.031); FY*2 = 0.709 (expressed 0.427; silent 0.282). The most surprising result in this work is the detection of the FY*1 silent allele, usually quite rare, in four samples (1.74%). For FY*2 silent, the predominant allele in Africans, genotyping results showed a prevalence of 29.57%. The FY locus was in Hardy-Weinberg equilibrium in the present sample.When compared with European and African data, Tunisian samples demonstrated the presence of the common signs of these two ancestries (FY*2 and FY*X for the first population; and FY*2 silent for the last one). These data confirm the mixed roots of this urban Tunisian population already suggested by numerous studies on other haematological markers.

Several studies of the association between HLA and type 1 diabetes have been carried out revealing differences between ethnic groups. Our study, as part of the studies that should be performed about this association in the rest of the word, aims at elucidating the HLA DRB1, DQB1 polymorphism in Tunisian type 1 diabetes. This study includes 43 unrelated type 1 diabetes patients, and their mean age at onset is less than 15 years. Analysis of the frequency of alleles and haplotypes in these subjects, compared to a reference group (n = 101) led to the following results. 1) The Tunisian insulin-dependent diabetics present similarities as well as differences with other ethnic groups (Caucasians, North Africans). 2) The haplotype DRB1*04 DQ*0302 and DRB1*03 DQB1*0201 is positively associated to type 1 diabetes. 3) The heterozygotic genotype DRB1*04 DQB1*0302 / DRB1*03 DQB1*0201 is strongly associated to type 1 diabetes. 4) The haplotypes DRB1*01501 DQB1*0602 and DRB1*11 DQB1*0301 proved to be protective. In addition, the study of the subtypes DRB1*04 showed that alleles DRB1*0405 predispose to type 1 diabetes, whereas the allele DRB1*0403, which is in linkage disequilibrium with the DQB1*0402 in the Tunisian population, has a protective effect.

Introduction L’allogreffe de CSH, seule therapeutique curative de maladies hematologiques (malignes et non malignes) et immunologiques, necessite la disponibilite d’un donneur (D) HLA compatible (geno-identique). En Tunisie, le don de CSH demeure limite a la famille. Objectif Evaluer : – la frequence d’un D de CSH geno-identique ou plus parmi la fratrie ; – la frequence d’un D parental (pere ou mere). Patients et methodes Il s’agit d’une etude retrospective qui s’est etendue sur 15 ans (2000–2014), periode pendant laquelle nous avons type 1764 familles en vue de rechercher un donneur HLA compatible pour 1764 patients atteints de diverses maladies hematologiques et immunologiques. Le typage HLA classe I de tous les membres a ete effectue par microlymphocytotoxicite. Le couple receveur/donneur potentiel est type en biologie moleculaire aussi bien en CL I qu’en CL II pour verifier la geno-identite (PCR-SSO Dot Reverse d’INNOGENETICS®). Resultats Parmis les patients tunisiens, 50,68 % ont une chance d’avoir au moins un D de CSH geno-identique. Plus qu’un donneur compatible est disponible dans 8,84 % des cas. L’un des parents est geno-identique au patient dans 4,64 % des cas. Conclusion Vu que 49,32 % des malades n’ont pas de D intrafamilial, l’elaboration d’un registre national de D de CSH volontaires en Tunisie est devenue une necessite. Ce projet est realisable moyennant une bonne sensibilisation de la population et un financement adequat.

Introduction L’aplasie medullaire acquise est une maladie heterogene d’etiologies variables et dont la physiopathologie n’est pas encore claire. Il semble que certains facteurs genetiques et environnementaux conferent une susceptibilite au developpement de cette maladie. Parmi les facteurs genetiques, le complexe majeur d’histocompatibilite comprenant les genes HLA reste le systeme immunologique le plus etudie et le plus nettement associe a l’aplasie medullaire acquise idiopathique. Dans ce travail, nous nous sommes proposes d’etudier l’association entre les alleles HLA-A et -B et l’aplasie medullaire acquise idiopathique chez les tunisiens. Patients et methodes Il s’agit d’une etude cas-temoins qui a concerne 64 aplasiques candidats a la greffe de cellules souches hematopoietiques colliges entre janvier 2000 et fevrier 2014 et 91 temoins sains non apparentes. Le typage HLA a ete realise par la technique PCR-SSO dot reverse. L’analyse statistique a ete realisee par le logiciel SPSS. Resultats Notre etude a revele le role predisposant de l’allele A*02 ( p = 0,047 ; OR = 1,93). Aucune association positive n’a ete retrouvee avec les alleles HLA-B. Conclusion Ce resultat nous laisse suggerer que l’allele HLA-A*02 peut etre considere comme un marqueur de risque de l’aplasie medullaire acquise idiopathique. Des meta-analyses regroupant les resultats d’autres etudes permettraient d’avoir une idee plus precise sur le role de l’allele HLA-A*02 dans la survenue de l’aplasie medullaire acquise.

The studies of the HFE mutations: H63D and C282Y in North African populations have revealed the extreme rarity or even the absence of the C282Y mutation. We have examined 1140 chromosomes (570 Tunisian people) for the presence of the two HFE mutations by PCR-RFLP analysis. We have found that the allele frequencies are, respectively, 15.17% (+/-2.1%) for the H63D and 0.09% (+/-0.17%) for the C282Y. These results are consistent with the worldwide spread of the H63D mutation and the north European restriction of the C282Y. This study will be completed by determining whether homozygote trait for H63D and associated risk factors (beta thalassemia) can lead to iron overload in Tunisia.