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We wish to determine the urinary trans,trans-muconic acid reference values in the Tunisian general population, and evaluate the impact of several factors (age, gender, tobacco...) on these reference values. Urine samples were collected from 182 healthy Tunisian subjects who had not been occupationally exposed to benzene. This determination was performed by solid phase extraction sampling technique together with high performance liquid chromatography-photodiode array detector. Trans,trans-muconic values ranged from 0.003 to 0.618 mg/g creatinine, the 95% reference interval was: 0.004-0.36, and the 90% confidence interval of the upper reference limit was: 0.24-0.62 mg/g creatinine. Urinary trans,trans-muconic levels were significantly higher among smokers. Significant differences were also observed for the < 20 and the > or = 40 age groups. As a result urinary trans,trans-muconic background levels allow the biomonitoring of workers occupationally exposed to benzene at levels as low as 0.5 ppm. Age and tobacco, but not gender may affect the trans,trans-muconic reference values.

Introduction: Myofibroblastic tumours or pulmonary pseudotumours are rare and, though benign, they may become invasive and recur after excision., Case Report: We report the case of a child aged 14, presenting with mild haemoptysis, who had a solitary nodule at the base of the left lung. CT scanning suggested a hypervascular tumour. Fibreoptic bronchoscopy was normal and it was not possible to perform percutaneous biopsy on account of its proximal situation. A lobectomy was performed via a postero-lateral thoracotomy with a successful outcome. Histological examination revealed a myofibroblastic tumour., Conclusion: Recourse to primary surgery is essential to confirm the diagnosis of a myofibroblastic pulmonary tumour. Complete resection is the only guarantee to prevent recurrence.

Introduction: Lymphocele of the thoracic duct is a rare pathological entity occurring as a consequence of deterioration and cystic dilation wall of this vessel. It may be of congenital or degenerative origin., Observation: We report the case of a 47 year old patient, operated on for a symptomatic cyst localised by CT scan to the inferoposterior mediastinum. At postero-lateral thoracotomy it was identified as a lymphocele and completely resected. Chemical analysis of the liquid and histopathology study of the cystic wall confirmed the diagnosis. The patient's post operative course was uneventful., Conclusion: This case demonstrates the clinical characteristics of this entity and describes diagnostic techniques and surgical management.

Introduction: Costo-vertebral echinoccoccus is a rare and serious condition which often presents with neurological complications requiring urgent surgical intervention., Case Report: We report the case of a seven year old girl admitted with a clinical picture suggesting medullary compression secondary to multifocal Hydatid disease. As well as a costo-vertebral cyst with extension into the spinal canal, lesions were also seen in the lower lobe of her right lung and throughout the liver, confirmed by CT scan and by magnetic resonance imaging. A resection of Hydatid material as well as the posterior part of the 4th rib, the transverse process of the 4th costal vertebra and adjacent bone was carried out via a posterolateral thoracotomy. The cyst in the right lung was successfully excised at the same operation. Three months later six hepatic lesions were removed via a subcostal approach again without complication. A scan 23 months later revealed no evidence of residual hydatid disease., Conclusion: This case illustrates the pathophysiological features of costovertebral Hydatid disease and the advantages of an anterior surgical approach.

Hydatid cysts in the heart are rare, with an unpredictable outcome and numerous complications, requiring rapid surgical management. We report the case of a 19 year old female patient, who underwent surgery with extra corporeal circulation for a hydatid cyst of the interventricular septum of the heart, complicated by secondary pulmonary echinococcus infection, confirmed on CT and MRI. Resection of the cyst was performed via a right auriculotomy. The post operative period was favourable; the other pulmonary sites were treated medically. We emphasise the methods of diagnosis and management.

Background: This study analyzes surgical approaches of 29 operations carried out for false aneurysms of the ascending aorta after prosthetic replacement (FAA) from January 1979 to April 2003, in 28 patients., Methods: Initial operations consisted of a composite valve graft with reimplantation of coronary arteries (n = 14) or a supracoronary tube (n = 14) with 7 aortic valve replacements. Initial pathology included acute aortic dissection (n = 20), aortic annuloectasia (n = 6), and aortic valvulopathies with concomitant aneurysm of the ascending aorta (n = 2). Resternotomy was performed under the following conditions: femoral artery cannulation in 7, femoral artery and vein cannulation in 6, femoral artery, vein, and carotid artery cannulation in 16 patients of whom 6 patients underwent partial circulatory arrest. The FAA ruptured during sternotomy in 9 cases. Operative intervention consisted of direct simple suture repair (n = 7), complete revision (n = 21), and one isolated reimplantation of the coronary artery., Results: No patients died after FAA rupture during resternotomy. Among the 6 patients who underwent partial circulatory arrest before sternotomy, the FAA ruptured 5 times. Carotid artery cannulation was always justifiable: 2 cases of FAA rupture, 9 cases of aortic arch replacement, and 5 cases with both. The operative mortality was 17.2% (n = 5). Mortality was influenced by the emergent nature of operations (p < 0.05)., Conclusions: The FAA can be surgically managed with acceptable results through a sternotomy using prior femoro-femoral and carotid cannulation. The latter allows for cerebral perfusion in cases of FAA rupture during resternotomy and is of value for the surgical treatment of these complex lesions.

Aim: The aim of this study was to assess the influence of drainage with a Redon drain versus a conventional drain on postoperative pain and blood loss after valve replacements., Methods: After approval by the local Ethics Committee and written informed consent, 30 patients, 20-60 years of age, scheduled for first elective valve replacement were included. After standardized anaesthetic regimens, cardiopulmonary bypass and coagulation therapy procedures and at the end of the operation, the patients were randomly assigned to 1 of 2 groups: (GI, n=15): drainage with 4 Redon drains; (GII, n=15): drainage with 2 conventional drains. Postoperative pain intensity at rest (VAS-R), during coughing and mobilization (VAS-M) in bed was independently evaluated using a visual analogue scale (VAS 100 mm) at 6 hourly intervals until 48 h after admission to the ICU (Ho). All patients received 2 g of paracetamol after obtaining the VAS score (8 g/24 h). No other analgesic agents were used. All patients were submitted to 2D echocardiography to verify the presence of pericardial effusion 24 h after surgery. Values are expressed as means. Pearson's chi squared and ANOVA (for repeated measurements) were used for statistical analysis. P<0.05 was considered significant., Results: There was no statistically significant difference in the mean postoperative VAS-R and VAS-M, and in the mean postoperative total blood drainage 822.3 ml in GI, versus 704.3 ml in GII. Non pericardial effusion was found, and we did not see side-effects in any of the patients., Conclusions: We have shown that drainage with a Redon drains versus a conventional drain does not influence postoperative pain intensity and blood loss after valve replacements.

The authors report the case of a drug abuser treated successfully for fungal tricuspid endocarditis complicated by massive pulmonary embolism. Partial valvular replacement with a segment of a tricuspid homograft associated with disobliteration of a pulmonary artery was performed. Peroperative transoesophageal echocardiography showed satisfactory tricuspid valve function. The postoperative course was uneventful. After 5 months' follow-up, the patient was asymptomatic and in good general condition. Control echocardiography showed a stable operative result.

Marastic endocarditis is a rare clinical condition described in cases of cancer or other severe inflammatory diseases. The authors report the case of a young patient in good general condition, admitted after a cerebro-vascular accident. Investigations showed an isolated mitral valvular mass on transoesophageal echocardiography which, after unsuccessful medical therapy, was operated. It was, in fact, a case of marastic endocarditis, and a pulmonary tumour was discovered one month after surgery. The bronchopulmonary adenocarcinoma had remained infraclinical beforehand. The advances in echocardiographic imaging will probably lead to an increase in such cases of early diagnosed thrombotic non-bacterial endocarditis (ETNB. This case suggests that it is justified to carry out an aetiological investigation of thrombotic non-bacterial endocarditis in all cases of isolated mitral valve masses.

Stimulation of the gastric parietal cell results in a massive redistribution of H+-K+-ATPase from cytoplasmic tubulovesicles to the apical plasma membrane. Previous studies have implicated the small GTPase rab11 in this process. Using matrix-assisted laser desorption mass spectrometry, we confirmed that rab11 is associated with H+-K+-ATPase-enriched gastric microsomes. A stoichiometry of one rab11 per six copies of H+-K+-ATPase was estimated. Furthermore, rab11 exists in at least three forms on rabbit gastric microsomes: the two most prominent resemble rab11a, whereas the third resembles rab11b. Using an adenoviral expression system, we expressed the dominant negative mutant rab11a N124I in primary cultures of rabbit parietal cells under the control of the tetracycline transactivator protein (tTA). The mutant was well expressed with a distribution similar to that of the H+-K+-ATPase. Stimulation of these cultures with histamine and IBMX was assessed by measuring the aminopyrine (AP) uptake relative to resting cells (AP index). In experiments on six culture preparations, stimulated uninfected cells gave an AP index of 10.0 +/- 2.9, whereas parallel cultures expressing rab11a N124I were poorly responsive to stimulation, with a mean AP index of 3.2 +/- 0. 9. Control cultures expressing tTA alone or tTA plus actin responded equally well to stimulation, giving AP index values of 9.0 +/- 3.1 and 9.6 +/- 0.9, respectively. Thus inhibition by rab11a N124I is not simply due to adenoviral infection. The AP uptake data were confirmed by immunocytochemistry. In uninfected cells, H+-K+-ATPase demonstrated a broad cytoplasmic distribution, but it was cleared from the cytoplasm and associated with apically derived membranes on stimulation. In cells expressing rab11a N124I, H+-K+-ATPase maintained its resting localization on stimulation. Furthermore, this effect could be alleviated by culturing infected cells in the presence of tetracycline, which prevents expression of the mutant rab11. We therefore conclude that rab11a is the prominent GTPase associated with gastric microsomes and that it plays a role in parietal cell activation.

Subclavian vein stenosis is a classical complication of longterm venous catheterization in hemodialysis. We report the case of a 74 years-old woman, operated for multiple arteriovenous fistulae, admitted to hospital with upper-limb oedema. Venous angiography demonstrated subclavian stenosis. Surgical treatment was performed by transposition of the external jugular vein onto the subclavian vein with a good result.