Intracranial abscess and empyema: neurosurgical management]

Brain abscesses and empyemas are severe infections with lethal outcomes in the case of inappropriate treatment. The files of 34 patients with brain abscesses, and nine with intracranial empyemas treated over eight years (1990-1997) were analyzed retrospectively. Cases were evaluated for treatment and compared with data from the literature. Patients with brain abscess underwent either aspiration of the lesion through a burr hole (79.5% of the cases), or craniotomy and excision (8.8% of the cases); 11.7% were treated only with antibiotics. The operative mortality was 2.9% and the outcome was satisfactory in 85% of patients. These results are in agreement with data from the literature. Prognosis is strongly related to the initial clinical status. Current methods of treatment include surgical aspiration of large abscesses with a mass effect, and are usually associated with a poor clinical status. Excision is suggested whenever aspiration procedures have failed, or in the presence of foreign material or fungal abscess. Medical treatment is indicated for small and deeply located abscesses in patients with satisfactory clinical states. Empyemas in our series were treated with burr hole and pus aspiration. The mortality rate was 11%, and 62.5% of the patients made a good recovery. In agreement with other reported studies, the method of treating subdural empyema is much less significant than an aggressive early drainage of the infection. Although brain abscesses and empyema remain a significant neurosurgical concern, aggressive treatment can result in an excellent outcome in the majority of patients.     

Hépatite C : Etat des lieux de la littérature Tunisienne (1991-2019)

Background:

Hepatitis C virus (HCV) is one of the leading causes of chronic liver disease and liver cancer related deaths in Tunisia.

Aim:

Perform a systematic review on viral hepatitis C in Tunisia between 1991 and 2019.

Methods:

A global search of HCV-specific documentation in Tunisia in bibliographic data search sites.

Results:

Tunisia is a low endemic country for hepatitis C with a prevalence that not exceed 1% in the general population. Several studies have focused on populations at risk of HCV contamination such as hemodialysis and polytransfused patients. The prevalence of hepatitis C is higher in these groups. In relatively small series, a clear predominance of genotype 1 and subtype 1b has been reported in Tunisia with a lower co-circulation of the other genotypes. Several polymorphisms of cytokine and chemokine genes can influence the clearance or persistence of HCV infection. Tunisian studies have focused on the efficacy of conventional dual therapy (pegylated IFN + ribavirin) by analyzing the predictive factors linked to SVR and mutations associated with resistance to viral inhibitors. No publication has discussed the effectiveness of new direct-acting antivirals in Tunisia.

Conclusion:

This review of the literature provides an update on the status of hepatitis C in Tunisia and reveals a lack of investigations on new directacting antivirals.     

Alteration of nociceptive integration in the spinal cord of a rat model of Parkinson's disease

Background : Pain is a major non motor symptom that contributes to impaired quality of life in PD. However, its mechanism is unknown. Objectives and Methods : We sought to identify the pain phenotypes and parallel changes in spinal integration of peripheral stimuli in a rat model of PD induced by lesions of SN dopamine neurons, using behavioral plantar and von Frey tests as well as electrophysiology of the dorsal horn. Results : We show that dopamine depletion by 6‐OHDA induced hypersensitivity to mechanical and thermal stimuli. These abnormal behaviors were paralleled by increased neuronal responses and hyperexcitability of wide dynamic range neurons of lamina V of the dorsal horn of the spinal cord in response to electrical stimulation of the sciatic nerve in the 6‐OHDA model as compared to sham rats. Conclusions : These results provide evidence for alteration of nociceptive integration in the spinal dorsal horn neurons in 6‐OHDA rats that can reflect changes in pain behavior. © 2018 International Parkinson and Movement Disorder Society     

Rituximab-induced interstitial lung disease: case report and literature review

Rituximab, a chimeric monoclonal antibody against CD20, very rarely causes lung toxicity. Toxicity may present as interstitial lung disease, alveolar hemorrhage and adult respiratory distress syndrome. Sixteen cases of rituximab-induced interstitial lung disease (R-ILD) have been reported. With this case and a review of all other cases reported in the literature, we will try to identify the features of R-ILD, its treatment and why the early diagnosis of this complication is important.     

Lidocaïne test for easier and less time consuming assessment of liver function in several hepatic injury models

Purpose

In this study, we developed an ex vivo functional assay to assess liver metabolic capacity adapted from the lidocaïne test in rats.

Methods

Animals used were subjected to different models of liver injury: hypothermic ischemia (H/I, n = 8), ischemia-reperfusion (I/R, n = 8) and CCl₄ induced liver cirrhosis (n = 11), and compared with sham operated rats (n = 5). Livers were then extracted and a fragment of whole tissue was incubated with lidocaïne for 15, 30, 60, 120, 240, 360, and 720 min at which both lidocaïne and its major metabolite monoethylglycinexylidide (MEGX) were measured by high performance liquid chromatography (HPLC). A histological study and biochemical assays (transaminase levels) were also performed to further evaluate and confirm our data.

Results

Pharmacokinetic profile of lidocaïne metabolism in sham-operated animals revealed that the maximum concentration of MEGX is achieved at 120 min. Both lidocaïne metabolism and MEGX formation levels were significantly altered in all three models of hepatic injury. The extent of hepatic damage was confirmed by increased levels of transaminase levels and alteration of hepatocyte’s structure with areas of necrosis.

Conclusion

Our method provides reliable and reproducible results using only a small portion of liver which allows for a fast and easy assessment of liver metabolic capacity. Moreover, our method presents an alternative to the in vivo technique and seems more feasible in a clinical setting.     

Systemic therapy in the management of metastatic or advanced salivary gland cancers

Salivary gland cancers are very rare tumors. They are characterized by a histologic heterogeneity and a poor outcome. According to this rarity, few prospective data are available to date. No standard recommendations could be held for the use of systemic therapy in these tumors. Several case reports and small studies have investigated the contribution of different agents of chemotherapy. With the extension of molecular biology approach in oncology several signaling pathways have been discovered in different cancers including salivary gland cancers; thus a number of targeted therapies have been investigated. This paper reviewed exhaustively the studies investigating the role of systemic therapies (chemotherapy, targeted therapy, hormone therapy) in salivary gland cancers.     

Influence of sildenafil on micturition and urethral tone in ovariectomized and non-ovariectomized mice

IntroductionNitric oxide synthases (NOSs) and estrogen receptors are expressed in the female urethra.AimWe aimed to assess the impact of sildenafil on micturition behavior, urethral tone according to the hormonal status and to determine the implications of the neuronal isoform of NOS (nNOS).MethodsFour‐week‐old C57/BL6 female mice were sham‐operated or ovariectomized. Six weeks later, they were injected intraperitoneally by any combination of sildenafil, 7‐nitroindazole (7‐NI)—a potent selective nNOS inhibitor—or the corresponding vehicles. The mice were then subjected to micturition behavior and leak point pressure studies. Urethral histomorphometry was performed.Main Outcome MeasuresThe main outcome measures were micturition behavior, leak point pressure, and histomorphometry.ResultsIn sham‐operated and ovariectomized animals, sildenafil did not impact micturition, although it decreased urethral resistance 10‐fold. nNOS inhibition by 7‐NI reduced the number of micturitions and increased residual volume and leak point pressure. It abrogated sildenafil‐induced drop in urethral resistances. Hormonal status did not influence the structure of the urethral layers.Conclusions.Irrespective of the hormonal status, sildenafil decreased leak point pressure by a nNOS‐mediated mechanism. Gamé X, Bouali O, Allard J, Gourdy P, Escourrou G, Tack I, Rischmann P, Arnal J‐F, and Malavaud B. Influence of sildenafil on micturition and urethral tone in ovariectomized and non‐ovariectomized mice. J Sex Med 2012;9:466–471.