[Spontaneous neonatal arterial thrombosis: a report of 4 neonates]

Arterial thromboses are rare in newborns, mostly caused by arterial catheters. Neonatal arterial thrombosis occurring in other contexts is much rare. We report arterial thrombosis, not caused by catheterisation in 4 neonates hospitalised in the neonatology department of the Farhat Hached de Sousse hospital in Tunisia. The diagnosis of arterial thrombosis was made based on signs of ischemia in 2 patients affected by thrombosis of the iliac arteries. The symptoms were less clear: anuria associated with arterial high blood pressure in 1 patient affected by thrombosis of the abdominal aorta and by anuria with melena in a newborn with aortic and mesenteric thrombosis. Diagnosis was confirmed by Doppler sonography in 3 patients and based on autopsy data in 1 patient. A delay to consultation was noted in 3 patients, whose outcome was fatal. The progression was favourable after thrombolysis and anticoagulation using heparin in 1 patient with major aortic thrombosis. A review of the literature on the epidemiological, clinical, therapeutic and outcome data of the arterial thrombosis in the newborn child is provided.

[Auditory hallucinations due to voriconazole: Illustration by plasma monitoring]

Voriconazole is a second-generation azole antifungal that is widely indicated in the treatment of invasive aspergillosis. It is generally well tolerated. It has nevertheless numerous side effects like hepatotoxicity, photosensitivity, skin rashes, and visual disturbances. Hallucinations were also reported as side effects to voriconazole but auditory hallucinations were rarely reported and seem to be related to toxic voriconazole blood levels. We report, herein, a case of auditory hallucination with monitoring of voriconazole plasma concentration during hallucination and after its disappearance. A 38-year-old man was treated with intravenously voriconazole for a pulmonary aspergillosis. Seven days after the initiation of voriconazole, the patient presented a sudden history of auditory hallucination associated to incoherence and temporo-spatial disorientation. Therapeutic drug monitoring of voriconazole showed a plasmatic residual concentration (C0) of 7.5μg/mL (therapeutic interval: 1.4-1.8μg/mL) and a pic concentration (Cmax) of 9.83μg/mL (therapeutic interval: 2.1-4.8μg/ml). Voriconazole was then stopped and, two days later, symptomatology completely disappeared and at the same time levels of voriconazole decreased (C0=0.11μg/mL and Cmax=2.17μg/mL). We concluded in our case that the patient's auditory hallucinations were caused by voriconazole treatment. In fact, the sudden onset of hallucinations was concomitant with high plasmatic voriconazole levels, and since the medication was stopped, an important decrease of voriconazole levels was observed which was associated with a sudden disappearance of the auditory hallucinations.

Polychlorinated biphenyls in sediments from Ghar El Melh lagoon, Tunisia

The concentrations of 20 Polychlorinated biphenyls (PCBs) were determined in 12 superficial sediments collected from The Ghar El Melh lagoon. Sediment samples were extracted by Soxhlet and analyzed by Gas chromatography with electron capture detector. The concentrations of PCBs, as sum of the 20 congeners, ranged from not detected to 3.987 ng/g on a dry weight basis, with a predominance of highly chlorinated (penta- and hepta-chlorobiphenyls) congeners. No significant correlation was found between the total PCB concentrations and organic carbon content suggesting that sediment organic carbon content did not play an important role in controlling the PCBs levels in the sediments. PCB levels in sediments were compared with Sediments Quality Guidelines (ERM-ERL indexes) for evaluation probable toxic effects on marine organism. The PCBs concentrations were lower than ERM and ERL values for all the collected samples.

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.

Polycyclic aromatic hydrocarbons in superficial sediments from Ghar El Melh lagoon, Tunisia

The concentrations of 17 polycyclic aromatic hydrocarbons (PAHs) were determined in 12 superficial sediments collected from the Ghar El Melh lagoon. Sediment samples were extracted by Soxhlet, and analyzed by Gas chromatography with flame ionisation detector (FID). PAH concentrations, ranged from 39.59 to 655.28 ng/g on a dry weight. Total PAH concentrations were not correlated with organic carbon (OC) content or grain size (% <63 microm). Special PAH compound ratios, such as Ft/Py and Ft/Ft + Py were calculated to evaluate different hydrocarbon origins and showed that PAHs are derived from pyrolytic process.

Diffuse primary malignant melanoma of the upper gastrointestinal tract

Primary malignant melanomas of the GI tract are very rare. Their symptomatology is not specific. We report a 78-year-old Tunisian woman hospitalised with a 6-month history of recurrent abdominal pain, loss of appetite, weakness and weight loss. She had no personal history of cutaneous or ocular melanoma. Upper gastrointestinal endoscopy revealed multiple small, raised darkly pigmented tumours. Theses lesions were found in the oesophagus, the stomach, the bulb and the duodenum. Biopsy specimens were taken and histology showed the presence of melanocytic cells with abundant melanin pigment. Immunohistochemically, tumour cells were positive for HMB-45. Morphological examinations revealed hepatomegaly with multiple nodules with small lymph nodes at the celiac axis. All available diagnostic procedures failed to identify any other site of ocular or cutaneous melanoma, the present case was considered as primary GI melanoma. Palliative chemotherapy was not possible because patient was extremely cachectic and she died one month later.

[Ulcerative colitis and schizophrenia: fortuitous association or etiopathogenic link?]

BACKGROUND

Ulcerative colitis is a chronic inflammatory bowel disease with multiple pathogenic factors. Psychiatric disorder have frequently been associated to ulcerative colitis, the most frequent being depression and anxiety, whereas schizophrenia is unusual.

AIM

Report a new case of ulcerative colitis associated topsychiatric disorder.

CASE-REPORT

We report the case of a 42-year-old woman with ulcerative colitis associated with schizophrenia. Although the two diagnoses were concomitant, on questioning, she revealed that digestive symptoms began before psychiatric disorders.

CONCLUSION

Few cases of schizophrenia associated with ulcerative colitis have been reported in the literature. We discuss epidemiological, etiopathogenic and therapeutic links between the two diseases.

Cerebral venous sinus thrombosis as presenting feature of ulcerative colitis

Thrombosis is a well recognized complication of inflammatory bowel disease that occurs in 1.3 to 6.4% of patients, however, cerebral vascular involvement is unusual. We present the case of a 16-year-old female in whom cerebral venous thrombosis was the presenting symptom of an active ulcerative pancolitis. Thrombophilia screen (plasma levels of proteins C and S, antithrombin, antibeta2-glycoprotein, lupus anticoagulant and anticardiolipin antibodies, activated protein C resistance, homocystein level antinuclear antibodies) was negative. The patient was successfully treated with anticoagulant therapy, phenobarbital and sulfasalazine. Cerebral venous thrombosis is an exceptional presenting feature of ulcerative colitis. Disease activity may play a major role in the occurrence of thrombosis.