First successful pregnancy outcome after twelve abortions in a Tunisian-woman with the rare p phenotype

INTRODUCTION

Anti-PP1P k alloantibody, is produced in the serum of individuals with the rare p phenotype. It is associated with severe haemolytic transfusion reactions, recurrent spontaneous early abortions as well as haemolytic disease of the foetus and newborn. Anti-PP1P k alloimmunization in pregnancy differ from others in their physiopathology. It seems that the placenta would be the main target of anti-PP1P k antibody.

CASE REPORT

This report concerns a 35 year old female, with a history of a high incidence (12) of early and recurrent miscarriages. She was found to have the extremely rare p phenotype and anti-PP1P k antibody in her serum. Her 13th pregnancy was successfully managed by plasmapheresis. No substitution fluid was added. Oral hydration was recommended before and after the apheresis sessions. 12 plasmapheresis cycles were performed before a healthy term female infant weighing 3kg600g, was delivered by caesarean section at 38 weeks of gestation.

CONCLUSION

Plasmapheresis seems to be the treatment of choice in the management of anti-PP1P k fetomaternal incompatibilities. However in this case, we opted for an original and less expensive protocol. We did resort, neither to substitution fluid nor to intravenous immunoglobulin.

Osmo-inelastic response of the intervertebral disc annulus fibrosus tissue

The aim of this article is to provide some insights on the osmo-inelastic response under stretching of annulus fibrosus of the intervertebral disc. Circumferentially oriented specimens of square cross section, extracted from different regions of bovine cervical discs (ventral-lateral and dorsal-lateral), are tested under different strain-rates and saline concentrations within normal range of strains. An accurate optical strain measuring technique, based upon digital image correlation, is used in order to determine the full-field displacements in the lamellae and fibers planes of the layered soft tissue. Annulus stress-stretch relationships are measured along with full-field transversal strains in the two planes. The mechanical response is found hysteretic, rate-dependent and osmolarity-dependent with a Poisson's ratio higher than 0.5 in the fibers plane and negative (auxeticity) in the lamellae plane. While the stiffness presents a regional-dependency due to variations in collagen fibers content/orientation, the strain-rate sensitivity of the response is found independent on the region. A significant osmotic effect is found on both the auxetic response in the lamellae plane and the stiffness rate-sensitivity. These local experimental observations will result in more accurate chemo-mechanical modeling of the disc annulus and a clearer multi-scale understanding of the disc intervertebral function.

Osmo-inelastic response of the intervertebral disc

The intervertebral disc exhibits a complex inelastic response characterized by relaxation, hysteresis during cyclic loading and rate dependency. All these inelastic phenomena depend on osmotic interactions between disc tissues and their surrounding chemical environment. Coupling between osmotic and inelastic effects is not fully understood, so this article aimed to study the influence of chemical conditions on the inelastic behaviour of the intervertebral disc in response to different modes of loading. A total of 18 non-frozen ‘motion segments’ (two vertebrae and the intervening soft tissues) were dissected from the cervical spines of mature sheep. The motion segments were loaded in tension, compression and torsion at various loading rates and saline concentrations. Analysis of variance showed that saline concentration significantly influenced inelastic effects in tension and especially in compression (p < 0.05), but not in torsion. Opposite effects were seen in tension and compression. An interpretation of the underlying osmo-inelastic mechanisms is proposed in which two sources of inelastic effects are identified, that is, extracellular matrix rearrangements and fluid exchange created by osmosis.

Robust sensorless vector control of an induction machine using Multiobjective Adaptive Fuzzy Luenberger Observer

This paper presents an inherent speed estimation scheme associated to the Indirect Field Oriented Control in case of Induction motor sensorless control. Indeed, through the design of a Multiobjective Adaptive Fuzzy Luenberger Observer, the speed sensorless control issue even at low speed, the observer poles' assignment issues and the speed estimation's sensitivity to rotor resistance uncertainties issue are treated concurrently. First of all, the structure of the proposed Takagi-Sugeno adaptive observer is described. Secondly, based on Lyapunov theory, observer gains are designed and a fuzzy speed estimation scheme is provided. The design's objectives consist of minimizing the sensitivity of the proposed observer to rotor resistance uncertainties (using the L₂ techniques) and to guarantee a specified observer dynamic performances through a D-stability analysis. The design conditions are formulated into Linear Matrix Inequalities terms. Finally, experiments are conducted to demonstrate the effectiveness of the proposed results regardless of uncertainties in the rotor resistance.

[A new case of food protein-induced enterocolitis syndrome]

We report a case of food protein-induced enterocolitis syndrome (FPIES) with milk whose signs of milk intolerance began in the 1st days of life, consisting in minor and nonspecific symptoms. The 3 foods in question were cow's milk, soja, and wheat. The diagnosis of FPIES was suspected at the age of 9 months, after 3 hospitalizations for vomiting, sometimes associated with lethargy and hypotension, which occurred around 2h after cow's milk ingestion. Symptoms were not associated with positive specific IgE and cutaneous tests. Signs then occurred with soja and wheat. Because of the late diagnosis, 3 anaphylactic shock episodes occurred. FPIES is an uncommon cell-mediated food allergy reaction. This syndrome is characterized by gastrointestinal symptoms, especially severe vomiting, sometimes associated with anaphylactic shock. Usually signs occur 2h after ingestion. These reactions begin early, in the 1st months of life, and regress by the age of 3 years in 38-100% of cases depending on the responsible food. They are usually induced by cow's milk and soy proteins. Diagnosis is difficult and delayed because of nonspecific symptoms. Oral food challenge is the only examination that confirms the diagnosis. Treatment involves the exclusion of the specific food involved. Severe reactions require treatment of shock and adjunction of corticosteroids.

Nasu-Hakola disease in two Tunisian siblings: new radiological findings

We report radiological features of a biopsy-proven early infantile form of Nasu-Hakoka disease in two Tunisian sisters with new bony and cerebral findings.

[Superior caval syndrome caused by chronic mediastinitis in Behçet's disease]

We report a case of Behçet disease complicated by superior vena cava syndrome secondary to extrinsic compression by mediastinal fibrosis. This association is not reported in literature. The habituel etiology of vena cava syndrome in Behçet disease is venous thrombosis. Radiological investigations of this syndrome are necessary to avoid an useless anticoagulant therapy.

[Rare causes of ossification of the posterior common vertebral ligament causing cervical compression. Apropos of 2 cases]

The ossification of the posterior longitudinal is always responsible of cervical myelopathy. Radiological study and the CT scan, are able to precise the level, the morphologic and associated abnormalities of this lesion. Two cases of ossification of the posterior longitudinal ligamentum with cervical myelopathy are reported. The radiologic studies determined the etiology, in the first case, it was fluorosis and the second DISH disease.

[Uncommon etiology of cruralgia]

A 58 year old man suffered from low back pain. Physical examination showed asymmetry of the quadriceps and slight motor deficiency of right leg. Plain radiography of the pelvis revealed a large osteophyte, developed anteriorly at the low part of the right sacro iliac joint. CT exam of lumbar spin was normal. But, it confirmed osteophyte of right sacro iliac. Percutaneous injection of a small quantity of xylocaine under CT guidance in the site of the osteophyte behind crural muscle was marked by immediate disappearance of the pain, confirming the site of conflict between the crural nerve and the osteophyte. The patient was treated by injection of corticosteroid at the same location. Recovery was good.

Cerebral candidiasis. Computed tomography appearance

A three year old child who had been suffering from oral candidiasis since the age of 1 year presented with osteitis of the clavicle, 2 cerebral frontal abscesses and an occipital abscess which extended across the calvaria and was associated with osteolysis. Histological and microbiological studies following surgery confirmed the diagnosis of candidiasis in this girl who was found to have IgA immunodeficiency. The authors report the computed tomographic appearance of the cerebral lesions and review the literature.

[Nephroblastoma with egg-shell peripheral calcifications. Apropos of 3 cases]

Three cases of nephroblastoma presented "egg-shell" peripheral calcifications of pseudocystic appearance of radiology. These peripheral lesions are compared with the more commonly reported central calcifications. Their pathology is unknown and they lack prognostic significance of any importance. As for all nephroblastomas the diagnosis is based on straight abdomen images, intravenous urography, ultrasound and computed tomography. Differential diagnosis is basically from renal adenocarcinoma in children, the latter often exhibiting similar calcifications, the distinction between the two types of tumor depending on age of onset. These calcified lesions are non-specific findings and various diagnoses are discussed.

[Circumscribed non-tuberculous osteomyelitis in children. Apropos of 31 cases]

Over the last eight years (1975-1983) a total of 31 cases of circumscribed non-tuberculous osteomyelitis in children have been treated as against 21 cases of classical acute osteomyelitis, suggesting transformation of the mode of presentation of this disease. Lesions were located in the pelvis (8 cases), the calcaneum (3 cases) and the long bones (20 cases), the metaphysis being affected in the latter in 13 patients, the diaphysis in 4 and the epiphysis in three. Specific radiologic images for each location are defined. Clinical expression was subacute and signs of infection inconstant. Differential diagnosis is discussed in relation to each region involved, a positive diagnosis depending on clinical, biologic and radiologic findings, with the need for biopsy in case of doubt. The latter was necessary in 12 of the 31 children. Diagnosis was confirmed in all cases by the favorable outcome from treatment.

[Congenital toxoplasmosis and transfontanelle brain echography. Apropos of 8 cases observed in newborn infants and infants]

The undeniable value of brain ultrasound imaging in the detection of ventricular dilatation is emphasized, and a classification of intracranial calcifications proposed: hyperechogenic, nodular and irregular large images and those without a posterior shadow cone. Comparison between simple films and particularly computed tomography images was conducted in the cases studied.