Nervous Complications Research Articles

Improvement of actin dynamics and cognitive impairment in diabetes through troxerutin-mediated downregulation of TRPM7/CaN/cofilin

Diabetic cognitive impairment is a central nervous complication of diabetes mellitus. Its specific pathogenesis is unknown, and no effective treatment strategy is currently available. An imbalance in actin dynamics is an important mechanism underlying cognitive impairment. Transient receptor potential channel 7 (TRPM7) mediates actin dynamics imbalance through calcineurin (CaN) and cofilin cascades involved in various neurodegenerative diseases. We previously demonstrated that TRPM7 expression is increased in diabetic cognitive impairment, and troxerutin has been shown to ameliorate diabetic cognitive impairment. However, the relationship between troxerutin and TRPM7 remains unclear. In this study, we hypothesize that troxerutin may improve diabetic cognitive impairment by enhancing actin dynamics through downregulation of the TRPM7/CaN/cofilin pathway. To test this hypothesis, we divided db/m and db/db mice into the following groups: normal control group (NC), normal + troxerutin group (NT), diabetic group (DM), diabetic + troxerutin group (DT) and diabetic + troxerutin + bradykinin group (DTB). The results showed that diabetic mice exhibited cognitive impairment at 17 weeks of age, TRPM7, CaN, cofilin and G-actin were highly expressed in the CA1 region of hippocampus, while p-cofilin and F-actin expression decreased. Furthermore, hippocampal neuronal cellsshowed varying degrees of damage. The length of synaptic active zone, the width of synaptic cleft, and the number of synapses per high-power field were decreased. Troxerutin intervention alleviated these manifestations in the DT group; however, the effect of troxerutin was weakened in the DTB group. In conclusion, our findings suggest that diabetes leads to cognitive impairment, activation of the TRPM7/CaN/cofilin pathway, actin dynamics imbalance, and destruction of hippocampal neuronal cells and synapses. Troxerutin can downregulate TRPM7/CaN/cofilin, improve actin dynamics imbalance, and ameliorate cognitive impairment in diabetic mice. This study provides a new avenue for exploring and treating cognitive impairment in diabetes.

Resveratrol ameliorates diabetic encephalopathy through PDE4D/PKA/Drp1 signaling

Diabetic encephalopathy (DE) is a central nervous complication of diabetes mellitus which is characterized by cognitive impairment and neurochemical abnormalities. However, no effective approaches are available to prevent its progression and development. PDE4D serves many functions in the pathogenesis of neurodegenerative diseases involving PKA signaling. This study illustrated the role of PDE4D in DE and investigated whether resveratrol protected against DE via inhibiting PDE4D. db/db male mice and hippocampus cell line (HT22) were used to investigate the role of PDE4D and the protective effect of resveratrol on cognitive function under high glucose (HG). PDE4D overexpression or knockdown lentivirus and PKA specific inhibitor H89 were used to further identify the indispensable role of PDE4D/PKA signaling pathway in resveratrol’s amelioration effect of neurotoxicity. Resveratrol attenuated cognitive impairment in db/db mice, reduced PDE4D protein, restored the impaired mitochondrial function in db/db mice. The in vitro study also confirmed the neuroprotective effect of resveratrol on neurotoxicity. PDE4D overexpression resulted in cell injury and downregulation of cAMP, PKA and pDrp1(Ser637) under normal condition. In contrast, PDE4D knockdown improved cell injury and elevated cAMP, PKA and pDrp1(Ser637) levels caused in HG-cultured HT22 cells. PDE4D over-expression blunted the improvement effects of resveratrol on PKA, pDrp1(Ser637) and mitochondrial function. Moreover, PKA inhibitor H89 blunted the inhibitory effects of resveratrol on pDrp1(Ser637) and mitochondrial function in HG-treated HT22. These data indicated that resveratrol may improve cognitive impairment in db/db mice by modulating mitochondrial function through the PDE4D dependent pathway.

PROJECTION FETAL ANATOMY VASCULAR AND NERVOUS FORMATIONS OF THE ANTERIOR REGION OF THE ARM

Abstract. In the case of gunshot wounds, the upper extremities prevail poly-structural injuries, primarily characterized by damage to nerve trunks, vessels, soft tissues, and bones. Compartment syndrome is one of the most di ffi cult pathological conditions underlying the majority of fi rearm complications is injuries of the limbs and, above all, those accompanied by bone fractures and limbs, and can lead to permanent disability.Until now, fetal patterns have not been defi nitively clarifi ed in the topography of fascial- muscular formations, fi ber spaces, and projection anatomy of the vascular and nervous structures of the anterior region of the arm at diff erent stages of human ontogenesis.The study aimed to establish the vascular- nervous projection structures of the anterior arm region in human fetuses.The study was conducted on preparations of the upper limbs of 48 human fetuses aged from 4 to 10 months using macromicroscopic dissection, injection of vessels, and morphometry.It was established that in human fetuses the projection of the main vascular of the nerve bundle of the shoulder on the skin corresponds to the line that connects the point between the middle and front thirds of the width of the axillary fossa to the middle ulnar fossa. The median nerve in the upper third of the shoulder is determined near the medial edge of the biceps muscle of the shoulder, as a rule, laterally of the brachial artery, within the middle of the anterior region of the arm, median the nerve crosses the brachial artery in front and goes straight in the lower third of the shoulder approximately from the brachial artery. Projection of the ulnar nerve within the upper third of the anterior region of the arm corresponds to the projection of the main vascular- nerve bundle, within the middle and lower thirds – the line that connects the middle of the medial bicipital groove of the shoulder with the medial epicondyle of the humerus. An anatomical landmark for the determination of topography of the main vein, the median cutaneous nerve of the forearm and of the median nerve is the medial edge of the biceps muscle of the shoulder, and the lateral edge of this muscle is a landmark for identifying the main vein.Obtained data on fetal and projection anatomy of structures of the anterior region of the arm in human fetuses of diff erent ages have an important role and applied value and will reduce the risk of iatrogenic injuries and exclude the possibility of developing vascular and nervous complications in the postoperative period, choose the correct tactics of operative interventions in the anterior region of the arm.

The implications of the anatomy of the nerves and vessels in the treatment of rectosigmoid endometriosis.

Endometriosis is a common benign gynecological disease characterized by the presence of endometrial glands and stroma outside the uterus. It can be defined as endometrioma, superficial peritoneal endometriosis or deep infiltrating endometriosis (DIE) depending on the location and the depth of infiltration of the organs. In 5%-12% of cases, DIE affects the digestive tract, frequently involving the distal part of the sigmoid colon and rectum. Surgery is generally recommended in cases of obstructive symptoms and in cases with pain that is non-responsive to medical treatment. Selection of the most optimal surgical technique for the treatment of bowel endometriosis must consider different variables, including the number of lesions, eventual multifocal lesions, as well as length, width and grade of infiltration into the bowel wall. Except for some major and widely accepted indications regarding bowel resection, established international guidelines are not clear on when to employ a more conservative approach like rectal shaving or discoid resection, and when, instead, to opt for bowel resection. Damage to the pelvic autonomic nervous system may be avoided by detection of the middle rectal artery, where its relationship with female pelvic nerve fibers allows its use as an anatomical landmark. To reduce the risk of potential vascular and nervous complications related to bowel resection, a less invasive approach such as shaving or discoid resection can be considered as potential treatment options. Additionally, the middle rectal artery can be used as a reference point in cases of upper bowel resection, where a trans mesorectal technique should be preferred to prevent devascularization and denervation of the bowel segments not affected by the disease.

Toxic encephalopathy after an overdose of cocaine : a case serie

Introductioncocaine is a widely used illegal drug, known for its fast ability to induce euphoria and arousal. However, cocaine exposure can contribute to several mental and physical effects. Cocaine induced brain damage can be divided into 3 mechanisms: direct effect leading to toxic encephalopathy, secondary to vascular damage causing vasculitis, stroke and vasospasm, and tertiary effect due to hypoxia through a cardiovascular collapse.ObjectivesHere, we report 2 young men who developed a subacute encephalopathy with different clinical and radiological presentation after a cocaine overdoseMethodsa case serieResultswe present two men aged respectively of 28 (P1) and 42 years-old (P2). Both had a history of alcohol consumption and toxicomania (mainly cocaine) during the past year. They manifested, 2 weeks following a cocaine overdose, with gait disorder and confusion. On examination, P1 was apathic and confused. He had a subcortical frontal syndrome with gait apraxia and grasping reflex, along with a quadri-pyramidal syndrome. While patient P2 developed a cognitive decline, parkinsonism with dystonic posture of the trunk and the right limbs, and a pseudobulbar syndrome. Brain MRI was performed in both patients and showed a bilateral multifocal leukoencephalopathy (P1) and the presence of bilateral hyper T2 and FLAIR weighted images affecting basal ganglia, the mesencephalon and the periventricular cerebral white matter. Cerebrospinal fluid (CSF) analysis showed no pleocytosis and normal proteinorrachia. Electroencephalogram was also normal. Infectious differential diagnosis including Human Immunodeficiency Virus (HIV) and syphilis were excluded and metabolic screening including copper analysis, serum and CSF lactate were normal. The urine toxic screening, performed 20 days following the drug overdose, was negative. Both patients were treated with benzodiazepine and fluids without significative improvement. They were discharged with major cognitive and motor impairment.Conclusionscocaine toxicity is associated with high morbidity and mortality. Usually, cocaine abuse can lead to cardio-vascular, pulmonary and nervous complication. Neuropsychiatric sequelae are uncommon with less recovery potential. To date, there is no drug to prevent or cure cocaine addiction. The key is to educate the patient when he or she presents to the emergency department. Patients should be urged to seek drug counseling.Disclosure of InterestNone Declared

Detection of porcine enteric picornaviruses from faecal samples of Indian pigs.

The online version contains supplementary material available at 10.1007/s13337-022-00756-0.

Neurological manifestations of COVID-19: A literature review

A novel coronavirus that started from the Wuhan province of China is affecting the whole world. As of this date, more than 222 million cases are reported with more than 4.60 million fatalities. Nepal has more than 771,000 cases reported with almost 11,000 death recorded to date. Though most of the patients present with flu-like symptoms, people with comorbidities like Diabetes mellitus, hypertension, lung, and heart disease most likely suffer from severe disease and even death. As reported, neurological manifestations are common in critically ill patients. The most common manifestation of CNS is headache, dizziness, and encephalopathy whereas loss of smell and taste is the common PNS manifestation. Other neurological complications seen are fatigue, myalgias, hemorrhage, altered consciousness, Guillain-Barre Syndrome, syncope, seizure, and stroke. Non-specific neurological symptoms may be present in the early stages which can mislead the treatment. In some cases, neurological manifestations precede the typical presentation of fever, cough, and shortness of breath and later develop into typical features. The virus enters the brain through 2 systems: hematogenous route or olfactory route. Angiotensin-converting enzyme-2 (ACE-2) is the port of entry to the brain for COVID- 19(SARS-CoV-2) which was also the entry point for SARS-CoV. Covid-19 cases are increasing in the world and prevention and control of spread are a must. Understanding the neurological invasion pathogenesis, and manifestation will help the neurologists and physicians on frontlines to recognize early cases with nervous system involvement, neurological complications, and sequelae during and after the pandemic.

A practical guide to neuro-oncology fellowship.

Neuro-oncology is a growing, interdisciplinary field at the intersection of neurology and oncology, devoted to the care of patients with central nervous system tumors and neurologic complications of cancer, and collaboratively interfacing with neurosurgery, neuropathology, medical oncology and radiation oncology. There is increasing trainee interest in the field of neuro-oncology and an increasing number of fellowship training programs, attracting applicants with backgrounds in neurology, neurosurgery and medical oncology. The present guide aims to provide some general recommendations for residents and fellows to help them make the most out of their neuro-oncology fellowship and enable them to start their careers as a neuro-oncologists on firm footing.

Effect of 6-week Endurance Training on the Hippocampal Tissue in the Streptozotocin-Induced Diabetic Rats: A Histological Study

Background: Glial cells perform several critical functions and exercise can moderate many of these interventions, so a comprehensive study is needed to elucidate the mechanisms that influence brain function following diabetes and exercise. In this study, the quantitative histological changes of glial in the hippocampus of Streptozotocin (STZ)-induced diabetic rats following endurance training were investigated.Methods: Twenty-four adult male Wistar Rats (aged 10 weeks with an average weight of 256 ± 11.8 g), were classified into four groups: Diabetic, diabetic trained, untreated control, and trained groups. Diabetes was induced by a single dose intraperitoneal injection of Streptozotocin (45 mg/kg). Then, moderate exercise was performed for 6 weeks (5 sessions in a week). Rats were anesthetized 48 hours after the last training session. Then, they were sacrificed and the hippocampal tissue was removed. Sections (5-6 µ) were prepared and stained with Hematoxylin and Eosin (H & E) staining method.Results: Histological evaluations showed that the number of astrocyte and oligodendrocyte cells in different hippocampal regions in diabetic rats significantly decreased compared to the untreated control and trained rats. However, the number of microglia cells in diabetic rats was significantly higher than that in the untreated control and trained rats (P ˂ 0.05). In addition, the number of astrocytes and oligodendrocytes significantly increased in the dentate gyrus, Cornu Ammonis, and subiculum of the hippocampal tissue after endurance training compared to the control group, while the number of microglial cells significantly decreased (P < 0.05).Conclusion: The findings of the present study confirmed the potential effects of moderate exercise on diabetes. Therefore, it seems that physical activity plays an essential role in improving the nervous complications in patients with diabetes.

Diabetic Foot: Epidemiological and Clinical Aspects in the Department of Medicine and Endocrinology of the Hospital of Mali, Mali

Introduction: Diabetes is a heterogeneous group of metabolic diseases characterized by chronic hyperglycemia resulting from a defect in the secretion and/or action of insulin, diagnosed by the observation of high levels of glucose in the blood, responsible in the long term for vascular and nervous complications. The diabetic foot is the set of pathological manifestations affecting the foot in relation to the diabetic disease. Approximately 5% of diabetics present a chronic lesion of the foot. Objective: To describe the epidemiological and clinical aspects of the diabetic foot in the medicine/endocrinology department of the Mali hospital. Methodology: This was a retrospective descriptive study from November 2011 to December 2015. It focused on diabetic patients hospitalized in the department with a foot wound and aged 14 years and over. Results: The study involved 94 patients out of 828 hospitalized, a prevalence of 11.35%. Our series included 36 (38.3%) men and 58 (61.7%) women, i.e. a sex ratio of 0.61%. The mean age was 42.66 years with extremes of 14 and 81 years. Type 2 diabetes was present in 95% of the patients with a duration of evolution of more than 5 years in 60.6% of the cases. The mechanism of occurrence of the wounds was minor trauma in 54 cases (57.4%). Self-medication was the primary treatment in 70 patients (74.5%). More than 50% of the patients wore unsuitable footwear. Clinical and para-clinical examinations revealed isolated neuropathy in 37 cases (39.4%), necrotic wound in 37 cases (39.19%), poor glycemic control: HbA1c > 7% (98.9%), absence of osteitis (57.4%), normal Doppler ultrasound 45 cases (45.7%), stenosing arteriopathy 11 cases (22.3%), non-stenosing 3 cases (20.2%), germs present 56 cases (59.6%) including 21 cases (22.4%) of Staphylococcus aureus. Conclusion: Diabetes and diabetic foot constitute a real public health problem. They are responsible for dreadful and sometimes disabling complications. Its management is multidisciplinary and requires significant financial resources.

NFB-16. mTOROPATHIES AND SUBEPENDYMAL GIANT CELL ASTROCYTOMAS: PREDICTIVE VALUE OF GERMINAL TSC1/2 MUTATIONS SCREENING IN FAMILIAL CASES

mTOR controls several important aspects of cell function particularly in the nervous system. Its hyperactivation has been involved in tuberous sclerosis complex (TSC) and other mTORopathies as well as drug-resistant epilepsy. Mutations in TSC1 and TSC2 genes cause loss of normal inhibition of mTORC1 complex, leading to cell overgrowth and disruptions in synaptogenesis. Many children and adults with TSC harbour neurologic defects especially subependymal giant cell astrocytomas (SEGAs) in the brain. Here, we have performed mutational analysis followed by a genetic counselling for a Tunisian family from Sfax town harboring epileptic seizures associated to a neurocutaneous disorder. Index cases were referred for renal angiolipomas (RAL) associated to seizures crisis and were diagnosed as having TSC. The first 26-year-old patient complained of epilepsy since the age of 22 with left temporal crisis related to cortical tubers near the Heschl’s gyrus. His brother, a 36-year-old man presented more severe epileptic crisis (since 15 years-old), multiples RAL, subependymal nodules, and a rapid evolution of his mTORopathy with tumoral progression of his renal and central nerve lesions: renal cell carcinoma and SEGAs. TSC1 gene mutation screening showed heterozygous two bp deletion at codons 213 and 214 of exon 5. SEGAs are rare, low-grade glioneuronal brain tumors that occur almost exclusively in TSC patients but can lead to nervous complications. We showed through this report, the predictive value of germinal TSC mutations screening in familial cases, because early recognition of the molecular defect may lead to appropriate management of the tumoral progression.

Research of complexity and organization of the physiological system of carbohydrate exchange regulation

The article is devoted to an actual methodological issue, that have also the direct practical interest, to clarify the complexity and organization of the physiological system of carbohydrate exchange regulation for selecting an adequate mathematical description of it in a stochastic or deterministic form. It is known that the frequently observed disturbances in this system lead to severe endocrinological disease – Diabetes mellitus. The most widespread form of it – the Diabetes mellitus type II has long latent period, at which, in the absence of treatment, the late dangerous vascular and nervous complications are already developing. To increase radically the level of early diagnostics of the latent Diabetes mellitus on the basis of available for the clinical measurement of the patient data on the periphery, it turned out to be possible only on the basis of the corresponding mathematical model. For a long time, the fundamental question of the complexity and organization of the system of carbohydrate metabolism regulation was solved intuitively in a deterministic form. Only recently this decision was questioned, and an attempt was made to model the carbohydrate exchange system regulation in a stochastic form, however, without proper justification and without obtaining any concrete results. At that, the bases for elaboration of the mathematical model of the system of carbohydrate exchange regulation in the class of stochastic models are obvious. Any complex system in general case is probabilistic in nature, the experimental data, used in its parametric identification, also always contain the measurement errors, that is, they are indeterminate variables. In this article, using the general method for the analysis of the complex Bir-Glushkov systems and the known exactness of glycemia and insulinemia measurings, for the first time the research of the complexity and organization of the physiological system of carbohydrate exchange regulation was carried out. It was shown that this system is very complex and deterministic, that permitted, when modeling the glycemia and insulinemia dynamics in the human body, to limit by the apparatus of the determinated differential equations.

Body Mechanics and Complications in the Nursing Personnel of the Emergency Service of Luis Vernaza General Hospital (Guayaquil-Ecuador)

The mobilization and transport of patients, repetitive movements, prolonged standing work, and lack of rest due to double work in the majority, are important risk factors that produce in nursing work. If this is added to an inadequate posture and incorrect application of the principles of body mechanics, the risk increases. The objective of this study was to determine the causes of complications related to the non-correct application of body mechanics in nursing personnel. To this end, the research question is: with the incorrect application of body mechanics increases the complications presented by the nursing staff working in this service. The responses received show that the staff is aware of body procedure techniques that do not apply and that most have nervous complications. Taking into account the above, frequent training of nurses is recommended, as well as the use of the manual of ergonometric techniques that guarantees the conservation of health.

Body Mechanics and Complications in the Nursing Personnel of the Emergency Service of Luis Vernaza General Hospital (Ecuador)

In nursing work, multiple tasks that require physical effort were developed. The mobilization and transport of patients, prolonged standing work, repetitive movements and lack of rest due to double work in the majority, are important risk factors that produce with the passage of time, bone, muscle, joint and tendinous. If this is added to an inadequate posture and incorrect application of the principles of body mechanics, the risk increases. The objective of this study was to determine the causes of complications related to the non-correct application of body mechanics in nursing personnel. To this end, the research question is: with the incorrect application of body mechanics increases the complications presented by the nursing staff working in this service. The responses received show that the staff is aware of body procedure techniques that do not apply and that most have nervous complications. Taking into account the above, frequent training of nurses is recommended, as well as the use of the manual of ergonometric techniques that guarantees the conservation of health.

Luxation divergente du coude associée à une fracture de la diaphyse radiale : à propos d´un cas

We here report the case of a 37-year old patient, with no previous medical-surgical history, admitted to Hospital with left upper limb injury. During the initial interview the patient reported fall following parachute jump landing on the wrist and elbow in extended position and on the forearm in supine position. The patient had pain with total functional impairment. Physical examination showed expansion of the cross sectional area of the elbow. The prominences of the radial head and of the olecranon were palpable laterally on both sides of the humeral palette. No vascular and nervous complications occurred. X-ray of the elbow objected dislocation of the radius out of position and of the ulna behind the humeral palette associated with complex fracture of the ipsilateral proximal third radius and fragmented coronary process. The patient was admitted to the operating room for open reduction with internal fixation of the proximal radius using screwed plate and anchor reinsertion of the lateral ligament and of the tendon of the anterior brachial muscle. The patient was immobilized with brachio-antebrachio-palmar splint and began passive mobilization 3 weeks later.

Preoperative Glycated Haemoglobin Level and Postoperative Morbidity and Mortality in Patients Scheduled for Liver Transplant.

Background:There is high prevalence of diabetes mellitus in patients of end stage liver disease and it has been implicated for complications in post-transplant patients. Glycated hemoglobin is now targeted as a modifiable preoperative risk factors for postoperative complications. Data describing the course and severity of postoperative liver transplant complication and their relation with pre-operative glycated hemoglobin level is sparse. In this study, we looked for co-relation between the preoperative HbA1c level and post-operative mortality and morbidity in patients scheduled for liver transplant.Materials and Methods:Retrospective data in 400 adult patients operated for liver transplant were retrieved. After exclusion, data were analyzed for 224 patients. Patients were divided into two groups on the basis of glycated hemoglobin levels (Group 1 (HbA1C ≥6.5) and Group 2 (HbA1C <6.5)).Results:Glycated hemoglobin levels were not associated with postoperative death during stay in intensive care unit, incidence of postoperative cardiovascular, renal, and central nervous complications. No difference was seen between 2 groups for need for renal replacement therapy, incidence of infections, rejection, need for re-exploration surgery and duration of intensive care unit and hospital stay. Glycated hemoglobin cannot predict 30 day survival (Area under curve {AUC} = 0.629, P value 0.05).Conclusion:Preoperative glycated hemoglobin level is not associated with postoperative morbidity and mortality in patients scheduled for liver transplant.Trial Registration Number:CTRI/2018/04/012966.

Neuroactive Steroids and Sex-Dimorphic Nervous Damage Induced by Diabetes Mellitus.

Diabetes mellitus is a metabolic disease where improper glycaemic control may induce severe complications in different organs. In this review, we will discuss alterations occurring in peripheral and central nervous system of patients with type 1 (i.e., insulin dependent diabetes mellitus,) or type 2 diabetes (i.e., non-insulin dependent diabetes mellitus), as well as related experimental models. A particular focus will be on the role exerted by neuroactive steroids (i.e., important regulators of nervous functions) in the nervous damage induced by diabetes. Indeed, the nervous levels of these molecules are affected by the pathology and, in agreement, their neuroprotective effects have been reported. Interestingly, the sex is another important variable. As discussed, nervous diabetic complications show sex dimorphic features in term of incidence, functional outcomes and neuroactive steroid levels. Therefore, these features represent an interesting background for possible sex-oriented therapies with neuroactive steroids aimed to counteract nervous damage observed in diabetic pathology.

New progress in etiology of central nervous complications after allogeneic hematopoietic stem cell transplantation

With the progress of allogenetic hematopoietic stem cell transplantation (allo-HSCT), especially umbilical cord blood transplantation (UCBT), central nervous system(CNS) complications after transplantation have become more prominent. At present, the etiological analysis of such complications mainly focuses on infection, treatment-related toxicity, immune response, cerebrovascular events, infiltration of primary tumor and so on. In this article, we review the new progress in etiology of CNS complications after allo-HSCT. Key words: Hematopoieic stem cell transplantation; Cord blood stem cell transplantaion; Central nervous system; Complications

La dysplasie fibreuse osseuse cranio-faciale

Fibrous dysplasia of bone is a benign, uncommon, sporadic, congenital skeletal disorder resulting in deformity. This disease arises from activating somatic mutation in GNAS which encodes the α subunit of the G stimulatory protein associated with proliferation of undifferentiated osteogenic cells resulting in marrow fibrosis, abnormal matrix production, and stimulation of osteoclastic resorption upon overproduction of IL-6 observed in dysplastic cells. Fibrous dysplasia may be monostotic or polyostotic. This mutation affecting many tissues, café au lait skin macules and endocrinopathies (precocious puberty, hyperthyroidism, growth hormone excess, Cushing syndrome) may be associated in McCune-Albright syndrome, but also myxoma in Mazabraud syndrome or phosphate diabetes. Diagnosis of craniofacial fibrous dysplasia should be considered in the presence of headache, neuralgia, sensory disorders (vision, hearing, balance, smelling), functional disorders (nasal obstruction, nasolacrimal duct obstruction, non-matching occlusion), infectious complications (sinusitis, otitis, mastoiditis). Such symptoms should lead to perform craniofacial CT scan completed with MRI. Bone biopsy is not systematic. Surgical treatment is discussed in cases of nervous complication, facial deformity or active lesions. In case of pain resistant to conventional analgesics, intravenous bisphosphonates can be proposed. In non-responder patients, several case reports suggest the efficacy of a monoclonal antibody directed against the IL-6 receptor which requires to be confirmed by randomized studies.

Endovascular Treatment of Atherosclerotic Iliac Stenosis: Local and Systemic Complications of the Open Brachial Access

The femoral access is the approach of reference for iliac angioplasty. In the current context of an early ambulation and a minimization of in-hospital stay period, the brachial access seems to be an appropriate approach, especially that long and small diameter equipments are available. Furthermore, it is extremely useful in case of inappropriate or unavailable femoral access. The aim of this study was to evaluate the complication risk factors of the brachial approach in the treatment of iliac stenosis. Between January 2012 and December 2013, we performed 281 iliac transluminal angioplasties of which 57 (20%) consecutive left brachial artery accesses were performed in 54 patients. The choice of brachial access was justified in 68% of the cases by an unavailable femoral access, in 29% of the cases by the presence of bilateral iliac lesions, and in 3% of the cases after failure of retrograde femoral approach. The patients were of a male majority (81%) with a mean age of 66±9years. The procedure was performed under local anesthesia in 65% of the cases. No upper limb ischemia or nervous complications had been reported. No cerebrovascular stroke has been identified. One patient presented with dysarthria associated with disorientation without the presence of cerebrovascular ischemia on the computed tomography scan and on the magnetic resonance imaging. There were 3 major hematomas at the brachial access site, which required reoperation; these 3 patients were on dialysis. There was no statistically significant relationship between a complication occurrence and the diameter or length of the introducer. The mean in-hospital stay period was 2days. The procedure was considered successful in 91% of the cases. We reported 5 cases of failure: 4 of which was due to a difficulty in crossing the lesion and 1 due to a very short material. The only significant risk factor of failure was the thrombosis of the iliac axis (odds ratio 23.3, 95% confidence interval 2.5-264.6, P=0.003). The femoral access remains the recommended approach for the treatment of iliac occlusive lesions. However, brachial artery access seems to provide a safe and secure alternative approach for patients when femoral artery access is unavailable. It allows a rapid ambulation and an ambulatory care.