[Contribution of closed mitral commissurotomy in the surgery of rheumatic mitral stenosis]

The objective of this work was to study the indications, techniques and results of closed heart mitral commissurotomy in patients with rheumatic mitral stenosis in Morocco.

METHODS

All patients who had undergone closed heart mitral commissurotomy for rheumatic mitral stenosis, operated between 1999 and 2008 were collected in this study. Mitral stenosis was diagnosed and evaluated using Doppler echocardiography. Patients with commissural calcification, severe mitral regurgitation, and surgical tricuspid or aortic valvular disease were excluded from this study.

RESULTS

Six hundred and twenty-five patients have been collected. 62.2% were young with an age between 18 and 35 years and 491 (78.8%) were female. Seventy-nine percent of patients had stage III or IV NYHA and were in sinus regular rhythm. The closed heart mitral commissurotomy was performed for all patients through a left thoracotomy using either digital or dual dilatation. The mitral area was significantly increased postoperatively to 2.11 ± 0.32 with 100% opening of the anterior commissure, while the posterior commissure was opened only for 93.7% of patients. There were nine perioperative deaths (4.9%) and all patients who died had severe mitral stenosis (<0.8 cm(2)) with an elevated systolic pulmonary artery pressure (>60 mmHg).

CONCLUSION

The closed heart mitral commissurotomy provides excellent results in young patients with rheumatic mitral stenosis.

LightCycler-based differentiation of Mycobacterium abscessus and Mycobacterium chelonae

In this study we introduce a rapid procedure to identify Mycobacterium abscessus (types I and II) and M. chelonae using LightCycler-based analysis of the hsp65 gene. Results from 36 clinical strains were compared with hsp65 gene restriction analysis and biochemical profiles of bacilli. As all three methods yielded identical results for each isolate, this procedure offers an excellent alternative to previously established nucleic acid amplification-based techniques for the diagnosis of mycobacterial diseases.

Anterior commissure carcinoma: I-histopathologic study

OBJECTIVES

To study the behavior of anterior commissure carcinoma regarding its tendency for cartilage invasion.

METHODS

Histopathological examination of the region of the anterior commissure (AC) was done with whole organ section in 30 randomly selected specimens. Serial sections were prepared and examined histopathologically for evidence of microscopic cartilage invasion in the region of the AC.

RESULTS

Microscopic involvement of the thyroid cartilage was detected in the 30 sections studied.

CONCLUSION

Whether recurrence was de novo or initiated by residual malignant cells, it is mandatory to excise the anterior portion of the thyroid cartilage with the tumor-bearing mucosa.

Disequilibria in the distribution of rpoB alleles in rifampicin-resistant M. tuberculosis isolates from Germany and Sierra Leone

The effectiveness of culture-independent resistance predictions by molecular techniques is dependent on the number and the frequency of accessible resistance-associated genomic mutations. We have characterized an rpoB gene region involved in rifampicin resistance in 49 Mycobacterium tuberculosis isolates resistant to rifampicin from Germany and Sierra Leone. The determined frequencies of mutations differed between both countries of origins as well as with respect to previously reported distributions of resistance mutations. It is concluded that at least for some isolates the acquisition of mutations leading to rifampicin resistance in clinical samples of M. tuberculosis is a non-random process which may lead to a geographical and temporal dependence of the sensitivities of molecular typing techniques for rifampicin resistance predictions.

Culture-independent prediction of isoniazid resistance in Mycobacterium tuberculosis by katG gene analysis directly from sputum samples

BACKGROUND

The molecular prediction of isoniazid (INH) resistance in Mycobacterium tuberculosis is hampered by the need for specialized equipment, expertise, high costs, a limited range of detectable mutations, or several of these factors. The rationale for the study was to find a practical alternative and to demonstrate generally valid problems.

METHODS AND RESULTS

DNA extracted from decontaminated sputum pellets was used to amplify a 0.26 kb target sequence within the katG gene. Mutations of codon 315, frequently found in isoniazid-resistant isolates, could be discriminated in a simple agarose minigel format following an AciI digest of the nested polymerase chain reaction (PCR) product. Within a panel of 22 sputum samples, INH resistance could be predicted in 5 of 10 samples containing isoniazid-resistant M. tuberculosis. The protocol is robust, requires little expertise and no specialized equipment, and provides the test results within 2 days.

CONCLUSION

The results show the feasibility to rapidly and easily detect mutations highly predictive of isoniazid resistance. Nevertheless, this, like any other molecular resistance prediction test, is affected by often neglected factors, including mutation prevalences, the phenomenon of heteroresistance, and a possible bias toward one's own method.

Significance of ahpC promoter mutations for the prediction of isoniazid resistance in Mycobacterium tuberculosis

To determine the value of ahpC promoter mutations for the rapid prediction of isoniazid resistance, this genomic region was characterized in 50 isoniazid-resistant and 12 isoniazid-sensitive Mycobacterium tuberculosis isolates. Of the resistant isolates, 12 had ahpC promoter mutations, but only one possessed both an ahpC promoter mutation and a katG codon 315 substitution, although the latter was found in the majority (54%) of the isoniazid-resistant isolates investigated. This investigation presents empirical evidence that the central portion of the ahpC promoter is the most valuable genetic locus to complement katG codon 315 characterizations in order to increase the sensitivity of molecular tests for the prediction of isoniazid resistance.

Usefulness of Mycobacterium tuberculosis genomic mutations in the genes katG and inhA for the prediction of isoniazid resistance

SETTING

Mutations in two genes of Mycobacterium tuberculosis, inhA and katG, are known to correlate with resistance to isoniazid (INH).

OBJECTIVE

To determine which mutation or mutations are the most predictive for INH resistance and the most frequent ones in such isolates. Further, to propose a simple and generally applicable method for their detection.

DESIGN

Codons 94 and 95 in the inhA gene and codons 315 and 463 in the katG gene were characterized in 50 INH-resistant and 12 INH-sensitive isolates from Germany and Sierra Leone.

RESULTS

Mutations in codon 315 of the katG gene were detected in 27 of the INH-resistant and none of the INH-sensitive isolates. All mutations in this codon altered an AciI restriction enzyme site. No mutations were found in the investigated codons of the inhA gene.

CONCLUSION

We propose that most INH resistances can be rapidly predicted by a simple AciI restriction enzyme digest of a polymerase chain reaction (PCR)-amplified katG fragment.

Geographic variation of the predictive values of genomic mutations associated with streptomycin resistance in Mycobacterium tuberculosis

Specific mutations associated with resistance to streptomycin (SM) in Mycobacterium tuberculosis suggest themselves for its rapid prediction. However, as with any diagnostic test, their predictive values are dependent on their prevalences. In this report, SM resistance associated mutations in the rrs and rpsL genes of 25 SM resistant isolates from Germany and 25 SM resistant isolates from Sierra Leone were characterized and compared. Mutations in the rrs gene were infrequent in isolates from both localities (20% and 12%, respectively) and thus of limited predictive values. In contrast, rpsL mutations were found in 48% of the German isolates but only in 24% of the isolates from Sierra Leone. It is concluded that the predictive values of mutations in this gene may vary significantly with the origin of the samples under investigation.

[Retroperitoneal marsupialization of renal cysts]

The use of minimal invasive surgery in urology continue to increase. Retroperitoneoscopic approach in performing minimal invasive surgery of retroperitoneum shortens the duration of operation in comparison with transabdominal approach, with minimal risk of intraabdominal complications. We described the use of the retroperitoneoscopic approach to the upper pole of a kidney for marsupialization of a symptomatic renal cyst. The procedure was minimally traumatic, morbidity was negligible and the patient was discharged from the hospital the third day after the operation. We believe that retroperitoneoscopic management of giant symptomatic renal cysts will be applicable, together with other existing methods.

Tsukamurella pulmonis sp. nov

Chemotaxonomic and 16S ribosomal DNA sequence analyses of an isolate from the sputum of a patient with a mycobacterial lung infection clearly delineated a new species of the genus Tsukamurella. This new species can be defined on the basis of genotypic and phenotypic data. The name Tsukamurella pulmonis sp. nov. is proposed for this organism; the type strain is IMMIB D-1321T (= DSM 44142T). This isolate shows 44.2 and 36.2% DNA relatedness to Tsukamurella paurometabola DSM 20162T (T = type strain) and Tsukamurella inchonensis DSM 44067T, respectively.

Rapid identification of mycobacterial species by PCR amplification of hypervariable 16S rRNA gene promoter region

A total of 0.3 to 0.4 kb of the promoter region of the 16S rRNA genes from Mycobacterium tuberculosis, M. gordonae, M. xenopi, and M. leprae was PCR amplified, cloned, and sequenced. The observed number of substitutions, insertions, and deletions exceeded those found in previously used target sequences, including the entire 16S coding region. A simple and generally applicable restriction fragment length polymorphism method that can be used to distinguish between mycobacterial species is described.

Arytenoidectomy and posterior cordectomy for bilateral abductor paralysis

Twelve patients with bilateral fixed vocal cords seeking decannulation of their tracheostomies were subjected to endoscopic correction of the compromised airway. They all had arytenoidectomy associated with posterior cordectomy whether as a primary or secondary stage procedure. Decannulation was achieved in all patients using the technique described.

Direct extension of laryngeal carcinoma to the skin of the neck

Invasion of the skin of the neck by laryngeal carcinoma is relatively uncommon. Twelve cases of cancer of the larynx fungating through the cervical skin are presented. They mostly followed initial treatment by deep X-ray therapy or partial laryngectomy. A high tracheostomy was also considered to be a contributing cause for the occurrence of such a mishap. The management and follow-up of these patients is described.

Visual dysfunction: abnormal sign of benign sphenoethmoidal lesions

Isolated visual dysfunction with or without proptosis is rarely described as a sign of benign sphenoethmoidal lesions. Five patients with benign swelling of the sino-orbital region and related visual defects are reported. Cases include one patient with fibrous dysplasia, two patients with mucocoeles and two patients suffering from aspergillosis of the sinuses. A review of the literature and discussion of the cases is presented.

Laryngotracheal resection for post scleromatous laryngeal stenosis

Scleroma is an endemic disease in Egypt, which frequently results in subglottic laryngeal stenosis. Six patients suffering from laryngoscleroma are represented. They all underwent laryngotracheal resection of the stenosed segment, followed by direct anastomosis. The results were satisfactory in four of the patients. Surgery was abandoned in one patient who was believed to suffer from perichondritis following previous surgery. Restenosis occurred in a 14-year-old girl two weeks after surgery. This was attributed to recurrence, possibly due to residual activity of the disease which was missed before surgery.

Pharyngeal repair after laryngopharyngectomy: 4-year experience

The most common forms of surgical intervention carried out at the National Cancer Institute of Cairo for patients initially seen with hypopharyngeal carcinoma are (1) laryngopharyngectomy and pharyngeal repair using the pectoralis major myocutaneous flap (PMMF) and (2) extrapleural total pharyngolaryngoesophagectomy with gastric transposition (GT) and pharyngogastrostomy. The advantages and disadvantages with both techniques will be discussed on the basis of results of 69 patients with different tumor distributions over a 4-year period.