Search

Contrast-induced nephropathy (CIN) is a common and severe complication in interventional cardiology.The aim of our study was to compare the incidence of contrast-induced nephropathy in two accelerated hydration protocols: the first one by the serum bicarbonate and the second combining the serum bicarbonate and oral vitamin C.This is a multicenter prospective, randomized study conducted between October 2012 and May 2013, including 160 patients.The mean age of our study population was 60.8±9.3 years (36-83 years). The two study groups were comparable in terms of cardiovascular risk factors, concomitant medication, and baseline serum creatinine. The CIN incidence was 6.3% in the vitamin C group and 10% in the control group (P=0.38). No significant difference was observed in terms of CIN incidence between the different subgroups analyzed.According to our study, ascorbic acid administered orally as part of an accelerated hydration protocol does not reduce the incidence of CIN.

Resume L'uveite chez l'enfant est une affection rare, souvent grave, pouvant conduire a la cecite. Les causes sont multiples mais le diagnostic etiologique n'est pas toujours etabli. But Decrire les caracteristiques cliniques, etiologiques, therapeutiques et evolutives de l'uveite de l'enfant. Patients et methodes Il s'agit d'une etude retrospective descriptive d'enfants admis pour prise en charge d'une uveite dans un service de pediatrie generale de Tunis sur une periode de 15 ans (1990–2005). Resultats Dix-huit observations d'uveite ont ete colligees (filles = 55,6 % et garcons = 44,4 %). L'âge moyen etait de 8 ± 3 ans. Plus de la moitie des uveites (55,6 %) ont ete diagnostiquees suite a une baisse de l'acuite visuelle apres un delai de 267 ± 571 jours. Il s'agissait d'une uveite anterieure dans 6 cas, d'une uveite intermediaire dans 1 cas, d'une uveite posterieure dans 3 cas et d'une panuveite dans 8 cas. La cause a ete determinee dans 5 cas : arthrite juvenile idiopathique (1 cas), maladie de Behcet (3 cas), et dermatopolymyosite probable (1 cas). La cause est restee indeterminee dans 13 cas. L'evolution sous traitement local associe a une corticotherapie par voie generale et/ou immunosuppresseurs a ete favorable dans 10 cas. Trois patients ont presente des complications. Conclusion Malgre une enquete etiologique large, l'uveite idiopathique reste preponderante dans notre serie. Le pronostic visuel est compromis. La prise en charge est lourde.

But Evaluer le pronostic anatomique et fonctionnel de la keratoplastie transfixante a chaud dans le traitement des ulceres corneens infectieux compliques d’une perforation corneenne. Materiel et methodes Sept yeux de sept patients ayant eu une keratoplastie transfixante a chaud pour un ulcere corneen infectieux complique d’une perforation corneenne ont ete inclus dans ce travail. Le succes anatomique a ete defini par l’eradication du processus infectieux avec la preservation du globe de l’enucleation et de la phtisie. La survie du greffon a ete definie par la presence d’un greffon clair. Resultats L’âge moyen des patients etait de 40,5 ans. Quatre yeux presentaient un ulcere corneen bacterien et 3 yeux avaient un ulcere corneen herpetique. Un succes anatomique a ete obtenu dans 6 yeux. Le greffon est reste clair dans 2 yeux. Un rejet a ete note dans 4 yeux avec un delai moyen de quatre mois et demi. Les complications postoperatoires se sont traduites par : une inflammation oculaire (7 yeux), une hypertonie oculaire (3 yeux), l’apparition d’une cataracte (1 œil), la presence de synechies anterieures peripheriques (1 œil), une ectasie du greffon (1 œil), une reinfection bacterienne (1 œil) et une recidive de la keratite herpetique (1 œil). Le suivi moyen est de 22 mois avec un suivi minimum de 9 mois et un suivi maximum de 32 mois. Conclusion La keratoplastie transfixante a chaud permet de preserver l’integrite du globe oculaire et d’eradiquer le processus infectieux dans la grande majorite des ulceres infectieux bacteriens et herpetiques perfores. La rehabilitation visuelle ne constitue qu’un objectif secondaire a atteindre. Un traitement antimicrobien adapte permet de reduire le risque d’infection du greffon et un traitement corticoide permet de diminuer la frequence de certaines complications, notamment le rejet de la greffe.

Arrhythmia is a major cause of morbidity and mortality in Europe and in the United States. The aim of this review article was to assess the results of the prospective studies that evaluated the risk of arrhythmia in patients with sleep apnea syndrome and discuss the management of this arrhythmia.Reports published with the following search terms were searched: sleep apnea syndrome, atrial flutter, supraventricular arrhythmia, ventricular arrhythmia, ventricular tachycardia, ventricular fibrillation, torsade de pointe, atrial fibrillation and sudden death. The investigation was restricted to reports published in English and French.The outcome of this analysis suggests that patients with untreated overt sleep apnea syndrome are at increased risk of arrhythmia.The timely recognition and effective treatment of sleep apnea syndrome in patients with arrhythmia are mandatory because the prognosis of arrhythmia may be improved with the appropriate treatment of sleep apnea syndrome.

The diagnosis of hypertrophic cardiomyopathy is usually established by echocardiography. Recently, there has been greatly increased use of cardiac magnetic resonance (CMR) because of its precise determination of myocardial anatomy and the depiction of myocardial fibrosis. In this review, we describe the role of echocardiography and magnetic resonance in the assessment of this complex disease. In conclusion, there is a complementarity between cardiovascular magnetic resonance imaging and echocardiography for the diagnosis and the management of HCM.

Trichophyton verrucosum is a zoophilic dermatophyte. It can be responsible of various clinical aspects especially inflammatory lesions of skin and scalp. The aim of this study was to determine the clinical and epidemiological characteristics of dermatophytosis due to T. verrucosum.It is a retrospective study realized on 35,918 patients suspected to have superficial mycoses in a 13-year-period (from 1998 to 2010).T. verrucosum was isolated in 178 patients corresponding to 1.2% of all dermatophytosis. Ochraceum variety was the most frequent (60%), followed by album variety (40%). Frequency of isolated T. verrucosum increased passing from one case in 1998 to 37 cases in 2010. The mean age was 22.7 years (range: 1.5-71 years). A percentage of 74.2 of our patients were male and 61% were from urban regions. A percentage of 32.5 could link their clinical lesions to contact with an animal (mainly cattle and sheep). Other family members were infected by tinea in 7.3% of cases. Tinea corporis was the most frequent (62.2%), followed by tinea capitis (31.6%). Ten cases of sycosis, one case of tinea pedis and one case of pubic tinea were diagnosed. Lesions of skin were erythemato-squamous (82.5%) and pustulo-inflammatory (17.5%), affecting mainly upper limb (58.3%) and face (25.8%). For tinea capitis, lesions were squamous (30.8%) and pustulo-inflammatory (41%). Eleven cases of kerion celsi were diagnosed (28.2%). Patients were affected in one site (79.7%), two sites (16.9%) and three or more (3.4%).Dermatophytosis due to T. verrucosum is in recrudescence in our region. This finding may be explained by changing behaviors and activities of the population with a low socioeconomic level who kept a larger number of domestic animals at homes.

Childhood uveitis is a rare but serious disease that may causes visual loss. Causes are various and an underlying disease is not always found.To analyse clinical features and prognosis of uveitis in children.A retrospective, descriptive study of cases observed in a general pediatric unit over a period of 15 years (1990-2005) at Tunis.We gathered 18 cases of uveitis (girls 55.6% ,boys 44.4%). Mean age at the diagnosis was 8+/-3 years. Diagnosis was made after a decreased of visual acuity in 55.6% of cases. Localization of uveitis was anterior (6 cases), intermediate (1 case), posterior (3 cases) and total (8 cases). An underlying disease was found in only 5 patients: Behçet's disease (3 patients), juvenile chronic arthritis (1 patient), possible dermatopolymyositis (1 patient). The evolution was favorable in 10 cases with local treatment, systemic corticotherapy and/or immunosuppressive agents. Complications occurred in 3 cases.Causes of uveitis in childhood remains most often undiagnosed Our study illustrates the pending risk of severe visual impairment and strict ophtalmology follow-up is mandatory.

The incidence of tertiary syphilis has declined in recent years owing to the early recognition of the disease and use of antibiotics. As a result, syphilitic aortic aneurysms are rarely encountered nowadays. We report the case of a 65 years old man, who was admitted to our hospital in June 2004 for dyspnea, cough and chest discomfort. On physical examination, blood pressure was 130/80 mmHg with no significant laterality, pulse rate was 70 per minute and there was a decrease of breath sounds over the right lung. Laboratory findings revealed a slight elevation of the erythrocyte sedimentation rate. Serological studies for syphilis showed a positive venereal disease laboratory test (VDRL) at 1/32 and a positive Treponema pallidum hemagglutination test (TPHA) at 1/2560. The chest radiography showed a right para cardiac opacity measuring 16 x 12 cm. Fiber optic bronchoscopy showed an extrinsic compression of the right upper lobar bronchus. Gadolinium-enhanced magnetic resonance angiography and 16 multidetector-row spiral computed aortography showed a huge partially thrombosed saccular aneurysm of the ascending aorta measuring 132 mm in diameter. The circulating lumen measured 53 mm in its largest diameter. This aneurysm involved the innominate artery. There was no other arterial involvement. The patient was given a three week course of intravenous penicillin followed by a successful surgical procedure in September 2004 with ascending aortic replacement and innominate artery reimplantation. This case illustrates well a formerly common, but now extremely rare disease.

To evaluate anatomical and functional prognosis of urgent penetrating keratoplasty in perforated infectious corneal ulcers.Seven eyes of seven patients had an urgent penetrating keratoplasty for perforated infectious corneal ulcers. Anatomical success was defined by eradication of infection and preservation of eye from enucleation and phthisis bulbi. Corneal graft survival was defined by the presence of a clear graft.The patients'mean age was 40.5 years. Four eyes had bacterial corneal ulcer and three eyes had herpetic corneal ulcer. Anatomical success was obtained in six eyes. The graft remained clear in two eyes. Graft rejection was noted in four eyes after a mean period of 4.5 months. Postoperative complications were ocular inflammation (one eye), ocular hypertension (three eyes), cataract (one eye), peripheral anterior synechiae (one1 eye), graft ectasia (one eye), bacterial infection (one eye) and recurrent herpetic keratitis (one eye). The mean follow-up period was 22 months, ranging from 9 to 32 months.Urgent penetrating keratoplasty can preserve eye integrity and eradication of the infectious process in a large part of perforated bacterial and herpetic corneal ulcers. Visual rehabilitation is often a secondary objective. Adapted antimicrobial treatment reduces graft reinfection and steroid treatment reduces the frequency of some complications, especially graft rejection.

Eosinophilic pustular folliculitis in children is a follicular inflammatory dermatosis, usually occurring early in life. The disease progresses in flares of prurigenous plaques studded with papules and sterile pustules of the scalp and other areas of the skin.A 7 year-old boy presented with itching papular vesicular and pustular plaques on the scalp and the face. Pigmented plaques with pustular border, located on the trunk, were associated with pustular and erosive lesions of the side of the lower lip and in the nostrils. A specimen taken from the pustules did not show bacterial or fungal infection. Histologic examination of a biopsy specimen showed subcorneal pustules with eosinophilic and neutrophilic infiltrates of follicles. Clinical improvement was obtained only by the combination of steroids and dapsone, but recurrence followed withdrawal of treatment.Eosinophilic pustular folliculitis in children is rare. Our case report combines features of the infancy form (lesions located on the scalp and face) and the adult form (location on the trunk and limbs with annular distribution), expressing the conceptual confusion that remains between both forms. The mucosal involvement seen in our patient has never been reported in the literature neither in the infancy nor in the adult form.

In spite of the progress of the imagery in ophthalmology, the retinoblastoma remains in some particular cases, difficult to make. Moreover, the therapy sanction is often heavy. The lactate dehydrogenase (LDH) dosage in aqueous humor is an invasive technique conceivable when there are diagnosis problems particularly in retino-blastoma of old children and in affections simulating retino-blastoma. The purpose of this work is to lay out three observations where the LDH dosage enabled to keep the retinoblastoma diagnosis in one 8-year old child and eliminate it in two children having pseudoglioma with spontaneous evolution allowing to confirm the non-tumoral nature of the affection. Thus, the technique of LDH dosage has been reliable for the 3 cases which we have introduced. The authors compare the reliability of the different cytochemical techniques during the retinoblastoma diagnosis.

Orbital dermoid cyst represents 3 to 4% of all primary orbital tumours. The intraorbital location is relatively rare. We report the case of a 9 year-old male child with an orbital dermoid cyst, who presented with progressive right proptosis, which had developed 3 months earlier. Visual acuity, ocular motility and funduscopic examination were normal. Imaging aspects (ultrasonography and computed tomography) have revealed an extraconical orbital, hypodense, well limited tumor, without bone destruction and no enhancement located at the postero-external side of the orbit. The tumors was extirpated surgically via a superior approach. Histopathology confirmed the diagnosis of dermoid cyst.

We present preliminary research on penetrating keratoplasty in corneal dystrophy secondary to congenital glaucoma. The aim was to analyse the functional and anatomic results of this morbid condition where visual prognosis is usually poor.Six cases of congenital glaucoma in which the ocular pressure is controlled were studied. Age varied from 10 months to 11 years, the medium age was 47.7 months (SD: 42.8). These patients underwent penetrating keratoplasty. Recession varied from 3 months to 29 months, with a medium recession of 18.4 months (SD: 11.54).Anatomic results: the graft remained transparent in 5 eyes. Some postoperative complications were noticed: ocular hypertonia medically treated in one case, minor uveitis in one case, total cataract operated by phacophagy with a final outcome of ophthalmomalacia, buphtalmia (31.5 of diameter and ocular tonus at 7 mmHg). Functional results: an amelioration of visual acuity was obtained in 5 of 6 cases.The anatomic and functional results were satisfactory. Ocular pressure must be normalised before keratoplasty. Important buphtalmia constitutes one contra-indication to this intervention. Hypotonia would appear to be a factor of poor prognosis.

The authors report the observation of a 35-year-old patient, mother of 5 children 4 of whom are carriers of bilateral retinoblastomas. Two of these children presented lesions suggestive of retinoma retinoblastoma association. The patient had peripheral retinal lesions evoking the diagnosis of regressive bilateral retinoblastoma. At present, the term retinoma or retinocytoma seems to be more adequate. The genetic study of this family was done with D esterase and DNA molecular biology.

Occupational contact dermatitis remains an important cause of disability. Eight steps in an operational definition of OCD are as follows: 1. Relevant clinical history 2. Relevant morphology 3. Positive diagnostic patch test with appropriate vehicle and concentration 4. Repeat patch test when excited skin syndrome is suspected 5. Positive provocative use test or repeat open application test to refine clinical relevance 6. Serial dilutions, when necessary, of the chemical tested 7. Reviewing controls for nonirritating concentrations when this is not known by the investigator 8. Generally, clearing of the dermatitis when allergen is removed, or exposure significantly decreased The diagnosis is not always easy. Well-conducted clinical investigations are needed, including clinical history, clinical examination, and patch testing with careful follow-up. However, many of the chemicals reported in the literature as sensitizers induce only sporadic allergic reactions. Thus, epidemiologic animal and human studies are necessary to determine the capacity of the chemicals used in industry to induce contact dermatoses. It is necessary to standardize the predictive tests to compare results among laboratories and to predict the potential for sensitization.

Vitamin A and E blood levels were determined, using a high-performance liquid chromatographic method, in 7 patients with erythrodermic psoriasis or psoriatic acral pustulosis associated or not associated with chronic alcoholism, during and after the acute episode. These vitamins were also studied in 5 patients with psoriasis vulgaris involving more than 80% of the surface body area and associated with chronic alcohol intake and in 17 patients with psoriasis vulgaris involving more than 50% of the skin but without chronic alcoholism. Vitamin A blood levels were reduced in all the patients in the group "erythrodermic psoriasis/psoriatic acral pustulosis", while vitamin E blood levels were below the normal range during the acute psoriatic episode only in the 5 patients having a history of chronic alcohol intake in this group. In the other groups--psoriasis vulgaris with chronic alcoholism and psoriasis vulgaris without heavy alcohol consumption--vitamin A and E blood levels were not reduced. The implication of vitamin E in psoriasis, probably by its antioxidant activity, and its relationship with selenium are discussed. We suggest that attention should be paid to the vitamin A deficiency in erythrodermic or pustular psoriasis and to the vitamin E deficiency when these inflammatory diseases are associated with chronic alcoholism.

Recurrent corneal erosion (RCE) is a disease which often occurs in women. The authors report one case of RCE in the right eye of a 38 year old woman age. Clinical signs and clinical course under treatment are described. The pathogenesis and treatment of RCE are also described.

The authors reported ten cases of familial nephropathy (two cystinosis, three Senior and Loken syndrome, one Alport's syndrome and four Oxalosis) associated to ocular manifestations. Aetiologic diagnosis was known from ocular symptoms in five cases (all cases of cystinosis and Senior and Loken syndrome). The authors undertook this study to analyse the value of ocular manifestations in determining the right aetiologic diagnosis in familial nephropathies. The results of this study showed that ocular manifestations are helpful for aetiologic diagnosis in the first diseases. Indeed, corneal injury is synonym of cystinosis and retinitis pigmentosa is usually associated with Senior and Loken syndrome. In Alport's syndrome, ocular manifestations: antcrior lenticonus cataractous and perimacular white points only have orientation value in the diagnosis of this disease. Oxalosis ocular manifestations which consist of retinal oxalate deposits appear late and are concomitant to familial renal insufficiency. They cannot help in the diagnostic search.

International audience; A human tracheobronchial lambda gt 11 cDNA library was screened using antiserum prepared against the deglycosylated protein backbone of human tracheobronchial mucins. Two cDNAs, designated JER 28 and 57, obtained from this immunoscreening, were used to isolate two other cDNA clones, JUL 7 and JUL 10, from a human tracheobronchial lambda gt 10 cDNA library. These four clones (561, 1830, 1631 and 991 bp), which mapped to chromosome 11p15, were all found to contain degenerate 87-base-pair tandem repeats which encode non-repetitive peptides. Numerous deletions or insertions in an otherwise virtually perfect 87-base-pair tandem repeat create many shifts in reading frame which completely destroy the repetitive peptide structure. The peptide is composed of alternate hydrophobic and hydrophilic domains which probably differ in the extent to which they are glycosylated. The mRNAs are expressed both in the respiratory and in the digestive tracts. These human mucin probes may be important in assessing the abnormal mucins associated with inflammatory diseases or carcinoma from human mucosae.

The subcorneal pustular dermatosis (SPD) is a rare dermatosis. IgA monoclonal gammapathy is the most frequently associated disease with the SPD. We report a case of SPD in a patient with metastatic apudoma, an association not previously described. The rare nature of both diseases suggests that this association is not fortuitous.

One of the major benefits of pseudophakia is to maintain a good visual field. Visual field was therefore studied in 40 pseudophakic eyes using: 1. kinetic perimetry according to Goldmann using 3 tests: I1, I2, I4; 2. Automated perimetry. Insertion of a posterior chamber intraocular lens was performed in 85% of cases whereas the remaining 15% received an anterior chamber intraocular lens. Visual acuity was5/10 P2-P4 in all patients. The results showed a 15% reduction in the visual field compared to normal values. This reduction was concentric and harmonious but was more marked in internal isopters. This reduction was less marked with posterior chamber intraocular lenses. On the other hand, automated perimetry showed that global retinal sensitivity was decreased in pseudophakia, and this deficiency was more pronounced in the periphery.

The course of diabetic retinopathy (DR) was studied in 93 pregnant patients. Results were compared with data from 98 diabetic non pregnant women. Worsening of initial retinal lesions was observed in 16% of the pregnant group whereas only 6% of the control group showed a similar aggravation. The difference between the two groups was statistically significant (p0.05). Argon laser panretinal photocoagulation of pre-proliferative and proliferative DR resulted in no subsequent DR-induced complications. On the other hand, the risk of appearance of DR and/or its worsening during pregnancy depends on initial network but mostly on the duration of diabetes mellitus. In conclusion, regular ophthalmologic examination of diabetic patients especially during pregnancy seems crucial for the early screening of any worsening. Furthermore, the importance of pregnancy planning is emphasized.

Congenital glaucoma has a very serious prognosis. It represents the first cause of blindness in Tunisian children. Trabeculectomy introduced by Cairns in 1968, was initially proposed as second-line treatment in congenital glaucoma surgery. It has now become more frequently used as first-line treatment in this indication. We have already used this technique directly in 35 children suffering from congenital glaucoma with a total of 54 eyes. Forty four eyes underwent a single operation, ten eyes underwent two to four trabeculectomies. Then study of these cases with a mean follow up of 24 months shows an overall success rate of 64% after one trabeculectomy, with or without additional medical treatment. The study of tonometric diagrams shows that the successful results obtained after 3 months persisted in the long term. Trabeculectomy gives better results in congenital glaucoma with intraocular pressure greater than 40 mmHg. Repeated operations are sometimes necessary. In these cases, postoperative subconjunctival 5 fluorouracil (SFU) did not improve the surgical outcome.

During organic acid screening by gas chromatography/mass spectrometry, we detected a large peak corresponding to glyceric acid in a patient's urine sample. The D(+) configuration was demonstrated by a polarimetric method and by enzymatic stereospecificity of D-glycerate dehydrogenase (EC 1.1.1.29). We biochemically investigated this fifth reported case of D-glyceric acidemia. In our patient, loading tests with L-serine and fructose led to an increase of D-glyceric acid in both plasma and urine. Determination of other metabolites involved in D-glycerate metabolism revealed no abnormality in any sample examined. After comparing all our results with those of the preceding observations described in the literature, we suggest a possible enzymatic defect located on one of the metabolic pathways shared by fructose and L-serine, possibly at the level of hepatic D-glycerate kinase (EC 2.7.1.31). Nevertheless, a primary defect of L-serine catabolism cannot be entirely excluded.

The authors study 202 strabismus cases and evaluate the strabismic epidemiology of Tunisia: 58% of squint children have amblyopia. The low vision is important, and getting worse with age. The treatment is simple, consisting of occlusion of the good eye, but it become longer and more difficult after six years. The best results are obtained in the first four years. Good cooperation from the parents is required. The authors insist on the necessity of early detection through testing, the prevention of recurrence and, above all, on preventing the advent of amblyopia as soon as strabismus appears.