Condylomata acuminata during pregnancy. Report of 15 cases

Genital warts (condylomata acuminata) are caused by human papilloma viruses (HPV) and usually are transmitted sexually. These lesions often increase in size during pregnancy and can pose some problems in the therapeutic management on one hand; vaginal labor can expose the new-born baby to the risk of contamination with HPV (estimated at 4%), on the other hand. Starting from 15 cases, the authors tried to show the clinical, therapeutic and prognosis distinctive features of this association.     

Genital primary herpetic infection in an infant: clinical features, diagnosis and management

Genital herpes is a rare disease in infants and is mainly associated with herpes simplex virus (HSV) type 1. Asymptomatic carriers are frequently implicated as transmitters of the disease. Clinical manifestations are the main criteria for diagnosis, However, type-specific serologies and PCR are the most sensitive techniques for detecting HSV. Genital herpes is treated with local or systemic antiviral therapy depending on the severity of the infection. Reducing transmission relies on counseling patients. The disease prognosis is correlated with the underlying immunological status. We report a case of genital primary herpetic infection in an infant.     

CT findings in severe thoracic sarcoidosis

Severe thoracic sarcoidosis includes manifestations with significant clinical and functional impairment and a risk of mortality. Severe thoracic sarcoidosis can take on various clinical presentations and is associated with increased morbidity. The purpose of this article was to describe the CT findings in severe thoracic sarcoidosis and to explain some of their mechanisms. Subacute respiratory insufficiency is a rare and early complication due to a high profusion of pulmonary lesions. Chronic respiratory insufficiency due to pulmonary fibrosis is a frequent and late complication. Three main CT patterns are identified: bronchial distortion, honeycombing and linear opacities. CT can be helpful in diagnosing some mechanisms of central airway obstruction such as bronchial distortion due to pulmonary fibrosis or an extrinsic bronchial compression by enlarged lymph nodes. An intrinsic narrowing of the bronchial wall by endobronchial granulomatous lesions may be suggested by CT when it shows evidence of bronchial mural thickening. Pulmonary hypertension usually occurs in patients with end-stage pulmonary disease and is related to fibrotic destruction of the distal capillary bed and to the resultant chronic hypoxemia. Several other mechanisms may contribute to the development of pulmonary hypertension including extrinsic compression of major pulmonary arteries by enlarged lymph nodes and secondary pulmonary veno-occlusive disease. Aspergilloma colonization of a cavity is the main cause of hemoptysis in sarcoidosis. Other rare causes are bronchiesctasis, necrotizing bronchial aspergillosis, semi-invasive pulmonary aspergillosis, erosion of a pulmonary artery due to a necrotic sarcoidosis lesion, necrosis of parenchymal sarcoidosis lesions and specific endobronchial macroscopic lesions.     

High blood presure for people aged more than 60 years in the distrct of Sousse

High blood pressure (HBP) is one of the most important cardiovascular risk factors all over the world. We conducted a prospective study including 600 elderly people aged more than 60 years in the district of Sousse. The mean age of our patients was 69 +/- 7.1 years with a ratio of 1.3 (340 females and 260 males). The prevalence of HBP was at 69.3%, diabetes 23% and obesity 24.2%. It is important to note that in 31% of cases HBP was newly diagnosed during our investigation. In 51.7% of patients with known hypertension there was evidence of non compliance to treatment and uncontrolled PB. It is obvious that HBP is a major health problem in our country and that inadequate control of hypertension is a potential source for cardiovascular problems. Our findings emphasize the need for implementing an educational program as well as sensitization compaigns targeting people, particularly those aged more than 60 years.     

Ochratoxin A and human chronic nephropathy in Tunisia: is the situation endemic?

Ochratoxin A (OTA) is a nephrotoxic mycotoxin that is being increasingly considered as the main causal agent of Balkan endemic nephropathy (BEN), a fatal kidney disease associated with the end stage of urothelial tumours. However, despite the considerable amount of data, it is still controversial whether OTA plays a causative or only a subordinate role in the induction of this human nephropathy. Tunisia for years had to confront a very similar human nephropathy, which is tentatively called chronic interstitial nephropathy of unknown cause. This study tends firstly to consolidate the suspected link between this Tunisian chronic interstitial nephropathy (CIN) of unknown cause and the presence of OTA in the blood and food of such patients, and second to enlighten the endemic character of this particular nephropathy. Therefore, in four consecutive inquiries, performed within the period 1991-2000, blood and food OTA contaminations were assayed and compared for 954 nephropathy patients and 205 healthy subjects from the Tunisian general population. This survey was also designed to show that, although the whole population is likely to be exposed to OTA, specific people living in conditions showing similarities with the Balkans do have a kidney disease apparently linked to ochratoxin in food. The results showed that the highest incidences were found in patients with CIN of unknown cause. Indeed, the percentages of OTA-positive samples ranged from 93% to 100%, whereas it was only from 62% to 82% in healthy subjects. Mean OTA concentrations were also higher in patients with CIN of unknown cause than in controls (44.4 +/- 19 microg/L to 55.6 +/- 19 microg/L as opposed to 1.22 +/- 1.2 microg/L to 3.35 +/- 2.32 microg/L, respectively). This study emphasizes further the implication of OTA on this particular human nephropathy and underlines the probable causative role of OTA in the onset of this disease. It is important to note that the highest levels of food OTA contamination were found in the group presenting with CIN of unknown cause, indicating that, similar to the case in the Balkans, people are exposed to OTA essentially by their food.     

Urachal cyst in the adult. A case report and review of the literature

Simple urachal cyst is a rare pathology in the adults. The diagnosis is rarely established clinically, it is based on ultra sonography and confirmed by anatomo-pathology. The authors report one case of urachal cyst in a 42-year-old patient who present bladder irritation symptom. The diagnosis has been established by ultra sonography. The mean complications of urachal cyst are infection and degenerescence. The treatment is usually surgical.     

Value of prenatal corticotherapy in the prevention of hyaline membrane disease in premature infants. Randomized prospective study

OBJECTIVE: The aim of the study was to determine the feasibility, the cost and the effects of antenatal maternal corticosteroid treatment on preventing respiratory distress syndrome in premature neonates of our population. SUBJECTS AND METHODS: Between January, 1, 1998 and June, 31, 1999, 118 pregnant women at 26-34 weeks' gestation and at a high risk of premature delivery, were prospectively randomized in 2 groups: group 1 received intramusculary 24 mg of betamethasone (12 mg every 24 hours), group 2 didn't receive antenatal corticosteroids. At birth, premature neonates were systematically examined by a neonatologist. RESULTS: 131 premature neonates were born (63 from group 1, 68 from group 2). The incidence and the degree of severity of respiratory distress syndrome, appeared substancially reduced (4.8% vs 27.9%) by the use of antenatal corticosteroids. Moreover, neonatal mortality due to respiratory distress syndrome was statistically less in group 1 than in group 2 (22.9% vs 57%). There was no significant difference in the occurrence of maternal or neonatal corticosteroid complications such as infection between treated group and control subjects. We estimated a potential annual savings of 21 thousands tunisian dinars, when the cost implications for antenatal corticosteroid therapy were estimated to 2 thousands tunisian dinars. CONCLUSION: Maternal administration of corticosteroids before preterm delivery results in a decrease in the incidence and severity of respiratory distress syndrome and a decrease in neonatal mortality rate among premature neonates born to treated versus untreated mothers at 26-34 weeks' gestation; added to an annual savings estimated to 21 thousands tunisian dinars.