Percutaneous mitral commisurotomy in patients aged 60 years and more

Of 745 patients treated by balloon mitral commissurotomy (BMC) between February 1988 and December 2002, 45 were > or = 60-years old. Immediate and late outcomes in this group (group 1) were compared with those in the patients aged < 60-years (group 2). Baseline hemodynamic parameters were comparable in the two groups. Mitral surface area and hemodynamic parameters improved significantly after BMC in group 1: mean left atrial pressure fell from 18.76 +/- 6.18 to 10.65 +/- 4.38 mmHg (P < 0.001), mean transmitral gradient from 11.03 +/- 4.70 to 4.63 +/- 2.05 mmHg (p < 0.001) and mitral valve area from 0.99 +/- 0.22 to 1.88 +/- 0.41 cm2 (p < 0.001). Similar significant improvements were seen in group 2. The hemodynamic result was good in 69% of group 1 patients. Tamponade occurred in one patient. Mitral regurgitation grade I or II developed in 8 patients and remained stable in 13 patients. These complication rates were comparable to those seen in group 2. In the group 1, a good result was maintained in 60% of patients after 43 +/- 23 months of follow-up. Although restenosis was observed in 40% of patients, functional amelioration was obtained in most of cases. In the group 2, restenosis was observed in 25% of patients. The data from this study suggest that BMC is effective first therapy in patients aged > or = 60-years with symptomatic mitral stenosis.     

Intrathoracic lymphadenopathy: an unusual manifestation of rheumatoid arthritis

Lung disease is the most frequent extra-articular manifestation of rheumatoid arthritis. It is detected in nearly 50% of patients with this multisystem affection, his knowledge has benefited from advances in computed tomography (CT). The inflammation can affect the pleura, the airways and the lung parenchyma. Intrathoracic lymphadenopathy complicating rheumatoid lung are not usual, and then pose the problem of differential diagnosis. We report a 51-year-old man, with a history of tobacco intoxication, suffering from rheumatoid arthritis who developed an interstitial lung disease at stage of fibrosis with mediastinal and hilar adenopathy. We will discuss the clinical, paraclinical, evolutionary and therapeutic particularities case.     

Characterization of Tunisian Mycobacterium tuberculosis rifampin-resistant clinical isolates

Analysis of the gene encoding the beta-subunit of Mycobacterium tuberculosis RNA polymerase (rpoB) has demonstrated a small region that harbors the mutations most frequently associated with rifampin resistance. In this study, we determined the occurrence of rifampin resistance in 544 Tunisian clinical M. tuberculosis strains isolated in a university hospital between 2004 and 2006 by using the standard-proportion agar method, the INNO-LiPA Rif.TB assay, and DNA sequencing.