Traumatismes de la rate dans le service de chirurgie générale du CHU Gabriel Touré

We have carried out a retrospective survey from January 1999 to December 2010, it has included all operated patients or not hospitalized for spleen traumatism at the general surgery service of training hospital Gabriel Toure. Our objectives were to determine the hospital frequency of spleen traumatism, describe the clinical and paraclinical signs and to analyze the treatment outcome. So, we have recorded 107 cases of splenic traumatisms, making 15.3% of abdominal traumatisms and 1.1% of abdominal emergencies, the average age was 23 year ±4–85, the sex ratio at 2.68. The etiology was dominated by road accidents with 80 (74.8%), followed by the fall off trees 12 (11.2%) The scuffles 10 (9.3%), the sport accidents 4 (3.7%) and one case from animal horns; the traumatism was closed 99% of cases, and located at left hypocondrium in 89.7% of cases. The average admission delay was 1.68 H, and the abdominal pain was diffuse in 80.3%. 86 (80.3%) patients were haemodynamically unstable, 44 (41.1%) had anemia. The splenic lesion was identified in 77.5%. According to Moore 58 (54.2%) were classified grade IV. The treatment was non-surgical in 21(19, 7%) of patients, the splenoraphy in 20 (18.6%) and the splenectomy in 63 patients (58.9%); the blood transfusion has been done in 44.9% of patients. We have noticed 4 (3.7%) parietal abscess. One evisceration, 5 (4.7%) fatalities. The average hospitalization duration was 8.7 days. Conclusion: spleen traumatisms are frequent in youth; the non-surgical treatment is the gold standard.     

Stress oxydant et effets bénéfiques rénaux de la restriction sodée dans l’insulinorésistance chez le rat

The aim of this work was to evaluate the influence of dietary sodium restriction on metabolic and renal changes associated with insulin resistance. At 8 weeks of age, rats received either a diet containing 60% fructose with or without sodium or a standard diet for 12 weeks. The insulin resistance and albuminuria induced by the high fructose diet were associated with a fibrosis and increase in oxidative stress in the kidney. The low salt diet prevented insulin resistance, renal fibrosis and albuminuria induced by the fructose diet. These beneficial effects on the kidney were associated with a decrease in kidney NADPH oxidase activity. Oxidative status is probably one of the major targets of the favourable effect of salt restriction on renal changes associated with insulin resistance, without excluding the involvement of other mechanisms.     

Azithromycine et pathologies bronchiques chroniques : quels patients ? Quels bénéfices ? Quelles modalités ?

Azithromycin is a macrolide widely used in chronic bronchial diseases due to its anti-inflammatory properties. This treatment is prescribed to patients with bronchiectasis, asthma and severe chronic obstructive pulmonary disease who present more than 3 exacerbations per year or a deterioration of respiratory function despite an optimal treatment. Macrolides decrease the number of exacerbation but azythromycine must be prescribed carefully. Indeed, it involves potential cardiovascular and otological toxicities and the emergence of resistant bacteria. In addition, studies remain insufficient to establish the optimal dosage and duration of azithromycine.     

Conséquences de la réalisation du test ExSel® sur la consommation excessive de sel chez des patients hypertendus suivis en médecine générale

ObjectiveTo evaluate the impact of the Exsel^® test administration on salt intake in hypertensive subjects followed in general practice.MethodIn a group practice of general practitioners in the Île-de-France, the ExSel^® test http://www.comitehta.org/testez-vous/consommez-vous-du-sel-en-exces-test-exsel/ was administered to 329 outpatients. The questionnaire was filled in the waiting room and then commented by the doctor. In patients treated for hypertension, 24 hours urinary Na was prescribed after the consultation. Excessive salt consumption (ESC) was defined as a urinary Na ≥ 200 mmol/day.ResultsThe population included subjects aged on average 57 years with 43 % of hypertensive patients. According Exsel^®, an ESC was suspected in 36 % of patients and was more common in treated hypertensive patients (44 %; [36–52]) in hypertensive men (57 %; [46–68]) than among non-hypertensive (31 %; [24–38]) and non hypertensive women (18 % [11–25]). Urinary Na has been finally performed by 63 % of subjects and 24 hours excretion was 157 ± 56 mmol in men and 123 ± 39 mmol in women. After this 24 hours urinary sodium evaluation, subsequent to ExSel^® test, ESC frequency was lower among men (19 %) and very low among women (5 %).ConclusionTo estimate the ESC, the ExSel^® test is easily performed in general practice while 24 hours urinary sodium is more difficult to obtain. Achieving an ExSel^® test was accompanied by a decrease in the frequency of excessive salt consumers with a greater effect in women.     

Épidémiologie de la repolarisation précoce chez le jeune maghrébin

An early repolarization variant (ERV) in inferolateral leads has recently been associated with vulnerability to ventricular fibrillation. These studies have been conducted in the occidental countries. The prevalence of ERV in the population of the Maghreb is unknown. The aim of this study was to evaluate the prevalence and risk factors of ERV in a young population from Algeria.MethodsWe assessed the prevalence of ERV within a population of 441 healthy subjects (mean age 25 years) using 12-lead electrocardiography. ERV was stratified by three independent cardiologists according to the J-point elevation (≥ 0.1 mV) in the inferior, apicolateral or both leads with QRS slurring or notching.ResultsThe inferolateral ERV pattern was present in 55 subjects (12.4%). A malign ERV (> 2 mm) was present in 5 subjects (9% of ER) and ER in inferior and lateral leads in 40% of ER. An ERV pattern was more frequently associated with young age, male, bradycardia and T wave in V1 lead.ConclusionAn ERV is a common finding in a healthy Algerian young population. This prevalence seems to be more important than other studies due to young age and not to a racial difference. Our population were more at risk that other studies, and we found more T waves in V1 lead in this people, due to an ethnic particularities or a phenotypic association with the Brugada syndrome.