Diarrhée du voyageur

Traveller's diarrhoea is a frequent disease which usually occurs the first week of the trip. Despite the apparent benignity of this affection, travellers may be ill enough to stop their activities. Its related morbidity has led to elaborate advices and recommendations to be considered before departure, and to propose a therapeutic schedule during the trip. In case of persistent diarrhoea after return, minimal medical investigation is mandatory, seeking for potential infectious aetiology.     

Physiologie du pancréas exocrine

The pancreatic physiology is examined on the basis of recent advances observed these past ten years. A new model for pancreatic duct cell bicarbonate secretion is proposed according to the recently discovered Cystic Fibrosis Transmembrane conductance Regulator mutated in cystic fibrosis. Enzyme activation and inactivation are detailed allowing comprehensive pancreatic secretory function and relationships between trypsinogen and the occurrence of hereditary pancreatitis. Previously, pancreatic secretion was thought to be exclusively controlled by neural reflex mechanisms. Later, it has been proposed to be predominantly regulated by gastrointestinal hormones, with CCK and secretin being the most important regulatory peptides. New data from the research on the localization and role of gastrointestinal peptide receptors in the human pancreas support the current concept of an integrative neurohormonal regulation.     

Syndrome de Budd-Chiari : complication rare du kyste hydatique du foie : �� propos de trois cas

Introduction

Hydatid disease is a parasitic infestation due to the development of Echinococcus granulosus in the organism. This disease is particularly frequent in Tunisia where echinococcosis is endemic. Liver is the most common organ to be affected by hydatidosis, and several complications have been described. Vascular complications secondary to hepatic echinococcosis such as Budd-Chiari syndrome have rarely been reported.

Case reports

We report three rare cases of hydatid cyst complicated by Budd-Chiari syndrome. The cyst occupied at least two segments of the hepatic dome in all patients, and its diameter was 12.5, 21 and 12.5 cm, respectively. According to the Gharbi classification, the cysts were type III in one case and type IV in the other two cases. The Budd-Chiari syndrome was chronic in one patient and asymptomatic in other cases. The diagnosis was established by abdominal ultrasound (US) in two cases, confirmed by Doppler US and CT angiogram in one patient and by CT angiogram in the other. The diagnosis was established only by CT angiogram in the third case. The Budd-Chiari syndrome was due to the compression of two hepatic veins in one case, compression of inferior vena cava in one case and compression of one hepatic vein and inferior vena cava in another case. Laparotomy was performed in all patients. The surgical procedure comprised the resection of the protruding hepatic tissue after puncture aspiration of the cyst in all the three cases. The postoperative period was complicated by abscess formation in residual cavity, requiring drainage, and by the development of ascites in one case.

Conclusion

Hydatid cyst should be suspected amongst the causes of Budd-Chiari syndrome in countries where the disease is endemic. Conversely, this vascular complication should be looked for routinely in patients with hydatid disease of the liver.     

La réadaptation du patient valvulaire

Valvular disease is the second indication of cardiac rehabilitation (CR) after coronary artery disease. Patients suffering valvular disease are addressed to CR after valvular repair, and are usually old. Valvular replacement are the most frequent, and more and more patients being treated by TAVI are addressed to CR. CR takes place on two phases: From the seventh (day 7) to the fifteenth (day 15) day: management of complications, respiratory physio, and help to autonomy if necessary. From the fifteenth day (day 15): rehabilitation to exercise after an exercise stress test with or without MVO₂ measurement. Because the patients are taking anticoagulants and are at risk of endocarditis, therapeutic education takes an important place during the stage. CR of patients suffering valvular disease has demonstrated its usefulness with: An increase of exercise capacity in all kind of valvular disease; A reduction of left ventricular hypertrophy in patients with aortic valve stenosis. No serious complication was observed in all studies regarding CR in patients with valvular disease.