Repigmentation d’un vitiligo universalis déclenchée par l’hémodialyse

Vitiligo is an acquired depigmenting disorder. Vitiligo universalis is a rare form responsible for significant aesthetic damage. To date, the exact pathogenesis remains unknown. Its treatment, a real challenge, consists rather in removing the still pigmented areas. We report a case of a patient followed for stable vitiligo universalis from an early age who presented with repigmentation shortly after initiation of hemodialysis.     

Angiodysplasie colique et hémodialyse chronique. Traitement par coagulation au plasma argon. À propos d’un cas

IntroductionGastrointestinal angiodysplasia is a very common cause of digestive haemorrhage among patients with chronic renal insufficiency. It is well known that bleeding from angiodysplasias can be a difficult therapeutic problem since therapeutic possibilities are scarce and surgery is scolded with high mortality rate. Endoscopic argon plasma ablation therapy is a new, effective and safe treatment in the management of gastrointestinal angiodysplasia.Case reportWe reported a case of a female haemodialysis patient aged 40 years. She was haemodialysed since 6 years in our center from unknown nephropathy. In March 2006, she complained of black stools and melena, and developed severe anaemia (Haemoglobin at 4 g/dL). Exploratory endoscope examination of the digestive tract showed the presence of bleeding from angiodysplastic lesions of the right colon. The patient had severe clinical picture extension of angiodysplastic lesions and frequent bleeding episodes. Bleeding arrest was observed after argon plasma coagulation, with a significant decrease of blood transfusions and improvement of anaemia.ConclusionGastrointestinal angiodysplasia was reported to be an important complication in dialysis patients and was recognized as an important cause of erythropoietin-resistant anaemia. It can worsen vital prognosis. Argon plasma coagulation is an effective treatment in these patients.     

Indice prédictif de l’évolution chronique des lombalgies aiguës. Élaboration par l’étude d’une cohorte de 2 487 patients

Low back pain (LBP) related disability involves patients with chronic outcome. Objective. To identify the factors predictive of chronic evolution of acute LBP and to develop a predictive clinical index. Patients and methods. Prospective investigation of 2487 patients in employment referred for their first consultation with acute LBP (less than 8 days). Chronic evolution defined by persistence of symptoms, unchanged or worse, at 7 weeks. A predictive index was developed according to a logistic regression model. Results. 155 patients (6.2%) were considered to have unchanged or worsened LBP at the time of final evaluation, which was carried out on average 42 ± 15 days after the initial visit, and were thus regarded as having a chronic outcome. When comparing patients with chronic outcome and the others, there were 25 elementary characteristics for which the degree of significance of the bilateral test was less than 0.01. They were introduced into a logistic regression model. Five parameters appeared to be related to chronic outcome: characteristics of current episode (isolated acute low back pain, acute exacerbation of chronic low back pain, sciatica), two daily living activities items, duration of  certificate to remain off work and taking part in a sport. They were used to develop an easily applied index providing identification, as of the initial consultation, of the risk of chronic evolution. Conclusion. The early recognition of patients with LBP with high risk of chronic outcome can be achieved with an easily applied clinical index.     

Traitement de l’hydrocéphalie de l’enfant par ventriculocisternostomie endoscopique au Sénégal

IntroductionSince its advent, endoscopic third ventriculostomy (ETV) has been an effective alternative to shunt placement for the treatment of hydrocephalus. The aim of this study was to report the results of our experience with this technique in children in Senegal.Materials and methodsThis was a retrospective study of 70 cases of children aged between 5 months to 15 years who were treated by ETV in the Neurosurgery Department of Fann Hospital in Dakar, between January 2010 to December 2012. The results were evaluated based on the clinical criteria of Drake and the Canadian Pediatric Neurosurgery Study Group. The mean follow-up duration was 24 months (9–32 months).ResultsThe mean age at diagnosis was 29 months. A male predominance (sex-ratio 1/3) was observed. We also noted a macrocephaly in 64.4 % of cases, psychomotor retardation in 40 % and decreased vision in 31.4 %. Headache and vomiting were found in 42.8 % and 61.4 % respectively. The main etiology was a stenosis of the mesencephalon aqueduct (30 %), followed by a Dandy-Walker malformation (25.7 %). Significant intraoperative bleeding was found in 2.8 % of patients. The most common postoperative complication was CSF leakage (18.6 %), followed by infections (14.2 %). The success rate according to the clinical criteria of Drake was 71.4 %. This success rate was influenced by the age of patients and the hydrocephalus etiology. No deaths occurred.ConclusionThe endoscopic third ventriculostomy is a simple, safe and effective technique. Its advantages in terms of quality of life and morbidity compared with bypass valves makes it the technique of choice, particularly in developing countries.     

Thrombose d’oxygénateur en l’absence de résistance à l’héparine mais en présence d’une maladie de Vaquez

A 55-year-old male with a history of positive HIV serology and polycythemia vera underwent coronary artery bypass graft surgery with normothermic extracorporeal circulation. Following heparin administration the activated clotting time (ACT) was 633 seconds (Hemocron^® with kaolin). Lower than expected arterial and venous oxygen partial pressures together with high pressure (350 mmHg) in the arterial line upstream of the oxygenator were observed. Because of these signs the oxygenator was changed during the procedure. The outcome was uneventful. Electronic microscopic examination of the oxygenator membrane and thermic exchanger revealed fibrin and platelet deposits. Similar cases are described in the literature during polycythemia vera. Therefore the prevention might be a preoperative treatment with antiplatelet therapy in polycytemia vera.     

Traitement de l’ostéoporose postménopausique par les agents anaboliques

The main efficacy criterion for drugs against osteoporosis is protection against fractures. Many resorption-inhibiting agents meet this criterion, including estrogens, alendronate, risedronate, raloxifene, calcitonin, and calcium-vitamin D supplements). Conversely, among anabolic agents, only parathyroid hormone (PTH) is known to reduce the fracture risk, the mechanism being increased bone matrix production by osteoblasts with no alterations in the mechanical properties of bone. Although fluoride salts induce a marked increase in bone mineral density (BMD), there is no evidence that this protects against vertebral or peripheral fractures. Growth hormone, IGF-I, statins, and strontium ranelate are under investigation. A recent controlled clinical trial in 1637 women with osteoporosis showed that daily subcutaneous injections of PTH (1-34) (20 or 40 μg) for 21 months reduced the fracture risk. With 20 μg/day, the reductions were 65 % for vertebral fractures and 57% for extravertebral fractures, 11% of patients had moderate postinjection hypercalcemia, and BMD increased by 9 % at the lumbar spine and by 3 % at the femoral neck. These findings open up the exciting possibility that PTH used alone or in combination with resorption-inhibiting agents may be helpful. To date, PTH is the only anabolic agent that has proved capable of reducing the risk of vertebral and extravertebral fractures in women with established postmenopausal osteoporosis.     

Rupture de rate intra-abdominale révélée par un hémothorax

We report a case of a 17-year-old patient with an haemothorax related to an intra-abdominal spleen rupture. The nature of this haemothorax is unusual and the problem is how to obtain the etiology in this case. The spleen was in intra-abdominal position on all radiological examinations and was the source of bleeding. Therefore, laparotomy is the only convenient therapy.