Faux anévrisme du ventricule gauche du sujet jeune : à propos de trois cas

Pseudoaneurysm of the left ventricle is a rare late complication of myocardial infarction. So-called non-coronary forms have been described in young people. In this context, we report three cases. Mr. M.B., aged 20, consulted for chest pain associated with palpitations. Cardiovascular examination found a pulsatile, expanding precordial bulging and a mesocardiac systolo-diastolic murmur. We noted a sinus rhythm with ventricular extrasystoles on ECG. The chest radiograph showed cardiomegaly and aneurysmal deformation of the left lower heart border. Doppler echocardiography showed a large left ventricular apical pseudoaneurysm. Mrs. O.B., aged 23, was admitted for biventricular heart failure and in whom the examination found a systolic murmur in the apical area. ECG showed a regular sinus tachycardia, left atrial and ventricular hypertrophy. The chest radiograph showed cardiomegaly and aneurysmal deformation of left middle and lower heart borders. Doppler echocardiography showed a large left ventricular apical pseudoaneurysm. Mr. I.S., aged 24, admitted for the management of congestive heart failure. The patient had non-specific laboratory inflammatory signs, a sinus tachycardia and extrasystoles on the ECG. Chest radiography showed a discontinuation at the posterior arch of the sixth rib, a cardiomegaly and a neurismal dilatation of the left lower heart border. Doppler echocardiography showed a large apical pseudoaneurysm of the left ventricle.     

Résultats du traitement laparoscopique de la lithiase de la voie biliaire principale : à propos d’une série de 50 cas

Background

Common bile duct stones (CBDS) are a frequent and potentially severe pathology. It remains the subject of controversies regarding its therapeutic strategy. Indeed, the opinions were divided between supporters of laparoscopy, laparotomy, or endoscopic sphincterotomy.

Aim of the study

To evaluate the feasibility of laparoscopic management of CBDS and review the results of this therapeutic approach.

Methods

We report a retrospective study of 50 cases of CBDS operated by laparoscopy in general surgery department of Habib Thameur hospital, collected over a period of 10 years from January 2000 to December 2010.

Results

There were 38 women and 12 men. The average age was 56 years. The intraoperative transcystic cholangiography was obtained for all patients except one who was pregnant. A choledochotomy was performed and allowed to extract lithiasis in 44 cases (88%). Conversion was necessary in 8 cases (16%). The main indications were an obstructing lithiasis (2 cases) and intense pedicle inflammation (2 cases). Biliary drainage was performed in all patients by either a T-tube in 33 cases, either by a transcystic drain in 17 cases. The average operative time was 170 min. Specific complications occurred in 5 patients. It was a choleperitoneum in one case and an external biliary fistula in 4 cases. The median duration of biliary drainage was 24.8 days. There was no mortality. The average hospital stay was 13 days.

Conclusion

The laparoscopic management of common bile duct stones is feasible subject to a trained team with adapted equipment. The extraction method and biliary drainage depend on per-operative data. The laparoscopic approach is currently the treatment of choice for experienced surgeons.     

Myocardite à COVID-19 : « à propos d'une série monocentrique de 33 cas »

IntroductionThe world is experiencing a pandemic linked to the respiratory spread of SARS-CoV2 which can affect the heart with elevated troponins, ECG abnormalities and kinetic disturbances in echocardiography, of ischemic or non-ischemic origin (most often fulminant myocarditis).ObjectiveTo describe the evolutionary modalities of post-COVID-19 myocarditis and to identify factors of poor ejection fraction (EF) recovery under treatment of heart failure.MethodMonocentric observational study including patients with post-COVID-19 non-fulminant myocarditis confirmed by cardiac MRI. These patients were divided into 2 groups according to the evolution of their EF at 3 months (EF > 50% vs EF < 50%).Results33 patients (19♂/14♀) aged from 30 to 61 were included, all of whom had repolarization disorder; mean EF at baseline was 44.3% (30–52%) with a troponin level 480 times normal (20–2100). Conventional treatment for heart failure was initiated in all patients with clinical, electrical and echocardiographic monitoring at 1 and 3 months. A significant improvement (EF > 50%) was observed in 29 patients. Gender, congestive signs, electrical and angiographic abnormalities do not seem to influence the evolution of EF (P > 0.10). Age > 60 years, troponins > 1200 times normal, pericardial effusion and a combined criterion of the three seem to be associated with poor evolution of EF (P at 0.07, 0.02, 0.035 and 0.01 respectively).DiscussionNon-fulminant post-COVID-19 myocarditis have a good prognosis (EF recovery in 87.88%). Factors of poor recovery are age > 60 years, elevated troponins, appearance of pericardial effusion and the combined criterion of the three.ConclusionNon-fulminant post-COVID-19 myocarditis seems to have a favorable course. Patients presenting factors of poor evolution had to have a longer follow-up.     

Révélations cardiaques atypiques rares du syndrome de Sheehan : à propos de trois cas

Sheehan syndrome is a potentially serious complication in the postpartum period corresponding to ischemic necrosis of the anterior pituitary related to postpartum haemorrhage. We report three original observations showing an unusual mode of revelation of this syndrome. The first observation is that of a 46-year-old patient admitted initially to resuscitation for a recovered cardiorespiratory arrest, severe hypoglycemia and profound hyponatremia. The second is that of a 45-year-old patient, admitted for recurrent cardiac tamponade after pericardial and pleural puncture and pericardial drainage; clinical survey found signs of slight panhypopituitarism. The latest case is that of a patient of 44 years, admitted to pericardial effusion average abundance revealed by dyspnea and tachypnea with hypotension. The interrogation of all patients revealed the concept of an old hemorrhagic syndrome, absence of lactation and secondary amenorrhea thereafter. Laboratory tests showed insufficient thyroid-stimulating, low cortisol, a hypogonadism hypogonadism. The pituitary magnetic resonance imaging showed an empty sella in the three cases. Patients were placed under replacement therapy with L-thyroxine and hydrocortisone with good clinical, biological and echocardiographic evolution. The three cases illustrate a rare heart atypical presentation for Sheehan's syndrome and underline the importance of early diagnosis and suitable replacement therapy of this syndrome to avoid this complication that can be life threatening.     

La pancréatite lupique : une série de 6 cas

Purpose

The onset of acute pancreatitis in systemic lupus erythematosus (SLE) is known but rare, and exceptionally revealing. Its pathogenesis is multifactorial, it is extremely difficult to separate what belongs to vasculitis, thrombotic phenomena in the context of antiphospholipid syndrome, or iatrogenic complications or intercurrent. We present six cases of lupus pancreatitis and discuss the difficulty of diagnosis.

Methods

A retrospective monocenter study of 110 patients with systemic lupus erythematosus. The diagnosis of lupus pancreatitis was established after exclusion of other causes of pancreatitis.

Results

Pancreatitis was noted in 6 patients (5.4%). There were five female and one male patients; the mean age of these patients was 36.3 years. In four patients pancreatitis was concurrent with the diagnosis of SLE and it occurred later during an exacerbation of the disease in the two remaining patients. In all patients, pancreatic manifestations were associated with other organ involvement. Clinical manifestations were: abdominal pain (n = 6), vomiting (n = 3) and fever (n = 3). Elevated pancreatic enzyme was noted in all cases. All patients were treated by high doses of glucocorticoids. The outcome was favorable in 5 patients, and one patient died.

Conclusion

Most cases of lupus pancreatitis have been described in patients with multiple organ involvement. It is important to recognize the etiology of pancreatitis in the course of SLE (drug, lupus, gallstones ??) because the therapeutic depends on it.     

Diagnostic de la lymphogranulomatose vénérienne : à propos d’une série de 5 cas

Introduction

Lymphogranuloma venereum (LG) is a sexually transmitted infection (STI) caused by Chlamydia trachomatis L serovar.

Mégaduodénum: à propos de deux cas

Megaduodenum is a rare condition. It may be idiopathic or secondary to visceral myopathy or neuropathy. The clinical manifestations vary from total latency to severe pseudo-obstruction. Recurrent urinary infections are common. The diagnosis is easily made by radiology and manometry revealing a motor disorder of the esophagus, small intestine, and anorectum. Surgical treatment poses specific technical problems related to the presence of biliarypancreatic confluence and head of the pancreas. The aim of this study is to describe the clinical manifestations; radiological and manometric abnormalities observed during megaduodenum and discuss therapeutic modalities. We report two patients: the first a 27-year-old man, operated for upper gastrointestinal stricture in another center where a large gastric dilatation was observed with a permeable pylorus. A lateral side anastomosis was performed between the duodenum and the second jejunal loop. The patient was readmitted to our department 4 years later for recurrence of the same symptoms. The former intraoperative duodenojejunal anastomosis was permeable. A total duodenal diversion was performed. The second patient a 22-year-old man, had a brother who is dead in the first year.. This case is associated with ophthalmologic disorders, facial dysmorphism, and a Barrett’s esophagus. The patient received a total duodenal diversion with satisfactory results, the blood karyotype showed no chromosomal abnormalities.     

Les kystes hydatiques cardiaques à propos de 17 cas opérés

Cardiac hydatid cyst is a rare parasitic disease. The purpose of this study was to describe the clinical, pathological features and the outcome of the surgical treatment of cardiac hydatid disease in our unit over a twenty-year period.MethodsBetween May 1994 and May 2014, seventeen cases of cardiac hydatid cysts were operated at our unit. Overall, twelve patients were male (mean age 25 ± 13 years). All patients were complaining of dyspnea and 71% presented with chest pain. The diagnosis, based on histological examination, was suspected on echocardiography and computed tomography of chest.ResultsOur study revealed five possible locations, which were in decreasing order of frequency: left ventricle, interventricular septum, right ventricle, left atrium and pulmonary artery. The surgical procedure was a controlled puncture and aspiration of the cyst content, with cystectomy (69%), or pericystectomy (31%). The resulting cavity left open in 6 cases (37.5%) or carefully closed in 10 (62.5%). Hospital mortality was 11.8% (n = 2). Morbidity was marked by conduction abnormalities (n = 2), bleeding and hematoma of the residual cavity that required surgical treatment (n = 3). Eleven patients were followed with a mean period of 40.5 ± 19.4 months. At follow-up, neither late deaths nor recurrence have occurred.ConclusionCardiac hydatid cyst is a serious disease whose treatment is surgical. Cystectomy and pericystectomy remain the two surgical techniques able to offer good chance of cure with acceptable morbidity and mortality.     

Syndrome platypnée-orthodéoxie secondaire à une pneumopathie : à propos de deux cas

IntroductionThe platypnea-orthodeoxia syndrome is a rare situation characterized by the appearance of dyspnea and/or hypoxemia during the transition to orthostatism.ObservationsWe report the case of two patients, who presented with a platypnea-orthodeoxia syndrome following pneumocystis pneumonia and COVID-19, revealing an intracardiac communication with a right-left shunt on contrast ultrasound.ConclusionThis syndrome can be detected easily at the bedside with positional maneuvers and the shunt demonstrated by a hyperoxia test. Non-reversible situations may require correction of the anatomical anomaly by transcatheter intervention or surgery.     

Syndrome de Sweet médicamenteux à l’hydroxychloroquine : à propos de 2 cas

IntroductionHydroxychloroquine is widely prescribed in systemic lupus erythematosus. Dermatologic adverse drug reactions are rare but can mimic a disease specific manifestation of lupus. Exceptionally, Sweet's syndrome, or acute febrile neutrophilic dermatosis, may be drug-induced.Case reportsTwo patients aged 31 and 42 years were treated with hydroxychloroquine for systemic lupus and Sjogren's syndrome, respectively. Three weeks after starting treatment, they had a febrile, purple and erythematous papular rash of the trunk and limbs. There was a biological inflammatory syndrome and skin biopsy disclosed an infiltrate of the dermis rich in neutrophils. Lesions regressed after stopping hydroxychloroquine and introducing systemic corticosteroid therapy. Allergologic tests discussed the differential diagnosis with a delayed-type hypersensitivity reaction.ConclusionWe report two exceptional cases of drug-induced Sweet's syndrome related to hydroxychloroquine treatment in autoimmune rheumatic diseases.