Profil étiologiques des thromboses veineuses profondes en milieu de médecine interne : une étude rétrospective de 318 cas

Objective

Venous thromboembolic disease is a common condition. Deep vein thrombosis (DVT) and pulmonary embolism are the most common manifestation but other locations may also occur. The objectives of the study were to estimate the incidence and determine the epidemiologic, topographic and associated conditions of venous thromboembolic disease in a department of internal medicine.

Methods

A retrospective study of a series of 318 cases of DVT was conducted in Internal Medicine CHU Hedi Chaker, Sfax, during a period of 15 years (1996–2010).

Results

DVT of the lower limbs was the most common location (87%). Other sites of DVT was noted in 16.35% of cases including upper limbs (19 cases), vena cava (16 cases), cerebral veins (10 cases), portal vein (10 cases) and hepatic vein (3 cases). A risk factor of VTE was found in 274 patients (86.1%). A state of thrombophilia was retained in 203 patients (63.5%). It was a hereditary thrombophilia (22.6%), an antiphospholipids syndrome (19.1%), Behçet's disease (16.4%) and neoplasia (7.2%). The study of the distribution of venous thrombosis as the seat and etiology showed that: the antiphospholipid syndrome was the most associated conditions with the upper extremity DVT (31.7%) whereas Behçet's disease was the most frequent etiology of vena cava thrombosis (7 cases) and the cerebral vein thrombosis especially in young males.     

Dysidrose : étude étiologique et apport des tests épicutanés

The etiology of pompholyx (dyshidrotic eczema) is a challenging diagnostic problem. The only established etiological link is between dyshidrosis and tinea pedis. Here, we report the results of a review of the causes of dyshidrosis in our patient population, focussing on allergic aspects. This was a prospective study carried out between June, 2003 and May, 2004. Epidemiological and clinical data were obtained for all the patients. They all had patch tests with the European patch test series. Sixty-two patients with pompholyx were included. Gender distribution was equal and the mean age of the patients was 31 years. Tinea pedis was reported in 35.5% of the patients. The patch tests were positive in 35.5% and relevant in 19% of the cases. The statistical analysis showed, on one hand, a significant relationship between gender and a positive patch test to nickel, and on the other hand, between work in a hot, wet environment and a positive patch test to chromium. These results revealed evidence of an increased frequency of tinea pedis and of sensitization to metals in patients with pompholyx compared to the general population. This suggests that in the development of pompholyx, sensitization to metals may be involved in a multifactorial process that includes both environmental and personal factors. However, we could not demonstrate a causal relationship between metal sensitization and pompholyx. Nevertheless, common factors might be involved in generating these two skin conditions.