Prise en charge diagnostique et thérapeutique de la tuberculose urogénitale

Genito-urinary tuberculosis is the fourth most common manifestation of the disease, but it is often underestimated by clinicians because of few and non-specific symptoms and insidious disease course. The most common urinary findings are multiple ureteral stenosis. The most common genital involvement is an epididymal nodule for men and a chronic salpingitis for women. The definite diagnosis of genito-urinary tuberculosis is obtained on the basis of culture studies. Due to the paucibacillary nature of the disease, especially of genital location in woman, a probable or presumptive diagnosis is frequently considered with several parameters including radiological imaging (abdominal CT-scan, pelvic ultrasound, pelvic MRI). Endoscopic and surgical procedures are frequently required to obtain specimens for histopathologic and bacteriological studies. Medical treatment is the method of choice, with a combination of four drugs, namely isoniazid, rifampicin, ethambutol and pyrazinamide, followed by a two-drug regimen, for a total of six month duration. Surgery might be indicated in complicated genito-urinary tuberculosis (decreased renal function, infertility, urologic complaints).     

Intérêt du traitement non opératoire des contusions hépatiques dans les pays en voie de développement

Introduction

Non-operative management is becoming more and more important in blunt liver trauma. The availability of high-quality equipment is one of the main conditions for the success of this approach. We try to assess the value of this type of care in developing countries through the results of a series of 25 patients.

Materials and methods

A series of 25 patients received non-operative treatment. The severity of liver damage was assessed according to Moore-Scanner Mirvis classification. The clinical and paraclinical data were analysed, as were morbidity and mortality.

Results

Traffic accidents were the leading cause of blunt liver trauma here. Hepatic lesions of type III and IV were the most frequent and observed in 70% of patients. The concept of multiple traumas was very common. The average duration of monitoring was 15.6 days. Eight patients were transfused and the average number of red blood cells was 3.8 per patient. Three patients also required surgery. One of the three patients operated died from septic shock secondary to infection in areas of pulmonary contusion.

Conclusion

Non-operative management of blunt liver trauma enabled us to obtain satisfactory results. In our opinion, it should therefore be adopted as the treatment of choice in developing countries, provided a minimum of infrastructure is available for the transfusion of labile blood products and radiological and biological controls.     

Indications de la désensibilisation en fonction des données épidémiologiques récentes

In most cases, hymenoptera venom allergy is caused by bees or wasps, but also occasionally by hornets, bumblebees or other members of the Vespidae family. The prevalence of sensitisation to venom in adults who have not had an allergic reaction following an insect sting but who have a positive skin test and/or specific IgE is estimated to be between 9.3% and 28.7%. The prevalence of systemic reactions in the general population reported in the literature ranges from 0.15% to 3.3%. The risk of having another systemic reaction following a subsequent sting depends on a number of factors: (1) the severity of the preceding reaction, (2) age, (3) the responsible insect, (4) occupation, (5) interval since the previous reaction. The risk of having a particularly severe reaction also depends on several other factors: the presence of cardiovascular disease, treatment with a beta-blocker, an elevated serum tryptase, and the presence of mastocytosis. The indications for venom immunotherapy in patients with positive skin and/or blood tests must take include consideration of the risk factors for a severe reaction with a new sting.