Actinomycose appendiculaire localisée (à propos d’un cas)

Actinomycosis is a suppurative granulomatous disease caused by a different Actinomyces species, and most generally by a Gram-positive anaerobic bacillus, Actinomyces israelii. Actinomycosis of the appendix is an infrequent pathology. Diagnosis is frequently done postoperatively on the analysis of a surgical specimen. Histology is required for confirmation. We report here the case of a woman who presented with an actinomycosis of the appendix diagnosed after surgical treatment. This case shows that actinomycosis of the appendix is an infrequent pathology that merits to be known. With antibiotic therapy, we can avoid surgery or wide resections.     

La cholécystite xanthogranulomateuse, un diagnostic histologique inattendu: à propos d’un cas

Xanthogranulomatous cholecystitis (XC) is an uncommon form of chronic inflammation of the gallbladder characterized by a thickening of the gallbladder wall. It may clinically and radiographically mimic gallbladder carcinoma. In spite the progress of imagery, preoperative diagnosis is still often difficult which can lead to inappropriate extended surgery. We herein report the clinical presentation of a 71-year-old man with no medical history who was admitted to our department with a chief complaint of intermittent pain in his right upper abdomen, radiating to the back since a year. There was no history of jaundice, fever, anorexia, or weight loss. Physical examination revealed no signs of cholecystitis. Routine laboratory tests including white cell counts were within normal ranges. For further examination, we performed an abdominal ultrasonography. It revealed a thickening of the gallbladder wall on the hepatic side. There was no associated biliary dilatation or gallstones. CT scan of the abdomen showed similar findings with regional enlarged lymph nodes. The boundary of the gallbladder and liver parenchyma was ill defined. The patient was discharged in good condition on the 7^th day following surgery. He is now in good health eight months after surgery. As imaging findings were strongly suggestive of malignancy, we decided to perform a radical surgery. Peroperative finding shows a gallbladder mass invading the liver bed with some regional lymph nodes. We performed subsegmentectomy of the liver S4a + S5 and lymph node dissection. Histological examination showed diffuse chronic inflammatory cell infiltration with focal lipid-laden macrophage accumulation in the gallbladder wall and conclude on chronic xanthogranulomatous cholecystitis with no evidence of malignancy. The patient was discharged in good condition on the 7th day following surgery. He is now in good health 8 months after surgery. Xanthogranulomatous cholecystitis is a rare destructive inflammatory disease of the gallbladder which may be indistinguishable from a malignant neoplasm on the basis of imaging findings. The clinical presentation is similar to that of cholecystitis. A correct preoperative diagnosis of XC is important to avoid unnecessary laparotomy.     

Hémorragie diverticulaire colique rare chez un noir africain: à propos d’un cas

Colonic diverticular disease is the most common cause of lower gastrointestinal tract bleeding. In many cases the source of the bleeding may not be identified. Medications, drugs and bleeding abnormalities are few well known risk factors. We are reporting the case of a 75 years old black African man with diverticular disease who presented a bleeding form a colonic diverticulum. The patient underwent a total colonoscopy examination for massive lower gastrointestinal tract bleeding of 72 hours after he had eaten fish few days before. His past medical history was not significant. The colonoscopy was performed using a Fujinon video and endoscope system. The finding was a bleeding from a sigmoid diverticulum where a bone fish has been lodged. There was no other cause of active bleeding. The bleeding stopped after we injected 1/10000^e of Adrenaline in the diverticulum with endoscopic removal of the foreign body. There was no recurrence of the hemorrhage. A bleeding from an embedded foreign body in the gastrointestinal tract may be suspected in patients staying in prisons, psychiatric units or consuming a lot of fish or practicing professions in relation with fish. A plain abdominal radiography may help to suspect the diagnosis     

Un asthme à l'arachide chez un enfant

We report the case of a 3-year-old child who had asthma caused by peanuts. The diagnosis was established by chance. Strict avoidance of peanuts led to complete remission of symptoms and rapid termination of inhalation therapy. Severe peanut allergy in asthmatic infants carries a risk of anaphylaxis. Hence, we believe that it is useful to look for peanut allergy in all infants with severe asthma in order to control the asthma and to prevent anaphylaxis.     

Tamponnade révélant un kyste hydatique intra-péricardique – un cas

Introduction

Hydatid disease is a parasitic infection caused by the development of the larval form of the Teania of Echinococcus granulosus. It is endemic in many regions of the world such as the Mediterranean basin. Location without pericardial cardiac involvement is extremely rare. In this case study, we will elaborate the case of an intra-pericardial hydatidosis disease without cardiac location revealed by a tamponade.

Observation

AA is a 60-year-old man with no pathological history and who was admitted for a tamponade assessment. Indeed, the cardiovascular examination showed a muffling of the heart sound and signs of a right heart failure. Besides, the ECG shows a microvoltage, and the chest radiography shows cardiomegaly. Moreover, the transthoracic echocardiogram confirmed the presence of an abundant pericardial effusion along with signs of a tamponade. It also reifies the presence of, at the intra-pericardial level, a multiple vesicular formation giving a cluster of grapes highly suggestive of an intra-pericardial hydatid disease. An emergency surgical drainage allowed removing about two liters of suspicious fluid along with cysts and white membranous. The pathological examination of the membranous confirmed the diagnosis of a pericardial hydatid cyst. The performance of a chest CT and an abdominal ultrasound's scan to identify other locations shows no further anomalies. The patient was put under medical treatment (Albendazole^®) and is showing a good clinical improvement.

Conclusion

The intra-pericardial hydatid disease is another cause of tamponade not to fail despite its rareness, as it is endemic to North African countries.     

Sildenafil(Viagra)用于心血管病患者(续)

Ⅳ.药-药相互作用及并存疾病状态 一、与硝酸盐的相互作用 若与Sildenafil同用,硝酸盐的扩血管作用大大加强,大大影响血流动力学,并可能发生致命性事件(辉瑞)。所有的硝酸盐及供NO剂,无论血流动力学的主要作用于何部位,均有此相互作用。Sildenafil还可能强化吸人的硝酸盐,如amyl nitrate或nitrite等,因此亦在禁忌之列。后者的作用是扩张血管,若用作保     

免疫耐受(tolerance)与调变(modulation)

免疫耐受（ｔｏｌｅｒａｎｃｅ）与调变（ｍｏｄｕｌａｔｉｏｎ）机体感染ＨＢＶ后形成的特异性免疫耐受，是影响病毒消除的主要原因。成人感染ＨＢＶ后，多为急性乙型肝炎。通过一次完全免疫反应清除病毒痊愈，仅５－１０％的患者成为慢性携带者，面胎儿或新生儿因垂直传...     

免疫耐受(tolerance)与调变(medulation)

核衣壳抗原(HBeAg)是细胞免疫反应的靶抗原之一,大量的HBeAg能抑制T细胞的分化增殖,后者又抑制细胞毒性T淋巴细胞(CTL),使其功能不全,不产生免疫应答反应,此即对HBeAg的免疫耐受。 胎儿或新生儿因垂直传播感染HBV时,母体血循环中抗