Bilateral malignant non-Hodgkin's lymphoma

Non Hodgkin's lymphoma (NHL) of the testis in young patient are rare. Bilateral involvement varies from 5 to 20% of cases and has a negative prognosis. The authors report a case of bilateral non Hodgkin's lymphoma of the testis in a 35 year old man. The patient died six months after the diagnosis.     

Presacral fibroma in a young laborer presenting with chronic lumbago

A 24-year-old patient had a long history of low backache. After examination he was found to have a presacral mass grossly displacing the rectum anteriorly. Surgical exploration revealed a large rounded mass (20x17x10cm) occupying the presacral space and adherent to the sacral promontory. The mass was totally excised. The histology was a benign fibroma. The patient persued an excellent post-operative course and has remained symptom free for one year now.     

Value of early systematic transoesophageal ultrasonography after mitral valve replacement by Saint-Jude prosthesis

The aim of this study was to assess the value of the routine multiplane transoesophageal echocardiography (TEE) in the early postoperative period after mitral valve replacement with a Saint Jude Médical (SJM) mechanical prosthesis. This prospective work enrolled 56 patients who have been operated between September 1999 and September 2001, all these patients had a multiplan TEE after 14.7 days (8-29 days) of post-operative. The effect of peri-prosthetic leaks was 59%. They were always minimal and asymptomatic. 68% of them disappeared at the late exam. An asymptomatic intermittent blockage of an leaflet had been noted in one patient. It appears to us today indispensable to achieve a systematic TEE in the early post operative period after mitral valve replacement. This exam remains little aggressive and comfortably supportable by the patient in look of information brought.     

Bullous pemphigoid in children. Report of three cases

Bullous pemphigo?d (BP) is an acquired immunobullous disease that usually affects adults and rarely children. About 60 cases of infant PB have been reported. Diagnosis is based on immunofluorescence investigations. Clinical, histological and immunopathological findings in childhood PB appear to be not different from the adult. Nevertheless, oral mucosal and palm and sole lesions seem to occur more frequently. We report 3 cases of children BP in one girl and 2 boys, aged respectively of 7.2 and 3 years. Palm and sole were affected in 1 case, and no oral mucosal lesion was noted. Recovery was reached in all cases under dapsone. Characteristics of BP in children are discussed with comparison to literature data.     

Congenital diaphragmatic hernias in the adult: report of six cases

The anterior hernia or the fissure of Larrey and Bochdalek hernia are exceptional in adult. We present 6 cases of congenital diaphragmatic hernia revealed in adult. Three hernia of the fissure of Larrey and three Bochdalek hernia. We discuss the different clinical, radiological, and therapeutic aspects of these hernia. We insist on the gravity of strangulated hernia and their surgical treatment.     

Dubin-Johnson syndrome: molecular basis and pathogenesis

The Dubin-Johnson syndrome (DJS) is an autosomal recessive liver disorder characterized by a chronic conjugated hyperbilirubinemia a dark greenish appearance of liver tissue, a double peaked sulfobromophthalein clearance curve, and a characteristic lysosomal accumulation of black pigment "melanine-like" in the hepatocytes. Laboratory datas indicated an increased urinary excretion of coproporphrin isomer I and leukotriene metabolites. In an effort to understand the morphological pattern and the pathogenesis of this disease we reviewed four cases of DJS.     

Malignant hyperthermia

Malignant hyperthermia is a potentially fatal pharmacogenetic disease triggered by volatile anesthetics and/or succinylcholine. Dysregulation of intracellular calcium homeostasis is the trigger of the acute crisis. Malignant hyperthermia crisis correspond to an hypermetabolic state, which occurred acutely and interesting skeletal muscular cell. Early manifestations grouped tachycardia, tachypnea, masseter spasm, mixed acidosis and raise of the end expiratory CO2 pressure. Hyperthermia is a late sign, rhabdomyolysis is a sign of the severity of the malignant hyperthermia. The successful treatment is based on an early diagnosis, immediately interruption of triggering agents, intravenous administration of Dantrolene in sufficient dosage and starting of adequate symptomatic treatment. Prevention of this complication is based on asking the patient about genetic predisposition to malignant hyperthermia. Confirmation of the susceptibility to malignant hyperthermia can be provided by in vitro contracture test with halothane or caffeine after muscle biopsy.     

Hypertrophic cardiomyopathy: a rare cause of vascular dementia. A case report

Herein, we report a case of a 51 year old man who experienced three ischemic cerebral infarcts in a time of few months. The patient consulted after the third accident. Neurological presentation included pseudobulbar syndrome with a mild cognitive deficit, aphasia, left hemiparesia, hemiasomatognosia and homonymous lateral hemianopsia. Cerebral tomodensitometry and magnetic resonance imaging evidenced large infarcts images involving right middle cerebral artery territory and bilateral borderline zones in the junction of the territories of the middle and posterior cerebral arteries. Ambulatory 24 hours ECG recording (Holter) revealed two hits of non-sustained ventricular tachycardia. Transoesophageal echocardiography conveyed to the diagnosis of hypertrophic cardiomyopathy and displayed the presence of a left auricular thrombus. Anticoagulant therapy and rehabilitation allowed a substantial recovering of the patient's cognitive functions and wasting of the intracardiac thrombus. The clinical features observed in our patient meet the recommended DSM IV diagnosis criteria of vascular dementia, an exceptional complication of HCM. The clinical findings, neuroimagery investigation results, and the chronological link between cerebral attacks and cognitive function deterioration argue for a demential syndrome of vascular origin resulting from multiple embolic infarcts involving medium sized arteries (multi-infarct dementia). The authors emphasize the rarity of such observation. HCM must be considered as a potential cause of embolic stroke and likewise a multi-infarct dementia.     

Tunisian health profile: present state and trends

We will try to value the Tunisian Health Profile, its present state and its tendencies. Data have been collected by various sources, in particular international and national organism. The total fertility rate passed from 8 in 1966 to 2.01 in 1999. Besides a light ageing of the population is started (9% of the population are aged of more than 60 years in 1999). Death rates recorded a decrease, mainly of the infantile mortality (140%@1000 in 1966 against 24.7%@1000 in 1999) and the maternal mortality (68.9 per 100,000 living births in 1994 against 220 in 1980-1984). The life expectancy at birth passed from 51 years in 1966 to 72.4 years in 1999. According the morbidity we attend the receding of the majority of transmitted diseases. Resources injected in the system of cares also evolved: The medical density passed from 1 per 6700 inhabitants in 1966 to 1 per 1300 in 1999. Tunisia recorded the most elevated scores for the preventive activities in particular at the vaccinal coverage. The global evolution of the Tunisian health profile is marked by the epidemiological transition buy which pass the country currently. This phase is delicate because it's generating of a growth of care expenses. Decision-makers must be careful to consider advantage priorities and the profitability of the investments.