Cirrhosis and cirrhogenic diseases in Tunisian children. Multicenter study of 65 cases]

Over a period of 10 years, 65 cases of hepatic cirrhosis and cirrhogenic disease have been observed in five Pediatric Centers in mid Tunisia. The age of the patients ranged from 30 days to 14 years. The main etiology was biliary cirrhosis (24 cases) followed by post-hepatic cirrhosis (15 cases). Eight cases had a metabolic origin, which was Wilson's diseases in five cases. Three children had cirrhosis of a pre-hepatic origin. In 15 children, the liver biopsy showed the presence of cirrhosis but the etiology could not be found. Preventive measures are needed in order to reduce the frequency of cirrhosis among Tunisian children: 1) early recognition of biliary atresia, 2) vaccination against hepatitis B virus of at risk neonates and children, 3) Genetic counselling and search for familial cases when cirrhosis of metabolic origin is identified, particularly Wilson's disease.     

Pregnancy complicating irradiation-induced constrictive pericarditis.

A case is reported of a 24-year-old primigravida who had severe effusive constrictive pericarditis secondary to mediastinal irradiation following chemotherapy for Hodgkin's disease. Pregnancy was threatened by serious maternal cardiovascular complications, and a non-viable fetus was born spontaneously and prematurely. Patient was completely asymptomatic before pregnancy.     

Amniotic band syndrome. Case report

Amniotic band syndrome is a rare fetal malformation involving limb ring strictions, cranio-facial and trunck abnormalities. The authors report a case of 5 months old infant with also facial cleft. The plastic reconstructive surgery leads to a better functional result. This affection represents a sporadic disease without genetic causes. The pregnancy ultrasonography visualise fetal abnormalities.     

Effects of lingual nerve afferents on swallowing in sheep

We investigated in sheep the effects of stimulation of the thick afferent fibers running through the lingual nerve (LN) upon the activity of some of the muscles and medullary interneurons or motoneurons which are active during swallowing. Using electromyography (EMG), and extra- and intracellular neuronal recording, we demonstrated that LN stimulation inhibited triggering and/or distal progression of deglutition reflexly induced by stimulation of the superior laryngeal nerve (SLN). This inhibition appeared as a delay, or the interruption or total suppression, of the EMG and neuronal swallowing activities, depending on the interval between SLN and LN stimulation. It was apparent at the level of the muscles and motoneurons of the nucleus ambiguus, as well as at the level of the interneurons of the dorsal medulla within or around the nucleus of solitary tract, which are assumed to be the core of the organizing system for swallowing, the so-called central pattern generator (CPG). Taking into account the stimulation parameters used in our experiments, it was likely that only LN-mechanosensitive fibers were excited. These fibers were involved in the jaw-opening reflex, and possibly in mastication regulation. Therefore, inhibition of swallowing could result from interactions between the hindbrain mastication and swallowing CPGs. However, it was also possible that mechanosensitive afferents acted upon the swallowing CPG directly or indirectly through supramedullary, especially cortical, loops.     

Investigation of the spread of human visceral leishmaniasis in central Tunisia

The epidemiology, clinical patterns, and spatial spread of Mediterranean visceral leishmaniasis were retrospectively studied in central Tunisia. The clinical profile of the disease was typical of the Mediterranean infantile form. Malnutrition and associated infectious diseases were observed in 62.5% and 55% of cases, respectively. The case-fatality rate was 6.2% and resistance to meglumine antimonate was observed in 1.6% of patients. The annual incidence of cases increased from approximately 10 cases per year before 1991 to approximately 50 cases per year between 1992 and 1994. The cumulative incidence was 133.7/100,000 among children aged < 15 years. This increase was preceded by 3 years of high mean annual rainfall in the region. The spatial distribution of the incidence of the infection through time showed an aggregation of cases in the northern part of the area where intensive agriculture projects took place during the last 10 years, leading to the establishment of a stable Leishmania infantum transmission cycle below the Atlas mountain chains, and an evident tendency to a progressive extension to the south.     

Mammography screening of breast cancer in Tunisia. Results of first experience]

This article reports the results of a mammography screening program of breast cancer, realized in the department of Radiology, Charles Nicolle hospital. A free screening mammography with two incidences was offered to women aged from 40 to 70 years old. 2200 mammographies were realized from May 1995 till July 1997. Women having a positive test benefited of a diagnostic explorations in the same unity. The positive test rate was 24%. Predictive positive value was 31%. This program allowed to detect 10 subclinical cancers, corresponding to a rate of detection of 4.5 cancers for 1000 women. This program is a first experience which demonstrated the feasibility of the mammography screening to wide scale and allowed the medical and paramedical team to acquire an experience.     

Clinical features and course of Kawasaki disease in central Tunisia: a study about 14 cases collected over a period of three years (2000-2002)

OBJECTIVE: To analyze the clinical features and course of Kawasaki disease in central Tunisia. We studied retrospectively 14 cases of children with Kawasaki disease collected in tunisian center during three years (2000-2002). The study is about 11 boys and 3 girls (sex - ratio: 3.6/1) aged from 6 months to 8 years (mean age : 4 years). Twelve patients had at least 5 diagnostic criteria of the illness, the two others had an incomplete form. We noted cardiac complications in seven patients treated belatedly, beyond 10 days of progression, because of atypical clinical presentations. All patients had all a middle caliber coronary aneurysm that was complicated by a thrombus in three cases, associated with pericarditis and minimal mitral insufficiency in a case and with a cardiac rhythm disturbance (block of branch) in another case. Besides the cardiac complications, several other visceral manifestation could be noted: joint symptoms in five cases, GI tract symptomes in three cases, neuro-meningeal in two cases and urinary trad symptomes in two other cases. Specific treatment (aspirin with antiinflammatory dose and intravenous immune globulin (IVIG)) has been instituted in all patients. The course was favorable for 12 patients with fast regression of clinical manifestation and progressive normalisation of biologic values. Two patients did not respond to the initial IVIG treatment, and had to recense received an additional course of IGIV but without clinical nor biological improvement. These two patients were treated with corticosteroids. Cardiac lesions disappeared completely in all patients even for those with thrombosis and in patients with IVIG-resistant Kawasaki disease. Only one patient had kept neurologic sequellae: aphasia, bevavioral problemes and partial epilepsy. CONCLUSIONS: Kawasaki disease is not rare in our region. Incomplete or atypical presentations are frequent and are a source of diagnostic delay. Coronary aneurysm due to the delay of treatment often regresses even in patients with IVIG-resistant Kawasaki disease.     

Effect of combined active recovery from supramaximal exercise on blood lactate disappearance in trained and untrained man

The purpose of this study was to determine the effect of different modalities of individualized active recovery on blood lactate disappearance after supramaximal exercise in subjects with different levels of aerobic fitness. Fourteen healthy subjects (7 trained and 7 untrained subjects mean age 20 +/- 1.5 and 19.5 +/- 1.5, respectively) participated in this study. They performed three supramaximal intermittent exercises at 60 % of the time to exhaustion at 120 % of the maximum aerobic power (MAP) with 5-min recovery periods (2 x 5 min). The third exercise was followed by 20 min of recovery. The effects of four types of recovery were compared in trained and untrained subjects: passive recovery (PR), an active recovery at an intensity corresponding to the first anaerobic ventilatory threshold minus 20 % (VT1), an active recovery at an intensity corresponding to the second anaerobic ventilatory threshold minus 20 % (VT2) and a combined active recovery (CR) which consisted of 7 min at VT2 followed by 13 min at VT1. Blood lactate levels were measured at rest and during the recovery periods. Peak blood lactate after supramaximal exercise was observed significantly earlier with VT2 and CR (4th min) than VT1 and PR (7th min) in trained and in untrained subjects. Combined active recovery (CR) showed a significantly faster lactate disappearance than did PR, VT1, or VT2 from the 7th min of recovery in trained subjects (p < 0.05) and at the 20th min in untrained subjects (p < 0.05). CR and VT2 conditions showed earlier peak blood lactate (4th min) than PR or VT1 (7th min). Blood lactate disappearance was faster in trained than untrained subjects during combined active recovery. This result suggests that the level of physical fitness plays an important role mainly in the pattern of blood lactate decrease during combined active recovery.