Bone mineral density in healthy Tunisian women

Interpretation of densitometric results requires a comparison with reference bone mineral density (BMD) values of normal age and sex-matched persons. Thus the aim of this study was to determine these values for healthy Tunisian women, to estimate the prevalence of osteoporosis and to compare our findings with other populations. A cross-sectional study of 1378 Tunisian women aged between 20 and 96 years was carried out using DXA (GE-Lunar Prodigy). Subjects with suspected conditions affecting bone metabolism were excluded. Measurements were taken at the lumbar spine and femoral neck. These values were expressed at T-scores, with reference to the mean BMD values of the group aged 20–40 years. The peak bone mass, estimated in this age group was 1.174 + 0.127 g/cm² at the lumbar spine and 1.016 ± 0.118 g/cm² at the femoral site. It was attained respectively within the age of 25 years and 36 years. For both sites, the expected decline in BMD was shown when the successive age groups [40–49 years] and [50–59 years] were compared. Bone loss was rapid during the first 5 years after menopause. Thereafter BMD declined slowly but continually. The prevalence of osteoporosis in the women over 50 years of age, taking account of peak bone mass observed in our cohort, was 23.3% at the spine and 17.3% at the femoral neck with a combined prevalence of 23.4%. These rates attained respectively 30.4%, 11.8% and 32.9% when we considered the Italian values, which demonstrate the variability of osteodensitometric depending to the reference population adopted.     

Tumeur à cellules de la granulosa juvénile de l’ovaire: à propos de deux cas

Juvenile granulosa cell tumor of the ovary is a rare neoplasm that makes up less than 5% of ovarian tumors in childhood and adolescence. The majority of they tumors are diagnosed in stage I (FIGO) with a favorable prognosis. The aim of this work was to describe the pathological, clinical and therapeutic features of this rare tumor of ovary. The authors describe a juvenile cell tumor expressed by an abdominal and genital syndrome occurring in 30 and 35-year-old two young females. The tumor was strictly localized in the ovary in one case; the second patient presented a bilateral ovarian tumor and peritoneal metastasis at the diagnosis. Clinical follow-up of the latter patient showed a recurrence with liver metastasis in spite of a radical surgical treatment followed by chemotherapy. The first patient has a favorable evolution with a follow-up of two years. Various prognostic factors of the juvenile granulosa cell tumor of the ovary are currently being evaluated. Surgery is the treatment for local disease. Patients with locally advanced, recurrent or metastatic tumors require chemotherapy, although the optimal regimen remains to be determined.     

Hemopigmented villonodular synovitis of the knee. Apropos of 2 cases

We report two cases of hemopigmented villonodular synovitis in two girls aged 5 years 9 months and 13 years respectively. This condition is a clinicopathologic entity of unknown pathogenesis and is exceedingly rare in childhood. Patients of both sexes can be affected, with no particular predominance. The clinical picture in our two patients consisted only in chronic hemarthrosis of the knee with occasionally tumor-like features. Arthrographic changes were not specific. Diagnosis was established upon arthrography and results of pathologic studies of biopsy specimens. Therapy of this condition is surgical and recurrences are infrequent.     

Bronchopulmonary aspergillosis: study of 17 cases

Aspergillosis is a fungic infection depending on the local or general physiologic and immunologic state of the host. We report the result of retrospective five year study (1995-1999) about 17 cases in the laboratory of Parasitology-Mycology of Rabta hospital in Tunis. Six aspergillomas were observed, they occurred after a pulmonary tuberculosis, two cases of allergic broncho-pulmonary aspergillosis described in two asthmatic patients, nine cases of invasive pulmonary aspergillosis complicating two cancers, one leukaemia, six chronic granulomatous disease. Aspergillus fumigatus is the most frequent species (67%). The clinical and biological characteristic of those will be studied, and compared with those of the literature.     

Emphysematous pyelonephritis. Two cases

The emphysematous pyelonephritis is a rare and severe renal infection characterized by the presence of gas in renal parenchyma and its perirenal spaces. We report two cases of emphysematous pyelonephritis in two diabetic women (53 and 50 years old respectively). In the first case, the treatment was based on nephrectomy because of the presence of a septic shock and three risk factors, which are acute renal failure, hematuria and thrombopenia. In the second case, the treatment was only medical. The evolution was favorable in the two cases. We insist in this article that this diagnosis should be considered in every female diabetic patient having severe acute pyelonephritis resistant to a well-conducted medical treatment.     

Toxocariasis: under-estimated disease. Report of 9 cases

Toxocariasis or visceral larva migrans is a parasitosis due to the migration in the human organism of animal ascarid larvae. Its importance is under-estimated and the reported tunisian cases are rare. We report nine cases of toxocariasis, noted between January of 2000 to March of 2002, in the laboratory of parasitology-mycology in La Rabta Hospital. They were six children and three adults. The clinical forms are varied: ophthalmologic form (5 cases), general syndrome (1 case), oedema (1 case) and hypereosinophilia (2 cases), and confirmed serologically by the presence of anti Toxocara canis antibody using ELISA test. Visceral larva migrans should be kept in mind to avoid severe forms such as ophthalmologic forms.     

Vertebroplasty success in a case of aggressive hemangioma

Vertebral hemangioma is a vascular tumor most oftenly asymptomatic and of casual radiological discovery. More rarely, it can be aggressive, causing neurological complications and therefore requiring a convenient and sustained therapy where vertebroplasty is of essential importance. In this context, we report a case of an aggressive vertebral angioma of L4 which was responsible for lumbocruralgy. She underwent verterbroplasty and then had a very good outcome. In this way we deal with the the different technics of vertebroplasty, their advantages compared to other therapeutic medical, and or surgical methods, as well as their complications.