La Tunisie médicale (Tunis Med)

Publisher: Ordre des médecins de Tunisie; Société tunisienne des sciences médicales

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Other titles Tunisie Medicale
ISSN 0041-4131
OCLC 2268769
Material type Periodical
Document type Journal / Magazine / Newspaper

Publications in this journal

  • La Tunisie médicale 11/2015; 93(5):330-331.

  • La Tunisie médicale 11/2015; 93(5):332-334.
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    ABSTRACT: Background: The pollen-foods syndrome is rare and of difficult diagnosis. The aim is to report a rare case, it's the four case reported in the literature. Case report: A 48-year-old woman presenting with palatal itching and generalized urticaria following ingestion of olive fruit, 5 years after being diagnosed with olive pollinosis. She did not have a history of other food allergy or urticaria. The prick-test was positive in olive pollen.The olive pollen specific IgE was positive. The oral provocation test was positive for olives and negative for olive oil. The diagnosis of "pollen-food olive-olive syndrome" was accepted. Interestingly, in this rare case the patient developed olive fruit allergy in the presence of olive pollinosis, but did not experience allergic symptoms to fruits other than olive. Conclusion: In spite its rarity this syndrome should be evoke particularly in our country.
    La Tunisie médicale 11/2015; 93(5):326-327.

  • La Tunisie médicale 11/2015; 93(5):328-329.

  • La Tunisie médicale 11/2015; 93(5):334-336.

  • La Tunisie médicale 11/2015; 93(5):329-330.

  • La Tunisie médicale 11/2015; 93(5):336-337.

  • La Tunisie médicale 11/2015; 93(5):331-332.
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    ABSTRACT: Pulmonary mucormycosis is a rare, devastating, opportunistic fungal infection, caused by the ubiquitous filamentous fungi of the Mucorales order of the class of Zygomycetes. This infection occurs principally in some particular conditions, specially in diabetic patients and immunocompromised host, and rarely in cirrhotic patients. The diagnosis of mucormycosis can only be confirmed by pathological and mycological examination of biopsy specimens. We report a case of pulmonary mucormycosis in a 68-year-old woman with underlying liver cirrhosis and diabetes mellitus. Endoscopic and radiologic findings supported the diagnosis of hydatid cyst of the lung. The patient underwent surgical resection and was started on amphotericin B, after pathological examination. Unfortunately, she succumbed to the infection within one month of surgery.
    La Tunisie médicale 09/2015; 93(4):259-62.

  • La Tunisie médicale 09/2015; 93(4):270-1.
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    ABSTRACT: Measurement of thyrotropin and free thyroxin made using immunoassays are usually needed in clinical endocrinology. Here, we report a case of a patient with type 2 diabetes who presented a weight loss. To eliminate hyperthyroidism, thyroid function tests were performed. Free thyroxin (FT4) was decreased using two automated immunoassays TOSOH AIA 1800 and Roche ELECSYS 2010, with a normal thyrotropin value. Thyroid function tests repeated a month later were normal. The patient's history revealed contact with sheep, which may partly explain the interference. Investigations into the patient's serum were carried out using both the PEG test and dilution test. Interference factors were probably antibodies. Despite progress in immunoassays, we should be aware of interference occurrence since it can lead to false results, unnecessary investigations and incorrect treatment. Thus, simple tests must be carried out as if interference in immunoassays were suspected. Dilutions and PEG tests are generally performed as first line investigations.
    La Tunisie médicale 09/2015; 93(4):263-5.
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    ABSTRACT: Background: Nocturnal gastroesophageal reflux has been shown to be associated with the more severe forms of gastroesophageal reflux disease (GERD), particularly with extraesophageal manifestations as well as complications of mucosal damage. Aim: To determine the frequency of nocturnal gastro esophageal reflux disease on 24-hour esophageal pH monitoring in patients with digestives or extra-digestives symptoms and to evaluate the clinical and pHmetric characteristics of nocturnal reflux in these patients. Methods: We conducted a retrospective study based on results of 24- hour esophageal pH monitoring during a 11-year period in patients with or without digestive symptoms of gastroesophageal reflux disease. The nocturnal gastroesophgeal reflux was defined. Results: We studied 696 patients (299 men, 397 women; mean age: 34.05 years). Gastroesophageal reflux was found in 350 patients (50%). Nocturnal reflux was observed in 240 patients (34.3%), mostly in association with pathological reflux in the total period (223 cases). Compared to the diurnal period, the nocturnal period was characterized by fewer number of reflux episodes (21.9±27.4 vs 67.4±5.,1 ; p<0.0001), more longer duration of reflux episodes (24.4±37.9 minutes vs 13.9± 17.5 minutes ; p<0.001), and a lower symptomatic correlation (26% vs 45% ; p=0.0005). Conclusion: Nocturnal reflux is associated with overall reflux on the 24 hour examination. Nocturnal period is characterized by longer reflux episodes, less number of reflux episodes and less symptomatic correlation.
    La Tunisie médicale 09/2015; 93(4):223-7.
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    ABSTRACT: Background: Non-invasive examination of coronary artery disease is an attractive and rapidly evolving possibility. In certain clinical situations ,multi-detector computed tomography coronarography (MDCT) is currently considered as a promising technique alternative to conventional coronary angiography (CCA). Purpose: We suggest from our personal study and from a review of the literature, to analyze diagnostic accuracy of MDCT , its limits and to deduct, its practical implications and its indications. Methods: 105 patients underwent 64-slice MDCT . Coronary angiography was performed every time when the MDCT was pathologic. In two cases the MDCT was realized in complement of inconclusive coronary angiography .Study of coronary arteries was based on "per -segment" and "per- patients" analyse Results : The mean age was 63,3 years., sex ratio was 0 ,7. Hypertension was noted in 63% of cases 29 ,9 % of patients had mellitus diabetes.The initial clinical presentation was unusual chest pain in 46 patients, exercise chest pain in 40 cases. the MDCT was done for the detection of silent ischemia In 5 cases, for screening of CAD in patients with dilated cardiomyopathy in 5 cases , before cardiac surgery in 3 case and before non cardiac surgery in 2 cases. MDCT was normal in 30 patients ( 28% ) so coronary angiography was avoided in 60% of patients with unusual chest pain, and in 50% of patients with dilated cardiomyopathy and in also in 50% of patients selected for cardiac or non cardiac surgery. In per-segment study the sensitivity, specificity, positive and negative predictive value of the MDCT in detecting coronary stenosis were respectively 89 %,98% , 91% and 97% versus, 98%,89%,94%, 95% the per-patient evaluation .The MDCT was inclusive in10 patients because .of calcifications in 8 cases and because uncontrolled unchecked heart rate in 40 cases Conclusion : our results for negative predictive value of MDCT are similar to reports from the literature. This suggests that in this clinical setting , MDCT may replace coronary in patients with low probability of coronary artery diseases, its is also useful for assessment of cardiomyopathy and before cardiac or non cardiac surgery.
    La Tunisie médicale 09/2015; 93(4):248-56.
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    ABSTRACT: Aim: To investigate the efficacy of misoprostol used alone, and the time of fetal expulsion for medical termination of pregnancy in the second trimester. Patients and methods: 50 patients were enrolled in a prospective study over two years and in whom termination of pregnancy was indicated between 14 and 28 weeks of amenorrhea. Misoprostol was reported in a well-defined protocol: group 1: 2 tablets every 3 hours as intra vaginal, group 2: half dose for women bull 4th or more or carrying a scarred uterus for terms greater than or equal to 22 weeks of amenorrhea. Results: 48 patients expelled misoprostol alone and we have used an aspiration in two cases. The period of expulsion for 24 hours was 97% for the first group and 90% for the second. Conclusion: using misoprostol within this protocol is effective and reduce the time required for the fetal expulsion of the secondtrimester pregnancy.
    La Tunisie médicale 09/2015; 93(4):212-6.
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    ABSTRACT: Background: One of the major side effects of anti-proliferative treatment is their medullar toxicity. This toxicity is particularly important in neutrophils and leads to a neutropenia. Fever during these episodes of neutropenia is a frequent complication but remains of indeterminate origin in 60% of cases. It's a medical emergency because of rapid evolution and a significant increase in mortality up to 10%. Thus, these episodes should be prevented and treated in priority with un empiric and large spectrum antibiotherapy, taking into account the bacterial ecology of each hospital. Aim: The aim of this study was to determinate the clinical, therapeutic and evolutive characteristics of febrile neutropenia (FN). Methods: This retrospective study concerned 186 episodes of FN in 136 patients treated for solid tumors and lymphoma in the department of medical oncology of Sfax from january 2006 to December 2010. Results: Mean age was 40 years (1 to 81) and sex ratio at 0.97. They were trated mainly solid tumors in 86.02%. Median time to onset of FN was 11 days and the mean duration of neutropenia was 5 days. 24.2% had a neutrophil count (ANC) <100 / mm3. Fever was clinically documented in 33.87%. Patients have mainly ORL clinical manifestations (38.46%) and specially mucositis (50%). Only 17.2% of cases were microbiologically documented and a bacteria was isolated in 76.46% of them in blood cultures, Gram-negative bacilli (GNB) accounted for the majority of organisms isolated in different samples in 66.66% of cases. Enterobacteriaceae were the most frequent dominated by Klebsiella spp, followed by Escherichia coli. Pseudomonas aeruginosa ranked second after the Enterobacteriaceae (21.21%). The Gram-positive cocci (GPC) were found in 24.24% mainly Staphylococcus aureus. The first line of empirical antibiotic therapy was associated in 88.7% of ceftazidime and amikacin or a fluoroquinolone that has to have an efficiency of 72.12%. The rate of death due to infection in our series was 9.14%. Conclusion: Our results are consistent with data in the literature concerning the short duration of neutropenia, causing fever and mortality, but our bacterial epidemiology is different from the current literature, where there is a predominance of CGP unlike our predominantly the BGN. And prescribing empiric antibiotic therapy must take into account the epidemiological and ecological particularities of each country, each hospital or each department.
    La Tunisie médicale 09/2015; 93(4):217-22.
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    ABSTRACT: Background: Cow's milk protein allergy (CMPA) can be responsible of a variety of symptoms and can be caused by IgE or non-IgEmediated reactions. The remaining questions concern the diagnosis (what are the most suggestive clinical manifestations, the laboratory evaluations which play a supporting role, and the management of CMPA in breast fed infants and formula-fed infants. Methods: Review of the pub med, science direct, Cochrane library, using the key words cow's milk protein allergy, guideline, and child. Evidence was levelled A, B, C. Results: No symptom is pathognomonic. A thorough history and careful clinical examination are necessary to suspect the disease. Skin prick tests, and serum specific IgE are only indicative of sensitivation to CMP. A double-blind placebo-controlled challenge is considered the gold standard in diagnosis, but in practice only an open challenge is performed. The patient with suspected pathology will follow a cow's milk free diet for 2-4 weeks. Formula-fed infants get an extensively hydrolyzed formula .If the allergy is present, clinical manifestations will disappear. If symptoms do not improve, an amino acid based formula should be considered. In severe Cow's milk protein allergy with life-threatening symptoms, an amino-acid formula is recommended. The infant should be maintained on an elimination diet until the infant is between 9-12 months or at least for 6 months. The overall natural evolution of the disease is favorable with most patients achieving tolerance to milk by the age of five years. Conclusion: The importance of defined diagnostic criteria needs to be emphasized. It precludes infants from an unnecessary diet and avoids delay in diagnosis, which can lead to malnutrition.
    La Tunisie médicale 09/2015; 93(4):205-11.
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    ABSTRACT: We report a case of Lymphocytic Lymphoma presenting with primary manifestation in the prostate. A 82 year-old man presented to emergency department with acute urinary retention. Digital rectal examination revealed a voluminous and firm prostate. Histology confirmed involvement of the prostate by small B Lymphocytic Lymphoma. The patient was treated with chlorambucil. Lymphocytic infiltration of prostate is a rare manifestation. However this may also be the first sign of an undiagnosed lymphoma. This observation shows that the prostatic lymphoma must be considered among the causes of low urinary retention.
    La Tunisie médicale 09/2015; 93(4):249-58.
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    ABSTRACT: Background: colon cancer is a public health problem worldwide and in Tunisia. The prognosis of patients with unresectable colorectal cancer varies according to the stage. The indication for adjuvant chemotherapy is well established in the colon cancer stage III, while it remains a matter of controversy for stage II. The aim of this work is to identify the epidemiological and anatomoclinical assess therapeutic outcomes in terms of overall survival of patients with high-risk stage II and stage III colon cancer treated with surgery and adjuvant chemotherapy. Methods: DS: It's a retrospective study based on 119 patients with colon adenocarcinoma from 1996 to 2010. This patients suffering from colon cancer classified stage II and III having them all radical surgery and adjuvant chemotherapy. Results: The average age of our patients was 53 years. The surgery was performed in an emergency situation in 53 patients (44%). Stages II and III, respectively, were observed in 47% and 53% of cases. Three regimens of chemotherapy were used: protocol FUFOL (50%), followed by FOLFOX (34%) and the protocol LV5FU2 (16%). Overall survival of patients all stages combined was 73.4% at 5 years. Stage III of the TNM classification (p = 0.03) and the number of cycles of chemotherapy <6 (p=0.02) were a negative prognostic factors influencing overall survival. Patients stage III treated with FOLFOX chemotherapy type had a better survival than those treated with chemotherapy type LV5FU2 or FUFOL with a significant difference (p= 0.05). Conclusion: Our results are consistent with those in the literature. The prognosis of colon cancer is improving thanks to recent advances that have enabled the integration of new cytogenetic factors in the therapeutic decision.
    La Tunisie médicale 09/2015; 93(4):242-7.