F Marouan

Centre Hospitalier Universitaire IBN Rochd, Anfa, Grand Casablanca, Morocco

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Publications (9)7.97 Total impact

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    ABSTRACT: Cushing paraneoplasic syndrome is a rare cause of hypercorticism. We report a case of 35 year-old man presenting with Cushing's syndrome characterized by severe signs of hypercorticism and hypokalemia. Endocrine investigations were suggestive of an hypercortisolism linked to an ectopic adrenocorticotropic (ACTH) secretion, both at baseline (mean ACTH levels=275 pg/ml, urinary free cortisol excretion=3.898 mmol/24 h) and after pharmacodynamic testing (lack of inhibition of ACTH by dexamethasone). Thoracic tomodensitometric examination revealed a 15 mm tumor corresponding to a neuroendocrine pulmonary carcinoid with positive immunostaining for chromogranin A. Postoperative ACTH measurement was undetectable, plasma cortisol and free urinary cortisol were also decreased after tumor resection suggesting complete tumor removal. This case report illustrates the characteristics of paraneoplasic Cushing syndrome due to ACTH secreting pulmonary neuroendocrine carcinoid.
    Annales d Endocrinologie 07/2006; 67(3):253-8. · 1.02 Impact Factor
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    ABSTRACT: Cushing paraneoplasic syndrome is a rare cause of hypercorticism. We report a case of 35 year-old man presenting with Cushing's syndrome characterized by severe signs of hypercorticism and hypokaliemia. Endocrine investigations were suggestive of an hypercortisolism linked to an ectopic adrenocorticotropic (ACTH) secretion, both at baseline (mean ACTH levels=275pg/ml, urinary free cortisol excretion=3.898mmol/24h) and after pharmacodynamic testing (lack of inhibition of ACTH by dexamethasone). Thoracic tomodensitometric examination revealed a 15mm tumor corresponding to a neuroendocrine pulmonary carcinoid with positive immunostaining for chromogranin A. Postoperative ACTH measurement was undetectable, plasma cortisol and free urinary cortisol were also decreased after tumor resection suggesting complete tumor removal. This case report illustrates the characteristics of paraneoplasic Cushing syndrome due to ACTH secreting pulmonary neuroendocrine carcinoid.
    Annales D Endocrinologie - ANN ENDOCRINOL. 01/2006; 67(3):253-258.
  • Médecine et Chirurgie du Pied 12/2005; 21(4):134-138. · 0.06 Impact Factor
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    ABSTRACT: Le pied diabétique est un véritable problème de santé publique, son pronostic est dominé par un taux d’amputation des membres inférieurs encore élevé, même dans les pays à haut niveau socio-économique. L’objectifest d’étudier les facteurs pronostiques influençant l’évolution vers l’amputation des ulcères du pied chez le diabétique. Patients et méthode:Sur une période de deux ans et demi (janvier 2002-juin 2004), 74 patients présentant un ulcère de pied ont été traités au service de diabétologie et suivis en consultation; 57 patients ont été suivis jusqu’à cicatrisation. Des critères prédéterminés ont été choisis pour le diagnostic et la prise en charge des lésions. Nous avons réparti les patients en deux groupes, le premier comprenait les patients amputés [28] et le deuxième les patients non amputés [29]. Une analyse bivariée a été effectuée rétrospectivement pour mettre en évidence les facteurs associés à l’amputation. Résultats:Les facteurs pronostiques de l’amputation sont: l’âge des patients (p = 0,01), la présence d’une artériopathie (p = 0,001), l’ostéite (p = 0,03), le stade C et D (p < 0,0001) et les grades 2 et 3 (p = 0,03) de la classification de San Antonio. Les facteurs n’influençant pas l’amputation sont le sexe (masculin) (p = 0,32), la durée du diabète (p = 0,16), la néphropathie (p = 0,25), la rétinopathie (p = 0,30), et la neuropathie (p = 0,25). Conclusion:Le retard diagnostique et la présence d’une artériopathie expliquent en partie la sévérité des lésions, celle-ci est significativement liée à un taux d’amputation élevé. La prise en charge précoce multidisciplinaire (notamment une revascularisation précoce) et la prévention permettent un sauvetage du membre et évitent l’amputation. Diabetic foot is a real public health problem. Its prognosis is dominated by a still high rate of lower limb amputation even in countries of high socio-economic level. Aim:To study the prognosis factors influencing the evolution towards amputation of foot ulcers in diabetic patients. Patients and methods:Over a period of tow and a half years (January 2002—June 2004), 74 patients showing foot ulcers were admitted to the Diabetology Department and followed up in consultation, 57 patients were followed up to cicatrisation predetermined criteria were chosen for the diagnosis and take in charge of the lesions. We divided the patients into two groups, the first one of the amputed [28] and the second one of the non amputed [29]. Bivaried analysis was carried out retrospectively in order to detect the factors associated to the amputation. Results:Amputation prognosis factors are: Patient’s age (p = 0,01), arteriopathy (p = 0,001), osteitis (p = 0,03), stage C and D factors not in influencing amputation are: sex (male) (p = 0,32), diabetes duration (p = 0,16), nephropathy (p = 0,25), retinopathy (p = 0,30), neuropathy (p = 0,25). Conclusion:Diagnosis dalay and arteriopathy presence partly account for the lesions severity which is significantly linked to a high rate of amputation. Precocious multidisciplinary take in charge (mainly a precocious revascularisation) and prevention allow to save the limb to avoid amputation.
    Médecine et Chirurgie du Pied 11/2005; 21(4):134-138. · 0.06 Impact Factor
  • R Hassani, A Chadli, F Marouan
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    ABSTRACT: Osteoarticular tuberculosis is the fourth leading extrapulmonary localization of tuberculosis. The disease has a progressive course and is often diagnosed in the stage of bone destruction, causing an important diagnostic problem in diabetics with nervous osteoarthropathy. We report the case of a 23-year-old patient with multicomplicated diabetes type 1, treated for pulmonary tuberculosis who consulted after a trauma distended the left ankle. Bone biopsy was performed because of the diagnostic doubt between diabetes and infectious osteoarthropathy. Pathology reported active tuberculosis. Osteoarticular tuberculosis is still a severe disease because of the functional prognosis that requires early diagnosis, a difficult task in some conditions particularly in the diabetic where the disease may mimic nervous osteoarthropathy. Bone biopsy should be performed if there is a doubt.
    Annales d Endocrinologie 10/2005; 66(4):365-8. · 1.02 Impact Factor
  • R. Hassani, A. Chadli, F. Marouan
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    ABSTRACT: La tuberculose ostéo-articulaire représente la 4e localisation extra pulmonaire de la tuberculose. D’évolution progressive, elle est souvent diagnostiquée au stade de destruction osseuse, à l’origine de problème diagnostique avec l’ostéarthropathie nerveuse chez le diabétique. Nous rapportons l’observation d’une jeune patiente de 23 ans, diabétique type 1, multicompliqué, traitée pour tuberculose pulmonaire, et qui a présenté suite à un traumatisme, un gonflement de la cheville gauche. Devant le doute diagnostique entre ostéoarthropathie diabétique et infectieuse, une biopsie osseuse est réalisée montrant une tuberculose évolutive.La tuberculose ostéoarticulaire reste une maladie grave en raison du pronostic fonctionnel, nécessitant donc un diagnostic précoce, difficile dans certaines conditions, notamment chez le diabétique où elle peut simuler l’ostéoarthropathie nerveuse, d’où l’intérêt du recours à la biopsie osseuse en cas de doute afin d’instaurer un traitement adéquat.Osteoarticular tuberculosis is the fourth leading extrapulmonary localization of tuberculosis. The disease has a progressive course and is often diagnosed in the stage of bone destruction, causing an important diagnostic problem in diabetics with nervous osteoarthropathy. We report the case of a 23-year-old patient with multicomplicated diabetes type 1, treated for pulmonary tuberculosis who consulted after a trauma distended the left ankle. Bone biopsy was performed because of the diagnostic doubt between diabetes and infectious osteoarthropathy. Pathology reported active tuberculosis.Osteoarticular tuberculosis is still a severe disease because of the functional prognosis that requires early diagnosis, a difficult task in some conditions particularly in the diabetic where the disease may mimic nervous osteoarthropathy. Bone biopsy should be performed if there is a doubt.
    Annales d Endocrinologie 09/2005; 66(4):365-368. · 1.02 Impact Factor
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    ABSTRACT: Patients with foot ulcers have a high risk of relapse and amputation. Several studies have reported that 28 to 51% of amputated diabetics will have a second amputation of the lower limb within five years of the first amputation. The purpose of this study was to assess the incidence of factors favoring relapse within two years. One hundred ten diabetic patients were treated for foot lesions in the Casablanca Ibn Rochd university hospital between 1997 and 2000. Ninety of these patients attended review consultations. There were 42 cases of relapse (46.6%). Male gender predominated in the relapse patients with a sex ratio of 3.2. Mean age at relapse was 55 years; 71.5% of the patients had type 2 diabetes. Lesions observed were neuropathic ulcer (n=23), arterial ulcer (n=6), infected wounds (n=13). Revealing factors were burns and wounds. The main risk factors were neuropathy (n=23, 52%), neuroarteriopathy (n=12, 31%), peur arteriopathy (n=6, 12%). Patients who relapsed (n=42) were significantly different from patients who did not relapse (n=48) for gender, presence or absence of neuropathy, and presence or absence of arteriopathy. Secondary preventive measures against these risk factors, medical care, and specialized follow-up were satisfactory in these patients. our findings illustrate the importance of specialized management of diabetic patients with foot lesions. Adequate care of the lesions and preventive measures against risk factors are needed.
    Annales d Endocrinologie 01/2003; 63(6 Pt 1):491-6. · 1.02 Impact Factor
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    ABSTRACT: Malignant primary lymphoma of the thyroid gland is a rare disease generally occurring women in the 6(th) or 7(th) decade of life. The principal clinical sign is giant goiter rapidly leading to sings of compression, raising the question of differential diagnosis with anaplastic cancer. The radiological findings in our patient were suggestive of malignancy due to the locoregional invasion. Immunohistochemistry study of the surgical specimen was required to reach the definitive diagnosis of thyroid gland primary lymphoma. Diagnosis of malignant primary lymphoma of the thyroid gland made at the stage of extensive locoregional extension compromises prognosis. Our patient died after one session of chemotherapy.
    Annales d Endocrinologie 07/2002; 63(3):231-4. · 1.02 Impact Factor
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    ABSTRACT: This open, randomised, cross-over study compared the acceptance and safety of NovoPen 3 with that of conventional syringes and vials when initiating insulin treatment in 96 NIDDM patients with secondary failure to oral hypoglycaemic agents. These patients had not previously been treated with insulin. All patients used each insulin administration system for 12 weeks. Group A started therapy using NovoPen 3 and crossed over to syringe/vial administration; Group B started with syringe/vial administration followed by NovoPen 3. In total, 78 patients completed the study. Most patients in Group A initially found the insulin injections very easy or easy and many of those who found injections easy at first found them very easy by the end of week 12. During the first period, patients in Group B found insulin administration more difficult than those in Group A. Injection pain was significantly lower with NovoPen 3 than with syringes and vials (P = 0.0018). Patients in Group B reported a significantly lower level of injection pain after the switch to using NovoPen 3 (P = 0.0003). Acceptance of insulin injections was significantly higher by patients using NovoPen 3 than by those using syringes and vials (P = 0.0059). Setting and drawing up the dose of insulin was also easier for patients using NovoPen 3 (P = 0.0490). At the end of the study, most patients (89.5% (68/76 replies)) said that they preferred NovoPen 3 to syringes and vials. Glycaemic control improved compared with baseline after starting insulin therapy, with no differences between Groups A and B, or between the two injection systems. The number of reported hypoglycaemic episodes was very low and was not significantly different between Groups A and B, or between the two administration systems. No treatment-related adverse events were reported. We conclude that use of NovoPen 3 provides better acceptance of insulin injection than use of conventional syringes and vials during initiation of insulin therapy in NIDDM patients with secondary failure to treatment with oral hypoglycaemic agents.
    Diabetes Research and Clinical Practice 08/1998; 41(1):15-23. · 2.74 Impact Factor