Heart involvement in systemic sclerosis.

INTRODUCTION: Primary and secondary heart involvement in systemic sclerosis are important mortality predictors. Aim of this study was to investigate by standard echocardiography associated to pulsed-tissue Doppler imaging, six-minute walk test (6MWT) and BNP level cardiac manifestation in 30 patients with ScS and to establish a strategy to detect and to evaluate this complication. METHODS: This was a cross-sectional study conducted over a period of 16 months: a total of 30 consecutive patients with ScS diagnosed as proposed by the American college of Rheumatology and the European League Against Rheumatism 2013 and who were hospitalized in Internal Medicine department of Habib Thameur hospital underwent cardiac assessment. RESULTS: Twenty-nine patients were female, the mean age of diagnosis was 46 years ± 13,49  [18-71 years]. Echocardiography found left ventricular systolic dysfunction (LVSD) on tissue doppler imaging, in 40% of cases, it was significantly associated with diffuse ScS (p=0,024), with Scl70 anti bodies (p=0,043) and interstitial lung disease (p=0,024). However, the left ventricular diastolic dysfunction (LVDD) was correlated with a high diastolic arterial hypertension (p=0,028), diffuse ScS (0,048), telangiectasia (p=0,029) and pulmonary hypertension (p=0,033). Higher systolic pulmonary arterial pressure (PAPs) (p=0,029) and higher BNP level (p=0,027) were noted in the group of patients with right ventricular systolic dysfunction (RVSD). Patients who had an elevated PAPs had: accelerated pulse (p=0,022), a cough (p=0,024), dyspnea III-IV (p=0,003), shorter six-minute walk distance (p=0,044), greater Borg score (p=0,025) and elevated BNP level (p=0,015). Thus, a positive correlation was found between PAPs and BNP (p=0,004, r=+0,53), a negative correlation was noted between PAPs and ST (p=0,006, r=-0,49). The ROC curve identified a discriminator threshold for ST<11,5cm/s (BNP ≥43,5pg/l) and PAPs >35mmHg (BNP ≥92pg/l). A discriminator value of the 6MWD (≥294m) was recorded for a PAPs >35mmHg. 2000-3000 salma Conclusion: Left ventricular diastolic impairment was the most frequent echographic abnormality in our study. The BNP level and 6MWT are sensitive and specific in the detection of an elevation of PAPs.

Kaposi's Sarcoma Presenting as Lymphadenopathy in an Immunocompetent Patient.

INTRODUCTION: Kaposi's sarcoma (KS) is an angioproliferative disorder first described in 1872 by Moritz Kaposi. Four main clinical presentations of KS have been described: classic, endemic, iatrogenic and epidemic. KS involvement of the lymph nodes is extremely uncommon in the classical variant form, especially if it precedes the skin manifestations. We describe the case of an elderly HIV-negative patient presenting with lymphadenopathy who was found to have KS. CASE REPORT: A 67-year-old patient was admitted for exploration of polyadenopathies in the context of a general decline in health. Physical examination revealed an erythematosus left lower limb rash associated with angiomatous nodules and multiple lymphadenopathies. The diagnosis of erysipelas in the left leg was retained and the patient was treated with good evolution of the rash but persistence of the angiomatous nodules and the polyadenopathies. Skin and lymph node biopsies led to a diagnosis of KS. The patient is proposed for polychemotherapy. CONCLUSION: KS must be suspected in lymphadenopathies despite the absence of typical cutaneous signs of the disease and in immunocompetent patients. LEARNING POINTS: Involvement of the lymph nodes is extremely uncommon in the classical variant form of Kaposi's sarcoma (KS).Human herpes virus-8 is an important cofactor in all forms of KS.Pathology and immunohistochemistry are key to diagnosing KS.KS must be suspected in lymphadenopathies without typical cutaneous signs of the disease and in immunocompetent patients.

[Etiologic profile of digital necrosis in an internal medicine department]. / Profil étiologique des nécroses digitales dans un service de médecine interne.

BACKGROUND: Digital necrosis is a frequent event in vascular pathology. They are multiple etiologies and are the translation of a general or locoregional pathology. The aim of our study was to clarify the various causes of digital necrosis in an internal medicine department. METHODS: We conducted a retrospective study of 23 cases of digital necrosis collected in the internal medicine department of the hospital Habib Thameur over a period from January 1998 to April 2011 . RESULTS: There were 16 women and 7 men with mean age of 46 years. The cardiovascular risk factors were observed in 39.13% cases. Digital necroses were interested fingers in 73.91% and toes in 30.43% of the cases. The causes were dominated by the connective diseases. The treatment was symptomatic in all cases and etiologic in only two cases. CONCLUSION: In internal medicine, the causes are dominated by connectivites. The prognosis is especially functional. It remains unfavorable in spite of the improvement of the therapeutic and etiologic care.

Renal paraneoplastic vasculitis complicating lung adenocarcinoma.

Renal paraneoplastic vasculitis (RNPV) is rare. It can be revealed by glomerulonephritis, microaneurysms or renal failure. RPNV may precede the onset of the primary tumor, and treatment and prognosis depend on the etiology (primary tumor). A 54-year-old man who had a primary lung adenocarcinoma was admitted for nephrotic syndrome. The investigations revealed RNPV. The patient was treated with corticosteroids at high dose and cyclophosphamide with improvement of the renal condition; however, the patient died from worsening of his pulmonary neoplasia.

Effect of pregnancy on the course of immune thrombocytopenia: a retrospective study of 118 pregnancies in 82 women.

In women with pre-existing immune thrombocytopenic purpura (ITP), the effect of pregnancy on the course of the disease is poorly known. We performed a dual-centre retrospective cohort study of 118 pregnancies in 82 women with primary ITP. In early pregnancy, the platelet count was <100 × 10(9) /l in 35·6% of pregnancies. During pregnancy the median platelet count nadir was 66 × 10(9) /l (25th-75th percentile: 42-117), with platelet count <30 × 10(9) /l for 26 pregnancies (22%). In 49% of pregnancies, a significant decrease of the platelet count required treatment at least transiently in preparation for delivery. At the time of delivery, the median platelet count was 110 × 10(9) /l (77-155). Compared to before pregnancy, at 3 months post-partum, only 11% of pregnancies [95% confidence interval (95% CI): 6·8-20·2] showed disease worsening. Previous splenectomy was the only factor significantly associated with ITP worsening after pregnancy (53·9% vs. 10·3%, P < 0·001). For 8·3% of the pregnancies (95% CI: 3·8-15·1), neonatal thrombocytopenia required treatment, especially in case of previous maternal splenectomy (adjusted odds ratio 16·7, 95% CI: 2·61-106). The overall risk of exacerbation of ITP and severe thrombocytopenia during pregnancy is acceptable.