[Thrombosis and cancer: retrospective study of 17 cases]. / Thrombophlébites paranéoplasiques : etude rétrospective de 17 observations.

BACKGROUND: The association cancer and venous thrombosis is almost always an independent criterion of poor prognosis of cancer. Thus, venous thromboembolic disease is with infection and organ failure, one of the leading causes of death in patients with malignant disease. AIM: To identify the characteristics of the association between cancer and venous thrombosis in any patient with deep vein thrombosis of lower limbs seemingly unexplained. METHODS: This is a retrospective study from January 1994 to December 2008, concerning 17 cases of patients with deep vein thrombosis of lower limbs associated with neoplasia, hospitalized in internal medicine department at Habib Thameur hospital between a total of 290 patients with deep vein thrombosis of lower limbs. Only patients hospitalized for deep vein thrombosis of lower limbs complicated or not by a pulmonary embolism were included. RESULTS: Our study concerned 17 patients. There were 10 women and 7 men with a sex ratio (Female / Male) at 1, 42. The average age was 68.7 years, with extreme ages ranging from 40 to 90 years. Cancer has formed 6% of the causes of deep venous thrombosis of lower limbs. Eight of our patients were known to suffer from a cancerous disease. Six cases of cancers were discovered at an advanced stage of evolution with multiple metastases. In seven cases the etiological could not be achieved. Deep venous thrombosis was complicated by pulmonary embolism in four inaugural events, five patients had recurrent thrombosis, and two cases of bleeding complications were noted. CONCLUSION: Venous thromboembolism is common in cancer patients. It can be the first manifestation of cancer completely silent. The course and prognosis depend on the stage of cancer combined.

Corticoid-associated complications in elderly.

BACKGROUND: Corticosteroids are widely prescribed products in the elderly particularly in systemic diseases. Corticosteroids were indispensable in controlling a variety of disease states. Various complications associated with this drug class warrant caution and monitoring with each formulation especially with old population. AIM: To evaluate the frequency and type of side effects and complications of long-term corticosteroid therapy in the elderly. METHODS: We conducted a retrospective study of 23 patients aged 65 and older hospitalized in the internal medicine department of the Habib Thameur hospital during January 2000 to December 2004. Corticoid adverse effects were recorded throughout the follow up period. RESULTS: There are 20 women and 3 men aged 66 to 87 years with a mean age of 75.7 years. The diagnoses were 8 cases of temporal arteritis, 7 cases of rheumatoid arthritis, 3 cases of multiple myeloma, 2 scleroderma, 1 case of systemic lupus erythematosus, 1 case of retroperitoneal fibrosis and 1 case of psoriatic arthritis. We selected 66 complications. Infectious complications were found in 26 cases (39.3%), 11 cases (16.7%) of iatrogenic diabetes, arterial hypertension in 9 cases (13%), skeletal complications in both cases,psychiatric complications in two cases, ophthalmologic complications in one case. CONCLUSION: Despite lifestyle rules and adjunctive therapy, complications seem to be frequent. To minimize the disadvantages of prolonged corticosteroid treatment, regular monitoring and careful screening is imperative for the support and time.

[Rheumatoid arthritis in the elderly: ten cases report]. / La polyarthrite rhumatoïde du sujet âgé : A propos de dix observations.

BACKGROUND: The occurrence of rheumatoid arthritis (RA) in elderly is frequent. If the reality of a real difference in clinical presentation between younger and older subjects is discussed, the central point remains that the prognosis is not better for the elderly. Finally, conventional treatment is as effective and safe as in younger patients, and the same stringent targets for management of the PR used for young subjects must be applied in the elderly. AIM: To identify the characteristics of RA in the elderly in its epidemiological, clinical, radiological, evolutive and therapeutic. METHODS: We conducted a retrospective study of RA in the elderly aged 65 and over, we've compiled ten cases hospitalized over a period of 4 1/2 years in the service of Internal Medicine, Habib Thameur Hospital (Tunis). RESULTS: There were 8 women and 2 men. The average age was 70.6 years. The onset of arthritis and the disease was progressive in seven cases. An inflammatory syndrome was present in seven cases. Rheumatoid factor was positive in eight cases. Five patients were classified as stage III and IV according to the radiological classification of Steinbrocker. The treatment was based on painkillers and anti-inflammatory drugs in all cases. Long-term treatment was initiated in seven patients. The outcome was favorable in all cases. CONCLUSION: Late-onset RA is a heterogeneous framework in which multiple clinical forms deserve to be individualized and should reflect this diversity, rather than approach to the problem of global RA after 60 years.

[Takayasu's arteritis in Tunisia: a monocentric study of 11 patients]. / La maladie de Takayasu en Tunisie: etude mono-centrique de 11 cas.

BACKGROUND: Takayasu's disease is a chronic inflammatory arteritis involving large vessels in young women. AIM: To assess the clinical, laboratory, and radiological features and course of Takayasu arteritis in Tunisia. METHODS: This retrospective study analyzed 11 patients with Takayasu arteritis between 1999 and 2010 who met the criteria for inclusion proposed by the American College of Rheumatology (ACR). RESULTS: The file review identified 11 women, with a mean age at diagnosis of 29.1 years (range: 17-50 years). Our series included involvement of the aortic arch and its branches in 8 cases, while only 3 cases of the abdominal aorta. Arterial hypertension due to stenosis of the renal arteries was noted in 4 cases. Aortic insufficiency and pulmonary hypertension were noted in one case. In all, 3 patients had type I disease, 3 type V and one type IV. In all, 4 patients had glucocorticoid treatment, and one needed immunosuppressive therapy. Three patients required surgical intervention. Our patients were followed for a mean period of 67.5 months. Disease remained stable in all patients. CONCLUSION: Despite the small number of our patients, the clinical manifestations, angiographic data and course in our study were similar to those in other reported series.

[Special features of systemic sclerosis in men]. / Particularités de la sclérodermie systémique chez l'homme.

BACKGROUND: Systemic sclerosis (SS) is a generalized disorder of connective tissue and microvasculature characterized by tissue fibrosis and obliteration of the vessels. Several features of systemic scleroderma in men are discussed in the literature. AIM: To investigate the initial clinical features, evolution and prognosis of systemic sclerosis in men. METHODS: Patients with systemic sclerosis based on ACR's criteria were included. In this retrospective study we compared a cohort of men to a cohort of women, diagnosed between 2000 and 2010 in department of internal medicine. RESULTS: Fifty four patients were included amongst which nine men. The mean follow-up duration was 39.5 months. A higher proportion of cardiac, renal and lung involvement were noted at diagnosis Localized cutaneous sclerosis was predominant in men. CONCLUSION: This work has highlighted several features of systemic sclerosis encountered in men. These results warrant confirmation by analyzing a larger population.

[Hemophagocytic syndrome: report of 4 cases]. / Le syndrome d'activation macrophagique: a propos de 4 observations.

BACKGROUND: Hemophagocytic syndrome (HPS) is a rare but potentially fatal disease. The diagnosis is based on the combination of clinical and biological signs, requiring histological or cytological research hemophagocytosis and exhaustive etiological investigation. AIM: To report four cases of the HPS in an internal medicine department. CASES REPORT: We report four cases of HPS associated with Still's disease in two cases, with Sjogren syndrome in one case and a severe sepsis in one case. There are three women and one man. The mean age was 34.75 years, with extremes of 21 to 50 years. In all cases, patients were hospitalized for fever of unknown origin. The etiologic research of this fever remained negative. In all cases, patients validated criteria of HPS confirmed by cytological studies. The treatment was based on corticosteroids in all cases and immunosuppressant in one case. The evolution was favorable in two cases and fatal in two cases. CONCLUSION: HPS is a serious, often overlooked, may affect the prognosis and complicating various infectious, neoplastic or autoimmune diseases.

[Urinary tract infections in elderly]. / Les infections urinaires chez les personnes âgées.

BACKGROUND: Urinary tract infections (UTI) in elderly are frequent and polymorphic clinical symptoms. This is a public health problem both in support and cost they generate. AIM: To study the epidemiological, clinical, paraclinical and therapeutic aspects of UTI in the elderly. METHODS: We conducted a retrospective study of 50 cases of UTI in the elderly collected in the Internal Medicine Department at Habib Thameur Hospital between January 2002 and December 2006 (Group I). We compared this group to another group of patients aged below 60 years also explored for UTI in the same service and during the same period (Group II). RESULTS: They were 37 women and 13 men in group I and 41 women and 9 men in the group II. In group I, the average age was 74.10 ± 6.7 years, in group II 43.58 ± 11.26 years. In group I, 35 patients (70%) showed no evidence of suspicion of a UTI on admission. 15 patients (30%) were admitted for suspected UTI. In group II, 36 patients (72%) showed no evidence of suspicion of a UTI on admission. 14 patients (28%) were admitted for suspected UTI. Urological abnormalities underlying the UTI, detected by ultrasound, were more frequent in Group I (40%) than in Group II (12%). Second-line antibiotics, due to the likely resistance of the microorganism, had to be prescribed in 16% cases in Group I vs. 4% of cases in Group II. The evolution under antibiotic treatment was marked by the occurrence of 3 deaths and transition to renal failure in 4 cases for Group I. In Group II, the outcome was favorable in all cases. CONCLUSION: Urinary tract infection is a significant factor in morbidity and mortality in the elderly. Female is much more concerned than male. Clinical manifestations of UTI are often crude and misleading in a pathological and poly polymedicated patient. The preventive arm accounts for most of the management of urinary tract infection in the elderly.

[Venous involvement in Behcet's disease: a series of 28 cases]. / Atteinte veineuse au cours de la maladie de Behcet: a propos de 28 cas.

BACKGROUND: Venous involvement is a rare and severe clinical feature in Behcet disease (BD). AIM: We reported our experience with a rare and interesting subset of BD patients with venous involvement. METHODS: From 1994 to 2008, twenty eight cases of venous BD were found amongst BD patients in the department of internal medicine of Habib Thameur Hospital. RESULTS: 45 episodes of venous thrombosis occurred in 28 patients. There were 25 men and 3 women the mean age when venous involvement manifested was diagnosed was about 32.25. Venous thrombosis occur in the first five years following the diagnosis of BD. Pericarditis was more frequently noted in patients with venous BD than others without vasculo-Behcet disease. In contrast digestive and rheumatologic symptoms were more likely observed in patients without vasculo-Behcet disease. Thirteen patients underwent corticosteroids. Relapses occurred more frequently in patients without corticosteroid therapy. CONCLUSION: Venous involvement is more frequently noted in vasculo-Behcet than arterial involvement. Its treatment should include anticoagulation in association with corticosteroids.

[Arterial involvement in Behcet's disease: a series of 7 cases]. / Atteinte artérielle au cours de la maladie de Behcet: a propos de 7 cas.

BACKGROUND: Arterial involvement is rarely described in Behcet disease BD and it is associated with poor prognosis. AIM: We report our experience with a rare and interesting subset of Behcet disease patients with arterial involvement: thrombosis and aneurysm formation types of angio-BD. METHODS: From 1994 to 2008, seven cases of arterial BD with 3 aneurysm formation and 4 thrombosis were found amongst BD patients in the department of internal medicine of Habib Thameur Hospital. RESULTS: Combination of venous and arterial manifestations occurred in 4 patients. All patients were male and the mean age when arterial involvement manifested was diagnosed was about 39.3. The artery most often affected is the aorta followed by the pulmonary arteries. Brain infraction occurred in about 4 cases. Pericarditis and neurological symptoms were more frequently noted in patients with arterial BD than others without vasculo-Behcet disease. All patients underwent corticosteroids and immunosuppressive therapy. Two patients were successfully operated for aneurysms. All patients were alive after a mean of 7.8 years follow-up. CONCLUSION: Arterial involvement is more frequently noted in vasculo-Behcet than venous thrombosis and it's associated with a high morbidity and mortality rate.

[Neurogenic bladder in diabetes mellitus]. / Les neurovessies du diabete.

BACKGROUND: Diabetic bladder dysfunction is among the most common complications of diabetes mellitus. It is principally caused by autonomic neuropathy defining diabetic cystopathy. AIM: characterize the bladder dysfunction in patients with diabetes mellitus. METHODS: The clinical and urodynamic records of patients with diabetes mellitus were reviewed. RESULTS: 40 patients with diabetes mellitus were included in the study mean aged 55 years. 32 patients had voiding dysfunction. Urinary frequency and difficulty emptying were the predominant symptoms that led to patient referral. 15 patients (31.25%) had decreased flow rates. 12 patients (37.5%) had diminished bladder sensation and/or impaired detrusor contractility. 10 patients (25%) had detrusor hyperreflexia and 6 patients had impaired detrusor contractility with increased bladder sensation. Vescico-uretral dyssynergia was found in 2 patients (5%). CONCLUSION: This study suggests that classical diabetic cystopathy is not the most common urodynamic findings in patients with diabetes mellitus and demonstrates the importance of urodynamic studies in diagnosing bladder dysfunction in diabetics before initiation of therapy.

[Spinal cord compression due to benign osteoporotic vertebral fracture]. / Compression médullaire par un tassement vertébral ostéoporotique bénin.

BACKGROUND: A neurologic compromise associated with vertebral fractures is generally due to a malignancy causes. Therefore, an osteoporotic vertebral fracture can sometimes cause neurologic complications. AIM: Report a case of neurologic compromise associated with osteoporotic vertebral fractures. OBSERVATION: A-62-year-old man suffered from rheumatoid arthritis since 1985, presented a cervical pain associated with quadriparesia secondary to a C5 osteoporotic vertebral fractures. CONCLUSION: Osteonecrosis may be the cause of neurologic compromise associated with osteoporotic vertebral fractures.

[Catastrophic antiphospholipid syndrome and rituximab: a new report]. / Syndrome catastrophique et anti-CD20: une nouvelle observation.

BACKGROUND: Catastrophic antiphospholipid syndrome is a distinctly rare dramatic condition characterized by widespread thrombosis of small vessels. Early diagnosis and aggressive therapies are essential in this condition because of its extremely high mortality rate. Therapeutic management include heparine, high dose steroids, cyclophosphamide, plasma exchange, intravenous immunoglobuline, however a number of patients are refractory to treatment. AIM: We review and discuss alternative and emerging treatment options by rituximab for patients who fail or cannot tolerate conventional therapy. CASE-REPORT: A 36-year-old female with a two mounths history of dyspnea, palpitation and chest pain was admitted. Physical examination upon admission revealed a fever, ischemic digital necrosis, scleroderma of the hands and beaking of the nose. Laboratory tests showed normal level of liver enzymes, elevation of creatinine level, lymphopenia, haemolytic anaemia with negative Coombs tests, low platelet count, prolonged partial thromboplastin time. The D-Dimer value was 158 ng/ml. Urinalysis revealed a proteinuria. Antinuclear antibody tests and lupus anticoagulant were strongly positive. Echocardiography revealed severe pulmonary hypertension and pericarditis. There was no pulmonary embolism on thoracic angio tomodensitometry. The diagnosis of catastrophic antiphospholipid antibody syndrome associated with systemic lupus and scleroderma was established. She was treated with anticoagulants, corticotherapy, one pulse of intravenous cyclophosphamide, 2 doses of intravenous immunoglobuline and 5 sessions of plasmapheresis. Because of lack of response 2 doses of 375 mg weekly rituximab i.v. were added but she developed pulmonary embolism, alveolar haemorrhage and she died. CONCLUSION: Effectiveness of Rituximab for the CSAPL should be demonstrated by further studies.