Myocardial and liver iron overload, assessed using T2* magnetic resonance imaging with an excel spreadsheet for post processing in Tunisian thalassemia major patients.

Thalassemia is a common genetic disorder in Tunisia. Early iron concentration assessment is a crucial and challenging issue. Most of annual deaths due to iron overload occurred in underdeveloped regions of the world. Limited access to liver and heart MRI monitoring might partially explain these poor prognostic results. Standard software programs are not available in Tunisia. This study is the first to evaluate iron overload in heart and liver using the MRI T2* with excel spreadsheet for post processing. Association of this MRI tool results to serum ferritin level, and echocardiography was also investigated. One hundred Tunisian-transfused thalassemia patients older than 10 years (16.1 ± 5.2) were enrolled in the study. The mean myocardial iron concentration (MIC) was 1.26 ± 1.65 mg/g dw (0.06-8.32). Cardiac T2* (CT2*) was under 20 ms in 30 % of patients and under 10 ms in 21 % of patients. Left ventricular ejection function was significantly lower in patients with CT2* <10 ms. Abnormal liver iron concentration (LIC >3 mg/g dw) was found in 95 % of patients. LIC was over 15 mg/g dw in 25 % of patients. MIC was more correlated than CT2* to LIC and serum ferritin. Among patients with SF <1000 µg/l, 13 % had CT2* <20 ms. Our data showed that 30 % of the Tunisian thalassemia major patients enrolled in this cohort had myocardial iron overload despite being treated by iron chelators. SF could not reliably predict iron overload in all thalassemia patients. MRI T2* using excel spreadsheet for routine follow-up of iron overload might improve the prognosis of thalassemia major patients in developing countries, such as Tunisia, where standard MRI tools are not available or expensive.

[Experience of a multidisciplinary team in the management of superficial venous malformations: 99 cases]. / Les malformations veineuses superficielles et leur prise en charge par un comite multidisciplinaire: 99 cas.

BACKGROUND: Vascular malformations are heterogenous angiodysplasias. AIM: The aim of this work is to study the epidemiological and clinical features of venous malformations (VM) as well as their multidisciplinary management. METHODS: It is a retrospective study of patients having simple VM, seen at the multidisciplinary consultation of angiodysplasias of our hospital, over a 10 year period. RESULTS: This study included 99 patients having VM. A female predominance was noticed. Average age was 18.5 years. VM had mainly cephalic location. All VM were treated with percutaneous sclerotherapy. Aesthetic results were excellent in the cases of small VM size. CONCLUSION: VM are most frequent in cephalic region and cause aesthetic and functional handicaps. Percutaneous sclerotherapy is the treatment of choice for such a venous malformations, especially for small VM. VM are anomalies which can have serious complications. Their management has to be multidisciplinary in order to better precise the diagnosis and to take the adequate therapeutic decision.

[Chronic disseminated intravascular coagulation caused by aortic dissection]. / Coagulation intravasculaire dissiminee revelant une dissection de l'aorte.

BACKGROUND: Disseminated intravascular coagulation (DIC) is a severe disease. It can be caused by loss of pathology. CASE REPORT: We report the case of chronic aortic dissection discovered during the evaluation of disseminated intravascular coagulation (DIC). This case is characterised by the severity of clinical presentation, challenging diagnosis and difficulty of therapeutic approach. Low dose of heparine may reduce the severity of this situation; but vital prognosis remains obscure. CONCLUSION: aortic dissection is a rare but a severe cause of disseminated intravascular coagulation

[Treating pain related to inoperable pancreatic cancer in tropical areas: the advantage of CT-guided celiac plexus block and splanchnic nerves neurolysis]. / Intérêt en milieu tropical de la neurolyse percutanée chimique du plexus solaire et des nerfs splanchniques sous contrôle scanographique au cours des tumeurs malignes évoluées du pancréas.

Many sub-Saharan African countries have recently acquired computed tomography scanners that make interventional radiology possible, especially for the treatment of cancer pain. We report the case of a patient with severe abdominal pain related to advanced pancreas cancer. After unsuccessful morphine treatment, he underwent CT-guided alcohol injection for neurolysis of the celiac plexus and splanchnic nerves. This report describes the technique and discusses its potential applications in tropical countries.

[Intramural small-bowel hematoma due to anticoagulant therapy: a radiologic study; with regard to two cases]. / Hématome intramural du grêle dû aux anticoagulants: une etude radiologique a propos de deux observations.

We report two cases of spontaneous small bowel hematoma in two patients receiving long-term anticoagulant therapy. Plain abdominal film, ultrasound, CT-scan and oral barium examination were performed. Abdominal ultrasonography and CT-scan are in most cases relevant for the correct diagnosis of intra-mural small bowel hematoma. The diagnosis was based on the acknowledgment by the patient of anticoagulant drug consumption. Early diagnosis is crucial because most patients are treated nonoperatively with good outcome.

[Mammography screening of breast cancer in Tunisia. Results of first experience]. / Depistage mammographique du cancer du sein en Tunisie. Resultats d'une premiere experience.

This article reports the results of a mammography screening program of breast cancer, realized in the department of Radiology, Charles Nicolle hospital. A free screening mammography with two incidences was offered to women aged from 40 to 70 years old. 2200 mammographies were realized from May 1995 till July 1997. Women having a positive test benefited of a diagnostic explorations in the same unity. The positive test rate was 24%. Predictive positive value was 31%. This program allowed to detect 10 subclinical cancers, corresponding to a rate of detection of 4.5 cancers for 1000 women. This program is a first experience which demonstrated the feasibility of the mammography screening to wide scale and allowed the medical and paramedical team to acquire an experience.

[Bone mineral density in patients with Crohn's disease. Contribution of bone densitometry in 53 cases]. / La densite minerale osseuse au cours de la maladie de Crohn: apport de l'osteodensitometrie chez 53 patients.

Fifty-three patients with Crohn disease were included in a prospective study. Bone mineral density was measured at the femoral neck and lumbar spine by dual-energy X-ray absorptiometry. Ten variables were analyzed in search of an association with bone demineralization; Age, sex, nutritional state, smoking, duration of the disease, hormonal status, inflammatory syndrome, site of disease: ileal, colic or ileocolic, accumulated doses of corticoids and intestinal resection. A bone demineralization was observed in 58.5% of cases. The ileum location and the corticothérapie were predictives of bone demineralization. Crohn disease is a disease at high risk of bone demineralization. Predictors of the bone loss were smoking, long duration of the disease, ileal site and systematic corticotherapy.