[Spinal hydatidosis: diagnostic and treatment]. / Hydatidose vertébrale: approche diagnostique et thérapeutique.

Hydatidosis is a parasitic disease due to Echinococcus granulosus. Spinal hytatidosis is the most common form, characterized by high morbidity and mortality. It is often diagnosed only when neurological complications occur, due to the long clinical latency and the non specific nature of symptoms. Standard radiography may show lacunar, areolar abnormalities separated by irregular walls without clear boundaries. Magnetic resonance imagery can reveal hydatic abcess presenting typical liquid abcess and locoregional extension. Laboratory methods are of little assistance to the diagnosis. Complete surgical excision of the lesions remains the only curative treatment, in the same way as for malignant tumors. Surgical eradication of hydatic lesions is difficult, however. Indeed, the surgeon is guided by the macroscopic aspect, but the bone may be infiltrated by microvesicles without clear boundaries. It is now recommended to accompany surgery by medical treatment based on albendazole. Rapid diagnosis and treatment of spinal hyatidosis may yield long-term remission or even cure, especially in localized forms.

[Percutaneous vertebroplasty for pain relief in patients with osteoporotic spine fractures]. / Efficacité antalgique de la vertébroplastie percutanée dans les fractures vertébrales ostéoporotiques.

BACKGROUND: Percutaneous vertebroplasty (PVP) is an interventional radiology technique where pathological vertebral bodies are filled with acrylic cement. This method is used to strengthen the vertebral body and reduce pain in certain diseases involving the vertebrae such as osteoporosis. AIM: To evaluated PVP in symptomatic osteoporotic vertebral fractures after failure of conservative management. METHODS: Between November 2008 to December 2009, PVP was performed for osteoporotic vertebral fractures i 12 consecutive patients in a single institution. Medium term (3 days and 15 days post PVP) and long term follow up (1 month and 3 months post PVP) consisted in the evaluation of residual or secondary pain using Huskisson's visual analogue scale. RESULTS: A total of 20 vertebrae were treated. Mean follow up was 80 days (30-90 days). Significant symptomatic improvement (p=0.002) was noted with pre PVP pain score of 7.4 (±1.6 ), 3 days post PVP score of 4.1 (±2.1), 15 days post PVP score of 1.8 (±1.1), 1 month post PVP score of 1.22 (±1.06) and 3 months post score of 1.4 (±1.14). CONCLUSION: PVP appears to be an effective technique in the treatment of symptomatic osteoporotic vertebral fractures with approximately 94% of satisfactory results in the short and medium term period.

[Epidemiological, clinical and therapeutic features of hepatocellular carcinoma in cirrhotic patients]. / Aspects épidémiologiques, cliniques et thérapeutiques du carcinome hépatocellulaire chez le cirrhotique.

BACKGROUND: Hepatocellular carcinoma (HCC) is the most frequent primitive hepatic tumor, the fifth most common cancer in the world,and the third highest cause of cancer-related mortality. The presence of cirrhosis is the main risk factor. AIM: To describe the epidemiological, clinical and therapeutic features of HCC. METHODS: Retrospective study including all the patients with HCC occurring in cirrhotic liver followed in the gastroenterological department of Charles Nicolle hospital between 1997 and 2009. RESULTS: A hundred and one patient were enrolled; 64 men and 37 women with a median age of 65.4 years (31-88 years). Cirrhosis was due to viral hepatitis B or C in 25.7% and 62.2% of cases respectively and was classified Child Pugh A, B and C in 30.7%,50.5% and 18.8% of patients respectively. HCC was inaugural in most cases (68.3 %) and it was revealed by a tumoral syndrome in 38.6% of cases, by decompensation in 22.7% and was discovered during systematic screening when cirrhosis was already known in 19.8% of cases. Diagnosis of HCC was non invasive, relying on imaging and alphafetoprotein in most cases (95%). 84 patients(83.2%) had an advanced HCC, with vascular or extra hepatic spread in 58 (57.5%) of them. Treatment was curative in 14 cases, based on surgical resection in one case and percutaneous ablation in 13 cases.Six patients received transarterial chemoembolization as a palliative treatment. In 71 patients, only symptomatic treatment was given. The median survival time was 11 months. CONCLUSION: In the majority of the cases, HCC was diagnosed at an advanced stage and treatment was only symptomatic.

Vascular complications after pediatric kidney transplantation.

BACKGROUND: Vascular complications, especially those including the renal vein, remain a major cause of lost graft. AIMS: To evaluate retrospectively the incidence and management of vascular complications after pediatric renal transplantation and to assess possible risk factors and their effects on patient and graft. METHODS: A total of 82 consecutive renal transplants were performed in 79 patients at a single institution. The diagnosis of vascular complications was suspected in the presence of suggestive symptoms and confirmed by Doppler ultrasound and if necessary by a computed tomographic angiography. Urgent exploration was performed in all suspected cases. RESULTS: There were seven vascular complications (8,5%), including renal vein thrombosis in four patients, renal artery stenosis in one, and sural thrombophlebitis in two. The thrombosis of the graft vein which is the main complication occurred at mean 24 hours after renal transplantation. All these patients needed transplant nephrectomy after thrombosis event. In the remaining cases, the outcome was favorable even for the patient with transplant renal artery stenosis. CONCLUSIONS: Vascular complications are common and serious events affecting patient and graft survivals. A perfect surgical technique and rigorous radiological monitoring may result in decreased incidence and severity of these complications.

Primary hyperoxaluria type 1 in Tunisian children.

BACKGROUND: Primary hyperoxaliuria type 1 is an autosomal recessive disorder characterized by increasing urinary excretion of calcium oxalate, recurrent urolithiasis, nephrocalcinosis, and accumulation of insoluble oxalate throughout the body. This inborn error of metabolism appears to be a common cause of end stage renal disease in Tunisia. AIMS: To review the clinical, biological and radiological futures of primary hyperoxaluria type 1 and to correlate these aspects with the development of end-stage renal disease. METHODS: we retrospectively reviewed 44 children with Primary hyperoxaliuria type I who were treated in our department during a period of 15 years between 1995 and 2009. The diagnosis was established by quantitative urinary oxalate excretion. In patient with renal impairment, the diagnosis was made by infrared spectroscopy of stone or by renal biopsy. RESULTS: Male to female ratio was 1.2. The median age at diagnosis was 5.75 years. About 43 % of those were diagnosed before the age of 5 years. Initial symptoms were dominated by uraemia. Four patients were asymptomatic and diagnosed by sibling screening of known patients. Nephrocalcinosis was present in all patients. It is cortical in 34%, medullary in 32% and global in 34%. At diagnosis, twelve children were in end-stage renal disease (27%). Pyridoxine response, which is defined by a reduction in urine oxalate excretion of 60% or more, was found in 27%. CONCLUSION: In the majority of patients, the clinical expression of Primary hyperoxaliuria type 1 is characterized by nephrocalcinosis, urolithiasis and renal failure. Pyridoxine sensitivity is associated with better outcome.

Pseudoaneurysm of the splenic artery presenting with gastrointestinal bleeding.

Gastrointestinal bleeding from a pancreatic pseudocyst is a rare condition that is diagnostically and therapeutically challenging. A 78-year-old woman with a history of acute pancreatitis due to gallstones was hospitalized for abdominal pain and gastrointestinal bleeding. Gastroscopy revealed blood extruding from the papilla of Vater. A computed tomography scan revealed hemorrhage into a pancreatic pseudocyst. The patient was successfully treated by coil embolization.

[Management of postpartum vaginal haematomas by embolisation: two cases]. / L'embolisation radiologique dans le traitement du thrombus vaginal (à propos de deux observations).

Postpartum vaginal haematomas are a rare complication of delivery. The incidence of large haematomas is estimated at 1/4000 deliveries, and this complication can be life-threatening. We report two such cases. The diagnosis is suggested by shooting perineal pain with urinary tenesmus and vulvovaginal swelling or an unexplained haemorrhagic syndrome in the postpartum period. Rapid management is essential. Embolisation by interventional radiology is preferred to surgery. In the first case, arterial embolisation was performed after bilateral ligation of the hypogastric arteries failed. Arterial embolisation was the first-line treatment for the second patient. It was successful for both women.

[Perigenital hematoma. Diagnosis and management]. / L'hématome périgénital: diagnostic et prise en charge.

OBJECTIVES: Discuss the clinical aspects and the management of perigenital hematoma, a rare complication of delivery that can engage the vital prognosis. CASES: We report 4 cases of peri-genital hematomas recorded in the department C of obstetrics and gynecology, in the maternity center of Tunis. In two cases, the patients had only medical treatment and in the two others arterial embolisation was performed. CONCLUSION: The diagnosis is evoked in front of an unexplained hemorrhagic choc with perineal pain. Upon diagnosis, the patient must be rapidly managed associating resuscitation, surgery and angiographic embolisation.

[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

[Isolated bilateral pulmonary occlusion]. / Sténose bilatérale isolée des artères pulmonaires.

BACKGROUND: Takayasu's arteritis (TA) is an unusual cause of bilateral and isolated pulmonary artery occlusion that may be difficult to distinguish from other aetiologies. AIM: Report a new case of isolated bilateral pulmonary occlusion. OBSERVATION: A 19 year-old girl presented to the hospital with a 2-year history of dyspnoea and recurrent hemoptysis. She was in respiratory distress on physical examination Clinical investigations revealed a total occlusion of the right pulmonary artery on perfusion lung scan. Pulmonary angiogrphy confirmed these data and revealed further more a partially occluded left lower lobe artery. Diagnosis of Takayasu's arteritis was suspected and a complete aortogram was made but proved to be normal. Corticosteroid therapy was prescribed but interrupted within 2 months for absence of clinical improvement. Patient's assessment revealed worsening of the clinical condition and she became oxygen-dependant. CONCLUSION: early diagnosis of isolated involvement of pulmonary arteries in TA while systemic arteries are normal may prove to be difficult. In spite of insufficient data to confirm TA, the latter seems to be the most probable diagnosis in our patient regarding clinical (young age) and angiographic arguments.

[Arteriovenous malformations: study about 54 patients]. / Malformations arterioveineuses: etude de 54 patients.

BACKGROUND: Arteriovenous malformation (AVM) are vascular anomalies that may threaten functional and vital prognosis. The aim of this study was to assess the managment of Arteriovenous malformation METHODS: It is a retrospective study about 54 patients, having AVM, collected over a 7-year period. RESULTS: Sex ratio MJF was 1.25; average age at the diagnosis was 25.4 years. Puberty, pregnancy and trauma, were the most important favoring factors for the development of AVM. Location was the head in 75% of the cases. Doppler ultrasound was the most indicated examination to confirm the diagnosis. In over than 70% of our patients, therapeutic abstention and follow-up were indicated. In the other cases, embolization, with or without surgery was the treatment. A patient died of massive haemorrhage. Treatment is necessary in complicated AVM. Follow-up (if abstention or after treatment) is mainly based on clinical and Doppler data. CONCLUSIONS: AVM are anomalies that may be serious and their management must be multidisciplinary, to allow better therapeutic indications.

Superselective embolisation of bilateral superior vesical arteries for management of intractable hematuria in context of metastatic bladder cancer.

Hematuria due to locally advanced or metastatic bladder cancer is a common condition and is often a management problem. Percutaneous embolisation is a mini-invasive option to handle this situation. We report a case of a patient with a metastatic bladder cancer and who presented with an abundant hematuria and severe anemia. After failure of endoscopic resections and "flush" of radiotherapy haemostatic and refusal of cystectomy by the patient, he was treated by superselective embolisation of bilateral superior bladder arteries with excellent immediate results. The technique is safe and effective in the short term. The long-term effectiveness requires further investigation.

[Post traumatic rupture in patients with uretero pelvic junction obstruction. Case report]. / Rupture post - traumatique d'un syndrome de la jonction pyelo -ureterale meconnu. A propos d'une observation.

Authors report a case of post traumatic pelvic rupture occurring in an unknown ureteropelvic junction (UPJ) obstruction. Ultrasonography showed pyelectasia and fluid effusion in the anterior perirenal space. CT scan confirmed the diagnosis of UPJ obstruction and showed the rupture of the anterior pelvic wall communicating with a perirenal urinoma. The patient underwent a retrograde stenting for decompression and surgical drainage of the urinoma. Pyeloplasty was performed 4 months after injury. A follow up intravenous pyelogram showed good flow through the repair and the patient remaines asymptomatic 2 years after treatment. Post traumatic rupture of UPJ obstruction is a rare event with few reported cases in literature. Diagnosis is suggested on imaging studies. CT scan shows the rupture site in the ureteropelvic tract and guides percutaneous drainage.

[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.