[Differentiation between physiological left ventricular hypertrophy and hypertrophic cardiomyopathy of athletes, usefulness Doppler tissue imaging]

Athlete's heart is a cardiac adaptation to long-term, intensive training, wich includes physiological changes as increased ventricular cavity, wall thickness and mass. Maron highlighted a "gray zone" of wall thickness with difficult distinction between physiological left ventricular hypertrophy of athletes from hypertrophic cardiomyopathy [HCM]. The aim of the study is to analyse the data published about the diagnostic tools wich differentiate between physiological athlete's left ventricular hypertrophy and HCM. Even if the standard two-dimensional echocardiography represents an irreplaceable method in the evaluation of cardiac adaptations to physical exercice, the data currently available suggests the usefulness of Doppler tissue imaging [DTI] in the distinction between HCM and athlete's heart. The authors, will report the best DTI parameters recommended in this setting. The best DTI parameter to differentiate pathological hypertrophy of HCM from physiological hypertrophy of athletes was the gradient of diastolic velocity between the endocardium and the epicardium. On this ground, DTI may be taken into account in the Maron's diagnosis cascade

[Clinical and etiological features of primary adrenal insufficiencies in children]

The chronic primary adrenal insufficiency or Addison's disease is uncommon in children and belongs generally to a complex syndrome. Study of the clinical and aetiological features of primary adrenal insufficiencies in children. In a retrospective study, we reviewed clinical and diagnostic data of all cases of Addison's disease admitted within a period of 15 years [from January 1991 to December 2006], in a department of paediatrics. Cases due to congenital adrenal hyperplasia were excluded. 6 cases of Addison's disease were diagnosed. Five patients are the product of consanguineous marriage. The age at the diagnosis of adrenal insufficiency yarned from 15 months to 9 years 8 months. The adrenal insufficiency was associated to Allgrove syndrome in three cases, to autoimmune polyendocrinopathy type 1 in one patient and to probable peroxisomal disease in another one. The etiological disease was not determined in one patient. A substitutive hormonal therapy was conducted in all patients. During a mean follow-up of 26 months, two adrenal crises were noted. larger studies about Addison's disease are needed to confirm the preponderance of the Allgrove syndrome

[Primary spinal epidural abscess - a case report]

Spinal epidural abscess is a rare affection in child. Bacteria gain access to the epidural space through contiguous spread or hematogenous dissemination. It is more common in thoracolumbar than cervical areas. The organisms most frequently encountered are Staphylococcus aureus. Back pain, fever and neurologic deficit are the three most common symptoms. MRI is the imaging method of choice in diagnosing spinal epidural abscess. Surgical drainage with systemic antibiotics is the treatment of choice. We report the case of a 8 years old children, without any pathological antecedent, hospitalized in the service of Pediatrics for back pain, fever and lameness. The clinical examination found a lumbar rachis painful to the palpation with limited mobility, there was no neurologic deficit. Laboratory investigations showed that inflammatory markers were uniformly elevated. MRI showed a spinal epidural abscess in L3-L4. No micro-organism was isolated in blood cultures. A diagnosis of spinal epidural abscess was suspected and a medical treatment was indicated for 3 months. The outcome was favorable. On the light of this observation, the authors make a review of literature

[Brucellosis. report of a case]

The brucellosis is an infectious disease caused by brucella. We reported a case of brucellosis in a 14 year old boy admitted for a trailing fever and slimming. The diagnosis was confirmed by two blood cultures and the serodiagnosis of Wright. He was treated by rifampicin and doxycyclin. Two weeks later, he developed a brucella arthritis [spondylodiscitis]. The evolution after six months of treatment was good. This arthritis must be searched earlier with the radiologic explorations

[Ambulatory pediatric morbidity. Evaluation of one year activity of consultation in department of Pediatrics, emergency and consultations of children's hospital of Tunis]

Pediatric morbidity has been the subject of many studies, nevertheless those concerning with ambulatory morbidity are rare. The subject of this study is to establish the epidemiologic profile of patients. Identify the encountered pathologies and their frequency, precise morbidity characteristics and raise difficulties in the diagnostic and therapeutic management. In this retrospective study we reviewed the data of 4387 children that have consult for the first time external consultation of the department of Pediatric External Consultations and Emergency [PUC] of the Children's Hospital of Tunis during the year 2003. The 4387 patients benefit from 7323 consultations which represent 44.3 per cent of the total of consultations of the year 2003 [16 507]. 59.4 percent of the studied population was male [sex ratio = 1.2] and two thirds were aged under 6 years old. The main motif of consultations was recurrent bronchopneumonia [15.2 percent], cutaneous disease [6.2 percent], vomiting [6.1 percent] and abdominal pain [5.6 percent]. 3.2 percent of the children were admitted. Ambulatory morbidity was dominated by four pathologies: digestive 16 percent, pulmonary 14.9 percent, neurologic 6.7 percent and hematologic pathothologies [6 percent]. Gastro-oesophageal reflux was the major digestive disease followed by acute diarrhea [10.6 percent]. The principal pulmonary disease were bronchopneumonia [60.5 percent], acute bronchitis [21.6 percent] and asthma [14.4 percent]. 59.9 percent of the neurologic pathology were represented by seizures. 28.4 percent of the seizures were feverous. Anemia is the most frequent hematologic pathology [55.1 percent]. It was caused by iron deficiency in 87 percent of cases. The endocrinologic pathology is essentially represented by the short stature. We suggest to informatize medical data so it would be more exploited for studies, to make more complementary explorations available in the Children's Hospital of Tunis and to decentralize the management of the simples diseases

Floating left atrial thrombus and dysfunction of mitral prosthetic. A case report

Echocardiographic evidence of parietal atrial thrombus is frequently and easily diagnosed in mitral valve diseases. In the opposite, mobile left atrial thrombus is rare; its diagnosis require special attention. Our case report is about a 52 years old lady, with prothetic mitral valve and atrial fibrillation who presented with ischemic cerebral stroke. Oral anticoagulation was inappropriately observed. Transthoracic and transesophageal echocardiography showed an organised intra left atrial appendage thrombus with two floating thrombus into the left atrial cavity. In spite of adequate intravenous anticoagulation, the patient died within 48 hours after a massive second ischemic cerebral stroke. This case report shows the therapeutic challenge of left atrial thrombus management in the acute phase of ischemic cerebral stroke