[Contrast-induced nephropathy after cardiac catheterization: a prospective study of 180 patients]

Contrast-induced nephropathy [CIN] is associated with an increased cardiovascular morbi-mortality. Little is known about the incidence and risk factors of CIN after cardiac catheterization in Tunisian patients. To determine the incidence of CIN and its predictors after coronary angiography as well as its prognostic and therapeutic repercussions in a Tunisian patients' cohort. In this prospective single center study, 180 consecutive patients who underwent cardiac catheterization were enrolled; all patients were followed-up for 3 months. The incidence of CIN defined as an absolute increase in serum creatinine >/= 5 mg/l [44micromol/l] and/or a relative increase in serum creatinine >/= 25%, was 17.2%. In multivariate logistic regression, independent predictors of CIN were: diabetes mellitus [Odds Ratio [OR]=2.26 ; 95% confidence interval [95%CI]: 1.29-3.98, p=0.005], creatinine clearance < 80ml/mn [OR=2.87 ; 95%CI: 1.59-5.19, p<0.001], left ventricular ejection fraction [LVEF] < 45% [OR=2.03 ; 95%CI: 1.22-3.39, p=0.007] and use of a volume of contrast media > 90ml [1.72 ; 95%CI: 0.99-2.99, p=0.05]. Perprocedural hypotension was the strongest independent predictor of CIN in our study [OR=3.99; 95% CI: 1.65-9.66, p=0.002]. CIN was totally regressive within one month in 27 patients [86.7%] while 3 patients [10%] had a residual renal dysfunction at the end of the follow-up period [3 months]. More than one angiocoronarography on 6 resulted in CIN in our population. CIN affects cardiovascular prognosis even if renal function normalization is usually obtained within one month after the investigation. Besides identifying risk factors of CIN in order to apply preventive measures in risky patients, we stress the necessity of insuring a good hemodynamic status while achieving the procedure

[Late stent thrombosis in a young patient who had ulcerative colitis]

Arterial and venous thrombosis are well recognized systemic complications of inflammatory bowel disease predominantly in patients with Crohn's colitis and in those with ulcerative colitis [UC]. report a new case We describe the case of a 35 years old man presenting previously an anterior infarct with a tighten stenosis in the middle part of the left anterior descending artery [LAD]. The stenosis was treated percutaneously with a bare stent deployment. During an acute exacerbation of UC, the patient developed an acute coronary syndrome with ST elevation secondary to a late stent thrombosis, needing a primary coronary angioplasty. Following course is favorable. Based on this case, we'll discuss the relationship between UC and thrombosis, and therapeutic considerations inherent to thrombotic and bleeding risks

Percutaneous balloon valvotomy for combined rheumatic mitral and aortic stenosis

Balloon dilatation of the mitral valve is an established modality of treating patients with mitral stenosis. However, there is limited experience for simultaneous dilatation of combined mitral and aortic stenosis report our experience in percutaneous balloon valvotomy for combined mitral and aortic rheumatic stenosis. we describe a case of a 33 years old woman who successfully balloon valvotomy for rheumatic mitral and aortic stenosis via the transseptal anterog ade approach using Inoue balloon for mitral valve and retrograde approach single balloon for aortic valve. Double valve balloon valvotomy is feasible and safe in selected patients with combined mitral and aortic rheumatic stenosis

[Return to work after acute myocardial infarction]

The aim of this work to study the professional repercussions of acute myocardial infraction and to analysis medical, social and occupational factors which could influence return to work. Our study concerns 70 patients less than 66 years old, working before their hospitalization and having been admitted for acute myocardial infraction between January 1[st], 1999 and December 31, 2000 in the Department of Cardiac Resuscitation of hospital La Rabta of Tunis. Data were collected from retrospective review of folders and answers to a questionnaire for which the patients have been summoned in 2002. There were 70 patients almost exclusively men [n=69]. The mean age was 49.0 +/- 6.8 years. The mean follow-up was 27.2 +/- 7.7 months. Sixty one patients [87.1%] have initially been back to work and eight of them lost it secondarily. The average delay of return to work has been 91 +/- 111 days. The direct repercussions of myocardial infraction on the preofessional capacities was observed at the majority of patients. Despite an important professtional repercussions of acute myocardial infraction, our study showed a high rate of return to work with relatively short delays

[Anomalous origin of coronary arteries from the aorta]

The authors report the series of 9 patients [6 male and 3 female, aged from 32 to 64 years] with anomalous origin of coronary arteries from the aorta discovered at coronary arteriography. In 4 cases, the circumflex artery aries from the right coronary sinus and in 5 cases, the right coronary artery arises from the left coronary sinus. Severe atherosclerotic coronary disease was discovered in 5 cases. We conclude that aberrant coronary origin from the aorta is a rare congenital anomalous discovered usually at coronary angiography and certain patients with this anomalous can develop severe myocardial ischemia especially when a vessel runs between the aorta and pulmonary artery

[ pathophysiology of irritable bowel syndrome]

The irritable bowel syndrome [IBS] is a frequent gastrointestinal disorder [10 -15% of the population].It is characterized by chronic abdominal pain with modification in the bowel habits. The diagnosis is based of ROME II criteria. The pathophysiology of the SII remains unknown. It result from visceral hypersensitivity with anomalies of the digestive motility. These anomalies are secondary of dysfunction of the brain - gut axis modulated by environmental and the psychosocial factors. The understanding of the pathophysiological mechanisms of the SII and in particular the function of the brain-gut axis will permit a better handling of the patients. Indeed, the present knowledge of the neurotransmitter implied in the communication between the central nervous system and the digestive tract are currently the basis of the new therapies aimed to modulate the mechanisms implicated in the causation of the several symptoms of IBS. These novel pharmacotherapy should reduce the indirect societal and costs of IBS

[Large ostium secundum atrial septal defect discovered after severe mitral regurgitation: a case report]

Mitral regurgitation is associated with ostium secundum atrial septal defect in about 22% of cases. mitral valve prolapse induced by atrial shunt is the main cause of this regurgitation. Ususually, atrial septal defect discovery precedes that of mitral regurgitation. The aim of this paper is to focus on clinical, hemodynamic and evolutive details of atrial septal defect and mitral regurgitation association. We report the case of large atrial septal defect in 37 years old girl referred for hemodynamic investigation of mitral regurgitation. The divergence of clinical data, electrocardiogram and echocardiography findings has led to atrial septal defect discovery. Hemodynamic data showed severe pulmonary arterial hypertension [medium pulmonary arterial pressure: 45 mmhg]. Hence, mitral valve substitution by mechanical prosthesis and closure of atrial septal defect have been carried out. Ten hours after surgery, death occurred because of severe pulmonary arterial hypertension and heart failure. Association of severe mitral regurgitation and large ostium secundum atrial septal defect is an original anatomo-clinic entity characterized by mitral valve lesions diversity and severe secondary pulmonary arterial hypertension. Danger of such a hypertension is due to progressive and infra clinical rise of pulmonary resistances and association of increased pulmonary blood flow and capillary pulmonary hypertension