[Homocysteinemia and coronary artery disease: a case-control study in a Tunisian population]. / Homocystéinémie et maladie coronaire: etude cas-témoins dans une population tunisienne.

We have determined the prevalence of hyperhomocysteinemia and tested its relationship with coronary heart disease in Tunisian patients. The study included 70 angiogrphically proven coronary patients and 140 age- and sex-matched healthy subjects. Plasma homocysteine folate and vitamin B12 were analyzed by immunoenzymatic methods. Hyperhomocysteinemia was considered for plasma homocysteine concentration >17 micromol/L. Mean plasma homocysteine concentration and hyperhomocysteinemia prevalence were significantly (p<0.001) higher in patients (16.3 +/- 7.9 micromol/L and 29%) than controls (12.6 +/- 4.0 micromol/L and 10%). The association between hyperhomocysteinemia and coronary heart disease persisted after adjusting on main cardiovascular risk factors (multi adjusted odds ratio, 2.99; 95% CI, 1.18-7.59; p=0.02). No association was observed between hyperhomocysteinemia and coronary disease severity and extent. This study showed an independent association between hyperhomocysteinemia and coronary heart disease, suggesting a role of hyperhomocysteinemia in atherothrombogenesis. However, causal relationship is not yet established. Until results of homocysteine-lowering therapy trials become available, hyperhomocysteinemia should be researched and treated in coronary heart disease patients.

[Renal actinomycosis: a case report]. / Actinomycose rénale: a propos d'une observation.

This report describes the case of a 26-year-old patient hospitalized for spontaneous abdominal pain. Palpation during clinical examination demonstrated a mass in the right abdomino-pelvic cavity. Radiological examination visualized the presence of grains suggestive of actinmycosis. The patient responded favorably to antimicrobial therapy. Actinomyces israeli is a gram-positive anaerobic bacterium that can cause tumor-like lesions usually on the face and neck and more rarely on retroperitoneal structures. Because renal involvement can require nephrectomy, diagnosis of renal actinmycosis must be made during pre-operative work-up. Ultrasound-guided needle biopsy of the lesion can achieve diagnosis and avoid nephrectomy since medical treatment using antimicrobial therapy is effective.