Isquemia de miembros inferiores secundaria a ergotamina. Reporte de casos y revisión de literatura / Lower limb ischaemia secondary to ergotamine. Case reports and a review of the literature

El ergotismo es en la actualidad un trastorno raro, asociado a la administración iatrogénica de ergotamina en pacientes que padecen de cefaleas migrañosas. La intensidad del vasoespasmo que presenta esta entidad clínica en la mayoría de los casos resulta en isquemia aguda de las extremidades. Presentamos 2 casos de isquemia aguda de las extremidades, en pacientes de sexo femenino, de mediana edad, con signos y síntomas que amenazaban la viabilidad de los miembros inferiores. El estudio por ultrasonido y la arteriografía (en el caso 1) confirmaron la presencia de espasmo arterial bilateral difuso. Inmediatamente se procedió a interrumpir la administración de ergotamina y se instauró terapia vasodilatadora. Los síntomas de las pacientes empezaron a mejorar a las 48-72 h de iniciado el tratamiento (AU)

Ergotism is a rare disorder associated with the iatrogenic administration of ergotamine in patients with migraine headaches. The intense vasospasm that occurs in this clinical condition results in acute limb ischaemia in the majority of cases. Two cases are presented of acute limb ischaemia in middle age female patients with signs and symptoms that threatened the viability of lower limbs. Duplex ultrasound and arteriography (in the first case) confirmed the presence of a bilateral diffuse arterial spasm. Ergotamine treatment was discontinued immediately and vasodilator therapy was administered. The patient's symptoms began to improve 48-72 h after starting therapy (AU)

Profile of living related kidney donors: a single center experience.

The living related donor still represents the unique source for renal transplantation in Morocco. Since 1986, 127 living related potential donors have been evaluated and 100 patients have been transplanted at the Ibn Rochd UHC in Casablanca. We retrospectively studied the potential donors and determined their profile and the exclusion criteria. The mean age at the time of donation was 37 ± 11 years (range 18-66 years) and 60% of donors were women. The predominant sources of donors were sisters, brothers and mothers of recipients in 34%, 31% and 24% respectively. Forty three percent of them were married, 20% housewives and 17% unemployed. In addition, 37% were illiterate, 45% school graduates, and 18% university graduates. Donors and recipients were incomplete HLA match in 72.7%, identical in 19% and different in 8.3%. The cross matching test was negative in all cases. The mean plasma creatinine was 0.8 ± 0.1 mg/dL with mean creatinine clearance of 103.16 ± 18.18 mL/min.

[Surgical treatment of secondary hyperparathyroidism in chronic renal failure. Report of 57 cases]. / Traitement chirurgical de l'hyperparathyroidie secondaire des insuffisants renaux: a propos de 57 cas.

AIM: The aim of this study was to report the experience of the department of general surgery (Aile III) Ibn Rochd Hospital in surgical management of hyperparathyroidism in patients with end-stage renal disease (ESRD). METHODS: Fifty seven patients (24 M, 33F) with hyperparathyroidism underwent surgical parathyroidectomy from 1998 to 2004. Surgical indication was established according to clinical or biological assessment. Fifty nine operations were performed (57 first-hand cervicotomies and resumptions in too cases). RESULTS: Histological examination of parathyroid gland specimens disclosed adenoma in 33 patients and hyperplasia in 14 patients. The follow-up was normal in 52 patients, marqued by cervical hematoma in 2 cases and death was deplored in 4 patients. The post-operative calcium level was in the normal range in 43 cases, low comparatively to the baseline in 12 cases and high in 2 cases. The PTH levelwas normal in 55 patients and high in two patients. Long-term outcome was evaluated in 36 patients mean follow-up (18 months). A good evolution was noted in all patient referring to clinical, biological and radiological investigations. CONCLUSION: That, in our context, surgical parathyroidectomy still an appropriate approach for the treatment of hyperparathyroidism in patients with end-stage renal disease.

Goodpasture's syndrome - four case reports.

Goodpasture's syndrome (GPS) is a rare but severe immunological disease, which is characterised by rapidly progressive glomerulonephritis and intraalveolar hemorrhage (IAH) with the presence of anti-glomerular basement membrane (GBM) antibodies. We report four cases of GP's syndrome referred to the nephrology unit at Ibn Rochd UHC in Casablanca from January 1995 to December 2003. All patients had rapidly progressive glomerulonephritis (RPGN) with proteinuria and microscopic hematuria. Elevated blood pressure was noted in one case. IAH was manifested as hemoptysis in two cases, radiological signs in three cases and confirmed by broncho-alveolar lavage in all cases. Laboratory assessment revealed anemia in all cases. Renal biopsy showed extracapillary glomerulonephritis with linear deposits of IgG along the GBM. Renal failure was severe and hemodialysis was required in all cases. All patients were treated with prednisone and cyclophosphamide and none recovered renal function. Two patients died due to severe lung hemorrhage.

Diabetic nephropathy in hemodialysis patients in casablanca.

Diabetes is the main cause of end-stage renal disease (ESRD) in the developed countries and its prevalence and incidence have been constantly increasing over the years. To determine the prevalence and profile of diabetic nephropathy in our ESRD population, we retrospectively studied 564 hemodialysis patients in ten dialysis units in Casablanca. The mean age was 49 +/-16.2 years. The diabetic nephropathy came at the third rank with a prevalence of 13.5% behind chronic glomerulonephritis (21.8%) and hypertensive nephropathy (14.7%). Almost 74% of our diabetics were type 2. From the time of diagnosis the type 2 diabetics reached the ESRD earlier than the type 1 diabetics with a mean period of 15.1 +/- 7 years and 18.8 +/- 5 years, respectively; however, the difference was not statistically significant. There was at least another microangiopathic complication in 95.4% of the patients and macroangiopathic complication in 82%. The median hemoglobin A1C in all patients was higher than normal value. We conclude that ESRD is a serious complication of diabetes, which is constantly increasing. The appropriate management of diabetes and a multidisciplinary approach are necessary to avoid it or at least delay its occurrence.

[Primary focal segmental glomerulosclerosis in adults: response to treatment and outcome]. / La hyalinose segmentaire et focale primitive de l'adulte: aspects thérapeutiques et evolutifs.

Response to therapy of primary focal segmental glomerulosclerosis (FSGS) in adults is poor, most studies demonstrated no response at all. We report our experience from a retrospective study about 22 adults patients. All patients presented proteinuria at admission with a nephrotic syndrome in 86 percent of cases. A high blood pressure was noted in 25 percent. A response to corticosteroid was obtained in 8 patients (36%) with complete remission in 5 cases (23%). Three patients were corticosteroid-dependant, two out of them went in remission under cyclophosphamide in one case and under chlorambucil in the other case. Fourteen patients did not respond to corticosteroids. Eight received cyclophosphamide with partial remission in 4 cases and progression to chronic renal failure (CRF) in 4 cases. The six non-responders did not receive immunosuppressive drugs because of severe CRF in 4 cases. The mean duration of follow-up was 39 months (20-55). The response to corticosteroid of primary FSGS in adults remain low (30%). The use of cyclophosphamide has improved the global remission to 50 percent.

[Ossifying fibroma of the face and hyperparathyroidism in a chronic hemodialysis patient]. / Fibrome ossifiant de la face et hyperparathyroïdie chez une hémodialysée chronique.

The bony complications in secondary hyperparathyroidism in chronic renal failure are varied. The ossifying fibroma is a rare manifestation. We report a case of a 40 years old woman with indeterminate nephropathy undergoing hemodialysis since 1982. Since may 1995, the patient had a diffuse and intensive bone pain of the two inferior members inducing functional importance with apparition of endobuccal tumefaction in the hard palate with an important increase of the volume of the maxillo-mandibular complex six months later associated to disturbances of the deglutition and phonation. In december 1995, the serum parathyroid hormone level is measured at 1527.6 pg/ml and the serum alkaline phosphatase level at 1620 UI/l. The bony lesions are disseminated to all the skeleton in the form of a demineralization with an ossifying expansive process affecting the maxillo-mandibular complex. Calcemia was at 2.3 mmol/l and phosphoremia at 2.1 mmol/l. The surgical biopsy of this pseudotumor showed an aspect of ossifying fibroma. The cervical echography showed a left inferior parathyroid nodular. In june 1996, a subtotal parathyroidectomy was done. The 9th day after surgery, the serum parathyroid hormone level was at 103 pg/ml with normal calcemia and phosphoremia. Five years later, the volume of the tumor reduced moderately. This observation induces 3 commentaries: the bony manifestations associated to secondary hyperparathyroidism have sometimes a tumoral aspect, the ossifying fibroma may be for known as well as the brown tumor and the treatment of these tumors in complex justifying furthermore a rigorous prevention of the hyperparathyroidism in hemodialyzed patients.

[Renal involvement in Behçet's disease. About six cases]. / L'atteinte rénale au cours de la maladie de Behçet. A propos de six observations.

PURPOSE: To analyze anatomoclinic and evolutive aspects of the renal involvement associated to the Behçet's disease through 6 observations collected in the nephrology department from 1985 to 2000 and to make a review of the literature. METHODS: Retrospective study, diagnosis of Behçet's disease according to the Classification of the International Group Study on the Behçet's disease and renal damage confirmed by histology. RESULTS: Our patients all male are aged between 25 to 55 years with a mean at 34 years old. The renal damage was revelated by a nephrotic syndrome in 3 cases and by a proteinuria at 1 to 2.7 g/day in 3 cases. Microscopic hematuria was present in 2 cases and arterial hypertension in 2 cases. The renal insufficiency has been noted in 2 cases of which severe in one of them. The renal biopsy showed an amyloidosis AA type in 3 cases, a segmental and focal glomerulonephritis in 2 cases and a thrombotic microangiopathy associated to a moderate tubulo-interstitiel lesions by toxicity of ciclosporine in 1 case. The extrarenal signs were dominated by bipolar aphtosis in all cases, necrotic pseudofolliculitis and the no specific cutaneous hyperreactivity in 5 cases and the erythema nodosum in 1 case. The ocular manifestation has been noted in 4 cases and articular manifestation in 3 cases. The vascular manifestation has been noted in one case. The treatment was colchicine in 4 cases and prednisone and cyclophosphamide in 1 case. Three patients were lost of view and a patient died in hemodialysis. The 2 other patients with amylosis had persistent proteinuria with a normal renal function. CONCLUSION: The kidney is one of organs that can alter the prognosis of the Behçet's disease; so, its screening must be realised in each patient with this disease.

[Obstetrical acute renal failure. Experience of the nephrology department, Central University Hospital ibn Rochd, Casablanca]. / Insuffisance rénale aiguë obstétricale. L'expérience du Service de néphrologie, Chu ibn Rochd, Casablanca.

The gravidic acute renal failure (ARF) becomes a rare complications of the pregnancy in the industrialized countries, whereas it is still frequent in the developing countries and responsible of great maternofetal morbidity and mortality. We studied the etiologic and evolutive aspects of the gravidic ARF in 55 patients during 18 years (1981-1998) at the department of nephrology, hospital center Ibn Rochd in Casablanca. The gravidic ARF represents 65% of the gravidic patients. The mean age of the patients is 30.92 +/- 6.44 years old. The mean parity is 3.38 +/- 2.25. The mean term is 31.73 +/- 10.02 weeks of amenorrhea. The main etiology is the preeclampsia and eclampsia, 41 patients (74.5%); the other causes are: the septic conditions: 6 patients (11%); the obstetrical hemorrhages: 4 patients (7.2%); the in uterofetal death: 3 patients (5.5%) and the post-cesarotomy: 1 patient (1.8%). 74.6% of the patients has been hemodialysed. The evolution has been characterized by the normal recuperation of the renal function is 48 patients (87.3%), a chronic renal failure in 2 patients (3.6%) and the death of 5 patients (mortality: 9.1%). The gravidic ARF is still a critical circumstances associated to a severe prognosis as well as in the woman and the fetus. So, the most effective measures are still the prevention and the managing of the obstetrical complications.

[Prevalence of subcutaneous, labial and rectal amyloid lesions in patients wi histologically confirmed renal amyloidosis]. / Prévalence des lésions amyloïdes sous-cutanée, labiale et rectale chez des patients ayant une amylose rénale confirmée histologiquement.

Our work is to evaluate the biopsies rectal (RB), cutaneous and one about the accessory salivary glands (ASGB) in the diagnosis of amyloidosis renal through 20 cases of renal amyloidosis confirmed by renal biopsy in unit of nephrology and hemodialysis in UHC lbn Rochd from February 1996 to January 1998. The mean age of our patients was 39 years old (15-80) with a male predominance of (4/1). The infectious pathology has been the most frequent cause (70%) which consisted essentially in the tuberculosis and the surinfection on dilatation of the bronchi. All the patients had nephrologic symptomatology dominated by the nephrotic syndrome. The 4 biopsies were practised in the 20 patients. Wright's reaction practised in all renal biopsy confirmed the AA nature of the amyloidosis. The amyloïd deposits were noticed in 100% of renal needle biopsy, 80% of accessory gland biopsy, 75% of rectal biopsy and in 35% of cutaneous biopsy. The association of RB and ASGB was positive in 90% of the cases. If the renal biopsy gave more positivity than the other biopsies, it caused complications that were severe sometimes. Also, the biopsy of the ASG, the simple technique is very reliable in the recognition of the amylosis and seems to be the best diagnostic test for this affection.

[Value of the biopsy of accessory salivary glands in amyloidosis]. / Intérêt de la biopsie des glandes salivaires accessoires dans l'amylose.

PURPOSE: To assess the value of accessory salivary gland biopsy for the diagnosis of amyloidosis, a study was conducted in the nephrology and hemodialysis department at Ibn Rochd University Hospital from February 1996 to January 1998. METHODS: Renal amyloidosis was confirmed by renal biopsy accompanying accessory salivary gland biopsy. RESULT: The patient's mean age was 39 years old (range 15-80), with a 4:1-male/female ratio. An infectious cause (either tuberculosis or superinfection and dilatation of the bronchi) was the most frequent (70% of the cases) etiology. All the patients presented renal symptomatology. Nephrotic syndrome predominated. Amyloid deposits were observed in 100% of renal needle biopsies and in 80% of accessory salivary gland biopsies. CONCLUSION: Renal biopsy led to more positive cases than the other biopsies. It may be accompanied by severe complications. Furthermore, biopsy of the accessory salivary glands is a simple and very reliable technique for the diagnosis of amyloidosis. It is currently the best diagnostic test.

[Lupus interstitial cystitis. Apropos of a case]. / Cystite interstitielle lupique. A propos d'un cas.

We report a case of lupus interstitial cystitis in 17 year-old female. The patient presented with suprapubic pain, urinary frequency, dysuria, nocturia and no bacterial growth. Intravenous pyelography showed a low capacity bladder with thickwall, and a bilateral ureterohydronephrosis. Interstitial cystitis was confirmed on bladder biopsy specimen. Clinical symptoms remained eventhough after steroid treatment. Clinical signs of cystitis occurring in a patient with systemic lupus erythematous could be a manifestation of a lupus cystitis.

[Arteriovenous fistula. Apropos of a local experience in Morocco]. / Les fistules artérioveineuses. A propos d'une expérience locale au Maroc.

During eleven years (1983-1994), 684 arteriovenous fistulas (AVF) were realized for 422 patients. The mean follow-up was 39 months. The most frequent AVF was Cimino and Brescia and the most frequent seat was radial. The failure rate in the immediate post-operative period was 10% and 8% after 48 hours. The permeability of the AVF was 59%, 51% and 42% at 1, 2 and 3 years. The late complications were thrombosis (28%), stenosis (15%) and false aneurysm (11%). In spite of recruiting patients with chronic renal failure and deficiency in hospital basic equipment, this experience permit us to start and then, to improve the activity of making AVF and to be able to pick-up patients with chronic renal failure.

Rhabdomyolysis and acute renal failure secondary to toxic material abuse in morocco.

We have studied 26 patients with rhabdomyolysis complicated with acute renal failure. The causes of rhabdomyolysis were dominated by paraphenylene diamine intoxication (PPD) (13 cases). The other etiologies were: crush syndrome (6 cases), eclampsia (3 cases), intense physical effort (1 case), butane intoxication (1 case), postural rhabdomyolysis induced by a prolonged surgical operation for pheochromocytoma (1 case). None of the patients had any past medical history of muscle or renal disease. Serum level of creatinine phosphokinase varied from 1200 to 5400 IU/L. The mean peak of serum creatinine level was 620 umol/1. Therapy included forced alkaline diuresis in all cases. Hemodialysis was required in 18 cases. All but eight patients survived. We conclude that rahabdomyolysis could be caused by intoxication, which was a prime cause in this study. Prevention may be possible with restriction of use of toxic products.

[Heart failure and arterial hypertension disclosing amyloidosis]. / Insuffisance cardiaque et hypertension artérielle révélatrice d'une amylose.

Amyloidosis results from protein infiltration of the extracellular space of organs and tissues. Several amyloidosis proteins have been identified. Protein AL, (deriving from immunoglobulin light chain), protein AA and prealbumin are the most involved in this disease. When AL amyloidosis involves the heart, the illness is often terminal. Most clinical symptoms are heart failure and arrhythmia or block conduction. This case was characterised by the unusual combination of hypertension and amyloidosis. The diagnosis suggested by the echocardiographic but was confirmed by the damaged organ's biopsy. The present case concerns a young woman, who has hypertension and a pulmonary oedema. The echocardiographic scan showed a septal hypertrophy with a shining and granite-like aspect which is compatible with heart amyloidosis. Systolic and diastolic disorder with mitral and aortic regurgitation were also revealed. The kidney and rectum biopsies confirmed amyloidosis AL of the Kappa dysglobulinemia type, without extraosseous plasmocytoma. The heart and kidney failure symptoms disappeared after treatment with diuretics and ACE inhibitors.

[Acute urine retention. Another presentation of a hydatid cyst of the kidney]. / La rétention aiguë d'urine. Un autre mode de révélation du kyste hydatique du rein.

We report on a case of hydatic cyst of the kidney, in a 12 year-old male, revealed by an acute urinary retention. After a brief report of the common signs of this parasitic disease, we emphasize the importance of hydaturia and acute urinary retention as another revealing sign of this disease.

[Tuberculosis in hemodialysis]. / La tuberculose des hémodialysés.

The authors report a retrospective study in order to illustrate the particular features of tuberculosis in hemodialysis population. Thirty two patients over 203 (15.8%) in periodic hemodialysis, have presented a tuberculosis between 1983 and 1996. There were 17 men and 15 women aged from 14 to 60 years old. The features of the tuberculosis in these cases were marked by the extrapulmonary localizations (50%) notably nodes tuberculosis, and the difficulties of the diagnosis certainty. The diagnosis was suspected basing on the fever, the weigh loss, the rate sedimentation increase and the radiologic lesions in pulmonary tuberculosis and peripheric or deep lymph nodes involvement. The diagnosis confirmation was established bacteriologically in 6 cases (18.7%) and histologically in 14 cases (43.8%). The treatment consisted on the association of isoniazide, rifampicin and pyrazinamide which leads to recovery in 87.5%. This treatment was a diagnosis proof in the absence of confirmation.

[Acute obstructive renal failure. Analysis of 28 cases]. / Insuffisance rénale aiguë obstructive. Analyse de 28 observations.

This retrospective study is concerned 28 patients hospitalized with acute obstructive renal failure at the department of nephrology in UHC Ibn-Rochd between 1988 and 1995. The objective of this study was to determine the clinical, étiological, therapeutical and evolutive aspects of the acute obstructive renal failure. It concerned 21 men and 7 women, their mean age is 52 years old. The main symptoms were anuria (85%) and lumbar pain (75%), the mean delay of consultation was 42 days. The diagnosis of the acute obstructive renal function and the presence of obstacle on the upper urinary tract. The obstacle was a stone in 19 cases, cancer in 8 cases and one case of retroperitoneal fibrosis was noted. Treatment of the cause was done whenever possible. Treatment was often palliative in the tumoral pathology. We observed 3 deaths (10.5%), 16 recoveries (58%), 6 cases of residual renal failure (21%), 3 cases of terminal chronic renal failure (10.5%) and 4 cases of recurrence. The lithiasic etiology of acute obstructive renal failure led to a high short-term mortality (15.5%), an effective etiologic causative treatment (69.5%) and a high rate or restoration of the renal function (69.5%). On the other hand, in the neoplastic etiology, there were no short-term mortality, but a frequent course to chronic renal failure.