[Association of celiac disease and cerebral venous thrombosis: report of two cases]. / Association maladie cœliaque et thrombose veineuse cérébrale. Revue de deux observations.

UNLABELLED: Thrombosis events may occur in celiac disease. Thrombophilic risk factors have been reported. INTRODUCTION: To report two cases of cerebral venous thrombosis in celiac disease patients and to determine associated thrombophilic factors. Case 1: a 63-year-old woman was admitted for cerebral venous thrombosis. Her past history included celiac disease which was untreated for the last 10 years. Biological data showed moderate hyperhomocysteinemia and positive reaction for antiphospholipid antibodies. Case 2: a 19-year-old girl was hospitalized for seizures and impaired consciousness. MRA demonstrated longitudinal sinus thrombosis with parietal infarction. Biological findings showed: protein S deficiency and positive reaction for antiendomysium and antigliadin antibodies. Gastroesophageal endoscopy with biopsy showed villous atrophy. Both patients improved under anticoagulant treatment. CONCLUSION: The sites of associated venous thrombosis are generally unusual in celiac disease, yet the cerebral localization is only exceptionally reported. It is essential to search for risk factors. Gluten-free diet remains the mainstay treatment for patients with celiac disease.

PP144. Profile of lupus pregnancy in internal medecine practice.

INTRODUCTION: The pregnancies in systemic erythematous lupus (SLE) disease is a situation of high risk and involve both the mother and the fetus. The prematurity and the miscarriage are there more frequent, with increase risks of eclampsia, acute hypertension, HELP syndrome and of worsening renal disease. So the morbimortality is multiplied particularly when a anti-phospholipid syndrome 'APLS' is associated. The pregnancy remains however authorized when the SLE is in remission for more than 6 months with a validated treatment and successful means of monitoring. OBJECTIVES: To review the clinical profile of the pregnancies at the SLE patients with or without APLS in Internal Medicine Practice. METHODS: it's a retrospective study, in an internal medical centre over a period going from January, 2008 till December, 2011. The collection of the data is made from the index cards of clinical observations collecting items to interpret the data. All the patients are diagnosed referring to the criteria ACR (SLE/APLS) and all benefit from a follow-up in a obstetrics monitoring (ultrasounds to monitor growth and placental development). RESULTS: On a cohort of 80 SLE young patients hospitalized we brought together 20 patients answering eligibility criteria. The average age is of 26 years (21-41), SLE evolve with an average of 2.5years, the parity is estimated at 5 on average by patient. The pregnancies are programmed in only in 25% . The others cases of pregnancy remain the consequence of a not adapted contraception (50%). Lupus patients have history of renal damage (8) requiring immunosuppressive therapy (4) but renal function is preserved at all the patient's. The treatment is adapted to the clinical context and prophylactic doses of heparin and a baby aspirin are required in most situations. The cardiovascular and metabolic risk factors show an overweight (12), one dyslipemia (10), type 2 diabetes (2), and hypertension (3). The pregnancy is at the origin of a degradation of the renal function (4) with definitive chronic renal Insufficiency (1). The specific events observed are a HELLP syndrome (1), pre-eclampsia (2), fetal losses (5), ischemic strokes (4) and post-partum cardiomyopathy (1). The pregnancies require caesarians (15) with ligature of trunks (2). We deplore fetal deaths (7) in tripled (1) and in twin (1) during the period of follow-up. We note a small birth weight (7), a preterm birth (5), a foetal distress (5) at the origin of a psychomotor disorders (1) and we observed a case of a transient skin lupus (1). CONCLUSION: The frequency of the maternal and fetal complications is partially understandable by the fact that the majority of the pregnancies neither are programmed, nor authorized by the treating physician. Indeed, between the denial of the disease and the desire of pregnancy in everything taken, the patients often take the risk and put the treating physician in front of pregnancies in top risks.

[Assessment of myocardial perfusion in systemic lupus erythematosus]. / Evaluation de la perfusion myocardique au cours du lupus érythémateux systémique.

INTRODUCTION: Cardiovascular disease is a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Necropsy studies found a high incidence of myocardial and coronary injuries while clinical manifestations were observed in less than 10%. The purpose of this study was to evaluate myocardial perfusion in SLE patients. PATIENTS AND METHODS: The study was carried out in 153 patients with a definite diagnosis of SLE according to the revised criteria of the American College of Rheumatology. Ninety-four (61.4%) underwent 99mTc-tétrofosmine SPECT analysis at rest and after stress. RESULTS: The average disease duration was 11 years. Ninety-four patients (93 women and one man) with a mean age 37 years were assessed. Twelve had a past history of vascular event: six stroke, four angina pectoris and two myocardial infarctions. Cardiovascular risk factor included: high blood pressure (35.2%), dyslipidemia (62.3%), moderate hyperhomocysteinemia (55%), BMI greater than 25 (40%).The cumulative prednisone dose per patient was 45.5g. Myocardial perfusion stress scanning showed abnormal perfusion in 21 patients (22.3%). Among these, eight underwent coronary angiography which was normal in seven cases. One patient had a right coronary stenosis. Perfusion abnormalities were correlated with stroke (p<0.01) and coronary events (p<0.02). CONCLUSION: Myocardial perfusion scintigraphy can be a useful noninvasive method to identify subclinical myocardial involvement in systemic lupus erythematosus and patients at risk of later events.

[Autoimmune chronic active hepatitis: anatomoclinic's study of 50 patients]. / Les Hépatites auto-immunes (HAI) chroniques de l'adulte: étude anatomoclinique d'une série de 50 patients.

PURPOSE: To analyse anatomoclinic and evolutive aspects of autoimmune hepatitis (AIH) through 50 observations collected in two Internal Medicine departments in Algiers from 1998 to 2002 and to make a review of the literature. METHODS: The study is prospective. The diagnosis of autoimmune hepatitis (AIH) is established according to the recommendations of the score of the International Autoimmune Hepatitis Group (1991) or/and hepatitic damage confirmed by histology. RESULTS: Fifty patients were studied: (32 women-18 men) and the mean age was 38 years (17 to 73). Autoimmune extra-hepatitic manifestations were associated in 26%. The AIH type 1 has been noted in 58%. AIH were type 2 in only 6%. In 22% of the cases AIH were sero-negative and the others AIH represented 14% were classed as overlap-syndrome (5 cases of primary biliary cirrhosis and 2 cases of primary sclerosing cholangitis hepatitis overlap syndrome). The first liver biopsy tissue showed strong necrotic-inflammatory activity in 56% and cirrhosis was identified in 19 patients (38%). The treatment (azathioprine and corticosteroid) was prescribed in 37 patients (74%) in active chronic hepatitis or in compensed cirrhosis. FOLLOW-UP: 28% of the patients died (9-36 months) because cirrhosis's complications or because complications of hepatocarcinoma (3 cases). CONCLUSION: The diagnosis of AIH must be established early for each patient with chronic liver disease particularly is those are supposed as a crypto genetic hepatitis. The prognosis is compromised by delayed diagnosis and the mortality in middle following up is high.