[Contribution of closed mitral commissurotomy in the surgery of rheumatic mitral stenosis]. / Apport de la commissurotomie à cœur fermé dans la chirurgie de la sténose mitrale rhumatismale.

UNLABELLED: The objective of this work was to study the indications, techniques and results of closed heart mitral commissurotomy in patients with rheumatic mitral stenosis in Morocco. METHODS: All patients who had undergone closed heart mitral commissurotomy for rheumatic mitral stenosis, operated between 1999 and 2008 were collected in this study. Mitral stenosis was diagnosed and evaluated using Doppler echocardiography. Patients with commissural calcification, severe mitral regurgitation, and surgical tricuspid or aortic valvular disease were excluded from this study. RESULTS: Six hundred and twenty-five patients have been collected. 62.2% were young with an age between 18 and 35 years and 491 (78.8%) were female. Seventy-nine percent of patients had stage III or IV NYHA and were in sinus regular rhythm. The closed heart mitral commissurotomy was performed for all patients through a left thoracotomy using either digital or dual dilatation. The mitral area was significantly increased postoperatively to 2.11 ± 0.32 with 100% opening of the anterior commissure, while the posterior commissure was opened only for 93.7% of patients. There were nine perioperative deaths (4.9%) and all patients who died had severe mitral stenosis (<0.8 cm(2)) with an elevated systolic pulmonary artery pressure (>60 mmHg). CONCLUSION: The closed heart mitral commissurotomy provides excellent results in young patients with rheumatic mitral stenosis.

[Onychomycosis in the elderly]. / Onychomycoses chez les sujets âgés.

BACKGROUND: Onychomycosis is more frequent in the elderly. The aim of this Tunisian study was to determine the prevalence and the epidemiological, clinical and mycological characteristics of onychomycosis in elderly subjects. PATIENTS AND METHODS: This was a prospective study performed over a 7-month period (October 2005 - April 2006). The fingernails and toenails of 290 new consecutive patients aged 65 years and over presenting at general practitioners' clinics were examined by certified dermatologists. Clinical signs of onychomycosis were observed in 120 patients. 137 nail samples and 103 skin scrapings were obtained from these subjects. RESULTS: The study population comprised 51 men and 69 women (sex ratio M/F: 0.74) of mean age 72.33 +/- 6.2 years. Fingernails were involved in 28 cases (20.4%), toenails in 109 cases (79.5%), and both fingernails and toenails in 17 cases (12.4%). On average, patients had 2.7 infected fingernails and 3.9 infected toenails. The big toenail and thumbnail were affected most often respectively on the feet and on the hands. Among the clinical presentations seen, distolateral subungual onychomycosis was the most common clinical presentation, on both the feet and the hands. Mycologically confirmed onychomycosis was detected in 110 of 137 nail samples. The rate of positivity was 80.3%. The prevalence of onychomycosis was confirmed in 34.1% of patients examined (99/290). Dermatophytes were the main agents causing onychomycosis in our population (79%). The most frequently detected fungus was Trichophyton rubrum (72.1%). In toenail infections, dermatophytes were most frequently isolated (97%), while in fingernail infections, yeasts were most often isolated (75%), with Candida albicans being dominant (60%). No moulds were isolated in either the hands or the feet. The same fungus was isolated in both skin scrapings and nail samples from 33 patients. Trichophyton rubrum was detected in 28 cases. CONCLUSION: This study confirms a higher prevalence of onychomycosis in the elderly. It shows dermatophytes, in particular Trichophyton rubrum, to be the most frequently isolated causative agents in onychomycosis in the elderly, followed by yeasts, with no moulds being detected.

[Which is the role of parasites and yeasts in the genesis of chronic blepharitis?]. / Quel est le rôle des parasites et des levures dans la genèse des blépharites chroniques?

INTRODUCTION: The chronic blepharitis is a current ophthalmic disease posing a therapeutic problem. The etiologic diagnosis is essential for adapting the treatment. PURPOSE: The aim of this study is to describe the role of Demodex sp, Malassezia sp and Candida sp in the pathogenesis of chronic blepharitis. PATIENTS AND METHODS: It's a prospective study realized during a period of 14 months. It interested 69 patients with chronic blepharitis and 96 controls. The prevalence of Demodex sp, Malassezia sp and Candida sp on the eyelash of chronic blepharitis patients and controls was investigated. RESULTS: Demodex folliculorum was found in 58% of patients with chronic blepharitis and in 15,6% of controls. The difference between the two groups was statistically significant (P<0,00001). The sex and the age intervene neither in the frequency, nor in the abundance of D. folliculorum in the two groups. Malassezia sp was identified in 10,4% of the control group and 31,88% of the group with chronic blepharitis. The difference is significant (P<0,00001). There is no correlation between frequency and abundance of Malassezia, sex and age in the two groups. CONCLUSION: In our study, D. folliculorum and Malassezia sp seem to be accused in the genesis of the chronic blepharitis. Their systematic search is necessary in order to adapt the treatment.

[Candida dubliniensis: a novel emerging species]. / Candida dubliniensis: une nouvelle espèce émergente.

Over the past decade, the incidence of opportunistic fungal infections continues to increase. Candida albicans remains the most important pathogenic yeast. Since 1995, a novel Candida specie has been identified and named Candida dubliniensis. This specie shares many phenotypic characteristics with Candida albicans, including the ability to produce germ tubes and chlamydospores. These similarities have caused significant problems in the identification of Candida dubliniensis. A large variety of methods have been developed for the discrimination of these two species. They included the sensitivity to different stress (temperature, salinity), growth on chromogenic and specific medium and carbohydrate assimilation. However, these methods can fail to assert the identification of Candida dubliniensis, but molecular typing methods are highly reliable and can confirm the identification. However, they are too complex for routine use. The identification of this specie in routine is essential in order to further understand the epidemiology, to better define the role of Candida dubliniensis as a potential pathogen and its susceptibility to develop a resistance to the antifungal agents. So, new methods have to be developed.

[Cortisone glaucoma: epidemiological, clinical, and therapeutic study]. / Glaucome cortisonique: étude épidémiologique, clinique et thérapeutique.

INTRODUCTION: Cortisone glaucoma is a secondary glaucoma induced by local or oral steroids used to treat chronic inflammatory diseases. PATIENTS AND METHODS: Retrospective study including 43 eyes of 23 patients (three patients were monophthalmos). We present epidemiological and clinical features with evaluation of functional damage (visual acuity, visual field), and therapeutic results with a follow-up period ranging from 2 to 10 years. RESULTS: Topical steroids were incriminated in 15 of 23 cases (self-medication), whereas general steroids (for chronic diseases) were used by eight patients. Visual function was seriously affected (visual acuity<1/10 in 23/43 eyes at the first visit with pronounced visual field abnormalities). Surgery was necessary in 16 of 43 eyes (deep sclerectomy with or without implant, trabeculectomy). DISCUSSION: Cortisone glaucoma is rather frequent in Tunisia where conjunctival allergy and self-medication are common. Young adults are concerned, making it a high surgical risk usually requiring surgical devices such as a T Flux implant. CONCLUSION: Cortisone glaucoma is a serious complication of steroid therapy that usually affects young adults. The disease is usually detected late, explaining the severe functional damage.

[Primary cardiac lymphoma. Report of a case]. / Lymphome cardiaque primitif. A propos d'un cas.

Malignant non-Hodgkins lymphomas have a secondary cardiac localisation in 20% of cases. However, a cardiac primary site is rare (44 cases described up to now). A positive diagnosis is rarely made before death. There is great interest in echocardiography, a non-invasive method, to identify these tumours early. The prognosis remains nevertheless gloomy. We report the case of a child aged 8 years, admitted with a scenario of low output right cardiac insufficiency. Chest radiography identified cardiomegaly with a prominent right border, and the electrocardiograph showed right auricular hypertrophy. A tumour mass infiltrating the right atrium, the right ventricle and the lateral face of the left ventricle was discovered on trans-thoracic echocardiography. Investigation for tumour spread was negative. The patient died before operation in a state of extreme low output. The histology favoured a highly malignant non-Hodgkins lymphoma type B.

[Ruptures of the posterior wall of the left ventricle after mitral valve replacement: surgical repair and prevention]. / Les ruptures de la paroi postérieure du ventricule gauche après remplacement valvulaire mitral: réparation chirurgicale et prévention.

We report two cases of type III rupture of the left ventricle posterior wall, situated midway between the mitral annulus and the posterior papillary muscle and occurring in immediate continuations of a mitral valvular replacement. The first case has occurred at the moment of the canulas removal in a 28 years old patient operated for mitral stenosis. The tear was repaired with horizontal mattress sutures through felt strips on the external surface of the heart. The immediate post operative course was marked by bleeding recurrence and cardiac failure which has led to death. In the second case, a 68 years old man was operated for degenerative mitral insufficiency. The rupture has occurred just before closing the chest. The repair was realized successfully by using an intra-ventricular patch. The chordae tendinae removal constitutes a factor predisposing to the left ventricle posterior wall rupture. The repair has to use an intra-ventricular patch. The prevention is based on the preservation of the continuity between the mitral annulus and papillary muscles by preserving the sub-valvular apparatus or by using synthetic chordae.

[Right atrial hemangioma presenting as pericardial tamponade. A case report]. / Tamponnade péricardique révélant un hémangiome de l'oreillette droite. A propos d'un cas.

Intracardiac haemangioma is a very rare benign primary cardiac tumour. A 40-year-old patient, with no notable history, presented with chest pain, accentuated by deep inspiration, associated with NYHA stage III dyspnoea. Physical examination revealed signs of right heart failure and electrocardiogram showed low voltage with diffuse repolarization disorders. Chez x-ray showed a cardiothoracic index CTI > 0.70, and enlarged right margins. A large pericardial effusion with a tumour mass filling the right atrial cavity was discovered on transthoracic echocardiography. Chest computed tomography demonstrated the tissue origin of the tumour and suggested extension to the inferior vena cava and hepatic veins. The patient was referred to a surgeon for tumour resection. Histological examination revealed intracardiac capillary haemangioma. Five month postoperative follow-up did not reveal any abnormalities.

[Multiple myxoma of the right ventricle with infiltration of the pulmonary infundibulum and arteries]. / Myxomes multiples du ventricule droit à forme infiltrante dans l'infundibulum et les artères pulmonaires.

The authors report a case of multiple myxoma of the right ventricle treated surgically. One of the myxomas infiltrated the right ventricular ourflow tract, the main pulmonary artery and its branches. This case underlines the difficulty of radical resection of infiltrating cardiac myxomas.

[Double recurrence of myxoma of the left atrium. Apropos of a case]. / Double récidive d'un myxome de l'oreillette gauche. A propos d'un cas.

Multiple recurrences of cardiac myxomas are rare and high-light the problem of re-operation. We report a case of double recurrence of left atrial myxoma and analyse the causes of recurrence. In our case, the first myxoma was inserted in the left inter-atrial septum, and the first recurrent tumor was inserted near the pulmonary vein, forming adhesion with the inter-atrial septum. The second recurrent tumor was inserted in the inter-atrial septum. The first operation resected the tumor, including part of the inter-atrial septum, and the sides of the septum were sutured. The two following operations used a patch for the septoplasty. This case is sporadic and not included in the high risk myxoma recurrence syndrome. Incomplete tumor resection is incriminated in one third of recurrences but seems unlikely in our case.

Epidermolytic Hyperkeratosis with Club Foot Deformity.

A case of epidermolytic hyperkeratosis is reported. The patient had extensive verrucous scaling resembling porcupine man. There was associated bilateral foot deformity in the form of congenital club foot.