Edinburgh questionnaire in the screening for peripheral artery disease in type 2 diabetic patients.

AIM: to analyze Edinburgh questionnaire (EQ) screening performance for peripheral artery disease (PAD) in type 2 diabetic patients. METHODS: Cross sectional study including 150 type 2 diabetic patients without PAD history. All patients responded to EQ and had peripheral pulse checkup and measurement of the ankle/brachial index (ABI). PAD was considered to be present when the ABI was ≤ 0.9 Results: Participants mean age was 57.46 ± 8.04 years and sex-ratio (men/women) was 1.3. EQ has revealed intermittent claudication in 18 patients (12%). On examination, 42 patients (28%) had at least one weakened or abolished pulse in upper limbs. ABI has revealed the presence of PAD in 16% of patients. The EQ sensibility specificity, positive and negative predictivevalueswere 29, 91,39 and 87%, respectively. Among patients with false negative results (n=17), nine had peripheral neuropathy. CONCLUSION: In diabetic patients, EQ had a very low sensibility for the PAD screening. In fact, the important false negative rate, due to the coexisting of peripheral neuropathy, had limited the use of this questionnaire.

A Tunisian patient with two rare syndromes: triple a syndrome and congenital hypogonadotropic hypogonadism.

BACKGROUND/AIMS: The coexistence of triple A syndrome (AAAS) and congenital hypogonadotropic hypogonadism (CHH) has so far not been reported in the literature. This study aimed to characterize at the clinical and genetic level one patient presenting an association of AAAS and CHH in order to identify causal mutations. METHODS: Clinical and endocrinal investigations were performed and followed by mutational screening of candidate genes. RESULTS: At the age of 18, the patient presented sexual infantilism, a micropenis and gynecomastia. No mutation was revealed in GnRHR, TACR3/TAC3, PROK2/PROKR2 and PROP1 genes, except a homozygous intronic variation (c.244 + 128C>T; dbSNP: rs350129) in the KISS1R gene, which is likely nondeleterious. A homozygous splice-donor site mutation (IVS14 + 1G>A) was found in the AAAS gene. This mutation, responsible for AAAS, is a founder mutation in North Africa. CONCLUSION: This is the first report on a Tunisian patient with the coexistence of AAAS and CHH. The diagnosis of CHH should be taken in consideration in patients with Allgrove syndrome and who carry the IVS14 + 1G>A mutation as this might challenge appropriate genetic counseling.

Efficacy of low-dose oral sulodexide in the management of diabetic nephropathy.

BACKGROUND: Diabetic nephropathy (DN) is the single greatest cause of end-stage renal disease (ESRD). Without specific interventions, microalbuminuria (incipient nephropathy) gradually progresses to macroalbuminuria (overt nephropathy) within 10-15 years in about 80% of type 1 and 30% of type 2 diabetic patients, and to ESRD within further 20 years in about 75% and 20%, respectively. A primary alteration in DN consists of decreased concentration of glycosaminoglycans (GAGs) in the glomerular extracellular matrix. This evidence has prompted interest in using exogenous GAGs and specifically sulodexide in DN treatment. PATIENTS AND METHODS: In this uncontrolled multicenter study, diabetic patients with albumin excretion rate (AER) >or=30 mg/24 hours were treated with oral sulodexide 50 mg/day for 6 months, while receiving concomitant medication as required. Two hundred thirty-seven patients (54% males and 46% females, mean age 55 years, mean diabetes duration 11 years) were evaluated; 89% had type 2 and 11% type 1 diabetes mellitus, 67% microalbuminuria and 33% macroalbuminuria. RESULTS: AER was significantly and progressively reduced during sulodexide treatment (p<0.0001): geometric mean after 3 and 6 months was 63.7% (95% confidence interval [95% CI], 59.3%-68.4%) and 42.7% (95% CI, 37.8%-48.2%) of baseline, respectively. The reduction was similar in type 1 and type 2 diabetes and was slightly greater in macroalbuminuric than in microalbuminuric patients. Blood pressure was slightly lowered, while fasting glucose and glycosylated hemoglobin were moderately reduced. Adverse effects were observed in 5.5% of patients, including gastrointestinal in 3.8%. CONCLUSIONS: Sulodexide therapy was shown to reduce AER in patients with DN.

[Clinical features and treatment in Cushing's disease. 18 cases]. / Aspects cliniques et thérapeutiques de la maladie de Cushing. A propos de 18 cas.

We report a retrospective study about 18 Cushing's diseases in the department of endocrinology at Charles Nicolle hospital in 24 years. The mean age was 33.7 years with a male-female ratio of 4/14. Diagnosis was established on adrenocorticotropin hormone analysis and pituitary imaging. Transsphenoidal adenomectomy was released in 8 cases of Cushing's disease, it was successful in 5 patients (62.5%). Bilateral adrenalectomy was performed in three cases.

Acute renal failure due to lymphomatous infiltration: an unusual presentation.

Renal lymphoma occurs most often as a part of a multi-systemic disseminated lymphoma or as a recurrence of the tumor. Renal involvement usually occurs late in the course of the disease and is clinically silent. Acute renal failure (ARF) from lymphomatous infiltration has been described but is quite rare. We report a 50-year-old Caucasian woman, who presented with features of ARF. Physical examination showed that her arterial blood pressure was 190/100 mm Hg with no lymphadenopathy or hepatosplenomegaly. Her urine output was about 100 ml/day, and urinanalysis revealed + proteinuria and microscopic hematuria. Biochemical findings revealed severely impaired renal function with a serum creatinine of 693 micromol/L. The patient's lactate dehydrogenase was elevated at 632 U/L. An abdominal ultrasound showed bilateral, large non-obstructed kidneys and a hypoechoic mass arising in the right lobe of the liver. An ultrasound-guided percutaneous liver biopsy showed typical features of B-cell lymphoblastic lymphoma. The patient expired two days later, even before any specific treatment could be started.

[Emphysematous pyelonephritis. Two cases]. / La pyélonéphrite emphysémateuse. A propos de deux observations.

The emphysematous pyelonephritis is a rare and severe renal infection characterized by the presence of gas in renal parenchyma and its perirenal spaces. We report two cases of emphysematous pyelonephritis in two diabetic women (53 and 50 years old respectively). In the first case, the treatment was based on nephrectomy because of the presence of a septic shock and three risk factors, which are acute renal failure, hematuria and thrombopenia. In the second case, the treatment was only medical. The evolution was favorable in the two cases. We insist in this article that this diagnosis should be considered in every female diabetic patient having severe acute pyelonephritis resistant to a well-conducted medical treatment.

[Diabetes following kidney transplantation. Report of 35 cases]. / Diabète induit après transplantation rénale. A propos de 35 cas.

Post-transplant diabetes mellitus (PTDM) is a frequent complication of renal transplantation. It has a prevalence rate ranging from 3 to 46%. We undertook a retrospective study of 175 nondiabetic renal transplant recipients to determine the prevalence rate, clinical characteristics, and risk factors of PTDM in kidney transplant recipients in our region. Thirty five patients (20%) developed PTDM, 50% were diagnosed by 3 months post transplantation. Eight patients (22.8%) were insulin recurrent. PTDM was independent of kidney source, family history of diabetes, age, sex, incidence of acute rejection, body weight gain, steroid or cyclosporine dose, use of beta-blockers and cytomegalovirus infection. Acturial 5 years survival was 79.4% in the diabetic compared to 80.5% in the control group. Patient survival was similar in the two groups. We conclude that PTDM is frequent in our patients. No significant risk factors of PTDM were identified in this study.

[Treatment of Graves' disease: 300 cases]. / Traitement de la maladie de Basedow: 300 cas.

OBJECTIVE: To try to select the best treatment among synthetic anti-thyroid agents, surgery and radioiodine in the case of Graves' disease. METHOD: We present a retrospective study of therapeutic and progressive aspects of 300 cases of Graves' disease. RESULTS: At the time of the diagnosis, the patients' mean age was of 38.17 years. Female sex predominated (70.7%). Medical treatment was prescribed in 25.7% of cases. Agranulocytosis occurred in one patient who died from septic shock. Surgery was performed in 29.3% of patients and 41% were treated with radioactive iodine. After a mean follow-up of 53.7 months, a progression towards euthyroidism was noted in 60, 22.7 and 21.7% of patients treated respectively with antithyroid drugs, surgery and radioiodine. Hypothyroidism was noted in around 40% of cases, 57.8% of which were treated surgically. Recurrent hyperthyroidism is more frequent with antithyroid drugs. CONCLUSION: Medical treatment increases the risk of relapse. It is therefore preferable to apply radical treatments in order to obtain permanent remission from hyperthyroidism.

[Primary hyperaldosteronism. A study of 18 cases]. / Les hyperaldostéronismes primaires. Etude de 18 cas.

Primary aldosteronism (PA) is defined as an autonomous over-production of aldosterone by the zona glomerulosa of the adrenal glands. It is classically considered as a rare cause of hypertension. Aldosterone producing adenoma (APA) and idiopatic hyperoldosteronism (IHA) represent the most frequent subtypes of PA. The authors report 18 cases of PA (14 women an 4 men) with a mean age of 42 +/- 13.5 years. All patients have hypertension and hypokaliemia (K < 3.5 mmol/l). Eleven patients have an APA, one patient has an adrenal carcinoma and three patients have IHA. The subtype of PA has not been established in three patients. We discuss in this article the clinical, biological, radiological and evolutif characteristics of our cases, and we insist on the necessity of making a precise etiologic diagnosis to propose the most adequate treatment.