[Neurological complications in adults following rabies vaccine prepared from animal brains]. / Les complications neurologiques observées chez l'adulte, secondaires au vaccin antirabique préparé sur cerveaux d'animaux.

OBJECTIVES: Despite well-known neurological complications, post-exposure semple-type rabies vaccine is still used in Tunisia. We retrospectively studied neurological manifestations following post-exposure rabies vaccine. METHODS: Over a 3-year period, semple-type phenol inactivated lamb nerve tissue vaccine (Pasteur Institute, Tunis) was given to 1392 adults after exposure to rabies. RESULTS: The frequency of neurological complications was 1/200. Seven patients presented complications 4 to 14 days after the first vaccine injection (median 11 days). Central nervous system manifestations occurred in all 7 patients with peripheral neuropathy in 5. Manifestations were meningoradiculitis (n = 3), meningomyeloradiculitis (n = 2), meningomyelitis (n = 1) and myelitis (n = 1). No vaccine-associated death occurred, but one patient suffered persistant paraplegia. CONCLUSION: Semple-type adult animal nerve tissue vaccine produces an unacceptable rate of severe post-vaccinal neurological complications in adults. Human diploid cell rabies vaccine should be used for post-exposure rabies vaccination.

[Pyomyositis in adults in central Tunisia. Apropos of 10 cases]. / La pyomyosite chez l'adulte en Tunisie centrale. A propos de dix cas.

Ten adult patients treated for pyomyositis between 1988 and 1994 in Sousse's university hospital (Tunisia) were retrospectively reviewed. Due to the non specific symptoms, the diagnosis was often delayed (mean = 17 days) and other primary diagnoses were considered, mainly including synovitis. The muscles around hip and thigh were most commonly involved (ten patients), and Staphylococcus aureus was the most common pathogen (nine patients). Ultrasonography was very helpful in the accurate diagnosis of the infection. Incision, drainage, and antibiotic therapy eradicated the infection in all patients. No residual functional limitations and no residual symptoms were noted. Our study showed that pyomyositis is present in central Tunisia and not associated with HIV infection. Clinical features and prognosis are similar to those previously described in the literature.

[Superior caval syndrome in adults in central Tunisia. Apropos of 26 cases]. / Le syndrome cave supérieur de l'adulte en Tunisie centrale. A propos de 26 cas.

We report 26 cases of superior vena cava obstruction (SVC) observed in Sousse University Hospital (TUNISIA). The diagnosis was confirmed by CT scan and/or superior vena cava angiography. The underlying disease was revealed by SVC on 76.9% of cases. Malignant underlying disease was noted on 61.53% of cases. Non malignant causes of SVC was Behçet disease (4 cases) and mediastinal fibrosis (5 cases). SVC revealed Behçet disease in the 4 cases.