[The health in Tunisia. Achievements and limitations]. / La santé en Tunsie. Réalisations et limites.

Since the independence in 1956, the health sector has scored a great deal of progress. Such a development has been observed also in other developing nations. The country is now facing a crucial issue. On one hand the resources devoted to the health sector are ever increasing and are likely to reach the limits acceptable to the national economy. On the other hand the citizens are seeking for more and better care and are no longer satisfied with the care and health insurance provided to them. On this background, the inequalities of health resources between the regions and areas of the country add an other aggravating factor.

[Imbalance of distribution of physicians in the Arab world]. / Les déséquilibres de la distribution des médecins dans le monde Arabe.

The Arab world, as a whole, now has 8.5 medical doctors per 10,000 population. This average covers a great diversity of national situations; for example 0.6 doctors per 10,000 population in Somalia, and 17.5 doctors per 10,000 population in Qatar. From the viewpoint of medical staffing, the Arab countries can be grouped into four categories: (i) Countries with low medical density: their national staff is scarce, they do not have a long academic tradition, and they have to rely on foreign physicians (Yemen, Djibouti, Somalia, Mauritania). (ii) Countries with acceptable medical density: they have strengthened their medical training system during the last decades, their production of medical graduates is now fairly high, and there is seemingly a threat of oversupply (Algeria, Tunisia, Syria, Iraq). (iii) Countries with relatively high medical density: their medical staffing is below that of developed countries, but their economic possibilities are reduced, which leads to an oversupply; these countries are exporters of medical manpower (Egypt, Jordan). (iv) Countries that import medical manpower although their own medical density is quite high: their medical training is recent or non-existent and their health system relies to a great extent on foreign doctors (Saudi Arabia, Bahrain, Qatar, United Arab Emirates, Libya, Kuwait). They are all oil producers. In brief, a shortage and an oversupply of medical doctors coexist in the Arab world, and concerted action is required.

[Osteoarticular amyloidosis in hemodialyzed patients. Report of 4 cases]. / Amylose ostéoarticulaire des hémodialysés. A propos de 4 cas.

Chronic hemodialysis is sometimes complicated by an osteoarticular amyloidosis, which happens after a middle delay of ten years, it can be expressed by a tunnel carpal syndrome, a shoulder pariarthritis, bony cysts, and erosive spondylarthropathy. The authors reported their experience about four cases, and insisted on some évocatoring radiologic aspects.

[Continuous ambulatory peritoneal dialysis in Tunisia]. / La dialyse péritonéale continue ambulatoire en Tunisie.

CAPD covers about 4% of renal replacement therapy patients in Tunisia. From February 1983 to 1988, 47 patients, 21 males and 26 females whose mean age was 36, 14 +/- 15 were treated. Their socio-cultural level was variable. The mean duration of therapy was 14.5 months/patient/year. The five years patient survival rate was 46% and the technique survival rate 21%. Most patients had a good general condition and were professionally rehabilitated. Peritonitis was the main complication: its incidence was 1.8 episodes/patient/year. Yeasts peritonitis were relatively frequent, specially in patients who had previously been treated with antibiotics. Peritonitis was often cured with a local and general treatment. Yearly CAPD cost was 1/3 lower than center hemodialysis and a better management allowed to decrease the expenses due to laboratory and X ray investigations and to hospitalization. On the basis of this clinical experience, we believe that CAPD is an efficient and valid therapeutic modality, less expensive than hemodialysis. It is probably a suitable renal replacement therapy in other centers in Tunisia and in other developing countries.

[The first thirty months of kidney transplantation in Tunisia]. / Les trente premiers mois de transplantation rénale en Tunisie.

Kidney transplantation is actually the best replacement therapy for the end stage renal failure. It sets free the hemodialysed patient from the hemodialysis restraint and contributes to solve the socio-economic problems risen by chronic hemodialysis. The authors report the results of this technic during the first 30 months of kidney transplantation in the "Hôpital Charles Nicolle" of Tunis. They describe the first steps which led to kidney transplantation, the therapeutic regimens, the medico-legal problems and the specific complications observed during this start period.

[Treatment of chronic renal failure in Tunisia]. / Traitement de suppléance de l'insuffisance rénale chronique en Tunisie.

Treatment of end-stage renal disease started in Tunisia in 1968 and has been used for 543 patients; 364 of them are still living. There are now 10 centers, 4 in public hospitals and 6 in private centers. Transplantation is still performed abroad. Among living patients, 312 (86%) are on hemodialysis, 11 (3%) are on CAPD and 41 (11.2%) are living with a transplanted kidney. The mean survival rate of patients is similar to the European mean and professional rehabilitation is good in most cases. New dialysis centers are planned to open and renal transplantation with related living donors will probably be performed soon.

[Usefulness of combined captopril-labetalol treatment in resistant hypertension (author's transl)]. / Intérêt de l'association captopril et labétalol dans le traitement de l'hypertension réfractaire.

Fifteen patients with severe or malignant resistant arterial hypertension were treated by simultaneous administration of captopril and labetalol. Seven patients (group A) were given captopril alone and 8 patients (group B) labetalol alone without noticeable results. However, when the two drugs were given jointly a significant fall in mean arterial pressure from 165 +/- 19.8 (+/- 1 S.D.) to 102.4 +/- 15.1 mmHg (p less than 0.001) in group A patients and from 162.7 +/- 20 to 117 +/- 21.4 mmHg (p less than 0.05) in group B patients was observed. There were no significant changes in heart rate, a few side-effects were recorded. The captopril-labetalol combination may be considered as a useful alternative treatment of resistant arterial hypertension.

[Pheochromocytoma with compression of renal vasculary pedicle and hypoplastic kidney: interest of sulpiride and propranolol tests (author's transl)]. / Phéochromocytomes pédiculaires compressifs avec atrophie rénale unilatérale. Intérêt diagnostique des tests au propranolol et au sulpiride.

This report concerns two pheochromocytomas of renal vasculary pedicle. Diagnosis is made on clinical features and urinary vanylmandelic acid excretion rate. Localisation is made by arteriography. In one case, there is a renal artery compression, and in the other the tumor is vascularised by lombar artery with hypoplasic ipsilateral kidney. These two cases stress the problem of the respective responsibility of both pheochromocytoma and renovascular disease in hypertension genesis. Beside the clinical and biological context pre-operatively, the sulpiride and propranolol tests may have a discrimination value. Excision of the tumor afforded complete relief of symptoms, the two patients remained normotensive three years later.