PP169. Management of fetal and maternal prognosis during severe toxemia.

INTRODUCTION: Severe gravidic toxemia gives heavy maternal and fetal morbidity and mortality. OBJECTIVES: The purpose of our data is to identify bad maternal and fetal factors during severe toxemia and the outcome of pregnancy. METHODS: It is a retrospective and comparative study about 200 cases of severe toxemia reported during 8 years 2004-2011 among 25,000 deliveries (control group). Toxemia is considered severe when blood pressure⩾160/100mHg, proteinuria ⩾2g/l, bad neurosensorial signs, hemostasis disorders, kidney and liver failure, some fetal tests: delay intra-uterine growth acute fetal suffering, fetal death. RESULTS: Frequency of severe toxemia 8‰, primiparous 58% vs. 35% control, gestational diabetes 12% vs. 10% control, oedema 87% vs. 45% control. Maternal morbidity is dominated by hemostasis disorders: low platelet count<80,000 23% vs. 8%, hypofibrinogenemia <4g/l 13% vs. 2%, HELLP syndrome eight cases vs. 0. We raised eight cases of eclampsia crises, 22 cases of retroplacental hematoma vs. 10 control. Blood transfusion 15% vs. 10% control, inhibitors of VII factor administered in two cases vs. 0. We do not deplore any maternal mortality. Fetal prognosis is very compromised ,the delay intra uterine growth 44% vs. 18% control, prematurity 66% vs. 15% control, perinatal mortality 60‰ vs 12‰ control CONCLUSION: More toxemia appears early during pregnancy more maternal and especially fetal prognosis is compromised. New drugs, predictive tests and preventives measurements improve maternal outcome better than fetals' one.

Aspergillus mastoiditis with intact tympanic membrane in immunocompetent host.

Aspergillus mastoiditis is a very rare condition usually observed in immunocompromised patients. Masked mastoiditis is defined as a subclinical infectious inflammatory process of the mucosal lining and bony structures of the mastoid air cells with intact tympanic membranes. To our knowledge, our report of a masked Aspergillus mastoiditis occurring in a 71-year-old diabetic woman is only the second case of masked mastoiditis in the literature. Aggressive medical and surgical management are necessary to avoid a fatal outcome from this invasive infection.

[Infantile visceral leishmaniasis: difficult diagnosis in cases complicated by hemophagocytosis]. / Leishmaniose viscérale infantile: un diagnostic difficile en cas d'hémophagocytose associée.

BACKGROUND: Hemophagocytosis has already been reported in cases of visceral leishmaniasis and thus may complicate search for diagnosis. CASE REPORT: A previously healthy 2 year-old boy was referred for fever and splenomegaly with pancytopenia. An initial diagnosis of kala-azar was refuted because of absence of biological inflammatory syndrome, negativity of bone-marrow aspiration and splenic ponction and of specific serology. After three months of clinical deterioration and apparition of active hemophagocytosis, both bone marrow aspiration and specific serology for visceral leishmaniasis became positive. The boy was given sodium stibogluconate for 20 days; he improved gradually with complete and definitive remission. CONCLUSION: Diagnosis of visceral leishmaniasis may be difficult, even in countries where this condition is relatively frequent; the association with hemophagocytosis is possible and does not constitute a poor factor of prognosis if specific therapy is proposed.

[Cirrhosis and cirrhogenic diseases in Tunisian children. Multicenter study of 65 cases]. / Les cirrhoses et les maladies cirrhogènes de l'enfant tunisien. Etude multicentrique de 65 cas.

Over a period of 10 years, 65 cases of hepatic cirrhosis and cirrhogenic disease have been observed in five Pediatric Centers in mid Tunisia. The age of the patients ranged from 30 days to 14 years. The main etiology was biliary cirrhosis (24 cases) followed by post-hepatic cirrhosis (15 cases). Eight cases had a metabolic origin, which was Wilson's diseases in five cases. Three children had cirrhosis of a pre-hepatic origin. In 15 children, the liver biopsy showed the presence of cirrhosis but the etiology could not be found. Preventive measures are needed in order to reduce the frequency of cirrhosis among Tunisian children: 1) early recognition of biliary atresia, 2) vaccination against hepatitis B virus of at risk neonates and children, 3) Genetic counselling and search for familial cases when cirrhosis of metabolic origin is identified, particularly Wilson's disease.

[The nephrotic syndrome in kala-azar]. / Syndrome néphrotique au cours du kala-azar.

Glomerular nephropathy is unusually known in kala-azar. We present 3 cases and we report a review on the clinical, biological and immunohistological aspects of this glomerulonephritis. The immunologic mechanisms of this parasitic nephropathy and its reversibility after specific treatment are characteristic.