[Diabetic papillopathy after intensification of insulin therapy: A case report]. / Papillopathie diabétique après insulinothérapie intensive : à propos d'un cas.

INTRODUCTION: Diabetic papillopathy is a rare ocular complication of diabetes. Its pathophysiology is not well known. It is a unilateral or bilateral optic disc edema with variable degrees of visual loss. OBSERVATION: A 66-year-old woman, with a twelve years old type 2 diabetes mellitus, suddenly presented a unilateral decreased vision. Her ocular examination was normal eight months earlier. Ocular examination, radiological investigations and laboratory analysis were conclusive of diabetic papillopathy. Medical history revealed a recent rapid improvement of blood glucose control after intensification of insulin therapy. A visual acuity improvement with spontaneous regression of papillary edema was observed. CONCLUSION: There is a risk of diabetic papillopathy associated with the rapid control of blood glucose levels after intensification of insulin therapy, even in diabetic patients without known retinopathy.

[Pseudo pheochromocytoma induced by professional stress: A case report]. / Un pseudophéochromocytome induit par le stress professionnel ; à propos d'un cas.

INTRODUCTION: An elevation of plasma or urinary catecholamines or their metabolites in the context of a suspicion of a secondary hypertension associated with paroxysms generally leads to the diagnosis of pheochromocytoma. However, this is not always true. CASE REPORT: We report the case of a 39-year old man with a severe hypertension that was resistant to drug therapy and associated with paroxysms. Urinary fractioned metanephrines were elevated. However, no tumor could be found on tomodensitometry and MIBG scintigraphy. Thus, the causes of pseudopheochromocytoma were reviewed and the diagnosis of professional stress was finally held. In fact, his professional redeployment resulted in an improvement of blood pressure levels, the disappearance of paroxysms and the normalization of urinary metanephrines. CONCLUSION: This observation involves professional stress in pseudo pheochromocytoma.

Testicular adrenal rest tumours in young adult males with congenital adrenal hyperplasia: prevalence and impact on testicular function.

Testicular adrenal rest tumours (TARTs) have been described in patients with congenital adrenal hyperplasia (CAH). The aim of the study was to determine the prevalence of TARTs in patients with CAH, the associated factors and their impact on gonadal function. It is a prospective study concerning six young adult men with CAH, four cases with 21-hydroxylase deficiency and two cases with 11-hydroxylase deficiency. All patients were under glucocorticoid therapy. The mean age was 25 years (range: 20-31). All patients underwent a physical examination with testicular palpation, scrotal ultrasonography, a blood sample for serum testosterone, FSH, LH, inhibin B, ∆4-androstenedione and 17-OH-progesterone measurements and a semen analysis. Ultrasound revealed TARTs in four patients; three were bilateral. The mean tumour size was 6.3 ml (range: 0.02-14.1). The tumours were palpable in two cases. 17-OH-progesterone was <10 ng/ml in all cases. Decreased testosterone level was found in one case. The semen analysis revealed azoospermia in one case and poor semen quality in four patients. TARTs were common and associated with impaired spermatogenesis.

[McCune-Albright syndrome associated with diabetes mellitus]. / Syndrome de McCune-Albright associé à un diabète sucré

McCune-Albright syndrome (MAS) consists of the triad of polyostotic fibrous dysplasia, cutaneous pigmentation, and multiple endocrine abnormalities. Type 1 diabetes mellitus is not included in MAS. We report the case of an 18-year-old girl who presented with McCune-Albright syndrome. The diagnosis was made by the presence of precocious puberty at the age of 6 years, cutaneous pigmentation, polyostotic fibrous dysplasia, and phosphate diabetes. Type 1 diabetes mellitus developed at the age of 16 years. We discuss this case, the relationship between type 1 diabetes mellitus and MAS, with a literature review.

[Cerebral venous thrombosis during pregnancy: about 7 cases]. / Thrombophlebite cerebrale survenant lors de la grossesse: a propos de 7 cas.

BACKGROUND: cerebral venous thrombophlebitis (CVT) is a rare but serious pathology. The pregnancy and especially the postpartum constitute supporting circumstances occured of the CVT. AIM: the aim of our study is to remember the symptomatology of CVT, the importance of the IRM and the angio IRM in the diagnosis of CVT, and its treatment. OBSERVATIONS: We present a retrospective study relating to 7 cases of CVT during gravidopuerperality over 7 years (1996 to 2002). The average age of our patients is 32.1 years. The CVT occured during the first trimester of the pregnancy in one case and in the postpartum in 6 cases. The symptomatology was dominated by cephalgia and the signs of intracranian hypertension. Convulsions occured in 3 cases. The diagnosis of CVT was confirmed by IRM coupled with the Angio-IRM in all cases. The treatment by heparinotherapy was instaured immediately and relayed by the Anti-Vit K as the evolution was favorable in all cases. CONCLUSION: cerebral venous thrombophebitis (CVT) is a serious pathology (especially in pregnancy and post partum). The diagnosis is performed by the magnetic resonance imaging (IRM) and the early introduction of the heparinotherapy.

[Endometrectomy. Analytical study of 20 cases]. / Endométrectomie. Etude analytique de 20 cas.

UNLABELLED: Endometrial removal represents a therapeutic alternative to hysterectomy. AIMS: Through a retrospective study of 20 cases of endometrial removal colleted over a period of 4 years, the authors try to determine the indications of this therapeutic method, its efficiency, its advantages as well as its contra indications. RESULTS: Average age of the patients was 44 years. Average parity was 4. Functional menstrual disorders were found in 90% of cases. Gynaecological examination revealed a uterus of normal size in 85% of cases, and increased in size in 15% of cases. All the women had a preoperative diagnostic hysteroscopy. A simple endometrectomy was performed in 70% of the cases, an endometrectomy with a polypectomy in 25% of the cases and an endométrectomy with a myomectomy in 5% of the cases. The rate of success was 90%. We had a case of uterine perforation, because of uncontrollable bleeding a hysterectomyhad to be carried out in 2 cases. CONCLUSION: Endometrectomy is an alternative to hysterectomy in cases of menorrhagia due to mild functional disorders resistant to medical treatment.

[Intra-uterine growth retardation: etiologic factors and management]. / Retard de croissance intra-utérin: etiologie et prise en charge obstetricale.

OBJECTIVE: The aim of this study is to define the etiologic factors, the diagnostic proceduresand obstetrical rules to be observed during a pregnancy in relation with low birth weight. PATIENTS AND METHODS: This is a retrospective study of 124 cases, carried out at the military hospital of Tunis, between January 1st 1999 and December 31 st 2001. RESULTS: The frequency of intra-uterine growth retardation (IVGR) was 2.1%. 46.8% of the patients were primiparous. The mean age of the patients was 30 years. 25.8% of the patients developed toxemia. The etiology was predominantly renovascular-syndromes, urinary infections, and idiopathic hypotrophy. The positive diagnosis was suggesred by the measure of the uterine height in 96% and was confirmed by sonogaphy in all cases. The ombilical Doppler was pathological in 17.76% of the cases. A corticosteroid administration for pulmonary maturation was prescribed in 28% of the cases. Obstetrical common rule was fetal extraction: 42.7% of the patients were delivered by cesarean. CONCLUSION: There is a real need to insist on the importance of early detection of fetal hypotrophy and of better management of the women at risk.

[Surgical laparoscopy in the management of women infertility]. / Apport de la coelioscopie operatoire dans la sterilite feminine.

The authors report their experience about surgical laparoscopy in the management of women infertility. Based on a series of 87 patients (median age: 31 years), 61% have primary infertility. The surgical procedures were distal tuboplasty in 26 cases, endometriosis cure in 19 cases, ovarian driling for polycystic ovarian syndrome in 18 cases and adhesiolysis in 24 cases. The rate of intra uterine pregnancy of the 81 followed patients is 40.7% with 23 newborn (28.39%), 5 abortions (6.17%) and 5 current pregnancies (6.17%). The rate of ectopic pregnancies is 3.7%.