[Factors associated with medical residents' brief counseling]. / L'aide au sevrage tabagique : la pratique du conseil minimal par les résidents en médecine.

INTRODUCTION: Smoking is a public health problem. Physicians have an important role in the fight against smoking, particularly by means of the brief advice they can give. The aim of this work was to study the prevalence of brief advice application by medical residents and to identify factors that may condition its practice. METHODS: We conducted a descriptive and analytical study with prospective data collection that included 302 residents practicing in Tunisia who had agreed to respond to an online questionnaire submitted in February and March 2020. RESULTS: Residents' mean age was 28±2 years and the gender ratio was 0.65. Sixty-four percent of them were non-smokers. During their practice, 94% systematically identified their patients' smoking status, but 61.9% were unfamiliar with the concept of brief advice. Residents' brief advice application rate was 57.6%. In multivariate analysis, the factors impacting brief advice application were: gender (OR=0.321, p=0.0001), familiarity with brief counseling (OR=2.808, p=0.002) and having observed brief advice being given by a senior physician (OR=2.328, p=0.0001). CONCLUSION: The rate of brief advice application remains low. On this subject, improved theoretical and practical teaching during medical studies is essential.

[Complications of head and neck expansion: Acting on modifiable factors. A study of 98 prothesis]. / Complications de l'expansion cutanée cervico faciale : agir sur les facteurs modifiables. Étude sur 98 prothèses.

BACKGROUND: Tissue expansion is a key tool in the therapeutic arsenal that is proposed for repairing soft tissue losses of the head and neck. This technique, however interesting it may be, is not without its risks. The aim of this work is to identify the different steps of this procedure, determine the complications risk factors inherent to each step of the expansion and propose recommendations to improve functional and aesthetic results. PATIENTS AND METHODS: We carried out a retrospective study on tissue expansion of the head and neck over a period of 10 years extending from January 2009 to December 2018, with at least one year follow-up for each patient. Our study counted 63 patients with the placement of 98 prostheses. We considered the various variables involved in the expansion process in order to determine those that increase the risk of complications. RESULTS: In our series we counted 66.3 % of complications and 22.4 % of failures. We found that a young age increased the risk of skin suffering and that smoking increased the risk of hematoma occurrence. Neck expansion was found to be the riskiest site of expansion followed by the scalp that increased the risk of exposure (especially the parietal section of the scalp). The face is considered as an interesting site for expansion. We found that the use of multiple expanders is an attractive alternative to iterative expansions and to the choice of large expanders. CONCLUSION: Tissue expansion of the head and neck requires careful planning that takes into account each step of the process.

Long-term therapeutic outcomes of facial arteriovenous malformations: A retrospective bi-centric study of 30 cases.

INTRODUCTION: Among vascular malformations, arteriovenous malformations (AVM) are potentially the most invasive and destructive especially when located on the face. Their management is still subject to controversy and yet no consensus exists. Our aim was to report long-term therapeutic outcomes for patients with facial AVM managed either by embolization alone or by resection with/without preoperative embolization. MATERIAL AND METHODS: A bi-centric retrospective study was carried out covering the period from 2001 to 2018 including 30 patients with a facial AVM. Outcomes were categorized as follows: with 1=controlled disease, 2=improved disease (residual, no expansion), 3=persistent or stable disease (neither improved nor worsened), and 4=recurrent or worsened disease. RESULTS: The initial treatment modality was embolization (n=5, 16.7%), surgical resection (n=16, 53.3%), and surgical resection after embolization (n=9, 30%). The follow-up period ranged from 12 to 216 months with a median of 54.9 months. Taking all treatment modalities together, disease control was achieved in 60% of the cases. Disease control was achieved in 77.8% of the cases after embolization followed by surgery, in 68.7% after surgery alone and in none of the cases after embolization alone. CONCLUSIONS: According to our results, optimal treatment is based on a combination of embolization followed by a well-conducted surgical treatment.

Cardiac hydatid cyst in the interventricular septum: A literature review.

Human hydatidosis occurs mainly as a result of infection with the larvae of Echinococcus granulosus. Cardiac echinococcosis is an uncommon disease and the interventricular septum is rarely involved. This article is a review of all of the literature related to hydatid cyst in the interventricular septum included in the PubMed database. Forty-five cases reported between 1964 and 2019 were identified.

Speckle tracking echocardiography in systemic sclerosis: A useful method for detection of myocardial involvement.

BACKGROUND: Systemic sclerosis is a multisystem disorder characterized by tissue fibrosis and organ damage. Heart involvement is one of the main factors shortening survival, which may be underestimated by conventional echocardiography measurements. Two-dimensional speckle-tracking echocardiography is a powerful novel modality to assess subclinical myocardial dysfunction. AIM: The aim of this study is to investigate heart involvement in systemic sclerosis patients, and to determine the usefulness of ventricular longitudinal deformation using the Two-dimensional speckle tracking technology for an early detection of ventricular dysfunction. PATIENTS AND METHODS: Between May 2016 and September 2016, 25 patients with systemic sclerosis and 25 healthy subjects underwent echocardiography to assess heart abnormalities and the strain of the two ventricles using two dimensions' speckle tracking echography. RESULTS: The two groups were comparable in age and gender. Despite comparable left ventricle systolic function (left ventricular ejection fraction patients 64.58±8.87 vs. in healthy 68.2±7.41, P=0.19), patients presented altered longitudinal peak systolic strain values (global longitudinal strain: patients -17.42±1.62 vs. healthy -19.24±8.85, P<0.0001). Despite comparable pulmonary artery systolic pressure, there was a significant alteration in right ventricular systolic and diastolic function assessed by standard measurement. Longitudinal peak systolic strain of the right ventricle was significantly lower in patients compared with controls (P<0.01). CONCLUSION: Ventricular deformation analysis by two dimensions' speckle tracking echocardiography appears to be a sensitive method to detect early ventricular impairment in patients with systemic sclerosis.

Early outcomes of cardiac surgery in elderly patients.

BACKGROUND: Due to the increase in average life expectancy and the higher incidence of cardiovascular disease, more elderly patients present for cardiac surgery nowadays. At the same time, age has been considered a predictor of morbidity and mortality. AIM: To evaluate the short-term outcomes of cardiac surgery in elderly patients. METHODS: We conducted a descriptive retrospective study including elderly patients who underwent cardiac surgery from January 2012 to 31st of December 2016. All patients were hospitalized before and after cardiac surgery in the cardiology department of Habib Thameur Hospital. RESULTS: Our study included 55 patients. Average age was 72±6 years old and sex-ratio was two. Eighty-five percent presented with angina, 18% with dyspnea and one patient with an aortic prosthetic valve endocarditis. Mean left ventricular function was 54 ±9 %. Mean EuroSCORE II was 1.91±1.18. Twenty-six per-cent had an urgent surgery. Mean extracorporeal circulation time was of 77±26 min and mean extubation time was 8±6 h. Eighty-four per cent had a coronary artery bybass grafting and 16% a valve replacement. Four per cent had a redux and 4% a combined surgery. Stay in surgical department varied between 3 and 10 days with average of 4.6±1.2 days. Early mortality rate was of 2% and 98% had complications. Ninety-eight complications occurred after surgery: 35 reintervention for mediastinal bleeding or tamponade, 28 bleedings requiring transfusions, eight heart rhythm disorders, an atrioventricular conduction block requiring ventricular, five atrial fibrillation, two ventricular tachycardias, a ventricular fibrillation, eight low cardiac outpout, seven prolonged mechanical ventilation and eight pneumonias. In univariate analysis, recent myocardial infarction and chronic kidney disease were predictive of early complications. CONCLUSION: Our data shows cardiac surgery is feasible in elderly patients with acceptable risk in terms of mortality and an increased morbidity due to their frailty. Careful patient selection is needed for the success of cardiac surgery in elderly patients.

[Results of percutaneous mitral balloon commissurotomy in pregnant women about 12 cases]. / Résultats de la dilatation mitrale percutanée chez la femme enceinte à propos de 12 cas.

INTRODUCTION: Mitral stenosis (MS) is the most common valvular heart disease revealed or exacerbated by pregnancy. Percutaneous mitral balloon commissurotomy (PMC) is currently the treatment of choice when mitral valve morphology is favorable. AIM OF THE STUDY: The purpose of this study is to evaluate the immediate, medium and long term results of percutaneous mitral balloon commissurotomy in pregnant women with a severe symptomatic mitral stenosis despite medical treatment. PATIENTS AND METHODS: It is a retrospective study including 12 pregnant patients diagnosed with severe mitral stenosis and hospitalized in the cardiology department of Habib Thameur hospital between 1994 and 2014. A clinical and ultrasonographic monitoring was performed for over 15 years. RESULTS: Mean patients age was 31.5±4.4 years. All patients were in NYHA class III or IV despite medical treatment. Mitral regurgitation was rated as moderate in four cases. Functional improvement was observed in all cases immediately after the procedure. Mitral valve area increased from 1.02±0.5cm2 averaged to 2±0.35cm2. Mitral regurgitation increased in three cases and appeared in two cases. All patients delivered at term. Newborns were all healthy. Two of them had a low birth weight. On the long term follow-up (95.58±64.1 months), five patients had mitral restenosis: two had a surgical valve replacement and three underwent a second percutaneous mitral balloon commissurotomy. CONCLUSION: The effectiveness of the percutaneous mitral balloon commissurotomy is clearly documented by clinical and echocardiographic evaluation. In the case of pregnancy, the goal is not so much to obtain an optimal result but to cause hemodynamic improvement authorizing the continuation of pregnancy and childbirth.

[Fatty tumors of the jaws]. / Tumeurs adipeuses des mâchoires.

Intraosseous lipoma is a benign tumor of the bone. It is mostly seen in the metaphyses of the long bones and calcaneus. There are few documented cases of intraosseous lipomas in the jaw. Clinically, the lesion is usually silent and radiologically it appears as a radiolucent area rarely including some radio-opacities. Diagnosis is based on clinical, radiological and histopathological features. Surgical removal of the lesion is the recommended treatment.

[Immediate results of repeat percutaneous mitral valvuloplasty]. / Résultats immédiats de la redilatation mitrale percutanée.

Percutaneous mitral valvuloplasty (PMV) has emerged as the procedure of choice in treatment of mitral stenosis and has proved effectiveness in cases of mitral restenosis after surgical commissurotomy. However, this technique is costly, is not devoid of complication and success is not guaranteed. Indications of an attempted redo percutaneous mitral valvuloplasty (redo-PMV) are not well established. Hence the idea to study the immediate results of (re-PMV). PURPOSE OF WORK: The purpose of this study is to evaluate the immediate results of the re-PMV in patients with mitral restenosis and analyze the different clinical and laboratory findings to determine predictors of success of re-PMV to better selection of candidates for a new attempt PMV. METHODS: Retrospective study from a series of 40 procedures of re-PMV with the Inoue balloon succeeding a successful initial procedure, collected in the cardiology department of Habib Thameur hospital of Tunis between 1996 and 2011, in which we identified the data of clinical and paraclinical examinations. RESULTS: The mean age of patients was 43 ± 11 years [23; 63]. Of the population, 87.5% were female (five men and 35 women). The average time between the two procedures was 8 ± 4 years [1; 15]. The immediate procedural success defined by a mitral valve area greater or equal to 1.5 cm(2) and a grade less than or equal to 2 mitral regurgitation was obtained in 31 patients (77.5%). A severe mitral regurgitation (MR) was observed in three patients (7.5%). A cerebrovascular stroke occurred in one patient (2.5%). No death or cardiac tamponade were noted. Class III or IV of NYHA, a pre-procedural MR, pulmonary hypertension and an overall score of Padial greater than 10 were retained as predictors of failure. More the overall score of Wilkins is high (>8), more it is predictive of failure. The two components of the Wilkins score: valvular mobility and subvalvular apparatus (SVA) and the parameter of the redesign of the SVA score of Padial considered separately are also predictive of failure. Only a left atrial area less than or equal to 25 cm(2) was linked to high risk of severe MR. CONCLUSION: Redo percutaneous mitral valvuloplasty is a therapeutic alternative to surgery that is effective and promising interesting immediate results. Analysis of clinical and mainly echographic parameters is useful for predicting the success of the gesture, which will allow a better selection of candidates for re-PMV.

[Complications of head and neck skin expansion]. / Complications de l'expansion cutanée cervico-faciale.

INTRODUCTION: Skin expansion is a good solution for the reconstruction of head and neck defects. We assessed the complications of cervico-facial skin expansion technique to draft recommendations so as to minimize risks. METHODS: We made a retrospective study from 1990 to 2005. Complications were analyzed according to age, sex, etiology, area to reconstruct, location of the expander, expander volume and number, simultaneous single or repeated technique, type of expander, duration of expansion, and type of flap used for reconstruction. RESULTS: One hundred and thirty-nine tissue expanders were placed in 114 patients. The rate of complications was 60.4%. Age was not a risk factor (P=0.21; Fisher's exact test). The early complications were not related to the expander volume (P=0.32; Fisher's exact test). Infection was the most frequent complication (51.3%). Hypertrophic or large scars, retraction, or cording accounted for 32.4% of sequels. A rate of 6.5% of total and 6.5% of partial failure were recorded. Infection was the cause of 77.8% of total or partial failure. DISCUSSION: The complications of head and neck soft tissue expansion are often minor. The rate of reconstruction failure remains acceptable.

[Facial infantile aggressive fibromatosis: a frequent localization of an exceptional tumor!]. / La fibromatose agressive faciale chez l'enfant: une localisation fréquente d'une tumeur exceptionnelle !

INTRODUCTION: Although fibromatosis is considered as benign tumor, it can have significant morbidity, particularly when it occurs in the head and neck. Their propensity for infiltrative local growth with encroachment on vital structures and their tendency to recur make fibromatoses of the head and neck extremely challenging lesions. CASE REPORT: We report the case of a 10-year-old boy with desmoid fibromatosis of the upper lip. For this patient, the medical treatment has been decided to avoid a mutilating surgery. He had a good result with chemotherapy using methotrexate and vinblastine. DISCUSSION: According to the literature, surgery is the most common treatment of fibromatosis in the head and neck region. However, particularly in children, alternative modes of therapy must be considered because of the high recurrence rate and to avoid mutilating operations. Chemotherapy using methotrexate and vinblastine may be a reasonable choice.

[Thyroid ectopic tumour in the right ventricle of the heart]. / Tumeur thyroïdienne ectopique dans le ventricule droit du cœur.

The intracardiac ectopic thyroid tumour is rare. We report the case of a woman who was admitted for exertional dyspnea. The echocardiography revealed an obstructive tumor in the right ventricular outflow tract. Histological examination of the removed tumour showed the ectopic follicular thyroid tissue.

[Mandibular fracture: a 10-year review of 685 cases treated in Charles-Nicolle Hospital (Tunis-Tunisia)]. / Particularités épidémiologiques et thérapeutiques des fractures de mandibule au CHU Charles-Nicolle de Tunis.

INTRODUCTION: The epidemiology and treatment of mandibular fracture vary from one country to another. The aim of this study was to present the current demographic pattern and treatment regimens of mandibular fractures in Tunisia. METHODS: The medical records and radiographs of 685 patients treated for mandibular fracture at the Maxillofacial and Plastic Surgery Department in the Tunis Charles-Nicolle Hospital between 1995 and 2004 were retrospectively studied. The relevant parameters were: age, sex, etiology, anatomical site of fracture, and treatment. RESULTS: The prevalence of mandibular fractures was higher in male patients (sex ratio 6:1). Traffic accidents were the main cause of these lesions (45%), followed by assault (22%). Angle fractures were the most common (24.8%) followed by parasymphyseal fractures (22.2%). The most frequent treatment was closed reduction with maxillo mandibular locking in 388 patients (56.6%). Transosseous wiring was the most commonly used method in open reductions. Tooth loss and neurological sensitive deficiency were the most common sequels. DISCUSSION: Our epidemiological data correlates to published data for developing countries. Analyzing this data can help to improve the management of maxillo-facial trauma in Tunisia. Therapeutic options vary according to the type of fracture but also depend on the economical status of the country.

[Acute hemorrhage due anti-vitamin K agents. A prognostic and descriptive study]. / Les accidents hemorragiques graves sous anti-vitamines K. Etude descriptive et pronostique.

BACKGROUND: The use of the antivitamines K for more than 50 years, has largely been the proof of its interest: well shown effectiveness, weak cost. However, these drugs are the cause of complications of which most frequent and most serious are the hemorrhagic accidents. AIM: To determine the characteristics of the patients hospitalized for grave bleeding under antivitamins K and identify the predictive factors of these accidents. METHODS: Retrospective study of pilot case type carried out in the service of cardiology of the hospital Habib Thameur of Tunis during the period going from January 2001 to December 2006. It related to a group of 50 patients admitted for "serious haemorrhage under antivitamines K". This group was compared with a reference group including/understanding 100 patients treated by antivitamines K and not having never presented a haemorrhage. The reserved criteria of gravity are the following ones: the location: intracérébrale, rétro péritonéale, articular, intra-ocular with blindness, muscular, subcutaneous if the nasty bruise is voluminous, hematurie, metrorragie, digestive bleeding (high or low), hemoptysie, hemothorax, hemopéricarde; the deglobulisation (fall of the haemoglobin of 2 g/dl or more) requiring or not a transfusion; the necessity of a surgical haemostatic gesture or endoscopique; the transfer in care unit or death. RESULTS: The Middle Age of the patients was of 55 +/- 14 years, the sex ratio was of 0.85. The intermediate duration of the treatment was of 243 +/- 225 weeks. The most frequent indications were the disorder of the supra-ventricular rate/rhythm (72%) and the mechanical valves cardiac (40%). These indications appeared debatable to us at 16% of the patients. One or more supporting factors the hemorrhagic accident were found at half of the patients, the first cause being medicamentous association (20% of the cases). The hématurie was the most frequent complication (28%). The evolution was favorable in all the cases. An internal injury under unclaimed ignored was found at 24% of the patients. The hepatic dysfonction and medicamentous association were in our study of the risk factors of which has occurred of haemorrhage under antivitamines K. In multivariate analysis, medicamentous association was an independent risk factor (Odds ratio adjusted 4.9). CONCLUSION: At least 50% of the hemorrhagic accidents under antivitamines K are avoidable with the help of a rigorous evaluation of the benefit ratio/risk and a vigilance with respect to medicamentous associations. The creation of centers of anticoagulation in our country is essential in order to improve quality of the clinical and biological monitoring.

[Columella defects: yet a challenge!]. / Les pertes de substance de la columelle : encore un défi !

The repair of nasal defects is thought to be the most ancient of facial reconstructive procedures, dating back to at least 3000 BC in India. In spite of the development of nasal reconstruction concepts, leading to remarkable esthetic and functional improvements, columella reconstruction is yet a contemporary challenge. Columella defects may result from trauma, infections, carcinoma resection, syphilis, bilateral cleft lip, etc. Maintaining symmetry, contour and function are essential for a successful columella reconstruction. Multiple factors help to determine the optimal repair method, including the size of the defect, its depth and location, and the strength of the underlying nasal framework. This article presents a range of techniques and discusses the application of these methods to specific columella defects. A chronological review of columellar reconstruction procedures used for this partial rhinoplasty is exposed.