[The role of bisphosphonate in the treatment of bone metastases from prostate cancer]. / Apport des bisphosphonates dans la prise en charge des métastases osseuses du cancer de la prostate.

BACKGROUND: Bone metastasis is very frequent in prostate cancer. It is a turning point that marks the severity of the disease. Before metastasis become symptomatic, treatment preventing bone events should be indicated. AIM: To evaluate the role of bisphosphonate in the treatment of bone metastases from prostate cancer. METHODS: A review of literature. RESULTS: Bisphosphonates play a very important role to prevent bone mass loss and to reduce bone complication events. CONCLUSION: Bisphosphonates are recommended as preventive treatment at the time of diagnosis of bone metastatic prostate cancer.

[Urinary tract infections in elderly]. / Les infections urinaires chez les personnes âgées.

BACKGROUND: Urinary tract infections (UTI) in elderly are frequent and polymorphic clinical symptoms. This is a public health problem both in support and cost they generate. AIM: To study the epidemiological, clinical, paraclinical and therapeutic aspects of UTI in the elderly. METHODS: We conducted a retrospective study of 50 cases of UTI in the elderly collected in the Internal Medicine Department at Habib Thameur Hospital between January 2002 and December 2006 (Group I). We compared this group to another group of patients aged below 60 years also explored for UTI in the same service and during the same period (Group II). RESULTS: They were 37 women and 13 men in group I and 41 women and 9 men in the group II. In group I, the average age was 74.10 ± 6.7 years, in group II 43.58 ± 11.26 years. In group I, 35 patients (70%) showed no evidence of suspicion of a UTI on admission. 15 patients (30%) were admitted for suspected UTI. In group II, 36 patients (72%) showed no evidence of suspicion of a UTI on admission. 14 patients (28%) were admitted for suspected UTI. Urological abnormalities underlying the UTI, detected by ultrasound, were more frequent in Group I (40%) than in Group II (12%). Second-line antibiotics, due to the likely resistance of the microorganism, had to be prescribed in 16% cases in Group I vs. 4% of cases in Group II. The evolution under antibiotic treatment was marked by the occurrence of 3 deaths and transition to renal failure in 4 cases for Group I. In Group II, the outcome was favorable in all cases. CONCLUSION: Urinary tract infection is a significant factor in morbidity and mortality in the elderly. Female is much more concerned than male. Clinical manifestations of UTI are often crude and misleading in a pathological and poly polymedicated patient. The preventive arm accounts for most of the management of urinary tract infection in the elderly.

[Leflunomide in the treatment of rheumatoid arthritis]. / Le leflunomide (ARAVA) dans le traitement de la polyarthrite rhumatoide.

The aim of this study was to assess the effect and safety of leflunomide (LEF) in refractory RA and to review the literature on this subject. A one year prospective study was conducted on a group of patients (n:15). Mean duration disease was 6.46 years. Rhumatoid factor was present in 12 cases. Leflunomide was administered at a dos of 20mg/day following a loading dose of 100mg/day for three days. The efficacy of LEF was evaluated on clinical and biological parameters of RA evolutivity at one, 3, 6, 9 and 12 months. Our mean follow up period was about 8 months (2 to 12 months). Good prognostic indicators of disease progression were observed with LEF at one month and later in eleven cases with a good safety. Non serious adverse events were observed with LEF. Our result confirm that LEF may present another therapeutic choice that is efficacious for the long term treatment of refractory RA. Nonetheless, these results must be evaluated on a larger series.

[Efficacy of cyclines in agammaglobulinemia arthritis]. / L'efficacité des cyclines dans un rhumatisme agammaglobulinémique.

Five to 40% of patients with agammaglobulineamia develop joint manifestation consisting of septic arthritis or aseptic arthritis of unclear pathogenesis. Intravenous gamma-globulin therapy seems effective on the better condition but is burden-some and expensive. We report the case of a 31-year old woman, having a common variable immunodeficiency that has a chronic oligoarthritis seronegative and not warping. Substitutive treatment with gamma-globulins resulted in a poor improvement. Blood Lymphocyte immunotyping ans analysis of synovial fluid showed high levels of CD8 with a low CD4/CD8 ratio. Synovial biopsy revealed a non specific synovitis with an lymphoid aggregates with a significant predominance of CD8 cells and suspicion of mycoplasm, only after centrifugation, justifying PCR techniques. Doxycycline therapy was effective in relieving the joint symptoms with six month recession.

[TNF alfa modulators in the treatment of rheumatoid arthritis]. / Les modulateurs du TNFalpha dans le traitement de la polyarthrite rhumatoide.

Current slow-acting anti-rheumatic drugs available at now for rheumatoid arthritis fail in majority of cases and have an inconstant chondro-protective effect. Improvements in our knowledge of its pathogenesis and advances in molecular biology have made possible to develop selective immunotherapy approaches. Tumor necrosis factor alfa (TNF alfa) is an important inflammatory mediator that play a crucial role in rheumatoid arthritis. This studies summarizes clinical essays that evaluate beneficial effects and tolerance of anti TNF alfa antibodies. This study showed the clinical, biological and radiological efficacy of these therapeutic agents. But some doubts persist concerning their long term side effects particularly infections, neoplasm or auto immune ones. High price of this treatment should evaluate report cost benefice to appreciate the better utilisation of these drugs.

[Cardiac involvement in spondylarthropathies]. / L'atteinte cardiaque au cours des spondylarthropathies.

Cardiac involvement is a real manifestation of spondylarthropathies and include specially aortic regurgitation and conduction troubles. We present a prospective open study of fifty patients with spondylarthropathy (responded to Amor criteria) in order to evaluate the frequency of cardiac involvement, to see its type and if we can evaluate a group of patients able to this complication. We have included forty-four men and six women with a mean age of 38 years. The disease evolve for 8.8 years in mean. Ag HLA B27 was present in 70% of the cases. Thirty patients have ankylosing spondylitis, although twenty have a secondary spondylarthropathy: psoriasic rheumatism (12 cases), inflammatory bowel disease: Crohn's disease (4 cases), RCH (three cases) and Fiessenger le Roy-Reiter syndrome in one case. All the patients have had a cardiac check up with research of clinical cardiac manifestation, thoracic chest, trans-thoracic echographi, Halter rhythmic done in five cases only. Cardiac involvement is found in five cases (10%): aortic regurgitation in 3 cases (6%) and mitral regurgitation in 2 cases (4%). These valvular disease are well tolerated.

[Antigliadin antibodies in rheumatoid arthritis]. / Les anticorps antigliadines au cours de la polyarthrite rhumatoide (PR).

We had study on the antibodies antigliadin type IgA in 40 patients having rheumatoid arthritis (33 Women and 7 men; middle age 51 years; rheumatoid factors was positive in 60%; the follow up of patient is 5.9 years). The technique applied is by ELISA. All the patients benefited of malabsorption biological test; of the immunoglobulins; and complex of histocompatibility (HLA); and gastrointestinal exploration composed of: fibroscopy duodno-jejunal with systematic biopsies. The search for this antibodies antigliadin (AAG) showed itself negative at all patients. Has histology, all these patients have a height villies normal. The abnormalities had been found in 37.5%, are minor partial intestinal villi, cellular infiltration of chorion and intraepithelial infiltration by lymphocytes more then 40%. By the way, we discuss the different mechanisms of these digestive involvment.