[Primary biliary peritonitis]. / Les péritonites biliaires primitives.

PURPOSE: The purpose of this study was to debate the epidemiologic and clinical features of primitive biliary peritonitis (PBP) as much as a rare pathology; and especially to obtain a more comprehensive view of factors associated with a severe prognosis. METHOD: It is a retrospective survey of 15 patients, collected from 2000 to 2003. Only primitive biliary peritonitis has been included. RESULT: It is a series of 15 patients, 6 men and 9 women, with a mean age of 62 years. Biliary lithiasis was incriminated in 14 cases. Clinical picture was an acute peritonitis in every case. Six patients were operated on by median incision, the others by costal one. The death rate is of 26,6%, all death were a direct complication of PBP. Factors associated with a higher mortality are an IGS II score superior or equal than 31 and a number of organ failures superior or equal to 3. CONCLUSION: PBP is a rare and severe pathology that concerns aged women. Biliary lithiasis is the main etiology. Treatment is essentially surgical, in association with active per-operative resuscitation.

Balloon dilatation of anastomotic strictures secondary to surgical repair of oesophageal atresia.

The purpose of this study was to evaluate the efficiency and safety of oesophageal balloon dilatation in strictures secondary to surgical treatment of oesophageal atresia in 25 children. Patients comprised 15 males and 10 females, aged 1-36 months. Median age was 4 months (interquartile range (IQR)=19). The strictures were more than 50% of oesophageal lumen and the delay from surgical treatment to balloon dilatation varied from 1 month to 36 months. Associated gastroesophageal reflux was noted in 15 patients. All procedures were performed under sedation using fluoroscopic guidance. Balloons of increasing diameter, 4-20 mm were used. Water soluble contrast swallow was performed after each dilatation session. A total of 115 balloon dilatation sessions were performed with a range of 1-14 procedures per patient (median 4 dilatations, IQR=4.5). Dilatation relieved the stricture in all patients over a follow-up period varying from 4 months to 33 months. The best results were noted in children under 6 months, who needed two or few dilatation sessions, with relative risk (RR) of 0.52 and 95% confidence interval of 0.29-0.92. The presence of associated gastroesophageal reflux indicated a high risk (RR of 12, p<0.001) for undergoing more than two balloon dilatation sessions. The only serious complications observed were two cases of oesophageal perforation, which were treated conservatively. Fluoroscopically guided balloon dilatation is a safe and effective treatment in the management of strictures secondary to surgical repair of oesophageal atresia, especially when started early (within 6 months of surgery) and not associated with gastroesophageal reflux.

[Traumatic rupture of the aortic isthmus revealed by a mesenteric infarct]. / Rupture traumatique de l'isthme aortique révélée par un infarctus mésentérique.

The traumatic rupture of the aortic isthmus is one of the worst complication due to high speed motor vehicle accidents. When death is not the immediate consequence of this lesion, the initial clinical signs are not very clear. The present article demonstrates the case of a 23-year-old patient, victim of a car accident. A traumatic aortic rupture was actually diagnosed after the unusual discovery of a mesenteric infarct. In this case report, the mesenteric infarct mechanism can be controversed, and an emphasis should be put on an early aortic lesion diagnosis and repair in order to avoid any ischaemic complications.

[Risk factors for eclampsia: a case-control study]. / Facteurs de risque d'éclampsie : étude cas-témoins.

OBJECTIVE: Our purpose was to characterize the risk factors of eclampsia in women with preeclampsia. PATIENTS AND METHODS: A case-control study was conducted at Monastir hospital to investigate risk factors for eclampsia between 1st January 1995 and 30th June 2000. Cases were matched to preeclamptic controls on a 2:1 ratio. Univariate analysis was used to determine which of the independent variables were significantly different between the groups. Those with significant differences were then entered into multiple logistic regression analysis to determine the characteristics that were independently related to eclampsia. RESULT: A total of 41 cases of eclampsia were ascertained from deliveries. The ratio of eclampsia cases to number of deliveries over the study period was 1.87 per 1000. The first seizures occurred at home in 59% of the cases. Univariate analysis revealed statistical significance for the following variables associated with eclampsia: systolic hypertension > or =160 mmHg and diastolic > or =110 mmHg, headache, visual symptoms, vivid deep tendon reflexes, proteinuria >3+ or >3 g d(-1), uric acid concentration > or =350 micromol l(-1), serum creatinine concentration >100 micromol l(-1) and aminotransferase aspartate >30 IU l(-1). A history of abortion appears to be the protective factor against eclampsia. However, with subsequent multivariate analysis, only vivid deep tendon reflexes and elevated uric acid concentration remained significant. CONCLUSION: These data indicate a need for improved prenatal care and medical attention focused on prodroms of eclampsia as well as the detection of preeclampsia to reduce the incidence of eclampsia.

[Malignant renal tumors before one year of age. Experience of a North African pediatric surgery service]. / Tumeurs rénales malignes avant l'âge d'un an. Expérience d'un service de chirurgie pédiatrique nord Africain.

UNLABELLED: The malignant tumours of the kidney are not very frequent during the first year of life and pose diagnostic and therapeutic problems. The aim of this work is to make an analysis of the epidemiologic, clinical and anatomo-pathological characteristics of these tumours during the first year of life and a development on the therapeutic methods and their results. MATERIAL AND METHODS: [corrected] This is a retrospective study of 8 observations of malignant tumours of the kidney whose first symptomatology appeared during the first year of life. RESULTS: The malignant tumours of the kidney observed before the one year age constituted 18% of the tumours of the kidney in the child. A female prevalence was noted with a sex-ratio of 0.6. The assessment of extension found cutaneous (one case), ganglionic (one case) and pulmonary (two cases) metastases. First chemotherapy was prescribed to five patients. The surgery consisted on a widened nephrectomy in seven cases and a tumorectomy for an infant presenting a nephroblastomatosis. The tumour corresponded to a nephroblastoma in seven cases and a rhabdoide tumour in the last case. Mortality was high (50%) caused by the toxicity of chemotherapy in three cases and an advanced stage of cancer in one case. CONCLUSION: Renal tumoral pathology occurring in infants less than one year of age poses true etiologic and therapeutic problems. The high frequency of the nephroblastoma and the absence of benign tumour in our series encourage us to evocate more often the malignant renal tumours and to practice per cutaneous biopsies in case of diagnostic doubt.

Predictive value of severity scoring systems: comparison of four models in Tunisian adult intensive care units.

OBJECTIVES: To compare the performance of four severity scoring systems: the Acute Physiology and Chronic Health Evaluation (APACHE) II, the new versions of the Mortality Prediction Model (MPM0 and MPM24), and the Simplified Acute Physiology Score (SAPS) II. DESIGN: A prospective cohort study. SETTING: Three Tunisian intensive care units (ICUs). PATIENTS: Consecutive, unselected adult patients (n = 1325). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Overall, observed death rates were higher than predicted by all models except MPM0. All the evaluated scoring systems had good discrimination power as expressed by area under the receiver operating characteristics curve, but their calibration was less perfect when compared with original validation reports. There were no major differences between the models with regard either to discrimination or calibration performance. CONCLUSION: Despite an overall good discrimination, APACHE II, MPM0, MPM24, and SAPS II showed a less satisfactory calibration in our Tunisian sample of ICU patients. Part of the models inaccuracy could be related to quality of care problems in our ICUs, but this issue needs further analysis.