[Impulsivity and externalization and internalization problems in adolescents]. / Impulsivité et problèmes d'internalisation et d'externalisation chez l'adolescent.

OBJECTIVES: The multidimensional aspect of the concept of impulsivity is proven by the composite structure of the rating scales of impulsivity. Several studies have already found correlations between trait-impulsivity and externalizing disorders. However, the studies interested in the relationship between trait-impulsivity and internalizing problems are rare. We have tried to explore correlations between impulsivity and externalization and internalization problems, in a population of adolescent outpatients. METHODS: We recruited 31 adolescent out-patients in the child and adolescent psychiatry department in the University Hospital of Monastir, Tunisia. The Barratt Impulsivity Scale (BIS) was used to evaluate a multidimensional concept of trait-impulsivity, including the dimensions of "Motor", "Non-planning" and "Attentional" impulsivities. The Strength and Difficulties Scales (SDQ) was used to assess different domains of externalizing and internalizing problems, including "Emotional symptoms", "Conduct problems", "Hyperactivity" and "Peer problems". RESULTS: The sex-ratio was 1.21. The mean age was 15.19±1.27 years. All patients but one were attending school. The diagnosis was "Major Depressive Episode" in 32% and "Behavior Disorder" in 38%. The means of the scores of externalizing and internalizing problems were 9.35±4.41 and 9.65±3.26, respectively. The total score of the BIS was significantly related to both scores of externalizing and internalizing problems. The "Motor" impulsivity was specially correlated with the externalizing dimension of the SDQ. The non-planning impulsivity was correlated with both scores of externalizing and internalizing problems, but it was mainly related to internalizing problems. The attentional impulsivity was also correlated with both dimensions of externalizing and internalizing problems. CONCLUSION: The dimensions of trait-impulsivity were correlated with various dimensions of the SDQ concerning externalizing and internalizing problems. That confirms the hypothesis that the impulsiveness is associated with wide domains of the psychopathology of the teenager which are not limited to behavior disorders. We can process these problems by influencing the "Motor impulsivity" and "Non-planning impulsivity". The cognitive and behavioral therapy and the selective serotonin reuptake inhibitor may be efficient.

An 18-cm-large renal arteriovenous fistula treated by nephrectomy.

Idiopathic renal arteriovenous fistulas are extremely rare. They are believed to occur as the result of congenital renal artery aneurysm that erodes into an adjacent vein. We report a case of a 48-year-old man in whom we discovered fortuitously a painless mass of the right flank. Computed tomography revealed a huge renal artery aneurysm with giant arteriovenous fistula in the absence of any clinical stigmata. Given the size of the fistula and the partial destruction of the renal parenchyma, nephrectomy was successfully performed.

[Primary alveolar soft part sarcoma of the lung]. / Sarcome alvéolaire primitif du poumon.

BACKGROUND: Alveolar soft part sarcoma is rare; it mainly appears in the lower extremities in adults and the head and neck in children. Primary pulmonary occurrence of this tumour is exceptional. OBSERVATION: We report a new case in a 49-year-old man who presented with thoracic pain developing over one month. Imaging showed a tumour in the left upper lobe. Diagnosis of primary alveolar sarcoma of the lung was made by histological examination of a biopsy specimen and elimination of a primary soft tissue tumour elsewhere. CONCLUSION: Primary alveolar sarcoma of the lung is exceptionally rare and the diagnosis should only be made after eliminating a soft tissue tumour elsewhere.

[Emboligenous hydatid cyst of the right heart]. / Kyste hydatique emboligène du coeur droit.

The cardiac location of the echinococcosis is rare. It is associated with complications potentially severe. Indeed, the break inside the cardiac chambers with pulmonary embolism is the inevitable complication of the echinococcosis of the right heart. Between January 1992 and January 2006, five patients were operated in the department of cardiac surgery of Sousse (Tunisia) for an emboligenous hydatid cyst of the right heart. The average age is of 30 years with extremes from 18 to 65 years. The cardio-pulmonary bypass is the technique of choice. We regretted a single death in immediate postoperative period. All the patients were controlled with an average recession of 36 months. A single late death was noticed. No recurrence was observed.

[Vertebral primary hydatid cyst with mediastinal involvement and paraplegia]. / Kyste hydatique vertébral primitif à extension médiastinale postérieure compliquée d'une paraplégie.

INTRODUCTION: The vertebrae are the most common localization of hydatid disease of bone. This can lead to fatal consequences. CASE REPORT: We report the case of a 40-year-old-man, from a rural area, who had symptoms of medullary compression. The diagnosis of primary vertebral hydatid cyst, already suspected on the imaging data, was confirmed. A right posterolateral thoracotomy allowed drainage of the cyst and relief of the medullary compression. Medical treatment with albendazole was continued for 4 months. The postoperative course was uneventful and the symptoms of medullary compression resolved progressively. No recurrence was observed during a follow-up of 24 months. CONCLUSION: Vertebral localization of hydatid disease is the most common and serious skeletal complication. Thoracotomy allows drainage of the cyst and the pleural cavity, and relieves the medullary compression.

[Familial idiopathic pulmonary fibrosis associated with autoimmune polyendocrinopathy and epidermodysplasia verruciformis]. / Fibrose pulmonaire idiopathique familiale associée à une polyendocrinopathie auto-immune et à une épidermodysplasie verruciforme.

Familial idiopathic pulmonary fibrosis (IPF) is a very rare and progressively fatal disease. Its pathogenesis is not fully understood and involves damage to alveolar epithelial cells of possibly immunological, microbiological or chemical origin, leading to fibrosing healing. A genetic predisposition has been demonstrated. The authors report the case of a female patient whose brother died at the age of 29 from IPF. She had epidermodysplasia verruciformis since childhood, with the absence of pubertal development. At the age of 31, she presented diffuse interstitial pneumonia. A lung biopsy confirmed the diagnosis of IPF. Endocrine explorations detected hypogonadotropic hypogonadism, primary hypothyroidism and magnetic resonance imaging revealed an empty sella turcica. The association of familial IPF, autoimmune polyendocrinopathy and genetic dermatosis caused by a cellular immune deficiency supports the hypothesis of an immune dysfunction in the pathogenesis of IPF.

[Early surgery in patients with native valve endocarditis]. / Chirurgie de l'endocardite sur valves natives à la phase active.

Between January 1990 and December 2006, 93 patients with infective endocarditis on native valves were operated in the active phase of the disease. The average age of our patients was 32 years with a male ascendancy. The causal heart disorder was found in 89 % of the cases, dominated by rheumatoid arthritis. The germ in cause was isolated in 52.6 % of the cases. The operative indication was hemodynamic in 29 cases, infectious in nine cases, mixed in 29 cases and embolic in 26 cases. The average operating delay was of 13 days with regard to the beginning of the antibiotic treatment. We realized a valvular aortic replacement at 32 patients with reconstruction of the ring in six cases, a valvular mitral replacement at 29 patients, a mitroaortic replacement at 21 patients, a reconstructive mitral surgery in nine cases, a valvular tricuspid replacement in one case and a reconstructive tricuspid surgery in one case. The early mortality was 13 %. The follow-up was 89 % with an average recession of 3.1 years and a late mortality of 5 %. The aim of this study is to analyze the immediate and late results of the surgery of infective endocarditis in the active phase and to bring to light the prognostic factors of mortality.

[Coronary artery fistula: case report and review of the literature]. / Fistule coronaire : rapport d'un cas opéré et revue de la littérature.

The coronary fistula is a rare abnormality making communicate a coronary artery with a cardiac cavity or a great vessel, so bypassing the myocardial capillary network. The majority of these fistulas are congenital but can nevertheless arise after a cardiac surgery. The right coronary artery and the left anterior descending coronary artery are mostly concerned. The circumflex coronary artery is rarely involved. The most frequent site of drainage is the right ventricle. We report the case of a 2-year-old child, brought by his parents for dyspnoea of effort. The diagnosis of coronary fistula was confirmed by the coronary angiography which showed an aneurysmal circumflex artery, draining into the right ventricle. The intervention was led under cardiopulmonary bypass. We proceeded to the longitudinal opening of the aneurysm then to the blindness of the fistula. The postoperative course was simple.

[Surgery of 56 patients having a partial atrioventricular septal defect]. / Chirurgie du canal atrioventriculaire partiel : résultats à court et à moyen terme à propos de 56 patients opérés.

Between January 1991 and December 2006, 56 patients having a partial atrioventricular septal defect (AVSD) were operated. The purpose of this retrospective study is to analyze the immediate and long-term results of the surgery by granting of the importance to two main problems which are the disturbances of the rhythm and the conduction and the residual mitral regurgitation (MR). The mean age of our patients is of 10 and a half years with a net feminine ascendancy. Ninety-three percent of the patients were in regular sinus rhythm. No case of complete atrioventricular block (AVB) was noted. The MR was of grade I in 28.5% of the cases, grade II in 60% of the cases and grade III and IV in 7.5% of the cases. The MR was mild in 4% of the cases. The correction was made under cardiopulmonary bypass (CPB) and consisted of a suture of the mitral cleft in most of the cases with lock of the ostium primum by a patch of pericardium. The perioperative mortality was 1,8% of the cases. The disturbances of the rhythm and the conduction were noted in 34% of the cases. All the patients were controlled with a mean follow-up of six years and seven months. The secondary mortality was nil. The MR, at mid-term follow-up, was mild in 78% of the cases. The partial AVSD is a congenital heart disease, the spontaneous evolution of which can be burdened by complications, notably the disturbances of the rhythm and the conduction, as well as the heart failure. This justifies a premature surgical repair.