[The local anesthesia for the prostatic biopsies echo-guided: forward-looking randomized study comparing two methods]. / L'anesthésie locale pour les biopsies prostatiques écho-guidées: étude prospective randomisée comparant deux méthodes.

INTRODUCTION: The realization of the prostatic biopsies is a painful act. The objective of our work was to compare the analgesic efficiency of the injection of the lidocaine at the level of periprostatics laterals and apical areas compared with the use of gel of lidocaine intrarectal associated with the taking of oral tramadol. PATIENTS AND METHODS: Between November 2007 and December 2009, 60 patients admitted in the service of urology of the university hospital Mohammed VI of Marrakesh for prostatic biopsies were randomized in two groups. The group 1 (30 patients) received two tablets from tramadol 50mg with 10 mL of gel of lidocaine 2% intrarectal while 30 patients of the group 2 received 10 mL from lidocaine 2% injected at the level of periprostatics laterals and apicales. The pain was estimated by a visual analog scale (AVS) at the introduction of the probe of echography (AVS 1), at the time of the biopsy (AVS 2) and 20 minutes later (AVS 3). RESULTS: There was no significant difference between both groups concerning AVS 1 means. The average score of the pain was significantly lower in the group 2 for the AVS 2 and AVS 3. CONCLUSION: The periprostatics anesthesia assured a better control of the pain at the time of the prostatic biopsy and 20 minutes later, without increase of the complications. We recommend it to decrease the pain and the discomfort related to this technique.

[Assessing knowledge, attitude, and practice on occupational blood exposure in caregiving facilities, in Morocco]. / Evaluation des connaissances, attitudes et pratiques sur les accidents d'exposition au sang en milieu de soins au Maroc.

OBJECTIVE: This study had for aim to evaluate practices and knowledge of infectious hazards, to determine the prevalence of viral infections related to occupational blood exposure among health care workers, and to propose a preventive policy. DESIGN: This descriptive multicentric and transversal epidemiological survey was carried out from 2003 to 2004 in 10 Moroccan cities. Two thousand eight hundred and forty four persons were contacted and 2086 accepted to answer the questionnaire (73.3 %). RESULTS: The mean age was 40.8+/-7.8 years and seniority 15.6+/-7.4 years. Blood was the most incriminated product (96.1%), followed by dirty linen and hospital waste. Instruments most often mentioned as dangerous were hollow needles (80.3%). The most feared infections were viral hepatitis (77.5%) and HIV (89.3%). Only 40.6% of the personnel were adequately vaccinated against hepatitis B. Post-vaccine serology was performed on only 1.8% of the vaccinated staff. During the last 12 months, 58.9% of the personnel underwent at least one occupational blood exposure 5.8% of which was reported. Universal precautions appeared poorly used as only 65.6% wore gloves for invasive acts and 61.5% correctly disinfected their hands. Re-sheathing used needles was frequent (51.2%). CONCLUSIONS: Infectious hazards in healthcare facilities are not sufficiently taken into account: the recent creation of occupational health services in hospital facilities should contribute to improve working conditions, make hepatitis B vaccination available and mandatory, and lead to more information and education on hazards related to occupational blood exposure for healthcare personnel.

[Hypertrophic cardiomyopathy disclosing Friedreich's disease. Report of a case]. / Cardiomyopathie hypertrophique révélant une maladie de Friedreich. A propos d'un cas.

The authors report the case of a 21 year old woman admitted to hospital for congestive cardiac failure due to concentric hypertrophic cardiomyopathy. Echocardiography showed severe systolo-diastolic left ventricular dysfunction without obstruction to ejection. Neurological examination showed a stato-kinetic cerebellar syndrome, a posterior radiculo-cordonal syndrome and a dysmorphic syndrome which characterise Friedreich's disease. In the light of this case and a review of the literature, the authors underline the rarity of cardiomyopathy in Friedreich's disease, its particular presentation and its poor prognostic significance in this disease.

[High incidence of sporadic non-A, non-B hepatitis in Morocco: epidemiologic study]. / Forte incidence des hépatites non-A, non-B sporadiques au Maroc: étude épidémiologique.

Non-A, Non-B hepatitis and their sequelae seem to be as frequent as HBV infections in Morocco. These diseases represent an important problem of public health because their high incidence and high fatal rate. Some aspects of the epidemiology of Non-A, Non B acute hepatitis were evoking a high incidence of enterically transmitted hepatitis E. That was confirmed by serum studies having shown that hepatitis E antibodies were detected in more than 60% of patients with acute Non-A, Non-B hepatitis. However this type of hepatitis has been recognized only as sporadic (non-epidemic), mainly transmitted by personal contacts in low hygiene conditions. Other Non-A, Non-B acute hepatitis (around 35%) were certainly due to hepatitis C virus infection, because the presence of hepatitis C antibodies in the serum of the patients. However, in our study, hepatitis C seemed to be rarely transmitted by transfusion or other blood related route. Chronic liver diseases related to Non-A, Non-B virus infection appeared to be as frequent as the ones due to hepatitis B virus. Serological studies had shown that about seventy-four per cent of the studied cases were related to an infection by hepatitis C virus (presence of hepatitis C antibodies). Among other Non-A, Non-B chronic liver diseases the possible existence of some cases due to hepatitis E virus infection cannot be ruled out but this hypothesis needs further investigations to be verified. The prevalence of the markers of past hepatitis B infection in convalescent patients from Non-A, Non-B hepatitis is comparable to the prevalence of hepatitis B infection markers in blood donors. However, chronic HBV infection could be a factor facilitating the clinical expression of the Non-A, Non-B hepatitis.

[Horton's disease presenting as a myocardial infarction]. / Infarctus du myocarde révélant une maladie de Horton.

The authors report the case of a 60-year-old man admitted for uncomplicated acute myocardial infarction. The history of persistent fronto-occipital headaches and palpation of bilateral tortuous temporal arteries with a decreased pulse suggested the diagnosis of temporal arteritis, particularly in the presence of marked laboratory signs of inflammation and the coronary angiograph findings. The diagnosis was confirmed by temporal artery biopsy. Treatment consisted of corticosteroid therapy, with a satisfactory outcome at three months. The diagnosis of temporal arteritis should be systematically suggested in patients over the age of 50 years, presenting with a marked inflammatory syndrome and recent-onset arterial disease. Similarly, any form of arterial disease occurring during treated temporal arteritis should initially be considered to be a secondary site of the arteritis, requiring intensification of corticosteroid therapy.

[Cardiac tamponade and transient ischemia revealing a syndrome of primary antiphospholipid antibodies]. / Tamponnade cardiaque et accident ischémique transitoire révélant un syndrome des anticorps antiphospholipides primitif.

The authors report a case of echocardiographically confirmed cardiac tamponade, which required emergency pericardial aspiration, and a transient ischaemic attack revealing an underlying primary antiphospholipid antibody syndrome in a 29-year-old patient. The test for antiphospholipid antibodies was positive on 2 occasions (IgG > 91.41 micrograms/l). The diagnosis of systemic lupus erythematosus was eliminated. A favourable course was observed after 3 months of corticosteroids and platelet antiaggregants. Any case of cardiac tamponade or transient ischaemic attack with an unexplained aetiology in a young patient must suggest the diagnosis of antiphospholipid antibody syndrome.

[Primary hyperaldosteronism. Apropos of 2 cases]. / Hyperaldostéronisme primaire. A propos de 2 cas.

Primary hyperaldosteronism (PHA) represents less than 1 to 2% of all causes of hypertension (HT). We report 2 cases of primary hyperaldosteronism which emphasize the difficulty of distinguishing neoplastic PHA from idiopathic PHA, observed in a 60-year-old woman and a 42-year old woman, respectively. In both cases, the diagnosis of PHA was suggested by marked hypokalaemia with inappropriate potassium excretion and was confirmed by hyperaldosteronaemia and low and poorly stimulated renin activity. In the first case, computed tomography showed nodular hyperplasia of the 2 adrenal glands. The patient was treated with spironolactone and calcium channel blockers which controlled blood pressure and serum potassium. In the second case, computed tomography and magnetic resonance imaging revealed an adrenocortical adenoma confirmed by pathological examination after the operation. The diagnosis of primary hyperaldosteronism is based on three steps: detection, positive diagnosis and aetiological diagnosis. Detection is essentially based on demonstration of hypokalaemia. Positive diagnosis is based on demonstration of elevated aldosterone secretion with inhibited renin secretion. The aetiological diagnosis is dominated by the differentiation between Conn's adenoma and bilateral adrenal hyperplasia, which has therapeutic implications.

[Bacterial endocarditis in Morocco]. / L'endocardite bactérienne en milieu marocain.

This retrospective study was based on 157 cases of infectious endocarditis observed in the Cardiology department of Ibn Rochd Hospital in Casablanca between January 1983 and December 1994. The mean age of the patients was 27.5 years (11 to 65 years) with a male predominance (62.8%). Infectious endocarditis was secondary to rheumatic valvular heart disease in 63.% of patients and was primary in 29.9% of cases. Mitral or mitro-aortic valve involvement was clearly predominant. A portal of entry of the infection was identified in 63% of patients. It was dental in 64% of cases. Blood cultures were positive in 42% of cases with a predominance of unclassifiable Streptococci (37.8%) and coagulase-negative Staphylococci (25.7% of cases). Echocardiography was very useful, particularly in the presence of negative blood cultures. It demonstrated specific lesions of infectious endocarditis in 73.2% of cases and revealed very large, mobile vegetations in every case complicated by systemic embolism. The clinical course was complicated by heart failure (47.8%), renal failure (14.6%) or neurological lesions (11.5%). The global mortality was 28.7%, related to refractory heart failure in most cases.

[Tuberculosis in patients infected with the human immunodeficiency virus. 30 cases]. / Tuberculose chez les malades infectés par le virus de l'immunodéficience humaine. Trente observations.

Between May, 1983 and September, 1987, 8 per cent of the patients hospitalised for an HIV infection (i.e. 30 patients, 20 with an ARC and 10 with AIDS) had tuberculosis. The percentage of patients originating from Central Africa or Haiti was important (23 per cent). Tuberculosis was thoracic (76 per cent) and/or extrathoracic (63 per cent). The main organs involved were the lungs (n = 21), the mediastinal lymph nodes (n = 9), the superficial lymph nodes (n = 9), and the liver (n = 8). The pulmonary infection was often multilobar (n = 14), but without caverns. The tuberculin PPD (purified protein derived) test was positive in 63 per cent of ARC patients and in 30 per cent of AIDS patients. The diagnosis of tuberculosis was confirmed in 27/30 patients by culture of Mycobacterium tuberculosis (n = 23) and/or histology (n = 13), and in the remaining patients by response to a specific treatment. In 3 patients with normal X-ray film of the chest, M. tuberculosis could be recovered by culture of the gastric fluid. Antituberculous treatment was effective, but its optimum duration is to be determined since relapse may occur, even after one year of treatment. The side-effects of the treatment were unusually frequent (54 per cent). The occurrence of tuberculosis seemed to aggravate the prognosis of the HIV disease, since 57 per cent of the ARC patients reached the stage of AIDS within 6 months on average. These results are in agreement with the new recommendations of the Centers for disease control which include extrapulmonary tuberculosis in the AIDS criteria. However, in our study, pulmonary tuberculosis had the same detrimental effect and should therefore be included in the AIDS criteria.