[Associated factors and sub-clinical myocardial dysfunction in obese patients with masked hypertension]. / L'hypertension artérielle masquée chez les obèses : facteurs associés et atteinte myocardique infraclinique.

INTRODUCTION: Obesity is a worldwide health problem. Masked hypertension is a relatively recent reported entity with a diagnostic problem. The aim of this study was to determine the clinical and paraclinical characteristics and to identify the predictive factors of masked hypertension in obese patients. METHODS: It is a prospective study including obese patients with normal arterial pressure at office. All of these patients were given ambulatory blood pressure measurement (ABPM) to screen for masked hypertension, laboratory tests and a complete echocardiography study. RESULTS: A total of 50 patients were included. The mean age was 46.52±10.4 years. The mean systolic blood pressure (BP) at office was 120.8±8.8mmHg and the mean diastolic BP was 75±7.3mmHg. The prevalence of masked hypertension in obese adults was 36% with a predominantly non-dipper profile (38%). The study of echocardiographic parameters found dilated left atrium (LA) in 16 patients (32%). The left ventricle (LV) was hypertrophied in 32 patients (64%). The overall LV global longitudinal strain (GLS) was on average -18.85±0.9% and the LA GLS was on average 37.35±4.5%. In our study, metabolic syndrome, low HDL cholesterol, elevated fasting blood glucose, hyperuricemia, LA dilatation, LV hypertrophy, diastolic LV dysfunction and altered myocardial deformities were factors associated with masked hypertension in obese adults. CONCLUSION: It is important to screen for hypertension by ambulatory measurement in at-risk obese patients who present associated cardiovascular risk factors to reduce morbidity and mortality. Echocardiography and speckle tracking analysis could be helpful in detection sub-clinical myocardial deterioration in obese patients with masked hypertension.

[A rare localization of solitary plasmocytoma]. / Une localisation rare de plasmocytome solitaire.

INTRODUCTION: Solitary bone plasmocytoma is rare, characterized by malignant plasmocyte proliferation, derived from a sole B lymphocyte clone located on a bony segment without medullar invasion. It, above all, affects the thoracolumbar spine. Costal involvement is rarely described. CASE REPORT: The authors report the case of a 60-year-old man who complained of dyspnea, dry cough, and thoracic pain four months before admission. Thoracic imaging revealed a left apical tissue mass with osteolysis of the first rib. A transparietal biopsy of the mass was not helpful. Surgical biopsy concluded as to the diagnosis of costal plasmocytoma. All of the examinations carried out to search for other localizations were negative confirming the solitary nature of the tumor. The treatment consisted of complementary radiotherapy at a dose of 45Gy. The patient was in remission after eight months. CONCLUSION: Solitary costal plasmocytoma should be called to mind when confronted with a lytic tumor of the rib. The treatment is based on surgery and radiotherapy. The prognosis is dominated by the risk of progression to multiple myeloma.

Well-differentiated extraskeletal chondrosarcoma: about a new case.

Extraskeletal chondrosarcoma is a rare malignant tumor. The well differentiated histological type, which is found primary in soft tissue, is extremely rare. This report  describes the case of a 58-year-old woman presented with a large palpable mass in the right buttock. Imaging studies revealed a well-defined soft tissue mass, with extensive calcification. A histological examination after surgical resection confirmed the diagnosis of well-differentiated extraosseous chondrosarcoma. The outcome was favorable, without recurrence or metastasis.

[Supracondylar fractures of the humerus in children]. / Les lésions nerveuses dans les fractures supra-condyliennes de l'humérus chez l'enfant.

PURPOSE OF THE STUDY: The most frequent type of elbow fracture in children is by far the supracondylar fracture. This type of fracture also raises the greatest risk of nerve injury. We wanted to study the clinical and prognostic features of nerve injuries in children presen-ting supracondylar fractures of the humerus. MATERIAL AND METHODS: We analyzed the files of 55 children with nerve lesions identified among 1 180 files on supracondylar fractures in children. Most presented Lagrange and Ribault stage IV fractures. Nerve injuries involved the radial nerve (n=28), medial nerve (n=20), and ulnar nerve (n=7). The nerve injury was diagnosed before treatment in 32 children, and after treatment in 23. When nerve injury was identified before treatment, closed reduction had been used for eleven fractures and open reduction for 21. Nerve injury identified after treatment was found in eleven fractures after closed reduction and in 12 fractures after open reduction. RESULTS: When nerve injury was recognized at the initial examination, spontaneous nerve recovery was achieved in all cases, irrespective of the treatment modality, within a maximum of four months. When nerve injury was recognized after treatment, spontaneous nerve recovery was obtained in twenty cases. Time to recovery was longer. The three other cases required nerve exploration with neurolysis for two and a nerve graft for one. DISCUSSION: Nerve injury discovered after treatment is either caused by or aggravated by the treatment. Prognosis is less favorable than for injuries discovered at the initial examination. This highlights the importance of carefully searching for nerve deficit, even partial deficiency, in all children presenting a supracondylar fracture of the humerus. It also emphasizes the importance of care in obtaining bone reduction if the initial examination did not reveal any nerve deficit.

Herpes simplex keratitis in a developing country. Natural history and treatment of epithelial ulcers in Tunisia.

Herpes simplex keratitis was found to be a common ophthalmic problem in Tunisia. Dendritic and geographic ulcers were complicated by deep stromal keratitis in 31% of patients, two thirds of whom were known to have been treated previously with corticosteroids. Herpes simplex virus was isolated from 41% of patients from whom corneal material was cultured. To develop an effective program for management of epithelial herpes in developing countries, treatment with idoxuridine was compared with debridement and patching. Average healing time for 31 ulcers treated with idoxuridine was 13 days, with three treatment failures; average healing time for 20 ulcers treated with debridement and patching was five days, with one failure. Debridement and patching of herpetic ulcers was an efficient way to treat herpes simplex keratitis within the context of overall medical care in Tunisia.

Chondromyxoid fibroma of the scapula : A case report.

Chondromyxoid fibroma of the scapula occurring in a 23 year old woman is of interest because of its unusual site and the extensive invasion of the soft tissues.

[Management of posteriorly dislocated lenses: a report on 18 cases]. / Traitement des luxations postérieures du cristallin.

The posterior dislocation of the lens is a relatively frequent complication of ocular trauma. Treatment is medical, surgical and optical. The authors present a retrospective study of 18 patients (18 eyes) operated between January 1990 and December 1999 for a posterior dislocation of the lens. The age of the patients varied from 9 to 60 years, with a mean of 46 years. The etiology of the dislocation was an eye contusion in 15 cases and spontaneous dislocation in 3 cases. Vitrectomy was performed in all the patients, followed by extraction of the lens using one of two methods Results were good in both groups, with a final visual acuity better than 1/10 in 11 cases out of 18. Complications were substantially fewer than when using old techniques and included 4 cases of hypertonia, 3 cases of corneal edema, 2 cases of retinal detachment, and 1 case of macular edema. All of these complications were treated medically and/or surgically. The authors discuss the advantages and disadvantages of all lens extraction techniques and the benefits of the use of perfluorocarbon liquid in the treatment of the dislocated lens.

[Corneal lesions caused by caterpillar hairs: four case studies]. / Lésions cornéennes dues aux poils de chenille.

Caterpillar hairs disseminated by the wind can cause serious ocular problems in humans. We present 4 cases of corneal lesions caused by caterpillar hairs. Intense functional signs observed in exposed subjects should bring this diagnosis to mind. The severity of this affection is due to the possibility of intraocular migration, even many years after the first accident. Treatment consists of removing the caterpillar hair associated with an antibiotic and local anti-inflammatory treatment.

[Clinical aspects and course of Adamantiades-Behçet disease in Tunisia: a report on 41 cases (author's transl)]. / Aspects cliniques et évolution de la maladie d'Adamantiades Behçet en Tunisie. A propos de 41 cas.

The clinical aspects and course of Behçet's disease in Tunisia are discussed. This affection is of frequent occurrence and should be systematically searched for in all patients with uveitis. Ocular manifestations are observed in 95 p. cent of cases. These are characterized by their polymorphic nature and the diagnosis should be suspected in cases with uveitis, periphlebitis, venous thrombosis, vitreous hemorrhage, congestive glaucoma, or macular edema. The characteristic signs of the disease appear over an extended period of time, making definite diagnosis difficult, but early, vigorous therapy is necessary to ensure a favorable prognosis.

[A long-term follow up of the shoulder in obstetrical brachial palsy]. / Suivi à long terme des épaules paralytiques obstétricales (à propos de 129 cas).

OBJECTIVES: To study shoulder impairment and disability caused by obstetrical brachial plexus palsy, their evolution under physical and surgical treatments, and the place of complementary explorations in persistent sequels. METHODS: From 1991 to 2000, 129 patients (66 M, 63 F) were included in a retrospective study. Impairment was assessed by muscle recovery (deltoid, biceps, external rotators) and shoulder passive motion. Disability was assessed by Mallet functional test. RESULTS: Full spontaneous recovery was noted in 20% of patients before the age of 3 months. Repair of the nerve lesion was undertaken in four children between the 18th and 24th months. Full recovery of deltoid and biceps was noted in three-fourth of whole cases before the 12th month, and of the external rotation in only 45% at this same age. Seventy-seven percent of patients showed stage >or= III of Mallet test (VI: 20%, IV: 32%; III: 25%) at a middle age of 3.5 years. A long-term follow-up showed an external rotation limited less than 20 degrees in 15 children. Investigation by RMN or Arthroscanner was realized for five patients, this reveals a deformation with subluxation of the humeral head in two cases. Ten children were operated (liberation of sub-scapula in nine cases associated to a tendinous transfer six times; humeral osteotomie in one case). This surgery has allowed the improvement of the functional state in all cases. CONCLUSION: After-effects in shoulder are frequent especially the limitation of external rotation, which can lead to a deformation, and subluxation of the humeral head. The authors insist on the importance to push investigations in case of limitation of the passive external rotation to improve the therapeutic choice.

[Total paralysis of the brachial plexus. Value of the preservation of the limb and the restoration of active flexion of the elbow]. / Les paralysies totales du plexus brachial. Valeur de la conservation du membre et de la restauration de la flexion active du coude.

Twenty-six cases of complete brachial plexus paralysis treated surgically have been studied with particular regard to the function of the preserved limb after at least four years. A partial reinnervation was attempted in 27 cases including six neurotisations in the absence of a useful nerve stump. Out of these 28 patients, 14 remained completely paralysed and 14 recovered active elbow flexion equal to or greater than grade 3. Examination of these young injured patients showed that: 1. The preservation of the limb was always preferable to amputation which was only requested by one patient. 2. Active flexion of the elbow greatly improved the functional result by allowing certain types of holding and gripping activity and the ability to put the paralysed and insensitive hand into the pocket or supported on a surface. It also limits downward dislocation of the shoulder which is often painful.

[Consequences of adult brachial plexus paralysis and its surgical treatment on respiratory function]. / Conséquences sur la fonction respiratoire des paralysies du plexus brachial de l'adulte et de leur traitement chirurgical.

The authors have studied 22 patients suffering from traumatic brachial plexus injuries and the consequences on respiratory function of paralysis of the diaphragm and other respiratory muscles. They have also studied the effects of some surgical treatment on respiratory function. The patients were divided into three groups: post-traumatic paralysis of the diaphragm (5 cases), patients who had had an intercostal neurotization (11 cases) and patients with paralysis of some respiratory muscles with an intact diaphragm (2 cases). Six tests were performed--vital capacity, total pulmonary capacity, residual functional capacity, airway resistance, maximum expiratory volume per second and airflow at 50 p. 100 of the vital capacity. Respiratory function was decreased by about 50 p. 100 in cases of diaphragmatic paralysis. This finding should be taken into consideration in cases of extensive lesions of the brachial plexus. The effects of intercostal neurotization were minimal when performed in cases with respiratory paralysis, but with an intact diaphragm. They were negligible in the absence of any respiratory paralysis. It is concluded that intercostal neurotization should not be performed in cases with diaphragmatic paralysis. In such cases, other types of neurotization are preferred.

[Restoration of elbow extension in the tetraplegic by transplantation of the posterior deltoid. Study of 21 cases]. / Réanimation de l'extension du coude chez le tétraplégique par transplantation du deltoïde postérieur. Etude de 21 cas.

The authors have transferred the posterior part of the deltoid muscle to the triceps in 21 tetraplegics. A modification of Moberg's technique has been employed utilising a strip of fascia lata reinforced by Dacron sutures to allow rehabilitation after only 3 weeks. Despite limited active extension of the elbow and diminished power, results were considered to be satisfactory by the patients. They benefited from a greater range of movement of the hand, an improved possibility of bearing weight, improvement in the use of wheelchairs and better ability to express their bladder.

[Retinal detachment in the patient surgically treated for cataract]. / Decollement de retine chez l'operé de cataracte.

We report 95 cases of retinal detachment in patients aged from 17 to 82 years, aphakic (49 cases) and pseudophakic (46 cases). Risk factors are vitreous issue, inflammation, Yag capsulotomy, retinal predisposal lesions and secondary implantation. Surgery is not different from other retinal detachment. Anatomic result are successful in 66% of aphakic and in 70% of pseudophakic patients.

[Chronic kidney disease and myocardial infarction: epidemiological, clinical, therapeutic and prognostic characteristics (about 231 cases)]. / Insuffisance rénale chronique et infarctus de myocarde : particularités épidémiologiques, cliniques, thérapeutiques et pronostiques (à propos de 231 cas).

AIMS OF THE STUDY: To study the epidemiologic, clinical, therapeutic and prognostic characteristics of the myocardial infarction (MI) in patients with chronic kidney disease (CKD). To identify the impact of CKD in hospital, mid- and long-term survival after myocardial infarction. To determine the predictive factors of hospital and midterm MACCE in patients with CKD. PATIENTS AND METHODS: The study population was 231 patients with a myocardial infarction admitted alive from January 2005 to December 2006. The population was divided into two groups. Group 1: glomerular filtration rate (GFR) ≥60 ml/min: 112 patients; group 2: GFR<60 ml/min: 119 patients. RESULTS: Patients with CKD had more history of stroke and arterial hypertension. They had received less medical therapies and urgent reperfusion. In multivariate analysis, CKD was a predictive factor of hospital (P=0.016), at 6 months (P=0.003), at 1 year (P=0.004) and at 2 years MACCE (P=0,015). The predictive factors of hospital MACCE in group 2 were: use of vasopressors (P=0.001) and primary angioplasty (P=0.043). In patients with CKD, only surgical coronary revascularization was MACCE predictive factor (P=0.03). CONCLUSION: Baseline renal function is a powerful predictor of short- and long-term events after myocardial infarction. Our results confirm the need to include the renal function in the evaluation of the level of risk among patients admitted with acute myocardial infarction.

[Supraventricular tachycardia in infants]. / Les troubles du rythme supraventriculaires chez le nourrisson et l'enfant. À propos de six cas.

Supraventricular tachycardia in infants are variable. We try to summarize clinical, electrical and treatment particularities of supraventricular arrhythmia in infants. The majority of infants with supraventricular arrhythmia have a good clinical outcome and an excellent prognosis and may not require chronic antiarrhythmic therapy if they had precocious treatment.