Antineutrophil cytoplasmic antibodies positivity in a case of idiopathic pulmonary haemosiderosis

Idiopathic pulmonary haemosiderosis is a rare disease of unknown etiopathogeny which is characterized by hemoptysis due to alveolar haemorrhage. We report the case of a 16 years-old girl with idiopathic pulmonary haemosiderosis, diagnosed through clinical, radiological, cytological and histopathological data. The finding of myeloperoxydase-anti-neutrophil cytoplasmic antibodies (ANCA) positivity led us to suspect an associated vasculitis which was not further demonstrated.     

Characteristics of Enterococcus strains isolated from neutropenic patients at the National Bone-Marrow Transplantation Center of Tunis

The frequency of digestive colonization of neutropenic patients by Enterococci during the phase of pre-transplant and post-transplant of bone marrow is important indeed as 441 Enterococcus spp strains have been isolated from stool-cultures and other specimens whithin a period of 35 months in 80 patients. A quantitative stool culture was done on appropriate media. Simple bile-esculine agar (BE) and bile esculine-agar additionned with 6 mg/l of vancomycine (BEV) were used for detecting Enterococci. These organisms were taken into account, when then numeration was > 10(3) UFC/g of fecal sample on BE and in all cases on BEV. Species isolated were essentially Enterococcus faecalis (39.4%), Enterococcus faecium (34.4%) and Enterococcus casseliflavus (17%). These strains were characterized by a high frequency of high-level resistance to gentamicin (40.8%). Resistance to amoxicillin concerns 40% of E. faecium strains. Seventeen multiresistant strains of E. faecium isolated from 7 patients (colonized during a long period and receiving a gut decontamination treatment) were the subject of a phenotypic analysis (biotyping, antibiotyping and determination of MICs to beta-lactam, aminoglycosides and glycopeptides). This analysis showed that these strains are distinguishable, endogenic and specific for each patient, the common multiresistance trait resulted from the selective pressure of decontamination treatment used for our patient.     

Outcome of intracytoplasmic injection of fresh and frozen-thawed testicular spermatozoa. A comparative study

OBJECTIVE: To compare the outcomes of intracytoplasmic sperm injection (ICSI) with fresh and cryopreserved testicular spermatozoa in patients with obstructive and nonobstructive azoospermia. STUDY DESIGN: Retrospective analysis. RESULTS: A total of 60 ICSI treatment cycles (32 fresh, 28 frozen) using testicular sperm obtained by open biopsy were analyzed retrospectively. No statistically significant differences were noted in any of the parameters examined between ICSI cycles from fresh and frozen-thawed testicular spermatozoa. Fertilization rates were 61.9% with fresh vs. 61.7% with frozen-thawed testicular sperm, pregnancy rates per embryo transfer 29.1% vs. 25.0%, respectively, and delivery rates 85.7% vs. 80.0%, respectively. CONCLUSION: Intracytoplasmic sperm injection with frozen-thawed testicular spermatozoa permits the obtaining of satisfactory fertilization and pregnancy rates, and the cryopreserved sperm can be used as an effective sperm source in future ICSI cycles.     

Recurrent bilateral shoulder hand syndrome induced by phenobarbital

Algodystrophy syndrome is characterized by pain, vasomotor disorders and/or trophic skin changes, without laboratory signs of inflammation. Among the etiological factors of this syndrome (trauma, cerebrovascular accident, diabetes mellitus...), iatrogenic ones including phenobarbital can be observed. We report a case of phenobarbital induced recurrent bilateral shoulder-hand syndrome in a 67 years old women with hypertension, diabetes, and history of epileptic crisis following ischemic cerebrovascular accidents. The patient recovered after barbiturate withdrawal and treatment with calcitonin. It's necessary to diagnose promptly shoulder-hand syndrome of iatrogenic cause in order to withdraw definitively the responsible drug, to start an effective therapy, at this stage, on pain and bone demineralization and to prevent severe sequels.     

School retardation in a suburban community of Tunisian Sahel

This study tries to assess the prevalence of the school retardation in a suburban community of the Tunision Sahel, to identify its determinants factors and to propose a preventive strategy. It is a transverse investigation having interested 540 registered pupils at the 6th year in six randomly chosen primary schools of Kalaa Kebira (Sousse-Tunisia). Showed that the prevalence of the school retardation is 29%. It appears therefore that the school retardation is especially a complex problem dominated by the socio-educational factors requiring the orientation of the school health team toward a multi sectorial intervention integrating teachers, social workers and representatives of parents.     

Massive gastric dilatation after a single binge in an anorectic woman

OBJECTIVE: Massive gastric dilatation is a very serious condition that is extremely rare in patients with no history of gastrointestinal disease. Several cases have been reported in patients with eating disorders, particularly after a binge. We report here the case of a young woman who developed severe gastric dilatation after a single binge. METHODS: A computed tomographic (CT) scan of the abdomen was done and a psychiatric evaluation was performed. RESULTS: The diagnosis of acute gastric dilatation was confirmed and superior mesenteric artery syndrome was excluded. The patient responded to nasogastric drainage and bowel rest. She was also found to have situational anxiety and depressive symptoms as well as a nonspecified eating disorder. CONCLUSION: This case illustrates the serious sequel of even a single binge in any patient with abnormal dietary habits, and demonstrates the useful role of the CT scan in the diagnosis.     

Ureteral injuries in gynaecologic surgery

Surgical injury to the ureter is an important problem that confronts the urologist, the gynaecologist and the general surgeon. We report 38 cases of iatrogenic ureteral injuries observed after gynaecological surgery between January 1972 and December 2004. Hysterectomy accounted for 22 injuries. Injuries were intra-operatively recognized in 3 cases and were treated immediately. In the case of lesions identified secondarily, a ureter-vesical implantation was performed in 66% of cases with a good result in 84% of them. Four patients required nephrectomy. We discuss the cicumstances of development, diagnosis approach and treatment of this lesion and review the literature about this subject.     

Audit of management of arterial hypertension in primary health care in Sousse

A medical audit has been carried out on a representative sample of 456 hypertensive patients followed in the health care facilities of Sousse during 2002, to evaluate the quality of management of hypertension in primary health care. The study yielded the following results: the patients selected for a first line follow-up did not represent more than 79% of the studied population. The minimal recommended balance was achieved in 8% of cases only. Adequate drug therapy was prescribed in 64% of cases. 59% of patients were considered compliant. Controls of blood pressure was achieved in 5,5% of patients. The quality of management of hypertension in primary health care was considered satis factory in 28,7% of patents with a significant difference between urban and rural areas (24,9% versus 40,5%). These results indicate that increased attention should be paid by the national program of Struggle against the Chronic Diseases to the quality of management of hypertension in primary health care institutions.     

DNA fingerprinting of a multi-resistant coagulase-negative staphylococci isolated from biomaterials in dialysis services

BACKGROUND: Coagulase-negative staphylococci (CoNS) have emerged as an important opportunistic pathogen isolated in hospital. Several species of CoNS have been implicated in human infections and disease especially in patients with poor health status. METHODS: A total of 71 clinical strains of CoNS were isolated from dialysis fluid and needles in a dialysis unit and characterized. Susceptibility to antibiotics, biofilm production and molecular typing by pulsed-field gel electrophoresis (PFGE) were achieved. RESULTS: The main isolated CoNS strains were Staphylococcus epidermidis (45%), Staphylococcus hominis (14%) and Staphylococcus haemolyticus (12.7%). The susceptibility profile of all strains revealed high resistance level to penicillin and oxacillin. PCR detection of oxacillin resistance gene (mecA gene) revealed a higher percentage of positive strains than the classic test (ATB Staph). Slime production test was positive in 60.6% of CoNS strains. PFGE analysis showed the presence of 69 restriction profiles clustered in 56 patterns. CONCLUSIONS: Profiles of all isolates were generally heterogeneous, suggesting independent circulation with some evidence of cross-transmission.