S. M'rad

Article originalLa maladie de Behçet en Tunisie. Étude clinique de 519 casBehçet's disease in Tunisia. Clinical study of 519 cases

PURPOSE To describe clinical characteristics of Behçets disease in Tunisia. METHODS Its a retrospective and multicentric study conducted by the Tunisian society of internal medicine. Inclusion criteria were those of the international study group. Were also included patients without international study group criteria but with at least one manifestation among arthritis, venous thrombosis or neurological manifestation with oral and genital ulceration or oral ulceration and skin lesions. RESULTS Five hundred and nineteen patients were included. 87.5% of them fulfilled the international criteria. The male to female ratio was 2,7. The mean age was 28.7+/-9.3 years at onset and 32.7+/-9.2 years at diagnosis. The incidence of each manifestations was as follows: oral ulcers: 100%, genital ulcers: 87.5%, pseudo-folliculitis: 67.6%, erythema nodosum: 17.5%, positive pathergy test: 51%, joint involvement: 55%, uveitis: 32.2%, vein thrombosis: 24.9%, arterial aneurysms: 3.9%, neurological involvement: 11.6%. The frequency of HLA B51 antigen was 35% among the 187 patients tested. There was no difference in the manifestations of the disease between patients having B51 and those lacking it. Venous thrombosis (29.8 vs 11.4%), arterial involvement (4.4 vs 1.4%) and uveitis (37.5 vs 17,9%) were significantly more frequent in men whereas erythema nodosum (22.9% vs 15.6%) and joint involvement (70,7 vs 49.9%) more frequent in women. The mean follow up was 6,1+/-5.7 years. Mortality rate was 2.3% in our series. CONCLUSION Our study confirms the androtropism of the disease in Mediterranean and Middle east countries. Positive pathergy test and venous thrombosis were more frequent in our study, like those from Mediterranean region. Whereas, ocular and neurological involvement were quite less frequent in our series.

Young ischemic stroke in Tunisia: a multicentric study.

Purpose: There is wanting data regarding young ischemic stroke in developing countries, especially in Tunisia. The purpose of this study was to investigate risk factors and etiologies of young ischemic stroke in Tunisian and make a comparison with previous reports. Materials and methods: A total of 102 young ischemic stroke patients (15–45 years old) were admitted, between January 1996 and August 2007, to 11 departments of internal medicine in different Tunisian hospitals. The risk factors for stroke were documented and assessed. Diagnosis workup consisted of anamnesis, complete physical examination and extensive laboratory, radiologic, immunologic, neurologic and cardiologic examination. Stroke etiologies were classified according the Trial of ORG 10172 in acute stroke treatment. Results: There were 42 men (41.2%) and 60 women (58.89%) with a mean age at onset of 35.7 years. As regards stroke subtype, large-artery atherosclerosis was diagnosed in 6.9% of cases, cardioembolism in 11.8%, small-vessel occlusion in 8.8%, other determined etiology in 37.3% and undetermined etiology in 35.3%. Concerning the traditional risk factors, smoking (31.4%), hypertension and diabetes mellitus (12.7% for each one) and a family history of stroke (10.8%) were the most common. The mean follow-up period was 30.5 months. Conclusions: In our study, traditional risk factors were not-so-uncommon in young adults with ischemic stroke suggesting that prevention can go through controlling these factors. Stroke of other determined etiology was the most common among our patients, so that a broad and detailed diagnostic workup is crucial to puzzle out the etiology for more and better stroke prevention.

Imaging Features of Behçet’s Disease

Behcet’s disease is a chronic vasculitis clinically characterized by relapsing orogenital aphthosis associated with a large multisystemic spectrum of clinical manifestations. Imaging is essentially helpful to evaluate vascular involvement and to monitor post-therapeutic evolution of cardiovascular, neurological, respiratory, and digestive involvements. Familiarity with the various and specific imaging findings of this disease is fundamental to make an early detection and guide the optimal care of patients.

Imaging Features of Takayasu Disease

The best diagnostic modalities of Takayasu disease are computed tomography, angiography, magnetic resonance angiography, and ultrasonography when the acoustic window is adequate. Diagnostic activity can be determinate by positron emission tomography–computed tomography scan and with a delayed-enhancement pulsed sequence by magnetic resonance angiography. The therapeutic methods are medical treatment, endovascular treatment, and surgery in the case of failure of both treatments.

Place de la coloration de Ziehl-Neelsen dans le diagnostic de la lèpre

Summary Leprosy is still a worldwide public health problem. In tunisia, it is rare. The authors report the case of a patient, 37 years of age, living in La Soukra (Northern suburb of Tunis) who has developed an inflammatory edema of hands and feet in 1996, which spread rapidly. 3 years before she had developed hypoesthesic skin lesions which lead to a suspected diagnosis of leprosy despite negative bacteriological tests. A direct examination of skin samples for the Hansen bacillus was carried out again, and this time results were positive, leading to a diagnosis of lepromatous leprosy. Investigation on family was negative.