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Isolated Tracheobronchial Amyloidosis

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International Journal of Clinical Medicine 2015年第9期6卷 643-645页

作者： Madiha Mahfoudhi imen gorsane Sami Turki Taieb Ben Abdallah Department of Internal Medicine A Charles Nicolle Hospital Tunis Tunisia

The tracheobronchial amyloidosis is a rarely localized form. It may manifest as a cancer. Only histological results allow diagnosis confirmation. A 68-year-old man was admitted for exploration of a low abundance hemoptysis. The chest radiograph was normal. CT scan objectified thickening of the walls of the trachea and bronchi which are the seat of calcifications. Bronchoscopy found a burgeoning infiltrative lesion training the right side face of the trachea and the anterior edge of the hull. Histological results confirmed tracheobronchial amyloidosis. Typing of this amyloidosis concluded to AL form. The study of amyloid extension lesion was negative. Immunoelectrophoresis of proteins in the blood and urine was normal. The patient was sent to receive external beam radiation to prepare for endoscopic surgical removal. Post-operative suites were marked by a complete resolution of clinical signs particularly hemoptysis with a follow-up of two years.

关键词： Amyloidosis Trachea Biopsy

Indications and Results of Kidney Biopsies in Patients over 65 Years Old

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Open Journal of Nephrology 2015年第2期5卷 49-53页

作者： imen gorsane Madiha Mahfoudhi Imed Helal Taieb Ben Abdallah Internal Medicine A Department Charles Nicolle Hospital Tunis Tunisia

Normal kidney aging is related to tissue and functional changes that make older patients very vulnerable to environmental modifications. Numerous factors can accelerate the impairment of renal function during aging. It was a single-center retrospective study extending over a period of 30 years from 1984 to 2014 and includes patients older than 65 years, hospitalized for nephropathy requiring renal biopsy and monitored in our service. There were 6 men and 7 women with an average age of 69.38 ± 4.5 years. Mean serum creatinine was 267.15 ± 124 mmol/l. Eleven patients had renal failure. Histological lesions were: Extramembranous glomerulonephritis (EMGN): 1 case, focal segmental glomerular sclerosis (FSGS): 3 cases, membranoproliferative glomerulonephritis (MPGN): 1 case, IgA nephropathy: 1 case, glomerulonephritis with IgG4 fibrillar deposits (GN IgG4): 1 case, diabetic nephropathy: 2 cases, myeloma-associated tubulopathy: 1 case, acute tubular necrosis: 1 case, acute interstitial nephritis: 1 case, vascular nephropathy: 1 case. Kidney disease will increasingly become a geriatric illness. Nephrologists are encountering a growing group of elderly patients with diminished equation for estimated glomerular filtration rate (eGFR) that require evaluation and management.

关键词： Renal Aging Chronic Kidney Disease Elderly Renal Biopsy

Prevalence and Risk Factors of Hypertension in Hemodialysis

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Open Journal of Nephrology 2015年第2期5卷 54-60页

作者： imen gorsane Madiha Mahfoudhi Fathi Younsi Imed Helal Taieb Ben Abdallah Internal Medicine A Department Charles Nicolle Hospital Tunis Tunisia

The prevalence of hypertension in iterative hemodialysis (HD) remains high and was associated with a high morbidity and mortality. It was a single-center retrospective study including 124 pa-tients on chronic HD in our unit. The prevalence of hypertension was determined from blood pressure (BP) monitoring in beginning, middle and end of dialysis. We defined hypertension as systolic BP (SBP) greater than or equal to 140 mmHg and/or diastolic BP (DBP) greater than or equal to 90 mmHg on at least two measures. We have established a comparative study between the group of hypertensive dialysis and those not hypertensive. The prevalence of hypertension was 69.35% (86/124). The mean age was 57.15 years with a sex ratio of 1.2. Echocardiograms, performed in 64.5% of patients, showed a high prevalence of cardiac consequences of hypertension with left ventricular hypertrophy in 80% of patients and an average ejection fraction of 62%. Diabetes, dialysis one session per week and the non-compliance with lifestyle and dietary rules were significantly associated with hypertension in HD in our study. The effect of HD on BP is dose-dependent. The reduction of BP allows a lower risk of cardiovascular (CV) events and mortality in hypertensive patients.

关键词： Hemodialysis Blood Pressure Hypertension Ultrafiltration Volume Expansion

Kikuchi-Fujimoto Disease Mimicking Tuberculosis

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International Journal of Clinical Medicine 2015年第10期6卷 725-728页

作者： Madiha Mahfoudhi imen gorsane Sami Turki Taieb Ben Abdallah Department of Internal Medicine A Charles Nicolle Hospital Tunis Tunisia

A 32-year-old woman presented with a fever and cervical lymphadenopathies. The research for Mycobacterium tuberculosis was negative. Tuberculin skin test was positive. Laboratory investigations showed an elevated erythrocyte sedimentation rate and a normal white blood cell count. Bacteriological and viral investigations were negative. Quantiferon-Tb Gold test was indeterminate. Thraco-abdominal and pelvic computed tomography, FDG-PET and gallium scintigraphy revealed no abnormalities. Histological study of cervical lymph node biopsy found signs in favor of histiocytic necrotizing lymphadenitis. There were no epithelioid cell granulomas. A test tuberculosis treatment was refused by the patient. The evolution was marked by spontaneous clinical and biological resolution in fifty days. The negative Lowenstein-Jensen culture eliminated formally the tuberculosis. KFD was thus the most likely diagnosis.

关键词： Kikuchi-Fujimoto Disease Mycobacterium tuberculosis Lymphadenitis Histology

Adult Onset Still’s Disease

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International Journal of Clinical Medicine 2015年第10期6卷 716-724页

作者： Madiha Mahfoudhi imen gorsane Rafik Shimi Sami Turki Taieb Ben Abdallah Department of Internal Medicine A Charles Nicolle Hospital Tunis Tunisia

The adult onset Still’s disease is a rare affection characterised by occurrence of fever, arthralgia or arthritis and evanescent cutaneous eruption. Multiple other systemic lesions make the diagnosis more difficult. Several diagnostic criteria were formulated to confirm this disease. The physiopathology of the adult onset Still’s disease is not well elucidated. However, several studies based on new facts in physiopathology, improved the therapy of refractory forms for which the biotherapy was an interesting alternative. The TNF alpha receptor antagonists are efficient on systemic and articular manifestations of this disease and allow a corticosteroid’s saving. Tocilizumab (interleukin 6 receptor antagonist), and Anakinra (interleukin 1 receptor antagonist) are also new promising treatments for resistant forms.

关键词： Adult Onset Still’s Disease Cytokine TNF Alpha Receptor Antagonist Interleukin 6 Receptor Antagonist Interleukin 1 Receptor Antagonist

Acute Kidney Injury in Pregnancy: A Single-Center Study in Tunisia

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International Journal of Clinical Medicine 2015年第10期6卷 729-733页

作者： imen gorsane Madiha Mahfoudhi Mounira El Euch Taieb Ben Abdallah Internal Medicine A Department Charles Nicolle Hospital Tunis Tunisia

Acute kidney injury is a rare but serious complication of pregnancy. It is still common in developing countries. The causes can be varied. It is imperative to distinguish these conditions to make appropriate therapeutic decisions which can be lifesaving for the mother and fetus. This study examined the incidence and etiology of acute kidney injury in pregnancy, the morbidity, fetomaternal mortality, and renal prognosis among pregnant patients developing acute kidney injury. This is a retrospective observational study involving cases of acute kidney injury during pregnancy and hospitalized in our department from 1995 to 2015. The study involved 10 patients. The average age of patients was 31.6 years. Personal history of preeclampsia was found in 2 patients. The average term of pregnancy in which appeared the acute kidney injury was 33 weeks. All patients had preeclampsia. Five of them had a retro-placental hematoma, 2 had eclampsia and another post-partum hemorrhage. Five patients underwent renal biopsy for a persistent acute kidney injury with an average delay of 26 days. The histological results were: partial cortical necrosis in one case, thrombotic microangiopathy in two cases, acute tubular necrosis in one case, and membranoproliferative glomerulonephritis in one case. Six of our patients had an antihypertensive treatment. Seven patients have required renal replacement therapy. The ultimate evolution was good in 9 patients with recovery of diuresis and total recovery of renal function. Only one patient had kept with advanced renal failure requiring hemodialysis. She has been transplanted after 2 years with normal graft function. The pregnancy care and quality of access to care remain fundamental to prevent complications of pregnancy, including acute kidney injury.

关键词： Acute Renal Failure Pregnancy Preeclampsia

Recurrence of Cortical Venous Haemangioma in the Tibia: Interest of Sclerotherapy

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International Journal of Clinical Medicine 2015年第9期6卷 661-666页

作者： Mohamed Bouabdellah Madiha Mahfoudhi imen gorsane Hatem Rajhi Wael Chabbi Ramzi Bouzidi Orthopedy Department Charles Nicolle Hospital Tunis Tunisia Internal Medicine A Department Charles Nicolle Hospital Tunis Tunisia Radiology Department Charles Nicolle Hospital Tunis Tunisia

We report on a rare case of an intra-osseous haemangioma involving the medial portion of tibia in a 29-year-old man. The aim is to emphasize on diagnosis difficulties, possible recurrence and interest of sclerotherapy. In radiographs, the lesion was a well-defined osteolytic lesion having 3 mm of diameter with perimeter’s sclerosis. The computed tomography images demonstrated an intra-medullar gap’s image of the tibia with cortical participation. An osteoid osteoma was evocated but eliminated by the histhological examination. The osseous scintigraphy didn’t find any anomaly. The outcome was marked by the recurrence of pain. T1-weighted Magnetic resonance imaging showed a hypointense lesion, while T2-weighted images revealed hyperintense areas, with internal, hypointense septa. Gadolinium-enhanced T1-weighted images showed lattice-like enhancement of the lesion. These images signed a recurrence of the intra-osseous venous haemangioma. The sclerotherapy improved the pain in three days and prevented another recurrence.

关键词： Intra-Osseous Haemangioma Computed Tomography Magnetic Resonance Imaging Tibia Sclerotherapy

Is There a Gender Difference of Metabolic Syndrome in Hemodialysis?

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International Journal of Clinical Medicine 2015年第10期6卷 711-715页

作者： imen gorsane Madiha Mahfoudhi Mounira El Euch Fathi Younsi Taieb Ben Abdallah Internal Medicine A Department Charles Nicolle Hospital Tunis Tunisia

The prevalence of metabolic syndrome is high in hemodialysis. MS is defined by the combination of high blood pressure, dyslipidemia, central obesity and a state of insulin resistance. The aim of this work is to see if there’s a difference by gender in the different parameters of metabolic syndrome and in cardiovascular morbidity in our hemodialysis patients. It is a cross-sectional study of 120 patients older than 18 years on hemodialysis. The metabolic syndrome was defined according to the criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). A comparison by gender was performed for the following parameters: age, diabetes, hypertension, obesity, dyslipidemia, coronary artery disease and heart failure. Forty chronic hemodialysis patients with metabolic syndrome have been the subject of this study. The sex ratio was 1.88 and the mean age was 55.97 years. Seventy percent had diabetes and 90% were hypertensive. Coronary artery disease was present in 57.5% of cases and heart failure in 52.5% of cases. The study by gender showed no significant difference except for the prevalence of hyper LDL cholesterol. There is a high prevalence of cardiovascular complications in men but a significant difference by gender could not be demonstrated.

关键词： Metabolic Syndrome Gender Renal Dialysis Cardiovascular Events

Recurrent Hemoptysis in a Young Man

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Open Journal of Internal Medicine 2015年第3期5卷 29-32页

作者： Madiha Mahfoudhi imen gorsane Mounira El Euch Sami Turki Taieb Ben Abdallah Internal Medicine Department Charles Nicolle Hospital Tunis Tunisia

Hughes-Stovin syndrome is a scarce entity associating pulmonary artery aneurysms and deep venous thrombosis. It was considered to be a form of Behcet’s syndrome at its initial feature. We present a case of a 27-year-old man having a Hughes-Stovin syndrome. The patient had a history of left ilio-femoral thrombosis and suffered from recurrent oral ulcers. He presented with recurrent hemoptysis. A giant pulmonary aneurysm was confirmed by chest CT scan. A right femoral thrombosis was shown on the inferior legs doppler ultrasonography. The patient was treated by steroids and cyclophosphamide and proposed to an embolization to prevent recurrence of symptoms.

关键词： Hemoptysis Pulmonary Aneurysm Hughes-Stovin Syndrome