Biomedical subjects
A Abid
Publications and source records attributed to A Abid.
[Cardiac myxoma. Surgical treatment. About 20 cases].
INTRODUCTION: Cardiac myxoma is the commune cardiac tumors. Their clinical status depends in the anatomic type. The aim of this study is to evaluate our results and to compare them for literature. PATIENTS AND METHODS: From January 1990 to June 2004, 20 patients (8 males and 12 females) with mean age of 49 years underwent surgical treatment of cardiac myxoma. The tumors were in left atrium in 14 cases, in right atrium in 4 cases and biatrial in 2 cases. Surgical treatment consisted in complete resection of the tumor in all cases associated with partial atrial septal resection in 9 cases. RESULTS: There is not death in the postoperative outcome. The mean follow up is 50 months. The late mortality rate was 10%. All patients are asymptomatic and the echocardiography control showed no tumor recurrence. CONCLUSION: Cardiac myxoma is the communist primary tumor of the heart. Diagnosis is based upon echocardiography. Surgical management has well out come with low morbidity and mortality. Late results are satisfactory but regular screening is recommended although risk of recurrence is low.
[Anastomotic false aneurysms after under-diaphragmatic bypasses: about 25 cases].
The purpose of our study is to determine the causes and the management of anastomotic aneurysms. We report the cases of 25 patients with a mean age of 64 years at the time of initial surgical revascularisation. The mean interval between the first operation and the occurrence of anastomotic aneurysm is 5 years (range 2 months-11 years). The treatment consists on the interposition of a graft in 8 patients, anastomotic angioplasty in 9 patients and the reconstruction of the anastomosis in 8 patients. Hospital mortality was 20%. Late death occurs 3 patients and the long-term morbidity was evaluated at 22%. A recurrence of anastomotic false aneurysm occurred in 4 patients (16%) (Range 7 months-1 year). In conclusion anastomotic false aneurysm is one of the major complications of vascular reconstruction; careful follow-up can detect the rare instances of anastomotic aneurysm and reoperation can be accomplished with a low-rate of adverse outcome.
[Cardiac sequelae of penetrating cardiac wounds].
OBJECTIVE: The aim of our work was to study cardiac sequelae of penetrating cardiac injuries. MATERIAL AND METHODS: It is a retrospective study including nine patients (eight men and one woman with an average age of 26.6 +/- 7.4 years) hospitalised between January 1st, 1988 and December 31, 2002 in cardiovascular surgery department of Tunis Rabta hospital for heart wounds. RESULTS: It was stab wounds in all patients. Heart lesions concerned primarily the right ventricle. In admission, two patients had cardiac tamponade and seven were in shock. Beating heart surgery without cardiopulmonary bypass in all patients performed surgical repair and it consisted in simple suture. Functional symptoms were observed in five patients at late outcome. Five patients had heart sequelae. It consisted of conduction abnormalities (right bundle branch block) in five patients. One patient had a small ventricular septal defect. Finally, partial permanent disability rates were less than 10%. CONCLUSION: Cardiac sequelae of penetrating cardiac wounds have good prognosis with the exception of a small partial permanent disability rate. Their prevention must be based on the fight against the urban violence and on the good initial management.
[A rare association: tetralogy of Fallot and Ebstein's anomaly].
The association of Tetralogy of Fallot and Ebstein's anomaly is very rare. The authors report a case in a 22 month old baby. As the Ebstein's anomaly was asymptomatic, the surgical indication for repair of the tetralogy of Fallot was the only planned procedure. During surgery, right ventricular dysfunction made it necessary to perform a cavobipulmonary anastomosis. The postoperative course was simple. Very few cases of this type have been found in the literature.
[Diverticulum of the left atrium detected antenatally. Management of a case].
Cardiac diverticulae are rare, most often affecting the ventricles rather than the atria. We report the case of a diverticulum of the left atrium discovered during routine fetal echocardiography. The diagnosis was confirmed at birth with cardiac echography and an MRI. In view of the patient's age and asymptomatic nature, it was decided to defer surgery and to observe the infant with regular echocardiography. Surgery was eventually performed via a left thoracotomy after the appearance of signs of cardiac compression, and there were no complications in the post-operative period.
Identification of novel mutations in the SEMA4A gene associated with retinal degenerative diseases.
Semaphorins are a large family of transmembrane proteins. The gene for SEMA4A encodes a transmembrane protein comprising 760 amino acids. To investigate its association with human retinal degeneration, mutation screening of the SEMA4A gene was carried out on 190 unrelated patients suffering from a variety of eye diseases. We report the first observation of the involvement of SEMA4A gene mutations causing retinitis pigmentosa (RP) and cone rod dystrophy (CRD). We screened the DNA of 135 patients with RP, 25 patients with CRD, and 30 with LCA using SSCP and direct DNA sequencing for mutations in the SEMA4A gene. Two mutations, p.D345H and p.F350C, were observed only in affected patients; they were not observed in any of the normal members or the 100 control subjects. Both mutations identified occur in the conserved semaphorin domain. Multiple sequence alignments using Clustal analysis showed that R713Q is a conserved substitution and D345H is a semi-conserved substitution. We conclude that these mutations are a cause of various retinal degenerations.
[Association study between diabetic retinopathy and aldose reductase gene polymorphism in Tunisians].
INTRODUCTION: Aldose reductase (ALR2), the enzyme of the polyol pathway, may play an important role in the pathogenesis of diabetic microvascular complications, namely diabetic retinopathy. The study aimed to determine whether the aldose reductase gene is involved in diabetic retinopathy in the Tunisian population. MATERIAL: and methods: A case-control study was conducted in 47 type 2 diabetic patients who have diabetic retinopathy and 28 diabetic patients without diabetic retinopathy in spite of diabetes lasting for more than 5 years and over 10 years in 13 cases. We investigated the association between the (CA)n polymorphism located at 2.1 kb upstream of the transcription start site of ALR2 and diabetic retinopathy. The distribution of genotypes and alleles was compared between cases and controls by chi2 test using Epi info software. RESULTS: Genotyping of the two groups did not demonstrate any association between the alleles of this marker and diabetic retinopathy in the Tunisian population studied. DISCUSSION: An association between one of the alleles (Z - 2) of this microsatellite and diabetic retinopathy was identified in Chinese and Japanese patients with type 2 diabetes. Discordant results were obtained for the different populations studied. The lack of an association between diabetic retinopathy and ALR2 alleles indicates that the ALR2 gene is not a genetic marker of predisposition to diabetic retinopathy for type 2 diabetic patients in the Tunisian population studied.
[Pulmonary artery aneurysms in Behcet syndrome].
Behcet syndrome is a systemic disease with venous tropism, generally expressed by thrombosis and phlebitis. Arterial involvement is more exceptional but can lead to aneurysm of the pulmonary artery, generally not more than three. We report a patient with Behcet syndrome who developed multiple aneurysms of the pulmonary artery and discuss the clinical, radiological aspects as well as the disease course and therapeutic management.
Novel association of RP1 gene mutations with autosomal recessive retinitis pigmentosa.
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[Cardiac hydatid cyst. Two cases in children].
INTRODUCTION: Diagnosis of a cardiac hydatid cyst is difficult because of the absence of specific clinical signs. This is a rare disease in adults, but even rarer in children. OBSERVATIONS: In a 12 year-old girl, operated on for a pulmonary hyatid cyst 4 years earlier, respiratory distress appeared. This was caused by right heart failure secondary to a chronic hyatid post-embolus pulmonary heart. In a 13 year-old boy exhibiting pulmonary hydatosis (first clinical signs 3 years earlier) echocardiography revealed a multi-compartmented cystic image of the anterior wall of the left atrium, with another similar image in the anterior section of the pulmonary infundibulum. DISCUSSION: These observations illustrate the potential gravity of complications of a hydatid cyst, endemic parasitosis in North Africa (metastatic pulmonary echinococcosis and chronic pulmonary heart). Imaging is crucial for the early diagnosis, assessment of the lesions and follow-up after treatment.
[Orthopaedic complications of neurofibromatosis].
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[Forty-one pediatric cases of non-typhoidal salmonellosis].
UNLABELLED: Non-typhoidal Salmonella (NTS) infections are a major cause of infantile death in developing countries. OBJECTIVE: The aim of this study was to determine the epidemiologic and therapeutic data, as well as the evolution of NTS in Morocco. METHOD: This retrospective study was made on 41 patients hospitalized for NTS between 1994 and 2002 in the Casablanca University Hospital Pediatric ward. RESULTS: Twenty cases of digestive salmonellosis were diagnosed, 16 cases of septicemia, and 10 cases of meningitis. Ten patients were hospitalized after an outbreak of resistant Salmonella typhimurium in a nursery. Fifty percent of the patients were less than 3 months of age. The three patients between 1 and 3 years of age presented with primary immunodeficiency. Fever, vomiting, and diarrhea were noted in 97% of the cases. The stools were watery in 89% and severe dehydration in 55% of the cases. Salmonella strains were identified in blood in 25 cases, from stools in 10 cases, and from CSF in nine cases. The following Salmonella serotypes were identified: S. typhimurium (53.6%), S. enteritidis (44%), and S. agona (2.4%). Resistance to antibiotics was noted, especially for Salmonella typhimurium (34%) in the nursery outbreak. The evolution was favorable in 80%, but two children with meningitis developed severe neurological sequels, and six hypotrophic infants under 3 years of age died after septicemia.
[Sub-dural abscess and empyema: unusual complications of meningococcal meningitis: four paediatric cases].
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[Cross over bypasses ilio-femoral and femoro-femoral. Indications and results about 60 cases].
UNLABELLED: The goal of this retrospective study is to review indications and results of cross over bypasses. METHODS AND MATERIAL: between January 1990 and December 2000, 60 patients (all males with mean age = 60 years) underwent cross over bypass for unilateral iliac occlusive disease: femoro-femoral in 48%, ilio-femoral in 44% and ilio-popliteal in 8%. RESULTS: mortality was 5% while complications occurred in 13.3%. Early limb salvage rate was 92%. During follow-up (mean: 32 months) we noticed 13 late thrombosis. The actuarial patency rate being at 83.5%, 74% and 67% at 1 year, 3 years and 5 years respectively. CONCLUSION: cross over bypasses are technically simple with low morbidity and acceptable results. In addition to widely accepted indications (general or local unfavourable conditions to approach abdominal aorta), cross over bypasses may be considered as satisfactory challenge even in young patients with how operative risk.
[Devic's optic neuromyelitis and viral hepatitis type A. A paediatric case report].
INTRODUCTION: Devic optic neuromyelitis is a rare clinical disease that involves severe transverse myelitis and unilateral or bilateral optic neuropathy. Its pathogenesis would be explained by demyelinization triggered by bacterial or viral infections phenomena. According to several author, prognosis would be better in children. CASE REPORT: We report a case of optic neuromyelitis in an 8-year-old child with an uneventful history who was admitted because he suffered from flaccid tetraplegia and sudden decline of the visual acuity. The ophthalmologic examination revealed bilateral neuropapillitis. The medullary MRI visualized a spreading myelitis with bifocal arachnoiditis. Search for a precipitating infectious factor showed positive IgM for viral hepatitis A. With corticosteroid treatment the child achieved total recovery of vision and recovered motor and sensorial function of the upper limbs and the trunk. Paraplegia with sphincteral disorders persisted. CONCLUSION: This case characterized by the precipitating factor (hepatitis virus A), illustrates this rare syndrome. We present a general review of the pediatric cases reported in the literature.
[Orbital cellulitis in children: a retrospective study of 33].
Orbital cellulitis is rare. However the high risk of severe ocular and neurological complications make early diagnosis and adequate therapy essential. The purpose of this retrospective study is to describe 33 cases observed in the pediatric infectious disease department of the Casablanca Children's Hospital in Morocco from 1994 to 2000. Orbital cellulitis was preseptal in 24 patients and retroseptal in 9. Infection occurred in relation with sinusitis in 10 cases, polydermitis in 8, wound infection in 6, ocular infection in 2, and dental abscess in 2. Ages ranged from 40 days to 15 years with a mean age of 5 years. Infants accounted for 25% of cases and always presented preseptal cellulitis. Fever and local edema were noted in all patients. Exophthalmia occurred in six patients and seizures in 2. The 9 cases of retroseptal cellulitis were complicated by empyema in 2 cases, meningitis in 1 case and thrombophlebitis of cavernous sinus with cerebromalacia in 1 case. Bacteriological testing identified micro-organisms in 10 cases, i.e., Staphylococcus aureus in 6 cases, Streptococcus B in 1, Streptococcus pyogenes in 1, Enterobacter Cloacae in land Acinitobacter jejuni in 1 case. Therapy was based on broad-spectrum antibiotics in association with surgery in the patient presenting in intracranial abscess. Ophthalmoplegia-like sequels including blindness, aphasia, and motor deficit occurred in 2 patients. Orbital cellulitis in children are usually preseptal and have a favorable prognosis. However prompt and adequate antibiotherapy is essential due to the risk of retroseptal involvement with inflammatory palpberal edema and possible cerebral extension.
Intracavitary cardiac hydatid cyst.
The purpose of this study is to determine the diagnosis means, the surgical management and the prognosis of patients with intracavitary cardiac hydatid cyst. We report a series of seven patients. The diagnosis was orientated by coexisting pulmonary locations in all patients. The cyst was located in the right cardiac chambers. Cardiopulmonary bypass with aortic cross clamping and cardioplegia was necessary in all cases. The postoperative course was satisfactory for all patients. There was a recurrence of pulmonary cysts in all patients after a mean duration of 42 months. Medical treatment (Albendazole) was instituted. One late death occurred at 3 years of follow-up due to chronic right heart failure. In conclusion, cardiac hydatid cysts with intracavitary location must be suspected in patients with pulmonary or systemic embolization. Early surgical treatment is necessary and medical treatment must be instituted after surgery.