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Biomedical subjects

S Bouchoucha

Publications and source records attributed to S Bouchoucha.

At least 19 recordsLinked to original sources
PubMed2005

Granular cell tumour of the perianal region: which therapeutic attitude?

Granular cell tumours are uncommon soft tissue tumours that could be located anywhere throughout the body. Most of time they are benign but the diagnosis of malignancy is difficult to establish on histology: this is why the therapeutic decision is not easy to take in particular for some locations. We report the case of a 18-year old man: he presented, in the perianal region, a granular cell tumour of uncertain malignant potential (so far the first case described in the literature) for which we decided a conservative surgical treatment that failed.

Adolescent↗
PubMed2004

[Neurosarcoidosis as the first manifestation of sarcoidosis: diagnosis difficulty. A case report].

Clinically apparent involvement of the nervous system occurs in a relatively small number of patients with sarcoidosis. The diagnosis of neurosarcoidosis is often difficult and particularly in patients who lack either pulmonary or systemic manifestations of sarcoidosis. Furthermore clinical and imaging features of neurosarcoidosis are extremely variable. We report a case of neurosarcoidosis which had been considered and treated at first as tuberculosis. Only the occurrence, two years later, of pulmonary manifestations of sarcoidosis enabled the diagnosis.

Aged↗
PubMed2000

[Buschke-Loewenstein giant condyloma in the perianal region with inguinal invasion: a case report].

The giant condyloma acuminatum of the perianal region is a tumor characterised by its large size with the propensity to infiltrate into deeper tissues, contrasting with a microscopically benign pattern. The evolution after malignant transformation of condyloma and lymph node invasion is rare. However it is exceptionally observed a lymph node invasion of microscopically benign condyloma acuminatum. The authors report a case of microscopically benign giant condyloma acuminatum of the perianal region associated with inguinal invasion, discovered in a 47 year-old man. Treatment consists in extensive surgery of the tumor and inguinal nodes, followed by a radiation therapy.

Anus Neoplasms↗
PubMed1999

Serotherapy in scorpion envenomation: a randomised controlled trial.

BACKGROUND: Evidence for the benefit of scorpion antivenom, the only specific treatment for scorpion envenomation, is scarce, despite its common use. We did a prospective, randomised, controlled trial to assess the efficacy of routine administration of scorpion antivenom to scorpion-stung patients, irrespective of clinical severity. METHODS: We included 825 consecutive patients older than 10 years, who presented to the accident and emergency department of the hospital in Tozeur, Tunisia. We graded severity by absence (grade I) or presence (grade II) of systemic manifestations of scorpion envenomation. Patients were randomly assigned placebo (n=413) or 20 mL bivalent intraveneous scorpion antivenom (n=412). All patients were observed for 4 h. Patients who developed life-threatening symptoms were admitted to the intensive-care unit. At the end of 4 h observation we reassessed grade and discharged grade II patients and admitted grade II patients. We assessed the preventive and curative effects of scorpion antivenom by prevention of worsening grade or by improvement from grade II to grade I. FINDINGS: Distribution of severity grades was similar in the two groups at baseline, as were the cure rates (55% scorpion antivenom, 66% placebo, absolute difference, 11% [95% CI -4.8 to 26.8]; p=0.234). Preventive effects were seen in 94% and 96% of patients in the scorpion antivenom and placebo groups, respectively, who were initially grade I and who remained symptom-free (absolute difference, 2% [-1.27 to 5.27]; p=0.377). Time from scorpion sting to administration of scorpion antivenom did not affect curative and preventive effects. INTERPRETATION: We found no benefit in routine administration of scorpion antivenom after scorpion sting, irrespective of clinical severity. Future studies should focus on patients with the most severe symptoms and signs.

Adolescent↗
PubMed1999

Efficacy of serotherapy in scorpion sting: a matched-pair study.

BACKGROUND/OBJECTIVE: Although evidence of scorpion antivenin effectiveness in the clinical setting is lacking, scorpion antivenin is generally considered the only specific treatment for scorpion sting irrespective of its clinical severity. We conducted a matched-pair study to assess the efficacy of systematic administration of scorpion antivenin. METHODS: Among 600 stung patients who participated in a study on the efficacy of high-dose hydrocortisone after scorpion sting, 135 (cases) had been treated with 10 to 20 mL intravenous scorpion antivenin (neutralizing 10 LD50 venom/mL). Controls were matched on disease severity on arrival to the emergency department. The severity of envenomation was graded I or II according to the absence (grade I) or the presence (grade II) of systemic manifestations of scorpion envenomation. Assessment of scorpion antivenin efficacy was based on the rate of changing severity grade in both groups (clinical improvement or worsening during an observation period of at least 4 hours). RESULTS: Both groups were similar with respect to clinical severity (36 patients were graded II in each group), age, sex, time-lapse between scorpion sting and ED arrival, and the administration of adjunctive therapy such as hydrocortisone. By the 4-hour evaluation, 50% and 64% of patients initially graded II exhibited a substantial clinical improvement in cases and controls, respectively, suggesting similar effects in cases and controls. There was no difference in preventive effects: 13% and 10% of cases and controls developed systemic manifestations of scorpion envenomation during the 4-hour observation period; 23% of cases and 17% controls were hospitalized by this time. There was no difference in the duration of hospitalization. Three cases developed anaphylactic shock as a consequence of scorpion antivenin administration, while 1 scorpion antivenin-untreated patient died from refractory shock. CONCLUSION: Systematic administration of scorpion antivenin irrespective of clinical severity did not alter the clinical course of scorpion sting. A prospective study is needed concerning the response of the more severe scorpion envenomations.

Adolescent↗
PubMed1998

Development of an ELISA for the detection of scorpion venoms in sera of humans envenomed by Androctonus australis garzonii (Aag) and Buthus occitanus tunetanus (Bot): correlation with clinical severity of envenoming in Tunisia.

A sandwich ELISA was set up for measuring scorpion venom levels in sera of accidentally envenomed humans with the aim to establish a quantitative relationship between these levels, envenoming severity and clinical symptoms. This assay used equine polyclonal F(ab')2, specific to two North African scorpion (Androctonus australis garzonii: Aag and Buthus occitanus tunetanus: Bot) venoms. The test proved to be simple, reproducible, very sensitive (detection limit = 0.9 ng/ml) and linear between 0.5 and 15 ng/ml of venom concentrations. A large survey on scorpion sting envenomings was conducted from 1993 to 1996 in Tunisia to gather accurate epidemiological, clinical and biological data from victims as well as informations on the treatment that they had received. Victims were classified into three grades (GI, GII and GIII) of increasing severity according to clinical signs of envenoming. Blood samples were collected from victims and tested by ELISA for their content of Aag and Bot venoms. A strong correlation was found between clinical symptoms of envenoming and the level of scorpion venom antigens in serum (r = 0.980). Mean serum venom concentrations were: 2.65 +/- 0.81 ng/ml in GI envenoming, 9.79 +/- 4.08 ng/ml in GII and 21.7 +/- 6.51 ng/ml in GIII. The difference between each group was statistically significant (p < 0.01). This ELISA may prove to be helpful to establish a rationale approach of specific antivenom therapy.

Adolescent↗
PubMed1998

Predictive value of severity scoring systems: comparison of four models in Tunisian adult intensive care units.

OBJECTIVES: To compare the performance of four severity scoring systems: the Acute Physiology and Chronic Health Evaluation (APACHE) II, the new versions of the Mortality Prediction Model (MPM0 and MPM24), and the Simplified Acute Physiology Score (SAPS) II. DESIGN: A prospective cohort study. SETTING: Three Tunisian intensive care units (ICUs). PATIENTS: Consecutive, unselected adult patients (n = 1325). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Overall, observed death rates were higher than predicted by all models except MPM0. All the evaluated scoring systems had good discrimination power as expressed by area under the receiver operating characteristics curve, but their calibration was less perfect when compared with original validation reports. There were no major differences between the models with regard either to discrimination or calibration performance. CONCLUSION: Despite an overall good discrimination, APACHE II, MPM0, MPM24, and SAPS II showed a less satisfactory calibration in our Tunisian sample of ICU patients. Part of the models inaccuracy could be related to quality of care problems in our ICUs, but this issue needs further analysis.

APACHE↗
PubMed1997

High-dose hydrocortisone hemisuccinate in scorpion envenomation.

STUDY OBJECTIVE: Scorpion envenomation is a common life-threatening hazard in tropical and subtropical countries. Standard treatment is not clearly defined. Many therapies, such as steroids, are prescribed without experimental justification. We sought to assess the efficacy of systematic administration of intravenous hydrocortisone hemisuccinate (50 mg/kg) in scorpion envenomation. METHODS: Six hundred consecutive envenomated patients older than 10 years who presented to the ED of a nonteaching secondary hospital in an area of Tunisia endemic for scorpion envenomation were randomly assigned to receive hydrocortisone hemisuccinate 50 mg/kg (n = 305) or placebo (n = 295) in addition to standard medical care. Patients in the two groups had similar clinical characteristics on initial clinical evaluation. Each was categorized as grade 1 (absence of systemic symptoms) or grade 2 (systemic symptoms of scorpion envenomation). Patients were treated in the ED for up to 4 hours or in the ICU, depending on clinical severity. Steroid and placebo groups were compared according to mortality rate, change of severity grade 4 hours after presentation and treatment, and duration of hospital stay. RESULTS: Distribution of patients with respect to severity grade was similar in the two groups at the 4-hour clinical evaluation. We detected no significant difference at the time of discharge between steroid-and placebo-treated patients with respect to mortality (one patient in each group) or duration of hospital stay. Extra costs incurred through steroid administration totaled US $989,000. CONCLUSION: Our findings do not support the use of intravenous high-dose steroids in scorpion-envenomated patients. The discontinuation of this practice would reduce costs substantially.

Adolescent↗
PubMed1996

[Subcapsular hematoma complicating acute pyelonephritis].

Spontaneous subcapsular renal hematoma is rare and essentially associated with malignant, or benign tumor vascular diseases, inflammatory processes. In few cases, no cause was detected. We observed one additional case in a diabetic women. She presented fever, and bilateral flank pain. Ultrasonography showed bilateral subcapsular hematoma. Computed tomography confirmed these findings and demonstrated multiple area of acute focal pyelonephritis.

Acute Disease↗
PubMed1995

Assessment of left ventricular function in severe scorpion envenomation: combined hemodynamic and echo-Doppler study.

OBJECTIVE: To assess left ventricular function in patients presenting with pulmonary edema following scorpion envenomation. DESIGN: Cohort study. SETTING: Medical intensive care unit of a teaching hospital. PATIENTS: Nine consecutive adult patients stung by Androctonus australis and presenting with pulmonary edema entered the study. Fourteen normal volunteers comprised the control group. INTERVENTIONS: Upon admission, all patients had right heart catheterization and, within the first 8 h, a Doppler echocardiographic study. Results of Doppler echocardiographic studies were compared to those of controls. MEASUREMENTS AND RESULTS: Usual hemodynamic information (heart and vascular pressures, derived data and tissue oxygenation parameters), left ventricular dimensions and indicators of systolic function, and Doppler-derived parameters of left ventricular filling and diastolic function were obtained upon admission. Serial echocardiographic measurements were repeated daily until full clinical recovery (eight patients) or death (one patient). All patients had a hemodynamic profile of acute congestive heart failure (mean PAOP = 24 +/- 2 mmHg; mean SVI = 22 +/- 7 ml/m2; mean CI = 2.5 +/- 0.5 l/min/m2). However, SVR were not increased (mean = 22 +/- 3 U/m2). Left ventricle was hypokinetic in all patients with transient mitral regurgitation present in five patients. Left ventricular systolic function was markedly depressed (FS = 12 +/- 6%; EF = 26 +/- 12%). An associated diastolic dysfunction is suggested by Doppler records of mitral inflow. Left ventricular systolic function evolved toward normalization within 6 +/- 2 days preceded by full clinical recovery. CONCLUSIONS: These data suggest that pulmonary edema in scorpion envenomation is of hemodynamic origin and is related to a severe and prominent impairment of left ventricular systolic function.

Adolescent↗
PubMed1995

A controlled trial of nebulized salbutamol and adrenaline in acute severe asthma.

OBJECTIVE: To compare efficacy and safety of nebulisation of adrenaline (2 mg over 10 min) and salbutamol (5 mg over 10 min) in acute severe asthma. DESIGN: Prospective randomized and double blind study. SETTING: Intensive care unit of a University teaching hospital. PATIENTS AND PARTICIPANTS: 22 asthmatic patients presenting to the emergency room with acute severe asthma. INTERVENTIONS: Patients were randomly assigned to receive either adrenaline (n = 11) or salbutamol (n = 11) via a nebulizer. Additional treatment comprised hydrocortisone hemisuccinate (100 mg) and supplemental oxygen (71/min). The efficacy and safety of both drugs were evaluated at 20 and 40 min. RESULTS: A statistically significant increase in the Peak Expiratory Flow (PEF) was achieved at the 20th min in both groups (from 85 +/- 38 l/min to 120 +/- 45 l/min; p < 0.001; and from 107 +/- 28 l/min to 145 +/- 19 l/min; p < 0.001; in adrenaline group and salbutamol group respectively). With both drugs, PEF further increased at 40 min to a level that was statistically significant when compared to the 20 min evaluation. The magnitude of the absolute variation in PEF was similar with both drugs. Both drugs induced a significant decrease in heart rate, respiratory frequency and PaCO2 while the increase of PaO2/FIO2 ratio was not significant. The decrease of respiratory frequency at 40 min was more important with salbutamol (p = 0.03). No side effects were recorded in both groups. CONCLUSION: After a single dose, nebulized adrenaline (2 mg) proved as effective and safe as salbutamol (5 mg) in acute severe asthma.

Acute Disease↗
PubMed1995

Right ventricular dysfunction following severe scorpion envenomation.

OBJECTIVE: Evaluation of right ventricular (RV) performance in patients presenting with pulmonary edema following scorpion envenomation. DESIGN: Cohort study. SETTING: Medical intensive care unit of a teaching hospital. PATIENTS: Eight consecutive adult patients stung by yellow scorpion Androctonus australis and presenting with pulmonary edema at hospital admission. INTERVENTIONS: In all patients, standard hemodynamic parameters and RV volumes were measured using a pulmonary artery catheter equipped with a rapid responding thermistor enabling measurement of RV ejection fraction (RVEF). MEASUREMENTS: Hemodynamic evaluation was performed at the time of hospital admission prior to any therapeutic intervention and just before the removal of the pulmonary catheter (2.3 +/- 0.5 days after admission) in the surviving patients (n = 7). RESULTS: All patients had a decreased RVEF (24 +/- 7%) and cardiac index (2.44 +/- 0.5 L/min/m2) and increased pulmonary artery occlusion pressure (23 +/- 6 mm Hg). Right ventricular end-systolic pressure/volume ratio was decreased (.56 +/- .19 mm Hg/mL/m2), suggesting an altered RV contractility. Follow-up evaluation performed in survivors, without any inotropic support, showed hemodynamic changes reflecting a trend toward full recovery. Right ventricular ejection fraction and cardiac index improved markedly (from 24 +/- 7% to 39 +/- 10% and from 2.44 +/- 0.5 to 4 +/- .3 L/min/m2, respectively). Pulmonary artery occlusion pressure, peak systolic pulmonary artery pressure, and mean pulmonary artery pressure decreased significantly from baseline values (12 +/- 3 mm Hg, 29 +/- 5 mm Hg, and 20 +/- 4 mm Hg, respectively). Right ventricular end systolic pressure/volume ratio remained almost constant, suggesting that afterload enhancement accounted predominantly for RVEF improvement. CONCLUSION: These data show that RV function impairment is associated with left ventricular dysfunction, suggesting similarities between left ventricular and RV alterations following severe scorpion envenomation providing further arguments to the hypothesis of scorpionic myocarditis.

Adult↗
PubMed1994

Prognostic value of serum cholinesterase in organophosphate poisoning.

OBJECTIVE: To determine whether serum cholinesterase level has a prognostic value in human acute organophosphorus poisoning. DESIGN: Cohort (prospective) prognosis study. SETTING: Medical ICU at University Hospital. PATIENTS: Thirty consecutive patients admitted to the ICU for acute organophosphate poisoning. MEASUREMENTS: Serum cholinesterase level was measured in all patients at the time of hospital admission. Severity of intoxication was assessed by the total dose of atropine required to relieve poisoning manifestations, the Simplified Acute Physiology Score, the need for assisted ventilation, and by a specific grading system previously validated that identified two groups of patients: group 1 (low severity, n = 18) and group 2 (high severity, n = 12). RESULTS: Serum cholinesterase level did not correlate with the total dose of atropine or with the Simplified Acute Physiology Score. Mean serum cholinesterase level was not significantly different between group 1 and group 2 patients (448 +/- 409 U/L in group 1 compared with 611 +/- 575 U/L in group 2 (p = NS); it was also not significantly different between patients with and without mechanical ventilation support (567 +/- 571 vs 470 +/- 409, respectively). CONCLUSION: Serum cholinesterase levels have no prognostic value in acute organophosphate poisoning. Thus, a grading system to identify high-risk patients based on this measurement is most likely unreliable.

Acute Disease↗
PubMed1992

Hellp syndrome: incidence and maternal-fetal outcome--a prospective study.

OBJECTIVE: To determine the incidence of Hellp syndrome (HS) and the maternal fetal outcome associated with its occurrence. DESIGN: A prospective study during a 6-month period. SETTING: The department of obstetrics and gynecology and the Intensive Care Unit of a 700 bed teaching hospital. PATIENTS: Sixty-two consecutive preeclamptic and eclamptic women. MEASUREMENTS AND RESULTS: All patients were systematically investigated for the biological markers of HS. The effects of the occurrence of HS on maternal and fetal prognosis were evaluated by comparing for prognosis indicators usually assessed in gravidic hypertension, pre-eclamptic and eclamptic woman who exhibited HS (HS+ subgroup) with HS free patients (HS- subgroup). HS was found in 12 out of the 62 pre-eclamptic and eclamptic women (19.3%). Its occurrence was associated with higher maternal mortality (16.7% vs 0%; p = 0.03), a greater incidence of eclamptic crisis (50% vs 20%; p = 0.03), severe hypertension (33% vs 8%; p = 0.03) and episodes of acute renal failure (66% vs 30%; p = 0.02). Mean proteinuria was also higher in HS+ patients (4.6 +/- 3.3 vs 2.2 +/- 2.5 g/day; p = 0.001). However, fetal outcome was not significantly altered. CONCLUSION: Pre-eclampsia and eclampsia may be more severe in the presence of HS with a worsening of maternal prognosis while fetal outcome seems not altered.

Adult↗
PubMed1991

Cardiac dysfunction and pulmonary edema following scorpion envenomation.

Cardiac dysfunction with pulmonary edema following scorpion envenomation (SE) has been documented only in a few isolated case reports. We conducted a systematic hemodynamic study in five consecutive patients (mean age, 21.6 +/- 8 years) presenting with pulmonary edema occurring a few hours (9.6 +/- 5.2 hours) after SE. All patients had increased pulmonary capillary wedge pressure (mean, 25 +/- 1.8 mm Hg) while the systemic vascular resistance was elevated only in one. The stroke volume index was markedly depressed (21.7 +/- 3.6 ml/sq m) whereas cardiac index was normal or slightly decreased (2.5 +/- 0.4 L/min/sq m). Cerebral infarct and sudden cardiac arrest were the cause of death in two patients. In the three survivors, all the hemodynamic disturbances and respiratory abnormalities disappeared within a few days. We conclude that cardiac dysfunction was found in all five patients and this was reversible in the three surviving the acute episode.

Adult↗