[Liver involvement in Gaucher's disease: a tunisian cohort study]

Gaucher disease is a sphingolipidosis related to glucocerebroside storage in reticuloendothelial cells leading to multisystemic disease. Liver involvement is frequent but clinical expression is rare. The aim of this study is to evaluate liver involvement among a cohort of 45 patients with type 1 Gaucher disease. Hepatomegaly often mild to moderate was seen in 86 per cent of cases. A correlation was noted between hepatic involvement, spleen enlargement and severity index score. Portal hypertension was documented in 20 per cent of cases and seemed to be primitive. Four children had cirrhosis and two a hepatopulmonary syndrome. Splenectomised patient didn't show worsening of liver involvement. Liver complications were more frequent in pediatric patients comparatively to adult patients in this cohort

Abdominal actinomycosis: about four cases

The abdominal actinomycosis [AA] is a rare and often unrecognised suppurative chronic illness. It is caused by an anaerobic positive Gram bacteria; Actinomyces israeli Abdominal actinomycosis is responsible of pseudotumoral syndrome in the most of the time leading in the doubt of a neoplasia, to a large and mutilating extraction surgery whereas a prolonged treatment by antibiotics would have permitted to heal the illness. The diagnosis is obtained generally from anatomopathologic exam. We report 4 cases of abdominal actinomycosis being revealed by a pseudotumoral syndrome. The diagnosis has only been made after surgery. In spite of an active treatment by antibiotics during several months, two of our patients had recidivism of their actinomycosis. These 4 observations confirm the diagnostic and therapeutic difficulties already reported by other authors

[Cerebral toxoplasmosis during AIDS in Tunisia: epidemic logical, clinical and therapeutic aspects]

Cerebral toxoplasmosis [CT] is a severe parasitic disease during HIV infection. It is the most frequent opportunistic infection of central nervous system in AIDS. To study epidemiological and clinical data, and to discuss therapeutic strategy during this disease. This is a multicenter retrospective study from the Tunisian departments of infectious diseases. All medical charts of patients admitted for CT from 1st January 1985 to 31[th] December 2004 were reviewed in order to investigate epidemiologic, clinical and therapeutic data. During the study period,78 cases were collected with an incidence of 9.75%. There were 65 men [83.3%] and 13 women [16.7%], with mean age of 34.5 years [range: 18-52 years]. CT was the first AIDS-defining illness in 30 patients [38.5%]. Heterosexuality was the main risk factor for HIV infection [41%]. Headache, fever and neurologic disorders were the main clinical signs. Toxoplasmic antibodies [IgG] were found in 88.4%. Median CD4 cell count was at 33/mm[3]. Diagnosis of CT was based on neuro-imaging data [CT-scan and/or magnetic resonance imaging] wich shows multiple lesions [59%] associated to cerebral oedema. Pyrimethamine-sulfadiazine or pyrimethamine-clindamycine were the 2 main regimen for treatment, associated in some cases to steroids. Improvement was observed in 50% of cases. Thirty three patients [42.3%] died during the first episode of CT. The severity of CT in AIDS requires early diagnosis and treatment to improve prognosis. Early detection of HIV infection and improvement of immunologic status of patients under antiretroviral treatment are necessary to decrease incidence of this opportunistic infection

[Acute post partum pancreatitis - about two cases]

The acute pancreatitis occurring during the pregnancy or the postpartum is rare but can be serious. It often causes diagnostic and therapeutic problems. It requires a multidisciplinary management and can sometimes threaten the vital prognosis. The authors report two observations of acute post-partum pancreatitis with biliary etiology, which is initially serious with a stage E scannogra-phic and more than 3 clinico-biological criteria of Ranson. The evolution under symptomatic treatment was favourable