[Hold in charge of children pain in Tunisien hospital services]

Children pain has been under estimated for long time. We attend, since a few years, a particular interest for the relief of the pain children. Our study is exhaustive, about doctors practicing in tunisien hospital services. A questionnary was addressed about children pain evaluation and treatment. We have177 answers included in 48 hospital services. The aim of this study is to perform a diagnostic of the situation about knowledge, attitude and practice of these doctors concerning children pain. Children pain stay under estimated by practitioner in 51 per cent of the cases. It's never evaluated in 64,4 per cent, and 85 per centof them haven't any evaluation methods for children pain. In 67 per cent of the cases, therapy protocol is not written. The treatment with morphin is never used in 36, 4 per cent. Authors suggest a strategy based on doctors formation, editing evaluation and therapeutically protocol and creation of a comity versus pain in each service

[Intra-uterine growth retardation: etiologic factors and management]

The aim of this study is to define the etiologic factors, the diagnostic procedures and obstetrical rules to be observed during a pregnancy in relation with low birth weight. This is a retrospective study of 124 cases, carried out at the military hospital of Tunis, between January 1st 1999 and December 31st 2001. The frequency of intra-uterine growth retardation [IVGR] was 2.1%. 46.8% of the patients were primiparous. The mean age of the patients was 30 years. 25.8% of the patients developed toxemia. The etiology was predominantly renovascular-syndromes, urinary infections, and idiopathic hypotrophy. The positive diagnosis was suggested by the measure of the uterine height in 96% and was confirmed by sonogaphy in all cases. The umbilical Doppler was pathological in 17.76% of the cases. A corticosteroid administration for pulmonary maturation was prescribed in 28% of the cases. Obstetrical common rule was fetal extraction; 42.7% of the patients were delivered by cesarean. There is a real need to insist on the importance of early detection of fetal hypotrophy and of better management of the women at risk

[Endometrectomy. Analytical study of 20 cases]

Endometrial removal represents a therapeutic alternative to hysterectomy. Through a retrospective study of 20 cases of endometrial removal collected over a period of 4 years, the authors try to determine the indications of this therapeutic method, its efficiency, its advantages as well as its contra indications. Average age of the patients was 44 years. Average parity was 4. Functional menstrual disorders were found in 90% of cases. Gynaecological examination revealed a uterus of normal size in 85% of cases, and increased in size in 15% of cases. All the women had a preoperative diagnostic hysteroscopy. A simple endometrectomy was performed in 70% of the cases, an endometrectomy with a polypectomy in 25% of the cases and an endometrectomy with a myomectomy in 5% of the cases. The rate of success was 90%. We had a case of uterine perforation, because of uncontrollable bleeding a hysterectomy had to be carried out in 2 cases. Endometrectomy is an alternative to hysterectomy in cases of menorrhagia due to mild functional disorders resistant to medical treatment

[Cardiothyrotoxicosis]

About a retrospective study of 20 cases of cardiothyreosis, collected at the cardiology department of University Hospital Ibn Rochd of Casablanca, during a period of7 years, we can pilot the following data: woman predominence is obvious [80%], the average is advanced [52 years old], the notion of preexistent cardio-vascular pathology is noted on 8 cases [40%], the goitre basedowing is the frequent aetiology of hyperthyreosis; the cardiac complications of hyperthyroidism are dominated by the disorders of rhythm [95%] and the heart failure [75%]. The treatment of cardiothyreosis is always double: the anti thyroidism therapy associate cardiac treatment where the beta blockers take an important place. On the evolutive level, the return to the euthyroidism is generally obtained, however it can persist the cardiovasculary disorders, in particular, the cardiac arrhythmia which is difficult to reduce

Apparently primitive dilated cardiomyopathy. About 30 cases

This retrospective study was conducted in the Cardiology Unit of the University Hospital Ibn Rochd Casablanca. Thirty cases of primary cardiomyoparhy were recorded between 1980 and 1985. -Frequency of the disease [0.42%] was underestimated. - The mean age of the patients was 37.5 years; Most of them were males [73%]. - The clinical picture was a cardiac failure [96.6%] which was bilateral in 73.3%. - Electrocardiogram was always disturbed, but there was no specific sign. Q and QS waves of transmural fibrosis were frequently associated [33.3%]. -Echocardiography was a privileged technique for studying the dilated cardiomyopathy; it allows the diagnosis and the study of the ventricular function which is an important element in the prognosis evaluation. Treatment remains disappointing, based on the combination of rest, salt free diet associated which diuretics and digitalis. - Etiology is still unkown and the prognosis poor. - Death rate was 23.3%. Mean duration of survival was 12 months. - Two cases of this disease were of interest: a post-partum myocardiopathy and an alcoholic myocardiopathy