[Cerebral venous thrombosis during pregnancy: about 7 cases]

cerebral venous thrombophiebitis [CVT] is a rare but serious pathology. The pregnancy and especially the postpartum constitute supporting circumstances occured of the CVT. the aim of our study is to remember the symptomatology of CVT, the importance of the IRM and the angio IRM in the diagnosis of CVT, and its treatment. We present a retrospective study relating to 7 cases of CVT during gravidopuerperality over 7 years [1996 to 2002]. The average age of our patients is .32,1 years. The CVT occured during the first trimester of the pregnancy in one case and in the postpartum in 6 cases. The symptomatology was dominated by cephalgia and the signs of intracranian hypertension. Convulsions occured in 3 cases. The diagnosis of CVT was confirmed by IRM coupled with the Angio-IRM in all cases. The treatment by heparinotherapy was instaured immediately and relayed by the Anti-Vit K as the evolution was favorable in all cases. cerebral venous thrombophebitis [CVT] is a serious pathology [especially in pregnancy and post partum]. The diagnosis is performed by the magnetic resonance imaging [IRM] and the early introduction of the heparinotherapy

[Complement hereditary deficiency in bacterial meningitis. Study of 61 Tunisian adults and litterature review]

Sixty one Tunisian adult patients with bacterial meningitis were screened for complement deficiency. Functional activity of the classical and the alternative pathways of complement [CH50 and AP50 respectively] were measured according to standard haemolytic procedures. Serum concentrations of C3 and C4 were determined by nephelometry. Late complement component [C5-C9] and properdin concentrations were assessed by double-ligand ELISA. Complement deficiency was found in eight patients [13%]: Seven had late complement component deficiency [three C7 deficiency, two C5 deficiency, one C6 deficiency and one C8 deficiency] and one had partial properdin deficiency. Patients with late complement component deficiency had a mean age of 24 years [range 17-32 years]. All deficient patients had meningococcal meningitis. Recurrent meningitis was reported in half of the patients. Our findings demonstrated a high prevalence of complement deficiency in Tunisia suggesting that screening for hereditary complement deficiency should be performed in case of bacterial meningitides and meningococcal disease patients

progressive family intrahepatic cholestasis difficulty of diagnosis and taking charge in a developing country

The progressive family intrahepatic cholestasis or Byler syndrome is a group of recessive autosomic illness. It is responsible of an intra-hepatic cholestate which is secondary to an anomaly of the metabolism and the excretion of biliareses acid .In spite of progress achieved over the last few years in the understanding of the physio-pathological mechanisms and the genetics of this group of cholestasis, the hold in charge remains difficult in a developing country like Tunisia. Patient and methods: it is about a retrospective survey concerning 12 children treated in the paediatric service during a period of 18 years [1986-2003] for progressive family intrahepatic cholestate confirmed by clinical, biological and histological data. our set includes 12 children who have presented a cholestatic jaundice with dark urine and discoloured waste beginning between the ages of 3 days and 18 months with an average age of 4 months, the parental inbreeding has been noted in 10 patients, the domestic antecedents of jaundice of the infant were found in 5 cases the jaundice was in irregular all cases and partner to a prurits in 8 cases. The hyperbilirubinemy and the increase of the alkaline phosphatases were present with all patients. The rate of cholesterol was normal with all patients. The gamma GT was normal in 10 cases and increased in 2 cases, biliary acids have been measured in 10 patients, they were raised in all cases. The hepatic biopsy has been achieved in 10 cases; it showed signs of cholestase and fibrosis in all cases. Eight patients received a treatment associating acidic ursodesoxycolic [AUDC] and Rifampicin, whereas 4 patients have been treated with cholesteramin in the absence of hold social. The K vitamin by way parenterale has been prescribed for all children, whereas vitamins A and E, not available in Tunisia are taken only by 2 patients. The evolution has been made toward the death in a graph of decomposed cirrhosis in 3 patient [age ranging from 1 month to 4 years]. The other patients are treated again with thrusts of jaundice and pruritus but with no sign of serious hepato-cellular insufficiency. A lot of difficulties persist at the level the diagnosis of the PFIC in Tunisia [biliary acid dosage abroad] and especially at the therapeutic level: unavailability of fat-soluble vitamin and absence of a hepatic transplantation program

[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