[Hepatorenal syndrome]

Hepatorenal syndrome [HRS] is a particular form of functional renal failure which may develop in patients with liver cirrhosis. Recent advances in the understanding of the biology of vasoactive mediators and the physiology of microcirculation have allowed to better anticipate its pathophysiological mechanisms. To review new advances in the knowledge of epidemiology, diagnosis criteria, pathophysiological mechanisms and treatment of HRS. Review of literature using medical data bases [Medline] with the following key words: hepatorenal syndrome, pathophysiology, medical treatment, MARS, liver transplantation. During the course of cirrhosis, portal hypertension leads to splanchnic and systemic vasodilation, responsible for a reduction of effective arteriel blood volume. As a result, a state of intense renal vasoconstriction develops, leading to renal failure in the absence of any organic renal disease. At this stage, liver transplantation is the only definitive therapy able to reverse renal dysfunction. Pharmacologic and radiologic therapy is aimed at improving renal function to enable patients to survive until transplantation is possible. These therapies are based on vasoconstrictor drugs associated with intravenous albumin infusion and transjugular intrahepatic portosystemic shunt [TIPS]. They improve circulatory function, normalize serum creatinine and may improve survival. Simple measures have been shown to reduce the risk of HRS in cirrhotic patients including the plasma volume expansion with albumin in patients with spontaneous bacterial peritonitis and optimal fluid management in patients undergoing large volume paracentesis

[Clinical and endoscopic prognostic factors in peptic ulcer bleeding]

Bleeding ulcer represent the most common cause of upper gastrointestinal hemorrhage. This study aims to evaluate the prognostic factors of recurrent bleeding and mortality in patients presenting with high risk of peptic ulcer bleeding. A cohort study with 88 patients was designed to investigate prognostic factors to the occurrence of new episodes of bleeding. Endoscopic hemostasis was performed in 32 cases [36%]. Recurrent bleeding and death occurred in 30 [34, 1%] and 3 cases [3, 4%] respectively. The predictors factors of rebleeding were hypovolemia at admission and the localization of the ulcer in bulb. The only predictor factor of death was the anticoagulant therapy. The identification of patients with risk of death by bleeding peptic ulcer remains as a challenge, once few factors are capable of predicting the severity of the evolution. The identification of such factors will allow the choice of the better therapeutic conduct improving the diagnosis and decreasing the rate of rebleeding and the mortality

[Occult hepatitis B among hemodialysed patients]

The rate of hepatitis B infection remains high in hemodialysis units despite preventive measures. This could be attribuated to the presence of occult hepatitis B among hemodialysis. To study the prevalence of occult HBV infection in haemodialysis patients with negative Hbs Ag. A group of patients Hbs Ag [-] [n=173] followed in hemodialysis units in Monastir has been tested by the hepatitis B virus Amplicor Monitor test to detect hepatitis B virus viremia [virus hepatitis B DNA] in serum. A total of 173 patients HBs Ag [-] were included in the study [mean age: 60 years [13-74 years] sex ratio: 1, 98]. 11EV vaccination was made in 93%of patients. Twenty percent of patients were infected with HCV. The rate of transaminases was always normal even in patients anti HCV [+]. No dialysis patients had detectable hepatitis B virus-DNA by polymerase chain reaction technology. Multivariate analysis demonstrated an independent and significant relationship between anti-HCV antibody and anti-hepatitis B virus core antibody in serum. occult hepatitis B virus was absent in our study group. This could be explained by the high prevalence of patients hepatitis B vaccinated

[Massive lower intestinal bleeding from colonic tuberculosis case report]

Colonic tuberculosis is an uncommon presentation of gastro intestinal tuberculosis. We describe a 46-year-old patient who presented with massive rectal bleeding. The patient had required a surgical resection following which the patient died to complications. This case emphasizes the need to include colonic tuberculosis in the diagnosis of lower intestinal bleeding

Degenerescence d'un kyste dermoide du cuir chevelu. A propos d'un cas

Dermoid. cysts are benign tumours, resulting of an embryologic defect. They usually have good prognosis, only a single case of malignant transformation of a sublingual dermoid cyst has been brought back in literature.We report a case of carcinomatous transformation of a dermoid cyst of the scalp, in a 54 years old man