Subdural hematoma during therapy of gastro-intestinal stromal tumor [GIST] with Imatinib mesylate

Imatinib mesylate is a widely used tyrosine-kinase inhibitor [TKI] in chronic myeloid leukemia [CML] treatment. Imatinib has contributed to complete and prolong cytogenetic responses so that it is now the standard treatment of CML. Recently, Imatinib mesylate has shown a significantly prolonged progression-free survival and overall survival in metastatic and locally advanced c-Kit positive gastro-intestinal stromal tumors [GISTs] and more recently a prolonged disease-free survival in operated high risk GIST. Imatinib is a welltolerated treatment with few side effects mainly gastro-intestinal symptoms [nausea, vomiting and diarrhea], headaches, rash and periorbital edema. Hemorrhage incidents are rare in patients treated with Imatinib. They are more frequently seen in CML patients. Hemorrhage incidents in CML include in many cases upper gastro-intestinal [GI] tract bleeding and central nervous system bleeding in rare ones. In GIST patients treated with Imatinib, hemorrhage incidents are exclusively made of upper GI tract bleeding consecutive to tumor perforation or necrosis. In our observation, we present the case of a subdural hematoma occurring in a patient treated with adjuvant Imatinib for a high risk localized gastric GIST. No other case of subdural hematoma in GIST treated with Imatinib has been reported in literature

[Prognostic factors of pneumococcal meningitis. Retrospective study of 31 cases]

Our aim was to study the susceptibility of Streptococcus pneumoniae to antibiotics in patients with pneumococcal meningitis and to search for the prognosis factors in those patients. We have studied retrospectively 31 cases of pneumococcal meningitis. Comparisons were performed with univariate analysis. The mean age was 36,7 +/- 20,5 years [ranged: 9 and 78 years]. The sex ratio was 3,4. The susceptibility of Streptococcus pneumoniae to penicillin G was affected in 10 cases [33% of isolated pneumococcus. The MIC to penicillin G was >/= 2 in only one case. The hospital mortality was 26% [8/31]. With univariate analysis, factors associated with death were: age >/= 55 years [Ss p= 0,006, OR: 17.2; IC[95%]: 2.3-134], albuminorachie >/= 7g/l [p= 0,002, OR: 22; IC[95%]: 1,9-251], shock [p= 0,031, OR: 6.7; IC[95%],: 1.05-42] and Glasgow Coma Score [GCS] /= 7g/l shock and Glasgow Coma Score

[Pituitary deficiency of elderly subject: analysis of 14 cases]

The pituitary deficiency [PD] of the old subject is rare. To study the clinical biological etiologic and therapeutic characteristicsof PD in old subject. We report in this work a retrospective study of 14 patients older than 65 years presenting pituitary deficiency. This PD is characterized by a female preponderance [78, 5%of cases] and insidious initial symptomatology dominated by signs of thyreotrope deficiency and with a less degree of the signs of corticotrope sufficiency Anaemia [57, 5%] hypoglycaemia [28, 5%] and hyponatremia [21, 4%] are the most frequent biological signs. Hormonal exploration showed a dissociated pituitaiy deficiency in 11 cases [782 and global in 3 cases [21, 5%] The axis more touched is the gonadotrope axis [85, 7%] followed by the corticotrope [71, 4%] and thyreotrope axis [71, 4%]. The aetiologies are dominated by the Sheehan syndrome in 5 cases [35, 7%] followed by the hypophysis adenoma m 4 case [21, 4%]. The pituitary deficiency was idiopathic probably of vascular ongin in 2 cases [14, 28%] and secondary to primitive turcic saddle in 1 cases to a cyst of the pocket of Rathke in I case and to prolonged corticotherapy in 1 case. The hormonal substitutive treatment hare per-miffed a spectacular improvement in all the cases. It is necessary to think about the PD in the old subjects in front of minor signs and at the vascular ongin of this one witch remains the most frequent aetiology at the old subject especially those presenting atherogens factors

[Congenital pituitary stalk interruption syndrome-Report of 6 cases]

Pituitary stalk interruption is a non-negligible cause of growth hormone [GH] deficiency. We report 6 cases [5 boys and 1 girl] with complete congenital GH deficiency. The average age was 13 years. 4 out of 6 cases [66, 6%] had corticotrophic hormone deficiency; 1 of 6 cases [16, 6%] had a hypothyroidism. 2 out of 4 children older than normal age of puberty had gonadotropin deficiency [50%]. Diabetes insipidus was not prsent and hyperprolcatinemia was present in 2 cases. 4 children had past history of fetal distress. Pituitary stalk interruption was assessed by the means of magnetic resonance imaging [MRI]. The cause of the stalk interruption syndrome is unknown. The MRI in this syndrome revealed ectopic posterior lobe location, stalk interruption and hypoplastic anterior-lobe. The outcome is progressive evolution towards panhypopituitarism and these patients require regular clinical survey and hormonal controls

[Diabetes mellitus cutaneous manifestations]

Diabetes mellitus cutaneous manifestations are numerous. The aim of this case control study [200 diabetic patients and 100 controls]. was to estimate the frequency of these manifestations, their clinical particularities and their relationship to the duration of the disease, the equilibrium and degenerative complications of the diabetes. Cutaneous manifestations were found in 84,5% of the diabetic patients and in 49% of controls. Diabetic dermopathy [DD] was found in 11,5% of patients and necrobiosis lipoidica in 1 case. Diabetic bullosa was reported in 6% of cases. It was more commune in ancient and poorly controlled disease. Diabetic rubeosis was found in 3% of diabetic patients and cheiroarthropathy in 7%. Cutaneous infections, mainly due to fungus [47%], were found in 63% of patients and 44% of controls. Side effects of antidiabetic medications were noted in 11% of cases. The high frequency of cutaneous manifestations in diabetes mellitus, in our study, could be explained by the inclusion of all skin diseases, in particular, cutaneous infections. The manifestations were significantly more frequent in diabetic patients. DD, diabetic bullosa and cheiroarthropathy are the most specific manifestations. Skin infections are common but non specific. They are favorised by poorly controlled diabetes. Complications of the diabetic foot are frequent

[Infections and diabetes complications degenerative]

We present a retrospective study of 195 diabetic patients how were hospitalized during the year 2002 and who had an evolution of the role of the different degenerative complications in the occurrence of different infections. The most common bacterial infections encountered were in the urinary tract [n =21], the soft tissue [n[degree] 21] and the bronchopulmonary tract [n =12]. In the soft issue infections, the foot was concerned in 40% of the cases. Urinary tract injections were more common in women [p<0.05]. The frequency of urinary tract infections, septicemia, and bronchopulmonary tract injections was not significantly linked to the existence of degenerative complications, exception the case of the .foot infections that were more frequent in patients with arterial or neuropathic disease of the lower e-extremities

[Primary Hypothyroidism subject of age: about 71 cases]

We report in this work a retrospective study of 71 patients older than 65 years who presented with primary hypothyroidism and were hospitalised. These patients represent 8.5% of all our hypothyroid patients. In our group, hypothyroidism was characterized by a female preponderance [72% of our cases] and by its atypical clinical presentation and the marked paucity of its clinical symptoms. The most frequent signs include physical asthenia [79%], weight increase [32%], cutaneo-mucosal signs [49.3%]. Anaemia and hyperlipidemia were the most frequent biological signs encountered [50% and 43% respectively] with hyponatremia found in 15% of the cases. Cardiovascular complications were present in 8 cases [11%]. A myxoedematous coma was present 3 patients [4%] and myopathy was seen in only one female patient. The aetiologies in our elderly patients were mainly auto-immune thyroiditis found in 74,6% of the cases and post-radiation hypothyroidism in 18.3%. Substitutive treatment was started during hospitalisation and the patients had thereafter a clinical and electrocardiographic follow-up to avoid ischemic coronary complications. The mean substitutive dose of L-thyroxine was 166 micro g/day

Evaluation de la consommation des antibiotiques dans un h“pital universitaire Tunisien

Purpose: To estimate the consumption of antibiotics in our hospital and to determine the points at which the recommendations of good practice of antibiotherapy will be targeted. Patients and methods: Our study is a one day prevalence study where antibiotic prescriptions are analyzed by a group of 6 doctors referents in antibiotherapy. During the study day, 443 patients were studied. Means age was 44.2 +/- 23.3 years [range: 1 and 102 years]. 101 infections were diagnosed in 48 patients [10.8%]. 192 patients [43.3%] received antibiotics. Antibiotherapy was curative in 44% of cases. The most prescribed antibiotics were gentamicin [85.2 DDD/1000 patients], metronidazole [79 DDD/1000 patients], and cefotaxime [73.9 DDD/1000 patients]. According to the evaluation group, 30.7% of the antibiotic prescription was considered unjustified. The antibioprophylaxis represents the category most often unjustified [49%]. The molecules in which prescription was frequently considered unjustified are the ciprofloxacin [67%], the amoxicillin-clavulonate [40%] and the cefotaxime [40%]. Our results suggest that an action of good practice should be targeted at the antibioprophylaxis and should concern especially molecules in which prescription was frequently unjustified