[Special features of systemic sclerosis in men]

Systemic sclerosis [SS] is a generalized disorder of connective tissue and microvasculature characterized by tissue fibrosis and obliteration of the vessels. Several features of systemic scleroderma in men are discussed in the literature. To investigate the initial clinical features, evolution and prognosis of systemic sclerosis in men. patients with systemic sclerosis based on ACR's criteria were included. In this retrospective study we compared a cohort of men to a cohort of women, diagnosed between 2000 and 2010 in department of internal medicine. Fifty four patients were included amongst which nine men. The mean follow-up duration was 39.5 months. A higher proportion of cardiac, renal and lung involvement were noted at diagnosis. Localized cutaneous sclerosis was predominant in men. This work has highlighted several features of systemic sclerosis encountered in men. These results warrant confirmation by analyzing a larger population

[Takaysu's arteritis in Tunisia: a monocentric study of 11 patients]

Takayasu's disease is a chronic inflammatory arteritis involving large vessels in young women. To assess the clinical, laboratory, and radiological features and course of Takayasu arteritis in Tunisia. This retrospective study analyzed 11 patients with Takayasu arteritis between 1999 and 2010 who met the criteria for inclusion proposed by the American College of Rheumatology [ACR]. The file review identified 11 women, with a mean age at diagnosis of 29.1 years [range: 17-50 years]. Our series included involvement of the aortic arch and its branches in 8 cases, while only 3 cases of the abdominal aorta. Arterial hypertension due to stenosis of the renal arteries was noted in 4 cases. Aortic insufficiency and pulmonary hypertension were noted in one case. In all, 3 patients had type I disease, 3 type V and one type IV. In all, 4 patients had glucocorticoid treatment, and one needed immunosuppressive therapy. Three patients required surgical intervention. Our patients were followed for a mean period of 67.5 months. Disease remained stable in all patients. Despite the small number of our patients, the clinical manifestations, angiographic data and course in our study were similar to those in other reported series

[Urinary tract infections in elderly]

Urinary tract infections [UTI] in elderly are frequent and polymorphic clinical symptoms. This is a public health problem both in support and cost they generate. To study the epidemiological, clinical, paraclinical and therapeutic aspects of UTI in the elderly. We conducted a retrospective study of 50 cases of UTI in the elderly collected in the Internal Medicine Department at Habib Thameur Hospital between January 2002 and December 2006 [Group I]. We compared this group to another group of patients aged below 60 years also explored for UTI in the same service and during the same period [Group II]. They were 37 women and 13 men in group I and 41 women and 9 men in the group II. In group I, the average age was 74.10 +/- 6.7 years, in group II 43.58 +/- 11.26 years. In group I, 35 patients [70%] showed no evidence of suspicion of a UTI on admission. 15 patients [30%] were admitted for suspected UTI. In group II, 36 patients [72%] showed no evidence of suspicion of a UTI on admission. 14 patients [28%] were admitted for suspected UTI. Urological abnormalities underlying the UTI, detected by ultrasound, were more frequent in Group I [40%] than in Group II [12%]. Second-line antibiotics, due to the likely resistance of the microorganism, had to be prescribed in 16% cases in Group I vs. 4% of cases in Group II. The evolution under antibiotic treatment was marked by the occurrence of 3 deaths and transition to renal failure in 4 cases for Group I. In Group II, the outcome was favorable in all cases. Urinary tract infection is a significant factor in morbidity and mortality in the elderly. Female is much more concerned than male. Clinical manifestations of UTI are often crude and misleading in a pathological and poly polymedicated patient. The preventive arm accounts for most of the management of urinary tract infection in the elderly

[Arterial involvement in Behcet's disease: a series of 7 cases]

Arterial involvement is rarely described in Behcet disease BD and it is associated with poor prognosis. We report our experience with a rare and interesting subset of Behcet disease patients with arterial involvement: thrombosis and aneurysm formation types of angio-BD. From 1994 to 2008, seven cases of arterial BD with 3 aneurysm formation and 4 thrombosis were found amongst BD patients in the department of internal medicine of Habib Thameur Hospital. Combination of venous and arterial manifestations occurred in 4 patients. All patients were male and the mean age when arterial involvement manifested was diagnosed was about 39.3. The artery most often affected is the aorta followed by the pulmonary arteries. Brain infraction occurred in about 4 cases. Pericarditis and neurological symptoms were more frequently noted in patients with arterial BD than others without vasculo-Behcet disease. All patients underwent corticosteroids and immunosuppressive therapy. Two patients were successfully operated for aneurysms. All patients were alive after a mean of 7.8 years fo11owup, Arterial involvement is more frequently noted in vasculo-Behcet than venous thrombosis and it's associated with a high morbidity and mortality rate

[Venous involvement in behcet's disease: a series of 28 cases]

Venous involvement is a rare and severe clinical feature in Behcet disease [ED]. We reported our experience with a rare and interesting subset of ED patients with venous involvement. From 1994 to 2008, twenty eight eases of venous ED were found amongst BD patients in the department of internal medicine of Habib Thameur Hospital. 45 episodes of venous thrombosis occurred in 28 patients. There were 25 men and 3 women the mean age when venous involvement manifested was diagnosed was about 32.25. Venous thrombosis occur in the first five years following the diagnosis of BD. Pericarditis was more frequently noted in patients with venous ED than others without vasculo-Behcet disease. In contrast digestive and rheumatologic symptoms were more likely observed in patients without vasculo-l3ehcet disease. Thirteen patients underwent corticosteroids. Relapses occurred more frequently in patients without corticosteroid therapy. Venous involvement is more frequently noted in vasculo-Behcet than arterial involvement. Its treatment should include anticoagulation in association with corticosteroids

atteinte cardiaque au cours des spondylarthropathies

Cardiac involvement is a real manifestation of spondylarthropathies and include specially aortic reguragitation an conduction troubles. We present a prospective open study of fifty patients with spondylarthropathy [responded to Amor criteria] in order to evaluate the frequency of cardiac involvement, to see its type and if we can evaluate a group of patients able to this complication. We have included forty-four men and six women with a mean age of 38 years. The disease evolue for 8.8 years in mean. Ag HLA B27 was present in 70% of the cases. Thirty patients have ankylosing spondylitis, although twenty have a secondary spodylartropathy: psoriasic rheumatism [12 cases], inflammatory bowel disease: crohn's disease [4 cases], RCH [three cases] and fiessenger le Roy-reiter syndrom in one case. All the patients have had a cardiac check up with research of clinical cardiac manifestation, thoracic chest trans-thoracic echographi, Holter rhythmic done in five cases only. Cardiac involvement is found in five cases [10%]: aortic regurgitation in 3 cases [6%] and mitral regurgitation in 2 cases [4%]. These valvular disease are well tolerated