[Adenosarcoma uterine]

This cancer is composed of a benign glandular component and sacromatous stroma. It is characterized by its rarity, difficulties in both diagnostic and therapeutic care. Patient aged 65 years old, complaining of a post-menopausal bleeding, the gynecological examination showed a collar - like benign polyp, both the ultrasound examination info showed an endometrial hypertrophy and the endometrial biopsy examination were negative. The positive diagnosis was based on the biopsy anatomopathological examination, after a subtotal hysterectomy with bilateral ovarian excision operation. This operation was ended by a neck -isthmectomy. Uretine adenosarcoma represents only 8% of all sarcomatous period. Its clinical symptoms are highly polymorphic dominated by the presence of metrorrhagia. Only the anatomo-pathological examination allows for the positive diagnosis by demonstrating the presence of malignant mesenchymal elements and benign epithelial components. Surgery is the main treatment the radio or chemotherapy were instituted in the advanced cases but their usefulness in terms of survival benefit remains controversial. The treatment involves a multidisciplinary team to establish a diagnostic and therapeutic proper conduct especially in advanced cases

[Sertoli-Leydig tumor of UC]

It represents 1% only of all malignancies that mostly affects young women. Its histological diagnosis is difficult and unpredictable. Trough this observation and literature review, we will outline the difficulties of management of this tumour. Mrs. I.R 28 years old had a secondary amenorrhea of 4 months with a huge abdominopelvic mass. CT examination described a mars occupying the right adnexa of 23 cm diameter orienting suspected teratoma or other tumours of ovarian origin. During surgery, we discovered an enormous fibrocyotic necrotic and friable mass, at the expense of the right ovary, so a right ophorectomy was done. The pathological examination confirmed the diagnosis. The patient was clinically manifested by an abdominal distension, with signs of hyperandrogenism and or hyperestrogenism. So a hormonal examination was essential in case of virilization to eliminate abnormal adrenal anomaly. The imaging and macroscopie study showed a solid avarian mass with some well-demarcated intra mural cysts of varying size. Histological examination defines the tumour grade. There are six sub-types that are valued by the degree of tubular differentiation of the Sertoli cell component and the abundance of primitive gonadal stroma. Recurrences are early. The reported prognostic factors are: histologic grade, tumor rupture and the presence of a heterologous mesenchymal elements. The differential diagnosis poses a problem with other ovarian tumours. Treatment consists of a lumpectomy or unilateral oophorectomy for the benign forms than a bilateral oophorectomy and hysterectomy if the tumour is poorly differentiated or greater than the stage of IFGO. This tumour is characterized by its rarity and difficulty of diagnosis. It occurs in a nulliparous or paucipare, young women. The unpredictable evolution causes a radical problem in the management of this entity

[Operative hysteroscopy]

It is essential and necessary therapeutic tool in the management of intrauterine pathologies. Indeed, it has facilitated the reach of these lesions and offers many advantages as a minimally invasive technique for either patients or physicians. Retrospective study on a series of 79 cases of operative hysteroscopy performed between January 2004 and December 2006. The mean age of patients was 43.7 years. Gestures made were: polypectomy in 27 cases [34.2%], myomectomy in 17 cases [21.5%], endometrial ablation in 14 cases [17.7%], septum resection in nine patients [11.4%], resection of trophoblastic tissue in two patients [2.5%]. Incidents and accidents during surgery accounted for 2.5%. This technique has now gained an important place in the field of gynecologic endoscopy, endo-uterine resection of intracavitary fibroids and endometrial polyps, the endometrectomy, cure of partition and synechiae are currently codified. Moreover, literature reports a net long-term improvement of clinical signs after hysteroscopic treatment, with improved pregnancy rates and embryo implantation. Hysteroscopy is currently the gold standard as a therapeutic technique for intrauterine lesions. However it has limits and not without complications

[Diagnostic hysteroscopy]

It is an essential and necessary tool in the management of intrauterine pathologies. Indeed, it allows a better diagnosis and better distribution of therapeutics, more precisely targeted. It is a quick, minimally invasive, reproducible and reliable. Retrospective study on a series of 174 cases of diagnostic hysteroscopy performed between January 2004 and December 2006. The mean age was 42,6 years; abnormal uterine bleeding is the main symptom in 110 patients [63%], followed by infertility in 30 patients [17.2%], the abortive disease [7.5%], removal of the intrauterine device [6.9%], and others [5.1%]. Nine patients [5%] had a normal examination; intrauterine abnormalities found were: polyps [31.6%], endometrial hypertrophy [32%], submucous adenomyomas [13.8%], synechiae [12%], endometrial atrophy [9.7%], the intrauterine device [6.9%], uterine septum [6.3%], trophoblast retention [3.5%], intraluminal neoplasms [1.7%], and adenomyosis [1.7%]. The hysteroscopy is accurate, safe, with a low failure rate in the diagnosis of intrauterine abnormalities. It has better sensitivity and specificity compared with sonography and hysterosalpingography. It involves certain risks, but generally remains rare. This examination is currently the gold standard as a diagnostic technique for intracavitary uterine lesions

[News flow about A, H1N1 influenza]

2009 H1N1 is a new influenza virus causing illness in people. The first cases detected were in Mexico and in the United States in April 2009. This virus is a variant of influenza virus A, coming from triple human restocking, aviaire and porcine. The first cases were discerned in Mexico and in USA joined in April, 2009. In the date of February 17th 2010, 17208 cases of influenza A, H1N1 was confirmed in Africa and including 167 deceases. The virus has an interhuman transmission across the world, probably according to the same mode of transmission as the seasonal virus influenza. The state of pandemic was signaled by the worldwide organization of health on June 11th, 2009 and is spreading from person-to-person worldwide, probably in much the same way that regular seasonal influenza viruses spread. On June 11, 2009, the World Health Organization signaled that a pandemic of 2009 H1N1 flu was underway. H1N1 a virus affect particularly young patient [20-40] at the difference to the seasonal influenza virus. The principal risk factors to the development of serious complications were: the young age, pregnancy and the presence of a chronic medical illness. The main clinical demonstrations of this virus are: fever, evil of throat, tiredness, aches and/or digestive disturbances with type of diarrheas and sometimes vomiting. The treatment consists of the seriousness of this influenza and the necessity of installation of appropriate prophylactic measurements [individual hygiene, vaccination and precautionary antiviral treatment in case of exhibition] to restrict the transmission of this infection and reduce total mortality. The aim of this study is to put a full stop on the clinical aspects, therapeutic measurements and the efficient means of prevention against this influenza

[Abdominal pain in case of uni-cornuate uterus]

Thinking of the diagnosis of complicated uterine malformation in case of acute abdominal pain. In our case, the patient was holding a unicornuate uterus and was admitted for abdominal pain. The etiological diagnosis was performed during laparotomy leading to hemi-hysterectomy. The unicornuate uterus with rudimentary horn results of a failure of the mullerian ducts. This malformation is discovered during examinations for infertility or after acute complication. The diagnosis is established by imaging [ultrasonography and magnetic resonance imaging] and laparoscopy. Although rare, these malformations should be evocated when patient present abdominal pain and justify the surgical excision of the rudimentary horn to prevent complications [endometriosis, sever dysmenorrhea, rupture of ectopic pregnancy in a rudimentary uterine horn]

[Management of chronic lymphocytic leukemia]

Lymphoide chronic leukemia [LLC] is characterized by a heterogeneous evolution introduced classficiations around thirty years ago by RAI and Binet, having based on clinical signs and biological parameters allowed of license to differentiate three groups of patients having distinct forecasts. These classifications allowed guiding therapeutic strategy. However, they do not allow predicting the evolution of illness precisely, particularly at the patients having a weak risk. Since a dozen years, the taking care of lymphoide chronic leukemia was transformed by progress accomplished in the understanding of the physiopathology of illness, the identification of new markers with value prognosticates and the advent of new therapeutic tools. The aim of this review is to report, the actualities in the management of lymphoid chronic leukemia

[Granular cell tumor of vulva]

Benign tumor whose histogenesis is uncertain, although most of the immunohistochemical and ultrastructural evidences support its neurogenic origin of Schwann cell derivation. It is mostly in the craniocervical region, vulvar involvement is quite rare. A 23 year old woman noted the presence of a 1 cm sized mass on her right labium majus which subsequently increased in size to approximately 3 cm. the mass was totally resected. Her postoperative follow-up was uneventful. Histologic examination of the tumor showed tumor cells with morphologic features consistent with a granular cell tumor. Although benign and slow growing, it has a tendency for recurrence, hence the need for complete surgical excision. Malignant forms, which account for 1-2%, are often fatal with primary and multicentric lesions or metastatic lesions vital organs. While the efficacy of radiotherapy and chemotherapy is unproven. It is a rare entity often benign but may cause, in certain forms, morbidity and mortality. Therefore, clinicians and pathologists should be aware of the clinical and histologic features of these tumors

Mycophenolate mofetil in the treatment of systemic discoid lupus erythematosus

The mycophenolate mofetile has been succesfully used for the treatement of several autoimmune skin diseases in a case of a 27 year old fenale patient, who was diagnosed as acute disseminater SLE in may 2002, according to the ARA document revised in 1987. Two years later, she had an intrauterine fetal death of 32 weeks, causing a severe, psychological impact. She complained of a generalised discoid lupus C face, thorax and both upper and lower limbs]. Due to the resistant oral and local hydroxychloroquine and local dapsone treatment, she had cortisonic diabetes, aseptic necrosis of the head of the femur, and macular toxicity caused by antimalarial therapy. The skin lesions was associated with proliferative segmental and focal lupus nephritis. Induction treatment with 29 per day of mycophenolate mofetil associated with corticaltherapy by prenidsone 1 mg/ kg/ id lead to the dissaperance of the skin lessions and porteinurea

Hypercalcemi in elderly patient

Hypercalcemia is not rare among elderly patients. Hyperparathyroidism and neoplasia are the most frequent causes of hypercalcemia in old patients. Symptoms due to hypercalcemia are usually non specific in old subjects, leading to consider easily this diagnosis and to measure plasma calcium level. Biological diagnosis of hypercalcemia is not always obvious in old patients because of frequently decreased plasma albumin levels leading to lower plasma total calcium level. Thus, it is always necessary to calculate plasma total calcium level corrected by albumin. The symptomatic treatment of hypercalcemia rests on the intravenous administration of isotonic saline and the use of the bisphosphonates which currently represent the therapeutic of choice. Specific treatment depends on the etiology. The short-term risk of hypercalcemia is acute hypercalcemia, which may be lifethreatening. The long-term risk of hypercalcemia is renal failure

Articular manifestations associated with HIV infection

During the infection by human immunodeficiency virus, there is dysfunction in the immune system because of the coexistence of immundeficiency and immune hyperactivity, and a disregulated production or activity of cytokines. Some of these mechanisms explain the development of articular manifestations associated with HIV infection Highly active anti retroviral therapy has changed the spectrum of the HIV-associated articular manifestations. New syndromes have emerged. A variety of disorders may be seen. Their prevalence is controversed. Several points remain obscures such as the existence of genetical predisposition for these manifestations, the role played by the anti retroviral therapy and utilisation of immunosuppressors like inhibitors of TNF alpha

[Peripheral neuropathies with monoclonal gammopathy of undetermined significance]

The association of peripheral neuropathy and the monoclonal gammopathy of undetermined significance CMGUSD has been frequently reported in 8 to 36% of cases. While the neuropathy associated with IgM-MGUS is well characterized and is often associated with a reactivity of the monoclonal protein with neural antigens, the relationship between the neuropathy and IgG and IgA MGUS is less clear. We report two cases of sensitive-motor chronic poly neuropathies associated with IgG MGUS in the first, and IgM MGUS in the second. Their clinical symptoms are foot numbness, paresthesias, imbalance, and gait ataxia, progress about months. Treatment associate plasma exchange, corticosteroids in combination with immunosuppressant. neuropathies with IgM MGUS tend to be most refractory than IgG MGUS

[Management of bone density abnormalities in inflammatory bowel diseases]

Osteoporosis is a common and life-threatening problem in patient with inflammatory bowel diseases. Its management is so very important and must be systematically investigated. The incomplete comprehension of pathogenesis and physiopathology of osteopenia in IBD is source of big difficulties in the treatment of this abnormality. Many advances had been realized last years in the management of osteopenia of IBD. This paper is a review of the physiopathology of low mineral density in patients with IBD and its implications on treatment

[ leptospirosis: clinical, biological and therapeutic study]

The Leptospirosis is an obligatory declared infectious disease, caused by a bacteria type spirochaete

Objectives: Analyse the clinical, biological and therapeutical characteristics of cases of leptospiral infection in the department of the internal medicine at CHU Ibn Sina, Rabat

Patients and Method: It was a retrospective study that begins in january 2000 still décember 2004.The inclusive criterions based on the epidemic circumstances orientated to the leptospirosis and the clinical and biological evokating arguments

Results: Seventeen cases were studied. Average age of the patients is 38 years old [28 years to 64 years] sex ratio of 7, 5 with predominance masculine. Contamination is related to of profession or exposure in a public bath in all the cases. The diagnostic period was 7-8 days. Clinically; icterus appears as a constant symptom, fever founded in 88% of the cases and hepatic cytolysis in 70% of the cases [transaminases are 2 times superior then the normal]. Renal insufficiency and thrombocytopenia are noted respectively in 58, 8% and 47% of the patients On the therapeutic plan; all patients benefited from parenteral rehydration. Thirteen patients benefited from a therapy based on Penicillin G; four patients were treated by Ampicillin parenteraly. One patient had presented with a mucocutaneous allergic reaction from Penicillin G at a 4 of the treatment so he had put on Cyclins. The average duration of hospitalization is 12, 5 days. Evolution was favourable in all patients

Conclusion: The diagnosis of leptospirosis must be evoked in all common cold [acute coryza] accompanied by hepatic cytolysis, renal insufficiency without thrombocytopenia. In the absence of serological proof, the clinical polymorphism of this disease makes the diagnosis sometimes difficult

[Periarteritis nodosa: experience of medecine interne]

Periartritis nodosa is a rare necrotic type of systemic vasculitis [angiitis] characterized by a multivisceral affection. Diagnosis is essentially histological. The prognosis has been improved, as a result of the therapeutic progress and the early management of this disease in the specialized centers. We report the experience of the internal medicine unit in the management of this disease depending on the new therapeutic strategies. It is a retrospective study carried out in the internal medicine unit of Ibn Sina hospital of Rabat through a period of 16 years between 1987 and 2003 responding to the clinico-biological criteria of the American College of Rheumatology [ACR] 1990- A series of twenty four cases 12 male and 12 female aged between 17 and 74 years with an age average of 45 years. Several parameters were evaluated: clinical manifistations, biological! [sedimentation rate-blood picture creatininemia], bacteriologically [B-C] serology], electromyographical and mainly neuromascular and or cutenous biopsy which assures the certitude of the diagnosis and also therapeutically [evaluation of the treatment]. Neuromuscular and or cutaneous biopsy showed lesions in favour of periarteritis nodosa in 12 patients, the other patients diagnosis was made according to the ACR criteria. As for the treatment, all patients were put under corticosteroid therapy, four severe form were treated by an association of cyclophosphamide and corticoides. Evolution was favourable in 15 patients, with recurrence in 3 cases, death of one case and 5 other patients were lost of sight. The prognosis of periartitis nodosa can be radically modified by the early diagnosis in the specialized centers

[Chronic diarrhea with difficult diagnosis during HIV infection]

Diarrhea is a frequent symptom related to HIV infection. It may impose diagnostical and therapeutical problems. We reported an observation of two HIV patients presenting with chronic diarrhea. It concerns two patients, a female aged 43 years and a male of 27 years old who had diarrhea related to HIV-AIDS infection. Parasitological stool analysis and colonoscopy examinations were necessary in the aetiological researches for both of them. The founded aetiology of the first case was a cryptosporidisis associated with cytomegalovirus colitis, while the second case diagnosed as an indetermined origin colitis. The evolution of diarrhea was favourable in the first case by a treatment composed of an association of antiretroviral and Ganciclovir therapy, while only a tritherapy was needed for the second patient. HIV - related chronic diarrhea imposes rigourous parasitological and endoscopical researches in order to get an effective therapy against the eventually opportunist infection

[Laryngeal amyloidosis]

Laryngeal amyloidosis is a rare cause of dysphonia. We report cases of 4 patients with laryngeal amyloidosis diagnosed in internal medicine department in Rabat. It is about 2 female and 2 male patients. The mean age is 53 years. Dysphonia and laryngeal dyspnea were the most frequent symptoms. Laryngeal endoscopy showed pseudotumoral lesion in all cases. The research of other localizations and of plasmocytic proliferation was negative. Two patients had chirurgical treatment and all patients had medical treatment. The outcome was good in the 4 cases. Laryngeal amyloidosis is a rare condition. The prognosis is better than in systemic amyloidosis. However, early diagnosis and appropriate management are essential for good evolution without complication