[Community bacterial meningitis of the adult. study of 70 cases]

Through a retrospective study of 70 cases of acute bacterial meningitidis which have occurred in adults admitted in a Tunisian military hospital, we propose to analyze the characteristics of these infections and to release from them the factors of bad forecast. Fifty seven men [including 26 young military recruits old of less than 25 years] and 13 women old on average 40 years are hospitalized during the period of study [1989-2005]. The average time of hospitalization is of two days. Fever and the meningeal syndrome are not constant [95.7% and 61.4% of the cases]. With the admission, half of the patients have disorders of the conscience. Six patients are allowed in a table of meningococcemia. The average value of the white cells in cerebrospinal fluid [CSF] is of 4900 cells/mm3. A raised prote‹norachie and a hypoglycorachie are found respectively only in 84.3% and 91.4% of the cases. The direct examination of the CSF and the research of the soluble antigens are positive only in 27.1% and 25.8% of the cases respectively. A germ is isolated in the CSF in 51.4% from the cases or blood in 14% from the cases. Neisseria meningitidis [23 cases], Streptococcus pneumoniae [13 cases] are the most frequent germs. The serotype B of N. meningitidis is most frequent [8 cases]. The serotype W135 is isolated in 3 cases. The sensitivity to principal antibiotics of the isolated germs is constant. The average period of antibiotherapy is 15.6 days. A corticotherapy is prescribed among 6 patients. Fourty nine patients [70%] presented at least a complication. The evolution is favorable among 42 patients [60%]. Nineteen patients [27.1%] kept after-effects. Nine patients [12.9%] died. The advanced age [. 60 years], pneumococcic etiology, the presence of a state of shock, the recourse to artificial ventilation, a positive blood culture, an initial leucocytorachie < 100 cells/mm3, an initial glycorachie < 20% of the glycemia, one duration of hyperthermia of more than 3 days under treatment and the hospitalization in an intensive care unit are factors bad forecast among our patients. In spite of the progress made in their assumptions of responsibility, acute bacterial meningitidis remain a major cause of morbi-mortality. In military medium N meningitidis is the most frequent germ and most serious. Introduction of antimeningococcal vaccine is necessary and effective in these communities

Les synovites et les tenosynovittes villonodulaires pigmentaires: a propos de 3 observations

Individualized by Jaffe in 1941, pigmented villonodular synovitis [P.V.N.S.] represent a rare lesion. The incidence is 1 to 3 case by year for all the statistics. The 2 sexes seem equally reached. The knee constitute the preferential site of these lesions [50 to 67% of cases] with frequency peak between 20 and 25 years. The hip is reached in 10% of cases with a peak between 40 and 50 years. P.V.N.S. are exceptional in children. They appear clinically by a painful chronic monoarthritis long time tolerated and radiologycally by associated bone lesions. It is the histologic examination which make the diagnosis of P.V.N.S. The etiopathogenic minds remain divided between traumatic theory and tumoral theory. Synovectomy permits a rate of recovery of 45% in the best cases [localized forms]. Synoviorthesis is of recent advent and haven't sufficient experience. P.V.N.S. remain threatened by recidive in 10 to 50% of the cases