[Profile of graves disease in the region of kairouan: about 186 cases]

In this retrospective study we tried to determine the epidemiologic, clinical, therapeutic and evolutive features in 186 patients with Graves disease [GD] followed at the ibn el Jazzar hospital in Kairouan during 15 years. GD represents the most frequent cause of hyperthyroidism [67%], mainly in young adults [mean age: 35.8 +/- 12.3 years] with a clear female prevalence [83.9%]. The diagnosis is suggested clinically in presence of a homogeneous [80.6%] and vascular [61.2%] goitre associated or not with an exophtalmy [52.2%]. The most frequent clinical signs of hyperthyroidism are weight loss [81.2%], tachycardia [86%], asthenia [74.4%] and tremor [55.9%]. R-TSH antibodies testing was performed in 35 patients with a rate of positivity of 91,4%. Thyroid scintiscanning was practised in 77,5% of the cases and echography in 23,4%. Antithyroid drug therapy was the only management in 51,5% of the cases with a rate of euthyroidism of 67% [mean follow up of 58,2 months]. Radioactive iodine was given in the event of failure of the Antithyroid drug therapy in 35,8% of the cases with 38.7% of hypothyroidism [mean follow up of 54,6 months]. The surgical treatment was a subtotal thyroidectomy in 89,5% of the cases with euthyroidism in 22.2% of the cases and hypothyroidism in 77.8% [mean follow up of 53.4 months]; hypoparathyroidism represented the major complication of the surgery [transient: 15.9% and definitive: 5.3%]

Tetralogie de Fallot chez l'adulte: a propos de 18 cas

18 cases of patients aged more than 15 years affected with non coected tetralgie of Fallot are reported. The average age is 20 years with au extreme of 15 and 37 years, 10 patients are females and 8 are males. All patients present a cyanosie in calm time 4 have signs of night heart insuficiency, 5 present syncorpss and 4 present hemoptysie. A right arricular hypertophy in 8 cases, and 3 intra-ventricular conduction are notreced during electrocardiogram. In heart catheterism the regleet auriculum premoir is of 6 mmHg, the ventricular telediaastolic pression is 11 mmHg. 3 patients hrad a palliative intervention. we notrced only one death. The immediate consequences are marpred by intra ventricular condiction in 11 cases, 2 regressive BAV and 5 heart insufficiency. 15 patients were controlled after 6 years, 14 have a normal life. These goods remits propose to surge all adults hairing tetralogie of Fallot but a complet reparaation in the early enfance

Evolution a long terme de l'insuffisance aortique operee [a propos de 80 cas]

This study present 80 cases of operated aortic insufficiency. The rhumatismal etiology was the important [62.75%] middle age was 31 +/- 16.5 years. For 74 patients, we practice a substitute aortic valvular by a mechanical prothesis and for 6 cases by a bio-prothesis. The early death was in 7.5%. the later death was in 11.3%. the study of the preoperatory prognosis factors had shown the role of the age in the cardiac insufficency in the dilatation of the left ventricular and its dysfunction aprreciated echocardiography

Evaluation par doppler des protheses de saint jude aortiques [gradient de pression et surface fonctionnelle]

The authors present the hemo dynamic performance of 31 prothesis aortic of saint- JUde by echo- doppler examination realised 48 months after this prothesis implantation. It was 6 prothesis N° 19, 12 prothesis N° 21 6 prothesis N° 6 and 7 prothesis N°25. Independenly of the size of the aortic Saint- Jude the maximal quickness trans prothetic is 2.59 +/- 0.35 m/s the maximal gradient is 26.95 +/- 2.3 mm hg. The transprothetic functional surface is 1.3 +/- 0.21 cm[2] and the indicative of permeability is 0.386 +/- 0.09. it was not a significative difference between the prothesis of small diameter and big diameter for the maximal quickness and the maximal gradient, the mitral surface is 1.2 +/- 0.2 cm[2] for the Saint- Jude n° = 19 and 1.53 +/- 0.3 cm[2] for the Saint jude n°25