[Cutaneous dirofilariasis: two Tunisian cases report]

Cutaneous dirofilariasis is a zoonosis which mainly occurs in dogs and cats. Human dirofilariasis is rare. At our knowledge, only five cases of human dirofilariasis were reported in Tunisia. We report here two new cases of cutaneous dirofilariasis arising in two 19 and 21 year-old patients. The first one was admitted for surgical excision of a paraombilical cutaneous nodule. The second patient presented with multiple erythematous and pruriginous papules. In both cases, the histological examination revealed the presence of a worm diagnosed as Dirofilaria repens. The evolution was favourable after surgical resection in the first case and spontaneously in the second case

[Auto-immune hepatitis of type 2 of the child. evolution quickly favorable of un usually serious affection]

Introduction: Auto-immune hepatitis of type 2 of the child associated with the presence with endoplasmic Antibody anti-reticulum were recognized there is more than 15 years. It is characterized by the presence of antibodies anti LKM1 associated in 30 per cent of the cases with antibodies anti LC1 with on the clinical level by an early beginning, according to an acute mode with an intense inflammatory activity with a high frequency of fulminant hepatitises and a fast evolution towards the cirrhosis

Observation: Malek aged of 8 years old was hospitalized for icteris with deterioration of the general state evolving 07 months before its admission. The examination found a patient eutrophic with cutaneo-mucus icteris moderate and a hepatic arrow to 13 cm; the examination in addition is normal. The biological assessment showed a hepatic cytolysis with ASAT/ALAT = 265/335; a marked cholestase [PAL = 3200 UI/I, sigma GT to 980 Ul/land a hyperbilirubinemy with 64,6 pmo1/1], an inflammatory syndrome and a hypergammaglobulinemy with 33,3 g/I. The TP was to 50 per cent, serologies of hepatitises A, B and C were negative, the cupremy = 15 mmol/I and the ceruloplasmine with 0,18 ng/mmol. The immunological assessment showed the presence of antibodies anti LKM1 and the antibodies anti LC1 which were positive to 1/640. Abdominal echography showed a liver of cirrhosis without signs of portal hypertension. The treatment rested on the association of prednisolone 40 mg/day and azathioprine 1,5 mg/kg/ day. The evolution was favorable with a clinical and biological remission with a 3 years passing

Conclusion: The Auto-immune hepatitis of type 2 is a severe affection which occurs readily in the child of more than 8 years. The intense inflammatory activity and the fast evolution towards the cirrhosis characterize this disease Our observation which corresponds to the first Tunisian pediatric case had the characteristic of a very insidious installation of the disease and of an evolution quickly favorable under treatment

Evaluation of microalbuminuria in diabetics with and without retinopathy

Micro albuminuria predicts not only nephropathy but also retinopathy in diabetic. In 50 diabetics, urinary albumine excretion rate [A.E.R]. was 12.44 +/- 11.39 micro g/mn. v.s 4.99 +/- 2.13 micro g/mn in control. In diabetics with retinopathy AER was 20.09 +/- 10.34 micro g/mn v.s. 10.02 +/- 10.75 micro g/mn in those without. So, an increased microlbuminuria in a diabetic must incite to a more vigorous control of ocular complications