[Percutaneous vertebroplasty for pain relief in patients with osteoporotic spine fractures]

Percutaneous vertebroplasty [PVP] is an interventional radiology technique where pathological vertebral bodies are filled with acrylic cement. This method is used to strengthen the vertebral body and reduce pain in certain diseases involving the vertebrae such as osteoporosis. To evaluate PVP in symptomatic osteoporotic vertebral fractures after failure of conservative management. Between November 2008 to December 2009, PVP was performed for osteoporotic vertebral fractures in 12 consecutive patients in a single institution. Medium term [3 days and 15 days post PVP] and long term follow up [1 month and 3 months post PVP] consisted in the evaluation of residual or secondary pain using Huskisson's visual analogue scale. A total of 20 vertebrae were treated. Mean follow up was 80 days [30-90 days]. Significant symptomatic improvement [p=0.002] was noted with pre PVP pain score of 7.4 [ +/- 1.6], 3 days post PVP score of 4.1 [ +/- 2.1], 15 days post PVP score of 1.8 [ +/- 1.1], 1 month post PVP score of 1.22 [ +/- 1.06] and 3 months post PVP score of 1.4 [ +/- 1.14]. PVP appears to be an effective technique in the treatment of symptomatic osteoporotic vertebral fractures with approximately 94% of satisfactory results in the short and medium term period

Primary hyperoxaluria type 1 in Tunisian children

Primary hyperoxaliuria type 1 is an autosomal-recessive disorder characterized by increasing urinary excretion of calcium oxalate, recurrent urolithiasis, nephrocalcinosis, and accumulation of insoluble oxalate throughout the body. This inborn error of metabolism appears to be a common cause of end stage renal disease in Tunisia. To review the clinical, biological and radiological futures of primary hyperoxaluria type 1 and to correlate these aspects with the development of end-stage renal disease. we retrospectively reviewed 44 children with Primary hyperoxaliuria type I who were treated in our department during a period of 15 years between 1995 and 2009. The diagnosis was established by quantitative urinary oxalate excretion. In patient with renal impairment, the diagnosis was made by infrared spectroscopy of stone or by renal biopsy. Male to female ratio was 1.2. The median age at diagnosis was 5.75 years. About 43% of those were diagnosed before the age of 5 years. Initial symptoms were dominated by uraemia. Four patients were asymptomatic and diagnosed by sibling screening of known patients. Nephrocalcinosis was present in all patients. It is cortical in 34%, medullary in 32% and global in 34%. At diagnosis, twelve children were in end-stage renal disease [27%]. Pyridoxine response, which is defined by a reduction in urine oxalate excretion of 60% or more, was found in 27%. In the majority of patients, the clinical expression of Primary hyperoxaliuria type 1 is characterized by nephrocalcinosis, urolithiasis and renal failure. Pyridoxine sensitivity is associated with better outcome

Vascular complications after pediatric kidney transplantation

Vascular complications, especially those including the renal vein, remain a major cause of lost graft. To evaluate retrospectively the incidence and management of vascular complications after pediatric renal transplantation and to assess possible risk factors and their effects on patient and graft. A total of 82 consecutive renal transplants were performed in 79 patients at a single institution. The diagnosis of vascular complications was suspected in the presence of suggestive symptoms and confirmed by Doppler ultrasound and if necessary by a computed tomographic angiography. Urgent exploration was performed in all suspected cases. There were seven vascular complications [8,5%], including renal vein thrombosis in four patients, renal artery stenosis in one, and sural thrombophlebitis in two. The thrombosis of the graft vein which is the main complication occurred at mean 24 hours after renal transplantation. All these patients needed transplant nephrectomy after thrombosis event. In the remaining cases, the outcome was favorable even for the patient with transplant renal artery stenosis. Vascular complications are common and serious events affecting patient and graft survivals. A perfect surgical technique and rigorous radiological monitoring may result in decreased incidence and severity of these complications

[Perigenital hematoma: diagnosis and management]

Discuss the clinical aspects and the management of pcrigenital hematoina, a rare complication of delivery that can engage the vital prognosis. We report 4 cases of pen-genital hematomax recorded in the department C of obstetrics and gynecology, in the maternity center of Tunis. In two cases, the patients had only medical treatment and in the two others arterial embolisation was performed. The diagnosis is evoked in front of an unexplained hemorrhagic choc with perineal pain. Upon diagnosis, the patient must be rapidly managed associating resuscitation, surgcry and angiographic embotisation

[Experience of a multidisciplinary comittee in the management of superficial venous malformations: 99 cases]

Vascular malformations are heterogenous angiodysplasias. The aim of this work is to study the epidemiological and clinical features of venous malformations [VM] as well as their multidisciplinary management. It is a retrospective study of patients having simple VM, seen at the multidisciplinary consultation of angiodysplasias of our hospital, over a 10 year period. This study included 99 patients having VM. A female predominance was noticed. Average age was 18.5 years. VM had mainly cephalic location. All VM were treated with percutaneous sclerotherapy. Aesthetic results were excellent in the cases of small VM size. VM are most frequent in cephalic region and cause aesthetic and functional handicaps. Percutaneous sclerotherapy is the treatment of choice for such a venous malformations, especially for small VM. VM are anomalies which can have serious complications. Their management has to be multidisciplinary in order to better precise the diagnosis and to take the adequate therapeutic decision

[Chronic dissiminated intravascular coagulation caused by aortic dissection]

Disseminated intravascular coagulation [DIC] is a severe disease. It's can be caused by lost of pathology. We report the case of chronic aortic dissection discovered during the evaluation of disseminated intravascular coagulation [DIC]. This case is characterised by the severity of clinical presentation, challenging diagnosis and difficulty of therapeutic approach. Low dose of heparine may reduce the severity of this situation; but vital prognosis remains obscure. Aortic dissection is a rare but a severe cause of disseminated intravascular coagulation

[Isolated bilateral pulmonary occlusion]

Takayasu's arteritis [TA] is an unusual cause of bilateral and isolated pulmonary artery occlusion that may be difficult to distinguish from other aetiologies. Report a new case of isolated bilateral pulmonary occlusion. A 19 year-old girl presented to the hospital with a 2-year history of dyspnoea and recurrent hemoptysis. She was in respiratory distress on physical examination Clinical investigations revealed a total occlusion of the right pulmonary artery on perfusion lung scan. Pulmonary angiogrphy confirmed these data and revealed further more a partially occluded left lower lobe artery. Diagnosis of Takayasu's arteritis was suspected and a complete aortogram was made but proved to be normal. Corticosteroid therapy was prescribed but interrupted within 2 months for absence of clinical improvement. Patient's assessment revealed worsening of the clinical condition and she became oxygendependant. Early diagnosis of isolated involvement of pulmonary arteries in TA while systemic arteries are normal may prove to be difficult. In spite of insufficient data to confirm TA, the latter seems to be the most probable diagnosis in our patient regarding clinical [young age] and angio graphic arguments

[Arteriovenous malformations: study about 54 patients]

Background: Arteriovenous malformation [AVM] are vascular anomalies that may threaten functional and vital prognosis

The aim of this study was to assess the management of Arteriovenous malformation

Methods: it is retrospective study about 54 patients, having AVM, collected over a 7-year period

Results: Sex ratio M/F was 1.25; average age at the diagnosis was 25.4 years. Puberty, pregnancy and trauma, were the most important favoring factors for the development of AVM. Location was the head in 75% of the cases. Doppler ultrasound was the most indicated examination to confirm the diagnosis

In over than 70% of our patients, therapeutic abstention and follow-up were indicated. In the other cases, embolixation, with or without surgery was the treatment. A patient died of massive haemorrhage

Treatment is necessary in complicated AVM. Follow-up [if abstention or after treatment] is mainly based on clinical and Doppler data

Conclusions: AVM are anomalies that may be serious and their management must be multidisciplinary to allow better therapeutic indications

Post traumatic rupture in patients with uretero pelvic Junction obstruction: a Case Report

Authors report a case of post traumatic pelvic rupture occurring in an unknown ureteropelvic junction [UPJ] obstruction. Ultrasonography showed pyelectasia and fluid effusion in the anterior perirenal space. CT scan confirmed the diagnosis of UPJ obstruction and showed the rupture of the anterior pelvic wall communicating with a perirenal urinoma. The patient underwent a retrograde stenting for decompression and surgical drainage of the urinoma. Pyeloplasty was performed 4 months after injury. A follow up intravenous pyelogram showed good flow through the repair and the patient remaines asymptomatic 2 years after treatment Post traumatic rupture of UPJ obstruction is a rare event with few reported cases in literature Diagnosis is suggested on imaging studies. CT scan shows the rupture site in the ureteropelvic tract and guides percutaneous drainage

[Embolization of head and neck hypervascular lesions. a retrospective study of 5 cases]

Embolisation of head and neck hypervascular tumours and arterioveinous malformations [AVMs] is now a well-established therapeutic procedure. The purpose of this study was to analyse the technique and to evaluate the safety and value of preoperative embolization of hypervascular lesions. We retrospectively reviewed the records of 5 patients, aged between 14 and 47 years, with hypervascular tumours and AVMs in the head and neck. Lesions were distributed as follow: nasal angiofibroma [n=1], nasal angioleiomyoma [n=1], nasopharyngeal angiofibroma [n=1], aneurysmal bone cyst in the posterior element of the second cervical vertebra [n=1] and AVM of the inferior lip [n=1]. Angiography and embolization were carried out at the same time. Complete exclusion of lesions was obtained without any complications. Complementary surgical resection was performed with not notable blood loss

Hematome entramural du grele d– aux anticoagulants: une etude radiologique a propos de deux observations

We report two cases of spontaneous small bowel hematoma in two patients receiving long-term anticoagulant therapy. Plain abdominal film, ultrasound, CT scan and oral barium examination were performed. Abdominal ultrasonography and CT scan are in most cases relevant for the correct diagnosis of intra-mural small bowel hematoma. The diagnosis was based on the acknowledgment by the patient of anticoagulant drug consumption. Early diagnosis is crucial because most patients are treated nonoperatively with good outcome

[Emergency embolisation in gynaecological bleeding. two case reports]

Two patients with gynaecological hemorrhage underwent successfully trans-arterial embolization. The first woman had an uncontrollable perineal hemorrhage following a delivery with forceps. Angiography showed extravasation of contrast from right and left vaginal artery. Hyperselective embolisation stopped the vaginal bleeding. The second woman had massive hemorrhage following radiotherapy for cervical cancer. Angiography demonstrated extravasation of contrast from both uterine arteries. The bleeding was controlled after hyperselective embolisation. Emergency arterial embolisation is a safe and effective means of control of irrepressible genital hemorrhage