RESUMEN
Background: Digital necrosis is a frequent event in vascular pathology. They are multiple etiologies and are the translation of a general or locoregional pathology. The aim of our study was to clarify the various causes of digital necrosis in an internal medicine department
Methods: We conducted a retrospective study of 23 cases of digital necrosis collected in the internal medicine department of the hospital Habib Thameur over a period from January 1998 to April 2011
Results: There were 16 women and 7 men with mean age of 46 years. The cardiovascular risk factors were observed in 39.13% cases. Digital necroses were interested fingers in 73.91% and toes in 30.43% of the cases. The causes were dominated by the connective diseases. The treatment was symptomatic in all cases and etiologic in only two cases
Conclusion: In internal medicine, the causes are dominated by connectivites. The prognosis is especially functional. It remains unfavorable in spite of the improvement of the therapeutic and etiologic care
RESUMEN
Hemophagocytic syndromes are mostly associated with underlying pathology, they can reveal: immunodeficiency, infections, hemopathies, cancers and auto-immune diseases. To investigate clinical, biological features, outcome characteristics and underlying pathology of Tunisian patients with hemophagocytic syndromes. A retrospective study of patients with hemophagocytic syndromes admitted in an internal medicine department in Tunis over the period 2009-2012. There were 11 patients included, 4 men and and 7 women. Mean age was 47,3years. Purpura was observed in 3 cases, hepatosplenomegaly in 6 cases and peripheral lymph nodes in 3 cases. Hemorrhagic complication was noted in 2 cases. There were an increase of inflammatory indices in all the cases. Eight patients had pancytopenia and 3 had bicytopenia. Six patients developed intravascular dissiminated coagulation. High levels of triglyceridemia was noted in 5 cases and an hyperferritinaemia in all cases. Cytological examination of bone marrow confirmed hemophagocytosis in ten cases. Hemophagocytosis was associated to infectious diseases in 6 cases, there were 2 cases of leishmaniasis, septicemia to E.Coli and staphylococcus aureus and lymph nodes tuberculosis with HIV. We also noted a case of lymphoma, myelodysplasic syndrome, rheumatoid polyarthritis, adult onset still's disease. In one patient, the origin of hemophagocytosis remained indefinite. Visceral leishmaniose were treated by Glucantime[registered sign], adult Still's disease by corticosteroids and méthrotrexate[registered sign], lymphoma by chemotherapy. In lymph nodes tuberculosis, there were good evolution. Six patients died. Hemophagocytic syndrome is a rare and life-threatening disease. Pejorative prognosis requires an early therapy with etiological treatment