[Prevalence of axial manifestations among patients with inflammatory bowel disease: a prospective study about 50 cases]

Rheumatologic manifestations occurring during inflammatory bowel disease are the most frequent extra intestinal features. They are dominated by spondyloarthropathies, sacro-iliite and peripheral arthritis. To identify in a group of inflammatory bowel disease, the frequency of axial manifestations, to describe the clinical and the radiological features and to identify the risk factors of their occurrence and/or worseness We have established a transversal prospective study including 50 cases of inflammatory bowel disease seen in the department of the internal medicine in the interior forces security hospital during a period of 5 years between January 2001 and December 2006. The prevalence of axial involvement in the case of inflammatory bowel disease was 26%especially spondyloarhropathies which were diagnosed in 11 cases according to the criteria of European Spondyloarthropathy study Group [ESSG], 8 of them fulfilled the modified criteria of new york for the diagnosis of spondyloarhropathy. Isolated sacro-iliitis was found in 4%of cases. By univariate study, only the age under 35 years with a relative risk of 5, 8 and the colic involvement in chron's disease was significativelly associated with the presence of spondyloarthropathy. Systematic checking of spondyloarhtropathies in the course of inflammatory bowel disease through a clinical exam and systematic radiological should be recommended especially if we are in front of a man aged more than 35 years old with a crhon disease involving the colon. This screening offers an early management and avoid ankylosis

[Bone loss owing to inflammatory bowel disease: Prospective study about 50 cases]

To evaluate the prevalence of osteoporosis during inflammatory bowel disease [IBD] and to determine the risk factors. We conducted a prospective study that includes IBD patients. For all patients, bone mineral density was measured by dual-energy X-rays absorptiometry. Study has included 50 IBD patients; thirty had Crohn's disease and 20 had ulcerative colitis. The average age of our patients was of 36, 4 +9, 9 years. A low osseous mineral density was noted in 21 patients [45%] distributed in 13% of osteoporosis and 32% of osteopenia. Only the age superior to 35 years, the duration of evolution of the disease superior to 10 years and intestinal resection constituted a risk factors of osteoporosis. After adaptation on the age and the intestinal resection the duration of evolution superior to 10 years persisted as risk factor of osteoporosis. The other risk factors: sex, type of IBD, denutrition and corticoids were not incriminated in the low osseous mineral density during IBD. These results confirm the necessity of the systematic search of the osteoporosis during IBD with the aim of proposing an early and effective treatment

[Cardiac amylodosis]

Amyloidosis is a rare infiltrative disease characterized by multiple clinical features. Various organs are involved and the cardiovascular system is a common target of amyloidosis. Cardiac involvement may occur with or without clinical manifestations and is considered as a major prognostic factor. To analyze the clinical features of cardiac involvement, to review actual knowledgement concerning echocardiographic diagnostic and to evaluate recent advances in treatment of the disease. An electronic search of the relevant literature was carried out using Medline and Pubmed. Keys words used for the final search were amyloidosis, cardiopathy and echocardiography. We considered for analysis reviews, studies and articles between 1990 and 2007. Amyloidosis represents 5 to 10% of non ischemic cardiomyopathies. Cardiac involvement is the first cause of restrictive cardiomyopathy which must be evoked. In front of every unexplained cardiopathy after the age of forty. The amyloid nature of cardiopathy is suggested if some manifestations were associated as a peripheral neuropathy, a carpal tunnel sydrome and proteinuria > 3g/day. Echocardiography shows dilated atria, a granular sparkling appearance of myocardium, diastolic dysfunction and thickened left ventricle contrasting with a low electric voltage. The proof of amyloidosis is brought by an extra-cardiac biopsy, the indications of endomyocardial biopsy are very limited. The identification of the amyloid nature of cardiopathy has a direct therapeutic implication: it indicates the use of digitalis, calcium channel blockers and beta-blockers. Today the treatment of amyloidosis remains very unsatisfactory especially in the cardiac involvement. An early diagnosis before the cardiac damage may facilitate therapy and improve prognosis

[Ocular findings in megaloblastic anemia associated with diabetes. A case report]

Ocular involvements of Biermer's anaemia are rarely reported in literature. We present a case of Biermer's anaemia associated with diabetes. Ocular examination showed important conjinctival paleness, diffuse retinal ischemia, Roth's tasks, macular oedema and ischemic optic neuropathy. The patient was treated with vitamin B12 intramusculary. A month later, on examination, we noted a regression of optic neuropathy, the aggravation of ischemic retinopathy and persistence of macular oedema. The patient was treated with laser photocoagubation. The majority of ocular manifestations are reversible if treatment is undertaken early. The combination of diabetes with Biermer's anemia deteriorates the ischemic retinopathy and aggavates its prognosis

Heparinotherapie et grossesse

The use of anticoagulants in pregnancy problematic. In this focus, the authors reviewed the problems associated with the use of vitamine k antagonist during pregnancy. Then, they presented the general considerations on the use of unfractioned heparin and low molecular weight heparin during pregnancy. Finally they established the therapeutic recommendations for anticoagulation during pregnancy including treatment and prophylaxis of venous thromboembolism, anticoagulation of pregnant women with mechanical heart valves and the management of pregnant women with antiphospholipid antibodies and multiple pregnancy losses