[News flow about A, H1N1 influenza]

2009 H1N1 is a new influenza virus causing illness in people. The first cases detected were in Mexico and in the United States in April 2009. This virus is a variant of influenza virus A, coming from triple human restocking, aviaire and porcine. The first cases were discerned in Mexico and in USA joined in April, 2009. In the date of February 17th 2010, 17208 cases of influenza A, H1N1 was confirmed in Africa and including 167 deceases. The virus has an interhuman transmission across the world, probably according to the same mode of transmission as the seasonal virus influenza. The state of pandemic was signaled by the worldwide organization of health on June 11th, 2009 and is spreading from person-to-person worldwide, probably in much the same way that regular seasonal influenza viruses spread. On June 11, 2009, the World Health Organization signaled that a pandemic of 2009 H1N1 flu was underway. H1N1 a virus affect particularly young patient [20-40] at the difference to the seasonal influenza virus. The principal risk factors to the development of serious complications were: the young age, pregnancy and the presence of a chronic medical illness. The main clinical demonstrations of this virus are: fever, evil of throat, tiredness, aches and/or digestive disturbances with type of diarrheas and sometimes vomiting. The treatment consists of the seriousness of this influenza and the necessity of installation of appropriate prophylactic measurements [individual hygiene, vaccination and precautionary antiviral treatment in case of exhibition] to restrict the transmission of this infection and reduce total mortality. The aim of this study is to put a full stop on the clinical aspects, therapeutic measurements and the efficient means of prevention against this influenza

[Management of chronic lymphocytic leukemia]

Lymphoide chronic leukemia [LLC] is characterized by a heterogeneous evolution introduced classficiations around thirty years ago by RAI and Binet, having based on clinical signs and biological parameters allowed of license to differentiate three groups of patients having distinct forecasts. These classifications allowed guiding therapeutic strategy. However, they do not allow predicting the evolution of illness precisely, particularly at the patients having a weak risk. Since a dozen years, the taking care of lymphoide chronic leukemia was transformed by progress accomplished in the understanding of the physiopathology of illness, the identification of new markers with value prognosticates and the advent of new therapeutic tools. The aim of this review is to report, the actualities in the management of lymphoid chronic leukemia

[Reactive macrophage syndrome]

It is also known as hemophagocyticc syndrome, defined as pathology group characterized in common by the proliferation and the accumulation of macrophages in the bone marrow and the lymphoid system, leading to an abnormal phagocytosis of the blood cells and the production of proinflammatory cytokines. It has a non specific clinical picture as well as a perturbed laboratory findings. We differentiate the hereditary primary forms and the secondary related to several etiologies. Its pathophysiology is not yet clear the treatment remains poorly codified. It is a serious like-threatening disease but recent advances in the comprehension of its physiopathologic mechanisms will allow for a better adapted treatment and improve the survival rate of these patients

Hypercalcemi in elderly patient

Hypercalcemia is not rare among elderly patients. Hyperparathyroidism and neoplasia are the most frequent causes of hypercalcemia in old patients. Symptoms due to hypercalcemia are usually non specific in old subjects, leading to consider easily this diagnosis and to measure plasma calcium level. Biological diagnosis of hypercalcemia is not always obvious in old patients because of frequently decreased plasma albumin levels leading to lower plasma total calcium level. Thus, it is always necessary to calculate plasma total calcium level corrected by albumin. The symptomatic treatment of hypercalcemia rests on the intravenous administration of isotonic saline and the use of the bisphosphonates which currently represent the therapeutic of choice. Specific treatment depends on the etiology. The short-term risk of hypercalcemia is acute hypercalcemia, which may be lifethreatening. The long-term risk of hypercalcemia is renal failure

Articular manifestations associated with HIV infection

During the infection by human immunodeficiency virus, there is dysfunction in the immune system because of the coexistence of immundeficiency and immune hyperactivity, and a disregulated production or activity of cytokines. Some of these mechanisms explain the development of articular manifestations associated with HIV infection Highly active anti retroviral therapy has changed the spectrum of the HIV-associated articular manifestations. New syndromes have emerged. A variety of disorders may be seen. Their prevalence is controversed. Several points remain obscures such as the existence of genetical predisposition for these manifestations, the role played by the anti retroviral therapy and utilisation of immunosuppressors like inhibitors of TNF alpha

[Peripheral neuropathies with monoclonal gammopathy of undetermined significance]

The association of peripheral neuropathy and the monoclonal gammopathy of undetermined significance CMGUSD has been frequently reported in 8 to 36% of cases. While the neuropathy associated with IgM-MGUS is well characterized and is often associated with a reactivity of the monoclonal protein with neural antigens, the relationship between the neuropathy and IgG and IgA MGUS is less clear. We report two cases of sensitive-motor chronic poly neuropathies associated with IgG MGUS in the first, and IgM MGUS in the second. Their clinical symptoms are foot numbness, paresthesias, imbalance, and gait ataxia, progress about months. Treatment associate plasma exchange, corticosteroids in combination with immunosuppressant. neuropathies with IgM MGUS tend to be most refractory than IgG MGUS

[Management of bone density abnormalities in inflammatory bowel diseases]

Osteoporosis is a common and life-threatening problem in patient with inflammatory bowel diseases. Its management is so very important and must be systematically investigated. The incomplete comprehension of pathogenesis and physiopathology of osteopenia in IBD is source of big difficulties in the treatment of this abnormality. Many advances had been realized last years in the management of osteopenia of IBD. This paper is a review of the physiopathology of low mineral density in patients with IBD and its implications on treatment

[Periarteritis nodosa: experience of medecine interne]

Periartritis nodosa is a rare necrotic type of systemic vasculitis [angiitis] characterized by a multivisceral affection. Diagnosis is essentially histological. The prognosis has been improved, as a result of the therapeutic progress and the early management of this disease in the specialized centers. We report the experience of the internal medicine unit in the management of this disease depending on the new therapeutic strategies. It is a retrospective study carried out in the internal medicine unit of Ibn Sina hospital of Rabat through a period of 16 years between 1987 and 2003 responding to the clinico-biological criteria of the American College of Rheumatology [ACR] 1990- A series of twenty four cases 12 male and 12 female aged between 17 and 74 years with an age average of 45 years. Several parameters were evaluated: clinical manifistations, biological! [sedimentation rate-blood picture creatininemia], bacteriologically [B-C] serology], electromyographical and mainly neuromascular and or cutenous biopsy which assures the certitude of the diagnosis and also therapeutically [evaluation of the treatment]. Neuromuscular and or cutaneous biopsy showed lesions in favour of periarteritis nodosa in 12 patients, the other patients diagnosis was made according to the ACR criteria. As for the treatment, all patients were put under corticosteroid therapy, four severe form were treated by an association of cyclophosphamide and corticoides. Evolution was favourable in 15 patients, with recurrence in 3 cases, death of one case and 5 other patients were lost of sight. The prognosis of periartitis nodosa can be radically modified by the early diagnosis in the specialized centers

[Chronic diarrhea with difficult diagnosis during HIV infection]

Diarrhea is a frequent symptom related to HIV infection. It may impose diagnostical and therapeutical problems. We reported an observation of two HIV patients presenting with chronic diarrhea. It concerns two patients, a female aged 43 years and a male of 27 years old who had diarrhea related to HIV-AIDS infection. Parasitological stool analysis and colonoscopy examinations were necessary in the aetiological researches for both of them. The founded aetiology of the first case was a cryptosporidisis associated with cytomegalovirus colitis, while the second case diagnosed as an indetermined origin colitis. The evolution of diarrhea was favourable in the first case by a treatment composed of an association of antiretroviral and Ganciclovir therapy, while only a tritherapy was needed for the second patient. HIV - related chronic diarrhea imposes rigourous parasitological and endoscopical researches in order to get an effective therapy against the eventually opportunist infection

[Laryngeal amyloidosis]

Laryngeal amyloidosis is a rare cause of dysphonia. We report cases of 4 patients with laryngeal amyloidosis diagnosed in internal medicine department in Rabat. It is about 2 female and 2 male patients. The mean age is 53 years. Dysphonia and laryngeal dyspnea were the most frequent symptoms. Laryngeal endoscopy showed pseudotumoral lesion in all cases. The research of other localizations and of plasmocytic proliferation was negative. Two patients had chirurgical treatment and all patients had medical treatment. The outcome was good in the 4 cases. Laryngeal amyloidosis is a rare condition. The prognosis is better than in systemic amyloidosis. However, early diagnosis and appropriate management are essential for good evolution without complication

Urticarial vasculitis revealing a lupus like syndrome

We report the case of a 38 years old woman with urticarial cutaneous lesions associated with multiple systemic involvemernt including arthralgias, myalgias, muscular weakness, persistant hypocomplementemia is noted. A biopsy of the urticaria demonstrated a leucocytoclasic vasculitis, the immunofluorescence study of the skin biopsy showed IgM, C3 and C1q deposits in the dermo epidermal junction and along the capillary wall. Antinuclear antibodies, anti DNA are present. The syndrome recognized in this patient and those few observations reported previously constitue a lupus like syndrome

Rectal prolapse

Twenty-five interventions for rectal prolapse have been done for 23 patients during 20 years, 12 direct rectopexies, 9 Orr-Loygue procedures, 2 resections, Delorme's procedure for 1 patient and one cystectomy. We observed 4 recurrences i.e. 17,3%. Abdominal rectopexy seems to be the best treatment for rectal prolapse

Behcet's Disease

Behcet's disease is a predominantly venous vasculitis. It was first described as a clinical triad associating oral aphthae, genital aphthae and anterior uveitis. It concerns mainly young subjects of male gender originating from the Far-East and the Mediterranean basin. Its pathogenesis is not well known. It comprises neutrophil hyperreactivity owing to genetic predisposition, abnormalities in gd T cell function and microbial agents that could act as triggering factors. The most frequent clinical manifestations are cutaneo-mucous, ocular, vascular, neurological and articular. There is no specific biological abnormality and diagnosis is actually still purely based on clinical evidence. Treatment is not codified and only suspensive. It is based on colchicine, anti-inflammatory drugs and different immuno-supressives. In this work, we present a review on this subject according to some recent bibliographic data

macrophage hyperactivation syndrome with hemophagocytosis

The hemophagocytic syndrome is a benign systemic histiocytic proliferation which may be caused by several etiologies: infections, autoimmune diseases, hemopathy; << solid >> cancers, immunity deficits. The inadequatee activation of the loop << macrophage - lymphocyte >> with hypercytokinemia explain in the large proportion the physiopathological, clinical and biological features. This syndrome includes: fever, organomegaly, cytopenia, hypertriglyceridemia, hyperferritinemia and clotting disorders. The diagnosis is based on clinical, biological and especially histopathological criteria: with tissue and/or medullary histiocytic infiltration. We report two cases of hemophagocytic syndrome in which the etiology had remained undetermined and the evolution had been fatal

maladie de fabry

Three cases of Fabry's disease are reported in the same family. Two patients have angiokeratoma and all cases have pains of extremities. The diagnosis in our patients has been confirmed by a high level of urinary T.H.C. and by histology whose showed a lipid deposits in all glomeruls

Donnees de la vitesse de sedimentation en medecine interne

The authors report the result of sedimentation rates in 1000 in patients. - 14,1% have S.R. more than 100 mm: 4,1% suffer of a kidney disease, 3,3% have infectiouses diseases, 4,7% blood diseases, and 8.4% visceral diseases. - About the S.R. under 20 mm. we find 268 patients [26,8%]: 7% of infectiouses diseases and. 4,7% hematologic diseases and 8,4% visceral diseases. - In the S.R. between 50 and 100 mm [257 cases]: 6% of kidney diseases, 5,4% of infectious diseases and 3,4% of Rheumotologic diseases

Traitement chirurgical de l'ulcere gastrique indications, methodes et resultat [a propos de 80 observations]

The surgical treatment of stomach ulcer is dominated by the fear of ignoring the neoplasie nature of the ulceration. However, it remains a subject of controversy and the partisans of different methods [resection surgery conservative surgery are regularity opposed to each other. The retrospective study of 80 cases and the literature review confirm, presently, that nothing justifies the doping of the gastrectomy of the vagetomy pyloroplasty and the ulcerectomy, this method remains indicated in high risk patients

L'anastomose choledocoduodenale dans le traitment de la lithiase de la voie biliare principale [a propos de 52 cas]

52 Choledoco duodenal anastomosis were performed between 1970 to 1980 in the ward of digestive surgery A2 at Avicenne's hospital for the treatment of the common duct lithiasis. The authors report their experience about this operation, reviewing the indications and the results of the technique. Mortality rate was 1,9% the consecutive complications are minor represented by a case of anastomotic defect and a case of angiocholitis treated medically. The authors conclud to the simplicity of the method compared to other bilio-digestive anastomosis