[Role of visceral obesity in metabolic disorders associated with hyperandrogenia in Hirsute women]

The aim of our study was to evaluate the relationship between the importance of visceral fat measured by tomodensitometry and the metabolic disturbances in hirsute women. It is a prospective study where 52 women were explored for hirsutism, They underwent a clinical and biological examination, as well as an abdominal tomodensitometry at the 4th and 5th lumbar spine level to measure the area of visceral fat [VF] and sub-cutaneous fat [ScF]. In the 25 patients with VF predominance [VF/ScF >/= 0.2] age, body mass index [BMI], fasting insulin, [12h] and the prevalence of dyslipidaemia were significantly higher compared with women with ScF predominance [VF/ScF<02] There was a positive correlation between VF and age, BMI, waist to hip ratio, I2h and triglyceridemia. In conclusion, hirsute women with visceral fat predominance are at higher risk to develop the insulin resistance syndrome, So, preventive measures against cardio-vascular risk factors, like overweight, must be a part of the treatment

[Riedel's thyroiditis: report of a case]

Riedel's thyroiditis is a chronic inflammatory disease of the thyroid gland characterized by a fibrosis of the gland extending to adjacent cervical structures. We report the case of a 56 year-old woman with Riedel's thyroiditis. The clinical presentation was that of a big, hard, and compressive thyroid nodule. The nodule was found to be cold on the thyroid scan. The diagnosis was given by biopsy. Because of the impossibility of a surgical cure and the presence of compressive symptoms, the patient was treated by corticosteroids at the initial dose of 1mg/kg/d of prednisone. The dose was decreased progressively over a period of 7 months. The evolution was favourable with disappearance of the compressive signs and a reduction in the size of the gland

[ silent myocardial ischemia of diabetics: screening and risk factors]

Silent myocardial ischemia [SMI] is a clinical form of coronary artery insufficiency. It is more frequent in diabetic subjects and has an unfavourable prognosis. The aim of our study is to evaluate the prevalence of SMI in diabetic subjects and to determine its risk factors. This is a prospective study of 114 diabetic outpatients free from known coronary artery disease and clinical and electric symptoms of coronary insufficiency. All subjects underwent an exercise electrocardiogram [EE]; a coronary angiography was indicated in the positive cases. The prevalence of SMI was 12.3%. The subjects with positive EE were older [58.0 +/- 7.8 vs 52.0 +/- 10.5 years, p<0.05], more frequently of male sex [M/W =7/7 vs 28/72, p<0.02], had a higher duration of diabetes [p<0.001], a higher body mass index [28.1 +/- 3.4 vs 26.2 +/- 2.8 Kg/m2, p<0.05] and were more frequently hypertensive [8/14 vs 24/100, p<0.05]. In conclusion, screening for SMI must primarily target elderly overweighted male subjects with a long duration of diabetes and at least one other vascular risk factor

Etude de la mortalite et des causes de deces dans un service interne

In this descriptive study we analysed the causes and circumstances of 166 death enregistered in the department of endocrinology and diabetology at the Rabta Hospital over 15 years. Sex ratio [men/ women] was 1, mean age was 54.9 +/- 10.8 years mortality rates ranged from 0.34% to 3.37% per years. 54% of patients were admitted from emergency service. 23.5% of them dead at the first 24 hours of admission, 48% of death occured at night and 47% at cold season [December to March]. Diabetes mellitus was the main disease noted in these patients [146] with a global mortality rate of 3.25% followed by the other endocrine diseases. We conclude that mortality rate could be decreased by a better appreciation of patients state and improvement of health care given in emergency service

pied diabetique: le vecu d'un service de diabetologie

Diabetic foot remains a main problem in diabetic patients regarding to its heavy consequences. This study is related to 286 diabetic inpatients with foot lesions [191 NIDDM and 95 IDDM]. Sex ratio [male/female = 2.7], mean age 56 +/- 10.4 years old, and diabetes duration 12.08 +/- 9.78 years. Diabetic foot lesions represent 7.35% of the total number of hospitalization [12% for men 4% for women]. Gangrenes were found in [39.9%] of patients and foot ulcer in [34.5%], neurologic and vascular complications were the principal etiological factors, respectively [51.8%] and 37.4%]. Amputation has been made in 28.8% of patients. In conclusion high frequencies of diabetic foot lesions and their heavy socio-economical consequences justify a more efficient management of diabetic foot with precocious screening for etiological factors