improvement in the ABI index following 3 month treatment with cilostazol in patients with mild to moderate peripheral arterial disease

Objective: To study the effects of cilostazol in patients with mild to moderate peripheral arterial disease [PAD] using the improvement in ankle brachial pressure index [ABI]

Methodology: This hospital based interventionist study was a prospective, open labeled clinical trial. After the baseline data collection cilostazol was given to the group A, while the group B didn't receive cilostazol. The effect of intervention was noted at the timed study points at 4, 6 and 12 weeks .The antiplatelets were used in the group B as a control

Results: The ABI improvement at the end of the study in the cilostazol treated group was marked compared with the control group. The group A had 65 males and 35 females, while the group B had 74 males and 26 females. The total ABI improved in the right and left lower limb with a P value of 0.001 each. The ABI results were better in the male, diabetic and hypertensive subsets of study as compared with female, obese and smoker

Conclusion: Cilostazol significantly improves ABI in PAD. Its use in the indicat-ed population group should be encouraged to improve the management and prevent the complications

[Isolated abscess of the thoracic and abdominal wall: an exeptional shape of tuberculosis]

The isolated thoracic parietal localization is a very rare shape of tuberculosis. It often leads to a diagnosis problem with the parietal tumours requiring surgical biopsy. We report a case of tubercular abscess localized in the antero-superior part of the thoracic wall with a second abdominal localization without any pulmonary localization. It was a 56-year-old woman presenting a swelling in the right side of the sternum accompanied after some months by a second swelling of the right flank of the abdomen, for one year. The radiological and biological explorations were in favour of a double localization parietal tumour. The diagnosis of certainty has been made by the histological exam of the surgical biopsy and the bacteriological exam of the trans-parietal withdrawal of the collection. The classic tuberculosis treatment has been maintained during 9 months with a good clinico-radiological evolution. Through this observation, we try to study the anatomo-clinical particularities and to clear the diagnostic difficulties of this affection

Early results of oesophagectomy for carcinoma oesophagus in 1008 cases

To determine the early results of 1008 oesophagectomies done for carcinoma oesophagus over a 9 years period. This observational descriptive study was conducted at Department of Cardiothoracic Surgery, Lady Reading Hospital, and Khyber Medical Centre Peshawar from June 2002 to June 2011. All patients had apart from routine investigations, Barium studies, Endoscopy and biopsy, CT thorax/upper abdomen with oral and I/V contrast and abdominal ultrasound. The operative approaches included left thoracolaparotomy with left neck anastomosis, transhiatal, left thoracolaparotomy with Roux en-Y, McKeown with right decortication, Ivor Lewis and left thoracolaparotomy with left decortication. All operations were done by one surgical team. The hospital records and operation reports of these patients were carefully analysed for demographic feature; operative approach and outcome. Out of 1008 cases, 698 were males and 310 were females with a mean age of 51.6 years. The age range was 17-80 years. Out of 1008 cases 611 [60.61%] cases had lower one third tumours, 384 [38.09%] cases had middle one third tumours while 13 [1.28%] tumours were just below the thoracic inlet. Of the 611 lower 1/3 tumours stomach involvement was present in 271 [44.35%] cases. Adenocarcinoma was present in 516 [51.19%] cases, squamous cell carcinoma was present in 485 [48.11%], adenosquamous was 6 [0.59%] and carcinoma in situ was present in 1 case [0.09%]. Morbidity was 63/1008 [6.25%], and comprised anastomotic leaks 15, aspiration pneumonia 13, wound infection 13, hoarseness 8, and strictures 14, 30-day mortality was 23/1008 [2.28%] and causes included aspiration pneumonia-respiratory failure [5], myocardial infarction [4], anastomotic leak [6], tracheal injury [2], and presumed pulmonary embolism [6]. More than 1000 cases in 9 years is a very high oesophageal workload for malignancy. Morbidity of 6.25% and mortality of 2.28% shows that such major operations can be done safely in thoracic centres

Impact of diet habits on clinical and biological characteristics of type 2 diabetics originating from south and costal regions

Type 2 diabetes is a very frequent pathology in our country. The objective of this study was to compare two diabetic populations recruited in the Monastir [M] and Sfax [S] areas. The aim of our study was to evaluate the effect of the diet on the evolution of the disease. The duration of diabetes was longer in the sample from Sfax and their levels for glycated haemoglobin and triglycerides were higher: 8.51 +/- 2.8 vs 10.2 +/- 3.6% [p=0.035] and 1.7 +/- 1.1 vs 2.6 +/- 1.3 mmol/l [p=0.006] respectively for group M and S. Total cholesterol, LDL-cholesterol and Apo AI levels were significantly higher in the M. group. Total homocysteine plasmatic levels were also significantly higher in the Monastir sample compared to the one from Sfax: respectively 23.3 +/- 15.4 vs 14.8 +/- 5.92 micro mol/l [p=0.002]. The protein food intake was positively correlated to the plasmatic homocysteine level only in the M. group [r= 0.439, p<0.001]. Olive oil consumption proved to be beneficial with a lowering of both systolic and diastolic blood pressure in the 2 groups [Monastir: r= -0.113, p<0.05 and Sfax: r= -0.403, p<0.001]. An appropriate and early management following the [Mediterranean diet] is called for in type 2 diabetes

[Diabetes mellitus cutaneous manifestations]

Diabetes mellitus cutaneous manifestations are numerous. The aim of this case control study [200 diabetic patients and 100 controls]. was to estimate the frequency of these manifestations, their clinical particularities and their relationship to the duration of the disease, the equilibrium and degenerative complications of the diabetes. Cutaneous manifestations were found in 84,5% of the diabetic patients and in 49% of controls. Diabetic dermopathy [DD] was found in 11,5% of patients and necrobiosis lipoidica in 1 case. Diabetic bullosa was reported in 6% of cases. It was more commune in ancient and poorly controlled disease. Diabetic rubeosis was found in 3% of diabetic patients and cheiroarthropathy in 7%. Cutaneous infections, mainly due to fungus [47%], were found in 63% of patients and 44% of controls. Side effects of antidiabetic medications were noted in 11% of cases. The high frequency of cutaneous manifestations in diabetes mellitus, in our study, could be explained by the inclusion of all skin diseases, in particular, cutaneous infections. The manifestations were significantly more frequent in diabetic patients. DD, diabetic bullosa and cheiroarthropathy are the most specific manifestations. Skin infections are common but non specific. They are favorised by poorly controlled diabetes. Complications of the diabetic foot are frequent

[Congenital pituitary stalk interruption syndrome-Report of 6 cases]

Pituitary stalk interruption is a non-negligible cause of growth hormone [GH] deficiency. We report 6 cases [5 boys and 1 girl] with complete congenital GH deficiency. The average age was 13 years. 4 out of 6 cases [66, 6%] had corticotrophic hormone deficiency; 1 of 6 cases [16, 6%] had a hypothyroidism. 2 out of 4 children older than normal age of puberty had gonadotropin deficiency [50%]. Diabetes insipidus was not prsent and hyperprolcatinemia was present in 2 cases. 4 children had past history of fetal distress. Pituitary stalk interruption was assessed by the means of magnetic resonance imaging [MRI]. The cause of the stalk interruption syndrome is unknown. The MRI in this syndrome revealed ectopic posterior lobe location, stalk interruption and hypoplastic anterior-lobe. The outcome is progressive evolution towards panhypopituitarism and these patients require regular clinical survey and hormonal controls

[Desmoid tumor of shoulder-Girdle]

Desmoid tumour is an uncommon connective tissue tumour arising from musculoaponevrotic tissue characterized by spindle cell fibroblast and myofibroblast proliferation. Although considered as a benign lesion, it can be very aggressive locally, and has a high rate of local recurrences afer surgical excision. The cause is unknown and it most often encountered in young women. Abdominal localization is the most frequent site. Extra-abdominal desmoid tumors particularly located in the girdles or the most proximal part of the limbs. We report a case of a 31 year old woman with desmoid with tumour of the scapular region which was treated with wide excision, but in the following year the tumour reccured locally of the shoulder-girdle and infiltrated into the brachial plexus. Nevertheless, surgical treatment of recurrent tumors is difficult and often insufficient, compromising functional outcome. Radiotherapy has been advocated for better control tumor growth

Syndrome of resistance to the thyroid hormones

In the adult, the daily needs of thyroid hormones are between 1.5 to 1.7 micro g/kg. In some conditions, these needs can be more important. We report the case of a woman with primary hypothyroidism that necessitated large doses of L-thyroxine. This female patient, age 47, without a family history of thyroid disease, was hospitalized in 1988 because of hypothyroidism [she had no goiter] and iron deficiency anemia. The patient was started on L-thyroxine with a dose of 150 micro g/ day [2.7micro g/kg/day] but the dose had to be increased to 650 micro g/day [12 micro g/kg/day] to obtain clinical and biological euthyroidism [TSH of l.3 microUI/L]. Six years later, while still receiving 650 micro g/day of L-thyroxine, the patient presented with signs of hyperthyroidism with a TSH of 0.01 microUI/L. The doses were progressively decreased to 125 micro g/day [2.3micro g/kg/day] over a five year period and the TSH was back to normal [0.9 micro UI/l] with clinical euthyroidism. This clinical picture is compatible with a syndrome of resistance to the thyroid hormones and the more so because transient forms similar to our case have been reported in the literature

Ruptured subrenal aortic false aneurysm after laparoscopy

The authors report a rare case of ruptured subrenal aortic false aneurysm; which has been done for an ascitis exploration. The diagnosis has been done after an emergency surgical exploration. The following up was without any complications after 36 months

[Infections and diabetes complications degenerative]

We present a retrospective study of 195 diabetic patients how were hospitalized during the year 2002 and who had an evolution of the role of the different degenerative complications in the occurrence of different infections. The most common bacterial infections encountered were in the urinary tract [n =21], the soft tissue [n[degree] 21] and the bronchopulmonary tract [n =12]. In the soft issue infections, the foot was concerned in 40% of the cases. Urinary tract injections were more common in women [p<0.05]. The frequency of urinary tract infections, septicemia, and bronchopulmonary tract injections was not significantly linked to the existence of degenerative complications, exception the case of the .foot infections that were more frequent in patients with arterial or neuropathic disease of the lower e-extremities

[Primary Hypothyroidism subject of age: about 71 cases]

We report in this work a retrospective study of 71 patients older than 65 years who presented with primary hypothyroidism and were hospitalised. These patients represent 8.5% of all our hypothyroid patients. In our group, hypothyroidism was characterized by a female preponderance [72% of our cases] and by its atypical clinical presentation and the marked paucity of its clinical symptoms. The most frequent signs include physical asthenia [79%], weight increase [32%], cutaneo-mucosal signs [49.3%]. Anaemia and hyperlipidemia were the most frequent biological signs encountered [50% and 43% respectively] with hyponatremia found in 15% of the cases. Cardiovascular complications were present in 8 cases [11%]. A myxoedematous coma was present 3 patients [4%] and myopathy was seen in only one female patient. The aetiologies in our elderly patients were mainly auto-immune thyroiditis found in 74,6% of the cases and post-radiation hypothyroidism in 18.3%. Substitutive treatment was started during hospitalisation and the patients had thereafter a clinical and electrocardiographic follow-up to avoid ischemic coronary complications. The mean substitutive dose of L-thyroxine was 166 micro g/day

[Tuberculomas intrasellaires: about 2 cases]

Sellar tuberculomas are extremely rare. Their diagnosis is difficult because other intrasellar lesions may have the same clinical and radiological appearance. We report two cases, in which the diagnosis was made on the basis of clinical, paraclinical and therapeutic arguments. The first observation is a 42-year-old unmarried woman who presented with central diabetes insipidus and secondary amenorrhoea. Magnetic resonance imaging [MRI] revealed a nodular thickening of the pituitary stalk, an increased size of the pituitary gland and a loss of the posterior pituitary hyperintensity signal at T1. The tubercular origin of these lesions was deducted from the presence of tubercle Bacillus in the bronchial fluid, and the favourable evolution after anti tubercular treatment. The second observation is a 29-year-old woman with secondary amenorrhoea at the 12th month of treatment for tubercular pleuropulmonary lesions and meningitis confirmed by the presence of Tubercle Bacillus in the cerebrospinal fluid. The MRI revealed a multinodular expansive processus that encircled the pituitary stalk and extended to the infuncibular and hypothalamic regions. These nodules regressed with continuation of the same antitubercular treatment