[Contrast-induced nephropathy after cardiac catheterization: a prospective study of 180 patients]

Contrast-induced nephropathy [CIN] is associated with an increased cardiovascular morbi-mortality. Little is known about the incidence and risk factors of CIN after cardiac catheterization in Tunisian patients. To determine the incidence of CIN and its predictors after coronary angiography as well as its prognostic and therapeutic repercussions in a Tunisian patients' cohort. In this prospective single center study, 180 consecutive patients who underwent cardiac catheterization were enrolled; all patients were followed-up for 3 months. The incidence of CIN defined as an absolute increase in serum creatinine >/= 5 mg/l [44micromol/l] and/or a relative increase in serum creatinine >/= 25%, was 17.2%. In multivariate logistic regression, independent predictors of CIN were: diabetes mellitus [Odds Ratio [OR]=2.26 ; 95% confidence interval [95%CI]: 1.29-3.98, p=0.005], creatinine clearance < 80ml/mn [OR=2.87 ; 95%CI: 1.59-5.19, p<0.001], left ventricular ejection fraction [LVEF] < 45% [OR=2.03 ; 95%CI: 1.22-3.39, p=0.007] and use of a volume of contrast media > 90ml [1.72 ; 95%CI: 0.99-2.99, p=0.05]. Perprocedural hypotension was the strongest independent predictor of CIN in our study [OR=3.99; 95% CI: 1.65-9.66, p=0.002]. CIN was totally regressive within one month in 27 patients [86.7%] while 3 patients [10%] had a residual renal dysfunction at the end of the follow-up period [3 months]. More than one angiocoronarography on 6 resulted in CIN in our population. CIN affects cardiovascular prognosis even if renal function normalization is usually obtained within one month after the investigation. Besides identifying risk factors of CIN in order to apply preventive measures in risky patients, we stress the necessity of insuring a good hemodynamic status while achieving the procedure

[Late stent thrombosis in a young patient who had ulcerative colitis]

Arterial and venous thrombosis are well recognized systemic complications of inflammatory bowel disease predominantly in patients with Crohn's colitis and in those with ulcerative colitis [UC]. report a new case We describe the case of a 35 years old man presenting previously an anterior infarct with a tighten stenosis in the middle part of the left anterior descending artery [LAD]. The stenosis was treated percutaneously with a bare stent deployment. During an acute exacerbation of UC, the patient developed an acute coronary syndrome with ST elevation secondary to a late stent thrombosis, needing a primary coronary angioplasty. Following course is favorable. Based on this case, we'll discuss the relationship between UC and thrombosis, and therapeutic considerations inherent to thrombotic and bleeding risks

Percutaneous balloon valvotomy for combined rheumatic mitral and aortic stenosis

Balloon dilatation of the mitral valve is an established modality of treating patients with mitral stenosis. However, there is limited experience for simultaneous dilatation of combined mitral and aortic stenosis report our experience in percutaneous balloon valvotomy for combined mitral and aortic rheumatic stenosis. we describe a case of a 33 years old woman who successfully balloon valvotomy for rheumatic mitral and aortic stenosis via the transseptal anterog ade approach using Inoue balloon for mitral valve and retrograde approach single balloon for aortic valve. Double valve balloon valvotomy is feasible and safe in selected patients with combined mitral and aortic rheumatic stenosis

[Congenital heart diseases in consultation of pediatric cardiology in mauritania]

Objectives: The aim of this study is to describe the epidemiological profile of congenital heart diseases in Mauritanian children. Material and Methods: Our population was composed of children referred by the different cardiologists of the country on the occasion of two missions of pediatric cardiologists in December 2001 and November 2002. All patients had physical examination. chest radio-gram, electrocardioeram. and echocardiogram

Results: There were 84 patients aged between 2 months and 16 years. Mean age was 6.1 +/- 5.0 years. Forty eight children [57.1%] were males and 36 [43.9%] females [sex ratio was 1.3]. Ventricular septal defect [17%], tetralogy of Fallot [13%] and pulmonary stenosis [12%] were the predominant pathologiese. Surgery was initially indicated for in 61 infants [73%], realized in 22 of them [26%] and considered out of date in 10 patients [12%]

Conclusion: Congenital heart diseases pose a major problem of treatment in Mauritania. They are dominated by the left to right shunts. The age of diagnosis is relatively late [6 years] exposing to the risk of complications. Therefore, a team of paediatric cardiologists on the spot and the setting up of cardiovascular surgery facilities are necessary

[Return to work after acute myocardial infarction]

The aim of this work to study the professional repercussions of acute myocardial infraction and to analysis medical, social and occupational factors which could influence return to work. Our study concerns 70 patients less than 66 years old, working before their hospitalization and having been admitted for acute myocardial infraction between January 1[st], 1999 and December 31, 2000 in the Department of Cardiac Resuscitation of hospital La Rabta of Tunis. Data were collected from retrospective review of folders and answers to a questionnaire for which the patients have been summoned in 2002. There were 70 patients almost exclusively men [n=69]. The mean age was 49.0 +/- 6.8 years. The mean follow-up was 27.2 +/- 7.7 months. Sixty one patients [87.1%] have initially been back to work and eight of them lost it secondarily. The average delay of return to work has been 91 +/- 111 days. The direct repercussions of myocardial infraction on the preofessional capacities was observed at the majority of patients. Despite an important professtional repercussions of acute myocardial infraction, our study showed a high rate of return to work with relatively short delays

[Anomalous origin of coronary arteries from the aorta]

The authors report the series of 9 patients [6 male and 3 female, aged from 32 to 64 years] with anomalous origin of coronary arteries from the aorta discovered at coronary arteriography. In 4 cases, the circumflex artery aries from the right coronary sinus and in 5 cases, the right coronary artery arises from the left coronary sinus. Severe atherosclerotic coronary disease was discovered in 5 cases. We conclude that aberrant coronary origin from the aorta is a rare congenital anomalous discovered usually at coronary angiography and certain patients with this anomalous can develop severe myocardial ischemia especially when a vessel runs between the aorta and pulmonary artery

[ pathophysiology of irritable bowel syndrome]

The irritable bowel syndrome [IBS] is a frequent gastrointestinal disorder [10 -15% of the population].It is characterized by chronic abdominal pain with modification in the bowel habits. The diagnosis is based of ROME II criteria. The pathophysiology of the SII remains unknown. It result from visceral hypersensitivity with anomalies of the digestive motility. These anomalies are secondary of dysfunction of the brain - gut axis modulated by environmental and the psychosocial factors. The understanding of the pathophysiological mechanisms of the SII and in particular the function of the brain-gut axis will permit a better handling of the patients. Indeed, the present knowledge of the neurotransmitter implied in the communication between the central nervous system and the digestive tract are currently the basis of the new therapies aimed to modulate the mechanisms implicated in the causation of the several symptoms of IBS. These novel pharmacotherapy should reduce the indirect societal and costs of IBS

[Large ostium secundum atrial septal defect discovered after severe mitral regurgitation: a case report]

Mitral regurgitation is associated with ostium secundum atrial septal defect in about 22% of cases. mitral valve prolapse induced by atrial shunt is the main cause of this regurgitation. Ususually, atrial septal defect discovery precedes that of mitral regurgitation. The aim of this paper is to focus on clinical, hemodynamic and evolutive details of atrial septal defect and mitral regurgitation association. We report the case of large atrial septal defect in 37 years old girl referred for hemodynamic investigation of mitral regurgitation. The divergence of clinical data, electrocardiogram and echocardiography findings has led to atrial septal defect discovery. Hemodynamic data showed severe pulmonary arterial hypertension [medium pulmonary arterial pressure: 45 mmhg]. Hence, mitral valve substitution by mechanical prosthesis and closure of atrial septal defect have been carried out. Ten hours after surgery, death occurred because of severe pulmonary arterial hypertension and heart failure. Association of severe mitral regurgitation and large ostium secundum atrial septal defect is an original anatomo-clinic entity characterized by mitral valve lesions diversity and severe secondary pulmonary arterial hypertension. Danger of such a hypertension is due to progressive and infra clinical rise of pulmonary resistances and association of increased pulmonary blood flow and capillary pulmonary hypertension

transition epidemiologique ses determinants et son impact sur les systemes de sante a travers l'analyse de la tendance des maladies cardiovasculaires en Tunisie

We aim at analyzing the increase of CVDs in the Tunisian hospitals in order to assess the burden of NCDs in the transitional context. Data are recorded through the Tunisian National Morbidity and Mortality Survey [TNMMS]. In order to assess the CVDs [CHDs vs RHDs] trend, two representative samples of Cardiology Departments patients were compared one is selected from the TNMMS and the second from the hospitalizations recorded in 1992. Causes, stay duration, status at the end of the hospitalization, transfer to an other hospital and patients socio-demographic characteristics are recorded and compared for the two periods. All the diagnosis are coded referring to the DMC 10. To analyze the determinant of the epidemiological transition, we have elaborated the CVD causal pattern and we have documented all their determinants. CHD rate has dramatically increased, while RHD has decreased especially on men. In 1992, 39.2% of men and 11.8% of women were admitted for CHD. In 2002, these rate are respectively 58,8% and 38, 2% while RHD rates were, in 1992, 11.8% on men and 25.3% on women vs 4.4% and 11.7% respectively. This study has confirmed that so far controlling transmitted diseases seems to be successful, Tunisian people are about to face a new problems as hypertension, obesity, diabetes and tobacco smoking. The new challenge with the burden of diseases requires the implementation of a national strategy relevant to the epidemiological. social and economical transition. Population needs and cost effectiveness of interventions assessment is crucial to set the national priorities

Cout direct medical de la prise en charge de l'infarctus du myocarde en phase algue

to assess the medical direct cost of acute myocardial infarction. Method: data are recorded through a prospective study in 7 wards of cardiology of the District of Tunis during one year: from November 2001 to October 2002. cost of hospital stay, biologic analyses, drugs, functional investigations and possible non surgical cardiologic intervention [IC] was calculated. 632 AMI cases are recorded, the death rate is 7.8%. The average of hospital stay was 13.3 days. 49.1% of patients benefited from thrombolytic therapy, 55.5% benefited from a coronary angiography and 16.1% of an act of IC. The mean of direct cost [CGM] was 2171 Tunisian Dinars and the median was 1731 DT, of whom room costs 31.7%, 22.5% acts of IC, 7.2% drugs, 26.2% functional investigations and 12.4% biological analyses. The mean cost of IC was 3030 +/- 401 DT. The methodology of our study remains original in our country and can be used to assess the other aspects of AMI as other diseases cost management

Fistules coronaires multiples dans la cavite ventriculaire gauche. A propos d'un cas

The authors report the case of a patient with multiple coronary artery-left ventricular fistulae discovered in coronary angiography for exertional angina

Resultat a 20 ans d'une reparation complete d'une tetralogie de fallot chez une femme de 50 ans

The authors report the case of a woman operated at 50 years of age for a tetralogy of Fallot with a good late result

Retrecissement valvulaire aortique congenital avec dysfonction ventriculaire gauche: effet de la dilatation percutanee

Two girls aged 6 ans 1 5 years with severe congenital valvular aortic stenosis and left ventricular [LV] dysfunction underwent successful balloon aortic valvotomy [BAV]. Both patients had severe symptoms at the time of initial evaluation. The electrocardiograms showed LV hypertrophy and cardiac enlargement [cardiothoracic ratio 0,7 and 0,65] was evident in the chest roentgenograms. Immediately after BAV, the aortic valve peak-to-peak gradients decreased from 60 to 8 mmHg and 120 to 30 mmHg respectively, the LV end-diastolic pressures decreased from 47 to 13 mmHg and 40 to 15 mmHg, the LV ejection fractions improved from 40 to 65% in the second girl. On follow-up [30 and 36 ms respectively], both patients were asymptomatic with normalization of LV function and without a change in the residual gradient a cross the aortic valve

effet immediat de l'atrioseptostomie de Rashkind sur la saturation systemique dans la transposition des gros vaisseaux

The purpose of this prospective study is to analyse the immediate effect of Rashkind's atrioseptostomy on systemic saturation in transposition of the great arteries [TGA]. Thirteen neonates and infants [10 males and 3 females] with TCIA underwent balloon atrial septostomy [BAS] at a median age of 20 days [range 2 ans 60 days]. The mean atrial septal defect diameter apter BAS was 6.5 +/- 1.1 mm. The right ventricular saturation increased from 37 +/- 17% to 67 +/- 13% [p<0.001]. there was no correlation between the atrial septal defect diameter and the increase of systemic saturation aiter BAS

Genetique des maladies inflammatoires cryptogenetiques de l'intestin

The inflammatory bowel disease [IBD] are multifactorial diseases involving the interaction of genetic and environmental factors. In genetic terms, the IBD are polygenic and multigenic disorders with incomplete penetrance. In the late decade, investigators have applied the complementary techniques of genome-wide scanning and candidate gene analysis to search susceptibility genes. The IBD susceptibility regions, widely replicated, are in chromosomes 16 [IBD1], 12 [IBD2] and 6 [IBD3]. Recently, a signification have been reported with crohn's disease and NOD2/ CARD15 gene. This gene is an appropriate candidate gene because its localization and function. More studies is necessary to confirm this association, search an other variants of this gene and other candidate gene. This studies provide best comprehension of the disease pathogenesis and deliver clinical application