Metanephric adenoma diagnosed on biopsy in an infant: a case report.

BACKGROUND: Metanephric adenoma is a rare benign renal tumor of the kidney, uncommonly observed in children. It is often misdiagnosed preoperatively as a malignant neoplasm, leading to an unnecessary nephrectomy. The challenge is to make the right diagnosis preoperatively and therefore manage it with conservative surgery. We report a case of a child with metanephric adenoma who underwent nephron-sparing surgery. CASE PRESENTATION: A renal tumor was discovered fortuitously in an 18-month-old Caucasian girl with several congenital malformations. Investigations showed a 28 × 27 × 27 mm left renal mass centrally located, well defined, nonvascularized, with no calcifications and which compressed the adjacent renal tissue. Furthermore, there were no signs of metastasis. The decision of a multidisciplinary meeting was to perform a computed tomography (CT)-scan-guided biopsy. Histologic examination concluded it was a metanephric adenoma. We performed a left open partial nephrectomy via a flank retroperitoneal incision. The final histopathological examination confirmed the diagnosis. The postoperative course was uneventful. CONCLUSION: Preoperative diagnosis of metanephric adenoma is challenging. Because of the high probability of unnecessary radical nephrectomy, preoperative biopsy can be safe and determining to guide a more conservative approach so nephron-sparing surgery can be performed.

[Percutaneous mitral commissurotomy. 5-year results]. / La commissurotomie mitrale percutanee. Resultats a 5 ans.

Long-term results of percutaneous mitral commissurotomy were evaluated in 410 patients with mean age of 31 years (18 to 68 years). 48% of patients had mean thickened leaflets, 35% had calcified valves and 17% had flexible leaflets and subvalvular apparatus. Procedure was performed with a double balloon in 57% and with Inoue's balloon in 43% patients. A good immediate results was obtained in 77% of patients. A good result was defined as a mitral valve area > or = 1.5 cm2 without mitral regurgitation. Clinical follow-up concern 378 patients. The actuarial 5 years rate were 84% in our serie, without surgery or new percutaneous mitral commissurotomy and good functional results (NYHA class I or II) were 71%. Valvular anatomy, immediate results (mitral valve area), history of mitral commissurotomy, old patients, atrial fibrillation can influence strongly the results.

[Percutaneous implantation under local anesthesia of an implantable automatic defibrillator: report of the first Tunisian case]. / Implantation percutanée sous anesthesie locale d'un defibrillateur automatique implantable: a propos du premier cas Tunisien.

We report the case of a 58 years old male affected by a severe relapsing ventricular tachycardia despite a well administered anti arrhythmic therapy. Etiology is an arrhythmogene right ventricular dysplasia. Considering the severity of this arrhythmia we proceed to percutaneous implantation of an automatically implantable defibrillator under local anesthesia. Evolution was favorable with a follow-up of 3 months.

Field evaluation of a dog owner, participation-based, bait delivery system for the oral immunization of dogs against rabies in Tunisia.

We evaluated a dog owner, participation-based, bait delivery system for the oral immunization of dogs against rabies. In a field study in a semirural area of northern Tunisia, dog owners were asked to come to temporary bait delivery sites. A total of 314 baits were given to 178 dog owners in four sites. The experimental baits used consisted of a freeze-dried core unit containing sulfadimethoxine (SDM) as a biological marker and an aromatized paraffin envelope. No vaccine was used. Preliminary tests had shown that by using a rapid commercial card test, positive SDM serum levels were detected in more than 95% of dogs up to two days after bait ingestion. During the two days following bait delivery, we visited more than 95% of all households in the study area and took blood samples from as many owned dogs as possible. Unconsumed baits were recovered and human contacts with the bait matrix were recorded. The campaign required 7.6 person-min per bait and 13.5 person-min per dog owner for providing baits, gloves, and instructions. The estimated average cost effectiveness ratio per dog accepting a bait was 1.7 US dollars. From the indications given by the dog owners and the results of the SDM test, it was concluded that 85-90% of the owned dogs in the study area had consumed a bait at least partially. Of 314 baits delivered, 78.7% were fully consumed by dogs and 4.1% were recovered during the household survey. The remaining baits (17.2%) that were not recovered were either not consumed or only partially consumed by the target dogs (3.7 baits per 100 inhabitants). These baits probably remained within the highly populated areas and were potentially accessible to other domestic animals and other nontarget species, including humans. Twenty-five unprotected human contacts with baits were recorded (1.7% of all inhabitants). Our study has demonstrated the potential of dog owner based bait delivery. This technique is simple and efficient, particularly if the human population is accustomed to mass immunization in defined centers. Before applying this method on a large scale with live vaccine loaded baits, further studies should focus on minimizing the number of human contacts with the vaccine bait, systematizing contact identification and establishing structures in ensuring proper treatment if exposure to vaccine should occur.

[Chronic cor pulmonale caused by hydatid embolism complicating hepatic hydatid cyst]. / Coeur pulmonaire chronique par embolies hydatiques compliquant un kyste du foie.

An hydatid cyst of the left lobe of the liver, associated with right heart failure, was diagnosed in a 61-year-old man presenting with dyspnoea. Doppler echocardiography combined with cardiac catheterization demonstrated the presence of pulmonary precapillary hypertension. Pulmonary perfusion scintigraphy with Technetium-labelled albumin microspheres demonstrated multiple pulmonary embolisms, leading to a diagnosis of postembolic chronic cor pulmonale. Due to the absence of thrombophlebitis and ultrasound signs of an intracaval hydatid membrane, floating at the level of the cyst of the left lobe of the liver, the diagnosis of parasitic postembolic chronic heart pulmonale, due to fistulization of an hepatic hydatid cyst into the inferior vena cava, was established. Only chemotherapy was proposed in this patient due to dissemination of the hydatid material in the lungs.

Test of three bait types for oral immunization of dogs against rabies in Tunisia.

Chicken heads and two types of artificial bait were tested in Tunisia during two field trials in a waste disposal site carried out in 1988 and 1989 to compare their effectiveness as vehicles for the oral administration of antirabies vaccine to free-roaming dogs. Baits were made available for 36 hr and those that disappeared or were consumed were replaced on several occasions. In 1988, an artificial bait composed of fat and fishmeal (artificial bait type I) was tested. In the second trial, chicken heads and an artificial bait composed of polymerized fishmeal and wax (artificial bait type II) were compared. The vaccine containers were loaded with a topical marker (rhodamine B or methylene blue) to identify animals that had consumed baits. The artificial type I bait tested in 1988 was poorly accepted, but in the second trial, the number of chicken-head baits probably taken by dogs was more than seven times greater than the number of artificial type II baits taken. Thirteen dogs observed during the day showed topical marker staining. In both trials, most baits were taken during the night when dog activity in the waste disposal site was at its maximum. Artificial baits were characterized either by their lack of thermostability (type I, melting) or a certain attractiveness for cats (type II, fish flavor). Chicken heads fulfill established requirements for baits for vaccine delivery. They are well-accepted by free-roaming dogs, inexpensive, usually easily available at local markets, unattractive to humans, relatively easy to store in large quantities, and easy to handle.

[Clinical course and prognosis of myocardial infarction]. / Evolution et pronostic de l'infarctus du myocarde.

1000 patients with myocardial infarction between 1975 and june 1991 were admitted in the cardiac unit at the university hospital in Sfax. The mean age is 60 years, with a masculine predominance (86%). The time between, onset admission is long, 47.4% were admitted within 24 h after onset and 16.5% within 6 h after onset. The site of MI was more often in anterior region (58.6%) against 36% in the posterior region. Evolution was favorable in 34.7% of cases, 36.5% cases of left cardiac failure were noted, and 11.7% of cardiogenic shock rhythm disorders were noted in 34.6% of cases (under estimated) and conduction disorders were noted in 22% of cases. Early mortality is about 17.4% occurring more often during the first 3 days.

[Ophthalmologic manifestations in patients under chronic hemodialysis]. / Les manifestations ophtalmologiques chez les hémodialysés chroniques.

Ocular modifications were assessed in a prospective study carried out on 61 chronically hemodialyzed patients. Their mean age was 39.6 years (range: 7-73 yr) and the mean duration of dialysis was 30.5 months. The loss of visual acuity was especially associated with cataracts or refractive disorders. Corneal-conjunctival calcifications were found in 36% of the patients and were statistically significantly correlated with the duration of hemodialysis. Eyeground modifications were observed in 36% of the subjects; 21.3% of them were hypertensive retinopathies. Cataracts were less common (5%) than small calcifications in the lens (24.5%). Conjunctival biopsies taken from two patients confirmed the presence of calcium salt deposits under the conjunctival epithelium.