[Myocardial infarction as complication of acute pancreatitis]. / Pancréatite aiguë compliquée d'infarctus du myocarde à coronaires normales.

We report a case of an acute pancreatitis complicated by myocardial infarction with normal coronary arteries on angiography. This observation presents a double interest. First, it illustrates unusual forms of coronary disease represented by the non-atherosclerotic infarction. On the other hand, it shows that the multiple visceral damage associated with acute pancreatitis can include myocardial infarction which complications aggravate prognosis.

[Skeletal manifestations in Behçet's disease. A report of 79 cases]. / Les manifestations articulaires de la maladie de Behçet. A propos de 79 cas.

PURPOSE: Our aim is to describe the skeletal manifestations of Behcet's disease (BD) among young adults in a military population. METHODS: We conducted a retrospective study of 176 patients with BD who were followed between 1980 and 2005. All the patients fulfilled the international study group on Behcet's disease diagnostic criteria. RESULTS: Rheumatic manifestations were noticed in 79 out of 176 patients (45%), ranking second after the skin and mucosal manifestations of the disease. Articular manifestations were the first disease manifestation in 16.5% of the patients. Inflammatory arthralgias were the most common manifestation and observed in 81%, interesting mainly the large lower limb joints. Disease course was acute in most of the patients. Arthritis was less common: oligoarthritis (7.5%), monoarthritis (6.5%) and polyarthritis (5%). Axial involvement was also noted: spine pain in 29%, isolated sacroiliitis in 7.5%, and definite ankylosing spondylitis in 5%. CONCLUSION: Joint involvement is common in BD and could be the first manifestation of the disease. Most of the patients present with inflammatory arthralgias of the large lower limb joints. Disease course is usually favourable, spontaneously or with treatment. However, in our study population, skeletal manifestations were responsible for significant disability.

[Severe imported malaria. The experience of the military hospital of Marrakech]. / Le paludisme grave d'importation à propos de neuf cas: expérience de l'hôpital militaire Avicenne de Marrakech.

Incidence of severe imported malaria increases with the multiplication of humanitarian and military missions in malarial endemic areas. The purpose of this study was to describe the demographic, clinical, therapeutic and outcome aspects of 9 cases which have been hospitalized in the intensive care unit and medecine service of the military hospital of Marrakech, between january 2001 and december 2004. Out of 68 patients admitted with symptomatic malaria during this period, 9 cases were considered as severe. All of them were male soldiers (mean age: 33,3 years), 7 of them have stayed in Democratic Republic of Congo, and 2 in Ivory Coast. Chemoprophylaxis consisted in chloroquine plus proguanil in 5 cases and mefloquine in 4 cases. The mean duration of stay in endemic area was 9,3 months. The clinical presentation was dominated by troubles of consciousness, which justified initial admission in the intensive care unit. The mean duration of hospitalization was 3,3 days in intensive care unit and 5,6 days in the medical department. Thick smear always revealed high parasitemia (5-15%) with Plasmodium falciparum, associated with Plasmodium ovale in two cases. Antimalarial treatment consisted in quinine salts administration. Evolution was favourable without recurrence in 7 cases, but 2 deaths were recorded. Severe imported malaria remains associated with bad outcome and requires early diagnosis and close monitoring of such cases.

[Severe imported malaria: the experience of the Avicenna military hospital of Marrakech]. / Le paludisme grave d'importation à propos de neuf cas : expérience de l'hôpital militaire Avicenne de Marrakech.

Incidence of severe imported malaria increases with the multiplication of humanitarian and military missions in malarial endemic areas. The purpose of this study was to describe the demographic, clinical, therapeutic and outcome aspects of 9 cases which have been hospitalized in the intensive care unit and medecine service of the military hospital of Marrakech, between january 2001 and december 2004. Out of 68 patients admitted with symptomatic malaria during this period, 9 cases were considered as severe. All of them were male soldiers (mean age: 33,3 years), 7 of them have stayed in Democratic Republic of Congo, and 2 in Ivory Coast. Chemoprophylaxis consisted in chloroquine plus proguanil in 5 cases and mefloquine in 4 cases. The mean duration of stay in endemic area was 9,3 months. The clinical presentation was dominated by troubles of consciousness, which justified initial admission in the intensive care unit. The mean duration of hospitalization was 3,3 days in intensive care unit and 5,6 days in the medical department. Thick smear always revealed high parasitemia (5-15%) with Plasmodium falciparum, associated with Plasmodium ovale in two cases. Antimalarial treatment consisted in quinine salts administration. Evolution was favourable without recurrence in 7 cases, but 2 deaths were recorded. Severe imported malaria remains associated with bad outcome and requires early diagnosis and close monitoring of such cases.

[Factors correlated with left ventricular mass in hypertensive patients]. / Facteurs corrélés à la masse ventriculaire gauche chez un groupe d'hypertendus.

UNLABELLED: Left ventricular hypertrophy (LVH) is an independent risk factor in hypertensive patient. THE AIM: Of our study is to evaluate prospectively the relationship between left ventricular mass and clinical, echocardiographical and ambulatory blood pressure data in hypertensive subjects. METHODS: We studied 88 hypertensive patient who underwent clinical and laboratory investigation, echocardiography and 24 hours ambulatory blood pressure monitoring. Correlations were made between these data and left ventricular mass. RESULTS: Clinical data, which correlated well with left ventricular mass, were duration of hypertension, systolic arterial pressure and pulse arterial pressure. In echocardiography left atrial area and left ventricular dysfunction correlated significatively with left ventricular mass. Data from 24 hours blood pressure monitoring as daytime systolic pressure, nighttimes diastolic pressure, ambulatory systolic pressure and ambulatory pulse pressure. CONCLUSION: In hypertensive patient, left ventricular mass correlated well with left atrial dilation and diastolic left ventricular dysfunction. It also correlated with 24 hours ambulatory blood pressure monitoring data.

[Heart and sports: modifications of electrocardiogram, late potentials and echocardiography. Study of 75 sportsmen and 46 witnesses]. / Coeur du sportif: modifications électriques et échocardiographiques au repos. Etude de 75 sportifs et de 45 témoins.

The authors report the results of prospective study, which compared 75 sports subjects and 45 witnesses. All subjects were male, the differentiating parameter being the type of sport practiced. This work analysed surface Electrocardiogramme, thransthoracic echocardiography and high amplification ECG. The statistical study used the student test t compare means and the Chi2 test for the percentages, the signification limit was fixed to 5%. Clinically, our two series didn't show a significant statistical difference, concerning: age, weight, height or arterial pressure. On the electrocardiographical level, the sport's men have a lower cardiac frequency (p = 0.005), a larger PR space (p = 0.05), an important Sokolow parameter (p < 0.005), and repolarisation disorders represented, essentially by negative T waves (p = 0.02) and an upper movement of ST segment in V2-V3 (p < 0.005). Echocardiography showed a dilatation of the right cavities: right auricular (p = 0.0125) and right ventricular (p = 0.025). Move over, it has been showed that the sport's men left ventricular walls were tabor (septal wall, p = 0.0125), (posterior wall, p = 0.025), despite a difference in the values of the left ventricular telediastolic diameter (4 mm average in the two series). The signification limit was not reached and it was also showed that the left auricular was also dilated (p = 0.025). The study of the delayed Potentials, tried to bring an explication to certain sudden deaths of sport's men which are to date unexplained and which could have a rhythmical origin? It is also to be noted that sport's men present more delayed ventricular Potentials. However, the statistical signification was not reached (p = 0.07).

[Endomyocardial fibrosis in Behcet's disease: a case report of a pseudo-tumoral form]. / Fibrose endomyocardique au cours de la maladie de Behçet: un cas à forme pseudo-tumorale.

Endomyocardial fibrosis is very rare in Behcet's disease. The authors report the case of a 28 year old patient with Behcet's disease complicated by a pseudo-tumoral right ventricular formation on echocardiography. This misleading appearance suggested the diagnosis of cardiac thrombus or tumour and led to a surgical approach which revealed a fibrous moderator band suggesting endomyocardial fibrosis, confirmed by antomopathological analysis. Besides the originality of this case and the unusual pseudo-tumoral presentation, the authors underline the difficulties of establishing the diagnosis, despite the advances of medical imaging. The pseudo-tumoral intra-cardiac lesion in a suggestive clinical context (Behcet's disease) should raise suspicion of the diagnosis of endomyocardial fibrosis.

[Hydatid cysts of the liver opening in the biliary tract. Report of 64 cases]. / Les kystes hydatiques du foie rompus dans les voies biliaires. A propos de 64 cas.

STUDY AIM: The aim of this retrospective study was to report a series of patients with hydatid cyst opened in the biliary tract, who were operated in Morocco. PATIENTS AND METHOD: From 1991 to 1998, among 250 hydatid cysts of the liver operated in the same center, 64 were in communication with the biliary tract (25%). There were 39 men and 25 women. The mean age was 34.2 years (range: 6-60). The revealing symptoms were abdominal pain, jaundice or cholangitis, but the biliary fistula was asymptomatic in more than 50% of the patients. The hydatid cysts were recognized by ultrasonography in all the patients but the biliary fistula was only suspected in 17 patients. The surgical procedure included drainage and sterilization of the cyst, resection of the protruding wall of the cyst (84.4%), unblockage of the main hepatic duct (n = 21) associated with a Kehr drainage, and treatment of the bilio-cystic fistula with suture (n = 23) or double side drainage (n = 24) or cystobiliary disconnection (n = 15). RESULTS: There were two postoperative deaths due to septic shock (n = 1) and encephalopathy secondary to a biliary cirrhosis (n = 1). The morbidity rate was 25%. Among complications, there were four subphrenic abscesses, four prolonged biliary leakages and two intestinal obstructions. The main hospital stay was 20 days. CONCLUSION: The opening of hyatid cysts of the liver into the biliary tract may be silent or revealed by biliary symptoms. The results of this series favour a conservative procedure, including resection of the protruding wall of the cyst and cysto-biliary disconnection, in spite of a high morbidity rate and a long hospital stay.

[Primary tuberculosis of the breast]. / La tuberculose primitive du sein.

BACKGROUND: Despite generalized BCG vaccination, tuberculosis remains a public health issue in France. Breast localizations are exceptional and constitute a diagnostic and therapeutic challenge. CASE REPORT: A 34-year-old woman who was nursing her 3-month old infant underwent emergency surgery for a breast abscess that had been incised one month earlier and treated with non-specific antibiotic therapy without success. All necrotic tissue was removed. Pathology provided the diagnosis of tuberculosis. An anti-tuberculosis regimen (INH + rifampicin + PZA + ethambutol for two months followed by INH + rifampicin for 7 months) was instituted. The epidemiology search was negative and no extension was found. The clinical course was favorable at 6 months. DISCUSSION: Tuberculosis is rarely localized in the breast. The main differential diagnosis is breast cancer. Pathology examination is required for diagnosis. Anti-tuberculosis antibiotic therapy may be associated with surgery in case of extension.

[Peritoneal hydatidosis: a study of 25 cases in Morocco]. / Hydatidose péritonéale. A propos de 25 cas marocains.

We carried out a retrospective study of 25 cases of peritoneal hydatidosis. The incidence of this disease was 6.9%, the sex ratio of the patients was about 2/1 and the mean age of the patients was 31.8 years. Peritoneal echinococcal disease was most frequently secondary to the rupture or splitting of hydatid cysts in the liver (84% of cases) or, more rarely, in the spleen (4% of cases). The principal symptoms were unusual abdominal pain and abdominal masses. Ultrasound scan is the radiological method of choice for investigation and for assessing the number of hydatid cysts in the abdomen. It was used in 20 cases in this series and led to diagnosis of the disease in 95% of these cases. The sensitivity of CT scan for topographical diagnosis was about 90%. Serological tests were negative for the five remaining patients. Surgical management depends on the location and number of hydatid cysts and on the general state of the patient. Total cyst removal was performed in ten patients, pericystectomy in nine cases and marsupialization in six cases in which the cysts were located in the Douglas cul-de-sac. None of the patients was treated with albendazole. None of the patients died and the morbidity rate was 20%, due mainly to the hepatic location of the cysts. We observed one case of small bowel occlusion due to a missed daughter vesicle, two abscesses of the residual cavity, one case of pleurisy and one case of unexplained febrile syndrome. No recurrence was observed over a follow-up period of five years.

[Cardiothyrotoxicosis in the young adult in Basedow disease: report of 30 cases]. / Les cardiothyréoses de l'adulte jeune au cours de la maladie de Basedow: à propos de 30 observations.

The authors report on 30 cases of cardiothyrotoxicosis in the young adult with Basedow's disease. Cardiac arrhythmia represented the most frequent clinical form of dysfunction, mainly atrial fibrillation. Conductive disorders came second, with seven cases of first-degree atrioventricular block [AVB], one case of second-degree AVB, and two cases of sinusoidal bradycardia. Three cases of ballooning of the mitral valve were detected by echocardiography. Myocardial hypertrophy was found in one case. The authors discuss the various physiopathological hypotheses regarding conduction and myocardial hypertrophy anomalies. No cases of severe cardiac insufficiency or coronaropathy were noted, which is explained by the absence of cardiopathic antecedents and the young age of the patient population. Treatment is more complicated in the case of a preexisting cardiac event.

[Papillary fibroelastoma of the large mitral valve disclosed by ischemic cerebrovascular accident: a case report]. / Fibroélastome papillaire de la grande valve mitrale révélé par un accident vasculaire cérébral ischémique: à propos d'un cas.

Thirty-four observations of papillary fibroelastoma (PFE) of the mitral valve have to date been reported in the literature. Our findings are the tenth so far documented on PFE revealed by a cerebral ischaemic vascular accident. The echocardiographic investigation detected a pedunculated tumour of the mitral valve 9 mm in diameter, and associated with moderate mitral leakage. The tumour was surgically excised tumour confirmed the original PFE diagnosis. The evolution seven years after surgery is favourable, with no signs of tumour recurrence and good functioning of the mitral valve system.

[Traumatic left ventricle-right atrial communication. A case report]. / Communication ventricule gaucheoreillette droite traumatique. A propos d'un cas.

The authors report the case of an acquired left ventricle-right atrial communication after open chest trauma. The initial clinical presentation was a haemothorax and haemopericardium responding well to emergency surgical drainage. Secondarily, a systolic murmur suggesting a ventricular septal defect and signs of right heart failure were observed. Colour Doppler echocardiography led to the diagnosis of a left ventricle-right atrial communication associated with tricuspid regurgitation with dilatation of the right heart chambers and pulmonary hypertension. At surgery, a defect in the membranous interventricular septum was confirmed with rupture of the septal tricuspid leaflet causing tricuspid regurgitation. The surgeon closed the defect with a patch and performed a De Vega tricuspid valvuloplasty. The postoperative outcome was uneventful.

[Angiosarcoma of the right atrium. Presentation of a surgically treated case and comparison with data of the literature]. / Angiosarcome de l'oreillette droite. Présentation d'un cas opéré et comparaison avec les données de la littérature.

The authors report the case of a 28-year-old woman referred to their department by a respiratory medicine department with an inferior mediastinal tumour arising from the right atrium, presenting in the form of dysponea, dry cough and chest pain associated with a general syndrome composed of fever, weight loss and physical asthenia. Physical examination revealed a superior vena cava syndrome, the electrocardiogram showed diffuse repolarization disorders and the chest x-ray showed an opacity of the anterior and inferior mediastinum. The diagnosis of tumour of the right atrium was based on echocardiography and thoracic CT scan. Subtotal surgical resection under cardiopulmonary bypass allowed examination of the histological type of the tumour. After routine chemotherapy, despite negative secondary staging and a favourable immediate course, the patient died 11 months after the operation in a context of local recurrence and hepatic and bone metastases.

[Two-dimensional echocardiography and left heart obstruction in the newborn infant. Diagnostic contribution and impact on therapy]. / Echocardiographie bidimensionnelle et obstacles du coeur gauche chez le nouveau-né. Apport diagnostique et impact sur la conduite à tenir.

Thirty-nine neonates with left heart obstructions (LHO) were investigated by two-dimensional echocardiography (2 D echo). Results of 37 investigations were compared with angiographic data (15 cases) and/or anatomic data (surgery: 20 cases; post-mortem examination: 20 cases). 2 D echo was always performed as an emergency procedure and was interpreted before further hemodynamic investigation. Accurate investigation of the left ventricle and of the aorta (arch and proximal branches) was possible in 38 patients (97%) by combining the supra-sternal and subcostal approaches. The existence of LHO and its localization were correctly predicted by 2 D echo in 37 of 39 cases including: aortic coarctation (Ao co) (23 cases), isolated aortic stenosis (iAo S) (5 cases), interruption of the aortic arch (IAA) (3 cases), hypoplastic left ventricle (6 cases), and ranged LHO (2 cases). In 2 patients, one of whom presented with transposition of the great arteries, a coarctation was overlooked and a false positive (Ao co) was found during the same period in a prospective study of 100 neonates by 2 D echo (sensibility 95%, specificity 99%, predictive value 97%). In all patients, 2 D echo made it possible to establish the associated lesions that could modify therapeutics. In no case was emergency diagnostic surgery necessary and the last 9 patients of this series underwent successful therapeutic surgery only on the basis of echographic data.

[Evaluation of the pulmonary artery and its branches by two-dimensional echocardiography in the tetralogy of Fallot and pulmonary atresia in infants. Angiocardiographic correlation and therapeutic implications]. / Evaluation de l'artère pulmonaire et de ses branches en échocardiographie bidimensionnelle dans la tétralogie de Fallot et l'atrésie pulmonaire chez le nourrisson. Corrélation angiocardiographique et implication thérapeutique.

Twenty-two infants aged 5 days to one year (mean: 3.8 months), consisting of 17 with tetralogy of Fallot and 5 with pulmonary atresia-ventricular septal defect, were prospectively investigated by two dimensional echocardiography (2 D echo) in order to evaluate the severity of the impairment of the pulmonary outflow tract and value of 2 D echo in the preoperative evaluation. Right pulmonary artery (PA), observed by angiography in 20 patients, was correctly recorded and could be measured in all cases (20/20), whereas the left PA was seen in 19 patients (19/20). Pulmonary confluence was recognized in 20/20 cases and its absence in 2 cases. In one patient without pulmonary confluence, a large substituted systemic vessel was mistaken for right PA. Echo established in the 22 patients (100%) the presence (17 cases) or absence (5 cases) of continuity between the right ventricle and the PA. Echo demonstrated 2 out of the 3 stenoses of the branches found by angiography. The internal diameter of PA measured by echo, ranging from 3 to 9 mm, was compared with angiographic measurements. A significant linear correlation was observed for each diameter (ring, trunk and branches) between the two techniques. However, echo slightly under-estimated the angiographic diameters. These results show that 2 D echo is a reliable method to determine the severity of impairment of the pulmonary outflow tract in infants with tetralogy of Fallot. They suggest that is may be used to guide the choice of surgical procedure and is adequate, in selected patients, to carry out a palliative intervention without open surgical procedure.

[Supraventricular arrhythmia in newborn infants and interatrial septal aneurysm]. / Dysrythmies supraventriculaires du nouveau-né et anévrisme du septum interauriculaire.

Three neonates with relapsing supraventricular arrhythmia, diagnosed in utero in one case, presented with aneurysm of the atrial septum (AAS) found at TM and bidimensional echocardiographic examination. Arrhythmia consisted of atrial flutter 1/1 or 2/1 (1 case) or supraventricular extrasystoles with episodes of supraventricular tachycardia (2 cases). Although AAS not associated with congenital heart disease related with a downstream obstacle on the right or left heart is considered a rare condition, it is likely that echocardiography will disclose it more frequently. Anyhow, it seems worthwhile searching for it in cases with apparently primary supraventricular arrhythmias. Although the precise relationships between arrhythmia and AAS are not yet known, one could suggest that this organic anomaly is susceptible of originating and of maintaining the arrhythmia longer, if not in a more sever fashion, than in neonatal isolated arrhythmia, especially without any preexcitation syndrome. Further studies are necessary for a better understanding of the meaning and mechanism of such an association.

[Use of emergency 2-dimensional echocardiography in the diagnosis and maintenance of newborn and nursing infants hospitalized because of poorly tolerated cardiopathy. A prospective study of 82 cases]. / Apport de l'échocardiographie bidimensionnelle en urgence dans le diagnostic et la conduite a tenir chez le nouveau-né et le nourrisson hospitalisés pour cardiopathie mal tolérée. Etude prospective de 82 cas.

The value of 2D echocardiography was assessed prospectively in 82 patients (average age 2.6 months) including 41 newborn babies, in the emergency investigation of cardiac distress. The recording was made before any other investigations or treatment and associated subcostal and supra sternal views, and the results were compared with angiography (64 cases) or anatomical findings (44 cases). A cardiac abnormality was excluded in 5 cyanotic newborn children (persistent foetal circulation) and a precise diagnosis was made in 74 of the remaining 77 patients (94 p. 100). All cases of malposition of the great vessels were recognised (17 cases). The diagnosis was based on the simultaneous recording of the vessels, proximal branches and their ventricular connections. In conditions with severe obstruction of the pulmonary outflow tract (26 cases), 2D echo enabled an exact evaluation of ventriculo arterial concordance, pulmonary confluence and a quantitative assessment of the diameter of the pulmonary artery in 25 patients. Angiography provided little further information, mainly concerning associated lesions (anterior muscular VSDs, abnormalities of the supra aortic vessels). On the other hand, 2D echocardiography was superior to angiocardiography for the study of the atrioventricular values and intracavitary and subvalvular obstruction. 2D echo is a reliable method for emergency assessment of the indication for therapeutic catheterisation (atrioseptostomy). In other cases it allows it to be deferred and guided. The comparison of the results of 2D echo and angiocardiography in this series suggests the possibility of reducing the number of endocavitary investigations in the newborn and infant in the future, even in cases where surgery is being considered.