Exceptional association of Budd-Chiari syndrome with pheochromocytoma.

We are reporting a case revealed by an abdomino-thoracic painful syndrome associated with multi-organ failure. A 61-year-old hypertensive woman was hospitalized for the management of hypertensive emergency associating acute coronary syndrome and abdominal pain. A thoraco-abdomino-pelvic CT-scan showed a right adrenal mass associated with hepatic vein thrombosis. After medical preparation, an adrenalectomy was performed by way of open surgery; the study of the surgical specimen found a pheochromocytoma score PASS 4. The follow-up was marked by the normalization of blood pressure and biological abnormalities.

Ductus diverticulum associated with Takayasu disease and incidental finding of Wolff Parkinson White syndrome.

Ductus diverticulum is either a remnant of the ductus arteriosus or the right dorsal aortic root. The most common diagnosis is the differentiation of an aortic isthmus pseudoaneurysm from a type III ductal diverticulum. Both aortic entities occur at roughly the same anatomical location often leading to diagnostic confusion. Aortic dissection should be considered if it is Takayasu's disease. We are reporting the case of a 31-year-old woman with chest pain and muscle weakness, functional impotence of the left upper limb with intermittent palpitations. Thoraco-abdominal CT angiography was in favor of inflammatory arteritis of the thoraco-abdominal aorta, common carotids and the left subclavian artery. Sub-occlusive stenosis of the left axillary artery was noted, in favor of Takayasu disease. There was an aspect of aortic ductus diverticulum type III, 24mm from the emergence of the subclavian artery simulating aortic dissection or ulceration of the aortic isthmus. An electrocardiogram revealed Wolff Parkinson White syndrome with left lateral Kent. There was good clinical outcome after immunosuppressive drugs and antiarrhythmic therapy.

Subclinical atherosclerosis and arterial stiffness in nonalcoholic fatty liver disease: A case-control study in Algerian population.

BACKGROUND & AIMS: Nonalcoholic fatty liver disease (NAFLD) was described for the first time in 1980, and became within a few years one of the most frequent causes of chronic liver disease. However, during the last decade, many studies suggested a strong relationship between NAFLD and cardiovascular diseases including carotid atherosclerosis evoking the hypothesis that NAFLD is a factor or a marker of cardiovascular risk. In Algeria, data on this subject are rare or inexistent. The objective of our work was to study the relationship between NAFLD and atherosclerosis in an Algerian population without diabetes. PATIENTS AND METHODS: It is a case-control study with a strict matching by age and sex. Non-diabetic participants between 30 and 70 years of age were consecutively included in the department of internal medicine of the public hospital of El Biar. The diagnosis of NAFLD was made by ultrasound and hepatic elasticity was assessed by FibroScan®. We collected the data of the carotid ultrasound, the carotid-femoral pulse wave velocity (cfPWV), ankle-brachial pressure index and arterial pressure (consultation and ambulatory monitoring). Non parametric statistical methods (chi 2 McNemar for the percentages, t Friedman test for medium) were used and the association between variables was estimated by odds ratio (OR). These analyses were performed using SPSS 21.0 software (IBM). RESULTS: 213 patients with NAFLD, with a mean age of 48.5 years±10.14 (100 men/113 women) were matched to 213 controls. The presence of carotid atherosclerotic plaque (CAP) was higher in NAFLD than in controls (31.92% (n=68) vs. 7.05% (n=15), P<0.001). In multivariate analysis, the CAP (OR 8.6, 95% CI [3.6-20.5], P<0.001), high Intima media thickness (OR 2.8, 95% CI [1.4-5.4], P=0.002), CRP≥6mg/l (OR 14.7, 95% CI [5.9-36.9], P=0.001), abdominal obesity (OR 3.8, 95% CI [1.4-9.7], P=0.05), high cfPWV (OR 4.4, 95% CI [2.4-8.1], P<0.001), elevated alanine aminotransferase(OR 4.0, 95% CI [1.6-9.8], P=0.002), overall obesity (OR 2.0, 95% CI [1.0-3.8], P=0.03), dyslipidemia (OR 2.0, 95% CI [1.0-3.8], P=0.02), and elevated GGT (OR 2.8, 95% [1.1-7.1] were independently associated to NAFLD. CONCLUSION: Our study suggests that NAFLD is significantly associated with carotid atherosclerosis and arterial stiffness. These results may have implications in the management of patients with NAFLD in terms of cardiovascular prevention.

Orthostatic hypertension in normotensive type 2 diabetics: What characteristics?

AIM OF THE STUDY: We aimed to determine the prevalence of orthostatic hypertension (OHT) in normotensive, newly diagnosed type 2 diabetics, to assess clinical, biological characteristics of those patients and evaluate the evolution of their blood pressure, after one year of follow-up. MATERIALS AND METHODS: It is an observational, prospective, cohort study, on 108 normotensive, newly diagnosed diabetics, 40 men and 68 women aged from 40 to 70 ans. OHT was defined as an increase of systolic blood pressure (SBP) ≥20mmHg and/or diastolic blood pressure (DBP) ≥10mmHg, after 1 and 2min of standing from supine position. Arterial hypertension and metabolic syndrome were respectively defined according to WHO and AHA 2009 guidelines. Clinical and biological data were collected for all patients. They had a screening for diabetic complications and a follow-up during one year. Statistical analysis was performed with Epi-Info 6.04. RESULTS: We found OHT in 22 patients (20.4%). Patients with OHT had a higher SBP at lying position (P=0.029), a higher waist circumference (P=0.022) and LDL (P=0.041). They had more frequently obesity (P=0.036) left ventricular hypertrophy (P=0.024), metabolic syndrome (P=0.042) and cerebrovascular events (P=0.050) when compared with those with normal blood pressure response to orthostasis. One year after follow-up, the prevalence of permanent hypertension was significantly higher in the OHT group (P=0.0008). CONCLUSION: Our study suggests that OHT is associated with insulin resistance syndrome and onset of sustained arterial hypertension in normotensive, newly diagnosed diabetics.

[The metabolic syndrome in hypertensive black population of South Algeria]. / Le syndrome métabolique chez les hypertendus de la population noire du sud algérien.

INTRODUCTION: The metabolic syndrome is a risk factor for cardiovascular diseases. It exposes to two main complications: cardiovascular diseases and type II diabetes. This risk is higher among women. It causes a high cardiovascular mortality. OBJECTIVES: Assess the prevalence of the metabolic syndrome (MS) among our black hypertensive population. Study of the distribution of the different criteria in the cluster. Search cardiovascular complications. MATERIALS AND METHODS: This longitudinal study that was carried out included one thousand five hundred and fifty subjects of both sexes from black and white populations aged 40 and older, living in the Algerian Sahara and reviewed after six years of decline. The control consisted of filling a questionnaire oriented on civil status, in addition to a clinical examination, including morphometry, measurement of blood pressure performed with validated electronic device (OMRON 705 CP). Also, a biological check-up was done (glycemy, HDL, cholesterol). A univariate and multivariate analysis have been carried out. All calculations and statistical analyzes are processed by the SPSS 17.0 and Epi Info6 software. RESULTS: The MS frequency is 20.8%, more frequent among women than among men, with a significant difference (28.4% versus 15.1%, P<0.001). We found out a difference between black and white populations in terms of obesity (37.6% versus 31.1%), hypertension (60.6% versus 55.0%), diabetes (25.2% versus 19.2%) or other metabolic syndrome criteria. The most frequent complications according to decreasing frequency are: hospitalization for cardiovascular diseases 8.9%, stroke 6.3%, heart failure 5.8%, myocardial infarction 3.6%. The mortality rate is 14.7% among the blacks and 11.3% among the whites without difference. The survival rate of the population is influenced by the MS and by a non-checked blood pressure by an antihypertensive treatment. CONCLUSION: The MS is highly prevailing among hypertensive black population, and significantly higher among women. The ranking of the cluster elements frequency shows clearly the specifities of our population. It is necessary to elaborate an adequate strategy to prevent such cardiovascular morbidity and mortality.

[Cardiovascular morbimortality after a follow-up of six years in black hypertensive in South Algeria]. / Morbimortalité cardiovasculaires en 6ans des hypertendus noirs du sud algérien.

INTRODUCTION: Arterial hypertension is a major public health problem not only internationally, but also in our country, and it is the major risk factor for cardiovascular diseases. In south Algeria, the black population is nearly half the population of the oases of the Algerian Sahara. THE OBJECTIVES OF THE STUDY: The objectives of the study are to analyze the long-term fate of the black hypertensive subjects in Algerian oases in southern Algeria, in terms of morbidity and mortality, comparing the morphometric profile and cardiovascular complications with the white population of the same oases. MATERIALS AND METHODS: One thousand four hundred and twenty-five subjects of both sexes were included (811 blacks and 614 white subjects), aged 40 and older, living in the Algerian Sahara and were reviewed after six years of decline. The control consisted of filling a questionnaire oriented on civil status, target organ damage, the number of hospitalizations and mortality. All calculations and statistical analyzes are processed by the SPSS 17.0 and Epi Info6 software. RESULTS: Mean age for the black population and the white population was 60.3±11.1 and 58.6±10.6years, respectively. The incidence of hypertension was 50 % among blacks. The main complications observed were: stroke in 3.8 %, heart failure in 3.1 %, myocardial infarction in 1.7 %, hospitalizations related to cardiovascular complications of the black population was around 4.4 %, mortality 5.4 %. CONCLUSION: These data on hypertension black subjects emphasize the importance of a policy of adequate local health issues raised, both in terms of the management of hypertension, as in investment in local medical research.

[Prevalence of hypertension in El-Menia oasis, Algeria, and metabolic characteristics in population]. / Prévalence de l'hypertension artérielle dans l'oasis d'El-Menia, Algérie, et profil métabolique de la population.

INTRODUCTION: El-Menia is an oasis located in the middle of Algerian Sahara. The drinking water in this oasis has low sodium content. The objectives of this study were to estimate the prevalence of hypertension, to describe the metabolic characteristics of population study and to assess the factors associated with blood pressure levels. METHODS: A cross sectional study was conducted in 2010. Subjects (n=722) were selected from individuals aged 40 years or older by random cluster sampling. Blood pressure measurements, combined with a clinical questionnaire, and standard blood samples for the detection of dyslipidemia and diabetes mellitus, were collected. RESULTS: Sixty-seven percent of subjects were females and 18% were black. The mean age was 58.5 ± 13.2 years. The prevalence of hypertension was 50.2%: 49.7% in females and 51.3% in males. The factors associated with presence of hypertension following a logistic multivariate regression were age, skin colour, waist circumference, and plasma glucose. The treatment and control of hypertension were 41% and 20% respectively. CONCLUSIONS: The prevalence oh hypertension was high in this oasis and the rate of treatment control was low. Our findings suggest that appropriate healthcare should be given to hypertensive subjects, including a better information on hypertension.