[Posterior reversible encephalopathy syndrome and eclampsia: a descriptive study of 13 cases in Morocco]. / Syndrome d'encéphalopathie postérieure réversible et éclampsie: étude descriptive de 13 cas au Maroc.

INTRODUCTION: The occurrence of posterior reversible encephalopathy in eclampsia is a rare but known event. We propose to describe the clinical and radiological features and the outcome. METHODS: A retrospective study was conducted from January 2005 to April 2010 including all cases of posterior reversible encephalopathy syndrome (PRES) occurring on eclampsia in patients hospitalized in the obstetrical intensive care unit, University Hospital of Casablanca. RESULTS: Thirteen cases of PRES on eclampsia were collected, the average age was 29 years (18-42). Systolic pressure and diastolic blood pressure at admission were higher than 150 mmHg and 100 respectively in 10 cases. The signs found were: a regressive blindness in five patients and focal signs in four. The complications were thrombocytopenia in 10 patients, abnormal liver function in eight, Hellp syndrome in nine, and acute renal failure in two. The brain regions most commonly affected were the parietal and occipital areas (13 patients), followed by temporal regions, frontal, and basal ganglia (eight patients each). Five patients required assisted ventilation (AV) over 24 hours. Death complicated the outcome in four of our patients, but no deaths were directly attributable to PRES itself, and all four patients had Hellp syndrome and required AV greater than 48 hours. In the other patients, total regression of neurological signs was noted. CONCLUSION: This study emphasizes the severity of the Posterior 'reversible' encephalopathy syndrome on eclampsia.

Eclampsia, study of 342 cases.

OBJECTIVES: To conduct a prospective review of all cases of eclampsia over a 4-year period and to establish prognostic factors that may assist in reducing morbidity and mortality in these patients. METHODS: The population studied was split into two groups: Group1 (survivors) and Group 2 (deceased). We compared their demographic, clinical, biological and radiological data. Patients were regularly followed for 2 months after discharge. Quantitative and qualitative statistic tests were used. RESULTS: 342 cases of eclampsia were studied. Based on 37,467 pregnancies in the 4-year period, in our catchment area, we estimated an overall incidence of 0.91%. 62.5% of patients were nulliparous and 82% of all patients had no ongoing antenatal care. 71% were delivered by Cesarean section. 23 (6.7%) maternal deaths were recorded. Our findings suggested that poor prognosis factors were: diastolic blood pressure 115 mm Hg, Glasgow Coma Scale 8, thrombocytopenia, liver cytolysis, acute renal failure, cerebral edema and hemorrhage, and pulmonary edema. CONCLUSIONS: This disease remains a veritable health problem in our country. We need to improve antenatal follow-up by increasing mothers' awareness and by facilitating access to medical care.

[Post-partum eclampsia: epidemiology and prognosis]. / L'éclampsie du post-partum: épidémiologie et pronostic.

INTRODUCTION: The post-partum eclampsia occurs usually in the first 48 hours, its incidence is between 13 and 37% of all eclampsia. The goal of this prospective study was to analyse the epidemiologic data and the prognosis of this complication in the post-partum stage. MATERIALS AND METHODS: We enrolled between January 1st 2000 to December 31st 2003 all eclampsia admitted to the intensive care unit of the maternity of the university hospital centre Ibn Rochd of Casablanca, Morocco. We noted for each patient epidemiologic, clinical, biological and radiologic data. We releaved outcomoe also. Two groups are individualized: 1) group 1 (N=247): when eclampsia diagnosed in the prepartum stage; 2) group 2 (N=58): when crisis diagnosed in the post-partum stage. We compared the groups (student test), p<0.05 was significative. RESULTS: The incidence of eclampsia in the post-partum in this study was 19% (58 over 305). Eighty-two percent had the crisis in the first 24 hours; we noted a crisis in the sixth, seventh and lately in the sixtieth day. The major proportion of patients are nulliparous (64%), young (mean age: 24 years), without prenatal care, and has high blood pressure (48%), low GCS (mean: 12) and massive proteinuria>3 g/24 hours (37%). The post-partum eclampsia has best out come than these occurring in prepartum, with significantly (p<0.05) less high blood pressure, hellp syndrome and less placental abruption. CONCLUSION: Eclampsia is still frequent in our service; it seems less bad when occurring in the post-partum stage. We must give more attention for severe preeclamptic patient in this period.

[Liver rupture in peripartum: about 8 cases]. / Rupture du foie en péripartum: à propos de huit cas.

OBJECTIVES: Subcapsular liver hematoma (SLH) is a serious complication of the preeclampsia and HELLP syndrom. We report eight cases, and we'll precise circumstances of occurrence of this complication, its management and its prognosis. MATERIALS AND METHODS: Between January 2000 and December 2005, we enrolled eight patients with SLH cases in the intensive care unit of maternity's Ibn Rochd university hospital in Casablanca, Morocco. RESULTS: The patients are 22 to 41-years-old; six are multiparous, without prenatal care. All are preeclamptic. We diagnosed the SLH in prepartum stage in one case, in operating room in five cases and in post partum stage in two cases. We established blood pressure and homeostasis disturbances, the surgeon made packing for six patients with hepatic artery ligature in two cases. In two other patients, we did only medical care. We noted five deaths, four after hematoma rupture. CONCLUSION: These results were compared with literature, we need to look for this complication in all-severe preeclampsia with HELLP syndrome, and treat all haemostatic disorders.

Spontaneous cervical epidural haematoma during pregnancy.

Spontaneous cervical epidural haematoma is very rare during pregnancy. We describe a woman who presented with tetraplegia at 41 weeks of pregnancy. She had no previous history of any relevant medical disorder. Her upper level of anaesthesia was at the second thoracic segment. The condition was diagnosed by magnetic resonance imaging, and both caesarean section and decompression were conducted 12 hours after the event. The neurological deficit showed little recovery. Histology was non-specific and follow-up magnetic resonance imaging showed spinal cord ischaemia. The prognosis in this condition depends on the interval of time between onset and decompression.

Pneumomediastinum and pneumothorax associated with labour.

A 19-year-old primiparous woman in labour presented with spontaneous pneumomediastinum, pneumothorax and surgical emphysema. The membranes were intact and the fetus had a breech presentation. There was little improvement in her symptoms and labour progressed slowly. A caesarean section was performed under intrathecal block resulting in the birth of a healthy infant. The patient's symptoms resolved with supportive management. This condition is very rare and is generally self-limiting. Management aims to avoid worsening of pneumothorax and pneumomediastinum. Recurrence is unlikely.

[Critical analysis of hemostasis disorders in the course of eclampsia. Report of 106 cases]. / Analyse critique des troubles de l'hémostase au cours de l'éclampsie. A propos de 106 cas.

OBJECTIVE: Study of hemostatic disorders during eclampsia, their risk factors, maternal complications and associated mortality. METHODS: Retrospective study concerning 106 cases of severe eclampsia treated in intensive care between September 1992 and December 96. Patients with or without hemostatic disorders were compared for laboratory findings, maternal complications and mortality. RESULTS: Forty patients had hemostasis disorders as follows: isolated thrombopenia in 19 cases, disseminated intravascular coagulation (DIC) in 5 cases, Hellp syndrome associated to DIC in 7 cases and Hellp syndrome in 9 cases. Hemostasis disorders were associated to maternal advanced age, but not with gestational age or blood pressure in admission or time of convulsions. Complications and mortality associated with hemostasis disorders were more frequent compared to patients without hemostasis disorders. Among the 17 deaths of our series, 10 had hemostasis disorders. CONCLUSION: Hemostasis disorders were prognosis factors in eclampsia requiring systematic laboratory tests at admission and immediate delivery.

[Postpartum cerebral thrombophlebitis. A case secondary to acquired antithrombin III deficiency]. / Thrombophlébite cérébrale du post-partum. Un cas secondaire à un déficit acquis en antithrombine III.

The cerebral thrombophlebitis is a rare complication of the pregnancy and the postpartum. We report a case of a 21 year-woman presenting a post-partum cerebral thrombophlebitis, secondary to an acquired deficiency of antithrombin III. The clinical symptoms of cerebral thrombophlebitis can be misleading. The angiography and the magnetic resonance imaging permit the diagnosis. The treatment is relied on anticoagulating heparin therapy. This treatment will be adapted in case of coagulation's factors deficiency that must be searched in any thromboembolic accident having an unusual localization.

[Mesenteric infarction secondary to antithrombin III deficiency]. / Infarctus mésentérique secondaire à un déficit en anti-thrombine III.

AT III is a physiologic inhibitor of blood clot formation: its deficiency is manifested by venous thrombosis. The authors reported case of mesenteric venous infarction in a 42-years-old woman. AT III deficiency was transient and caused by an oral contraceptive. In patients with AT III acquired deficiency it is necessary to suppress any risk factors of venous thrombosis.

[Acute phostoxin poisoning]. / Intoxication aiguë au phostoxin.

Phostoxin is a mixture of aluminium phosphide and ammonium carbonate. When exposed to water, it releases phosphorus hydrogen (PH3), a highly-poisonous gas. In Morocco, death rate from suicide due to self-administration of phostoxin pills is high. Clinical signs include abrupt digestive and nervous disorders. Pulmonary oedema or cardiogenic shock dominate early prognosis. Liver and renal damage is secondary. Prevention requires both legal constraints and regulation of sales.

[Fatal hepatic necrosis during treatment with sodium valproate]. / Nécrose hépatique mortelle au cours d'un traitement par le valproate de sodium.

The authors report a case of fatal hepatic failure in a 19-year old young man suffering from absence seizures and treated for two months with valproic acid (VPA). The duration of VPA therapy before onset of clinical manifestations was four weeks. The prodromal symptoms were weakness, anorexia, and vomiting, then in a few weeks occurred a jaundice and an hepatic encephalopathy leading to death. Among laboratory findings disturbance of liver tests and particularly depressed levels of clotting factors were observed. The histologic study of the liver showed an extended centrolobular necrosis associated with fatty change and fibrosis. The mechanism of this hepatic failure remains unknown. The seriousness of this complication necessitates to respect any contraindications.

Tetanos postoperatoire: a propos de 4 cas a Casablanca (Maroc)

Le tetanos postoperatoire est une affection rare; le but de ce travail est d'en preciser les difficultes diagnostiques et therapeutiques et d'etudier son pronostic. Les auteurs rapportent quatre observations de tetanos postoperatoire; la duree d'incubation est courte: 9 jours en moyenne; et la periode d'invasion est rapide; elle est de 24 a 48 heures. Le trismus est present dans tous les cas. Tous les tableaux sont graves d'emblee. Le traitement a comporte les memes volets que le tetanos commun grave. Trois patients sont decedes: deux complications directes du tetanos et le troisieme par une complication de la reanimation. Le tetanos postoperatoire peut compliquer toute intervention; avec une predisposition de la chirurgie digestive et gynecologique. La porte d'entree est souvent endogene. L'evolution est emaillee de complications inherentes au tetanos et a la reanimation vue la duree de la maldie. Son pronostic est sombre. Un traitement preventif du tetanos est a conseiller chez les sujets a haut risque

[Pulmonary edema following laryngospasm in a child]. / Oedème pulmonaire consécutif à un laryngospasme chez un enfant.

A case is reported of a pulmonary oedema secondary to a laryngospasm in a 10-year-old child during a scheduled orchidopexy. Anaesthesia was induced with 50% nitrous oxide in oxygen and halothane via a face mask. Pulmonary oedema occurred before the relief of the laryngospasm and its course was uneventful after tracheal intubation and mechanical ventilation with PEEP. Hydrostatic forces or an increased capillary permeability are likely causes of the oedema. The outcome is usually favourable.

[Cerebral complication in eclampsia]. / Complications cérébrales dans l'éclampsie.

Many brain complications occur during eclampsia with various degree of gravity. The pathogenesis of these lesions continues to be a source of considerable controversy. Five cases of eclampsia with severe neurologic manifestations were treated in our surgical intensive care unit. The CT image appeared to be related to haemorrhagic lesions (3 cases) and ischaemic lesions (2 cases). The clinical course was favourable, often reversible, in cases with oedema and ischaemia maternal prognosis was poor in the case with haemorrhage.

[Acute hepatic steatosis in pregnancy can be cured without interrupting the pregnancy]. / La stéatose hépatique aiguë gravidique peut guérir malgré la poursuite de la grossesse.

Fatty liver during pregnancy is an acute hepatic disease of unknown origin. We report the case of a 24-year-old woman in whom the diagnosis was made on the basis of the histological examination. The disease did not disturb the normal course of the pregnancy and delivery. In the literature, it is generally suggested that pregnancy must be terminated in cases of acute fatty liver since no favourable outcome has been reported with continued pregnancy. We suggest that, in minor forms, close clinical observation and laboratory monitoring can provide the means of continuing the pregnancy to term.

[An unusual case of HELLP syndrome]. / Un cas singulier de HELLP syndrome.

The Hellp's syndrome is a complication of gravidic hypertension which associates the microangiopathic hemolysis, the cytolytic hepatic anomalies and a thrombocytopenia. There are resemblences between the biologic and histologic forms of the thrombotic microangiopathy and Hellp's syndrome. In this publishing, we report one case of Hellp's syndrome which the particular character is that the hepatic and hemolytic biologic anomalies are still very discrete, where as the thrombopenia is deep; this led us to rediscuss about the authencity of Hellp's syndrome. A neurologic complication, particulary gravissim, is noticed in one case, it concerns the intracerebral hematoma with left deficiency syndrome.

[Severe hemobilia of cholecystic origin]. / Hémobilie grave d'origine vésiculaire.

The authors report a case of severe hematobilia originating in the gall bladder itself ans associated with a cholecysto-colic fistula. They review the different etiologies of hematobilia and stress the major value of selective arteriography of the coeliac trunk and possible pitfalls in this condition. This case highlights the rare complications of cholelithiasis (hematobilia and cholecyto-colic fistula) and the severity of blood spoliation. Therapy is reviewed as a function of the lesion causing hematobilia.