[Unexplained diffuse arteriosclerosis in a 26-year-old patient]. / Artériosclérose diffuse inexpliquée chez une jeune patiente de 26 ans.

Arteriosclerosis is an alteration of the blood vessels whose walls calcify, lose their elasticity and thicken. The result is a decrease in circulating blood flow and ischemic manifestations. Calcification of the arteries is a physiological phenomenon in the elderly but young subjects may also be affected. Indeed, certain risk factors can favor the formation of plaques at the level of the vessels. These include classic cardiovascular risk factors, as well as systemic inflammatory diseases, connective tissue diseases, chronic hypercalcemia… We report the case of a 26-year-old female patient with diffuse arteriosclerosis discovered accidentally, and whose exhaustive etiological investigation remained negative.

[Primary retroperitoneal fibrosis: a report of 7 cases]. / La fibrose rétropéritonéale idiopathique: à propos de sept cas.

Retroperitoneal fibrosis is a rare fibrosing disease of the retroperitoneal tissue characterized by a significant clinico-biological polymorphism. No codified treatment exists, particularly for the primary type which is the most frequent. We retrospectively report on 7 cases of primary retroperitoneal fibrosis seen over a period of 10 years. There were 4 men and 3 women (mean age: 58 years).The most common presenting symptom was lumbar pain. A biological inflammatory syndrome and a renal insufficiency were found in 4 cases. The diagnosis was confirmed by abdominal CT scan and/or histology. Etiological investigations remained negative. The evolution was generally favourable under corticosteroids. Retroperitoneal fibrosis requires a careful etiological investigation before it is considered primary. Prognosis is good in spite of the absence of a well codified treatment.

[Isolated abdominal pain revealing a paraprosthetic fistula in a patient with Takayasu arteritis]. / Douleur abdominale isolée révélant une fistule paraprothétique au cours d'une maladie de Takayasu.

Aortic aneurysms and stenosis occurring in Takayasu arteritis may require aortic prosthesis that can be complicated by aorto-digestive fistula. We report a 41-year-old female who presented with an isolated abdominal pain revealing a para-prosthetic aorto-duodenal fistula complicating a Takayasu arteritis. The diagnosis of aorto-digestive fistula may be difficult if abdominal pain is isolated and imaging inconclusive. Surgical procedure may be necessary to obtain the diagnosis and constitutes the main part of the treatment before fatal outcome.

[Diagnostic strategy and management of anemia: a consensus from a detailed study of 100 patients followed in internal medicine]. / Strategie diagnostique et conduite pratique devant une anemie: d'apres une etude approfon- die de 100 patients suivis en medecine interne.

Anemia is a frequent reason for seeking medical care in Internal Medicine. It is not a diagnosis, but rather a symptom that needs to be investigated in order to find an etiology. In a retrospective review of 100 cases of anemia, the cause was found in 86 % of cases. The etiologic profile was varied. Iron deficiency remained by far the most frequent cause seen in 47% of case. Other etiologies have been found such as neoplasm in 13 % of cases, chronic renal failure in 8% of cases and endocrinal cause in 5 % of cases. We recommend a diagnostic decision tree that provides a tool for rational and cost effective approach for anemia.

[Thyroid surgery (356 cases): risks and complications]. / Chirurgie thyroïdienne (356 cas): risques et complications.

The purpose of this study was to evaluate the risks and complication rate of thyroid surgery. The authors present a retrospective study of 356 patients surgically treated for thyroid nodules, between 1987 and 1998, at the military hospital of Tunis. The patients were categorised into 3 groups: group I: 238 solitary thyroid nodules (66.8%); group II: 92 multinodular goitres (25.8%) included 12 retrosternal goitres (3.37%) and group III: 26 cases of Basedow's disease (7.4%). Patients benefitted from unilateral surgery in 72% of cases and from bilateral surgery (total or subtotal thyroidectomy) in the remaining 28% of cases. Malignancy was found in 34 cases (9.5%). The complications observed were haemorrhage (0.56% of cases), unilateral post operative recurrent laryngeal palsy (1.12% of cases), and permanent hypoparathyroidism in 0.81% of cases. Experienced surgeons and the use of a meticulous surgical technique can reduce the incidence of post operative complications in thyroid surgery.