[Digital ischemia revealing multiple myeloma]. / Une ischémie digitale révélant un myélome multiple.

Digital ulcers generally arise in a context of microangiopathy-related focal ischemia. In women, connective tissue diseases are the main etiology, while in men the cause is often diffuse arterial disease, e.g. Leo-Buerger disease, or emboligenic heart disease. A paraneoplastic origin of digital necrosis due to ischemia is rarely reported. A 75-year-old man presented with cyanosis of the fingertips and toes that had begun one month earlier. The physical examination found pulp ulcers on the fingers and toes of both hands and feet. Two weeks later, necrotic damage developed distally, with no other associated symptoms. Blood tests were suggestive of Kahler disease; immunodeficiency disorders tests were negative; the cyroglobulin test was positive. Multiple-drug chemotherapy was followed by clinical improvement. Distal necrotic damage is a frequent inaugural symptom in vascular disease. If the common causal mechanisms (iatrogenic, occupational, toxic, atheromatous, emboligenic heart disease, or systemic disease) have been ruled out, it is important to search for a blood disorder or cancer as the cause of distal necrotic damage.

[Takayasu's arteritis revealed by aortic regurgitation with ascending aortic aneurysm (About 2 cases)]. / Maladie de Takayasu révélée par une fuite aortique massive associée à un anévrisme de l'aorte ascendante (A propos de deux cas opérés).

Aortic regurgitation caused by non-specific aortitis is relatively rare, and is now considered as an important risk factor related to mortality. Aortic valve replacement surgery is the only curative treatment. Aneurismal dilatation of the ascending thoracic aorta associated with aortic regurgitation is a rare involvement in Takayasu, there are many difficult problems in surgical treatment of this lesion, because of its inflammatory nature, so steroid therapy before and after surgery is therefore vital. We report the cases of tow young Moroccans women (32-35 years-old) with an ascending aortic aneurism associated to aortic insufficiency. The subsequent evaluation of the entire aorta, demonstrated the presence of multiple steno-occlusive lesions. Aortic valve replacement was performed associated with graft replacement of the ascending aorta without coronary artery reimplantation. Histopathological examination of the ascending aorta and aortic valve, showed findings in favour Takayasu's arteritis.

[Arterial blood pressure in Moroccan children and adolescents]. / La tension artérielle chez l'enfant et l'adolescent marocains.

To develop blood pressure reference values for Maroccan children, a survey was carried out in 1987-88 in a group of 10,000 children 4 to 18 years of age. Study subjects were randomly selected among schoolchildren from the Great Casablanca Wilaya. There were 4,818 boys and 5,182 girls. To ensure optimal reliability of data, a precise, standardized methodology was used; blood pressure was measured in the supine position after at least five minutes rest, two cuffs of different sizes were available and selected according to age and body weight, and diastolic blood pressure was defined as Korotkow phase V. Distribution of blood pressure values was studied by age, sex and stature. Results were expressed as means +/- standard deviations and as percentiles. Blood pressure values were found to increase gradually with age, with sex-specific variations. Values were higher in post-pubertal girls. A linear positive correlation between arterial blood pressure and stature was found. This correlation was stronger than the blood pressure-age correlation. These data were compared with previous reports in the literature, although this analysis proved difficult because of variations in methods and results across studies.