[A Tunisian case of pachydermoperiostosis]. / La pachydermopériostose. Expériences tunisiennes.

Clubbed fingers are classically associated with chronic cardiac and pulmonary affection. Pachydermoperiostosis, a rarer aetiology, is a hereditary affection which is difficult to diagnose in its incomplete form. We relate a Tunisian case report. Our patient consulted for joint manifestations. The diagnosis of Pachydermoperiostosis was set up on 3 out of the 4 Borochowitz criteria. The osteoarticular manifestations mainly led to differential diagnosis with secondary hypertrophic osteoarthropathy. The underlying pathogenic mechanism of this disease still remains unclear.

[Chronic recurrent multifocal osteomyelitis: a case report]. / L'ostéite chronique récurrente multifocale: a propos d'un cas.

Chronic recurrent multifocal osteomyelitis (CRMO) is a recognized condition that usually affects children and adolescents. It's characterized by insidious onset of local swelling and pain in affected bones. Clinical, biological and especially radiological abnormalities are suggestive of septic osteomyelitis, so the diagnosis is delayed. Bone biopsy with culture is certainly necessary to rule out bacterial osteomyelitis and bone tumor. Authors report the case of a 27-years old man in whom the diagnosis of CRMO was done after 14 years course.

[Tuberculous sacro-iliitis: a series of twenty-two cases]. / Sacro-iliites tuberculeuses: à propos de 22 cas.

BACKGROUND: Despite their relative rarity, increased awareness of tuberculous sacro-iliitis is necessary. Indeed, diagnosis is usually delayed, because of the non specific clinical features and the difficulty to explore the sacro-iliac joint. OBJECTIVE: To study the characteristics of sacro-iliac joint tuberculosis. MATERIALS AND METHODS: A retrospective study of 22 cases of tuberculous sacro-iliitis collected between 1987 and 2003 in four university hospital centres. All our patients were explored clinically and radiologically. Microbiology, biochemical and serologic tests were also performed. RESULTS: 13 cases were confirmed bacteriologically or histologically and for the remaining nine cases evidence of tuberculous sacroiliitis was based on clinical, biological, radiological features and outcome on treatment. Inflammatory pain was present in almost all cases, and a collected abscess in 11 cases. Standard radiographs were also in all cases and ultrasound and CT scan showed an abscess in 8 patients. The average duration of treatment was nine months. The outcome was excellent in the majority of cases. CONCLUSION: Sacro-iliac joint is difficult to explore and has recently beneficiated of technical improvement in imaging and diagnostic. Medical treatment of tuberculosis sacro-iliitis is often sufficient.

[Current aspects of Pott's disease in Tunisia. 29 cases]. / Aspects actuels du mal de Pott en Tunisie. A propos d'une série de 29 cas.

It is a retrospective study, reviewing all cases of vertebral tuberculosis recorded between 1989 and 1999 in La Rabta Hospital (Tunis). 29 patients have been included whose average age was 49 years. The main symptoms which appeared within a average period of six months were vertebral pain, associated with fever in half of the cases. The diagnosis of infectious spondylitis was made according to the results of Computer tomography in 26 cases. The diagnosis of infection was confirmed by characteristic histological pattern and/or culture biopsy. 27 patients were cured without complications except for 2 of them who developed a spinal cord compression. This complication was quickly stemmed by steroid therapy.

[Therapeutic results of 5-fluorouracil in multiple and unresectable facial carcinoma secondary to xeroderma pigmentosum]. / Résultats thérapeutiques du 5-fluorouracile dans les carcinomes multiples ou non resécables de la face secondaires au xeroderma pigmentosum (XP).

A prospective study was done to test the efficacy of 5-fluorouracil (topical and systemic) in multiple and unresectable histologically proven facial squamous cell carcinomas (SCC) secondary to XP. Twelve patients (7M/5F, mean age 19.8 years) with multiple facial SCC were treated between 1994 and 1997. 5-FU was used as a twice-a-day local application in the documented areas, by continuous infusion associated with cisplatin (2 patients) and short infusion combined with folic acid (3 patients). Evaluation was done by clinical examination every two months for topical therapy and after every cycle for systemic treatment. Median treatment duration was 12 months (2 to 36 months). Treatment was well tolerated excluding episodes of pruritus in the treated areas. We observed mainly superficial tumour regression followed by dryness and crusting. In 5 cases, we performed biopsies after treatment showing in one case an extensive fibrosis with absence of tumour. However in the remaining 4 cases, despite a superficial reduction of tumour and a reconstitution of the epidermis, viable and unmodified squamous cell carcinoma remained in the deeper dermis. In the 5 patients treated by systemic 5-FU, we observed 1 complete response and 3 partial responses. Despite a dissociation between a good cosmetic result and a relatively superficial effect, topical 5-FU represents a useful therapeutic option in multiple unresectable facial SCC in patients with XP. Systemic chemotherapy is recommended in the event of more extended or profound lesions.