[Epileptic seizures and vardenafil]. / Crise d'épilepsie et vardenafil.

INTRODUCTION: Epileptic seizures complicating treatment with selective inhibitors of phosphodiesterase type 5 are scarcely reported. CASE REPORT: A previously non-epileptic 78-year-old patient presented with a partial epileptic seizure following oral intake, for the second time, of 10mg of vardenafil (Levitra). The brain MRI failed to show any preexisting lesion. To our knowledge, only 2 cases of generalized tonic-clonic seizures induced by sildenafil (Viagra) use have been reported. In our patient, the seizure could be due to the epileptogenic potential of the drug or to its vascular complications. CONCLUSION: Further studies are needed to elucidate the association of phosphodiesterase inhibitors use and epileptic seizures.

[Neurobrucellosis: clinical features and therapeutic responses in 15 patients]. / Neurobrucellose: études clinique et thérapeutique de 15 patients.

We report a retrospective analysis of 15 cases of neurobrucellosis. Initial clinical manifestations consisted of meningoencephalitis in 5 patients, acute and subacute meningitis in 4, intracranial hypertension in 2, polyradiculoneuritis with albumin-cell dissociation in 2 (one with cerebral and subarachnoid hemorrhage), and transverse myelitis and lumbar epidural abcess with root involvement in 1 each. Cranial nerve involvement was noted in 5 patients. Fever was absent in 3. Transient clinical manifestations mimicking transient ischemic attacks were noted in 3 patients. Unusual central nervous system demyelinating lesions were observed on the MRI in 1 of the patients with meningoencephalitis. Cerebrospinal fluid Wright titers and culture were rarely helpful. Most patients responded favorably with minor neurological sequelae. The most commonly used antibiotics were rifampin, doxycycline, and trimethoprim-sulphamethoxazole, in various combinations for at least 3 months. The differential diagnosis of neurobrucellosis is wide. However, in endemic areas, the disease should be ruled out in all patients who develop unexplained neurological symptoms.

[Tramadol-induced epileptic seizures]. / Crises d'épilepsie induites par le tramadol.

A previously non-epileptic 17-year-old patient presented with 2 generalized epileptic seizures, which occurred at 6 months of interval, following the oral intake of 200-250 mg of tramadol. Urine analysis showed only the product and its metabolites. Epileptic seizures induced by tramadol and high risk factors are described and discussed.

[Human brucellosis. Retrospective studies of 63 cases in Lebanon]. / Brucellose humaine. Etude rétrospective de 63 cas observés au Liban.

OBJECTIVES: We performed an epidemiological survey to ascertain the clinical features of brucellosis in Lebanon. PATIENTS AND METHODS: Between 1994 and 1998, 63 patients were seen at the Hôtel-Dieu de France Hospital in Beirut Lebanon. Diagnostic criteria were brucellar agglutinins at a titer > or = 1/160 with symptoms suggestive of brucellosis in the absence of another diagnosis. We also conducted a survey in 1138 cases registered by the Ministry of Health during the same period. RESULTS: Among the 1137 cases, 40% of the patients were over 60 and only 16% were under 14. The overall male to female ratio was 1.01 and 69% of the patients were seen in spring and summer. Among the 63 patients, 10 were pediatric cases. The disease was acute in 41 (65%), subacute in 21 (33%) and chronic in 1. The main presenting symptoms were fever, sweating, easy fatigability and joint pain. Osteoarticular involvement was the most prevalent complication (25%), predominantly spondylitis. Among the blood tests, relative lymphocytosis was significantly more frequent in children than adults (80% versus 13%, p < 0.001). CONCLUSION: Brucellosis is still an endemic disease in Lebanon and should be considered notably in patients presenting with prolonged fever, and articular and neurological manifestations.

[Hypovitaminosis D: a major worldwide public health problem]. / L'hypovitaminose D, problème mondial majeur de santé publique.

PHYSIOLOGY: Vitamin D increases intestinal absorption of calcium favoring the microenvironment necessary for bone mineralization. In addition, vitamin D prevents hypocalcemia via its osteoclastic action. Severe hypovitaminosis leads to rickets in children and its equivalent in adults, osteomalacia. Mild to moderate hypovitaminosis D causes secondary hyperparathyroidism increasing the risk of fracture, particularly femoral neck fracture. Vitamin D would also have an antiinflammatory and anticancer effect. WORLDWIDE: Hypovitaminosis D is frequently observed in Europe in the elderly, particularly in the institutionalized population, but is also seen in otherwise healthy younger adults. An estimated 40% of the young European population has some degree of hypovitaminosis D. Surprisingly, it is more frequent in sunny Mediterranean countries than in certain northern countries such as Norway. The lower incidence observed in the United States is probably related to the vitamin D supplementation of the American diet. Hypovitaminosis D in Africa and the Middle-East is also an important problem, being considered to be one of the 5 most prevalent childhood diseases in developing countries. ENVIRONMENTAL FACTORS: The limited quantity of vitamin D in food and multiple environmental factors contribute to hypovitaminosis D. These factors include insufficient sun exposure and urban lifestyle with a high degree of pollution. In addition, cutaneous photosynthesis of vitamin D is limited by hyperpigmentation in black people, wearing traditional veils that limit sun exposure, and use of sun lotions, further contributing to vitamin D deficiency. CONCLUSIONS AND RECOMMENDATIONS: The very high prevalence of hypovitaminosis D in the world, and particularly in Europe, Africa and the Middle-East, points to the need for public health measures in these countries. While waiting for these measures to be implemented, vitamin D supplementation (for example in tablet form) should be encouraged in order to meet minimum requirements. Finally, the beneficial effect of moderate sun exposure on cutaneous vitamin D synthesis (and psychological well-being) must not be overlooked.

[Agents and consequences of nosocomial infections in a Lebanese university hospital. Retrospective study over a two-year period]. / Agents et conséquences des infections nosocomiales dans un centre hospitalier universitaire libanais. Etude rétrospective sur 2 ans.

OBJECTIVES: Study the common sites of nosocomial infection, pathogens and antibiotic resistance in a university hospital. METHOD: Retrospective study during 1997 and 1998. RESULTS: One hundred eighty nosocomial infections were recorded in 154 patients. The incidence was 1.3 per 1 000 patient-days. Pneumonia was the second most frequent type of nosocomial infections after urinary tract infection, but caused the highest mortality. Gram-negative bacteria were the predominant agents (81%) with a major antibiotic resistance. CONCLUSION: A strict application of the preventive measures and surveillance program is warranted to control outbreaks of these infections.

[Vertebral actinomycosis: case report and review of the literature]. / Actinomycose vertébrale: a propos d'un cas et revue de la littérature.

In this article, the case of a 32-year-old man with a paravertebral actinomycosis is discussed. Initially, the diagnosis was not obvious but it was confirmed later with the repetitive radiologic procedures, the elimination of other etiologies (purulent, mycobacterial or mycotic infections and neoplasia) and the biopsy. Treatment with penicillin initially and then with tetracycline for a long term led to a very good outcome at a 3-year follow-up with a radiologic remission. Following the discussion of the case, a review of the literature concerning the paravertebral actinomycosis, its diagnostic clues and treatment is undertaken.

[Behçet disease. Genetic factors, immunologic aspects and new therapeutic methods]. / La maladie de Behçet. Facteurs génétiques, aspects immunologiques et nouveautés thérapeutiques.

PATHOGENESIS: The pathogenesis of Behcetp3disease is still unknown, although a genetic predisposition appears to play an important role with a strong association with the MICA gene located between the HLA-B and TNF genes rather than HLA B51. Abnormal immune responses affect especially cellular immunity and significant T-cell proliferative responses by the gamma ô subset of T cells are shown after stimulation with heat shock protein peptides. Systemic levels of the soluble TNF R-75 and IL 12 could be the best biological markers of disease activity. NEW THERAPEUTIC APPROACHES: Systemic colchicine being implicated in polynuclear neutrophil over-production of toxic super-oxides, its prescription for controlling eye involvement should be reevaluated. Steroids and immunosuppressive drugs are still the treatment of choice for severe manifestations of the disease. Beneficial effects of cyclosporine are established in uveitis. Tacrolimus (FK 506) and pentoxifylline may be valuable.

[Unusual presentation of typhoid fever. Apropos of 3 cases]. / Presentations rares de la fièvre typhoïde. A propos de 3 cas.

Typhoid fever is still an endemic disease in Lebanon with a risk of mortality especially in the immunosuppressed patients. We report 3 atypical observations and discuss cardiopulmonary, neurological, hematologic and urinary manifestations of this disease.

[Neonatal lupus erythematosis and atrial-ventricular block. A case report and review of the literature]. / Lupus erythemateux neonatal et bloc auriculo-ventriculaire. A propos d'un cas avec revue de la littérature.

Neonatal lupus erythematosus is a rare syndrome. It is characterized by a transient lupus dermatitis and congenital heart block. The immunopathogenesis of the disease has been linked to the presence of the SSA antibody. In this report, we describe a symptomatic congenital heart block in a 13-year-old male whose mother had documented systemic lupus erythematosus. We also discuss how to manage a woman with lupus erythematosus and positive antiSSA/Ro antibodies. We conclude that patients with neonatal lupus and their mothers should be observed closely before delivery and for prolonged periods for signs of active disease.

[Vitamin D status in aged subjects. Study of a Lebanese population]. / Statut vitaminique D des sujets âgés. Etude de la population libanaise.

OBJECTIVES: To evaluate vitamin D status in two subgroups of the Lebanese aged population. To compare results with reference values observed in healthy young volunteers. METHODS: Fifty aged institutionalized patients (25 men and 25 women) and 51 aged ambulatory subjects (25 men and 26 women) underwent the following explorations during winter: serum 25-OH vitamin D, parathyroid hormone, corrected serum calcium, phosphorus, creatinine, and alkaline phosphatases and urinary calcium/creatinine. Serum 25-OH vitamin D and urinary calcium/creatinine were also measured in 34 healthy young volunteers. RESULTS: Serum 25-OH vitamin D levels in 25 ambulatory subjects (49%) and 30 institutionalized patients (60%) were below 10 ng/ml. There was non significant difference in 25-OH vitamin D levels between the ambulatory and institutionalized aged populations, nor between aged women and aged men. Parathyroid hormone, alkaline phosphatases and urinary calcium/creatinine levels were higher in the institutionalized population than in the ambulatory population (p = 0.07; p = 0.0001; p = 0.0001 respectively). Aged women had higher parathyroid hormone and calcium/creatine levels than aged men (p = 0.005; p = 0.005 respectively). Finally, in the young population, 25-OH vitamin D was higher than in the aged institutionalized and ambulatory populations (p = 0.0001 and p = 0.0009 respectively). An inverse non-significant correlation (r = -0.16) was found between parathyroid hormone and 25-OH vitamin D. CONCLUSION: Our results show that even in a sunny country like Lebanon, vitamin D deficiency is often observed. The degree of deficiency probably lies between that observed in Europe and the United States. It could be related to low vitamin D diet.

[Werner's syndrome]. / Syndrome de Werner.

BACKGROUND: Werner's syndrome associates early aging in young adults, small height, cataract, glucose intolerance, hypogonadism, skin ulcers, vascular calcifications and osteoporosis. CASE REPORT: We report a new case of Werner's syndrome in a 34-year-old man with suggestive alterations of the skin and endocrine anomalies in addition to hypospadias, urethral stenosis, bilateral mega-ureter and chronic renal failure. DISCUSSION: The diagnosis of Werner's syndrome in our patient was unquestionable because of the clinical presentation and the familial context. However, the urology anomalies have not been reported in this syndrome. A simple coincidence cannot be excluded.

[Neurologic manifestations in Behçet's disease. 16 cases in a cohort of 110 patients]. / Manifestations neurologiques de la maladie de Behçet. Seize observations dans une cohorte de 110 malades.

OBJECTIVE: To discuss neurological involvement of Behçet's disease and therapeutical possibilities. PATIENTS: Among 110 patients with Behçet's disease, 16 were found to have neurological involvement. All these patients fulfilled Japanese and International Study Group criteria for diagnosis of Behçet's disease. RESULTS: Central nervous system involvement was found in 15 patients and peripheral nervous system involvement in one. Meningoencephalitis and/or transverse myelitis were the most frequent features (69%) followed by tumor-like manifestations (13%); cerebral venous thrombosis was identified in 1 patient with occlusion of the left lateral sinus. Focal deficits were the major presenting signs and cranial paralysis were present in 19% of patients. In meningoencephalitis, the cerebrospinal fluid findings were lymphocytic pleocytosis and elevated protein level. Cerebral CT Scan, performed in 6 patients, was normal in 33% of cases. MRI, performed in 4, showed abnormal signals distributed over hemispheric white matter, the brainstem and the thalamus in one patient, an occlusion of the left lateral sinus in the second one and a tumor-like lesion in the third. MRI abnormalities were associated with concording clinical deficits. CONCLUSION: Neurological involvement in Behçet's disease con be classified into 3 clinical aspects: meningoencephalitis (and/or myelitis), cerebral venous thrombosis and tumor-like features. Corticosteroids, when prescribed early, are useful and are associated with better prognosis.

[Scleroderma with anomalies of the thyroid function. 7 cases]. / Sclérodermie avec anomalies de la fonction thyroïdienne. Sept observations.

Thyroid function, studied in 36 scleroderma patients revealed 7 abnormal cases: 6 hypothyroid patients secondary to autoimmune thyroiditis and 1 hyperthyroidism secondary to Graves' disease. In the hypothyroid subgroup, 3 cases presented a localized systemic sclerosis and the 3 others presented a diffuse systemic sclerosis; Sjögren syndrome was found in 2 of these patients. The hyperthyroid patient presented a diffuse systemic sclerosis. Because of the association between scleroderma and thyroid diseases, we suggest to perform thyroid screening regularly for all patients with systemic sclerosis.

[Inflammatory intestinal diseases and their extra-intestinal manifestations observed at Liban]. / Les maladies inflammatories des intestins et leurs manifestations extra-intestinales au Liban.

101 cases classified as inflammatory bowel disease at the Hôtel-Dieu de France Hospital between 1982 and 1994 were investigated. Files containing a sure diagnosis and complete clinical and biological investigations were included. 65 files were retained for the study: 48 cases had ulcerative colitis (UC), 17 had Crohn's disease (CD). UC averaged 4.7 admissions per 10,000 admissions to the hospital, while CD averaged 1.54 per 10,000. The UC/CD ratio was 2.8 and the Female/Male ratio was 1.4 for UC and 0.9 for CD. Medium follow-up was 6.4 years. 30% of our group was followed for more than 10 years. Overall frequency of extra-intestinal manifestations was similar to that reported worldwide. This is especially true for UC. However, no cases of ankylosing spondylitis, sclerosing cholangitis or erythema nodosum were found. One case of pyoderma gangrenosum was found in the series of CD. Extra-intestinal manifestations were found in 54% of UC patients and 94% of CD patients, probably because milder cases of this disease were misclassified as infectious diarrhea.

[Nervous system brucellosis in Lebanon. Report of six cases]. / La neurobrucellose au Liban. A propose de 6 observations.

The authors report 6 cases of nervous system brucellosis (3 males, 3 females) and present the different clinical features of this localization. Meningoencephalitis is observed in 4 patients and is associated with subarachnoid hemorrhage in one. Pure meningitis occurred in one case and acute myelitis in another one. Cerebrospinal fluid composition is studied in all these patients. Rifampicine associated with Cotrimoxazole, for at least 3 months, is very helpful in nervous system brucellosis because of their good central nervous system penetration but neurological sequelae are noted in one case of meningoencephalitis with chronic infection and in the case of myelitis.

Behçet's disease in Lebanon: report of 100 cases.

PURPOSE: To present clinical features of Behçet's disease in Lebanon and to evaluate the efficacy of treatment. PATIENTS AND METHODS: The 100 patients are seen at Hotel-Dieu de France Hospital of Beirut between 1980 and 1992. Diagnostic criteria are those of the Behçet Syndrome Research Committee of Japan. RESULTS: Recurrent oral ulcers are present in 95% of cases, genital ulcers in 78%, ocular manifestations are more frequent than those of several studies whereas skin lesions and vascular signs are less frequent. Joint involvement are recorded in 65% of cases and neurological one in 14%. The effectiveness of colchicine therapy is confirmed for mucocutaneous lesions and arthritis. Immunosuppressive agents are more beneficial than steroids alone on serious uveitis. An aggressive treatment with corticosteroids and immunosuppressive drugs improve the prognosis of meningoencephalitis. CONCLUSION: Behçet's disease doesn't have any specific characteristics in Lebanon despite some variation in the frequency of lesions.