Glomérulonéphrite extra-membraneuse et syndrome myélodysplasique: une association rare

Les syndromes myélodysplasiques peuvent s’accompagner de maladies auto-immunes. L’atteinte rénale au cours de ces syndromes est rare. Dans ce cas, les glomérulopathies prédominent cette atteinte. La glomérulonéphrite extra-membraneuse est exceptionnellement reportée en association avec un syndrome myélodysplasique. Nous rapportons dans ce papier le cas d’une patiente présentant une glomérulonéphrite associée à une anémie révélant un syndrome myélodysplasique de faible risque. Dans la lumière de ce cas, nous faisons une courte revue de la littérature des cas précédemment publiés et nous discutons le lien pathogénique entre ces deux entités

Les rhinopoieses: techniques et indications a propos de 68 cas

La réparation des pertes de substances nasales reste à ce jour une chirurgie difficile et exigeante. En effet, la réparation de chacune des trois couches constitutives de la pyramide nasale pose des problèmes spécifiques d’autant plus qu’il existe une limitation imposée par la quantité et la qualité du matériel disponible, et cela est d’autant vrai pour le tiers inférieur du nez. Ainsi la rhinopoïése moderne ne se contente donc plus de combler une perte de substance, elle a pour ambition de rétablir une apparence aussi normale et aussi esthétique que possible pour que la reconstruction soit fonctionnelle. A travers une série de 68 patients traités au service de chirurgie plastique, chirurgie maxillo-faciale et stomatologie de l’hôpital militaire d’instruction Mohamed V, nous envisageons les différentes techniques de rhinopoïèse et leurs applications pratiques en fonction de la localisation initiale et de l’étiologie de la perte de substance, tout en comparant nos résultats obtenus avec ceux des autres séries publiées dans la littérature

Complete remission of nephrotic syndrome secondary to amyloid a amyloidosis in patient with inactive Crohn's disease after treatment by infliximab

Secondary amyloidosis Amyloid A (AA) is an infrequent but a severe complication of Crohn's disease (CD). This complication results from the activity of the underlying inflammation disease to form amyloid fibril deposits in tissues. We present a case of a 34-year-old female patient with CD treated by azathioprine with inactive disease for three years and who developed a nephrotic syndrome secondary to AA amyloidosis. The treatment by infliximab for one year leads to a complete remission of the nephrotic syndrome. In this case, this complication occurred while the patient was clinically well, with biological and endoscopic markers showing an inactive or only mildly active disease. Infliximab could be a useful tool for a successful treatment of amyloidosis secondary to CD

Late-onset choreoathetotic syndrome following heart surgery in adults with end-stage renal disease

Choreoathetotic syndrome is a rare complication of open cardiac surgery that is seen usually in children after surgery for congenital cardiac anomalies. Here, we report two cases of adult patients with end-stage renal disease (ESRD) on regular hemodialysis who developed acute choreoathetotic syndrome few days after cardiac surgeries under cardiopulmonary bypass (CPB). Improvement was seen after an interval with complete resolution in one case. Investigations of the cause have been noncontributory. Long CPB time seems to be the main identified risk factor in these cases. One of the unusual features of our adult cases was the existence of ESRD. To the best of our knowledge, this is the first time this complication is described in association with ESRD although the role of this comorbidity in these cases is uncertain

Insomnia in hemodialysis patients: A multicenter study from morocco

Previous studies have shown that insomnia is a common sleep disorder in patients with end-stage renal disease. This study aims to determine the prevalence and risk factors of insomnia in our chronic hemodialysis (HD) patients. This is a cross-sectional study conducted in three HD units in Morocco. To assess the prevalence of insomnia, we used a specific questionnaire. Patients complaining of difficulty in falling asleep and/or nocturnal awakenings occurring seven nights a week during the last month were included in the group “insomnia;” the other patients were used as controls. Clinical, biological, and dialysis data were recorded for each patient. Sleep disorders and their subjective causes were also identified. Eighty-nine percent of questioned patients admitted to having sleep disturbances of different degrees. Insomnia was significantly associated with female gender and time of dialysis. Age, body mass index, inter-dialytic weight gain, and blood pressure were similar between the two groups, as well as dialytic parameters and drug use. There was no significant difference in the values of plasma creatinine, urea, hemoglobin, parathyroid hormone, calcium, phosphorus, C-reactive protein, and albumin between the groups. Disorders most frequently encountered in patients with insomnia were waking up at night (90%), difficulty falling asleep (60%), and daytime sleepiness (60%). The restless legs syndrome was seen in half of these patients. The main reported causes of insomnia were anxiety and/or depression (70%) and bone pain (67%). Insomnia is common in HD patients and is frequently associated with other disorders of sleep. Female sex and duration on dialysis are the two risk factors found in our study. Insomnia does not appear related to any biochemical or dialysis parameters. Increased attention should be given to the management of dialysis patients regarding the diagnosis and management of insomnia and associated sleep disorders