17 research outputs found
Prise en charge tardive des sequelles de fractures du plancher orbitaire
Introduction : Les fractures du plancher orbitaire, sont devenues une pathologie assez frĂ©quente Ă©tant donnĂ©, lâaugmentation du nombre dâaccidents de la route. Le plancher orbitaire de part sa constitution anatomique est certainement le maillon faible du cadre orbitaire. Observation : Nous prĂ©sentons le cas dâun jeune de 35 ans polytraumatisĂ© avec des sĂ©quelles de fracture du plancher orbitaire qui ne sera opĂ©rĂ© que deux annĂ©es plus tard, prioritĂ© chirurgicale oblige ( le rachis Ă©tant opĂ©rĂ© en premier) avec les risques certains dâĂ©chec de la chirurgie ophtalmologique. Discussion : Les sĂ©quelles de ce type de fracture sont exposĂ©es, ainsi que les diffĂ©rentes modalitĂ©s thĂ©rapeutiques. Lâenophtalmie, la diplopie, les anomalies osseuses et palpĂ©brales constituent autant de sĂ©quelles parfois difficiles Ă prendre en charge. Les voies dâabord chirurgical sont discutĂ©es ; lâusage de matĂ©riaux tels les implants en hydroxyapatite Ă©galement. Conclusion : Le traitement des fractures du plancher de lâorbite est actuellement bien codifiĂ© et doit toujours ĂȘtre tentĂ© mĂȘme des annĂ©es aprĂšs le traumatisme causal.Mots clĂ©s : fracture plancher orbitaire, diplopi
Manifestations Ophtalmologiques Au Cours Du Syndrome D\'apert : A Propos D\'un Cas
Introduction : Parmi les crĂąniostĂ©noses, le syndrome d\'Apert demande la collaboration de plusieurs spĂ©cialistes, pour sauver ce qui peut l\'ĂȘtre de la fonction visuelle des patients et permettre un dĂ©veloppement cĂ©rĂ©bral le plus proche de la normale.
Observation : Nous présentons le cas d\'une jeune suivie et traitée depuis son jeune ùge pour un syndrome d\'Apert. Elle a subi plusieurs interventions successives pour garder à un ùge assez avancé une fonction visuelle appréciable à 3/10.Les modifications anatomiques ont inéluctablement influé sur l\'état visuel de la patiente avec une myopie forte,un
astigmatisme relativement important et une atrophie papillaire partielle. Discussion : D\'origine génétique, le syndrome d\'Apert est dû à une mutation allélique du récepteur 2 d\'un facteur fibroblastique. Les signes de souffrance cérébrale sont inévitables, et l\'atrophie optique relative représente la séquelle fonctionnelle principale. Conclusion : Une prise en charge de longue haleine est nécessaire dans le syndrome d\'Apert pour espérer sauver une
fonction visuelle utile.Introduction : Several craniosynostotic syndromes are described such as Apert syndrome in which collaboration between different specialists is necessary to preserve visual function and to allow normal cerebral development. Case-report : It\'s a case note of a girl with Apert syndrome. She underwent since her infancy several surgical operations. Anatomic modifications affected her visual status with a best visual acuity of 3/1O, high myopia, astigmatism and partial optic atrophy. Discussion : Apert syndrome is a genetic disorder due to a mutation in fibroblast receptor growth factor genes. Optic
atrophy attributed to optic neuropathy represents the major functional sequella and the major cause of visual loss. Conclusion : Apert syndrome, like all craniosynostotic syndromes, requires a correct management in order to preserve the visual function. Keywords: craniosynostosis, Apert syndrome, decompression surgery, optic atrophy. Journal Tunisien d\'ORL et de chirurgie cervico-faciale Vol. 18 2007: pp. 46-4
Visceral leishmaniasis in 26 HIV-negative adults
<p>Abstract</p> <p>Background</p> <p>Visceral leishmaniasis is a notifiable parasitic disease that had increased in incidence in our region on the past few years. It is common in children. In adults, it occurs more on a background of immunodeficiency, and frequently with incomplete clinical manifestations, making the diagnosis complicated.</p> <p>Findings</p> <p>The aim of our study is to reveal different features of visceral leishmaniasis in adults, through the analysis of its epidemiological, clinical and biological parameters, in a group of 26 patients. No one was infected with HIV or under immunosuppressive therapy Clinical presentation was generally conservative, but there was few differences in adults compared to children, concerning both the clinical symptoms and the laboratory parameters. Diagnosis was provided by direct examination of bone marrow smears in 24 cases (sensitivity 92%), and anti-leishmanial serology in the others.</p> <p>Conclusion</p> <p>We should think to the diagnosis of VL even if the patient is not known immunocompromised, and even if the clinical is incomplete, to avoid a delay of care which can lead to serious complications.</p
Retinal vein occlusion in Crohn's disease
Crohn's disease is an inflammatory bowel disease, which may be associated with a variety of extraintestinal complications, including ocular involvement. However, retinal vascular involvement is noted to be uncommon. We present 2 rare cases of retinal vein occlusion associated with Crohn's disease
Relapse profile of early breast cancer according to immunohistochemical subtypes: guidance for patientâs follow up?
Purpose: To analyze the profile of annual recurrence rate (ARR) of patients with early breast cancer (BC) in Tunisia. Patients and methods: We classified 293 patients with histologically confirmed early BC relapsing after 1 year of follow up into three subgroups: hormone receptor (HR)+ âHRâ [estrogen receptor (ER)+ or progesterone receptor (PR)+ and human epidermal growth factor receptor 2 (HER2)â], triple negative âTNâ (ERâ, PRâ and HER2 score 0/1 or fluorescence in situ hybridization (FISH)/chromogenic in situ hybridization negative) and HER2 overexpression âHER2â (HER2+). ARR was restricted to follow-up contribution of each specified time interval. The HR group was the reference group for comparison. Results: A higher proportion of patients who were up to 35 years old (18% versus 10%, p = 0.04), and patients with obesity (46% versus 26%, p = 0.045) was seen in the TN group. Median time to relapse (MTR) was shorter in TN and HER2 groups than in HR patients (20 and 29 months compared with 56 months, respectively, p < 0.001). In the HR group, the ARR was 22%, 16% and 10% at 3, 4 and 5 years respectively, becoming less than 3% at 7 years. In the TN group, 71% of patients relapsed during the first 2 years and the ARR declined rapidly to less than 1.5% after 4 years. In the HER2 group, the ARR peaked at 2 years (29%) and decreased significantly to 7% and 3% at 5 and 7 years respectively. Adjuvant trastuzumab delayed the MTR from 24 to 34 months ( p = 0.022). Conclusion: The relapse risk in Tunisian patients is higher in young women and patients with HER2+ and TN tumors. A long and close follow up is recommended for patients with HR and HER2. Conversely, we suggest that follow up in patients with TN could be spaced after 4 years (ARR being <1.5% after this period)
Contribution à une meilleure explicitation du vocabulaire dans le domaine des solutions dites « alternatives » de gestion des eaux pluviales urbaines
La façon de gĂ©rer les eaux pluviales urbaines est en train de changer rapidement pour rĂ©pondre Ă des enjeux de plus en plus nombreux et complexes : maĂźtrise des flux dâeau et de polluants produits par la ville, prĂ©servation des ressources, meilleure intĂ©gration dans le paysage, prise en compte dâobjectifs sociaux, Ă©conomiques, climatiques, Ă©cologiques et environnementaux, etc. De plus, ce changement sâinscrit dans des Ă©volutions plus larges concernant Ă la fois la ville et la gestion dâun patrimoine assainissement vieillissant et coĂ»teux Ă entretenir. Pour rĂ©pondre Ă ces enjeux et dĂ©velopper des solutions de gestion adaptĂ©es Ă ces nouveaux besoins, les hydrologues et les spĂ©cialistes de lâassainissement doivent travailler avec des acteurs de plus en plus nombreux qui abordent la question avec des cultures trĂšs diffĂ©rentes les unes des autres. Dans ce contexte, la terminologie devient trĂšs importante pour pouvoir Ă©changer et se comprendre. Or le vocabulaire comme les concepts sont encore en phase de construction. Lâobjectif de ce texte, rĂ©digĂ© par un panel variĂ© de spĂ©cialistes du domaine de lâhydrologie urbaine, vise Ă montrer la grande diversitĂ© du vocabulaire aujourdâhui associĂ© Ă la gestion des eaux pluviales, et propose une grille de lecture pour clarifier autant que possible les principales notions. Il ne sâagit pas de tomber dans le piĂšge dâune normalisation des mots, mais dâaider Ă une meilleure comprĂ©hension entre acteurs. Ce travail porte sur les concepts gĂ©nĂ©raux qui structurent la rĂ©flexion et la stratĂ©gie, ainsi que sur le vocabulaire technique et en particulier sur la façon de distinguer les solutions. Ce document est destinĂ© Ă tous les acteurs de la ville, dâune part, et de la gestion de lâeau et de lâenvironnement, dâautre part. Il nâa pas la prĂ©tention de clore le dĂ©bat.The way urban stormwater is managed is changing rapidly to meet increasingly numerous and complex challenges: control of water flows and pollutants produced by the city, preservation of resources, better integration into the landscape, consideration of social, economic, climatic, ecological and environmental objectives, etc. In addition, this change is part of broader developments concerning both the city and the management of an aging and expensive to maintain sewerage heritage. To meet these challenges and develop management solutions fitted to these new needs, hydrologists and drainage specialists must work with an increasing number of actors who approach the issue with very different cultures. In this context, terminology becomes very important to be able to exchange and understand each other. However, the vocabulary, like the concepts, are still in the construction phase. The objective of this paper, written by a large panel of specialists in the field, aims to show the great diversity of the vocabulary associated with stormwater management today, and proposes a reading grid to clarify as much as possible the main concepts. The aim is not to fall into the trap of a standardizing words, but to help improve understanding between actors. This paper covers the general concepts that structure thinking and strategy, as well as technical vocabulary and in particular how to distinguish solutions. This document is intended for all the actors of the city on the one hand and of water and the environment management on the other hand