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Détails du magazine
Format
Magazine
eISSN
2501-062X
Première publication
30 Mar 2015
Période de publication
4 fois par an
Langues
Anglais

Chercher

Volume 56 (2018): Edition 4 (December 2018)

Détails du magazine
Format
Magazine
eISSN
2501-062X
Première publication
30 Mar 2015
Période de publication
4 fois par an
Langues
Anglais

Chercher

7 Articles
Accès libre

How much bloating in the irritable bowel syndrome?

Publié en ligne: 05 Dec 2018
Pages: 221 - 226

Résumé

Abstract

The irritable bowel syndrome (IBS) is the most common chronic gastrointestinal disorder referred to gastroenterologists. One of the most common manifestations of IBS is bloating. Abdominal bloating is defined as subjective sensation of abdominal distension associated with girth increment. Therefore, it is described in the Rome IV criteria as bloating/abdominal distension. Bloating symptoms are reported by 10-30% of the general population and it was rated as the most bothersome symptom by 60% of IBS patients; the lack of specificity of this complaint prevented bloating to be included between the diagnostic criteria for IBS. Indeed, bloating may be reported also in healthy people or in other functional conditions. This paper looks to the evolutions of the concepts on bloating according to the Rome working groups from the beginning until now and it represents a comprehensive review on the prevalence and pathogenesis of bloating.

Mots clés

  • Bloating
  • functional gastrointestinal disorders
  • irritable bowel syndrome
  • Rome criteria
Accès libre

Laparoscopic sleeve gastrectomy and gastroesophageal reflux

Publié en ligne: 05 Dec 2018
Pages: 227 - 232

Résumé

Abstract

The prevalence of obesity is rising, becoming a medical problem worldwide. Also GERD incidence is higher in obese patients compared with normal weight, with an increased risk of 2.5 of developing symptoms and erosive esophagitis. Different treatment modalities have been proposed to treat obese patients, but bariatric surgery due to its complex interactions via anatomic, physiologic and neurohormonal changes achieved the best long-term results, with sustained weight loss and decrease of complications and mortality caused by obesity. The bariatric surgical procedures can be restrictive: laparoscopic adjustable gastric band (LAGB) and laparoscopic sleeve gastrectomy (LSG), or malabsorptive-restrictive such as Roux-en-Y gastric bypass (RYGB). These surgical procedures may influence esophageal motility and lead to esophageal complications like gastroesophageal reflux disease (GERD) and erosive esophagitis. From the literature we know that the RYGB can ameliorate GERD symptoms, and some bariatric procedures were finally converted to RYGB because of refractory reflux symptoms. For LAGB the results are good at the beginning, but some patients experienced new reflux symptoms in the follow-up period. Recently LSG has become more popular than other complex bariatric procedures, but some follow-up studies report a high risk of GERD after it. This article reviews the results published after LSG regarding gastroesophageal reflux and the mechanisms responsible for GERD in morbidly obese subjects.

Mots clés

  • obesity
  • bariatric surgery
  • sleeve gastrectomy
  • gastroesophageal reflux
  • stomach
Accès libre

Pancreas divisum: a reemerging risk factor for pancreatic diseases

Publié en ligne: 05 Dec 2018
Pages: 233 - 242

Résumé

Abstract

Pancreas divisum (PD) is the most common developmental anatomic variant of pancreatic duct. The attention towards the PD has grown significantly since there are reports that this condition may cause acute relapsing pancreatitis, chronic pancreatitis and chronic abdominal pain syndrome. Furthermore, over the years, there have been multiple reports of PD associated with different types of tumors. There is evidence that PD can be associated with pancreatic tumors (up to 12.5% of cases). The golden standard for diagnosing PD is endoscopic retrograde cholangiopancreatography, but since it is an invasive procedure magnetic resonance cholangiopancreatography with secretin is a good alternative. In case the patient is symptomatic, endoscopic or surgical treatment should be performed. This review describes the key points of the pathophysiology, diagnostic modalities, risks of pancreatitis and tumors, as well as treatment options of PD.

Mots clés

  • acute relapsing pancreatitis
  • pancreas divisum
  • pancreatic tumors
Accès libre

Malignancy in a retrospective cohort of 17 patients with Dermatomyositis or Polymyositis in southern Tunisia

Publié en ligne: 05 Dec 2018
Pages: 243 - 249

Résumé

Abstract

Introduction. The prognosis of dermatomyositis (DM)/ polymyositis (PM) in adults is partly related to their association with neoplasia. The aim of our study was to report the epidemiologic, clinical, paraclinical, therapeutic and evolutionary aspects of DM associated with malignancy in patients from Sfax, south eastern of Tunisia. Methods. A retrospective cohort study of patients with DM or PM admitted in Dermatology and Internal Medicine Departments of Hedi Chaker University Hospital of Sfax between 1996 and 2015. Cases of DM or PM associated with malignancy were retained. Results. Seventeen cases (13.5%) of DM or PM associated with malignancy were noted. Fourteen patients had DM and 3 patients had PM. The Sex ratio M / F was 0.3 and the mean age at diagnosis was 56.5 years. In DM patients, malignancy preceded the myositis in 64.2% of cases. In PM patients, only one patient was known to have breast cancer and the myositis revealed the cancer for 2 others. Treatment consisted of corticosteroids associated with methotrexate in 4 cases. Outcome was fatal in 5 cases (29.4%), due to the underlying cancer in 3 cases. Swallowing disorders related to DM/PM were responsible for death in 2 cases. Conclusion. There are no specific clinical or biological features in paraneoplastic DM. In our series, breast neoplasm represented the first cancer associated with DM. Cancers of nasopharynx, colon and urinary tract had the second position.

Mots clés

  • dermatomyositis
  • polymyositis
  • cancer
  • paraneoplastic syndrome
  • risk
Accès libre

Is Troponin really a reliable marker in patients with acute ischemic stroke?

Publié en ligne: 05 Dec 2018
Pages: 250 - 256

Résumé

Abstract

Background and purpose. Cardiac troponin I (cTnI) is a reliable marker to diagnose acute myocardial infarction, but the pathophysiological explanation for the increase in cTnI levels in patients with acute ischemic stroke (IS) remains unknown. To overcome this question, we aimed to compare serum cTnI levels in acute coronary syndrome (ACS) concomitant with and without stroke. By doing like this, we thought that we could demonstrate the effect of stroke on TrpI level. Methods. Serum cTnI levels of 41 patients having ACS with acute IS during hospitalization were compared with 97 control patients having only ACS. Cranial CT was performed to evaluate the lesions. The severity of IS was evaluated objectively by national institutes of health stroke scale. Results. cTnI levels were found to be similar in both groups. Presence of diabetes mellitus, coronary artery disease and previous myocardial infarction were more frequent in patients with acute IS. The cTnI levels in the patients with the cranial lesion in the anterior circulation was higher (p = 0.039). Presence of acute IS, cTnI level higher than 20 ng/mL and left ventricular ejection fraction < 40% were found to be independent risk factors for mortality (p < 0.05). Conclusions. We found that abnormal troponin levels were more likely to be due to cardiac causes than cerebral ones in this first study evaluating the cTnI levels in patients with ACS concomitant with acute IS. The severity of IS, lesion location in the anterior circulation and higher troponin levels were associated with mortality.

Mots clés

  • stroke
  • troponin I
  • acute coronary syndrome
  • brain ischemia
  • mortality
Accès libre

Beneficial effects of combined therapy with lacidipine and candesartan in obese hypertensive patients

Publié en ligne: 05 Dec 2018
Pages: 257 - 264

Résumé

Abstract

Introduction. Obesity is becoming one of the leading risk factors of coronary heart disease, hypertension, cerebrovascular disease. Despite the presence of a large number of antihypertensive agents and scientific substantiation of antihypertensive treatment principles it would be wrong to assume that the problem is completely solved. Development of endothelial dysfunction is one of the key pathogenic mechanisms in hypertension. This process is proven to have contributed by immune inflammation activation which is mediated by pro-inflammatory cytokines and oxidative stress. Aims. To investigate the additional benefits of the combined antihypertensive therapy with lacidipine and candesartan on the basis of studying their antioxidant properties, impact on endothelial function and pro-inflammatory cytokines activity in hypertensive patients with overweight and obesity. Methods. A combination of a calcium channel blocker and angiotensin receptor blocker (lacidipine 2 mg, 4 mg, and candesartan 4mg, 8mg, 16mg) was prescribed to 30 patients with essential hypertension of grades 1-3, 30 to 65 years old (mean age - 54.7 ± 5.8 years), who previously have not been receiving regular antihypertensive therapy. Results. During the course of combined antihypertensive therapy with lacidipine and candesartan, a significant reduction in i-NOS activity, TNF-α to its type I soluble receptor ratio (TNF- α/sTNF-αRI), and oxidative stress marker - 8-iso-PgF2α has been observed. Activity of e-NOS, levels of SOD and catalase, in contrast, have increased by the end of observation period. Conclusion. The improvement of endothelial function due to lower level of oxidative stress and a significant decrease of immune activation has been observed in hypertensive patients with overweight and obesity under the influence of combined antihypertensive therapy with lacidipine and candesartan.

Mots clés

  • hypertension
  • obesity
  • oxidative stress
  • nitric oxide synthase
  • tumor necrosis factor-α
  • catalase
  • lacidipine
  • candesartan
Accès libre

Multiple acute ischemic strokes as the onset manifestation of acute promyelocytic leukemia

Publié en ligne: 05 Dec 2018
Pages: 265 - 268

Résumé

Abstract

Acute promyelocytic leukemia often manifests with hemorrhagic diathesis, thrombotic events being much rarer. This is the case of a 59-year-old patient with thrombotic cerebro-vascular complications as the onset manifestation of acute promyelocytic leukemia.

Mots clés

  • multiple ishemic strokes
  • acute promyelocytic leukemia
  • leukemia
7 Articles
Accès libre

How much bloating in the irritable bowel syndrome?

Publié en ligne: 05 Dec 2018
Pages: 221 - 226

Résumé

Abstract

The irritable bowel syndrome (IBS) is the most common chronic gastrointestinal disorder referred to gastroenterologists. One of the most common manifestations of IBS is bloating. Abdominal bloating is defined as subjective sensation of abdominal distension associated with girth increment. Therefore, it is described in the Rome IV criteria as bloating/abdominal distension. Bloating symptoms are reported by 10-30% of the general population and it was rated as the most bothersome symptom by 60% of IBS patients; the lack of specificity of this complaint prevented bloating to be included between the diagnostic criteria for IBS. Indeed, bloating may be reported also in healthy people or in other functional conditions. This paper looks to the evolutions of the concepts on bloating according to the Rome working groups from the beginning until now and it represents a comprehensive review on the prevalence and pathogenesis of bloating.

Mots clés

  • Bloating
  • functional gastrointestinal disorders
  • irritable bowel syndrome
  • Rome criteria
Accès libre

Laparoscopic sleeve gastrectomy and gastroesophageal reflux

Publié en ligne: 05 Dec 2018
Pages: 227 - 232

Résumé

Abstract

The prevalence of obesity is rising, becoming a medical problem worldwide. Also GERD incidence is higher in obese patients compared with normal weight, with an increased risk of 2.5 of developing symptoms and erosive esophagitis. Different treatment modalities have been proposed to treat obese patients, but bariatric surgery due to its complex interactions via anatomic, physiologic and neurohormonal changes achieved the best long-term results, with sustained weight loss and decrease of complications and mortality caused by obesity. The bariatric surgical procedures can be restrictive: laparoscopic adjustable gastric band (LAGB) and laparoscopic sleeve gastrectomy (LSG), or malabsorptive-restrictive such as Roux-en-Y gastric bypass (RYGB). These surgical procedures may influence esophageal motility and lead to esophageal complications like gastroesophageal reflux disease (GERD) and erosive esophagitis. From the literature we know that the RYGB can ameliorate GERD symptoms, and some bariatric procedures were finally converted to RYGB because of refractory reflux symptoms. For LAGB the results are good at the beginning, but some patients experienced new reflux symptoms in the follow-up period. Recently LSG has become more popular than other complex bariatric procedures, but some follow-up studies report a high risk of GERD after it. This article reviews the results published after LSG regarding gastroesophageal reflux and the mechanisms responsible for GERD in morbidly obese subjects.

Mots clés

  • obesity
  • bariatric surgery
  • sleeve gastrectomy
  • gastroesophageal reflux
  • stomach
Accès libre

Pancreas divisum: a reemerging risk factor for pancreatic diseases

Publié en ligne: 05 Dec 2018
Pages: 233 - 242

Résumé

Abstract

Pancreas divisum (PD) is the most common developmental anatomic variant of pancreatic duct. The attention towards the PD has grown significantly since there are reports that this condition may cause acute relapsing pancreatitis, chronic pancreatitis and chronic abdominal pain syndrome. Furthermore, over the years, there have been multiple reports of PD associated with different types of tumors. There is evidence that PD can be associated with pancreatic tumors (up to 12.5% of cases). The golden standard for diagnosing PD is endoscopic retrograde cholangiopancreatography, but since it is an invasive procedure magnetic resonance cholangiopancreatography with secretin is a good alternative. In case the patient is symptomatic, endoscopic or surgical treatment should be performed. This review describes the key points of the pathophysiology, diagnostic modalities, risks of pancreatitis and tumors, as well as treatment options of PD.

Mots clés

  • acute relapsing pancreatitis
  • pancreas divisum
  • pancreatic tumors
Accès libre

Malignancy in a retrospective cohort of 17 patients with Dermatomyositis or Polymyositis in southern Tunisia

Publié en ligne: 05 Dec 2018
Pages: 243 - 249

Résumé

Abstract

Introduction. The prognosis of dermatomyositis (DM)/ polymyositis (PM) in adults is partly related to their association with neoplasia. The aim of our study was to report the epidemiologic, clinical, paraclinical, therapeutic and evolutionary aspects of DM associated with malignancy in patients from Sfax, south eastern of Tunisia. Methods. A retrospective cohort study of patients with DM or PM admitted in Dermatology and Internal Medicine Departments of Hedi Chaker University Hospital of Sfax between 1996 and 2015. Cases of DM or PM associated with malignancy were retained. Results. Seventeen cases (13.5%) of DM or PM associated with malignancy were noted. Fourteen patients had DM and 3 patients had PM. The Sex ratio M / F was 0.3 and the mean age at diagnosis was 56.5 years. In DM patients, malignancy preceded the myositis in 64.2% of cases. In PM patients, only one patient was known to have breast cancer and the myositis revealed the cancer for 2 others. Treatment consisted of corticosteroids associated with methotrexate in 4 cases. Outcome was fatal in 5 cases (29.4%), due to the underlying cancer in 3 cases. Swallowing disorders related to DM/PM were responsible for death in 2 cases. Conclusion. There are no specific clinical or biological features in paraneoplastic DM. In our series, breast neoplasm represented the first cancer associated with DM. Cancers of nasopharynx, colon and urinary tract had the second position.

Mots clés

  • dermatomyositis
  • polymyositis
  • cancer
  • paraneoplastic syndrome
  • risk
Accès libre

Is Troponin really a reliable marker in patients with acute ischemic stroke?

Publié en ligne: 05 Dec 2018
Pages: 250 - 256

Résumé

Abstract

Background and purpose. Cardiac troponin I (cTnI) is a reliable marker to diagnose acute myocardial infarction, but the pathophysiological explanation for the increase in cTnI levels in patients with acute ischemic stroke (IS) remains unknown. To overcome this question, we aimed to compare serum cTnI levels in acute coronary syndrome (ACS) concomitant with and without stroke. By doing like this, we thought that we could demonstrate the effect of stroke on TrpI level. Methods. Serum cTnI levels of 41 patients having ACS with acute IS during hospitalization were compared with 97 control patients having only ACS. Cranial CT was performed to evaluate the lesions. The severity of IS was evaluated objectively by national institutes of health stroke scale. Results. cTnI levels were found to be similar in both groups. Presence of diabetes mellitus, coronary artery disease and previous myocardial infarction were more frequent in patients with acute IS. The cTnI levels in the patients with the cranial lesion in the anterior circulation was higher (p = 0.039). Presence of acute IS, cTnI level higher than 20 ng/mL and left ventricular ejection fraction < 40% were found to be independent risk factors for mortality (p < 0.05). Conclusions. We found that abnormal troponin levels were more likely to be due to cardiac causes than cerebral ones in this first study evaluating the cTnI levels in patients with ACS concomitant with acute IS. The severity of IS, lesion location in the anterior circulation and higher troponin levels were associated with mortality.

Mots clés

  • stroke
  • troponin I
  • acute coronary syndrome
  • brain ischemia
  • mortality
Accès libre

Beneficial effects of combined therapy with lacidipine and candesartan in obese hypertensive patients

Publié en ligne: 05 Dec 2018
Pages: 257 - 264

Résumé

Abstract

Introduction. Obesity is becoming one of the leading risk factors of coronary heart disease, hypertension, cerebrovascular disease. Despite the presence of a large number of antihypertensive agents and scientific substantiation of antihypertensive treatment principles it would be wrong to assume that the problem is completely solved. Development of endothelial dysfunction is one of the key pathogenic mechanisms in hypertension. This process is proven to have contributed by immune inflammation activation which is mediated by pro-inflammatory cytokines and oxidative stress. Aims. To investigate the additional benefits of the combined antihypertensive therapy with lacidipine and candesartan on the basis of studying their antioxidant properties, impact on endothelial function and pro-inflammatory cytokines activity in hypertensive patients with overweight and obesity. Methods. A combination of a calcium channel blocker and angiotensin receptor blocker (lacidipine 2 mg, 4 mg, and candesartan 4mg, 8mg, 16mg) was prescribed to 30 patients with essential hypertension of grades 1-3, 30 to 65 years old (mean age - 54.7 ± 5.8 years), who previously have not been receiving regular antihypertensive therapy. Results. During the course of combined antihypertensive therapy with lacidipine and candesartan, a significant reduction in i-NOS activity, TNF-α to its type I soluble receptor ratio (TNF- α/sTNF-αRI), and oxidative stress marker - 8-iso-PgF2α has been observed. Activity of e-NOS, levels of SOD and catalase, in contrast, have increased by the end of observation period. Conclusion. The improvement of endothelial function due to lower level of oxidative stress and a significant decrease of immune activation has been observed in hypertensive patients with overweight and obesity under the influence of combined antihypertensive therapy with lacidipine and candesartan.

Mots clés

  • hypertension
  • obesity
  • oxidative stress
  • nitric oxide synthase
  • tumor necrosis factor-α
  • catalase
  • lacidipine
  • candesartan
Accès libre

Multiple acute ischemic strokes as the onset manifestation of acute promyelocytic leukemia

Publié en ligne: 05 Dec 2018
Pages: 265 - 268

Résumé

Abstract

Acute promyelocytic leukemia often manifests with hemorrhagic diathesis, thrombotic events being much rarer. This is the case of a 59-year-old patient with thrombotic cerebro-vascular complications as the onset manifestation of acute promyelocytic leukemia.

Mots clés

  • multiple ishemic strokes
  • acute promyelocytic leukemia
  • leukemia

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