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Biomedical subjects

A Tahiri

Publications and source records attributed to A Tahiri.

29 records · Page 2Linked to original sources
PubMed1998

Pericardial tamponade as the first manifestation of dermatopolymyositis.

Pericardial involvement in polymyositis and dermatomyositis (PM/DM) is rare, usually asymptomatic and exceptionally part of the initial presentation. We describe a 37-year-old patient hospitalized for overt acute pericarditis, revealing dermatomyositis, which to our knowledge has not been previously reported. Pericardial puncture relieved the patient. The pericardial fluid was citrine yellow, exsudative, and mainly contained lymphocytes. Search for LE cells and anti-DNA antibodies was negative, whereas the antinuclear antibodies and the rheumatoid factor were present in the pericardial fluid. A biopsy of the pericardium showed a non-specific chronic inflammatory state and the search for an etiology was negative. There was no sign of tuberculosis, systemic lupus, nor neoplasia. Moreover bacteriological cultures and HIV serology were negative. After pericardiostomy associated with corticosteroid therapy at the dose of 1 mg/kg/day, outcome was good with a resolution of the pericarditis confirmed at one-year follow-up. Since pericardial tamponade, even though rare, may be fatal in a patient with dermatomyositis, we emphasize that a two dimensional echocardiographic study should be performed in all patient presenting with dermatopolymyositis.

Acute Disease↗
PubMed1997

[Deep venous thromboses and occult cancers].

The association between venous thrombosis and cancer has been known for a long time. Thrombophlebitis often occurs during the course of a known cancer, but sometimes constitutes the presenting sign. Based on a series of 10 cases of deep venous thrombosis (DVT) revealing an underlying cancer, the authors analyse the various aspects of this association and the elements which help to guide the diagnosis towards a cancer. A simple assessment comprising clinical examination, full blood count and differential white cell count, erythrocyte sedimentation rate, protein electrophoresis, chest x-ray and abdomino-pelvic ultrasonography was performed on admission in 75 cases of presumably idiopathic DVT and revealed a cancer in 10 cases: 6 women and 4 men with a mean age of 53 years. Cancers were located in the urogenital tract in 5 cases, in the bronchi in 2 cases, in the stomach in one case, and there was one case of acute myeloblastic leukaemia (AML) and another case of liposarcoma of the left iliac fossa. The histological type most frequently encountered was adenocarcinoma in 6 cases. In 9 out of 10 cases, the cancer was discovered at the stage of metastases. However, a localized cancer was detected in one case, in which surgical treatment allowed cure of the patient. Comparison of the various characteristics of DVT between the group of DVT revealing a cancer and the group of DVT which remained idiopathic did not reveal any statistically significant difference. A simple, inexpensive assessment looking for a cancer must be systematically performed in all cases of idiopathic DVT in patients between the ages of 50 and 85 years. Other more elaborate examinations may be requested on the basis of the results of the preliminary assessment.

Adult↗
PubMed1997

[Blood pressure determination and medical competence].

Hypertension diagnosis depends closely to the blood pressure measurement. The aim of this work is to show whether blood pressure measurement should be done by a beginner or a competent doctor. The blood pressure of 180 patients, (150 females, 30 males) was taken by two physicians. The patients' average age was 51 +/- 11. One of the two physicians was a cardiologist who took all the patients blood pressure. Others where six doctors in training, that is sixth' year students at the faculty of medicine. They took part in this study for a week. The procedure was that the cardiologist and one of the training doctors took the patient's blood pressure at the same time after 15 min rest. We have calculated the average systolic blood pressure and diastolic blood pressure of 720 measures. Then the difference between the cardiologist's measures and those of all the training doctors. After that we have analysed the difference between the average of 120 measures taken by one of the training doctors and the corresponding measurement of the specialist. We have then compared the difference of the 20 measures of every day taken by the training doctor and the ones taken by the specialist. The difference wasn't statistically significant either for the systolic blood pressure or the diastolic blood pressurement. We have studied the evolution of the average of the 20 measurements of every day during the whole week. So, we have noticed that the difference lowers from the first days to the sixth. In the end, we were interested in the last figure of each measurement of blood pressure. The training doctor often gave measurements up to 0 or 5 whereas the specialist gave precise measurements. We have concluded from this work that if experience is needed, the physician has to know the principals and the tricks of blood pressurement. Moreover, the blood pressure variations by "white coat" effect can't be explained by measurements techniques. This effect can be considered as psychic, interactions between doctors and patients.

Adult↗
PubMed1995

[Cardiac manifestations of diffuse systemic scleroderma. Apropos of 4 cases].

Based on a series of four cases and a review of the literature, the authors describe the lesions of the various cardiac tissues in the course of systemic scleroderma. Pericardial involvement presents in the form of either acute pericarditis or chronic pericarditis. Pericardial tamponade is exceptional. Sclerodermal cardiomyopathy is frequent and serious and can be responsible for heart failure. Arrhythmias are frequent and may be either ventricular or supraventricular. Involvement of the conduction tissue often requires implantation of a pacemaker. Endocardial and valvular involvement is very rare. Lastly, coronary involvement appears to be fairly rare and responsible for vasospastic episodes in the coronary artery territory.

Adult↗
PubMed1995

[Bacterial endocarditis in Morocco].

This retrospective study was based on 157 cases of infectious endocarditis observed in the Cardiology department of Ibn Rochd Hospital in Casablanca between January 1983 and December 1994. The mean age of the patients was 27.5 years (11 to 65 years) with a male predominance (62.8%). Infectious endocarditis was secondary to rheumatic valvular heart disease in 63.% of patients and was primary in 29.9% of cases. Mitral or mitro-aortic valve involvement was clearly predominant. A portal of entry of the infection was identified in 63% of patients. It was dental in 64% of cases. Blood cultures were positive in 42% of cases with a predominance of unclassifiable Streptococci (37.8%) and coagulase-negative Staphylococci (25.7% of cases). Echocardiography was very useful, particularly in the presence of negative blood cultures. It demonstrated specific lesions of infectious endocarditis in 73.2% of cases and revealed very large, mobile vegetations in every case complicated by systemic embolism. The clinical course was complicated by heart failure (47.8%), renal failure (14.6%) or neurological lesions (11.5%). The global mortality was 28.7%, related to refractory heart failure in most cases.

Adolescent↗
PubMed1994

[Cardiac tamponade disclosing neoplasm: apropos of 23 cases].

The authors report a series of cardio-pericardial metastases presenting acutely with tamponade. There were 14 men and 9 women with an average age of 39 years. The primary tumour was mainly bronchial in the men (5 cases: 20.8%) and breast (3 cases: 16.6%) or uterine (4 cases: 16.6%) in the women. The other malignancies were blood dyscrasias (5 NHL and 1 MHL) one pericardial mesothelioma, one Schwannoma, one Ewing's sarcoma and one carcinoma of the larynx. The primary tumour was not found in one case. Echocardiography showed a large, circumferential pericardial effusion in all cases and compressing the right heart chambers (RA and/or RV) in half the cases. Rounded echogenic masses implanted on the pericardial membranes (2 cases) or images of false membranes (10 cases) were also demonstrated. The clinical emergency led to pericardiocentesis with surgical drainage in 5 cases. A pleuro-pericardial window was fashioned in 4 cases. The effusion was important in all cases and bloody in 75% of cases. Cytology of the pericardial liquid was positive for malignant cells in 1 out of 2 cases. The diagnosis was made after death in 3 cases. The other biopsies, bronchial, lymph node, pleural and bone marrow also provided valuable diagnostic information. Undifferentiated carcinoma was found in 75% of bronchial carcinomas. In all three breast tumours, the histology showed moderately well differentiated adenocarcinoma. The authors underline the paucity of therapeutic measures: at this stage, pericardiocentesis is almost the only procedure apart from the cases of haemopathy. Some authors have suggested radiotherapy of the precordial region and others, intrapericardial chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

[Aortic coarctation and pregnancy. Apropos of 3 cases followed-up during a period of 10 years].

Classically, coarctation of the aorta is poorly tolerated during pregnancy or at least is associated with a risk of rupture of the aorta, rupture of a cerebral aneurysm or, more rarely, cardiac failure or bacterial infection. The authors turned their attention to this association of coarctation of the aorta and pregnancy in the light of 3 cases of pregnancy brought to term in the Department of Cardiology of the Ibn Rochd Teaching Hospital Group, Casablanca, Morocco. During a 10 year period, 20 patients were hospitalised in the department with coarctation of the aorta. There were 10 women, 3 of them pregnant. The mean age of these women was 26, with a range of 24 to 30. All patients had a normal pregnancy, delivery and post-partum, with neither cardiovascular, renal nor cerebral complications. There were no maternal deaths, ruptures of the aorta, cerebrovascular accidents, bacterial infections nor myocardial failure. All the pregnancies were brought to term. One patient was delivered vaginally with the use of forceps after full dilatation facilitating expulsion. One cesarean section with extraction of a live infant was induced at 38 weeks. One patient was lost to follow-up at 7 months and was seen again only after delivery at home, i.e. without supervision but equally without complications. The 3 newborn infants had an Apgar of 10/10 and a birth weight of 3.2-3.5 kilos. There were no spontaneous abortions and no premature deliveries.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Meadows syndrome: puerperal cardiomyopathy].

This retrospective study concerns six cases of gravido-puerperal cardiomyopathy. These six cases account for 18% of all cases of non-obstructive cardiomyopathy (NOCM) affecting women in general and 67% of NOCM in women of childbearing age. Mean age was 28.5 with a range of 18 to 39. Reported risk factors include poor socio-economic conditions, multiparity, twin pregnancies and anemia. The clinical picture is that of cardiac failure, most often congestive (83.3%), with a systolic murmur of functional mitral incompetence (50%) and atypical chest pain (50%). The ECG is invariably abnormal, without specific signs. The high incidence of repolarisation disturbances is a fairly special feature. Echocardiography is the technique of choice, enabling detection, diagnosis and study of ventricular function, which is an important factor in prognostic evaluation. Medical treatment is based upon a combination of rest, salt-free diet, diuretics, digitalis and vasodilators. The etiology remains unknown and the prognosis is severe despite cases of complete recovery.

Adolescent↗
PubMed1993

[Cardiovascular manifestations of hereditary dysplasias of connective tissue].

The purpose of this study was to demonstrate the special features of cardiovascular effects in connective tissue disorders through a group of fifteen cases observed over a period of ten years. The group consisted of eleven cases of Marfan syndrome (or Marfan-like syndrome), two cases of pseudoxanthoma elasticum and two cases of Ehlers-Danlos disease. The cardiovascular lesions were as follows: 1) dissection of the ascending aorta which was confirmed and had been treated surgically in 2 cases; 2) aneurysmal dilatation of the ascending aorta in 5 cases; 3) moderate mitral valve prolapse, which was isolated in 2 other cases; 4) distention of the mitral valve in 2 cases; 5) mitral valve prolapse combined with tricuspid valve prolapse in 1 case; the mitral incompetence was severe and made it necessary to carry out mitral valve replacement; 6) moderate aortic valve prolapse combined with tricuspid prolapse in a case of type-I Ehlers-Danlos disease; 7) Fallot's tetralogy combined with Marfan's syndrome and treated surgically in one case; 8) severe hypertension with abnormalities of the iliac and renal arteries in one case of elastic pseudoxanthoma elasticum. In three cases complications occurred leading to death, extension of the dissection of the abdominal aorta and global recalcitrant heart failure respectively. The outcome in the other 12 cases, with a mean follow-up time of 3 and one half years (range: 3 years to 7 years) was not marked by complications.

Adolescent↗