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Chabrak S, Haggui A, Allouche E, Ouali S, Ben Halima A, Kacem S, Krichen S, Marrakchi S, Fehri W, Mourali MS, Jabbari Z, Ben Halima M, Neffati E, Heraiech A, Slim M, Kachboura S, Gamra H, Hassine M, Kraiem S, Kammoun S, Bezdah L, Jridi G, Bouraoui H, Kammoun S, Hammami R, Chettaoui R, Ben Ameur Y, Azaiez F, Tlili R, Battikh K, Ben Slima H, Chrigui R, Fazaa S, Sanaa I, Ellouz Y, Mosrati M, Milouchi S, Jarmouni S, Ayadi W, Akrout M, Razgallah R, Neffati W, Drissa M, Charfeddine S, Abdessalem S, Abid L, Zakhama L. National Tunisian Study of Cardiac Implantable Electronic Devices: Design and Protocol for a Nationwide Multicenter Prospective Observational Study. JMIR Res Protoc 2024; 13:e47525. [PMID: 38588529 PMCID: PMC11036188 DOI: 10.2196/47525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/29/2023] [Accepted: 10/31/2023] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND In Tunisia, the number of cardiac implantable electronic devices (CIEDs) is increasing, owing to the increase in patient life expectancy and expanding indications. Despite their life-saving potential and a significant reduction in population morbidity and mortality, their increased numbers have been associated with the development of multiple early and late complications related to vascular access, pockets, leads, or patient characteristics. OBJECTIVE The study aims to identify the rate, type, and predictors of complications occurring within the first year after CIED implantation. It also aims to describe the demographic and epidemiological characteristics of a nationwide sample of patients with CIED in Tunisia. Additionally, the study will evaluate the extent to which Tunisian electrophysiologists follow international guidelines for cardiac pacing and sudden cardiac death prevention. METHODS The Tunisian National Study of Cardiac Implantable Electronic Devices (NATURE-CIED) is a national, multicenter, prospectively monitored study that includes consecutive patients who underwent primary CIED implantation, generator replacement, and upgrade procedure. Patients were enrolled between January 18, 2021, and February 18, 2022, at all Tunisian public and private CIED implantation centers that agreed to participate in the study. All enrolled patients entered a 1-year follow-up period, with 4 consecutive visits at 1, 3, 6, and 12 months after CIED implantation. The collected data are recorded electronically on the clinical suite platform (DACIMA Clinical Suite). RESULTS The study started on January 18, 2021, and concluded on February 18, 2023. In total, 27 cardiologists actively participated in data collection. Over this period, 1500 patients were enrolled in the study consecutively. The mean age of the patients was 70.1 (SD 15.2) years, with a sex ratio of 1:15. Nine hundred (60%) patients were from the public sector, while 600 (40%) patients were from the private sector. A total of 1298 (86.3%) patients received a conventional pacemaker and 75 (5%) patients received a biventricular pacemaker (CRT-P). Implantable cardioverter defibrillators were implanted in 127 (8.5%) patients. Of these patients, 45 (3%) underwent CRT-D implantation. CONCLUSIONS This study will establish the most extensive contemporary longitudinal cohort of patients undergoing CIED implantation in Tunisia, presenting a significant opportunity for real-world clinical epidemiology. It will address a crucial gap in the management of patients during the perioperative phase and follow-up, enabling the identification of individuals at particularly high risk of complications for optimal care. TRIAL REGISTRATION ClinicalTrials.gov NCT05361759; https://classic.clinicaltrials.gov/ct2/show/NCT05361759. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/47525.
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Affiliation(s)
- Sonia Chabrak
- Pasteur Clinic, General and Cardiovascular Clinic of Tunis, Tunis, Tunisia
| | - Abdeddayem Haggui
- Military Hospital, Faculty of Medicine of Tunis, University of Tunis, Tunis, Tunisia
| | - Emna Allouche
- Cardiology Department, Faculty of Medicine of Tunis, Charles Nicole Hospital, University of Tunis, Tunis, Tunisia
| | - Sana Ouali
- Cardiology Department, Faculty of Medicine of Tunis, La Rabta Hospital, University of Tunis, Tunis, Tunisia
| | - Afef Ben Halima
- Abderrahmen Mami Hospital, Faculty of Medicine of Tunis, University of Tunis, Tunis, Tunisia
| | | | | | - Sonia Marrakchi
- Cardiology Department, Versailles Cardiology Center, Paris, France
| | - Wafa Fehri
- Cardiology Department, Faculty of Medicine of Tunis, Military Hospital, University of Tunis, Tunis, Tunisia
| | - Mohamed Sami Mourali
- Cardiology Department, Faculty of Medicine of Tunis, La Rabta Hospital, University of Tunis, Tunis, Tunisia
| | - Zeineb Jabbari
- Cardiology Department, Faculty of Medicine of Tunis, La Rabta Hospital, University of Tunis, Tunis, Tunisia
| | - Manel Ben Halima
- Cardiology Department, Faculty of Medicine of Tunis, Abderrahmen Mami Hospital, University of Tunis, Tunis, Tunisia
| | - Elyes Neffati
- Cardiology Department, Faculty of Medicine of Sousse, Sahloul Hospital, University of Sousse, Sousse, Tunisia
| | - Aymen Heraiech
- Cardiology Department, Faculty of Medicine of Sousse, Sahloul Hospital, University of Sousse, Sousse, Tunisia
| | - Mehdi Slim
- Cardiology Department, Faculty of Medicine of Sousse, Sahloul Hospital, University of Sousse, Sousse, Tunisia
| | - Salem Kachboura
- Cardiology Department, Faculty of Medicine of Tunis, Abderrahmen Mami Hospital, University of Tunis, Tunis, Tunisia
| | - Habib Gamra
- Cardiology A Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Majed Hassine
- Cardiology A Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Sondes Kraiem
- Cardiology Department, Faculty of Medicine of Tunis, Habib Thameur Hospital, University of Tunis, Tunis, Tunisia
| | - Sofien Kammoun
- Cardiology Department, Faculty of Medicine of Tunis, Habib Thameur Hospital, University of Tunis, Tunis, Tunisia
| | - Leila Bezdah
- Cardiology Department, Faculty of Medicine of Tunis, Charles Nicole Hospital, University of Tunis, Tunis, Tunisia
| | - Gouider Jridi
- Cardiology Department, Faculty of Medicine of Sousse, Farhat Hached Hospital, University of Sousse, Sousse, Tunisia
| | - Hatem Bouraoui
- Cardiology Department, Faculty of Medicine of Sousse, Farhat Hached Hospital, University of Sousse, Sousse, Tunisia
| | - Samir Kammoun
- Cardiology Department, Faculty of Medicine of Sfax, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
| | - Rania Hammami
- Cardiology Department, Faculty of Medicine of Sfax, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
- Tunisian Society of Cardiology and Cardiovascular Surgery, Tunis, Tunisia
| | - Rafik Chettaoui
- Pasteur Clinic, General and Cardiovascular Clinic of Tunis, Tunis, Tunisia
| | - Youssef Ben Ameur
- Cardiology Department, Faculty of Medicine of Tunis, Mongi Slim Hospital, University of Tunis, Tunis, Tunisia
| | - Fares Azaiez
- Cardiology Department, Faculty of Medicine of Tunis, Mongi Slim Hospital, University of Tunis, Tunis, Tunisia
| | - Rami Tlili
- Cardiology Department, Faculty of Medicine of Tunis, Mongi Slim Hospital, University of Tunis, Tunis, Tunisia
| | | | - Hedi Ben Slima
- Cardiology Department, Faculty of Medicine of Tunis, Menzel Bourguiba Hospital, University of Tunis, Bizerte, Tunisia
| | - Rim Chrigui
- Pasteur Clinic, General and Cardiovascular Clinic of Tunis, Tunis, Tunisia
| | - Samia Fazaa
- Pasteur Clinic, General and Cardiovascular Clinic of Tunis, Tunis, Tunisia
| | - Islem Sanaa
- General & Cardiovascular Clinic, Tunis, Tunisia
| | - Yassine Ellouz
- Pasteur Clinic, General and Cardiovascular Clinic of Tunis, Tunis, Tunisia
| | | | - Sami Milouchi
- Tunisian Society of Cardiology and Cardiovascular Surgery, Tunis, Tunisia
- Cardiology Department, Habib Bourguiba Hospital, University of Sfax, Medenine, Tunisia
| | - Soumaya Jarmouni
- Pasteur Clinic, General and Cardiovascular Clinic of Tunis, Tunis, Tunisia
| | | | | | | | | | - Meriem Drissa
- Tunisian Society of Cardiology and Cardiovascular Surgery, Tunis, Tunisia
- Cardiology Department, Faculty of Medicine of Tunis, Mongi Slim Hospital, University of Tunis, Tunis, Tunisia
| | - Selma Charfeddine
- Cardiology Department, Faculty of Medicine of Sfax, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
- Tunisian Society of Cardiology and Cardiovascular Surgery, Tunis, Tunisia
| | - Salem Abdessalem
- Tunisian Society of Cardiology and Cardiovascular Surgery, Tunis, Tunisia
| | - Leila Abid
- Cardiology Department, Faculty of Medicine of Sfax, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
| | - Lilia Zakhama
- Cardiology Department, Hospital of the Interior Force Security, University of Tunis, Tunis, Tunisia
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Fall S, Farhat SB, Chelly A, Kaddour H, Saad SB, El Hedi AM, Slim M, Thabet H, Ouannes S, Gribaa R, Elhraiech A, Elyes N. The spiked helmet sign in a patient with erysipelas: an alarming electrocardiogram sign (a case report). Pan Afr Med J 2023; 46:58. [PMID: 38223872 PMCID: PMC10787137 DOI: 10.11604/pamj.2023.46.58.40438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/07/2023] [Indexed: 01/16/2024] Open
Abstract
Early diagnosis of the spiked helmet sign is challenging. This ST-elevation myocardial infarction mimic was first described in 2011 by Littmann and colleagues and was linked to severe non-coronary pathologies, with a high risk of mortality. We present a case of a 60-year-old female patient who developed severe erysipelas with sepsis associated with severe hypokalemia. She had a spiked helmet sign on her routine electrocardiogram at hospital admission. We performed a coronary angiogram that showed no culprit artery. She developed afterward an ischemic stroke. Through intensive management of the patient's sepsis and electrolyte disturbance, she had a favorable outcome.
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Affiliation(s)
- Salihou Fall
- Cardiology Department, Sahloul University Hospital, Faculty of Medicine Ibn El Jazzar of Sousse, University of Sousse, Sousse, Tunisia
| | - Sameh Ben Farhat
- Cardiology Department, Sahloul University Hospital, Faculty of Medicine Ibn El Jazzar of Sousse, University of Sousse, Sousse, Tunisia
| | - Ahmed Chelly
- Cardiology Department, Sahloul University Hospital, Faculty of Medicine Ibn El Jazzar of Sousse, University of Sousse, Sousse, Tunisia
| | - Hella Kaddour
- Cardiology Department, Sahloul University Hospital, Faculty of Medicine Ibn El Jazzar of Sousse, University of Sousse, Sousse, Tunisia
| | - Saeb Ben Saad
- Cardiology Department, Sahloul University Hospital, Faculty of Medicine Ibn El Jazzar of Sousse, University of Sousse, Sousse, Tunisia
| | - Ahmed Mohamed El Hedi
- Emergency Medical Service Department (SAMU03), Sahloul University Hospital, Faculty of Medicine Ibn El Jazzar of Sousse, University of Souse, Sousse, Tunisia
| | - Mehdi Slim
- Cardiology Department, Sahloul University Hospital, Faculty of Medicine Ibn El Jazzar of Sousse, University of Sousse, Sousse, Tunisia
| | - Houssem Thabet
- Cardiology Department, Sahloul University Hospital, Faculty of Medicine Ibn El Jazzar of Sousse, University of Sousse, Sousse, Tunisia
| | - Sami Ouannes
- Cardiology Department, Sahloul University Hospital, Faculty of Medicine Ibn El Jazzar of Sousse, University of Sousse, Sousse, Tunisia
| | - Rym Gribaa
- Cardiology Department, Sahloul University Hospital, Faculty of Medicine Ibn El Jazzar of Sousse, University of Sousse, Sousse, Tunisia
| | - Aymen Elhraiech
- Cardiology Department, Sahloul University Hospital, Faculty of Medicine Ibn El Jazzar of Sousse, University of Sousse, Sousse, Tunisia
| | - Neffati Elyes
- Cardiology Department, Sahloul University Hospital, Faculty of Medicine Ibn El Jazzar of Sousse, University of Sousse, Sousse, Tunisia
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Slim M, Ben Farhat S, Gribaa R, Cherif T, Mgarech I. An unusual cause of chest pain after redux aortic valve replacement surgery. Eur Heart J Cardiovasc Imaging 2023; 24:e285. [PMID: 37480359 DOI: 10.1093/ehjci/jead179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 07/24/2023] Open
Affiliation(s)
- Mehdi Slim
- Université de Sousse, Faculté de médecine de Sousse, Hôpital Sahloul de Sousse, Service de cardiologie, Sahloul 1, 4054 Sousse, Tunisie
| | - Sameh Ben Farhat
- Université de Sousse, Faculté de médecine de Sousse, Hôpital Sahloul de Sousse, Service de cardiologie, Sahloul 1, 4054 Sousse, Tunisie
| | - Rym Gribaa
- Université de Sousse, Faculté de médecine de Sousse, Hôpital Sahloul de Sousse, Service de cardiologie, Sahloul 1, 4054 Sousse, Tunisie
| | - Taieb Cherif
- Université de Sousse, Faculté de médecine de Sousse, Hôpital Sahloul de Sousse, Service de chirurgie cardiovasculaire et thoracique, Sousse, Tunisie
| | - Imene Mgarech
- Université de Sousse, Faculté de médecine de Sousse, Hôpital Sahloul de Sousse, Service de chirurgie cardiovasculaire et thoracique, Sousse, Tunisie
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Yiannakis C, Hamilton L, Slim M, Kontorinis G. A systematic review and meta-analysis of prophylactic medication of vestibular migraine. J Laryngol Otol 2023; 137:953-961. [PMID: 36200521 DOI: 10.1017/s0022215122001979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Vestibular migraine is in the process of recognition as an individual clinical entity. At present, no guidelines exist for its management. This study aimed to conduct a systematic review and meta-analysis to determine the effectiveness of available prophylactic medication. METHOD A literature search was performed using PubMed, Ovid and Embase databases. Qualitative and quantitative analysis were performed as well as risk of bias analysis. Meta-analysis for the mean differences for pre- and post-treatment impact based on Dizziness Handicap Inventory and Vertigo Symptom Scale were performed. Proportionate transformation meta-analysis for the successful event rate based on complete symptoms control was explored. RESULTS Thirteen publications were identified: 3 were randomised, controlled trials and 10 were non-randomised, controlled trials. Propranolol and venlafaxine improved the Vertigo Symptom Scale score by -13.31 points and -4.16 points, respectively, and the Dizziness Handicap Inventory score by -32.24 and -21.24, respectively. Only propranolol achieved statistically significant impact with 60 per cent of patients achieving complete symptom control. CONCLUSION Propranolol should be offered as the first-line treatment for vestibular migraine followed by venlafaxine. Amitriptyline, flunarizine and cinnarizine showed a trend for symptom improvement, but this was not statistically significant.
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Affiliation(s)
- C Yiannakis
- Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - L Hamilton
- Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - M Slim
- Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - G Kontorinis
- Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
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Hammami R, Abid S, Jihen J, Triki Z, Ben Mrad I, Kammoun A, Slim M, Kacem M, Thabet H, Abdessalem AB, Mallek S, Charfeddine S, Triki F, Hejri SE, Naffeti I, Denguir H, Kraeim S, Abid L. Prevention of radial artery occlusion with rivaroxaban after trans-radial access coronary procedures: The RIVARAD multicentric randomized trial. Front Cardiovasc Med 2023; 10:1160459. [PMID: 37153470 PMCID: PMC10160658 DOI: 10.3389/fcvm.2023.1160459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/27/2023] [Indexed: 05/09/2023] Open
Abstract
Background Radial artery occlusion (RAO) remains the most frequent complication of trans-radial access. Once the radial artery is occluded, its future use as an access site for coronary procedures, or as a conduit for coronary bypass grafting or fistula for hemodialysis, will be precluded. Therefore, we aimed to assess the value of the short-term use of Rivaroxaban to prevent RAO after a trans-radial coronary procedure. Methods This was a prospective, open-label, randomized study. The patients were randomly assigned (1:1) to one of two groups: those who received Rivaroxaban 10 mg for 7 days following the trans-radial coronary procedure (the Rivaroxaban Group) and those who received the standard treatment (the Control Group). The primary outcome was an occurrence of RAO evaluated by Doppler ultrasound at 30 days, and the secondary outcomes were hemorrhagic complications according to BARC classification. Results We included 521 patients randomized into two Groups: the Control Group (N = 262) and the Rivaroxaban Group (N = 259). The 1-month RAO was significantly reduced in the Rivaroxaban Group as compared to the Control Group [6.9% vs. 13%; p = 0.011, OR = 0.5, (95% CI, 0.27-0.91)]. We noted no cases of severe bleeding events (BARC3-5). The overall incidence of minor bleeding (BARC1) was 2.3%, with no significant difference between the two groups [Rivaroxaban Group = 2.7%, Control Group = 1.9%, p = 0.54, OR= 1.4, (95%CI 0.44-4.5)]. Conclusions Short-term postoperative anticoagulation with Rivaroxaban 10 mg for seven days reduces the rate of 1-month RAO.
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Affiliation(s)
- Rania Hammami
- Cardiology Department, Hedi Chaker Hospital, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
- Correspondence: Rania Hammami
| | - Slim Abid
- Cardiology Department, Hedi Chaker Hospital, Sfax, Tunisia
| | - Jdidi Jihen
- University of Sfax, Sfax, Tunisia
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
- Epidemiology Department, Hedi Chaker Hospital, Sfax, Tunisia
| | - Zied Triki
- Cardiology Department, Hedi Chaker Hospital, Sfax, Tunisia
| | | | - Amine Kammoun
- Cardiology Department, Hedi Chaker Hospital, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | | | | | | | | | - Souad Mallek
- Cardiology Department, Hedi Chaker Hospital, Sfax, Tunisia
| | - Selma Charfeddine
- Cardiology Department, Hedi Chaker Hospital, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Faten Triki
- Cardiology Department, Hedi Chaker Hospital, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | | | | | | | | | - Leila Abid
- Cardiology Department, Hedi Chaker Hospital, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
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Slim M, Mekki N, Ouannes S, Neffati E. Transcatheter closure of residual Gerbode defect after aortic valve replacement surgery. Eur Heart J Case Rep 2022; 6:ytac283. [PMID: 35865229 PMCID: PMC9295689 DOI: 10.1093/ehjcr/ytac283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/24/2022] [Accepted: 06/30/2022] [Indexed: 11/25/2022]
Abstract
A 42-year-old man with a history of surgically repaired coarctation of the aorta presented with a refractory right heart failure. Echocardiography revealed a calcified bicuspid aortic valve both regurgitant and stenotic and a defect within the membranous septum with left to right shunt from the left ventricle (LV) to the right atrium. The patient was referred to surgery for an aortic valve replacement and closure with patch repair of the Gerbode type defect. Post-operative course was complicated by refractory heart failure with a persistent left to right shunt through the defect due to loose sutures. Taking into account the high surgical risk, percutaneous closure of the defect was decided. An Amplatzer Duct Occluder (St Jude Medical, USA) I device was successfully released within the defect. The patient was completely asymptomatic on follow-up.
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Affiliation(s)
- Mehdi Slim
- Cardiology Department, Sahloul University Hospital, Hammam Sousse , 4011 Sousse , Tunisia
| | - Nouha Mekki
- Cardiology Department, Sahloul University Hospital, Hammam Sousse , 4011 Sousse , Tunisia
| | - Sami Ouannes
- Cardiology Department, Sahloul University Hospital, Hammam Sousse , 4011 Sousse , Tunisia
| | - Elies Neffati
- Cardiology Department, Sahloul University Hospital, Hammam Sousse , 4011 Sousse , Tunisia
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Slim M, Ben Farhat S, Ben Ouannes S, Chrigui R, Yahya F, Thabet H, Ghardallou H, Gribaa R, Elhraiech A, Neffati E. Transcatheter closure of congenital ventricular septal defects using the Amplatzer Duct Occluder II device: preliminary data from a Tunisian monocentric study. Tunis Med 2022; 100:450-454. [PMID: 36206064 PMCID: PMC9585695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Percutaneous closure of congenital ventricular septal defects (VSDs) represents a promising alternative to surgery with lower rate of complications and shorter hospital stay. Its main limitation is the choice of the appropriate device for each type of defect. AIM To report the experience of the service of cardiology (Sahloul hospital, Sousse, Tunisia) in percutaneous closure of congenital VSDs with Amplatzer Duct Occluder II (ADOII). METHODS This was a retrospective, monocentric study, conducted from January 2013 to December 2017. The study included patients treated by percutaneous closure of congenital VSDs with the ADOII device. RESULTS Twelve patients (6 boys; 6 girls) were included. The mean±SD of patients' age and weight were 65±41 months and 23±10 kg, respectively. VSDs were peri-membranous (n=9) and muscular (n=3), and defects were restrictive (n=11) and non-restrictive (n=1). The mean (minimum-maximum) size of VSDs was 4.72 (3-6) mm. Eleven ADOII prostheses were successfully implanted. One failure procedure was noted with migration of the device into the pulmonary artery. A second child with perimembranous defect developed transient atrioventricular block. No deaths occurred. CONCLUSION The present early experience shows that percutaneous closure with ADOII device of perimembranous and trabecular VSDs is safe and effective.
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Affiliation(s)
- Mehdi Slim
- 1. Service de cardiologie, Hôpital Sahloul de Sousse / Université de Sousse, Faculté de médecine de Sousse
| | - Sameh Ben Farhat
- 1. Service de cardiologie, Hôpital Sahloul de Sousse / Université de Sousse, Faculté de médecine de Sousse
| | - Sami Ben Ouannes
- 1. Service de cardiologie, Hôpital Sahloul de Sousse / Université de Sousse, Faculté de médecine de Sousse
| | - Raoudha Chrigui
- 2. Service d’anesthésie réanimation, Hôpital Sahloul de Sousse / Université de Sousse, Faculté de médecine de Sousse
| | - Faten Yahya
- 1. Service de cardiologie, Hôpital Sahloul de Sousse / Université de Sousse, Faculté de médecine de Sousse
| | - Houceme Thabet
- 1. Service de cardiologie, Hôpital Sahloul de Sousse / Université de Sousse, Faculté de médecine de Sousse
| | - Houda Ghardallou
- 1. Service de cardiologie, Hôpital Sahloul de Sousse / Université de Sousse, Faculté de médecine de Sousse
| | - Rym Gribaa
- 1. Service de cardiologie, Hôpital Sahloul de Sousse / Université de Sousse, Faculté de médecine de Sousse
| | - Aymen Elhraiech
- 1. Service de cardiologie, Hôpital Sahloul de Sousse / Université de Sousse, Faculté de médecine de Sousse
| | - Elies Neffati
- 1. Service de cardiologie, Hôpital Sahloul de Sousse / Université de Sousse, Faculté de médecine de Sousse
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Thabet H, Gribaa R, Kacem M, Meddeb A, Slim M, Ben Farhat S, Ben Ali I, Hraiech A, Ouannes S, Neffati E. Percutaneous closure of the persistent ductus arteriosus in adults. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ben Halima A, Aouina H, Hamzaoui A, Gharbi L, Chaouech N, Dhahri B, Ghrairi H, Maazaoui S, Sahnoun I, Ben Mansour A, Louhichi S, Ben Amar J, Lakehal R, Allouche E, Ben Ahmed H, Aissa MS, Fathi M, Boudiche F, Ben Jemaa H, Béji M, Ouechtati W, Bezdah L, Ben Abdessalem MA, Cheikh Sidiya K, Romdhane AF, Ben Ameur Z, Mosrati H, Ammar F, Bouraoui H, Hajri S, Mahdhaoui A, Jeridi G, Nasser K, Elhraiech A, Kacem M, Tekaya MA, Meddeb A, Ben Hamda K, Maatouk F, Wachem O, Antit S, Fekih R, Antit C, Boussabah E, Thameur M, Zakhama L, Ben Youssef S, Ben Doudou M, Kamoun S, Ben Mrad I, Ben Moussa F, Fennira S, Mzoughi K, Zairi I, Kraiem S, Messaoudi Y, Ben Abdallah M, Ghabi O, Ben Halima N, Mleyhi S, Sandi T, Miri R, Besbes T, Ghédira F, Ben Omrane S, Denguir R, Drissa M, Brahim A, Mousli E, Ousji C, Abou Nada H, Bouslimi A, Merdassi A, Taher O, Drissa H, Yaakoubi W, Ben Hlima M, Rekik B, Soula MA, Zouari F, Boudiche S, Mghaieth F, Ouali S, Mourali MS, Taamallah K, Abid M, Hajlaoui N, Haggui A, Fehri W, Ben Abdallah M, Azaiez F, Cherif N, Jaoued F, Tlili R, Ben Ameur Y, Khorchani A, Ben Ali Z, Dali AE, Milouchi S, Boufares A, Ben Krayen I, Mtimet H, Ben Haj Mbarek MG, Bouhamed O, Dardouri S, Gribaa R, Ben Ali I, Slim M, Neffati E, Damak E, Jaber C, Cherif T, Bousnina M, Jemel A, Jerbi S, Marzouki Y, Neji S, Beji M, Chaabene I, Tahri S, Kechida M, Daada S, Hammami S, Ben Abdallah W, Klii R, Khochtali I, Rekik E, Abdelhedi M, Lahbib N, Aouadi D, Abid S, Besbes B, Oumaya Z, BelKahla N, Arbaoui I, Daoued F, Jebali H, Lahmaier E, Chaabouni E, Hajji M, Zouaghi MK, Abdallah M, Mlayah S, Selmi Y, Idriss H, Ahmed J, Brahim O, Turki E, Ghzel R, Ouaghlani K, Hakim K, Boussema A, Ben Arbia H, Said S, Msaad H, Ouarda F, Khalifa R, Hamila G, Triki S, Ataoui S, Keita A, Ben Othman R, Ghardallou H, Karmous R, El Bardi M, Lassoued C, Laadhar L, Khadhar Y, Aouini F, Ben Mrad M, Ben Romdhane N, Hamdi S, Chenik S, Jabloun Y, Talhaoui A, Mahfoudhi H, Ghardallou M, Noamen A, Raddaoui H, Chourabi C, Amorri A, Boukhili H, Khannouch A, Louati M, Alzain H, Hamdani A, Bousnina S, Ajra Z, Gheni R, Ben Hmida R, Ounissi T, Ibn Elhadj Z, Fekih W, Ben Yedder M, Medi W, Elghoul J, Ben Dayekh A, Ben Radhia B, Nasser K, Mtir H, Kortas C, Mgarrech I, Jamli M, Kaddour H, Mekki N, Amamou I, Achour A, Ouannes S, Ben Farhat S, Jaouadi A, Ben Saad S, Letaief R. Abstracts of the Tunisian Society of Cardiology and Cardiovascular Surgery congress, STCCCV 2021. Tunis Med 2022; 100:72-90. [PMID: 35822336 PMCID: PMC9028527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Allouche E, Lachter G, Aissa MS, Ben Jemaa H, Boudiche F, Ben Ahmed H, Ouechtati W, Bezdah L, Bousnina S, Antit S, Ben Kaab B, Boussabah E, Zakhama L, Brahmi H, Ammar F, Belkhiria H, Dali A, Daassa C, Jamel A, Ben Halima N, Hamdani A, Ajra Z, Bayar MF, Gheni R, Rashikou L, Ben Hmida R, Ounissi T, Ibn Elhadj Z, Chelbi H, Fekih R, Boufares A, Thameur M, Abdelhedi M, Neji S, Boudiche F, Chetoui A, Ouechtati W, Cherif N, Mekki N, Slim M, Ouannes S, Ghardallou H, Neffati E, Kadardar F, Hachani M, Iddir S, Marzouki Y, Dardour S, Mejber W, Ben Slima H, Lassoued T, Chamtouri I, Jomaa W, Ben Hamda K, Maatouk F, Hakim K, Ben Othmen R, Msaad H, Ouarda F, Ben Gandoura A, Ben Halima A, Taktak I, Draoui Y, Yaakoubi W, Tamallah K, Chourabi C, Oussema M, Haggui A, Hajlaoui N, Fehri W, Ben Romdhane R, Tlili R, Azaiez F, Bachraoui K, Drissa M, Ben Youssef A, Fatou AW, Khadra H, Diouf MT, Ba S, Diouf D, Sarr MN, Mingou JS, Sarr SA, Dioum M, Ngaide AA, Beye SM, Manga S, Affangla DA, Diouf Y, Diop KH, Bodian M, Leye MMCB, Ndiaye MB, Mbaye A, Kane AD, Diao M, Kane A, Ben Ghorbel C, Soudani S, Gribaa R, Leye M, Ismael Ibouroi MH, Ba EHM, Affangla DA, Ba DM, Diagne Diallo A, Fall AL, Saidane S, Mzoughi K, Bouzidi H, Khannouch A, Ben Mrad I, Kamoun S, Zairi I, Kraiem S, Guesmi A, Mestiri B. ABSTRACTS CONGRÈS STCCCV 2022. Tunis Med 2022; 100:809-818. [PMID: 37551524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
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Gribaa R, Ouannes S, Tangour H, Ben Farhat S, Thabet H, Slim M, Elheraiche A, Neffati E. Trans-Catheter Closure of Patent Ductus Arteriosus, which device should we use? Tunis Med 2021; 99:1085-1092. [PMID: 35288912 PMCID: PMC9390122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Despite the operational experience in the percutaneous closure of Patent ductus arteriosus (PDA), complications can arise during the procedure. To overcome these complications the choice of the device must be adapted to each patient. AIM To report the experience of the cardiology department in the transcatheter device closure of PDA and to determine the influencing factors of choice of the device. METHODS Our study included patients with patent ductus arteriosus that are admitted for transcatheter closure, between September 2003 and June 2016. RESULT One hundred and fifty-three patients were included in our study. Transcatheter closure was not done in 9 cases. The transcatheter closure was successful in 140 patients. The complications were observed in 11 patients that includes device embolization in 3 cases, aortic protrusion in four cases pulmonary protrusion in three cases and inguinal hematoma in one another. Three predictive factors of complications were: age < 2 years, tubular PDA type C and ratio duct diameter/weight > 0.95. A mild residual shunt was observed at the end of the procedure in 22.85 % of the patients. The risk of residual shunt was significantly increased when the age < 2 years, the large PDA, the presence of pulmonary hypertension and the tubular C PDA. CONCLUSION The choice of the device depends essentially on age, the weight and the duct anatomy.
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Affiliation(s)
- Rym Gribaa
- 1- Service de cardiologie hôpital de Sahloul, Faculté de médecine de Sousse, Université de Sousse
| | - Sami Ouannes
- 1- Service de cardiologie hôpital de Sahloul, Faculté de médecine de Sousse, Université de Sousse
| | - Heithem Tangour
- 1- Service de cardiologie hôpital de Sahloul, Faculté de médecine de Sousse, Université de Sousse
| | - Sameh Ben Farhat
- 1- Service de cardiologie hôpital de Sahloul, Faculté de médecine de Sousse, Université de Sousse
| | - Houssem Thabet
- 1- Service de cardiologie hôpital de Sahloul, Faculté de médecine de Sousse, Université de Sousse
| | - Mehdi Slim
- 1- Service de cardiologie hôpital de Sahloul, Faculté de médecine de Sousse, Université de Sousse
| | - Aymen Elheraiche
- 1- Service de cardiologie hôpital de Sahloul, Faculté de médecine de Sousse, Université de Sousse
| | - Elyes Neffati
- 1- Service de cardiologie hôpital de Sahloul, Faculté de médecine de Sousse, Université de Sousse
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Slim M, Gribaa R, Neffati E. Anomalous origin of circumflex artery with atypical aortic coarctation. Rev Esp Cardiol (Engl Ed) 2021; 74:879-880. [PMID: 33771488 DOI: 10.1016/j.rec.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/19/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Mehdi Slim
- Department of Cardiology, Sahloul University Hospital, Sousse, Tunisia.
| | - Rim Gribaa
- Department of Cardiology, Sahloul University Hospital, Sousse, Tunisia
| | - Elies Neffati
- Department of Cardiology, Sahloul University Hospital, Sousse, Tunisia
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Slim M, Neffati E, Farhat SB, Jemli M, Tarmiz A. An unusual non-tumoural cardiac mass. Eur Heart J Cardiovasc Imaging 2021; 22:e12. [PMID: 32637992 DOI: 10.1093/ehjci/jeaa182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mehdi Slim
- Service de cardiologie, Université de Sousse, Faculté de médecine de Sousse, Hôpital Sahloul de Sousse, Route de la ceinture, Sahloul 1, 4054 Sousse, Tunisie
| | - Elies Neffati
- Service de cardiologie, Université de Sousse, Faculté de médecine de Sousse, Hôpital Sahloul de Sousse, Route de la ceinture, Sahloul 1, 4054 Sousse, Tunisie
| | - Sameh Ben Farhat
- Service de cardiologie, Université de Sousse, Faculté de médecine de Sousse, Hôpital Sahloul de Sousse, Route de la ceinture, Sahloul 1, 4054 Sousse, Tunisie
| | - Marah Jemli
- Service de chirurgie cardiovasculaire et thoracique, Université de Sousse, Faculté de médecine de Sousse, Hôpital Sahloul de Sousse, Route de la ceinture, Sahloul 1, 4054 Sousse, Tunisie
| | - Amin Tarmiz
- Service de chirurgie cardiovasculaire et thoracique, Université de Sousse, Faculté de médecine de Sousse, Hôpital Sahloul de Sousse, Route de la ceinture, Sahloul 1, 4054 Sousse, Tunisie
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Gribaa R, Kacem M, Ouannes S, Majdoub W, Thabet H, Ali IB, Elheraiche A, Slim M, Hmissa S, Neffati E, Cherif T, Kortas C, Marah J, Jerbi S. Neonatal cardiogenic shock revealing obstructive cardiac Hibernoma: case report. J Cardiothorac Surg 2021; 16:222. [PMID: 34348738 PMCID: PMC8340373 DOI: 10.1186/s13019-021-01582-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background Cardiac Hibernomas are very rare benign tumors and usually remain asymptomatic. Neonatal cardiogenic shock due to cardiac tumors is extremely very rare. Until this date a few cases of cardiac hibernoma have been reported in the literature. Transthoracic echocardiography help in the differential diagnosis, but the definitive diagnosis is histological. The management strategy is not clearly codified. The Aim is to report and discuss the clinical features of a cardiac Hibernoma and review the relevant literature. Case presentation We describe a case of a 2-day-old Caucasian full-term male neonate admitted in neonate intensive care with cardiogenic shock, having fluid resuscitation and inotropic drugs. Ventilatory support was started immediately with the subsequent reestablishment of normal blood pressure. Then he was transferred to the echocardiography laboratory. Transthoracic echocardiography showed two echogenic masses in the right atrium and right ventricle. The masses were extended to the pulmonary trunk. Pulmonary artery flow measurements showed the presence of pulmonary and tricuspid obstruction. Surgery was rapidly considered since the baby was hemodynamically unstable. Intraoperative evaluation showed a mass embedded in the interventricular septum that occupy the right ventricular cavity and the right atrium. The tumor involved also the chordae of the tricuspid. Partial resection was done. Tricuspid valve repair was performed by construction of new chordae from the autologous pericardium. The specimen was sent for histopathological analysis. The baby died immediately after surgery. Histological examination of the surgical specimen revealed clear multivacuolated cells filled with lipid droplets and granular intense eosinophilic cytoplasm which confirms the diagnosis of Hibernoma. Conclusion Cardiac Hibernomas are rare benign tumors. The prognosis and treatment strategy is closely dependent on the location, initial clinical presentation and possible complications. The prognosis can be unfavorable if the tumor was obstructive and infiltrate the myocardium.
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Affiliation(s)
- Rym Gribaa
- Cardiology Department, Sahloul University Hospital, Sousse, Tunisia.
| | - Marwen Kacem
- Cardiology Department, Sahloul University Hospital, Sousse, Tunisia
| | - Sami Ouannes
- Cardiology Department, Sahloul University Hospital, Sousse, Tunisia
| | - Wiem Majdoub
- Anatomic and cytopathologic laboratory, Sahloul University Hospital, Sousse, Tunisia
| | - Houssem Thabet
- Cardiology Department, Sahloul University Hospital, Sousse, Tunisia
| | - Imen Ben Ali
- Cardiology Department, Sahloul University Hospital, Sousse, Tunisia
| | - Aymen Elheraiche
- Cardiology Department, Sahloul University Hospital, Sousse, Tunisia
| | - Mehdi Slim
- Cardiology Department, Sahloul University Hospital, Sousse, Tunisia
| | - Sihem Hmissa
- Anatomic and cytopathologic laboratory, Sahloul University Hospital, Sousse, Tunisia
| | - Elyes Neffati
- Cardiology Department, Sahloul University Hospital, Sousse, Tunisia
| | - Taieb Cherif
- Cardiovascular surgery department, Sahloul University Hospital, Sousse, Tunisia
| | - Chokri Kortas
- Cardiovascular surgery department, Sahloul University Hospital, Sousse, Tunisia
| | - Jamli Marah
- Cardiovascular surgery department, Sahloul University Hospital, Sousse, Tunisia
| | - Sofiene Jerbi
- Cardiovascular surgery department, Sahloul University Hospital, Sousse, Tunisia
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Bigoteau M, Grammatico-Guillon L, Massot M, Baudet JM, Duroi Q, Pichard T, Slim M, Pisella PJ, Khanna RK. [Clinical and economic impact of an ambulatory cataract surgery center without anesthesia in an area with poor ophthalmologic coverage]. J Fr Ophtalmol 2021; 44:947-956. [PMID: 34148703 DOI: 10.1016/j.jfo.2020.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The Ambulatory Clinic for Cataract Surgery (CACC) is a public department of the Bourges Medical Center, with a fast-track protocol without perioperative anesthesia care launched in 2015. This study aimed to evaluate the benefits of the CACC in terms of access to cataract surgery. METHODS This retrospective study included all patients undergoing cataract surgery between 2012 and 2018. Data were collected from the French PMSI database. In order to evaluate the impact of the CACC, the surgical activity and change in indicators of patient flow and usage, as well as clinical and economic factors were analyzed. RESULTS Between 2012 and 2018, with the same number of ophthalmologists, surgical activity increased by 50.2% in the Cher (vs. a mean increase of 22.7% in France). The patient loss ratio decreased by 5.9 points, the attraction and self-sufficiency ratios increased by 2.3 and 8.6 points respectively. The standardized rate of healthcare utilization for cataract surgery increased by 4.3 points (from 11.6 to 15.9 surgeries per 1000 inhabitants). As a result, Cher became the second highest French Department in 2018 in terms of utilization rate despite its 96th place out of 109 Departments in terms of density of ophthalmologists. CONCLUSION The ambulatory cataract surgery center without anesthesia for selected patients might represent a solution in medical deserts to improve access to cataract surgery without increasing costs.
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Affiliation(s)
- M Bigoteau
- Service d'ophtalmologie, centre hospitalier universitaire régional de Bretonneau, Tours, France; Service d'ophtalmologie, Centre Hospitalier Jacques Cœur, Bourges, France
| | - L Grammatico-Guillon
- Service de santé publique, faculté de médecine de Tours, unité d'épidémiologie EpiDcliC, université de Tours, CHRU de Tours, France
| | - M Massot
- Département d'information médicale, centre hospitalier Jacques Cœur, Bourges, France
| | - J-M Baudet
- Service d'ophtalmologie, Centre Hospitalier Jacques Cœur, Bourges, France
| | - Q Duroi
- Service d'ophtalmologie, centre hospitalier universitaire régional de Bretonneau, Tours, France
| | - T Pichard
- Service d'ophtalmologie, Centre Hospitalier Jacques Cœur, Bourges, France
| | - M Slim
- Service d'ophtalmologie, Centre Hospitalier Jacques Cœur, Bourges, France
| | - P-J Pisella
- Service d'ophtalmologie, centre hospitalier universitaire régional de Bretonneau, Tours, France
| | - R K Khanna
- Service d'ophtalmologie, centre hospitalier universitaire régional de Bretonneau, Tours, France.
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Bigoteau M, Massot M, Baudet JM, Pasco J, Pichard T, Slim M, Bourges JL, Pisella PJ, Khanna RK. [Epidemiology of ocular emergencies in a non-university hospital: Clinical characteristics and severity grading according to the Base Score]. J Fr Ophtalmol 2021; 44:813-821. [PMID: 33965273 DOI: 10.1016/j.jfo.2020.08.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/24/2020] [Accepted: 08/11/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to analyse the epidemiological characteristics of ophthalmological emergencies at the Bourges Medical Center (CHB) and to identify factors associated with severity according to the Base Score in a region of France considered a healthcare desert. METHODS All consecutive charts of patients seen for an eye-related condition between January 1 and April 30, 2019 in the ocular emergency department of the CHB were studied retrospectively. Seven demographic and nine medical variables were collected, and ocular severity was defined according to the Base Score. Linear regressions were performed to identify the factors associated with higher severity. RESULTS 1809 patients were included (mean age: 53.3±22.7 years, 51.4% women), of whom 1619 (89.5%) were self-referred. Ocular surface disease (12.5%) was the most frequent diagnosis. The severity of the eye-related condition was significantly associated with the following factors: male gender, distance from home to the emergency department, presentation soon after the onset of symptoms, and referral from a physician (ophthalmologist or not). The regression coefficient was greater than 1 only for the patient referral pattern. CONCLUSION The current study highlights that when patients with ocular emergencies can self-refer to an ocular emergency department within a French healthcare desert, 9 patients out of 10 self-refer. Referral from a physician is the main factor associated with ocular severity; thus, these cases should be considered severe until proven otherwise.
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Affiliation(s)
- M Bigoteau
- Service d'ophtalmologie, Centre hospitalier universitaire régional de Bretonneau, Tours, France; Service d'ophtalmologie, Centre hospitalier Jacques-Cœur, Bourges, France
| | - M Massot
- Département d'information médicale, Centre hospitalier Jacques-Cœur, Bourges, France
| | - J-M Baudet
- Service d'ophtalmologie, Centre hospitalier Jacques-Cœur, Bourges, France
| | - J Pasco
- Département d'information médicale, Centre hospitalier universitaire régional de Bretonneau, Tours, France
| | - T Pichard
- Service d'ophtalmologie, Centre hospitalier Jacques-Cœur, Bourges, France
| | - M Slim
- Service d'ophtalmologie, Centre hospitalier Jacques-Cœur, Bourges, France
| | - J-L Bourges
- Service d'ophtalmologie, Université de Paris, Faculté de médecine Paris Descartes, hôpital Cochin, AP-HP, Paris, France
| | - P-J Pisella
- Service d'ophtalmologie, Centre hospitalier universitaire régional de Bretonneau, Tours, France
| | - R K Khanna
- Service d'ophtalmologie, Centre hospitalier universitaire régional de Bretonneau, Tours, France.
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Thabet H, Gribaa R, Kacem M, Meddeb A, Sghaier A, Ajmi N, Ghardallou H, Slim M, Lagren A, Ben Ali I, Ouaness S, Neffati E. Percutaneous closure of ventricular septal defect: Short and medium term results. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Thabet H, Slim M, Dahmani W, Ben Slama A, Kacem M, Meddeb A, Dardouri S, Kallala Y, Amamou I, Mekki N, Ghariani A, Lagren A, Ben Ali I, Hraiech A, Ouannes S, Gribaa R, Neffati E. Cirrhotic cardiomyopathy: Prevalence and predictive factors. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ben Farhat S, Slim M, ElHraiech A, Gribaa R, Ben Ali I, Ghardallou H, Letaief R, Thabet H, Ouannes S, Neffati E. Prevalence and factors associated with spontaneous closure of congenital ventricular septal defects. Tunis Med 2020; 98:980-985. [PMID: 33480000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Most of congenital ventricular septal defects evolve towards spontaneous closure of different mechanisms depending on their location. AIM To determine the prevalence and factors associated with spontaneous closure of congenital ventricular septal defects. METHODS We conducted a retrospective study of 1000 patients diagnosed with congenital ventricular septal defects in our department from January 2000 to December 2017. RESULTS After an average follow-up of 52.65 months (± 76.93 months), 183 (18.88%) of ventricular septal defects closed spontaneously. The average time for spontaneous closure was 45.78 months (76.34 months). 30.77% of trabecular ventricular septal defects (p<0.05) and 16.93% of perimembranous defects closed spontaneously (p=0.17). 28.5% of perimembranous defects associated with aneurysm formation versus 17.4% of those without associated aneurysm evolved to spontaneous closure (p<0.05). 65.6% of spontaneous closure occured during the first 3 years of life. In multivariate analysis, trabecular site [OR=2.85; CI (2.05-3.97)] and aneurysms of membranous septum [OR=1.9; CI (1.41-2.8)] were independent factors associated with spontaneous closure of defects. CONCLUSION The highest VSD closure rate was observed during the first three years of life. Trabecular site and aneurysms tissue of membranous septum were found as independent factors associated with spontaneous closure.
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Abstract
Behçet’s disease (BD) is a multisystemic chronic vasculitis characterized by its clinical polymorphism. It concerns mainly young men and generally appears between the third and the fourth decades. Cardiac involvement in Behçet’s disease is rare but represents a major prognostic factor. We report the case of a young man admitted in our department for the management of an acute coronary syndrome revealing a Behçet’s disease. Coronary angiography had shown a giant thrombosed aneurysm of the left coronary artery. Surgical treatment was successfully performed and the patient had a left anterior descending coronary artery bypass using the left internal mammary artery graft.
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Affiliation(s)
- Sameh Ben Farhat
- Department of Cardiology, Sahloul University Hospital, Sousse, Tunisia
| | - Mehdi Slim
- Department of Cardiology, Sahloul University Hospital, Sousse, Tunisia
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Thabet H, Gribaa R, Slim M, Lagren A, Hraiech A, Neffati E, Boughzala E. Percutaneous mitral dilatation in pregnant women: Short-term results. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Thabet H, Gribaa R, Slim M, Lagren A, Hraiech A, Ouannes S, Neffati E, Boughzala E. Short, medium and long-term results of a series of percutaneous mitral dilatation. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dlamini N, Slim M, Kirkham F, Shroff M, Dirks P, Moharir M, MacGregor D, Robertson A, deVeber G, Logan W. Predicting Ischemic Risk Using Blood Oxygen Level-Dependent MRI in Children with Moyamoya. AJNR Am J Neuroradiol 2019; 41:160-166. [PMID: 31806596 DOI: 10.3174/ajnr.a6324] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/02/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Moyamoya is a progressive steno-occlusive arteriopathy. MR imaging assessment of cerebrovascular reactivity can be performed by measuring the blood oxygen level-dependent cerebrovascular reactivity response to vasoactive stimuli. Our objective was to determine whether negative blood oxygen level-dependent cerebrovascular reactivity status is predictive of ischemic events in childhood moyamoya. MATERIALS AND METHODS We conducted a retrospective study of a consecutive cohort of children with moyamoya who underwent assessment of blood oxygen level-dependent cerebrovascular reactivity. The charts of patients with written informed consent were reviewed for the occurrence of arterial ischemic stroke, transient ischemic attack, or silent infarcts. We used logistic regression to calculate the OR and 95% CI for ischemic events based on steal status. Hazard ratios for ischemic events based on age at blood oxygen level-dependent cerebrovascular reactivity imaging, sex, and moyamoya etiology were calculated using Cox hazards models. RESULTS Thirty-seven children (21 female; median age, 10.7 years; interquartile range, 7.5-14.7 years) were followed for a median of 28.8 months (interquartile range, 13.7-84.1 months). Eleven (30%) had ischemic events, 82% of which were TIA without infarcts. Steal was present in 15 of 16 (93.8%) hemispheres in which ischemic events occurred versus 25 of 58 (43.1%) ischemic-free hemispheres (OR = 19.8; 95% CI, 2.5-160; P = .005). Children with idiopathic moyamoya were at significantly greater risk of ischemic events (hazard ratio, 3.71; 95% CI, 1.1-12.8; P = .037). CONCLUSIONS Our study demonstrates that idiopathic moyamoya and the presence of steal are independently associated with ischemic events. The use of blood oxygen level-dependent cerebrovascular reactivity could potentially assist in the selection of patients for revascularization surgery and the direction of therapy in children with moyamoya.
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Affiliation(s)
- N Dlamini
- From the Division of Neurology (N.D., M. Slim, M.M., D.M., A.R., G.d.V., W.L.)
| | - M Slim
- From the Division of Neurology (N.D., M. Slim, M.M., D.M., A.R., G.d.V., W.L.)
| | - F Kirkham
- Developmental Neurosciences Unit and Biomedical Research Centre (F.K.), University College London Great Ormond Street Institute of Child Health, London, UK
| | - M Shroff
- Department of Pediatrics, and Departments of Diagnostic Imaging (M. Shroff)
| | - P Dirks
- Surgery (P.D.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - M Moharir
- From the Division of Neurology (N.D., M. Slim, M.M., D.M., A.R., G.d.V., W.L.)
| | - D MacGregor
- From the Division of Neurology (N.D., M. Slim, M.M., D.M., A.R., G.d.V., W.L.)
| | - A Robertson
- From the Division of Neurology (N.D., M. Slim, M.M., D.M., A.R., G.d.V., W.L.)
| | - G deVeber
- From the Division of Neurology (N.D., M. Slim, M.M., D.M., A.R., G.d.V., W.L.)
| | - W Logan
- From the Division of Neurology (N.D., M. Slim, M.M., D.M., A.R., G.d.V., W.L.)
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Slim M, Ha C, Vanstone CA, Morin SN, Rahme E, Weiler HA. Evaluation of plasma and erythrocyte fatty acids C15:0, t-C16:1n-7 and C17:0 as biomarkers of dairy fat consumption in adolescents. Prostaglandins Leukot Essent Fatty Acids 2019; 149:24-29. [PMID: 31421524 DOI: 10.1016/j.plefa.2019.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/09/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Pentadecanoic (C15:0), heptadecanoic (C17:0) and trans-palmitoleic (t-C16:1n-7) fatty acids (FAs) are often used as biomarkers for dairy fat in adults. This study aimed to investigate the relationship between dairy product intake and these FAs in adolescents. MATERIAL AND METHODS Healthy adolescents were randomized to one of three groups (Group 1: control; Group 2: consume 3 dairy servings/day; and Group 3: consume ≥ 4 servings/d). C15:0, C17:0 and t-C16:1n-7 were quantified using gas chromatography. Dietary intakes were assessed by 24 h diet recalls. RESULTS No difference was observed in FAs at baseline or 6 months (mo), however, at 12 mo, erythrocyte C15:0 increased in group 3 (+0.37 µg/ml, p = 0.01). Dairy intake increased in both intervention groups (Group 2: +1.4 servings/d; Group 3: +2.4 servings/d, p < 0.0001) and positively correlated with erythrocyte C15:0 at 12 mo. CONCLUSION Erythrocyte FAs appear to be associated with increasing dairy intakes during adolescence.
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Affiliation(s)
- M Slim
- School of Human Nutrition, McGill University, 21,111 Lakeshore Road, Ste Anne de Bellevue, QC, H9X 3V9, Canada
| | - C Ha
- School of Human Nutrition, McGill University, 21,111 Lakeshore Road, Ste Anne de Bellevue, QC, H9X 3V9, Canada
| | - C A Vanstone
- School of Human Nutrition, McGill University, 21,111 Lakeshore Road, Ste Anne de Bellevue, QC, H9X 3V9, Canada
| | - S N Morin
- Department of Medicine, Division of General Internal Medicine, McGill University, Montreal, QC, Canada
| | - E Rahme
- Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada
| | - H A Weiler
- School of Human Nutrition, McGill University, 21,111 Lakeshore Road, Ste Anne de Bellevue, QC, H9X 3V9, Canada.
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Azouzi A, Omri M, Kraiem H, Mbarek H, Slim M, Boussarsar M. Iatrogenic epinephrine-induced Takotsubo cardiomyopathy in beta-blocker poisoning: case report. Cor Vasa 2019. [DOI: 10.1016/j.crvasa.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Slim M, Meddeb MA, Neffati E, Ghardallou H, Lagren A, Tarmiz A, Kortas C, Gribaa R, Boughzela E. A comparative study of bypass versus percutaneous intervention for left main disease. Tunis Med 2019; 97:533-540. [PMID: 31729703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Left main coronary artery disease is known as the highest risk lesion subset of ischemic heart disease. Several studies have shown a significant benefit following treatment with coronary artery bypass grafting compared with medical treatment. As a result, surgery has been the standard of care for the revascularization of left main disease for a long time. However, with the remarkable improvements in interventional cardiology, percutaneous coronary intervention has become technically feasible and showed favorable clinical outcomes. AIM We sought to evaluate trends in treatment strategies of left main coronary artery disease over time in Sahloul University Hospital and to compare patient's characteristics as well as early, mid-term and long-term adverse outcomes of each therapeutic option. METHODS From 2005 to 2016, 260 patients with unprotected left main disease (defined as stenosis of at least 50%) were included. 109 patients underwent PCI (group 1), 102 patients underwent Surgery (group 2) and 49 patients were medically treated (group 3). Major cardiac and cerebrovascular events were defined as the composite of: mortality, nonfatal myocardial infarction, stroke, and need for repeat revascularization. Event rates were estimated with Kaplan-Meier analyses. RESULTS Over time, the proportion of patients treated with percutaneous coronary intervention rather than coronary artery bypass grafting increased substantially, whereas the proportion of patients who received medical therapy remained steady. Group 1 patients had more cardiogenic shock (6.4% vs 0%, p=0,01) at presentation compared to group 2. More patients treated with surgery had multivessel disease (73% vs 40%; p <0.001), more distal left main bifurcation lesions (52.3% vs 73.5%; p=0.001) and higher SYNTAX scores (23.3±9.96 vs 32.5±8.7; p <0.001). All the other baseline variables were similar. At follow up, there were no differences, at the adjusted analysis, in the rate of myocardial infarction, cerebrovascular accidents, and the composite endpoint of major cardiovascular and cerebrovascular events (HR: 1, 04; 95% CI: 0.59 to 1.83; p=0.88). Compared to percutaneous coronary intervention group, group 2 has a higher all-cause mortality (p=0.017) driven exclusively by an elevated incidence of operative mortality (13.7% vs. 6.4%; HR: 0.08; 95% CI: 0.017 to 0.43; p=0.003). Nevertheless, long-term advantage of coronary artery bypass grafting over percutaneous coronary intervention was the less need for repeat revascularization (HR: 3.1; 95% CI: 1.26 to 8.12; p=0.014). CONCLUSION Our data show that revascularization therapy have evolved remarkably in the favor of percutaneous coronary intervention over the last decade. Angioplasty and coronary artery bypass graft show comparable safety. However, the need for revascularization is more common after percutaneous treatment.
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Brahim KB, Gribaa R, Slim M, Labidi O, Abdallah M, Ghardallou H, Boughzela E. Long-term outcomes of coronary chronic total occlusion: Percutaneous coronary intervention versus optimal medical therapy. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2018.10.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Thabet H, Boughzala E, Abdllah M, Laabidi O, Slim M, Gribaa R, Ben Brahim K, Lagren A, Neffati E. Coronary artery birth defects, epidemiological and clinical features: A retrospective study of 82 cases. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2018.10.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ibañez-Juliá MJ, Berzero G, Reyes-Botero G, Maisonobe T, Lenglet T, Slim M, Louis S, Balaguer A, Sanson M, Le Guern E, Latour P, Ricard D, Stojkovic T, Psimaras D. Antineoplastic agents exacerbating Charcot Marie Tooth disease: red flags to avoid permanent disability. Acta Oncol 2018; 57:403-411. [PMID: 29243538 DOI: 10.1080/0284186x.2017.1415462] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Charcot Marie Tooth (CMT) disease is the most common form of hereditary neuropathy. Due to the high prevalence of mild and undiagnosed forms, patients with CMT disease may be exposed to severe neurotoxicity following the administration of neurotoxic chemotherapies. The aim of this report is to alert oncologists to the potential to precipitate severe irreversible peripheral neuropathies when administering neurotoxic compounds to undiagnosed CMT patients. MATERIAL AND METHODS A retrospective research in the OncoNeuroTox database was performed (2010-2016), searching for patients with the diagnosis of chemotherapy-induced peripheral neuropathy (CIPN) and CMT disease. A comprehensive literature review for previously published cases was performed using the Pubmed and Cochrane databases (1972-2017). RESULTS Among 428 patients with CIPN, we identified eight patients with concomitant CMT disease. Seven patients out of the eight had no previous diagnosis of CMT disease, although accurate familial history disclosed mild signs of peripheral neuropathy in five cases. Patients themselves had minor stigmata of long-standing peripheral damage. Patients received chemotherapy regimens based on vinca alkaloids, taxanes or a combination of vinca alkaloids and platinum compounds. In two cases, cumulative doses were below or equal to the expected neurotoxic threshold. Following chemotherapy administration, patients developed severe length-dependent sensory-motor deficits. Despite early drug discontinuation, most patients remained severely disabled. CONCLUSION A brief checklist to disclose long-standing signs of peripheral neuropathy could be helpful to detect patients with undiagnosed hereditary neuropathies who could be at risk of developing severe irreversible neurotoxicity following the administration of neurotoxic agents.
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Affiliation(s)
- M. J. Ibañez-Juliá
- Department of Neurology Mazarin, Hôpitaux universitaires Pitié-Salpêtrière Charles Foix. Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - G. Berzero
- Neuroscience Consortium, University of Pavia, Monza Policlinico and Pavia Mondino, Pavia, Italy
| | - G. Reyes-Botero
- Cancer Unit, Neuro-oncology Section, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - T. Maisonobe
- Department of Clinical Neurophysiology, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix. Assistance Publique Hôpitaux de Paris (APHP), Paris, France
- OncoNeuroTox Group: Center for Patients with Neurological Complications of Oncologic Treatments, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix et Hôpital d’Instruction des Armées Percy, Paris and Clamart, France
| | - T. Lenglet
- Department of Clinical Neurophysiology, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix. Assistance Publique Hôpitaux de Paris (APHP), Paris, France
- OncoNeuroTox Group: Center for Patients with Neurological Complications of Oncologic Treatments, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix et Hôpital d’Instruction des Armées Percy, Paris and Clamart, France
| | - M. Slim
- OncoNeuroTox Group: Center for Patients with Neurological Complications of Oncologic Treatments, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix et Hôpital d’Instruction des Armées Percy, Paris and Clamart, France
- Department of Oncology, Hôpitaux universitaires Pitié-Salpêtrière Charles Foix. Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - S. Louis
- Department of Neurology Mazarin, Institute of Myology, Hôpitaux universitaires Pitié-Salpêtrière Charles Foix. Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - A. Balaguer
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - M. Sanson
- Department of Neurology Mazarin, Hôpitaux universitaires Pitié-Salpêtrière Charles Foix. Assistance Publique Hôpitaux de Paris (APHP), Paris, France
- Inserm U 1127, CNRS UMR 7225, Sorbonne Université, France
| | - E. Le Guern
- Department of Genetics, Hôpitaux universitaires Pitié-Salpêtrière Charles Foix. Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - P. Latour
- Department of Genetics, Hospices Civils de Lyon, Lyon, France
| | - D. Ricard
- OncoNeuroTox Group: Center for Patients with Neurological Complications of Oncologic Treatments, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix et Hôpital d’Instruction des Armées Percy, Paris and Clamart, France
- Department of Neurology, Hôpital d'Instruction des Armées Percy, Service de Santé des Armées, Clamart, France
| | - T. Stojkovic
- Department of Neurology Mazarin, Institute of Myology, Hôpitaux universitaires Pitié-Salpêtrière Charles Foix. Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - D. Psimaras
- Department of Neurology Mazarin, Hôpitaux universitaires Pitié-Salpêtrière Charles Foix. Assistance Publique Hôpitaux de Paris (APHP), Paris, France
- OncoNeuroTox Group: Center for Patients with Neurological Complications of Oncologic Treatments, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix et Hôpital d’Instruction des Armées Percy, Paris and Clamart, France
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Sanabria-Cabrera J, Sanjuan-Jiménez R, Stephens C, Robles-Díaz M, Ortega-Alonso A, Jiménez-Pérez M, Medina-Cáliz I, Slim M, Andrade R, Lucena M. Hepatitis E Virus, A Diagnosis to Consider in Drug Induced Liver Injury Assessment. Clin Ther 2017. [DOI: 10.1016/j.clinthera.2017.05.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Slim M, Guedri Y, Neffati E, Lagren A, Cheikh Bouhlel M, Gribaa R, Remadi F, Boughzela E. The implantable cardioverter defibrillator: Indications and follow-up. Tunis Med 2017; 95:242-248. [PMID: 29492927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Sudden cardiac death (SCD) is a public health problem. In most cases, it is the consequence of ventricular arrhythmias. The only treatment of proven effectiveness is the implantable cardioverter defibrillator (ICD). AIM To describe indications for ICD implantation according to the underlying heart disease and report it's short and long-term results. METHODS We report a retrospective and descriptive study involving 90 patients implanted with an ICD in our facility collected between January 2003 and December 2014. RESULTS The average age of our population was 49 ± 15 years (14-76). A male predominance was noted (sex ratio: 6). Ischemic heart disease was the most common underlying heart disease found in 37% of cases. The average left ventricular ejection fraction was 43.5 ± 17.7%. A slight predominance of primary prevention was noted in our series (52%). Single, dual and triple chamber ICD were used in respectively 34%, 36% and 30% of cases. The use of triple chamber ICD was more frequent in cardiomyopathies and ischemic heart disease. Early complications were observed in 9 patients (10%). No deaths directly related to the ICD implantation procedure was observed in our series. The mean follow-up was 39.7 months (3-136). We recorded 14 deaths. The main cause of death was refractory heart failure. During follow-up, 16 patients (18%) received appropriate ICD shocks. The only predictor of appropriate therapies was the indication of ICD for secondary prevention (p=0,002). Twenty one patients (23%) had complications inherent to the implantation of ICD. The main complication was inappropriate shocks found in 11 patients (12%). The main cause of these shocks was supraventricular arrhythmias 68%). Ischemic heart disease (p = 0.001) and secondary prevention (p = 0.048) were significantly associated with the occurrence of inappropriate ICD shocks. The ICD was explanted after varying delays in 4 patients (4.4%). CONCLUSION The results of our study were comparable to major ICD studies and registries particularly in terms of procedural, late complications and the occurrence of appropriate ICD therapies.
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Tarmiz A, Mgarrech I, Slim M, Kortas C, Jerbi S. [Right ventricular myxoma in a child: an uncommon presentation]. Pan Afr Med J 2017; 25:138. [PMID: 28292100 PMCID: PMC5326036 DOI: 10.11604/pamj.2016.25.138.10563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 08/27/2016] [Indexed: 11/18/2022] Open
Abstract
Le myxome du ventricule droit est une localisation très rare des myxomes cardiaques. Les complications les plus fréquentes sont l'embolie pulmonaire et l'obstruction par la tumeur de la valve pulmonaire. Nous rapportons le cas d'un enfant âgé de 11 ans admis en Cardiologie pour des syncopes à répétition. L'échographie cardiaque met en évidence un myxome du ventricule droit de 2cm, obstruant l'orifice pulmonaire. L'exérèse chirurgicale est pratiquée en urgence sous circulation extracorporelle, avec des suites opératoires favorables. L'examen anatomopathologique de la pièce a permis de confirmer le diagnostic de myxome. Le suivi à 18 mois ne montre pas de récidive tumorale.
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Affiliation(s)
- Amine Tarmiz
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Sahloul, Sousse, Tunisie
| | - Imene Mgarrech
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Sahloul, Sousse, Tunisie
| | - Mehdi Slim
- Service de Cardiologie, CHU Sahloul, Sousse, Tunisie
| | - Chokri Kortas
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Sahloul, Sousse, Tunisie
| | - Sofiane Jerbi
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Sahloul, Sousse, Tunisie
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Tarmiz A, Mgarrech I, Slim M, Hlima NB, Kortas C, Jerbi S. [Acute pulmonic valve endocarditis]. Pan Afr Med J 2017; 25:209. [PMID: 28270905 PMCID: PMC5326261 DOI: 10.11604/pamj.2016.25.209.10550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 11/02/2016] [Indexed: 11/25/2022] Open
Abstract
L'endocardite du cœur droit touche dans la plupart des cas la valve tricuspide, notamment chez les toxicomanes. L'infection isolée de la valve pulmonaire est rarement retrouvée. Nous rapportons dans cette observation le cas d'une jeune femme âgée de 32 ans chez quile diagnostic d'endocardite communautaire de la valve pulmonaire a été confirmé. Cette observation est d'autant plus intéressante qu'elle survient chez une patiente sans antécédents de toxicomanie, avec néanmoins la notion de communication interventriculaire restrictive. La patiente a été opérée en urgence devant l'image de grosse végétation très mobile sur les données de l'échographie cardiaque transthoracique. La chirurgie a été pratiquée sous circulation extracorporelle et la valve pulmonaire a été remplacée par une bioprothèse. Les hémocultures et la culture de la valve ont retrouvé un staphylococcus aureus sensible à la Méticilline. L'évolution postopératoire a été favorable avec un recul de 06 mois sans récurrence infectieuse.
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Affiliation(s)
- Amine Tarmiz
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Sahloul, Sousse, Tunisie
| | - Imene Mgarrech
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Sahloul, Sousse, Tunisie
| | - Mehdi Slim
- Service de Cardiologie, CHU Sahloul, Sousse, Tunisie
| | - Najeh Ben Hlima
- Service de Cardiologie, CHU Ibn El Jazzar, Kairouan, Tunisie
| | - Chokri Kortas
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Sahloul, Sousse, Tunisie
| | - Sofiane Jerbi
- Service de Chirurgie Cardiovasculaire et Thoracique, CHU Sahloul, Sousse, Tunisie
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Slim M, Lagran A, Sebri A, Amara R, Meddeb A, Neffati E, Gribaa R, Remadi F, Boughzela E. Results and prognosis factors associated with percutaneous coronary interventions for left main coronary artery disease. Archives of Cardiovascular Diseases Supplements 2017. [DOI: 10.1016/s1878-6480(17)30077-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Cardiac hemangiomas are benign tumors with an unpredictable natural history. Surgical resection is the treatment of choice; however, conservative management can be an alternative in some patients. We report a case of a left-sided cardiac hemangioma that we managed conservatively for 11 years without obvious major complications in the patient, an adult woman.
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Gribaa R, Slim M, Slim K, Ben Salem H, Neffati E, Ouali S, Remadi F, Boughzela E. Short, midterm and late results of percutaneous coronary interventions for left main coronary artery disease. Tunis Med 2015; 93:612-617. [PMID: 26895123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Left main coronary artery disease is found in 4-6% of patients undergoing diagnostic coronary angiography. Coronary artery bypass graft is the gold standard. However, percutaneous coronary intervention is a continuously evolving substitution for surgery in such patients. METHODS We report a retrospective study of 32 patients with relevant left main coronary artery disease treated by angioplasty in our faculty, between January 2005 and March 2011. RESULTS The mean age of the population on the study was 59.7±10.9 years. The sex-ratio was 3.57. The rate of angiographic success was 97%. The in-hospital stay was uneventful in 94%¨of our patients. Only one patient died of cardiogenic shock complicating an acute anterior myocardial infarction. After a mean follow up of 18.5 ± 15.4 months, the in-stent restenosis rate was 16.12%. The rate of major adverse cardiac events (MACE) was 29%. Independent predictive factors of MACE were: cardiogenic shock on admission (p=0.022), emergency procedures (p=0.033), Euroscore > 6 (p=0.001), Parsonnet score > 20 (p=0.036), High C réactive protein levels on admission (p=0.007),le taux de créatinine (p=0.008), un diamètre de référence du TCCG < 3.5 mm (p =0.036) et l'utilisation de stents (p=0.036) and the use of bare metal stents (p=0.036). Independent predictive factors of in-stent restenosis were: use of bare metal stents (p=0.004) and Paclitaxel drug eluting stents (p=0.037). CONCLUSION Percutaneous coronary intervention is safe and a validated alternative to coronary artery bypass graft for left main coronary artery disease. However, it should be reserved to selected patients and limited to experienced centers.
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Gribaa R, Slim M, Kortas C, Kacem S, Ben Salem H, Ouali S, Neffati E, Remadi F, Boughzela E. Right ventricular myxoma obstructing the right ventricular outflow tract: a case report. J Med Case Rep 2014; 8:435. [PMID: 25515693 PMCID: PMC4301803 DOI: 10.1186/1752-1947-8-435] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 07/30/2014] [Indexed: 12/01/2022] Open
Abstract
Introduction Primary cardiac tumors are uncommon during infancy and childhood. Myxomas originating from the right ventricle are even less common in pediatric patients. Case presentation Here we describe a case of an 11-year-old Tunisian boy who was referred for syncope. Transthoracic echocardiography revealed a large mobile mass attached to his right ventricle, obstructing his right ventricular outflow tract. Complete surgical excision of the mass with preservation of the pulmonary valve was performed. The diagnosis of myxoma was histologically confirmed. Conclusion Cardiac myxomas located in the right ventricular outflow tract are rare and can present unusual diagnostic and therapeutic challenges.
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Affiliation(s)
- Rym Gribaa
- Department of Cardiology, Sahloul Hospital, Sousse, Tunisia.
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Gribaa R, Slim M, Ouali S, Neffati E, Boughzela E. Transcatheter closure of a congenital coronary artery to right ventricle fistula: a case report. J Med Case Rep 2014; 8:432. [PMID: 25511876 PMCID: PMC4301068 DOI: 10.1186/1752-1947-8-432] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 09/25/2014] [Indexed: 01/15/2023] Open
Abstract
Introduction Congenital coronary artery fistula is a rare anomaly that may cause angina, atrial fibrillation, endocarditis, aneurysmal dilation and myocardial infarction. Both spontaneous regression and life-threatening complications have been described. Treatment can be conservative, surgical or more recently through transcatheter closure. Case presentation We report the case of a 27-year-old Tunisian man with a large coronary artery fistula from the left anterior descending artery to the right ventricle associated with pulmonary stenosis. This patient underwent a successful transcatheter closure of his coronary artery fistula followed by pulmonary dilatation and had an uneventful recovery after treatment. Conclusions Transcatheter closure of a congenital coronary artery fistula is feasible and should be considered in carefully selected patients. Recanalization of the treated coronary fistula can occur, so follow-up angiography or other imaging modality should be performed in these patients.
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Affiliation(s)
| | - Mehdi Slim
- Department of Cardiology, Sahloul University Hospital, Hammam Sousse, Route de la Ceinture, 4011 Sousse, Tunisia.
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Gribaa R, Slim M, Ouali S, Neffati E, Remadi F, Boughzela E. Four successful pregnancies in a woman after Fontan palliation: a case report. J Med Case Rep 2014; 8:350. [PMID: 25335555 PMCID: PMC4209458 DOI: 10.1186/1752-1947-8-350] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 08/18/2014] [Indexed: 11/30/2022] Open
Abstract
Introduction A Fontan operation is performed to provide palliation for patients with many forms of highly complex congenital heart disease that cannot support a biventricular circulation. Increasing numbers of women who have undergone these connections in childhood are now reaching their childbearing years, and some are becoming pregnant. The low flow and fixed cardiac output of a Fontan circulation poses several problems during pregnancy. Case presentation We report the case of four successful pregnancies in a 31-year-old Tunisian woman with congenital tricuspid atresia after Fontan operation. Her pregnancies resulted in delivery of four healthy neonates. Her clinical status remained unchanged. Conclusions This case suggests that patients after adequate Fontan palliation could complete pregnancy without long-term cardiac sequelae. Intensive care should be provided with specialists, including a neonatologist, anesthesiologist and cardiologist.
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Affiliation(s)
| | - Mehdi Slim
- Department of Cardiology, Sahloul University Hospital, Sousse, Tunisia.
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Gribaa R, Slim M, Ben Salem H, Neffati E, Boughzela E. Anomalous origin of the left coronary artery from the pulmonary artery presenting as dilated cardiomyopathy: a case report. J Med Case Rep 2014; 8:170. [PMID: 24885797 PMCID: PMC4086689 DOI: 10.1186/1752-1947-8-170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 03/10/2014] [Indexed: 12/02/2022] Open
Abstract
Introduction Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital anomaly and one of the causes of myocardial ischemia. The usual clinical course is severe left-sided heart failure and mitral valve insufficiency presenting during the first months of life. Case presentation We report the case of a 6-month-old Tunisian girl who presented with dilated cardiomyopathy. Echocardiography suspected anomalous origin of the left coronary artery. The definitive diagnosis of anomalous origin of the left coronary artery from the pulmonary artery was reached by multislice computed tomography and coronary angiography. Conclusion In cases of dilated cardiomyopathy, anomalous origin of the left coronary artery from the pulmonary artery syndrome has to be kept in mind as a surgically correctable cause.
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Affiliation(s)
- Rym Gribaa
- Department of Cardiology, Sahloul Hospital, Sousse, Tunisia.
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Calandre EP, Slim M, Garcia-Leiva JM, Rodriguez-Lopez CM, Torres P, Rico-Villademoros F. Agomelatine for the treatment of patients with fibromyalgia and depressive symptomatology: an uncontrolled, 12-week, pilot study. Pharmacopsychiatry 2014; 47:67-72. [PMID: 24549860 DOI: 10.1055/s-0033-1363659] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Agomelatine, a melatonin agonist and selective 5-HT2C antagonist, is a novel antidepressant with sleep-enhancing properties. The purpose of this study was to assess the efficacy and tolerability of agomelatine among patients with fibromyalgia and depression. METHODS 23 patients with fibromyalgia and depressive symptomatology received 25-50 mg of agomelatine daily for 12 weeks. The primary outcome measure was the change of the Beck depression inventory score. Secondary outcome measures included the hospital anxiety and depression scale, Pittsburgh sleep quality index, Fibromyalgia Impact Questionnaire, short-form health survey, brief pain inventory and patient's global impression scale. RESULTS Agomelatine significantly improved depression, global fibromyalgia severity and pain intensity but effect sizes were small. No improvement was seen in sleep quality. Patients categorized as responders to treatment had milder disease severity than non-responders. Agomelatine therapy was well tolerated and patients only reported mild and transient side effects. DISCUSSION Agomelatine slightly improved depressive and fibromyalgia symptomatology but did not improve sleep quality. Our data do not support agomelatine as a first-line treatment option for the treatment of fibromyalgia and depression.
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Affiliation(s)
- E P Calandre
- Instituto de Neurociencias, Universidad de Granada, Granada, Spain
| | - M Slim
- Instituto de Neurociencias, Universidad de Granada, Granada, Spain
| | - J M Garcia-Leiva
- Instituto de Neurociencias, Universidad de Granada, Granada, Spain
| | | | - P Torres
- Instituto de Neurociencias, Universidad de Granada, Granada, Spain
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Attia S, Megarrech M, Jellti B, Slim M, Gargouri S, Chaabani L, Jenzri S, Khairallah M. 741 Rétinite nécrosante post-streptococcique : à propos d’un cas. J Fr Ophtalmol 2009. [DOI: 10.1016/s0181-5512(09)73866-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Messaoud R, Ammari W, Hmidi K, Abdelhadi W, Slim M, Laajimi M, Jenzeri S, Khairallah M. 471 Signes électro-rétinographiques au cours de la microphtalmie postérieure. J Fr Ophtalmol 2009. [DOI: 10.1016/s0181-5512(09)73595-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ramani R, Newman R, Salkin IF, Li K, Slim M, Arlievsky N, Gedris C, Chaturvedi V. Cokeromyces recurvatus as a human pathogenic fungus: case report and critical review of the published literature. Pediatr Infect Dis J 2000; 19:155-8. [PMID: 10694005 DOI: 10.1097/00006454-200002000-00014] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- R Ramani
- Wadsworth Center, New York State Department of Health, Albany 12208-2002, USA
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Abstract
BACKGROUND Prenatally diagnosed neuroblastomas have been reported in increasing numbers over the past several years, and there are now a few reviews based on up to 21 cases. The purpose of this article is to review the clinical and biologic features of prenatally diagnosed neuroblastoma based on a review of 55 cases. METHODS A review was conducted of 3 cases seen at the study institution and 52 other cases reported thus far in the literature. RESULTS Prenatal diagnosis was made usually after 32 weeks of gestation. Approximately 93% of the tumors were adrenal in origin, and 44% of these were cystic. Thirty-seven patients (67%) had Stage I disease, 12 (22%) had Stage IV-S disease, and only 3 (5%) had Stage IV disease. The DNA index was favorable (> 1) in 14 of 16 patients studied. None of these 16 patients studied had amplification of the N-myc oncogene. Catecholamines were elevated in only 33% of the patients. The liver was the most common site of dissemination, which was observed in 25% of patients; bone involvement was not observed in any patient. Ultrasonography failed to detect existing hepatic metastasis in three patients. Primary surgical resection was performed in 47 patients (85%). Chemotherapy was given to five patients and radiotherapy to three. Of the 50 patients for whom follow-up information was available, 45 (90%) were alive at a range of 2-120 months from diagnosis. CONCLUSIONS Prenatally diagnosed neuroblastomas are predominantly adrenal in origin and frequently cystic. The liver is the most common site of dissemination and bone involvement is notably absent. The vast majority of these infants have a favorable stage of disease (I, II, and IV-S) and favorable biologic features, and consequently have an excellent prognosis. Although surgery alone is curative for most patients, a period of observation may avoid surgery in some individuals who may achieve spontaneous regression.
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Affiliation(s)
- S Acharya
- Division of Pediatric Hematology-Oncology, New York Medical College, Valhalla 10595, USA
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Sandoval C, Oiseth S, Slim M, Tugal O, Ozkaynak MF, Brudnicki A, Beneck D, Bostwick H, Jayabose S. Gastric ganglioneuroblastoma: a rare finding in an infant with multifocal ganglioneuroblastoma. J Pediatr Hematol Oncol 1996; 18:409-12. [PMID: 8888754 DOI: 10.1097/00043426-199611000-00016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE This report describes a female infant with stage 4 multifocal ganglioneuroblastoma with gastric involvement. PATIENT The patient had a right cervical tumor, a left posterior mediastinal tumor, bilateral adrenal tumors, and bony and bone marrow metastases. The tumor cells were diploid and lacked N-myc gene amplification. The gastric involvement, which did not produce clinical symptoms, was only detected by meticulous exploration during laparotomy. RESULTS Our patient achieved only a partial response to alternating cycles of cyclophosphamide, vincristine, and adriamycin; and etoposide and cisplatin. She currently has stable, unresectable disease with elevated catecholamines. CONCLUSIONS Multifocal ganglioneuroblastomas may arise from either neuroblastic rests or aberrant deposits of neuroblasts. The latter mechanism may have accounted for our patient's gastric tumor. Patients with multifocal ganglioneuroblastomas warrant meticulous radiographic and surgical evaluation to completely document the full extent of disease, and to ensure appropriate staging and therapy.
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Affiliation(s)
- C Sandoval
- Department of Pediatrics, Pathology, Pediatric Surgery and Radiology, New York Medical College, Valhalla 10595, USA
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Levendoglu-Tugal O, Slim M, Davidian MM, Klein S, Jayabose S. Solid variant of aneurysmal bone cyst in a patient with cyclic neutropenia. Pediatr Hematol Oncol 1996; 13:549-54. [PMID: 8940739 DOI: 10.3109/08880019609030871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A 16-year-old female with cyclic neutropenia (CN) was incidentally found to have a thoracic vertebral mass during the preoperative work-up for maxillary sinus surgery. An exploratory thoracotomy revealed a very vascular tumor involving T-10 and T-11 vertebral bodies. Gross total resection of the tumor was achieved. Pathology revealed a solid variant of aneurysmal bone cyst. This is a rare benign neoplasm of bone more commonly seen in the mandible and facial bones as well as involving the small tubular bones of the hands and feet. Because of its rarity, location, and an unknown association with CN, we found this case worthwhile to publish.
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Levendoglu-Tugal O, Noto R, Juster F, Brudnicki A, Slim M, Beneck D, Jayabose S. Langerhans cell histiocytosis associated with partial DiGeorge syndrome in a newborn. J Pediatr Hematol Oncol 1996; 18:401-4. [PMID: 8888752 DOI: 10.1097/00043426-199611000-00014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE We report the unrecognized association of Langerhans cell histiocytosis (LCH) with partial DiGeorge syndrome. PATIENT AND METHODS A 7-week-old infant with endocrine and immunologic characteristics of DiGeorge syndrome displayed multisystem involvement of Letterer-Siwe disease at birth. RESULTS Despite vigorous medical support and chemotherapy, she died at 9 months of age with multisystem failure. CONCLUSIONS This case supports the role of the thymus n the pathogenesis of LCH.
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Boyer J, Dozor A, Brudnicki A, Slim M, Paliotta M, Kwark HE. Extralobar pulmonary sequestration masquerading as a congenital pleural effusion. Pediatrics 1996; 97:115-7. [PMID: 8545204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- J Boyer
- Department of Pediatrics, New York Medical College, Valhalla 10595, USA
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