RESUMEN
Cocaine is a potent sympathomimetic drug usually associated with cardiotoxicity, including ventricular arrhythmia, systemic hypertension and acute myocardial infarction. It constitutes the most frequent cause of drug-related death reported by medical examiners in the US, and these events are most often related to the cardiovascular manifestations of the drug. However; to the best of our knowledge; cocaine induced acute myocarditis has very rarely been reported. We describe the case of a 19 year-old male regular user of marijuana and cocaine who was admitted for a suspicion on an acute lateral-wall myocardial infarction and in whom the final diagnosis of acute cocaine myocarditis has been made. We report diagnosis modalities and evolution.
Asunto(s)
Trastornos Relacionados con Cocaína/complicaciones , Miocarditis/etiología , Enfermedad Aguda , Humanos , Masculino , Adulto JovenRESUMEN
BACKGROUND: Hepatocellular carcinoma (HCC) is the most frequent primitive hepatic tumor, the fifth most common cancer in the world,and the third highest cause of cancer-related mortality. The presence of cirrhosis is the main risk factor. AIM: To describe the epidemiological, clinical and therapeutic features of HCC. METHODS: Retrospective study including all the patients with HCC occurring in cirrhotic liver followed in the gastroenterological department of Charles Nicolle hospital between 1997 and 2009. RESULTS: A hundred and one patient were enrolled; 64 men and 37 women with a median age of 65.4 years (31-88 years). Cirrhosis was due to viral hepatitis B or C in 25.7% and 62.2% of cases respectively and was classified Child Pugh A, B and C in 30.7%,50.5% and 18.8% of patients respectively. HCC was inaugural in most cases (68.3 %) and it was revealed by a tumoral syndrome in 38.6% of cases, by decompensation in 22.7% and was discovered during systematic screening when cirrhosis was already known in 19.8% of cases. Diagnosis of HCC was non invasive, relying on imaging and alphafetoprotein in most cases (95%). 84 patients(83.2%) had an advanced HCC, with vascular or extra hepatic spread in 58 (57.5%) of them. Treatment was curative in 14 cases, based on surgical resection in one case and percutaneous ablation in 13 cases.Six patients received transarterial chemoembolization as a palliative treatment. In 71 patients, only symptomatic treatment was given. The median survival time was 11 months. CONCLUSION: In the majority of the cases, HCC was diagnosed at an advanced stage and treatment was only symptomatic.
Asunto(s)
Carcinoma Hepatocelular , Cirrosis Hepática , Neoplasias Hepáticas , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/complicaciones , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/epidemiología , Carcinoma Hepatocelular/terapia , Femenino , Hepatitis B/complicaciones , Hepatitis B/diagnóstico , Hepatitis B/epidemiología , Hepatitis B/terapia , Hepatitis C/complicaciones , Hepatitis C/diagnóstico , Hepatitis C/epidemiología , Hepatitis C/terapia , Humanos , Cirrosis Hepática/complicaciones , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/epidemiología , Cirrosis Hepática/terapia , Cirrosis Hepática Alcohólica/complicaciones , Cirrosis Hepática Alcohólica/diagnóstico , Cirrosis Hepática Alcohólica/epidemiología , Cirrosis Hepática Alcohólica/terapia , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/epidemiología , Neoplasias Hepáticas/terapia , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Three species of scorpions have been reported from Tunisia: Androctonus amoreuxi Audoin, A. aeneas Koch, and A. australis L. The latest has been divided in two subspecies: A. australis garzonii Goyffon & Lamy and A. australis hector Koch. Despite the public health importance of these animals, which cause several cases of poisoning each year, nothing is know about the genetic diversity of the group. To gain a better understanding of the group, we studied the variation of rDNA sequences of the ITS1, 5.8S, and ITS2 region of 14 representatives of the four taxa in Tunisia. The main result is the high polymorphism of the ITS regions. In some instances in both intra- and interspecific comparisons, it was difficult to unambiguously align the sequences. However, some representatives of different species were relatively similar, so that it appeared difficult to recognize the species on the basis of these sequences. A phylogenetic analysis was conducted that inquires the validity of the subspecies status of A. australis garzonii and A. australis hector. Moreover, the taxonomic status of A. aeneas is also questioned. Our studies highlighted the need of a revision of the taxonomy of the scorpions in Tunisia; however, the use of other genetic markers will be necessary to solve this question.