Quelques études retrouvent parmi les complications d'une capsulotomie au laser YAG la formation d'un oedème maculaire cystoïde apparaissant dans les semaines qui suivent le geste. Toutefois, on ne retrouve pas dans la littérature de mesures OCT de l'épaisseur centrale maculaire après capsulotomie. L'objectif de l'étude est de mesurer l'épaisseur maculaire après capsulotomie YAG chez 30 patients ne présentant par ailleurs aucune pathologie rétinienne connue. Il s'agit d'une étude prospective unicentrique chez des patients adressés dans le service pour capsulotomie au laser YAG. Les capsulotomies ont été réalisées par 5 ophtalmologistes différents. Les différents paramètres ont été étudiés à J0 (avant le laser), J7, J30 et J90. Ces paramètres étaient : l'acuité visuelle, le tonus oculaire et la mesure par OCT (OCT 3 de Zeiss) de l'épaisseur maculaire centrale. De plus, le nombre d'impact et la puissance du laser ont été notés pour chaque patient. Un test de Student a été utilisé pour l'étude statistique. Un « p » < 0.05 était considéré comme significatif. On ne constate pas d'épaississement significatif de l'épaisseur maculaire après capsulotomie au laser YAG (p > 0.05). Les complications connues après capsulotomie YAG sont l'oedème maculaire cystoïde, le décollement de rétine, et l'hypertonie. Dans notre série, nous n'avons pas retrouvé de telles complications, notamment pas d'oedème maculaire cystoïde. Nous avons noté une légère augmentation de l'épaisseur maculaire après laser à J7 mais non significative (p > 0.05). La capsulotomie au laser YAG n'apparaît pas, sur ce petit échantillon, comme un facteur favorisant l'épaississement maculaire.

Les auteurs rapportent une observation d'occlusion de l'artère centrale de la rétine compliquant l'évolution d'un syndrome néphrotique. Une revue de la littérature permet de répertorier les causes favorisant de tels accidents.

According to data from the literature, intraorbital involvement in multiple myeloma is rare. Such involvement may result in exophthalmia, itself the first manifestation and presenting feature of myeloma. These lesions can respond remarkably to radiotherapy. The authors present a new case report.

Kidney transplantation is actually the best replacement therapy for the end stage renal failure. It sets free the hemodialysed patient from the hemodialysis restraint and contributes to solve the socio-economic problems risen by chronic hemodialysis. The authors report the results of this technic during the first 30 months of kidney transplantation in the "Hôpital Charles Nicolle" of Tunis. They describe the first steps which led to kidney transplantation, the therapeutic regimens, the medico-legal problems and the specific complications observed during this start period.

Chronic hemodialysis is sometimes complicated by an osteoarticular amyloidosis, which happens after a middle delay of ten years, it can be expressed by a tunnel carpal syndrome, a shoulder pariarthritis, bony cysts, and erosive spondylarthropathy. The authors reported their experience about four cases, and insisted on some évocatoring radiologic aspects.

Pregnancy concomitant with Wegener's granulomatosis is extremely rare: so far, only four cases have been published. The authors report a fifth case where the disease appeared during the post-partum period, a situation which has already been noted in two of the published cases. Interruption of a subsequent pregnancy was followed by a flare-up of the disease resulting in the patient's death. This suggests that post-partum and post-abortum are probably instrumental in the onset and deterioration of Wegener's granulomatosis. The two patients previously reported who received immunosuppressants combined with corticosteroids had no flare-up after delivery. It seems permissible to prescribe such a therapeutic combination before and after delivery or abortion, especially since the fear of foetal toxicity from these drugs seems to be exaggerated.

We report the observation of a 40 year old man who was admitted with acute renal failure. Renal biopsy revealed massive interstitial infiltration by lymphocytes. Bone marrow examination was diagnostic for acute lymphoblastic leukemia. This presentation of acute leukemia is unusual. The mechanism of renal failure is discussed.

Les observations de grossesse au cours de la granulomatose de Wegener sont très rares quatre seulement ont été décrites. Les auteurs rapportent un cinquième cas au cours duquel la maladie s'est déclarée dans le post-partum, ce qui a été déjà noté deux fois dans la littérature. L'interruption de la grossesse ultérieure a été suivie d'une flambée évolutive qui a emporté la malade. Le rôle du post-partum et du post-abortum dans le déclenchement et l'aggravation de la maladie paraît ainsi probable. Les deux malades qui recevaient des immunosuppresseurs, en association avec les corticoïdes n'ont pas présenté de poussées évolutives après l'accouchement. L'encadrement systématique de l'accouchement ou de l'avortement par une telle association paraît licite, d'autant plus que les craintes quant à la toxicité fœtale d'un tel traitement semblent exagérées.

CAPD covers about 4% of renal replacement therapy patients in Tunisia. From February 1983 to 1988, 47 patients, 21 males and 26 females whose mean age was 36, 14 +/- 15 were treated. Their socio-cultural level was variable. The mean duration of therapy was 14.5 months/patient/year. The five years patient survival rate was 46% and the technique survival rate 21%. Most patients had a good general condition and were professionally rehabilitated. Peritonitis was the main complication: its incidence was 1.8 episodes/patient/year. Yeasts peritonitis were relatively frequent, specially in patients who had previously been treated with antibiotics. Peritonitis was often cured with a local and general treatment. Yearly CAPD cost was 1/3 lower than center hemodialysis and a better management allowed to decrease the expenses due to laboratory and X ray investigations and to hospitalization. On the basis of this clinical experience, we believe that CAPD is an efficient and valid therapeutic modality, less expensive than hemodialysis. It is probably a suitable renal replacement therapy in other centers in Tunisia and in other developing countries.

Wegener's granulomatosis in pregnancy. One case report.Pregnancy concomitant with Wegener's granulomatosis is extremely rare: so far, only four cases have been published. The authors report a fifth case where the disease appeared during the post-partum period, a situation which has already been noted in two of the published cases. Interruption of a subsequent pregnancy was followed by a flare-up of the disease resulting in the patient's death. This suggests that post-partum and post-abortum are probably instrumental in the onset and deterioration of Wegener's granulomatosis. The two patients previously reported who received immunosuppressants combined with corticosteroids had no flare-up after delivery. It seems permissible to prescribe such a therapeutic combination before and after delivery or abortion, especially since the fear of foetal toxicity from these drugs seems to be exaggerated.

Two patients with non-systemic idiopathic glomerulonephritis were found to have a complete deficiency of C2, the second component of complement; the clinical course and serological abnormalities are reported in detail. An immunogenetic analysis of the patients of two families was carried out. It was demonstrated that the homozygous C2 deficiency was associated with homozygosity for HLA-A25-B18-DR2-BfS-C4A4-C4B2 haplotype.