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Objectives To assess whether 2 polymorphisms of the methylenetetrahydrofolate reductase (MTHFR) gene, C677T and A1298C, are risk factors for vascular complications in Tunisian patients with type 2 diabetes mellitus. Methods The MTHFR polymorphisms were genotyped, and plasma homocysteine levels were evaluated in 160 Tunisian patients with type 2 diabetes mellitus. Results Prevalence of the 2 heterozygous polymorphisms of the thermolabile MTHFR gene (CT and AC) was encountered more commonly in patients with diabetes mellitus than in the healthy controls (p −3 ). Subjects with diabetes had significantly higher homocysteine (Hcy) levels than the control subjects; however, there was no statistical difference in plasma Hcy values between carriers of mutant genotypes (CT/TT for C677T and AC/CC for A1298C) and wild types (CC and AA) in patients with diabetes. Retinopathy was found to be a vascular complication in patients with either the 677CT or the 1298(AC+CC) genotype more commonly than in those with the wild-type genotypes (p=0.003; OR=3.2, 95% CI, 1.4 to 7.4; p −3 ; OR=5.9, 95% CI, 2.7 to 13). Only patients who carry the A1298C mutation (AC+CC) are at risk for at least 1 complication (p=0.002). Double heterozygous mutants were at the greatest risk for retinopathy and for suffering at least 1 complication (p −3 ). Conclusions Studies involving a larger study population and various ethnic groups are required before ruling out the role of MTHFR gene in type 2 diabetes mellitus and in vascular complications.

Resume Introduction Le diabete de type 2 est une pathologie chronique dont la survenue est associee a la presence de plusieurs facteurs. Parmi les nouveaux facteurs etudies, on cite la proteine C-reactive et la micro-albumine. Objectif Etudier la correlation entre le taux d’excretion urinaire d’albumine, les concentrations plasmatiques de la CRP et la presence de complications cardiovasculaires chez un groupe de patients diabetiques non insulinodependants. Patients et methodes L’etude a porte sur 48 diabetiques de type 2 subdivises en trois groupes selon le type de complication vasculaire (GI : diabetiques sans complications, GII : avec complications microvasculaires et GIII : avec complications macrovasculaires). Le dosage de la CRP et de la micro-albumine a ete realise pour tous les individus. Resultats Les diabetiques avec complications vasculaires presentent des taux significativement plus eleves de la CRP et de la micro-albumine lorsque compares aux diabetiques sans complications, avec des valeurs plus elevees chez les diabetiques avec complications macrovasculaires. Une correlation significativement positive a ete trouvee entre les taux de la CRP et ceux de la μalb ( r = 0,32 ; p Conclusion Le dosage des nouveaux marqueurs : CRP et la micro-albumine presente un interet dans le depistage des complications vasculaires chez les diabetiques de type 2.

Summary Introduction Nowadays the role of liver in the development of type 2 diabetes presents an interest in the recent studies research. Objectives In the present study we intend to determine the relationship between hepatic enzymes and insulinresistance in type 2 diabetic patients. Material and method The study group consists of 68 diabetics subdivided into two sub-groups: insulinsensitive diabetics (n = 26) and insulinresistant diabetics (n = 42) and a group of 24 control subjects. Results Diabetics have significant elevated levels of Alat (p = 0.03), Asat (p = 0.02) and GGT (p = 0.03) when compared to control subjects. Insulinresistant diabetics present the highest levels of hepatic enzymes Asat, Alat and GGT when compared to insulinsensitive diabetics. Conclusion Insuline may play a role in the hepatic function.

Summary Aims The aims of this study were to evaluate the chronic subclinical inflammation by determining high-sensitivity C-reactive protein level and to study the relation between inflammation and insulin resistance syndrome in a non-insulin-dependent diabetes mellitus group. Methods The study population consisted of 100 subjects divided into two groups. A control group consisted of 30 healthy subjects and a patients group of 70 non-insulin-dependent diabetes mellitus subjects. This group was subdivided into two subgroups according to the insulin resistance. The insulin resistance was estimated by the insulin resistance index of homeostasis model assessment (HOMA index). High-sensitivity C-reactive protein was measured by an immunonephelometric method. Results High-sensitivity C-reactive protein levels were significantly higher in diabetic patients than in controls (3.52 ± 1.49 mg/l versus 1.25 ± 0.78 mg/l, p Conclusion Our study confirmed the association between the inflammation, obesity and insulin resistance in non-insulin-dependent diabetes mellitus.

Summary Hyperhomocysteinemia is considered a risk factor for cardiovascular diseases. Many factors can cause hyperhomocysteinemia and the more evocated is the C677T mutation on the methylenetetrahydrofolate reductase gene (MTHFR). In the present study we intend to determine the relation between homocysteine (Hcy) concentrations and the C677T mutation in a type 2 diabetics group. The population study consists of 51 type 2 diabetic patients (29 men/22 women) with mean age 53,52 ± 13,56 years. The mutation was determined by PCR, and homocysteine, VitB12 and folates were assayed for each subject. The mutation was detected in 30 patients. CT and TT genotypes were found respectively in 16 and 14 patients. Hcy in diabetics with TT genotype was more elevated than in diabetics with CT genotype (p

Resume Introduction L’histiocytose est une maladie systemique rare. L’atteinte hypothalamo-hypophysaire est le plus souvent retardee et rarement etudiee chez l’adulte. Observations Nous rapportons les particularites cliniques et paracliniques chez 4 patientes avec histiocytose multifocale. Le diabete insipide a ete la manifestation de decouverte dans tous les cas. Un panhypopituitarisme est present chez 2 patientes et a ete inaugural dans 1 cas. L’insuffisance antehypophysaire s’installe dans un delai de 6 mois a 4 ans apres la decouverte du diabete insipide et les atteintes systemiques sont retardees de 3 a 6 ans par rapport a l’atteinte hypothalamo-hypophysaire. L’imagerie par resonance magnetique nucleaire a trouve un processus tumoral hypthalmo-hypophysaire chez 2 patientes et un epaississement de la tige pituitaire chez les 2 autres. Une patiente a une selle turcique partiellement vide. Discussion L’atteinte antehypophysaire semble predominante chez la femme adulte. Un panhypopituitarisme est possible des le debut de la maladie. Le polymorphisme clinique de cette maladie rend le diagnostic souvent difficile et retarde.

Objectives. – The prevalence of mycotic infection seems to be higher among diabetic patients than in the non-diabetic population. The aims of this study were to determine the frequency of mycosis and to compare clinical and fungal results. Patients and methods. – This transversal study included 307 type 1 and 2 diabetic patients admitted between January 1998 and January 2000. A dermatologist examined all patients. The mean age was 44 ± 17 years and the duration of diabetes 8 ± 6 years. Patients with suspected lesions underwent mycological examination. Results. – Clinical signs of presumed fungal infection were found in 61% of patients, but mycosis was confirmed only in 30%. Fungal foot infection accounted 38% of the patients, mostly due to dermatophytes (94%). The commonest localizations of dermatophytes were interdigital (60%) followed by onychomycosis (30%). The main fungal agent was Trichophyton rubrum. The main risk factors for fungal infections were the age of patients (P = 0.0003) and duration of diabetes (P < 0.05). Interdigital foot localization of dermatophytes was correlated to age (P < 0.0001) and to the male gender (P < 0.01). The frequency of dermatophytes in nails was higher in type 2 diabetic patients (P < 0.01). Vulvovaginal candidosis and interdigital dermatophytes were more frequent in obese than in non-obese patients. The accuracy and specificity of direct examination were respectively 85% and 79%. Conclusion. – The high frequency of mycosis in diabetic patients at hospital is demonstrated. The main risk factors were age, male gender and obesity.

Resume Introduction L’association entre stenose de l’artere renale et adenome de Conn est rare. Observation Nous rapportons l’observation d’un homme âge de 27 ans ayant presente une hypertension arterielle severe, associee a une hypokaliemie. Les explorations radiologiques concluaient a une stenose de l’artere renale gauche avec agenesie du rein gauche. Une nephrectomie gauche etait pratiquee. La pression arterielle se normalisait avec un seul antihypertenseur. Cinq ans plus tard, le patient presentait a nouveau une hypertension arterielle severe. La kaliemie etait a 2,8 mmol/L, avec une kaliurese a 84 mmol/24 heures et un rapport aldosterone/renine tres eleve, superieur a 462. Le scanner abdominal montrait un nodule surrenalien droit. Une surrenalectomie droite etait pratiquee. La pression arterielle etait a nouveau controlee avec un seul antihypertenseur. La kaliemie ainsi que le rapport aldosterone/renine se normalisaient. Conclusion Nous discutons du caractere fortuit ou causal de l’association de ces deux entites.

The authors report three new cases of ectopic pheochromocytoma: latero-aortic, bladder and near the kidney. From the review of the literature, they propose a diagnostic and therapeutic strategy for the management of ectopic localisation of pheochromocytoma.

Retroperitoneal bronchogenic cysts are rare and those located in the diaphragm are exceptional. We describe an additional case of bronchogenic cyst of the left crus of diaphragm. Diagnosis of a diaphragmatic lesion was confirmed during laparotomy and complete resection was successful. Final diagnosis was done on pathology.