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Introduction Les abces musculaires peuvent etre primitifs ou secondaire a une infection locoregionale. Leur profil microbiologique et leur prise en charge ont change ces dernieres annees. Notre etude retrospective a concerne 31 cas d’abces musculaire colliges dans le service de medecine interne de l’hopital militaire de Tunis sur 7 ans (2000–2006). Resultats Il s’agit de 24 hommes et de 7 femmes dont la moyenne est de 43 ans. Un terrain pathologique predisposant est retrouve chez 15 patients. Le diabete est la tare la plus frequente (11 cas). L’abces est primitif dans 12 cas et secondaire dans 19 cas (a une spondylodiscite : 6 cas ; a un erysipele : 5 cas ; a une osteoarthrite de la hanche : 3 cas ; a une sacroiliite : 2 cas ; a une arthrite du genou : 1 cas ; a un abces appendiculaire : 1 cas ; a une infection du site operatoire apres nephrectomie : 1 cas). Le germe est isole dans 21 cas. L’infection est a pyogene dans 16 cas (Staphylococcus aureus methicilline sensible : 11 cas ; Citrobacter diversus : 2 cas ; Escherchia coli : 2 cas ; Pseudomonas aeruginosa : 1 cas) et tuberculose dans 5 cas. L’abces est multiple dans 8 cas. L’infection siege essentiellement dans le muscle psoas (8 cas) et au muscle quadriceps (8 cas). Le tableau clinique est domine par la fievre (15 cas) et les douleurs qui varient selon la localisation de l’abces. Un syndrome inflammatoire biologique est present chez 18 patients. L’echographie et/ou la TDM et/ou l’IRM ont participe au diagnostic positif chez 21 patients. Dans tous les, une antibiotherapie (duree moyenne de 27 jours pour les pyogenes et 13 mois pour la tuberculose) est prescrite associee a un drainage chirurgical dans 10 cas et a un drainage percutane dans 3 cas. L’evolution est favorable sauf pour un patient qui est decede suite a un choc septique (S. aureus). Conclusion Au vu du progres dans leur prise en charge, les abces musculaire ont eu une amelioration dans leur pronostic. Les techniques d’imageries modernes orientent facilement le diagnostic, permettant de detailler les localisations et de guider un eventuel geste de drainage.

Introduction La toxocarose est une zoonose cosmopolite liee a la presence intra-tissulaire de larves d’ascarides des chiens et des chats. Deux nematodes sont responsables de la toxocarose humaine : Toxocara canis et T. catis. La forme clinique la plus frequente est la toxocarose commune faite d’asthenie trainante, de douleurs digestives en cadre et des manifestations allergiques diverses. Des manifestations neurologiques, oculaires et cardiaques ont ete decrites mais elles sont rares. Patients et methodes Nous rapportons dans cette etude 5 patients atteints de toxocarose. Nous avons analyse leur profil clinique, biologique et evolutif. Resultats Il s’agit de 4 hommes et une femme. L’âge moyen etait de 39.2 ans (14–81 ans). La notion d’elevage de chiens etait rapportee dans un cas. Le motif de consultation etait un prurit tenace dans les 2 cas atteints de toxocarose commune et on a note 3 cas de toxocarose oculaire revelee par une baisse de l’acuite visuelle. Il s’agissait de 2 cas de pan-uveite et un cas d’uveite intermediaire. La vascularite retinienne etait retrouvee chez les 3 patients. Le bilan etiologique exhaustif de l’uveite etait negatif. L’hypereosinophilie a ete retrouvee chez 2 patients. Par ailleurs, la serologie de la toxocarose etait positive (technique Elisa et Western Blot) dans tous les cas. Les patients atteints de toxocarose oculaire ont ete traite par trois boli de solumedrol a la dose de 1 g par jour pendant 3 jours relayes par une corticotherapie orale de 0.7 mg/kg/j associee a l’albendazole a la dose de 400 mg/j pendant 15 jours avec une regression de l’uveite et amelioration de l’acuite visuelle. Les deux patients, presentant une toxocarose commune, ont ete traites par albendazole a la dose de 400 mg/j pendant 10 jours avec une bonne evolution clinique et biologique. Conclusion Notre travail illustre la gravite de la toxocarose lorsqu’elle touche l’œil. Ainsi devant toute uveite, la serologie de la toxocarose par technique immuno-enzymatique (Elisa) ou Western Blot doit etre demandee a fin d’instaurer un traitement urgent.

Objectives This study aimed to investigate EULAR 2003 recommandation application on a sample of 60 (KOA) patients. Methods Retrospective longitudinal study done on the department of Physical and Rehabilitation Medicine of the Principal Military Hospital of Tunis between January 2011 and December 2012, about 60 patients with knee OA. These patients were divided into two groups of 30 cases: patients aged 65 years and over (SA) and young adults 30 to 55 years (SJ). Results All patients received therapeutic management combiningpharmacologic and nonpharmacologic. This treatment was individualized, taking into account: clean Knee risk factors (obesity, mechanical, physical activity), general risk factors (age, comorbidity, polypharmacy), the intensity of pain and disability that it entails, to the presence of inflammatory signs (particularly effusions)? of the location and the degree of structural reached. The above-mentioned elements have been identified in interrogation and the initial review of our patients, further management was judged on these factors. However, the treatment received and appreciation of weight reduction have not mentioned in their records. All patients received an educational program focusing on the economy joint, the need for weight loss and self-rehabilitation. this program was initiated concomitantly with functional rehabilitation sessions. The use of assistive devices were limited to 13.3% of our patients, all of elderly. Weight loss could not be assessed (default data). Paracetamol is the most prescribed treatment in our series: 53.3% of our patients received paracetamol alone or in combination. The Topical NSAIDs are prescribed in 63.3% of patients in which 60.5% are of older group In 5 cases of patients with peptic ulcer documented, there has been use of Anti of H2 as gastric coverage during short periods of NSAID prescription. Analgesics II were used in 5 cases. The AASALs were used in 10 cases, especially in young patients. Infiltration of chondroprotectors using hyaluronic acid were found in 4 cases. Intra articular corticosteroid injections were performed in 8 patients. These findings were not influenced by age. Conclusions Application of recommadations depends greatly on socio-economic conditions of countries and their social security systems. In our study, several recommendations were insufficiently met. A study on a larger population should investigate the factors influencing the implementation of these recommendations and the opinion of various stakeholders (physicians, patients and physiotherapists) Disclosure of Interest None declared

Background Physical therapists provide a variety of interventions, such as manual therapy techniques, balance, coordination, and functional retraining techniques, knee taping techniques, electrical stimulation, and foot orthotics to assist in overcoming some of the barriers that make participation in exercise and physical activity difficult. Objectives This study aimed to assess the role of physical therapy in management of knee osteoarthritis on both levels pain and function. Methods Retrospective longitudinal study done on the department of Physical and Rehabilitation Medicine of the Principal Military Hospital of Tunis between January 2011 and December 2012, about 60 patients with knee OA. These patients were divided into two groups of 30 cases: patients aged 65 years and over (SA) and young adults 30 to 55 years (SJ). The evaluation protocol included clinical algofunctional before and after medical and rehabilitative treatment performed on an outpatient program with three sessions per week for two months. Results There were 35 women and 25 men with a mean age of 58±6.27 years. The average duration of knee OA was 63.74±38.62 months. The main characteristics of elderly subjects compared to young subjects, before rehabilitation, were the bilateral involvement of the knees (p=0.02), severity of pain (p=0.02), disability (p=0.006), stiffness (p=0.02), muscle weakness of the quadriceps (p=0.006), hamstrings (p=0.03), the retraction of the latter (p=0.04) and reducing the walking distance (p=0.04). 38 patients (19 and 19 SA SJ) adhered to the rehabilitation program. After rehabilitation, the main features were the reduction of pain by 60%, improving activities of daily life of 50%. The rehabilitative treatment was more effective in the elderly in terms of pain (p=0.03) and activities of daily living improvement (p=0.01). Patients in both groups improved their scores with no significant differences related to age. Considering respectively the VAS pain (p=0.48), WOMAC index (p=0.39) and LEQUESNE Index (p=0.75). At the end of the rehabilitation program, a reduction in pain intensity was observed in all AS (19 cases), 13 of them have lowered their VAS pain threshold of less than 50 mm. In young subjects, the pain remained stationary in 2 cases and was exacerbated in one case. Conclusions Physical therapy appears to be an important tool for KOA management. Future studies are needed to improve our understanding of factors that can influence the responsiveness of patients with knee osteoarthritis to exercise and physical activity programs. Disclosure of Interest None declared

Objectives Intrathoracic manifestations other then vascular aneurysm and thrombosis are rare in the course of Behcet’s disease. Mediastinal fibrosis is also unusual. Methods Three cases of Behcet’s disease with initial mediastinal fibrosis are reported. Diagnosis means, pathogenic mechanisms and therapeutic modalities are also more precisely defined. Results Three male patients (21, 25 and 27 years of age, respectively) were hospitalized for progressive vena cava superior syndrome accompanied by mediastinal fibrosis demonstrated by MRI and/or CT scan which both showed infiltration of the mediastinal fat. Multiple calcifications were also present in one patient. Histology was performed in one case. Thrombosis of the vena cava superior and innominata veins was associated with fibrosis in all three cases. Thrombosis of venae subclavia and left jugularis was also present in one case. Other manifestations leading to the diagnosis of Behcet’s disease were demonstrated by the patient’s history and, in one case, occurred on the fourth day of hospitalization. After initiation of a treatment including corticoids, anticoagulants and colchicine, the outcome was favorable in two cases. The third patient died. Conclusions Mediastinal fibrosis combined with Behcet’s disease has rarely been described. However, it should be included in manifestations of the disease. The causative process which might be vasculitis has to be demonstrated. Disclosure of Interest None Declared

Background Cardiac involvement in ankylosing spondylitis is uncommon. We have tried through this study to analyze the cardiovascular events among 50 patients with ankylosing spondylitis. Methods A retrospective study including 50 patients with ankylosing spondylitis. all patients underwent a complete physical examination with a heart and lung auscultation and an electro-cardiogram (ECG). Transthoracic ultrasound was performed whenever there was an abnormal physical examination and/or ECG. Results the study included 47 men and 3 women, the sex ratio is 15.6. The average age of onset was 26±7 years. The mode of onset is axial in 95% of cases (low back pain and/or buttock). The extra-articular manifestations are present in 54% of cases. Cardiac involvement is present in 9 cases (18% of cases). The reason for consultation is dyspnea in 2 patients. In other cases, cardiac involvement was discovered incidentally. Aortic regurgitation was noted in 4 patients. Mitral insufficiency was found in 3 cases. Two patients have predominantly septal hypertrophic cardiomyopathy and one patient presented an array of pulmonary insufficiency. The average time of onset of cardiac involvement was 8±5 years. All patients were put under special medical treatment of their heart, with good clinical outcome. Conclusions Cardiac involvement in ankylosing spondylitis is seen more frequently in men, especially in the old cases. A close relationship between time to onset of aortic insufficiency and duration of disease progression was found. It would be responsible for one third of deaths of patients. It was significantly more frequent in HLA B27 positive patients (especially complete atrioventricular block and aortic insufficiency). Cardiac involvement should be sought routinely in patients with APS because it presents a poor prognosis that can be life-threatening. Disclosure of Interest None Declared

Objectives To gain additional knowledge on the joint manifestations of Behcet’s disease, with special attention to epidemiological and clinical aspects. Methods Retrospective review of 100 cases collected over a period of 13 years. All the patients met International Study Group for Behcet’s disease criteria. 60 % of patients had rheumatic manifestations. Ophthalmic examination and the pathergy test were performed in all patients, sacroiliac radiographs were taken in 58 patients. HLAB51 and B27 antigens were investigated in 70 patients, antinuclear antibodies were sought in in 57 patients, C3, C4 in 44 patients. Results Joint manifestations were present in more than half of the patients (60%) and were inaugural in 38% of cases. The knees and ankles were the joints most commonly affected. Monoarthritis and oligoarthritis polyarthritis are denoted respectively in 26%, 19%, 14% of cases. arthralgias occured in 80% of cases. Two patients showed a sacroilite isolated. Furthermore, popliteal cyst was noted in 4 cases, broken in 2 cases. The arthritis is associated with erythema nodosum in 55% of cases and in 70% pseudofolliculitis cases. The HLA B51 and HLA-B27 were found in 13.8% and 36.9% of cases, these joint manifestations were benign, limiting and never evolved to deformation or destruction. Conclusions Joint manifestations are common in Behcet’s disease. The unusual forms deserve to be known since they can raise diagnostic problems when they are inaugural. Rheumaticmanifestations of Behcet’s disease are the most frequently associated with erythema nodosum and pseudofolliculitis Disclosure of Interest None Declared