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Le syndrome des ovaires polykystiques (SOPK) est souvent associé à des anomalies métaboliques. Cette étude explore l’association entre le SOPK et le syndrome de l’« obésité métabolique à poids normal » (MONW) dans la population tunisienne.

L’étiopathogénie du mycosis fongoïde (MF) est multifactorielle. L’origine professionnelle de ce type de lymphome a été évoquée mais reste jusqu’à nos jours controversés. Notre étude a pour objectifs de décrire les différents aspects démographiques et cliniques du mycosis fongoïde et d’identifier les éventuels facteurs professionnels incriminés dans la genèse de cette affection.

L’ostéosarcome vertébral est extrêmement rare. Il pose un problème de diagnostic différentiel avec l’ostéoblastome et les métastases osseuses. Nous rapportons un nouveau cas chez une patiente âgée de 47ans avec curalgie et déficit moteur du membre inférieur droit. Bien que le pronostic de cette tumeur reste sombre, une chimiothérapie efficace préopératoire, suivie d’une exérèse large, restent les meilleurs garants d’une prise en charge carcinologique initiale optimale.

Le cisplatine est un antinéoplasique qui peut entraîner une perte rénale de magnésium.

Le cancer du nasopharynx (CNP) représente une des tumeurs épithéliales les plus fréquentes de l’enfant et de l’adolescent dans les régions à risque intermédiaire. Dans les pays du Maghreb, il représente le premier cancer des adolescents âgés de 15 à 20 ans. L’Epstein-Barr virus (EBV) est le facteur étiologique le plus important. Son rôle dans la pathogenèse du CNP a été confirmé par plusieurs études. Chez les jeunes patients, le taux des anticorps anti-EBV est souvent peu élevé par rapport à celui observé chez les adultes. Deême, le taux de cellules exprimant la LMP1 est beaucoup plus élevé. Le carcinome indifférencié de type nasopharyngé (UCNT) représente le type histologique le plus fréquent. L’étude immunohistochimique (IHC) des CNP juvéniles nord-africains est caractérisée par une faible expression de Bcl-2 et de p53 et une forte expression de LMP1 et de c-kit, ce qui les fait distinguer des formes de l’adulte. Sur le plan clinique, l’atteinte ganglionnaire cervicale est quasi constante avec une extension locorégionale très importante ainsi qu’à distance. Plus de 15 % des patients sont métastatiques au diagnostic notamment au niveau osseux. Le traitement repose essentiellement sur la radiothérapie. Seules des études rétrospectives ont été publiées pour déterminer l’intérêt, le type et le timing de la chimiothérapie dans la prise en charge des CNP juvéniles. La dose de radiothérapie reste un sujet de controverse surtout que les doses élevées se sont accompagnées d’une toxicité tardive invalidante. Les rechutes métastatiques constituent la cause principale de décès chez ces jeunes patients. Une amélioration du pronostic peut être attendue en associant de façon concomitante la chimiothérapie à la radiothérapie avec modulation d’intensité. Cependant, desétudes randomisées multi-institutionnelles sont nécessaires pour standardiser le traitement des CNP juvéniles.

Le carcinome nasopharyngé (NPC) représente une entité distincte des autres tumeurs de la tête et du cou, principalement par son association constante avec le virus d’Epstein-Barr (EBV) et sa répartition géographique inégale. Ce carcinome pose un sérieux problème de santé publique dans de nombreux pays, particulièrement le Sud-Est asiatique et l’Afrique du Nord où les incidences enregistrées sont les plus élevées. Au cours de cette décennie, un effort considérable a été déployé pour définir les bases moléculaires du NPC. Toutefois, l’analyse de certains paramètres cliniques et biologiques du NPC nord-africain et sud-est asiatique a montré des différences notables suggérant ainsi des différences au niveau des facteurs et des mécanismes étiologiques mis en œuvre. La première caractéristique distinctive du NPC nord-africain est la répartition bimodale des malades en fonction de l’âge avec un premier pic vers l’âge de 50 ans et un second autour de 15-20 ans qui n’est pas observé dans le NPC asiatique. Dans cette forme juvénile de NPC, les études immunohistochimiques retrouvent une expression moins importante des deux protéines clés du contrôle apoptotique, p53 et Bcl-2, et au contraire une expression plus importante du récepteur cellulaire c-kit et de l’oncoprotéine virale LMP1. En outre, les modifications des anticorps anti-EBV circulants sont moins informatives pour le diagnostic de la forme juvénile que pour celui de la forme adulte du NPC nord-africain. Par ailleurs, la majorité des souches EBV nord-africaines détectées au niveau tumoral présentent un profil génotypique distinct de celui décrit dans les séries sud-est asiatiques (avec une prédominance des polymorphismes F, D, H1-H2, XhoI+ et f, C, H, XhoI– respectivement). En revanche, des études préliminaires portant sur les anomalies chromosomiques ou les phénomènes de méthylation aberrante aboutissent à des résultats similaires à ceux rapportés pour les séries du Sud-Est asiatique soulignant ainsi l’existence de mécanismes fondamentaux communs à toutes les formes de NPC, quelle que soit l’aire géographique.

A polymorphic AC repeat in intron 1 of the EGFR gene was genotyped on 352 healthy individuals and 118 women with breast cancer sampled from the Kuwaiti and Tunisian populations. We compared allele frequencies in these populations with published data on various ethnic groups. We found very close similarity between Tunisian and Kuwaiti populations for both allelic and genotypic frequencies and in both control and patient groups. Our analysis revealed clear interethnic differences between populations; in Europeans, allele 16 occurred predominantly, whereas in Tunisia and Kuwait allele 17 was the most frequent and allele 20 predominated in Asians. One hundred twenty-three healthy women, matched with the 118 breast cancer patients, were used as controls to test for associations between AC repeat and cancer risk. Strong evidence for such an association was found for allele 18 when considered alone (χ2=27.04, corrected p=0.0000016, OR=3.94) or with longer alleles (>17 repeats) (χ2=20.21, p=0.0005, OR=2.30). This contrasts with Asian populations where allele 16 was identified as the risk allele, showing allele heterogeneity depending on ethnicity.

Modification of two samples of Tunisian clays of the type of natural smectites with organic derivatives of ammonium salts was studied. The physicochemical properties of the modified products and the possibility of their use as components of lubricating oils were analyzed.Modification of two samples of Tunisian clays of the type of natural smectites with organic derivatives of ammonium salts was studied. The physicochemical properties of the modified products and the possibility of their use as components of lubricating oils were analyzed.

Nasopharyngeal carcinoma (NPC) in Tunisia is characterized by its bimodal age distribution involving juvenile patients of 10–24 years and adult patients of 40–60 years. Three serological techniques were compared for primary diagnosis (N = 117) and post‐treatment monitoring (N = 21) of NPC patients separated in two age groups. Immunofluorescence assay (IFA) was used as the “gold standard” for detection of IgG and IgA antibodies reactive with Epstein‐Barr virus (EBV) early (EA) and viral capsid (VCA) antigens. Results were compared with ELISA measuring IgG and IgA antibody reactivity to defined EBNA1, EA, and VCA antigens. Immunoblot was used to reveal the molecular diversity underlying the anti‐EBV IgG and IgA antibody responses. The results indicate that young NPC patients have significantly more restricted anti‐EBV IgG and IgA antibody responses with aberrant IgG VCA/EA levels in 78% compared to 91.7% in elder patients. IgA VCA/EA was detected in 50% of young patients versus 89.4% for the elder group (P< 0.001). Immunoblot revealed a reduced overall diversity of EBV antigen recognition for both IgG and IgA in young patients. A good concordance was observed between ELISA and IFA for primary NPC diagnosis with 81–91% overall agreement. Even better agreement (95–100%) was found for antibody changes during follow‐up monitoring, showing declining reactivity in patients in remission and increasing reactivity in patients with persistent disease or relapse. ELISA for IgA anti‐VCA‐p18 and immunoblot proved most sensitive for predicting tumor relapse. VCA‐p18 IgA ELISA seems suitable for routine diagnosis and early detection of NPC complication. J. Med. Virol. 75:593–602, 2005. © 2005 Wiley‐Liss, Inc.

Le syndrome des ovaires polykystiques (SOPK) affecte 5 à 15 % des femmes en âge de procréer. Il s’associe dans la moitié des cas à l’excès pondéral. L’accumulation de graisse serait étroitement liée à la présence d’une insulinorésistance.

• Objectives:The predictive value of APACHE II and SAPS severity scores were evaluated in a group of patients with acute renal failure admitted in ICU after emergency surgery. The criteria of poor prognosis identified in the 24 hours following admission were also evaluated.• Study design:Open prospective study.• Patients and methods:During 22 months, we included every patient admitted in ICU after emergency surgery with a serum creatinine concentration ≥ 130 mol·L−1. Clinical and biological parameters were collected in the first 24 hours following admission and the severity scores were calculated. Prediction of hospital outcome, based on APACHE II score, was calculated. The standard mortality ratio (observed mortality/predicted mortality) was calculated. Accuracy of SAPS and APACHE II score was compared using ROC curves and comparison of the areas under the curves.• Results:Death in ICU occurred in 44% of the patients while hospital mortality was 51%. The standard mortality ratio for APACHE II score was 1.35. The areas under the curves for SAPS and APACHE II scores were not statistically different. The criteria of poor prognosis, identified in the first 24 hours following admission, were cardiovascular failure, oliguria and sepsis.• Conclusion:Conventional severity scores are inaccurate for prediction of mortality in patients with acute renal failure following emergency surgery.

The development of industry and urbanisation is at the origin of ever-increasing levels of anthropogenic pollution. Emissions of sulphur-containing compounds are partly composed of volatile organic compounds which add to those generated through natural processes. For low concentrations, direct assaying is problematic and a preconcentration step is necessary at the time of sampling. In order to select efficient solid sorbents for use in preconcentration of volatile organic sulphur-containing compounds, the breakthrough volumes of a certain number of mercaptans and sulphides have been determined on 9 porous polymers (Chromosorb 101, 103, 107, - Porapak Q, T, N, - XAD-4, XAD-7 and Tenax G.C.) and on Carbosphere.The breakthrough volumes were determined using a direct method with an apparatus based on diffusion tubes dynamically generating standard mixtures of carrier gas and sulphur-containing compounds.

Pure squamous cell carcinoma (SCC) of gallbladder is a very rare tumour and is responsible for only 3% of the malignant neoplasm of this organ. We report a case of SCC of gallbladder in a 58-year-old woman. Through this new observation, we propose to study the clinicopathologic features, pathogeny and treatment of this rare entity.

L’identification précoce au moment du diagnostic des formes malignes d’un phéochromocytome s’avère essentiel afin d’améliorer leurs pronostics. À travers cette étude nous avons essayé d’identifier des critères permettant de prédire la malignité de ce type de tumeur.

The generator contains diffusion tubes of known length and internal diameter. Once produced, the mixture of the carrier gas and acetone, the reference material, is sent through a chromatographic flame ionisation detector. Its signal reaches a constant level after a time corresponding to the stabilization time of the generator. The technique described is simple and gives repeatable results.

Background: HL, independently of socio economic conditions, is often intrinsically more aggressive in developing countries, including in Tunisia (Tunis Med.1999 77:614). We evaluated clinical characteristics and outcome of HL pts included in a prospective multicenter Tunisian adult HL trial.

Background: HL, independently of socio economic conditions, is often intrinsically more aggressive in developing countries, including in Tunisia (Tunis Med.1999 77:614). We evaluated clinical characteristics and outcome of HL pts included in a prospective multicenter Tunisian adult HL trial. Methods: Between 2002 and 2006, 251 consecutive eligible pts from 6 Tunisian departments with newly diagnosed HL were enrolled in a prospective trial (MDH 2002). Pts were staged using EORTC prognostic factors in early stages and the international prognostic scoring (IPS) in advanced stages. ABVD was used at 3 cycles for favorable (fav) early stages (G1), 6 cycles for unfavorable (unfav) early stages (G2) and stage IIIA (G3) and 8 cycles for fav advanced stages (IPS <3) (G5). Involved field RT was combined to chemotherapy (CT) for early stage and stage IIIA. Intensive CT (4 escalated BEACOPP + 4 standard BEACOPP) was used for unfav advanced stages (IPS 3 3): (G4). G-CSF was given after each escalated BEACOPP course Refractory and relapsed pts were proposed for intensive CT and autologous SCT. Closing date of the study was Dec 2007 Results: Median age at presentation was 31 years (range 15–70), with 140 M and 111 F. 50% patients had advanced disease (28% with stage IV) and 44% had unfav early stage (G2). 25% pts had Bulky mediastinal disease and 69% had B symptoms. 40% pts were treated in G2, 29% in G4, 17% in G5 and only 9% in G1. Eleven (4.3%) toxic deaths were observed during treatment, including 10 deaths in the 72 pts treated with escalated BEACOPP. Of the remaining pts, 83% had CR and 17% had primary failure at the end of the planned treatment (including 14 % with response <50% and 3 % with response between 50 and 75 %. Only 17 (42%) of the primary failure pts could receive auto SCT (13 pts alive in CR, 2 progressive disease and 2 relapses). The 23 remaining refractory pts had progressive disease and died before SCT (16 pts) or failed to respond to salvage CT before SCT (7pts). Twenty five relapses (12%) were observed with a median time to relapse of 9 months: 9(10%) in G2, 6(8%) in G4 and 10(23%) in G5. Five year OS, EFS, and RFS were respectively 88%, 73% and 88%. In multivariate analysis, the only unfavorable prognostic factors emerging were bulky mediastinal disease for primary failure rate (35% vs 10% p=0.0004, OR=5.3) and for EFS (55% vs 80% p = 0.03, OR = 1.9)and remission status at the end of therapy which influenced EFS (87% vs50% vs5% p=0.0000, OR=21.8) and OS (96% vs62%vs 55% p=0.001, OR=14.6) in pts who achieved CR, had primary failure with >50 % to 75% response and with <50% response, respectively Conclusions: This study confirms the high incidence of aggressive forms of HD in Tunisia, therefore frequently requiring intensive treatment, sometimes difficult to apply in pts with relatively low socio economic condition Apart from escalated BEACOPP (which resulted in high toxicity that will have in the future to be better prevented), treatments could however generally be administered completely, which possibly contributed to the relatively few relapses. Bulky mediastinal disease and absence of CR at the end of treatment were, as in other countries, major issues requiring treatment intensification