Search

Résumé: Introduction: La technique de Koyanagi a suscité depuis quelques années un intérêt croissant, de par ses résultats satisfaisants ou encore le risque moindre de complications postopératoires pour le patient, dans l’hypospadias postérieur. Objectifs: Evaluer les indications et les résultats de la technique de Koyanagi. Patients et méthodes: C’est une étude rétrospective descriptive portant sur les patients hospitalisés au service de chirurgie pédiatrique de l’EPS de Monastir pour hypospadias postérieur et opérés selon la technique de Koyanagi avec un suivi ultérieur en ambulatoire et un recul d’au moins 02 ans. Résultats: Au total 35 patients ont été colligés. L’âge moyen lors de la première consultation en chirurgie pédiatrique était de 12,2 mois avec une moyenne d’âge au moment de l’intervention de 28,8 mois. La durée moyenne de l’intervention chirurgicale était de 166,1 min. La durée totale moyenne de séjour était de 7,9 jours. Uniquement 4 patients soit 11,4% de l’échantillon ont présenté des complications immédiates. La reprise chirurgicale a été indiquée pour 23 cas et les indications étaient par ordre de fréquence décroissant: le recul du méat (34,3%), fistule isolée ou associée à un recul du méat (11,4%) et le recul du méat avec transposition péno-scrotale (2,9%). L’évaluation finale de l’acte chirurgical a permis de retrouver que le siège du méat était distal dans la majorité des cas (85,7%), deux patients ont gardé une courbure résiduelle estimée par l’opérateur comme étant minime et ne nécessitant pas une reprise chirurgicale et aucun de nos patients n’a gardé d’anomalies du jet urinaire. Conclusion: L’urétroplastie selon Koyanagi, est une technique intéressante pour la correction d’hypospadias postérieur surtout en cas de courbure ventrale mais avec un taux de complications assez élevé. Abstract: Introduction: The koyanagi technique because of its satisfying results and less risk of postoperative complications for the patient has generated an increasing interest during recent years. Objective: To report the indications and the results of the koyanagi technique. Patients an methods: This is a descriptive retrospective study of patients admitted in the pediatric surgery's department of the EPS Monastir, Tunisia for proximal hypospadias and operated on according to Koyanagi's technique during the period from 02 january 2006 to 30 june 2013, with subsequent follow-up of at least 02 years. Results: The data of total 35 patients were collected. The average age at the first consultation in pediatric surgery was 12.2 months and the age at surgery was 28.8 months with extremes ranging from 12-55 months. The mean operative time was 166.1 min. The average stay at hospital was 7.9 days. Only 4 patients (11.4%) presented immediate complications. Reoperation was indicated for 23 cases and indications were by decreasing order of frequency: dehiscence (34.3%), fistula (11.4%) and dehiscence with persistent penile-scrotal transposition (2.9%). The final clinical evaluation of the surgery found that meatus was distal in the majority of cases (85.7%), two patients kept a residual curvature estimated as being minimal and not requiring any further surgery and none of our patients presented abnormalities of the urinary stream. Conclusions: Koyanagi's technique in repairaing proximal hypospadias seems to be an excellent option especially in cases of severe curvature but with a high rate of complications. Mots clés: Hypospadias postérieur, Chirurgie, Koyanagi, Enfant, Keywords: Posterior hypospadias, Surgery, Koyanagi, Children

Tuberculosis (TB), a chronic bacterial disease caused by Mycobacterium tuberculosis, commonly affects the lung but can also affect other parts of the body (extrapulmonary tuberculosis, EPT). A rapid diagnosis is essential to initiate a specific and effective treatment. Although mycobacterial culture remains the gold standard for EPT diagnosis, molecular tools are attracting increasing interest. GeneXpert MTB/RIF, a rapid automated diagnostic test, allows the detection of Mycobacterium tuberculosis as well as mutations in the hot-spot region of the rpoB gene associated with Rifampicin resistance. The present study was performed to evaluate the performance of the GeneXpert MTB/RIF test for the diagnosis of EPT compared to the standard method. This prospective study was conducted on 304 clinical samples collected from 192 patients attending the Laboratory of Mycobacteria and Tuberculosis of Pasteur Institute of Morocco, between 2016 and 2017. Out of the 304 samples, 113 were pleural f luids decontaminated using the Petroff method and 191 were biopsies (78 lymph nodes and 113 pleural biopsies) decontaminated using the Löwenstein method. Mycobacterium tuberculosis detection and identification were performed on all samples using smear microscopy, Löwenstein–Jensen medium culture and the GeneXpert MTB/RIF test. Our results showed that 54.5 (103/189) were men and 45.5% (86/189) were women. The age of patients ranged from 2–78 years and the majority of patients was in the age group 25–45 years. Extrapulmonary samples were derived from lymph nodes, pleural f luids and pleural tissues, with a percentage of 25.66, 37.17 and 37.17%, respectively. Interestingly, the sensitivity of the GeneXpert was 51.4 for all samples and 83.3% for lymph nodes. In conclusion, the present study revealed that the performance of the GeneXpert test depends highly on the type of sample, with a high sensitivity observed for lymph nodes. Additionally, we clearly showed that the GeneXpert MTB/RIF test presents limitations in the diagnosis of pleural TB. Thus, we recommend the coupled use of the GeneXpert MTB/RIF and the conventional techniques for EPT diagnosis.

The clinical management of metastatic melanoma requires predictors of the response to checkpoint blockade. Here, the authors use immunological assays to identify potential prognostic/predictive biomarkers in circulating blood cells and in tumor-infiltrating lymphocytes from patients with resected stage III melanoma.