Search

Background:A high prevalence of osteopenia and osteoporosis is observed in patients with Inflammatory Bowel Disease (IBD).Objective:The aim of our study was to investigate the prevalence of bone loss, bone remodeling and risk factors in Tunisian patient with IBD.Patients and Methods:The study included 40 patients with IBD and 32 age- and sex-matched healthy controls subjects. All participants underwent bone densitometry by dual energy X-ray absorptiometry at the femoral neck and lumbar spine. Serum levels of 25-hydroxy vitamin D (25(OH)D), parathyroid hormone (PTH), osteocalcin(OC), and urinary degradation products of C-terminal telopeptide of type I collagen (CTXI) were measured in all participants to assess the bone metabolism status.Results:Twelve (30%) patients were normal, 32.5% were osteopenic and 37.5% were osteoporotic. Osteoporosis was more frequent in IBD patients than controls (p=0.0001). Age and inflammation were associated with low bone mineral density (BMD). Mean calcium, phosphorus and alkaline phosphatase levels were similar in both groups. Median 25(OH) D levels were significantly lower in IBD patients compared with controls (p=0.0001). Median urinary CTXI levels were significantly higher in IBD patients compared with healthy controls (p=0.007). No significant differences between IBD patients and controls concerning the median serum OC and PTH levels were found.Conclusion:In our study, there is a high prevalence of low BMD in IBD patients and an increase in bone resorption without a change of bone formation. Low BMI and hypovitaminoses D were identified as risk factors for low BMD.

International audience; Serine proteases are extensively known to play key roles in many physiological processes. However, their dysregulation is often associated to several diseases including inflammatory bowel diseases (IBD). Here, we used specific substrates to monitor fecal protease activities in a large cohort of healthy and IBD patients. Of interest, serine protease activity was 10-fold higher in IBD fecal samples compared to healthy controls. Moreover, functional analysis of these fecal proteolytic activities revealed that the most increased activities are trypsin-like, elastase-like and cathepsin G-like. We also show for the first time, an increase of proteinase 3-like activity in these samples compared to controls. Results presented here will guide further investigations to better understand the relevance of these peptidases in IBD.

OBJECTIVE The common association of NOD2/CARD15 and TLR4 genes variants with inflammatory bowel disease (IBD) have not been universally replicated. We aimed to study the polymorphism of these two genes in Tunisian patients with IBD. METHODS Polymorphism of NOD2 (R702W, G908R and 1007fs) and TLR4 (Asp299Gly and Thr399Ile) genes were analyzed in 106 IBD patients (68 ulcerative colitis (UC), 38 Crohn's disease (CD)) and 160 healthy controls using PCR-RFLP. A genotype-phenotype correlation was performed. RESULTS The mutated allele of TLR4-Thr399Ile was strongly associated to the disease (9.4% in IBD, 7.4% in UC, 13.2% in CD Versus 2.5% in controls; p values 4.10-4; 0.014; 6.10-5 respectively). Frequencies of the heterozygous genotypes were significantly higher in IBD (17%), UC (14.7%) and CD patients (21.1%) in comparison with controls (5%) (p 0.0012; 0.012 and 0.001 respectively). Interestingly, the CC wild genotype was found to be protective (OR 0.24). The mutated allele of TLR4-Asp299Gly was more frequent in controls (6.8%) than in IBD patients (2.9%). A phenotypic correlation of Asp299Gly-AG genotype with arthritis in UC patients was detected (p= 0.003). Regarding NOD2 gene, the studied SNPs were not polymorphic and there was no genetic association or phenotypic correlation with gene variants. CONCLUSION In our study, TLR4-Thr399Ile variant is strongly associated with the susceptibility to IBD whereas, TLR4-Asp299Gly seem to play a role in the clinical expression of UC. The rarity and non association of the NOD2 mutations with IBD in our study may reveal a genetic characteristic of the disease in our region.

International audience; This paper deals with the conception of a new 6 DoF (Degree of Freedom) platform to reproducenatural motion feeling when the human is completely merged in mixed reality environments. The proposedsystem is open and supposed to be flexible and adaptable to three different applications: sport, health andrescue. In this paper, we focus on the sport simulation domain, namely the ski sliding movement. Wepresent the mechanical study of this platform, the 6 DOF motion modelling and some mechatronics aspects.

Background:Rheumatologic manifestations are frequent extraintestinal manifestations (MEI) of chronic inflammatory bowel disease (IBD). Some of these manifestations develop in parallel with the underlying disease, others evolve on their own account. They sometimes lead to reconsider the initial therapy for intestinal purposes.Objectives:The aim of our study is to specify the epidemioclinical characteristics of osteoarticular manifestations of chronic inflammatory bowel disease and their possible impact on intestinal diseaseMethods:This is a retrospective study conducted between January 2000 and December 2015 including patients hospitalized in our department for chronic inflammatory bowel disease (IBD).Results:During the study period, 206 patients with IBD were hospitalized in our department, 78 of whom had rheumatic MEI (frequency equal to 37.8%). These 78 patients were divided into 48 men and 30 women with a sex ratio of 1.6 and an average age of 40.7 ± 13.6 years (18–79). They had Crohn’s disease in 60% of the cases. The average length of service for IBDs was 83 ± 73 months (4–360). Osteoarticular MEIs were peripheral in 56.4% of cases, axial in 29.5% of cases, mixed in 6.41% of cases with the presence of osteopenia in 6.41% of cases and osteoporosis in 1 28%. The activity of IBD associated with these MEI was moderate with an average number of outbreaks / year of 1.6 ± 0.8. These patients were treated with salicylates in 30.7% of the cases using corticosteroid therapy at least once in 23% of the cases. Maintenance treatment based on immunosuppressants was found in 38.46% of cases and anti-TNF alfa in 10.25% of cases. During follow-up, 3 patients died (3.84%). There was no significant difference between patients with IBD with rheumatic MEI and without rheumatic MEI regarding epidemiological data and disease activity.Conclusion:Rheumatic MEIs are found in almost 40% of IBDs. They affect men more frequently than women and Crohn’s disease than UC. They are rather peripheral and do not associate with a more important activity of the disease.References:[1]Journal of the Canadian Association of Gastroenterology, 2019, 2(S1), S73–S80 doi: 10.1093/jcag/gwy053 Supplement ArticleDisclosure of Interests:None declared

Background:Osteoporosis is as known a chronic complication of inflammatory bowel diseases (IBD). Its etiopathogenesis is often multifactorial.Objectives:The aim of our study was to describe the prevalence of reduced bone mineral density and to identify risk factors of osteoporosis in patients with inflammatory bowel diseases.Methods:This is a retrospective study over three years, collecting patients suffering from IBD and having benefited from a bone densitometry. We have specified for each patient the clinical data and the IBD characteristics. Bone mineral density (BMD, g/ cm) was assessed by dual X-ray absorptiometry. Osteoporosis was diagnosed when BMD was 2.5 standard deviations below the mean peak value in young adults (T score,22.5 SD). Patients with other pathology that may change the bone metabolism were excluded.Results:sixty-one patients were included with an average age of 38 ± 13 years [16-73]. The sex ratio M / F was 1.25. 69% of patients had ulcerative colitis. The bone density profile was normal in 49.2% of the cases. Osteoporosis and osteopenia were noted in 13.1% and 37.7% of patients, respectively. Osteoporosis was associated with advanced age (50.5 ± 16.5 years vs 36.26 ± 12.93 years; p = 0.007) and longer course disease (6.75 ± 7, 4 years vs 2.5 ± 4 years; p = 0.015). The cumulative dose of prednisone equivalent used in patients with osteoporosis was significantly higher than the other patients (2775 ± 3338 mg vs 706 ± 1449 mg; p = 0.003). Osteopenia was more frequently associated with crohn’s disease (58% vs 28.6% p = 0.0029). There was no significant difference between the group with osteoporosis or osteopenia and the group with normal bone densitometry for sex and body mass index.Conclusion:Osteoporosis during IBD is associated with advanced age, longer duration of illness and administration of high doses of corticosteroids. The high proportion of osteoporosis and osteopenia in our study underlines the importance of systematic BMD measurement in all IBD patients as a base for initiating the appropriate treatment.References:[1]The prevalence and risk factors for osteoporosis in patients with inflammatory bowel disease. Miznerova E et al. Bratisl Lek Listy. 2013;114(8):439-45.[2]Osteoporosis and inflammatory bowel disease: prevalence and risk factors in Tunisian patients. Boubaker J et al. Gastroenterol Clin Biol. 2003 Oct;27(10):901-7.Disclosure of Interests:None declared

Liver cancer is the third deadliest cancer in the world. It characterizes a malignant tumor that develops through liver cells. The hepatocellular carcinoma (HCC) is one of these tumors. Hepatic primary cancer is the leading cause of cancer deaths. This article deals with the diagnostic process of liver cancers. In order to analyze a large mass of medical data, ontologies are effective; they are efficient to improve medical image analysis used to detect different tumors and other liver lesions. We are interested in the HCC. Hence, the main purpose of this paper is to offer a new ontology-based approach modeling HCC tumors by focusing on two major aspects: the first focuses on tumor detection in medical imaging, and the second focuses on its staging by applying different classification systems. We implemented our approach in Java using Jena API. Also, we developed a prototype OntHCC by the use of semantic aspects and reasoning rules to validate our work. To show the efficiency of our work, we tested the proposed approach on real datasets. The obtained results have showed a reliable system with high accuracies of recall (76%), precision (85%), and F-measure (80%).

The relationship between liver enzymes and T2D risk is inconclusive. We aimed to evaluate the association between liver markers and risk of carbohydrate metabolism disorders, as well as their discriminatory power, for T2D prediction. This cross-sectional study enrolled 216 participants classified as normoglycemic, prediabetic, newly diagnosed diabetics, and diagnosed diabetics. All participants underwent anthropometric and biochemical measurements. The relationship between hepatic enzymes and glucose metabolism markers was evaluated by analyses of covariance. The associations between liver enzymes and incident carbohydrate metabolism disorders were analyzed through logistic regression and their discriminatory capacity to predict T2D by ROC analysis. High AP, ALT, γGT, and AST levels were independently related to decreased insulin sensitivity. Interestingly, a higher AP level was significantly associated with an increased risk of prediabetes (p = 0.017), newly diagnosed diabetes (p = 0.004), and T2D (p = 0.007). An elevated γGT level was an independent risk factor for T2D (p = 0.032) and undiagnosed T2D (p = 0.010) in prediabetic and normoglycemic subjects, respectively. In ROC analysis, AP was a powerful predictor of incident diabetes and significantly improved T2D prediction. Liver enzymes within the normal range, specifically AP levels, are associated with increased risk of carbohydrate metabolism disorders and significantly improved T2D prediction.

Cirrhotic cardiomyopathy is associated with poor prognosis and risk of acute heart failure after liver transplantation or interventional procedures. We aimed to assess the relationship between the severity of cardiac impairment and hepatic disease. Eighty patients and eighty controls underwent echocardiography, tissue Doppler imaging and speckle tracking measures. We assess the correlation between echocardiographic parameters and Child and MELD scores. Systolic parameters function (s wave, p < 0.001) and global longitudinal strain (p < 0.001) as well as diastolic parameters were significantly more impaired in cirrhotic patients compared to controls. There were no differences among the different groups in ‘Child score’ regarding systolic function as well as diastolic function. Paradoxically, the left atrium size correlated positively to both Child (p = 0.01, r = 0.26) and MELD scores (p = 0.02, r = 0.24). Left ventricular ejection fraction was significantly lower in decompensated patients as compared to compensated patients(p = 0.02).. We did not identify any association between severity of liver disease and cardiac dysfunction. Therefore, a transthoracic echocardiography should be performed in all cirrhotic patients before interventional and surgical procedures regardless of the severity of liver disease.

Le syndrome de Plummer Vinson (PV) est une entite rare qui associe une dysphagie, une anemie ferriprive et un anneau au niveau du tiers superieur de l’œsophage. Il expose a un risque accru de cancers de l’hypopharynx et de l’œsophage cervical. Son association a un carcinome de la cavite buccale, de l’œsophage thoracique ou de l’estomac est plus rare. Nous rapportons deux observations ou ce syndrome etait associe a un cancer de l’œsophage thoracique. A travers ces observations et une revue de la litterature, nous precisons les caracteristiques physiopathologiques, epidemio-cliniques et evolutives du syndrome de PV ainsi que la pathogenie de la carcinogenese au cours de ce syndrome.

Introduction L’hypereosinophilie sanguine est associee a un groupe heterogene de manifestations cliniques et biologiques. L’atteinte gastro-intestinale et peritoneale est retrouvee dans 23% des cas. Elle est exceptionnellement revelee par une ascite isolee. Nous rapportons l’observation d’une patiente atteinte d’un syndrome hypereosinophilique (SH) de type myeloproliferatif, avec identification du gene de fusion FIP1L1-PDGFRA, entrainant une infiltration peritoneale, gastro-intestinale et colique, revelee par une ascite.

L’achalasie est un trouble moteur primitif de l’oesophage caracterise par un defaut de relaxation de son sphincter inferieur et un aperistaltisme de son corps. Son association avec les varices oesophagiennes est rare et complique sa prise en charge. Une femme de 26 ans etait hospitalisee devant une dysphagie evoluant depuis 2 ans. L’examen abdominal revelait une splenomegalie arrivant jusqu’a l’ombilic. Les explorations avaient conclu a une achalasie associee a des varices oesophagiennes. La patiente beneficiait d’une cardiomyotomie de Heller. L’evolution etait favorable avec disparition de la dysphagie (recul actuel de 6 mois). A travers cette observation et une revue de la litterature, nous discutons l’apport et les risques des differents moyens therapeutiques de l’achalasie au cours de son association avec les varices oesophagiennes.

Background / Aims: Inflammatory bowel diseases (IBDs), Crohn′s disease (CrD) and ulcerative colitis (UC), are chronic gastrointestinal inflammatory disorders. The precise etiology of IBD remains unclear, and it is thought that interactions among various factors, including, genetic factors, the host immune system and environmental factors, cause disruption of intestinal homeostasis, leading to dysregulated inflammatory responses of the gut. As inflammation is intimately related to formation of reactive intermediates, including, reactive oxygen species, oxidative stress has been proposed as a mechanism underlying the pathophysiology of IBD. The purpose of this study is to examine the lipid peroxidation, protein oxidation and anti-oxidative profile in Tunisian IBD. Materials and Methods: Malondialdehyde (MDA), conjugated dienes (CD), protein thiol levels, as well as the catalase (CAT) activity were evaluated in intestinal biopsies of 17 patients affected by IBD (12 CrD and 5 UC) and 12 healthy control individuals. Results: Oxidative stress was confirmed in these two types of disease biopsies as compared to controls. MDA and CD levels were significantly increased in both UC and CrD patients′ biopsies as compared to controls′ biopsies ( P < 0.001). CAT activity was similar in UC and CrD biopsies′ and was not significantly increased in IBD patients′ biopsies compared with controls′ biopsies ( P > 0.05). Anon-significant decrease in thiol (SH) level was observed in both UC and CrD patients′ biopsies compared with controls′ biopsies ( P > 0.05). Conclusion: Increased levels of MDA and CD in IBD patients′ biopsies underline the implication of oxidative stress in the physiopathology of IBD.

Le « blue rubber bleb nevus syndrome » est une maladie rare caracterisee par de multiples malformations veineuses cutanees et gastro-intestinales, souvent a l’origine d’une anemie chronique et d’une hemorragie digestive. Nous rapportons deux cas de patientes ayant un blue rubber bleb nevus syndrome decouvert a l’occasion d’une hemorragie digestive recurrente et d’un syndrome anemique severe. A travers ces deux cas et une revue de la litterature, nous discutons les caracteristiques cliniques et les modalites therapeutiques de cette pathologie rare.

Bien que l’ingestion d’un corps etranger (CE) soit un accident classique chez l’enfant, une complication severe revelatrice est un evenement rare. La fistule œsotracheale est l’une de ces complications rares, elle est habituellement secondaire a l’ingestion de pile. Une piece de monnaie comme cause de cette fistule n’a pas ete anterieurement decrite. Nous rapportons le cas d’une fistule œsotracheale chez une jeune de 12 ans secondaire a une piece de monnaie impactee dans la paroi œsophagienne. Les manifestations atypiques etaient a l’origine d’un retard diagnostique de l’ingestion du CE et de ce type de complication. A travers cette observation et une revue de la litterature, nous insistons sur les particularites diagnostiques et de prise en charge de ce type de complication parfois grave.

Alterations in different signaling pathways are involved in initiation and progression of colorectal carcinoma, such as those related to p53, MLH1, p16INK4a, Kras, etc.This study was conducted with the aim to investigate the expression of p16INK4a and p53 in colorectal cancer (CRC) and evaluated their correlation with major clinicopathologic features and patients' survival.The expression of p16INK4a and p53 were analyzed by immunohistochemistry on 70 paraffin specimens of CRC.Positive immunostaining for p16INK4a and p53 was observed in 27 (38.6%) and 53 (80%) cases, respectively. Significant correlation between loss of p16INK4a expression and tumor size was found (P=0.008), whereas overexpression of p16INK4a correlated with favorable prognosis parameters, such as absence of lymph node metastasis (P=0.029) and early stage of CRC (P=0.027). Furthermore, p53 overexpression significantly correlated with distal tumor location (P=0.022) and was related to a better overall survival in the group of patients with distal colon carcinomas (P=0.002). Patients with p16INK4a-positive tumors had a significant longer overall survival time than patients with p16INK4a-negative carcinomas (P=0.033). In addition, Cox regression model showed that overexpression of p16INK4a is an independent factor for prognosis with depth of invasion, p53 accumulation, and coincident abnormal expression of p16INK4a or p53.Our data suggest that the assessment of both p53 and p16INK4a expression might be helpful in predicting prognosis in patients with colorectal cancer.

The identification of susceptibility genes for inflammatory bowel disease (IBD) is key to understanding pathogenic mechanisms. Recently, the results of genetic association studies have highlighted many loci that are shared among several autoimmune diseases. We aimed to study the genetic epidemiology of polymorphisms in specific genes previously associated with other autoimmune diseases, namely the CREM, STAT4, STAT5a, Stat5b, and IRF5 genes. Twelve polymorphisms in the CREM, STAT4, STAT5a, Stat5b, and IRF5 genes were genotyped in a cohort of 107 IBD patients (39 Crohn's disease [CD] and 68 ulcerative colitis [UC]) and 162 controls from southern Tunisia. One CREM single nucleotide polymorphism (SNP) displayed evidence for genetic association with IBD ( p = 8.7 × 10 −4 , odds ratio [OR] = 2.84 [1.58; 5.09]). One STAT4 SNP ( p = 0.026; OR = 1.65 [1.06; 2.58]) exhibited a marginal association with UC but not with CD. No significant association was observed with the SNPs in STAT5a , IRF5, and STAT5b . These results suggest that common variants of the CREM gene are involved in the genetic component conferring general susceptibility to IBD, whereas STAT4 appears to be more specifically associated with UC. This work provides motivation for studies aiming to replicate these findings in larger populations.

Le syndrome de Plummer-Vinson (SPV) ou de Kelly-Patterson, caracterise par une dysphagie, une anemie hyposideremique et un diaphragme sur l’oesophage cervical est extremement rare de nos jours. Bien que la correction de la sideropenie pourrait ameliorer ces symptomes, la dilatation endoscopique du diaphragme oesophagien associe est parfois necessaire. Nous rapportons une serie de neuf cas de SPV traites par dilatation endoscopique. Toutes les patientes avaient une histoire d’anemie et une dysphagie d’installation et d’aggravation progressive. La biologie a montre une anemie hypochrome, microcytaire et sideropinique dans tous les cas. La fibroscopie oesogastroduodenale a montre un diaphragme au niveau de la region sous cricoidienne. Toutes les patientes ont recu un traitement substitutif en fer associe a une dilation endoscopique par des bougies de Savary (diametre de 7 a 14 mm). Le diaphragme a ete facilement detruit sans aucune complication. Cette dilatation a permis une disparition rapide de la dysphagie. Cependant, trois patientes ont presente une recidive de la dysphagie associee a l’anemie. Ces patientes ont ete retraitees avec sucees par une autre seance de dilatation endoscopique. Toutes les patientes ont ete surveillees regulierement avec une bonne evolution apres un recul de 46 mois en moyenne. Notre experience demontre que la dilatation endoscopique au cours du SPV est efficace, bien toleree et relativement facile. Cependant, plusieurs seances sont parfois necessaires

Les lipomes coliques sont des tumeurs adipeuses benignes et rares. Ils sont generalement de petite taille et asymptomatiques. Neanmoins, lorsqu’ils sont geants, ils peuvent etre symptomatiques, voire compliques. Nous rapportons deux observations de lipomes geants symptomatiques dont un complique d’une invagination colocolique. A partir de ces cas et d’une revue de la litterature, nous discutons les caracteristiques cliniques, diagnostiques et les modalites therapeutiques de cette pathologie rare.

Points essentiels Au cours d’une endoscopie digestive, l’appareil traverse des cavites naturelles ayant toujours une flore bacterienne commensale, parfois une flore pathogene. Dans tous les cas, l’appareil est contamine apres l’examen. L’absence de desinfection efficace expose aux risques de transmission de germes. Le risque infectieux depend du terrain, de la procedure endoscopique ainsi que de la technique de desinfection. La bacteriemie, meme si elle est non negligeable pour certaines procedures, n’est cliniquement significative qu’exceptionnellement. La transmission endoscopique des germes d’un patient a un autre est tres rare et est le plus souvent due a un defaut de desinfection. Les procedures de desinfection du materiel doivent etre connues, mises en place et controlees.

L'objectif de l'etude a ete d'evaluer la sensibilite, la specificite et les valeurs predictives des anticorps anti-Saccharomyces cerevisiae (Asca) et des anticorps anti-nucleaires associes aux neutrophiles (Nana) separement et en association chez les patients tunisiens atteints de maladies inflammatoires de l'intestin (Mici) et d'etudier l'association entre leur presence et les particularites cliniques de la maladie. Les echantillons seriques de 128 patients (39 atteints de rectocolite hemorragique (RCH), 25 de maladie de Crohn (MC) et 64 temoins) ont ete analyses. Asca et Nana ont ete determines par Elisa et immunofluorescence indirecte, respectivement. Les valeurs de sensibilite, specificite, VPP et VPN des Nana pour la RCH ont ete : 56,4 %, 88 %, 88 % et 56,4 % ; et des Asca pour la MC de : 56 %, 82,1 %, 54,5 % et 75,6 %, respectivement. L'association des deux marqueurs entraine des changements dans la precision du diagnostic : Nana+/Asca- pour la RCH : 53,8 %, 92 %, 91,3 %, 56,1 % Asca+/Nana- pour la MC : 52 %, 94,9 %, 86,7 % et 75,5 %. Aucune association n'a ete trouvee entre la presence d'un marqueur serologique specifique et les caracteristiques cliniques des patients. En conclusion, la specificite de ces marqueurs combines tend a etre superieure a la sensibilite, ce qui les rendrait plus utile dans la differenciation des sous-types des Mici, plutot que le depistage de la population.

Resume Introduction L’objectif de ce travail etait de determiner les particularites epidemiologiques, cliniques, therapeutiques et evolutives de la tuberculose peritoneale, dans une region d’endemie tuberculeuse. Methodes Tous les cas de tuberculose peritoneale confirmes par l’examen anatomopathologique et colliges dans le service de gastroenterologie du centre hospitalo-universitaire Hedi-Chaker de Sfax, entre janvier 1987 et decembre 2006, ont ete retrospectivement analyses. Resultats Quarante-deux patients, d’âge moyen 38,2 ans, ont ete inclus dans cette etude. Outre la presence d’ascite (100 %), le tableau clinique etait domine par l’existence d’une fievre (76,2 %) et d’une douleur abdominale (73,8 %). Le delai moyen entre la date d’apparition du premier symptome et la consultation etait de 3,6 mois. L’ascite etait exsudative dans 100 % des cas avec une predominance lymphocytaire dans 96,6 % des cas. L’intradermoreaction etait superieure a 10 mm dans 39,1 % des cas. Tous nos patients ont eu une exploration chirurgicale peritoneale. L’aspect nodulaire du peritoine etait retrouve chez 40 patients. Les adherences etaient notees chez 25 patients. Les modalites therapeutiques variaient en fonction des annees. L’evolution etait favorable chez tous nos patients. Conclusion La tuberculose peritoneale pose des difficultes diagnostiques pour le clinicien. A defaut de nouveaux tests diagnostiques, la cœlioscopie avec biopsies peritoneales constitue l’examen de choix pour le diagnostic.

The mucosa-associated lymphoid tissue (MALT) lymphoma is a distinct clinical pathologic entity that develops in diverse anatomic locations such as the stomach, salivary gland, thyroid, lung, skin and breast. However, colorectal involvement is extremely rare. To our knowledge, only ten cases of primary rectal MALT lymphoma have been reported in the literature. We report a 46-year-old woman with rectal MALT lymphoma, which regressed after radiotherapy. The patient had rectal bleeding. Colonoscopy showed a pseudonodular and ulcerated big fold in the rectum. Microscopic and immunohistologic studies of the biopsy specimen showed typical features of low grade MALT lymphoma. Upper endoscopy showed chronic gastritis with lymphoid follicles but without any infiltration of lymphoma cells. Helicobacter pylori infection was confirmed by histology. No extra-intestinal involvement was found on the staging evaluation, which included computed tomography (CT) of the abdomen, chest, pelvis and a bone marrow biopsy. We attempted to eradicate H. pylori with a 7-day course of omeprazole, amoxycillin, and metronidazole. Eradication was proved successful by endoscopy. Repeated colonoscopy 4 months after the end of treatment showed that the rectal tumor had not regressed. Biopsy specimens confirmed the persistent infiltration of lymphoma cells. The patient was considered to be a non-responder to eradication therapy and was indicated for radiotherapy. He underwent a total of 34 Gy. Complete regression was confirmed by colonoscopic and histologic examination at 2 months after the end of treatment. He was followed up closely with colonoscopy, but no relapse of these lesions was detected after 12 months.

Key points Reactivation of viral hepatitis B is a well-known complication in patients receiving chemotherapy or immunosuppressive therapy; its incidence reaches 50%. This reactivation is associated with a high rate of morbidity and mortality . Prophylactic treatment of viral reactivation with lamivudine resulted in lowering the incidence of this risk and improving prognosis in recent studies. Patients with hematological malignancies and other cancers require a precise assessment of their hepatitis B status and adequate management. There is not yet a consensus about the appropriateness of prophylactic treatment of occult hepatitis B infection or of pretreatment virologic assessment , especially measurement of viral DNA.

Le cystadenocarcinome mucineux pancreatique represente une tumeur rare mais potentiellement agressive. Nous rapportons l’observation d’une femme âgee de 48 ans, sans antecedents pathologiques particuliers, qui a ete hospitalisee pour douleur de l’hypochondre droit avec ictere et alteration de l’etat general. La tomodensitometrie abdominopelvienne a objective une lesion kystique pancreatique avec metastases hepatique et gastrique. L’oesogastroduodenoscopie a montre un processus tumoral gastrique ombilique au centre. La biopsie etait en faveur d’un cystadenocarcinome avec un stroma fibreux de type ovarien. A travers cette observation et une revue de la litterature, nous discuterons les caracteristiques epidemiologiques, clinicomorphologiques et therapeutiques de cette entite rare.

La localisation rectocolique des lymphomes non hodgkiniens primitifs extranodaux demeure rare et ne represente que 10–20 % des lymphomes gastro-intestinaux et 0,2–0,6 % des tumeurs malignes colorectales. Nous rapportons l’observation d’un homme âge de 84 ans qui etait hospitalise pour exploration d’une constipation avec douleur abdominale. La coloscopie avait montre une lesion ulceree du colon transverse dont les biopsies avaient conclu a un lymphome B a grandes cellules. Le bilan d’extension etait negatif. Le patient est decede apres trois cures de chimiotherapie. A travers cette observation et une revue de la litterature, nous discuterons les caracteristiques epidemiologiques, clinicomorphologiques et therapeutiques de cette entite rare.

Associations with different autoimmune diseases of polymorphisms in genes encoding the IL2RA and IL2RB subunits (located in 10p15 and 22q13, respectively), were identified through genome-wide studies. Polymorphisms in these two genes were studied in 107 inflammatory bowel disease (IBD) patients (39 Crohn's disease [CD] and 68 ulcerative colitis [UC]) and in 162 ethnically healthy controls from Tunisia (Sfax). Two of the 15 IL2RA single-nucleotide polymorphisms (SNPs) genotyped (rs4749924 and rs706778) were significantly associated with UC (pcorr=0.018 and 0.048, respectively), but no evidence of association with CD was observed. The IL2RA GTCT haplotype was also more frequent in UC patients compared to controls (2.6% vs. 0%; p=0.002). One of the 6 IL2RB SNPs genotyped (rs743776) was significantly associated with CD (pcorr= 0.039), but no evidence of association with UC was observed. No significant association between IL2RB haplotypes was observed among investigated groups. Our study identified markers in the IL2RA and IL2RB genes that are significantly associated with UC and CD, respectively. Our results supporting IL2RA and IL2RB as promising candidate genes for IBD and suggesting a potential role of IL2R in the pathogenesis of IBD, likely involves regulatory T cells.

Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory disorders of the gastro-intestinal tract with unknown etiology. Both environmental and genetic factors are involved in the pathogenesis of these inflammatory bowel diseases (IBD).The purpose of the present study was to determine the association between the polymorphism of the transmembrane region of MICA (MICA-TM), and the genetic susceptibility in Tunisian patients with IBD.A total of 102 Tunisian patients (66 with UC, 36 with CD) and 123 healthy controls were enrolled in our study. MICA-TM was genotyped by a semiautomatic fluorescent-labelled PCR method, amplicons were analysed on an ABI Prism 310 genotyper. Comparisons of allele frequencies between patients and controls, and between patients' subgroups were performed using SPSS 13.0.No MICA allele was significantly increased in both groups of IBD compared to controls. The MICA-A5.1 allele was significantly decreased in CD patients (p=0.006, pc=0.03). In UC, MICA-A6 was associated with the presence of extraintestinal manifestations (p=0.04, pc=0.2), whereas MICA-A5 was associated with late age of onset (p=0.04). In CD, MICA-A6 was significantly increased in active disease patients when compared to moderately active or inactive disease (p=0.03, pc=0.15).Some clinical features of CD and UC may be influenced by specific MICA-TM alleles. In our South Tunisian population, MICA plays a disease modifying role, rather than being an important gene in the susceptibility for developing IBD.

This deposit is composed by a publication in which the IGC's authors have had the role of collaboration (it's a collaboration publication). This type of deposit in ARCA is in restrictedAccess (it can't be in open access to the public), and can only be accessed by two ways: either by requesting a legal copy from the author (the email contact present in this deposit) or by visiting the following link: https://link.springer.com/article/10.1007%2Fs11033-014-3596-5 This deposit is composed by the main article plus the supplementary materials of the publication. This publication hasn't any creative commons license associated. Further funders are not indicated in the document. Autoimmune diseases (ADs) share several genetic factors resulting in similarity of disease mechanisms. For instance polymorphisms from the KIAA1109-interleukin 2 (IL2)-IL21 block in the 4q27 chromosome, has been associated with a number of autoimmune phenotypes. Here we performed a haplotype-based analysis of this AD related region in Tunisian patients. Ten single nucleotide polymorphisms (rs6534347, rs11575812, rs2069778, rs2069763, rs2069762, rs6852535, rs12642902, rs6822844, rs2221903, rs17005931) of the block were investigated in a cohort of 93 systemic lupus erythematosus (SLE), 68 ulcerative colitis (UC), 39 Crohn's disease (CD) patients and 162 healthy control subjects of Tunisian origin. In SLE population, haplotypes AGCAGGGTC, AGAAGAGTC, AGAAGGGTC and AGCCGAGTC provided significant evidence of association with SLE risk (p = 0.013, 0.028, 0.018 and 0.048, respectively). In the UC population, haplotype AGCCGGGTC provided a susceptibility effect for UC (p = 0.025). In the CD population, haplotype CAGGCC showed a protective effect against the development of CD (p = 0.038). Haplotype AAGGTT provided significant evidence to be associated with CD risk (p = 0.007). Our results support the existence of the associations found in the KIAA1109/IL2/IL21 gene region with ADs, thus confirms that the 4q27 locus may contribute to the genetic susceptibility of ADs in the Tunisian population. This work was supported by a grant from the «Ministère de la recherche Scientifique et de la recherche scientifique» (Tunisia). Genotyping was supported by the Instituto Gulbenkiande Ciência, Oeiras, Portugal. info:eu-repo/semantics/publishedVersion

Crohn's disease (CD), ulcerative colitis (UC), systemic lupus erythematosus (SLE) and autoimmune polyglandular syndromes (APS) are autoimmune diseases (ADs) that may share common susceptibility pathways. We examined ribonucleo-protein, polypyrimidine tract-binding protein (PTB)-binding 2 (RAVER2) loci for these diseases in a cohort of 39 CD cases, 67 UC cases, 93 SLE cases, 60 APS cases and 162 healthy control subjects of Tunisian origin. We genotyped 3 SNPs of RAVER2 (rs2780814, rs1333739 and rs2780889) and evaluated it genetic association with each ADs, using X2-test. For each association, odds ratio (OR) and 95% CI were calculated. We show that rs2780814 is significantly associated with UC (P = 0.00016, P(corr) = 0.00048, OR = 3.66 (1.82; 7.34)). We also observed a trend of possible association to SLE (P = 0.023, P(corr) = 0.69, OR = 2.19 (1.1; 4.36)). None of these RAVER2 SNPs were associated with CD and APS susceptibility. These findings establish RAVER2 as a new UC genetic susceptibility factor and reveal a genetic heterogeneity of the associated polymorphisms and risk alleles between ADs suggesting different immunopathological roles of RAVER2 in these diseases.

Plasmacytoid variant of melanoma is reported in only rare cases. We present the case of a 54-years-old man admitted for enlarged lymph nodes in the lumbar region. Initial diagnosis of plasmablastic lymphoma/plasma cell myeloma was considered. At our institute, a bladder polyp was removed. Microscopic exam demonstrated dense plasmacytoid cells infiltration with pigment deposits. Immunohistochemical study showed strong expression of HMB45, Melan A, and vimentin. There was focal positivity with S100 protein and CD138/syndecan-1. The diagnosis of metastatic plasmacytoid melanoma was finally established. Clinical exam revealed an esophageal melanoma with melanosis supporting its primary location. Although rarely, melanoma especially plasmacytoid variant may express plasma cell markers which may lead to erroneous diagnosis of plasma cell proliferation. Careful morphological examination for melanin pigment and the use of panel of melanocytic markers are helpful for diagnosis.

Cyclo-oxygenase 2 (COX-2) and E-cadherin are promising biomarkers for cancer diagnosis and therapy. The aim of this study was to examine the expression of these two proteins in primary colorectal adenocarcinomas and to investigate their association with clinicopathological characteristics including survival of patients. Immunostaining of E-cadherin and COX-2 was assessed in 70 primary colorectal adenocarcinomas from Tunisian patients. Membranous E-cadherin immunostaining and cytoplasmic COX-2 expression were observed in 74.3% and 68.6% of cases respectively. A significant association was found between COX-2 expression and age at diagnosis (P=0.02), and vessel invasion (P=0.037). The expression of E-cadherin correlated with age at diagnosis (P=0.01), and tumor size (P=0.02). In addition, by multivariate analysis, we revealed a significant association with 1-year disease free survival and a tendency with distant metastasis (P=0.017 and P=0.065 respectively). On the other hand, tumors exhibiting COX-2+/E-cadherin-profile were larger (P=0.006), and in an advanced stage (P=0.001). Survival analysis showed that COX-2 over-expression confers a reduced overall survival rate (Plog rank=0.036) and is an independent factor predictive for prognosis.

We evaluated the combined use of different fixatives for the identification of atypical perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) in patients with inflammatory bowel diseases (IBD) by indirect immunofluorescence (IIF). Sera from 59 ulcerative colitis (UC) and 37 Crohn’s disease (CD) patients, and from 64 healthy controls were studied. The IIF on ethanol-, formalin-, and methanol-fixed neutrophils was used for the detection of ANCA. Enzyme linked immunosorbant assay (ELISA) was performed to identify the antigens recognized by ANCA. ANCAs were present in 35 of 59 (59.3%) UC patients and in 10 of 37 (27.02%) CD patients. Atypical p-ANCA positivity was strongly associated with UC disease (44.1% in UC vs. 8.1% in CD; p = 0.0002). The combined application of different fixatives contributed to make easy the differentiation between typical p-ANCA and atypical p-ANCA. Atypical p-ANCA determination appears to be a useful parameter for the distinction between UC and CD.

Lymphangiomas are rare benign proliferations of the lymphatic system. Acquired lymphangioma circumscriptum of the vulva is induced by impaired lymph flow. We describe a new case of lymphangioma circumscriptum resulting from tuberculosis involving a lymph node. A 45-year-old female presented with swelling of the vulva for the past 8 years. She had a history of multiple left inguinal swellings successfully treated with four antituberculosis drugs. Her vulval swelling did not respond and was diagnosed as acquired lymphangioma circumscriptum. She becomes the fifth reported case of acquired lymphangioma circumscriptum of the vulva with tubercular lymphadenitis. The single antituberculosis treatment is insufficient to control lymphangioma. Ablative methods seem encouraging.

L’aspect pseudotumoral de la maladie de Crohn est exceptionnel. Nous rapportons le cas d’un patient âge de 46 ans chez qui le diagnostic de maladie de Crohn colique dans sa forme pseudotumorale a ete retenu sur des criteres morphohistologiques et evolutifs. La hantise d’une neoplasie nous incite a realiser des macrobiopsies.

La pancreatite aigue est d’incidence elevee au cours des maladies inflammatoires chroniques de l’intestin. Elle serait le plus souvent d’origine biliaire, alcoolique, medicamenteuse ou secondaire a une hypertriglyceridemie. Dans certains cas, aucune cause ne peut etre mise en evidence. Les anomalies des canaux pancreatiques peuvent etre en cause. Nous rapportons un cas de patient porteur d’une rectocolite ulcero-hemorragique chez qui le diagnostic de pancreas divisum a ete retenu au decours de poussees recurrentes de pancreatite aigue. A partir de ce cas et d’une revue de la litterature nous dicuterons les caracteristiques de telle association inedite.

Background Metabolic bone disease is common among patients with chronic liver disease. It is known as hepatic osteodystrophy. Osteoporosis is the most common complication; its incidence varies between 20 and 100% depending on the series. Objectives the aim of this study was to assess the prevalence and risk factors of hepatic osteodystrophy in patients with chronic viral hepatitis. Methods The study was carried out in 47 patients with chronic viral hepatitis B or C. Bone mineral density (BMD, g/cm) was assessed by dual X-ray absorptiometry. Osteoporosis was diagnosed when BMD was 2.5 standard deviations below the mean peak value in young adults (T score, 22.5 SD). Patients with other pathology that may change the bone metabolism were excluded. Results This is a prospective study including 47 patients (16 women and 31 men), with a mean age of 49.8 years (19-80 years). Thirteen patients had hepatitis C (28%) and thirty four were carriers of hepatitis B (72%). Liver cirrhosis was found in 38, 3% of patients (Child A: n=5, Child B: n=8, child C: n=5). No patient was taking calcium supplements, four of them had a history of fractures, and only three had a family history of osteoporosis. Almost a third of our patients were smokers and 10% of them were alcohol drinkers. Among patients with hepatitis C, 4 had osteoporosis and 3 had osteopenia. For those with hepatitis B, five had osteoporosis and 13 osteopenia. Osteoporosis was associated with female sex (p=0.022). Patients with bone loss had respectively a body mass index and albumin levels lower than patients with normal bone density 26.3 vs 23 kg/m 2 ; p=0.05 and 38.2 VS 33.2 g/l; p=0.03 respectively. There were no significant differences between the two groups regarding the nature of hepatitis, disease duration, sex, cytolysis, cholestasis and cirrhosis. Conclusions Bone loss must be systematically sought in chronic viral hepatitis. Female sex, low body mass index and low albumin level are risk factors of hepatic osteodystrophy in patients with viral hepatitis. Disclosure of Interest None Declared

Background Bone manifestations are well-known extra hepatic complication of chronic liver disease. The prevalence of osteoporosis among patients with chronic liver diseases ranges from 10% to 60%. Objectives the aim of this study was to assess the prevalence and risk factors of osteoporosis in patients with chronic liver disease. Methods The study was carried out in 60 patients with viral hepatitis B, C and primary biliary cirrhosis (PCB).Bone mineral density (BMD, g/cm) was assessed by dual X-ray absorptiometry. Osteoporosis was diagnosed when BMD was 2.5 standard deviations below the mean peak value in young adults (T score, 22.5 SD). Patients with other pathology that may change the bone metabolism were excluded. Results Sixty patients (29 women and 31 men) were included in our study, with a mean age of 51.2 years (19-82 years). Thirteen patients had PBC (21.7%), thirteen suffering from hepatitis C (21.7%) and thirty four had hepatitis B (56.7%). Cirrhosis was found in 36.7% of patients (Child A: n=6, child B: n=10, Child C: n=6). No patient was taking calcium supplements, six of them had a history of fractures, and only four had a family history of osteoporosis. Eighteen patients had osteoporosis (30%), eighteen had osteopenia (30%) and 24 patients had normal bone density. Osteoporosis was found in 27% of patients with hepatitis B, 30% of patients with hepatitis C and in 70% of patients with PBC. The bone loss was associated with advanced age (54.5±12, 87 VS 46.2±16 years, p=0.03), with a low body mass index (23.6±4,7 vs 26,67±6 kg/m 2, p=0.0038) and with a low albumin levels (33.6±6 vs 38.2±5.36 g/l, p=0.004). It was also significantly associated with the presence of esophageal varices (p=0.02) and PBC (p=0.04). Conclusions Osteoporosis is effectively a complication of chronic liver disease. Cholestasis in addition to advanced age, low body mass index, low albumin level and the presence of esophageal varices are risk factors of osteoporosis in chronic liver disease. Disclosure of Interest None Declared

Introduction Les steatohepatopathies non alcooliques regroupent deux entites : la steatose non alcoolique et la steatohepatite non alcoolique. Contrairement a la steatose, la steatohepatite non alcoolique a un risque d’evolution vers la cirrhose et ses complications. La ponction biopsie du foie (PBF) reste l’examen de reference pour differencier ces deux entites. L’objectif de notre etude etait de determiner les facteurs predictifs de steatohepatite et de fibrose au cours des steatohepatopathies non alcooliques. Patients et Methodes Il s’agit d’une etude prospective menee entre septembre 2005 et mai 2008. Au cours de cette periode, 37 patients ayant une steatose hepatique confirmee a l’examen anatomopathologique des PBF, etaient inclus. L’evaluation des lesions histologiques etait basee sur le score de Kleiner. Resultats Le diagnostic certain de steatohepatite (score Non Alcoholic Steatohepatitis ≥ 5) etait retenu chez 14 patients (37,8 %). La fibrose etait presente chez 65 % des cas dont 35 % avaient une fibrose ≥ 2. La presence d’un syndrome metabolique et/ou de l’un de ces criteres (diabete, HTA, obesite), la cytolyse, l’insulinoresistance et les taux seriques eleves d’ALAT, d’ASAT, d’insuline et de l’index HOMA etait significativement associes a la steatohepatite. Le diabete, l’elevation de la tension arterielle et un rapport ASAT/ALAT ≥ 1 etaient correles a une fibrose ≥ 2. En analyse multivariee, les facteurs predictifs independants etaient : – l’obesite, l’insulinoresistance et le diabete pour la steatohepatite ; – un rapport ASAT/ALAT ≥ 1 pour la fibrose ≥ 2. Conclusion Au cours des steatohepatopathies non alcooliques, l’obesite, l’insulinoresistance et le diabete sont predictifs de la steatohepatite. Un rapport ASAT/ALAT ≥ 1 est predictif d’une fibrose ≥ 2. En presence de ces criteres, nous recommandons la realisation d’une PBF.