[Head and neck cancer of aircrew personnel in aeronautical medical expertise]

ENT cancers due to their location and treatment encompass a number of physical symptoms related to swallowing and communication disorders. To evaluate flight capacity of aircrew personnel with ENT cancer and consequences on fitness and waiver criteria. Case 1: A 52 years old smoker pilot whish present laryngeal epidermoid carcinoma staged T3M0N0 and treated by total laryngectomy with curative radio-therapy [70Gy]. Metastasis occurred on lumgth and death heaped after acute respiratory failure. Case 2: A 55 years old mechanic whish had rhinopharyngeal undifferentiated carcinoma staged T4N2M0 and treated with radiochemotherapy with favourable follow-up. Inability for flight was proclaimed because of severe psychological impact. Case 3: Concerned a vesiculograpillary carcinoma of thyroid gland occurring in a 46 years old helicopter pilot. After total thyroidectomy and iodine treatment, the patient has obtained complete fitness to flight. Fitness to flight can be controversed in ENT cancer occurs. Epidemio-clinical paraclinical, functionnel and operational criterias must be considered when wainer to be proclaimed

[Acanthosis nigricans: epidemiologic study of 69 cases]

Acanthosis nigricans is a well-defined skin disorder with a distinctive appearance and an elective topography to the flexural areas that facilitate its diagnosis. In Tunisia, apart from isolated reports of malignant AN, few epidemiologic data are available. In order to describe the characteristics of this affection, we conducted a retrospective study in the area of Tunis over a 12-year period. Retrospective study of all the cases of AN seen in the dermatology department of Habib Thameur teaching hospital between 1991 and 2003, including the cases coming from the north and of the centre of Tunisia. Sixty-nine cases were recorded with a sex-ratio H/F of 0.17. The average age was 24.1 years [extremes of 3 and 66 years] and 57.9% of the patients were aged between 9 and 22 years. The neck [98.6%] and the axillae [75.4%] represented the most common localizations. All the patients presented a benign AN, comprising 51 cases of pseudo-AN, 11 cases of AN associated with endocrine diseases, 5 cases of familial AN and 2 cases of AN associated with an auto-immune disease. Local treatments associated an hypocaloric diet [AN with obesity] were recommended with a light improvement after 3 months an average follow-up. The frequency of the AN is probably underestimated because of the usually asymptomatic character of this affection. AN constitutes a double cutaneous marker, being able to reveal either an hyperinsulinemia constituting a cardiovascular risk factor or an ignored subjacent neoplasm engaging the vital prognosis

[Sneddon wilkinson's subcorneal pustular dermatosis: an atypical case]

Sneddon-Wilkinson disease [SW] is chronic and benign disease belonging to the heterogeneous spectrum of neutrophilic diseases. It is characterised by flask, superficial, aseptic pustules, mainly involving the trunk axilla and inguinal folds, favourably responsive to sulfones. We report an original case with an atypical clinical presentation and course. A 25-year old women presented with an erythematous pustular eruption appeared one week ago. Similar flares were reported since 3 years. No drug intake history nor recent infection were reported. Physical examination showed superficial pustules mainly located on the face and limbs, lying on an erythematous skin and sometimes grouped in larges plaques with a serpiginous disposition having a characteristic aspect of hypopion pustule. A specimen taken from the pustules did not show bacterial or fungal infection. Histological examination of a biopsy specimen showed subcorneal pustules with a dermal peri-capillar neutrophilic infiltrate. Direct immunofluoresence was negative. No associated diseases were found. The patient was resistant to a 1 month treatment with dapsone [100mg/day]. Improvement was obtained with acitretin [25mg/day] within 3 months. Our case has some specificities: cephalic involvement, resistance to dapsone and favourable outcome to a low dose of acitretin

[Study of the cutaneous drugs reactions in a teaching hospital in Tunis]

Cutaneous adverse drug reactions correspond to adverse effects with cutaneous expression resulting from the systemic penetration of a drug in the body

The aim of this study is to evaluate the various clinical pictures of RCM, their epidemiologic characteristics as well as the different causative drugs, through a retrospective hospital series

Methods: It is about a retrospective study about all the patients consulting and/or hospitalized for suspicion of an adverse cutaneous drug reaction led to the service of dermatology of the teaching hospital Habib Thameur of Tunis over a 3-year period [from January 2002 to December 2004]. The diagnosis was based on a beam of clinical and anamnestic arguments. Only the patients having a positive pharmacovigilance investigation were retained

Results: 28 patients were retained for this study. The macular and popular exanthema represented the most frequent clinical aspects followed by acute urticarial and fixed drug eruption. The antibiotics represented the most causative drugs followed by analgesics and non steroidal anti-inflammatory

Conclusion: We record a lower frequency of cutaneous adverse drug reactions in comparison with the literature. We also find a high frequency of severe forms and stress on the difficulties encountered in the identification of the causativele drugs. Though, a close cooperation between the various hospital structures and pharmacovigilance centers is mandatory

[Epidemiological and clinical profile of vitiligo in Tunisia: retrospective study of 503 cases]

Background: Vitiligo is an acquired leucoderma whose etiology remains unknown. Its frequency in the world is estimated at 1%

Aim: The purpose of our study is to asses, with through a retrospective hospital series, the epidemiologic, clinical, therapeutic and course of this dermatosis and to compare our results with those of the literature

Methods: This is a retrospective study of consecutive patients attending the outpatient dermatological department at Charles Nicolle Hospital in Tunis over a 5 year-period [from June 1999 to July 2000]

Results: 503 patients were reviewed during a 5-year period. They were 288 women and 215 men [sex-ratio F/H=1.33]. The average age was 28.2 years [extremes of 3 and 80 years]. The peak of frequency was located in the 2nd decade of the life [26%]. A family history of vitiligo was found in 27% of the cases. The average time of consultation was 21 months. The localization of the lesions was ubiquitary prevalent at the uncovered areas. An association with other pathological conditions was found in 23% of cases. Most patients were treated by a photochemotherapy [78.2%]. Photoprotection was advised among all patients. The course was specified in 112 cases corresponding to a partial [28.9%] or a complete repigmentation [0,8%], a stabilization of lesions [41.6%] and an extension [26%]

Conclusion: Our results are consistent with the literature stressing the frequency of vitiligo which can cause an aesthetic and psychological damage of variable and sometimes major importance

Sweets syndrome: about of 8 cases

Sweet's syndrome is a dermatosis classically determined by painful erythematous plaques or nodules associated with fever, neutrophilia and dense neutrophilic dermal infiltrate. In most cases, Sweet's syndrome may occur in the absence of other diseases. However, it can be associated with an inflammatory disease and essentially with malignant conditions in 20% of cases requiring a careful investigation. We report herein, the epidemiological, clinical, therapeutic and evolutive features of a hospital serie. We retrospectively reviewed all the files of patients conforming with the diagnosis of SS, seen at the dermatology departement of Habib Thameur hospital during a 7-year period [from 1997 to 2003]. All patients fulfilled at least two major criteria and two minor criteria of Su et Liu's diagnostic criteria modified by Von Den Driesch. 8 cases of .Sweet's syndrome were diagnosed. All patients were females. The mean age was 51.62 years. The lesions occurred on the upper limbs in 7/8 cases. SS was isolated in 6 cases and para-inflammatory in one case corresponding to an associated Sjogren's syndrome. Besides the st and ard therapy using oral corticosteroids [3 patients], non steroidal inflammatory agents has been efficient in 4 cases. In our serie, we report an exclusive female involvement and a lower frequency of associated diseases compared with the relevant literature. Association of SS and Sjogren's syndrome is exceptional. To our knowledge, only 6 cases have already been reported