[Tumours of the pineal region: retrospective study about 40 cases]

The tumours of the pineal region are rare brain tumours, most common in children and characterized by a large clinical and histologic polymorphism. To assess the outcome and prognostic factors of 40 patients with primitive pineal region tumours treated at the department of radiotherapy of Salah Azaiz institute. Between January 19977 and December 2000, 40 patient received radiotherapy. There were 22 adults and 18 children [age <16 years]. The mean age was 20.4 years and sex ratio was 2.07. Histologic diagnosis was confirmed in 11 cases; 16 patients had a CT evaluation after 20 Gy radiotherapy and in 13 cases diagnosis was performed with CT aspects +/- germinal tumour markers. Target volume varied: 10 had craniospinal irradiation, 16 had local irradiation and 14 had whole brain irradiation with a boost at the tumour bed. Chemotherapy was proposed for metastases and recurrent diseases. Survival rates were 87% at 2 years and 74, 5% at 5 years. For children, survival rates were 88% at 2 and 4 years. Eight patients [20%] failed locally and 5 patients [12.5%] had metastasis. Age, performance status and large fields of radiotherapy seem to be associated with prognosis and survival. Pineal tumors and especially germinal tumours are chemosensitive and radiosensitive, care of these tumours is multidisciplinary involving surgery, chemotherapy and radiotherapy. From our study and a review of the literature, we tried to find a therapeutic strategy for tumours of the pineal region

[Skin cancer in Tunisia: a retrospective study: 1379 cases and risk factors]

The aim of this study was to determine the clinical and epidemiological aspects of skin cancer in Tunisia. We analysed the clinical files of all cases of skin cancer registrated at the ISA institute between 1975 and 1984. 1379 cases of skin cancer were referred to ISA, representing 9.02%of all cancer cases referred to the institute during the same period. Basal cell carcinoma [CBC] was the most frequent type [57.5%] followed by squamous cell carcinoma [CSC]: 32.6%and melanomas: 4%. The sex ratio was 1.7 with a mean age of 61 years in men and 60 years in women. The face was the most frequent involved sites in CBC [92%]. This region is usually exposed to the sun. The distribution of CSC in the body was different. The lesions were multiple in 11%of the cases. 13.7%of the CSC were developped on a burn scar. 21 cases were radio-induced and 45 patients had a xeroderma pigmentosum. Skin cancer is relatively frequent in Tunisia. However, our incidence is inferior to other countries. Sun exposure is the main risk factor

radiochimiotherapie concomitante preoperatoire dans le cancer du col uterin: resultats preliminaires

This is a retrospective study of patients treated for cancer cervix staged IB2, IIA or lIB with bulky tumor [>4cm]. Treatment was concurrent radiotherapy [45Gy with I,8Gy daily fraction] and chemotherapy [5 cycles of Platinum 40mg/m2/week]. All patients. underwent Brachytherapy [l5Gy on the reference isodose according to Paris system] followed by surgery [radical abdominal hysterectomy and bilateral pelvic lymphadenectomy: Piver 3]. Between October 1999 and December 2002, forty five patients were treated in this protocol. Median age was 46 years [21- 68]. Histology was squamous cell carcinoma in 93% and glandular carcinoma in 7%. Average external radiation dose was 44Gy [20-50]. Ninety three% of patients had at least 3 cycles of chemotherapy and 46,5% received the planned 5 cycles. On the operative specimens, there was 62,5% complete response and only 7 pelvic node involvement [17,5%]. Four postoperative complications were noted [one vascular injury, one urinary fistula, one phlebitis and one lymph collection]. Preoperative combined radiotherapy and chemotherapy in the early bulky stages of uterine cervix cancer is well tolerated and "gives" a high rate of sterilisation. There was no increase in surgical morbidity

Effects de la consanguinite et des facteurs sociaux sur la mortalitee et la fecondite en Mauritanie

This study is to evaluate the consequences of consanguinity and social factors on infanto-adolescent mortality and fertility in Mauritanian ethno groups. Thereafter we studied the correspondence between the methods of all the studied variables. The analysis of a sample of 2413 couples obtained according to the quota method showed that the infanto-youthful death rate in Soninkes and the Poulard ones was higher in the consanguineous groups than in the non consanguineous ones. On the other hand, in Maures, Wolofs and black Maures the difference is not significant. For all the Mauritanian ethno groups the consanguineous couples had averages of fertility significantly higher than those of non consanguineous. Analysis of the correspondences revealed two groups. The first was formed by the related ones. The second by the non-related ones. Each group formed a unit with other specific demographic characteristics

[Cost effectiveness of cervical cancer screening strategies in Tunisia]

Cervical cancer is a public health problem in developing countries and is the first cancer among women in several of these countries. Screening using the Pap test is the principle control strategy for this cancer. The aim of this study is to identify the highest cost-effectiveness strategy of Pap test screening, according to age group [20 - 64 years, 35 - 64 years and 40 - 64 years] and the frequency of this test [every 3 years or every 5 years]. Number of cases avoid by screening and mean cost to prevent one case were used to compare these screening strategies. The principles results showed that the number of cervical cancer cases avoid increase with the coverage level of the screening and age group size, and decrease with the frequency of the Pap tests. The screening strategy interesting age group "40 - 64 years" every 5 years observed the highest cost-effectiveness ratio [19MD]; however cost is 23MD for age grovy 35 - 64 years. These results lead to choice a frequency of Pap tests every 5 years. However, for determination of age group, other factors, as psycho-social ones, should be taken into account besides economic criterias