[Acanthamoeba keratitis: report of 3 cases diagnosed in central Tunisia]

Amoeba of the genus Acanthamoeba are ubiquitous free-living protozoa encountered in water and soil. They frequently cause sight-threatening keratitis. Report of the three first cases diagnosed at the laboratory of Parasitology of Sousse Hospital. [Tunisia]. Our study concerned three lens-wearing female patients. aged 17, 20 and 29 years respectively. The patients originate from central Tunisia and presented with unilateral [2 cases] or bilateral [one case] keratitis. Diagnosis was made by demonstrating Acanthamoeba trophozoites and/or cysts on direct examination and/or culture [in agar-Escherichia coli medium] of contact lenses and/or lenses' solution. Direct examination of corneal swabs was negative in three cases but culture was positive in one. The three patients were treated with hexamidine and neomycine eye-drops for three months. Treatment led to scarring of lesions with however sequellar opacities that was minor to moderate in two cases and consisted of a central leucoma with a poor visual outcome in the last case. The need for systematic research of amoeba in lenses wearing patients with keratitis is emphasized

Microsurgical direct transnasal approach to pituitary adenomas assisted by endoscope: description and advantages

The sub-labial transsphenoidal approach is frequently used in pituitary surgery. The direct transnasal transsphenoidal route is a minimally invasive technique. The main difficulty associated in this approach is its tendency to take an oblique trajectory, so it can benefit from the combination of use of the microscope and the endoscope. We have analysed the data of the first 10 patients operated on through the direct transnasal route for pituitary adenomas in our institution. The operating procedure was done in 2 steps: 1. Direct transnasal approach to the sphenoid sinus to reach the floor of the sella turcica with the endoscope for trajectory guidance 2. Effraction of the sella turcica floor, opening of the dura mater and adenoma excision under the operating microscope We have analysed the feasibility, endoscopic benefits and effectiveness of this procedure. Ten patients were operated having pituitary adenomas between March 2003 and September 2004. The endoscope is introduced through the right nostril to reach the sphenoid sinus. We did not resort to fluoroscopy. Adenoma exeresis was made under microscope and was complete in 8 cases. Complications such as transient CSF leakage and epistaxis were observed in one case. The initial use of the endoscope permits rapid and direct access to the sella turcica. Relay by the operating microscope allows ease of tumoural exeresis. Moreover, this approach avoids the traditional drawbacks of the sub-labial route

Cervical Ewing's sarcoma presenting as neurinoma

Considering their usual bone localisation, Ewing's sarcomas of soft tissues are rare. We report a case of a 19-year-old patient who had been suffering from cervico-brachial neuralgia followed by symptoms of progressive spinal cord compression. Magnetic resonance imaging detected a tumour at the C [7] level in the antero-lateral part of the spinal canal with an intracanal extension via an enlarged inter vertebral foramen, mimicking a neurinoma. The patient underwent an incomplete tumoural exeresis. The pathological examination yielded typical findings of Ewing's sarcoma. The patient underwent chemotherapy followed by complementary tumoural exeresis and radiotherapy. Literature review denotes the exceptional feature of the presentation. Correct and definitive diagnosis is made by pathological examination. Management of Ewing's sarcoma with the three main modalities: surgery, radiotherapy and chemotherapy increase the patient's survival