[Radiological protocol of large scale mammographic screening for breast cancer in L'ariana state of Tunisia]

We present the radiological protocol of the breast cancer screening program of Ariana state in Tunisia. Specifications of this protocol are largely inspired from the french model adapted to the socioeconomic Tunisian conditions. We explain the guidelines of the mammograph specifications, quality insurance of all the process, mammography procedure, double reading, complementary views and ultrasound indications and final results management

[Lesions classified ACR3 with the breast cancer screening mammography program of Ariana state: features and problems encountered]

This retrospective work is related to ACR3 mammograms of the program "Feasibility of breast cancer screening by mammography in Ariana Governorate" in order to evaluate the efficiency and short-term quality control of these probably benign lesions. Mammograms classified ACR3 raised the indication of further examination, futher mammogram [profile. expanded or compression]. The monitoring and control period are explained to the patient by the radiologist. 6.6% mammograms were classified as ACR 3 with 71.3% under the age of 50 years. Breast is very dense in 20.5% of cases, and transparent in 6% of cases. Further exams has been performed in 94.5% of cases with a profile in 52% of cases, enlarged in 22.1%, compression in 24.9% and ultrasound in 82.5%.The surveillance protocol was insufficient for 126 women lost to the 1st control, 32 women lost for the 2nd control and 19 women were lost to the 3rd control. After two years monitoring. 219 women were reclassified as ACR2 with a negative test. In 2 patients, we found an invasive ductal carcinoma at 4 months control. ACR 3 mammograms are the most important operator dependent category. The diagnosis of probably benign lesion dependant of the analysis of images and requires a great experience of the radiologist and a comprehensive complementary examination. In this study, this assessment was often heavy in relation to the frequency of dense breasts itself in connection with the young age of patients. In addition, for this particular category, the need of training is important and in terms of public health cost, the management of ACR3 mammograms increases difficulties and cost of screening

[Retrospective results of breast ultrasonographically-guided cytoponctions and microbiopsies within the breast cancer screening program of L'Ariana state in Tunisia]

To report the results of breast ultrasonographically-guided fine needle aspirations and needle biopsies within the breast cancer screening program of L'Ariana state in Tunisia. Our retrospective study include 143 patients, with mammographically detected lesions, which underwent a diagnostic percutanous ultrasonographically guided procedures. 57 patients underwent a fine needle aspiration, 25 underwent a needle biopsy and 61 patients underwent both procedures. Sensitivity and specificity of fine needle aspiration are of 84, 2% and 98, 5%. We report 13, 5% of non contributive results. The needle biopsy have a sensitivity of 97, 3% and a specificity of 100% with one false negative corresponding to an atypical ductal hyperplasia at the excisional biopsy. Fine needle aspiration is a reliable method of accurately establishing a diagnosis. Needle biopsy is recommended for a preoperative lesion characterisation before adequate treatment

[Incidence of pediatric nosocomial infection in Bizerte district: results of 3 months survey]

Children nosocomial infections are different than adult's according some criteria that makes necessary to conduct a special kind of surveillance program, which is specific to this category. In Tunisia, there are so few data available related to such hospital infections frequencies in paediatric services. In Bizerta region, the only survey on paediatric nosocomial infection was held in the beginning of the 90s. Recently a specific surveillance system for children was held there. The output of such system is able to provide a lot of information, according new cases [incidence], main criteria and risk factors. Because of practical matters, mainly feasibility, we've chosen to use repetitive periodic surveys as measurement method. This paper is reporting the first step of the study conducted in 2005 [called NOSOBIPED05] and concerning the two paediatric services of the region for three months [from 1[st] October to 31[st] December 2005]. A total of 860 sick children were concerned by the study, including 525 [61%] male and 335 female [39%]. Two hundred and eighty eight [288] of them were under one month age [33.5%] and 424 [49.3%] were more than one year. Perinatal pathologies were the first hospitalization diagnosis [267 cases], followed by respiratory illnesses [139 cases]. The average of the hospital stay was 4.9 days [with 0 and 46 days as extremes]. In our population study, there were so few intrinsic and extrinsic risk factors: diabetes [1.0%], malnutrition [0.6%], immune depression [0.5%], mechanic ventilation [0.2%]. But the use of peripheral vascular catheters was frequently found [52.8%]. Among the 860 sick children, only 705 were concerned by the academic definition of nosocomial infection [155 had stayed less than 48 hours]. The total number of nosocomial infection was 25, then 3.5 per 100 hospitalizations. That means 6.0 infections per 1000 patient-days density of incidence [reported to the number of days stay for the 705 concerned sick children]. No one case of infection was positive [14 negative bacterial researches were held]. Respiratory infections were the most commune location [68%] [17/25]. These results must be used by concerned services to improve prevention. More surveillance steps have to be continued in the next years, to better understand the epidemiology of those special paediatric infections in Bizerta region

[Knowledges - practical abilities- study about the accidental blood exposures in first lines of healthy structures in Tunis]

Accidental Blood Exposures [ABE] represents a real threat to healthcare workers. To our knowledge, in the two sanitary districts of Ouardia and Djebel Jeloud, few actions, in terms of ABE prevention, have been conducted. As a result, we have carried out there a knowledges-practical abilities [KPA] study during the month of April, 2007, in order to assess the initial situation, gauge the overall level of knowledge and practices of all the exposed personnel, and help define a training and improvement program. A questionnaire has been distributed to 49 people, using the technique of the direct interview. The results have shown a good knowledge of contamination risk by the three viruses HBV, HCV and HIV. The vaccination rate against B hepatitis is 59%. The resheathing of needles, considered as risk practice, has been identified among 58% of the people investigated. The police to follow, in case of ABE, seems to be insufficiently known. The results have enabled to set up an improvement procedure to reinforce the awareness and enhance the consciousness of the healthcare workers regarding ABE risks

Distribution of P53 and mdm2 genes in patients with hepatocellular carcinoma

50 patients with hepatocellular carcinoma, 36 males and 14 females 14-73 years old were studied in this work. Abnormal values of s.. bilirubin. AST, ALT and alkaline phosphatase were found in 52, 64 and 76% of cases respectively. 70%of cases had AFP levels between 50 and 150ng/dl while 6/had levels below 10ng/dl. 46.had stage 1:36 stage II and 18/had stage III disease. P53 was overexpressed in 46% of cases not related to age or sex. A statistically significant relationship was found between mdm2 overexpression and the stage of the tumor. 42% of cases were P53 positive and mdm2 negative and 24% of cases were P53 negative and mdm2 positive that may indicate that mdm2 overexpression and P53 mutation represent alternative mechanisms for inactivating the same regulatory pathway for suppressing cell growth. Concomitant overexpression of either P53 or mdm2 or both was found to have statistically significant relation with tumour stage indicating that P53 mutation and mdm2 overexpression are alternative mechanisms for inactivating the same pathway for suppressing cell growth. It can be concluded that P53 in activation may be involved in the molecular pathogenesis of HCC and its mutation is late in HCC and its frequency is related to tumour progression mdm2 overexpression has the same significance. Tumors with mdm2 overexpression were devoid of P53 mutations and vice verca; indicating that they represent alternative mechanisms for inactivating the same regulatory pathway for suppressing cell growth

Adjuvant epirubicin and cisplatinum in high-grade osteosarcoma of the extremity

Twenty three patients with the diagnosis of non-metastatic high-grade osteosarcoma of the extremity were treated in the National Cancer Institute, Cairo University with adjuvant hemotherapy after definitive surgery. The adjuvant treatment regimen consisted of epirubicin and cisplatinum given every 3 weeks for 6 cycles. The evaluable seventeen patients were followed up regularly for period ranged 21-42 months with a median of 24 months. The 3-year actuarial disease-free survival was 76%. Metastases occurred in only 4/17 patients, all of which were in the lung parenchyma. Of the toxicities observed in these patients were both tolerable and manageable. This regimen is quite effective in controlling micrometastases and is reasonably safe

Treatment of adult acute nonlymphatic leukemia using combination chemotherapy regimens

A prospective clinical study including 43 consecutive patients was conducted to assess the effectiveness and compare Adria-OAP and Amsa- OAP regimens in the induction of previously untreated ANLL patients. Patients who achieved CR were assigned to receive one more course of the same induction regimen as consolidation. Maintenance sequential therapy was given monthly for a total period of 24 months. Twenty four patients received Asma-OAP, while 19 patients were assigned to Adria-OAP regimens. Both treatment groups were comparable for their clinical and hematological characteristics. CR was achieved in 10/24 [42%], and in 10/19 [52%] patients on the two treatment arms respectively. The difference in response rates was not statistically significant [p = 0.7]. Survival of patients in both groups was identical and remained at the level of 30% till 52 weeks. No relapses occurred within one year of treatment among those who received their maintenance therapy regularly, while most patients whose maintenance therapy was irregular or those receiving no maintenance treatment, relapsed within one year of treatment