Clinicopathologic and prognostic factors of thymoma in Tunisia

Background: although rare, thymomas are the most common tumors of the thymus in adults. They represent about 20% of all mediastinal tumors

Aim: the aim of this study is to present clinicopathological features of thymomas in Tunisia and analyse the prognostic factors

Methods: From 1993 to 2004, clinical data of 40 cases of thymomas were compiled retrospectively. Microscopic slides were reviewed and reclassified according to the WHO classification of thymic tumors 2004. Clinical staging adopted was Masaoka system. Analysis of survival was determined by Kaplan-Meier method and log-rank test was used to compare survival curves. These statistical analyses were performed by SPSS

Results: they were 23 women and 17 males of ages ranging from 14 to 76 years [mean age 51 years]. The distribution of histological WHO types was: 1 type A, 7 type AB, 6 type B1, 17 type B2, 6 type B3, 2 cases of micronodular thymoma with lymphoid stroma and 1 case of metaplastic thymoma. According to Masaoka stage, 10 patients were in stage I, 11 stage II, 9 stage IIIa, 4 stage IIIb, 5 stage Iva and 1 stage IVb. The average overall survival was 56 months. Univariate analyses showed that Masaoka stage, completeness surgical resection and age were prognostic factors whereas in multivariate analysis, age was the only prognostic factor. Neither myasthenia gravis nor histological WHO subtypes had effect in survival

Conclusion: masaoka stage, completeness surgical resection and age are the prognostic factors predicting survival in our series

[Beating heart coronary artery bypass:100 case]

Coronary artery revascularization with cardiopulmonary bypass has been reported to carry several risks. Off-pump coronary artery bypass grafting has been proposed to result in a better outcome. The aim of this study is to assess the effect of off-pump cardiopulmonary bypass. In a 7-year period, a total of 100 patients undergoing isolated first-time off-pump coronary artery bypass graft were studied. The mean ejection fractions was 48% and the EUROSCORE mean was 4.9. The average number of grafts was 1.55 per patient. The postoperative outcomes were simple for most patients with little use of inotropes after 24 hours [42%], few cases of atrial fibrillation [9.4%], and transfusion [27.3%]. Time to extubation was less than 48 hours in most cases [94.7%] and hospital mortality rate was 10.5%.The beating heart bypass surgery allows good immediate results including multi-vessel disease and in patients at high risk

[Primary malignant tumors of the sternum]

Primary tumors of the sternum are rare and account only 0.5% of all primary bone tumors. They are often malignant, osteolytic and aggressive. They often present difficulties in management. To determine clinical, pathological and therapeutic characteristics for primary malignant tumors of the sternum. We report a series of six cases of primary malignant tumors of the sternum, collected in our institution between 1993 and 2009. There were 4 men and 2 women with a mean age of 69, 5 years. Parietal swelling was the most frequent symptom. Imaging showed a sternal lytic lesion. Three tumors were treated surgically. Associated treatments were neoadjuvant chemotherapy [1 case] and postoperative radiotherapy [1 case]. A medical treatment [radiotherapy alone or chemotherapy] was performed in 3 cases. These tumors were divided as below: 3 plasmacytoma, 1 chondrosarcoma, 1 osteosarcoma and 1 large B cell lymphoma. The management of primary malignant tumors of the sternum is multidisciplinary. It depends on the histological type, the possibility of surgical treatment and the distant and local aggressiveness

[Adjuvant chemothgerapy in resected non small cell lung cancer: preliminary results about 8 cases]

Report the preliminary results of adjuvant chemotherapy in patients surgically treated for non small lung cancer. Its a prospective study about 12 patients surgically treated between January 2005 and December 2007.8 patients had benefit of adjuvant chemotherapy. The protocol had been based at 4 cycles of Cisplatine Our 8 men patients, aged for the mean of 59 years with a Performans Status at 1, had benefit of adjuvant chemotherapy after curative surgery. Six patients considered us II B stage, had benefit immediately for surgically treatment. Adjuvant chemotherapy protocol had been based of Cisplatin and Vinorelbine [5 patients] and Cisplatin and Gemcitabine [1 patient]. The 4 cycles can be administered without any limiting toxicity only for one patient who's received 2 cycles of Cisplatin and Gemcitabine in front of the severity of digestive side effects. Two patients considered us IIIB stage, had been surgically treated after neo adjuvant chemotherapy based at Cisplatin and Vinorelbine. Histological response was complete for twice of them. The same chemotherapy was stopped after 2 cycles us adjuvant, in front of haematological side effects. Two patients did at 4 and 15 months of neoplasic progression. The six other patients had been still on life with a move back of 33 months. Post operative adjuvant chemotherapy is the standard treatment for the II A and II B stages and probably for lB stage. For none immediately operative patients [IIIA and some III B], articulation of chemotherapy with surgery must be clarified

[Iatrogenic gas embolism after use of hydrogen peroxide in the treatment of lung hydatid cyst: a report of 2 cases]

Echinococcus disease in endemic in our country. Surgical resection of the hydatid cyst with the use of a protoscolicidal solution in the operative field remains the standard treatment. The degradation of hydrogen peroxide results in considerable amounts of gaseous oxygen witch has proven protoscolicidal properties. This gas can enter the circulation and determine sever embolism. We report two cases of severe oxygen embolism with neurological signs during surgical treatment of thoracic hydatid cysts. We report 2 cases of embolic events with neurological signs. The first, during a pleural cleaning with hydrogen peroxide after cystectomy of a pulmonary hydatic cyst at the right upper lobe. The second case, after a pleural washing during the treatment of hepatitic hydatidosis complicated by a ruptured cyst in the thorax. The most important diagnostic criterion is the patient's history, because the clinical suspicion of embolism is based on the initial neurologic or cardio-respiratory symptoms and the direct relation between these symptoms and the use of hydrogen peroxide and imposes appropriate treatment before further examination including brain imaging. The treatment with hyperbaric oxygen in the first line treatment, thus, transfer to a hyperbaric oxygen facility should be accomplished without delay. The possibility of such serious complication leads us to use hydrogen peroxide with great care or to use other protoscolicidal solutions

[Patient controlled epidural analgesia: interest in thoracic surgery]

To compare efficacy of pain control, the consumption of local anaesthetics and opioids as well as the side effects between continuous epidural analgesia, patient controlled analgesia and patient controlled epidural analgesia in thoracic surgery. Prospective randomised study included 66 patients who had thoracotomy. Patients were divided into 3 groups, to receive different pain control methods. Group 1 [n=22] received patient control analgesia Group 2 [n=22] received continuous epidural analgesia [Bupivacaine 0,125% + 5 micro g/ml of Fentanyl] between 6 and 10 ml/h in order to obtain a T2 level Group 3 [n=22] received patient controlled epidural analgesia [Bupivacaine 0,08% + 3 micro g/ml of Fentanyl] 6ml/h and bolus of 5ml. There was no difference between the three groups in age, delay of surgical operation and per operative morphine consumption. VAS was less at rest and after cough in patient group with patient controlled epidural analgesia. The difference was less significant in local anaesthetics and opioids consumption in patient with controlled epidural analgesia. The benefit of patient controlled epidural analgesia in thoracic surgery is proven by the following analgesic efficiency which allows good respiratory rehabilitation, decreasing the risk of drug toxicity by decreases consumption, weak hemodynamic effects and absence of motor block

[Clinical epidemiology of primary lung in Tunisia. 100 cases]

Lung cancer is frequent and its incidence is increasing in Tunisia and in all over the world. Few published Tunisian studies have described epidemiology of lung cancer. To report the clinical features and outcomes of lung cancer in Tunisia from a retrospective review of 100 consecutive patients seen in F.S.I. hospital in La Marsa. a retrospective study was carried out 100 cases of bronchial carcinoma seen in pulmonology department between 2000 and 2004. We analysed diagnosis modalities. histological subtypes, staging of the disease, treatment strategies and survival. Survival rates were calculated using Kaplan-Meier method. mean age was 59.5 years, sex-ratio at 19. 92%of patients were smokers; the average of tobacco consumption was 48.5 PY. The diagnosis was histologically proven in 90%of the cases. Specimen were obtained by bronchoscop [53.4%of cases], fine-needle lung biopsy [30%], metastasis biopsy [7.7%], surgical biopsy [7.7%] and more rarely by thoracoscopy [1.2%]. Histologically, 39%were squamous carcinomas, 30%adenocarcinomas and 8.7%small cell carcinomas. 51%of non small cell lung carcinomas were stage IV. 26%stage IIIB, 9%stage IIIA and 14%were stage I or II. 6 of 10 patients with small cell carcinomas were with disseminated disease. 18 of 21 patients with resectable tumors receive surge. Patients with locally advanced tumors received combined chemotherapy and radiotherapy. 14 of 46 stage IV patients received palliative chemotherapy. Survival rate was 18%at 2 years

Primary mediastinal seminoma. Report of three cases

Primary mediastinal seminomas [PMS] are rare tumors that are morphologically similar to their testicular counterparts but may have different biologic behavior due to their particular anatomical location. New cases report of PMS. Three new cases of primary mediastinal seminoma are presented. The patients were men aged of 16, 33 and 47 years. Their clinical symptoms included cough, dyspnea, chest pain and superior vena cava syndrome. None of the patients had a previous history of testicular neoplasm or tumor elsewhere. Mediastinoscopie biopsy was performed and histological examination results revealed a seminoma. Immunohistochemical showed membranous staining with placental alkaline phosphatase in the three cases. Chemotherapy has largely replaced surgical resection and radiotherapy as the initial treatment in patients with mediastinal seminoma