Bladder carcinosarcoma treated by cystectomy and adjuvant chemotherapy with good outcomes: a case report.

BACKGROUND: Primary carcinosarcoma of the bladder is a rare and highly aggressive tumor, representing less than 1% of all bladder neoplasms. There is no specific treatment guideline has for carcinosarcoma of the bladder, and majority of published patients was treated exclusively by surgery. CASE PRESENTATION: We report a case of 65-year-old Moroccan man, presented with macroscopic hematuria, pollakiuria and painful urination. Histological analysis showed a biphasic epithelial and mesenchymal proliferation, with invasion of lamina propria and muscularis, compatible with diagnosis of bladder carcinosarcoma. The patient was treated with cystectomy and adjuvant chemotherapy based on gemcitabin-cisplatin, 18 months after treatment, patient still free of recurrence. CONCLUSION: Carcinosarcoma of the urinary bladder is a rare and aggressive tumor regardless treatment. A multidisciplinary management based on radical cystectomy and combined adjuvant treatments can improve prognosis. In this work, we suggest to propose adjuvant chemotherapy whenever possible.

[Unusual complication of radiation therapy, corneal perforation: about a case]. / Complication inhabituelle de la radiothérapie: la perforation cornéenne: à propos d'un cas.

Radiation-induced ocular complications are common during radiation therapy for cancers of the head and neck. Some are mild and transient, others can be very serious jeopardizing visual function. This rare and unusual case study aims to highlight the different clinical manifestations and the ocular but especially corneal complications associated with radiation therapy as well as the diagnostic and therapeutic procedures of a corneal perforation which is a serious complication of radiation therapy.

[What nutritional management in patients with head and neck cancers undergoing radiotherapy? An overview]. / Quelle prise en charge nutritionnelle des patients atteints du cancer de la sphère oto-rhino-laryngée traités par la radiothérapie ? Une mise au point.

Radiotherapy is an effective treatment for head and neck cancers but patients often experience side effects, which lead to malnutrition. Morbidity related to weight loss during treatment may include dehydration, hospitalization, compromised treatment efficacy, and reduced quality of life and may impact survival hence the importance of early nutritional management prior to radiotherapy. Multiple interventions have been implemented to help ameliorate the impact of treatment on weight loss and nutritional status, including the use of percutaneous endoscopic gastrostomy tubes. The goal of this overview is to search the predictive factors of malnutrition and an overview of the different types of nutritional interventions and their impact on the local control of the disease, mortality and quality of life of patients treated with radiotherapy or concomitant chemoradiotherapy.

Coexistence of Hodgkin's Lymphoma and Castleman's Disease: A Case Report with Successful Response to Chemotherapy and Radiotherapy.

Background. Castleman's disease is a rare clinicopathological entity of unknown origin. Coexistence of Hodgkin's lymphoma and Castleman's disease is rare. We report a case of Hodgkin's disease of cervical lymph nodes in a patient previously diagnosed with Castleman's disease. Case Presentation. A 43-year-old man admitted in July 2009 for a right cervical pain with lymph node at the physician examination. He underwent a right adenectomy and histological studies showed typical features of Castleman's disease. Three years after, the patient consulted for increasing the volume of cervical lymph node. Clinical examination showed a right cervical lymph node of 3 cm. The computed tomography scan of chest, abdominal and pelvic was normal. Histological and immunohistochemical studies of cervical lymph node biopsy specimen were in favor of Castleman's disease associated with Hodgkin's disease. Reed-Sternberg cells were positive for CD15 and CD30. The patient received chemotherapy based on anthracyclines, bleomycin, vinblastine, and dacarbazine (ABVD) and radiotherapy with complete response. Conclusion. Prevalence of Hodgkin's lymphoma in Castleman's disease is more difficult to establish because of the low number of cases reported in the literature.

Findings from a needs assessment of public sector emergency obstetric and neonatal care in four governorates in Yemen: a human resources crisis.

Recent reviews suggest that it is unlikely Yemen will reach Millennium Development Goal 5 on maternal health by 2015. We conducted a needs assessment in 2010 to identify the human resources constraints in delivery of emergency obstetric and neonatal care (EmONC), in one urban and three under-served rural governorates. The assessment tools were adapted from the UN Guidelines for Monitoring Availability and Use of EmONC. Findings showed that while the urban governorate (total population 666,210 with 26,648 expectant mothers yearly) had 54 obstetricians, 10 anaesthetists and 72 paediatricians, the three rural governorates (total population 1,885,371 with 75,414 expectant mothers yearly) together had only three obstetricians, three anaesthetists, and eight paediatricians. Furthermore, in the rural governorates, with an 0.5% caesarean section rate, which is far below the 5% minimum for this UN indicator, no district hospital had an operating surgeon or an anaesthetist. There was also a marked scarcity of female general physicians and a large disparity in the proportion of births with a skilled attendant between the rural (12%) and urban (34%) governorates. Findings emphasize the need for increasing the coverage of EmONC nationally, but especially in rural areas, through more equitable staff distribution and promotion of task shifting. Developing a national human resources plan and ensuring an enabling policy are prerequisites.

Reducing maternal mortality in Yemen: challenges and lessons learned from baseline assessment.

OBJECTIVE: The Yemen is a signatory of the Millennium Development Goals (MDGs) and one of 10 countries chosen for the UN Millennium Project. However, recent MDG progress reviews show that it is unlikely that the maternal health goal will be reached by 2015 and Yemen still has an unacceptably high maternal mortality of 365 per 100000 live births. Because 82% of deaths happen intrapartum, the purpose of this needs assessment was to identify and prioritize constraints in delivery of emergency obstetric care (EmOC). METHODS: Four district hospitals and 16 health centers in 8 districts were assessed for functional capacity in terms of infrastructure; availability of essential equipment and drugs; EmOC technical competency and training needs; and Health Management Information System. RESULTS: We found poor obstetric services in terms of structure (staffing pattern, equipment, and supplies) and process (knowledge and management skills). CONCLUSION: The data argue for strengthening the 4 interlinked health system elements-human resources, and access to, use, and quality of services. The Government must address each of these elements to meet the Safe Motherhood MDG.