Pre-Emptive Retransplantation in Patients With Chronic Kidney Graft Failure.

INTRODUCTION: The aim of this study was to compare the group of patients receiving a new kidney transplant before starting dialysis again (pre-reTR) with a group of patients receiving a new kidney transplant after restarting dialysis (reTR). METHODS: This retrospective cohort included all the kidney retransplantations (second transplantations) between 2000 and 2012 performed at our center and their follow-up until July 2014. We analysed graft and patient survival, rejection rates, and immunologic parameters of these patients. RESULTS: We studied 18 patients who had pre-reTR and 83 who had reTR. In the pre-reTR group no patient had panel-reactive assay (PRA) >10% at any time. In the reTR group 26.5% had PRA >10% at the time of transplantation (P = .014) and 54.2% had a historical highest PRA >10% (P < .001). The rejection rate was 11.1% in the pre-reTR group and 27.7% in the reTR group during the first year post-retransplantation (P = .227). Patient survival rate was 100% in the pre-reTR group at 5 years of follow-up, whereas in the reTR group at 1 year it was 95.2% and 85.9% at 5 years after retransplantation. Allograft survival at 1 and 5 years was 88% and 89%, respectively, in the pre-reTR group. On the other hand, in the reTR group it was 89% after the first year and 65% at 5 years post-retransplantation. CONCLUSION: Pre-emptive renal retransplantation is a feasible option that should be assessed in patients with kidney graft failure and may help to minimize the morbidity associated with dialysis reinitiation.

Tokuhashi score and other prognostic factors in 260 patients with surgery for vertebral metastases.

BACKGROUND: Metastatic disease of the spine is an increasingly common public health problem. Surgery should be an integral component of the overall cancer treatment plan and, importantly, must neither delay not jeopardize any of the other components. The prognosis governs the choice of the surgical strategy. Tokuhashi et al. developed a prognostic score in 1990, then revised it in 2000 and 2005. Here, our objective was to evaluate the performance of the Tokuhashi score in a cohort of 260 patients and to look for other variables that might improve preoperative outcome prediction. MATERIAL AND METHOD: We retrospectively established a single-centre cohort of 260 patients who underwent spinal metastasis surgery between 1998 and 2008. For each patient, the following data were collected prospectively: socio-demographic features, history of the malignancy, variables needed to determine the Tokuhashi score, and treatments used. SAS 9.0 software was chosen for the statistical analysis. Variables were described as mean ± SD, overall survival was estimated using the Kaplan-Meier method, and survivals in subgroups were compared by the log-rank test. To assess agreement between survival predicted by the Tokuhashi score and observed survival, we computed Cohen's kappa and interpreted the results according to Landis and Koch. RESULTS: There were 143 females and 117 males with a mean age of 59 years and overall median survival of 10 months. Median observed survivals in the three Tokuhashi score categories (< 6, 6-12, and > 12 months predicted survival) were 5, 10, and 36 months, respectively. These survival times differed significantly (P < 0.0001). Cohen's kappa indicated moderate agreement between predicted and observed survivals. Other factors associated with significant survival differences were time from cancer diagnosis to metastasis diagnosis (synchronous, < 2 years, 2-5 years, or > 5 years; P < 0.0001) and age (< 70 years or ≥ 70 years, P = 0.0053). CONCLUSION: Our cohort study supports the validity and reproducibility of the Tokuhashi score. Our finding that shorter time to metastasis diagnosis and age ≥ 70 years were also significantly associated with survival in our population invites further efforts to improve and update the Tokuhashi score.

[Breast cancer in young patient in Morocco]. / Cancer du sein chez la femme jeune dans le Nord-Est du Maroc.

OBJECTIVE: Breast cancer occurring in young women is rare with epidemiological, diagnostic and prognostic characteristics of their own. It is more often linked to genetic predisposition and especially correlated with a lower survival and higher rates of recidivism. The aim of the study was to analyze epidemiological, clinicopathological, biological and evolutionary characteristics. PATIENTS AND METHODS: It is a retrospective study concerning 74 patients aged 35 and younger, in whom a diagnosis of invasive breast cancer was made between September 2004 and December 2009. RESULTS: Incidence of breast cancer in women aged under 35 in our series was 18.6%, mean age was 30.62years and five patients (6.75%) had a family history of breast cancer. The mean tumor size was 3.9±2.6cm; 45.4% of tumors were locally advanced. It was an infiltrating ductal carcinoma of grade III of Scarff-Bloom and Richardson (SBR) in 45.7% cases and half the time it was accompanied by an axillary lymph node involvement. Negative hormone receptor (HR-) was found in only 28.7% of cases and 13 cases overexpressed Her2. Eighteen percent of the tumors were classified as triple negative. The overall survival at 3years was 87.8%. DISCUSSION AND CONCLUSION: The incidence of breast cancer in young Moroccan patients is high. In our context, it is distinguished by a delayed diagnosis explaining the advanced stage at diagnosis. Biological characteristics are often more aggressive, including high histological grade, lack of hormone receptors and the higher rate of triple negative tumours significantly reducing treatment options.

[Management of spinal metastases of lung cancer]. / Prise en charge des métastases rachidiennes de cancer bronchopulmonaire.

INTRODUCTION: Spinal metastases of lung cancer occur frequently and lead to the risk of spinal cord compression. Our objective is to clarify the management of this disease, emphasizing, in particular the use of prognostic scores. BACKGROUND: The first step is to evaluate the characteristics of the spinal lesion and its impact on the autonomy and quality of life of the patient. A clinical examination is complemented by imaging procedures, such as X-rays, MRI of the spine, and PET scanning. The precise characterization of the spinal lesion permits the calculation of a predictive score for mechanical stability. The characteristics of the disease (number of metastatic sites, therapeutic possibilities, co-morbidities) can be used in decision-making. VIEWPOINTS: The use of prognostic scores is recommended by the Global Spine Tumour Study Group (GSTSG) for the management of spinal metastases. Among these scores, the most used are the Tokuhashi index, and the Tomita classification. They help to identify the treatment modalities, sometimes combined that might be used in the management: surgery, vertebral resection, tumour embolisation, radiotherapy, chemotherapy. CONCLUSIONS: The management of spinal metastases of lung cancer should be multidisciplinary. Use of prognostic scores should be encouraged to identify optimal management.

[Migration of a ventriculoperitoneal shunt in the liver: A rare complication]. / La perforation hépatique d'un cathéter de dérivation ventriculo-péritonéale : une complication rare.

We report on a case of migration inside the liver of the distal end of a ventriculoperitoneal shunt catheter in an adult patient. A simple laparotomy permitted the surgical removal with no haemorrhagic complication. We discuss the other cases reported in the literature and we outline the need to perform an abdominal CT scan in patients carrying a VP shunt with digestive symptoms.

[Spontaneous resorption of thoracic calcified disc herniation: Report of two cases and review of the literature]. / Résorption spontanée de hernies discales thoraciques calcifiées : à propos de deux cas et revue de la littérature.

We report on two cases of spontaneous resorption of a calcified thoracic hernia. This phenomenom is widely recognised in lumbar and cervical hernia, but is exceptional at the thoracic level. The potential mechanisms underlying this resorption are discussed trough a review of the literature. We think this could be another argument for a "wait and watch" period before a surgical decision in the patients who have few symptoms.

[Buschke-Lowenstein tumor associated with scrotal melanoma. A case report]. / Tumeur de Buschke-lowenstein associé à un mélanome scrotal. À propos d'un cas.

Buschke-Lowenstein tumour (BLT) is a giant condyloma acumina, which is rare entity and represents only 1% of all populace. It is a rare viral disease, essentially transmitted by sexual intercourse, characterized by a potential for malignant transformation, invasion and recurrence after treatment. We report a case of BLT associated with perinea-scrotal melanoma. This association was never described in the literature. The purpose of our case report is to discuss the clinical and pathological appearances of these two entities and to outline the recent studies of molecular biology, which can explain this association.

[Epidemiological and biologic profile of breast cancer in Fez-Boulemane, Morocco]. / Le profil épidémiologique et biologique du cancer du sein à Fès-Boulemane (Maroc).

In a retrospective study of 265 patients with breast cancer over 3 years (January 2007-September 2009) we examined the epidemiological profile of breast cancer to determine the impact of biological and prognostic factors on survival over 3 years and on the epidemiology of this cancer. Estrogen (RE), progesterone (RP) and human epidermal growth factor receptors (HER2) were evaluated and RE/RP/HER2 status determined. The patients were young (median age 45 years). Invasive tumours were found in 95.5% of the women. The average tumour size was big [3.6 (SD 2.6) cm] and only 14% were histological grade 1. Large tumour size and high histological grade were independent of patient's age. Overall survival at 3 years was only 49% for the RE-/RP-/HER2- subtype and 75% for the RE-/RP-/HER2+ subtype, while it was 96% for the RE+/RP+/HER2- subtype. The young age, large tumour size and high histological grade in our population suggest a lack of awareness of women about breast cancer.

Epidemiological and biologic profile of breast cancer in Fez-Boulemane, Morocco

In a retrospective study of 265 patients with breast cancer over 3 years [January 2007-September 2009] we examined the epidemiological profile of breast cancer to determine the impact of biological and prognostic factors on survival over 3 years and on the epidemiology of this cancer. Estrogen [RE], progesterone [RP] and human epidermal growth factor receptors [HER2] were evaluated and RE/RP/HER2 status determined. The patients were young [median age 45 years]. Invasive tumours were found in 95.5% of the women. The average tumour size was big [3.6 [SD 2.6] cm] and only 14% were histological grade I. Large tumour size and high histological grade were independent of patient's age. Overall survival at 3 years was only 49% for the RE-/RP-/HER2- subtype and 75% for the RE-/RP-/HER2+ subtype, while it was 96% for the RE+/RP+/HER2- subtype. The young age, large tumour size and high histological grade in our population suggest a lack of awareness of women about breast cancer

[Ischemic fasciitis. A case report]. / La fasciite ischémique. A propos d'un cas.

Ischemic fasciitis, also called atypical decubital fibroplasia, was recently described as a distinctive fibroblastic proliferation occurring predominantly in elderly, bed-ridden individuals. It is very rare. Forty cases only are reported in the literature. We report the observation of a 50-year-old patient, having an antecedent of prolonged confinement, who presents since 1 year a tumefaction compared to the higher end of the tibia of soft consistency with inflammatory signs in glance. The pathologic examination shows a pseudo tumoral lesion of ischemic fasciite type. Through this observation, we suggest to review the various problems of diagnostic differentials in particular with a sarcoma of soft tissues and to discuss the anatomoclinic features of this recent description lesion.

Two-levels mini-open transforaminal lumbar interbody fusion: technical note.

OBJECTIVE: Mini-open transforaminal lumbar interbody fusion (oTLIF), previously described by Mummaneni et al., is a well-established technique that uses tubular dilators and retractors for treatment of single-level lumbar spinal stenosis. TECHNIQUE: We describe eight patients with two-level spinal stenosis who were operated on with minimally invasive spinal arthrodesis via a transforaminal route with the use of tubular retractors. This approach allowed us to obtain double-level cages insertion in all patients, with direct visualization of pedicular entry points and no screw malpositioning. CONCLUSION: The oTLIF represents a good compromise in patients with two-level lumbar degenerative disease deserving surgery. Compared to standard open TLIF, it is associated with less postoperative muscular trauma, and faster recovery. This seems to be more evident in that category of patients in whom open approaches need longer incisions and more muscular fiber splitting. Compared to percutaneous TLIF (pTLIF), it allows for bilateral root decompression in every case. Bilateral cage insertion was also possible with this technique.

Cervical and thoracic spine tumor management: surgical indications, techniques, and outcomes.

Since the first pioneering work in the area of tumors of the spine, medical professionals have sought to determine the proper role of spine surgery in the management of spinal tumors. Experience has proven that spine surgery is effective in the treatment of spinal cord compression for decreasing pain and improving quality of life with low rates of surgical complications. We use several staging systems to assess the patient's prognosis, to determine the best type of tumoral resection in preoperative surgical planning, and to provide guidance as to the best therapeutic option for the patient. In the surgical treatment of spine tumors, one of two opposing strategies must be chosen: (1) palliative surgery with cord decompression and spine stabilization or (2) curative surgery with en bloc radical resection of the tumor and stabilization. In this article, we describe indications and surgical techniques related to cervical spinal tumors: fixation and laminectomy of the upper and lower cervical spines, corporectomy, and partial and total vertebrectomy. For tumors of the cervicothoracic region, the most frequent level of spine metastasis and thoracic spine tumors, we describe the fixation and laminectomy technique, en bloc tumor resection, and partial and total vertebrectomy. The last part of the article addresses outcomes following spinal surgery, including outcomes related to en bloc Pancoast Tobias tumor resection, malignant dumbbell schwanomas, and metastasis.

[Solid pseudotumoral tubo-ovarian actinomycosis. A case report in Morocco]. / Une actinomycose pseudo-tumorale tubo-ovarienne. A propos d'une observation marocaine.

Tubo-ovarian actinomycosis is a rare location for infection by actinomyces. Only around 50 cases have been described in the world literature since 1963. Diagnosis can be difficult due to the highly misleading solid pseudotumoral appearance of this infection. The purpose of this report is to describe the case of a 40-year-old patient with an intrauterine device who presented abdomino-pelvic pain associated with guarding in the right iliac fossa. Pelvic ultrasound revealed an ovarian mass. Histological examination of the surgical specimen after annexectomy demonstrated tubo-ovarian actinomycosis. Based on this case involving a rare clinical form of the actinomycosis, we review the various clinical aspects of this infection and underline the importance of histology in achieving diagnosis. We also provide a general review of the literature.

[Chondrosarcoma of the nasal septum]. / Chondrosarcome de la cloison nasale.

INTRODUCTION: A chondrosarcoma is rarely located in the nasal septum with only fifty cases reported in the literature. CASE REPORT: We report a new case of a seventy years old woman presenting with a large facial midline mass extending to the nasal cavity, having evolved for six months. Subsequent computed tomography revealed a mass destroying the nasal septum and extending to the endocrane. Intranasal biopsy revealed a chondrosarcoma. The extended work up revealed pulmonary metastasis. The course was not favourable and the patient died after one year. DISCUSSION: The bones of the pelvis and of the lower extremities are the most common localizations for chondrosarcoma. It is rarely located in the nasal septum. Histological analysis is required for the diagnosis. It is characterized clinically by local aggressiveness, frequent metastatic evolution, and poor prognosis. Surgical resection is reserved to operable cases. Chemotherapy and radiotherapy used as adjuvant treatment and palliation are not effective.

[Femoral metaphyso-diaphyseal chondroblastoma: a case report]. / Chondroblastome métaphyso-diaphysaire du fémur: à propos d'un cas.

Chondroblastoma is a rare benign tumor of cartilage tissue accounting for less than 1% of all bone tumors. The epiphysis of long bones is the typical localization, often extending to the metaphysis. Metaphyseal, metaphysodiaphyseal or pure diaphyseal forms are exceptional. We report a case in a 15-year-old boy who presented a metaphyso-diaphyseal chondroblastoma of the distal portion of the left femur. The inaugural signs were pain and limited joint motion. We discuss the anatomic aspects and the clinical course of this rare tumor and present current knowledge of the histogenesis.

[Role of cervical smear in the diagnosis of cervical cancer in Fes-Boulemane region of Morocco]. / La place du frottis cervico-vaginal dans le diagnostic du cancer du col utérin au Maroc, région Fès-Boulemane.

A retrospective study was conducted between 2000 and 2003 on 1620 women (mean age 39.6 years) in northern Morocco to determine the incidence of cervical cancer and assess the value of cervical smear in the diagnosis. Patients were interviewed using a questionnaire before carrying out a gynaecological examination and taking a cervical smear sample. Of the total sample, 23.1% had an abnormal cervical smear, of whom 5.6% showed intraepithelial lesions, both low and high grade. The women presenting with cervicitis represented the highest percentage with suspect smears (30.8%); 90.9% of the smears showing high grade lesions were histologically confirmed as cervical cancer. A screening programme is a matter of urgency in northern Morocco.

[Role of cervical smear in the diagnosis of cervical cancer in Fes-Boulemane region of Morocco]

A retrospective study was conducted between 2000 and 2003 on 1620 women [mean age 39.6 years] in northern Morocco to determine the incidence of cervical cancer and assess the value of cervical smear in the diagnosis. Patients were interviewed using a questionnaire before carrying out a gynaecological examination and taking a cervical smear sample. Of the total sample, 23.1% had an abnormal cervical smear, of whom 5.6% showed intraepithelial lesions, both low and high grade. The women presenting with cervicitis represented the highest percentage with suspect smears [30.8%]; 90.9% of the smears showing high grade lesions were histologically confirmed as cervical cancer. A screening programme is a matter of urgency in northern Morocco

Oregano and clove essential oils induce surface alteration of Saccharomyces cerevisiae.

The antimicrobial properties of volatile aromatic oils have been recognized since antiquity. Oregano and clove oils have been shown to possess a broad spectrum of antimicrobial activity. In this paper, the fungicidal action of these two essential oils was studied on the yeast model Saccharomyces cerevisiae. Yeast cell lysis was shown by the release of substances absorbing at 260 nm. In addition, scanning electron microscopy analyses revealed that the surface of treated cells by oregano and clove oils was significantly damaged.

Study of anticandidal activity of carvacrol and eugenol in vitro and in vivo.

BACKGROUND/AIMS: The mechanism of the anticandidal action of the major phenolic components of oregano and clove essential oils - carvacrol and eugenol - was studied. This activity was also evaluated for the therapeutic efficacy in the treatment of the experimental oral candidiasis induced by Candida albicans in immunosuppressed rats. METHODS: In vitro, the addition of carvacrol at 0.1% or eugenol at 0.2% during the exponential growth of C. albicans was evaluated. The release of substances absorbing at 280 nm by cells treated with these two components was also measured spectrophotometrically. In vivo, oral candidiasis in immunosuppressed rats was established by inoculating 3 x 10(8) cells of C. albicans with a cotton swab on three alternate days. The number of colony counts was evaluated from the oral cavity of rats treated for eight consecutive days with carvacrol, eugenol or nystatin and compared to untreated controls. RESULTS: Carvacrol and eugenol were fungicidal in exponentially growing C. albicans. Interestingly, this fungicidal effect was accompanied by the release of substances absorbing at 280 nm. In an immunosuppressed rat model of oral candidiasis, carvacrol or eugenol treatment significantly (P < 0.05) reduced the number of colony counts sampled from the oral cavity of rats treated for eight consecutive days compared to untreated control rats. Similar results were obtained with nystatin used as a reference treatment. CONCLUSION: The in vitro results indicated that both carvacrol and eugenol exerted an anticandidal effect by a mechanism implicating an important envelope damage. Their in vivo efficacy on experimental oral candidiasis leads us to consider them as possible antifungal agents.