[Clinical and pathological profile of the pleural malignant mesothelioma: A retrospective study about 30 cases]. / Le profil anatomoclinique du mésothéliome pleural malin : une étude rétrospective à propos de 30 cas.

BACKGROUND: The malignant pleural mesothelioma (MPM) is a rare tumour usually associated to asbestos exposure. The delay between the exposure and the occurrence of the cancer can reach 40 years. This caused the pick of incidence described in many countries including Tunisia. The diagnosis is suspected based on clinical features but positive diagnosis is microscopic. Our aim was to describe the clinical and microscopic features of MPM through a single institution experience. PATIENTS AND METHODS: We conducted a retrospective study about 30 MPM diagnosed over a 20-year-period (1995-2015). We included only patients with complete records including clinical, radiologic and microscopic features. All the microscopic diagnoses were reviewed by 2 pathologists. A mean of 12 slides per case was reviewed. The diagnosis was based on the 2015 WHO classification. RESULTS: The mean age of the patients was 61 years, average 22 to 80 years. The sex ratio was 6,5. An asbetose exposition was reported in 21 cases. The most frequent symptoms was chest pain reported in 25 cases. Physical exam was normal in 9 cases. It revealed pleural syndorm in most patients (60 %). Imaging findings consisted mainly in diffuse pleural thickening in 17 cases. Twelve tumours were classified as stage I, 3 stage II, 14 stage III et 1 stage IV. Pleural biopsy was performed using needle in 18 cases, through thoracoscopy in 16 cases, thoracotomy in 3 cases and allowed the diagnosis in respectively 7 cases/18, 16 cases/16 and 3 cases/3. A lymph node biopsy was performed through mediastinoscopy in one case and yelded the diagnosis. The diagnosis was performed on surgical specimen in 2 patients: one bullectomy and one right upper lobectomy. The microscopic exam concluded to an EM in 17 cases, sarcomatoid mesothelioma (SM) in 4 cases and biphasic mesothelioma (BM) in 9 cases. Pan-cytokeratin antibody was used in all cases in association with 2 antibodies with positive diagnostic value and 2 antibodies with negative diagnostic value. It was repeated in 15 cases and the most used antibodies were the anti-calretinin and the TTF1. This was due to the lack of fixation in one case and in order to reach a quality criteria in the other cases. Surgical resection was possible in 2 patients. 15 patients were lost of view after a mean follow-up period of 3 months. Thirteen patients died before or during the follow-up. CONCLUSION: This work was about a Tunisian experience in the diagnosis and management of MPM. The major limits faced were the incomplete databases, the small number of patients included. Microsocpic positive diagnosis necessitates a degree of expertise and every laboratory has to determine the most valuable antibodies through its experience in order to optimize the diagnosis and to reduce the delay of diagnosis.

[Incidence of venous thromboembolism in men admitted to a pneumology unit for acute respiratory disease]. / Incidence de la maladie thromboembolique veineuse chez des hommes admis dans un service de pneumologie pour affection respiratoire aiguë

BACKGROUND: Venous thromboembolism (VTE) is a major source of morbidity and mortality all over the world. It is one of the complications arising in a hospital environment. The main aim of this study is to estimate the incidence of VTE in respiratory inpatients. METHOD: The authors carried out a prospective study on acute respiratory disease inpatients. A medical analytical index card was used. An echo-venous Doppler of lower limbs was practiced on D1 and D10 of hospitalization. The Wells scored was used to estimate the clinical probability of the occurrence of VTE. RESULTS: Seven of 100 patients studied developed VTE (95% CI : 2-12%), four of which presented a pulmonary embolism. The patients with VTE are 60-years-old±11.67. The incidence of VTE includes 20% (95% CI : 12.2-27.8%) of the patients hospitalized for bronchial cancer, 7.14% (95% CI : 2.1-12.18) of the patients presenting pulmonary tuberculosis and 4.54% (95% CI : 0.46-8.62%) of the patients hospitalized for exacerbation of chronic obstructive pulmonary disease (COPD). The duration of hospitalization was prolonged for the treatment of VTE (21±4.41 days for these patients compared with 12±5 days in the absence of VTE (P<0.001)). The analysis of the various risk factors shows that a Performance Status>2 (P=0.005) and lung cancer (P=0.028) are the factors most incriminated in the occurrence of VTE. It is associated with a mortality of 2%. CONCLUSION: VTE is a reality which is necessary to prevent in respiratory inpatients in situations at risk, especially in patients with lung cancer and with a PS>2.

[Etiology and evolution of bronchiectasis in women]. / Profil étiologique et évolutif des bronchectasies chez la femme.

INTRODUCTION: Although considered as an orphan disease in the developed countries, bronchiectasis are frequent in our country as in all emerging ones. They are most common in women and they represent a frequent cause for consultation and hospitalization in pulmonology departments. PATIENTS AND METHODS: To determine the etiology and prognosis of the bronchectasies in women, a retrospective study was performed including 200 patients. RESULTS: The mean age was 55.60 years. The diagnosis of bronchiectasis was confirmed in all patients. Bronchiectasis were post-tuberculosis in 56.5% of cases and primitive in 29.5% of cases. The systemic diseases, in particular the rheumatoid polyarthritis represented 3% of cases. The infectious complications and the chronic respiratory failure were more frequent in patients with primitive bronchiectasis than those with secondary bronchiectasis. However this difference was statistically significant only for the chronic respiratory failure. CONCLUSION: The bronchiectasis remains frequent in women in our country, as a sequel of pulmonary tuberculosis more than primitive forms. Bronchiectasis secondary to systemic diseases, although rare, must be known.

Hydroalcoholic extract based-ointment from Punica granatum L. peels with enhanced in vivo healing potential on dermal wounds.

The present study reports for the first time, the in vivo wound healing potential of Punica granatum L. peels. A 5% (w/w) methanolic extract based-ointment was formulated and evaluated for its wound healing in guinea pigs. The ointment was applied in vivo on the paravertebral area of twelve excised wounded models once a day for 10 consecutive days. The ointment significantly enhanced the wound contraction and the period of epithelialization as assessed by the mechanical (contraction rate, tensile strength), the biochemical (increasing of collagen, DNA and proteins synthesis) and the histopathological characteristics. Such investigation was encouraged by the efficiency of the methanolic extract as antimicrobial and antioxidant. Indeed, the extract showed antioxidant activity as strong as natural and synthetic compounds (Trolox, BHA, Quercetin). Furthermore, the extract exhibited significant antibacterial and antifungal activity against almost all tested bacteria: Pseudomonas aeruginosa ATCC 9027, Staphylococcus aureus ATCC 25923, Escherichia coli ATCC 25922, Klebsiella pneumoniae, Salmonella anatum, Salmonella typhimurium, Streptococcus pneumoniae, and fungi Candida albicans, Candida glabrata, Trichopyton rubrum and Aspergillus niger. The formulated ointment might well find use as skin repair agent without hazard to human health based on these results and on the fact that it has been well established that the extracts of pomegranate used in conditions similar to those applied by traditional medicine, showed no toxic effects.

[Pleural empyema revealing osteopoikilosis]. / Pleurésie purulente révélatrice d'une ostéopoecilie.

INTRODUCTION: Osteopoikilosis is a rare, inherited and usually asymptomatic sclerosing bone dysplasia of unknown etiology which predominantly involves the appendicular and rarely the axial skeleton. CASE REPORT: We report the case of a 24 year old man who was hospitalized for pleural empyema and treated with antibiotics for six weeks in addition to pleural evacuation and physiotherapy. The diagnosis of osteopoikilosis associated with the pleural empyema was made on the radiological findings. In fact the chest X-Ray showed spherical areas of increased bone density in both humeral epiphyses. In order to explore these bone abnormalities further investigations were performed, including red and white blood cell counts, sedimentation rate and protein electrophoresis. There were no biological abnormalities. Radiography of the whole skeleton showed disseminated sclerotic lesions in the pelvis and the metacarpal and carpal bones of both hands. A neoplastic aetiology was excluded. In the light of these investigations, the diagnosis of osteopoikilosis was established. CONCLUSION: Widespread osteopoikilosis can be revealed on chest radiography.

Bilateral elastofibroma dorsi. A case report and review of the literature.

Elastofibroma is a rare benign soft tissue lesion, typically located deep under the lower pole of the scapula. It is characterized by a fibrous and adipose tissue proliferation and most frequently affects older females. Its characteristic location and its specific aspect in imaging studies most often provides the diagnosis following an incidental discovery. Nevertheless, anatomic and pathologic confirmation is necessary to formally rule out a malignant tumor diagnosis. We report a 66-year-old woman original observation; this lady's occupation involved a number of strenuous manual activities; she consulted for chronic pain related to a left subscapular mass. MRI demonstrated, in fact, two symmetrical tumor masses under each scapula. The only symptomatic lesion was surgically excised.

[Avian infectious bronchitis disease in Tunisia: seroprevalence, pathogenicity and compatibility studies of vaccine-field isolates]. / La bronchite infectieuse aviaire en Tunisie: séroprévalence, pathogénicité et étude de compatibilité vaccin-isolats.

A sero-epidemiological study was carried out on 5660 sera collected, between 2006 and 2008, from different flocks in different regions of the country. The ELISA results showed low levels of antibodies indicating vaccination failures. 45 to 69% of the flocks showed positive levels of antibodies and only 5 to 15% of these were protected. The pathogenicity studies of the Tunisian field isolates TN20/00 and TN335/01 demonstrated high clinical and lesion scores indicating the pathogenic effect of the two isolates. The challenge experiments conducted to evaluate the cross-protection between the H120 vaccine and the field isolates showed low protection rate, especially against the TN20/00 virus. The overall results allowed the determination of the pathogenic nature of the field isolates and a vaccination program based on the use of the only Massachusetts H120 strain did not reduce tracheal and kidney lesions. To better control the disease, adapting the vaccination program by using vaccine allowing better protection against variant strains, is recommended.

[Benign myoepithelioma of the lung]. / Myoépithéliome bénin du poumon.

Benign myoepithelioma of the lung is a benign tumor caused by proliferating myoepithelial cells with no ductal component. These tumors are exceptional: only three cases have been reported in the literature. We report a fourth case in a 37-year-old woman at 8 months gestation. Pathological proof of diagnosis was obtained.

Effects of antivenom on Buthus occitanus tunetanus (Bot) scorpion venom pharmacokinetics: towards an optimization of antivenom immunotherapy in a rabbit model.

The pharmacokinetic parameters of Bot venom were determined in a rabbit model using a specific sandwich type ELISA. After intravenous injection, Bot venom seems to follow a three-compartment pharmacokinetic open model. However, after subcutaneous injection, the distribution and elimination kinetics of Bot venom are best characterized by a bi-compartment pharmacokinetic open model. Bot venom is completely absorbed from its SC injection site, since the absolute bioavailability is higher than 95%; the maximum plasma venom concentration is reached between 30 and 60 min after venom injection. Bot venom diffuses rapidly to tissues and is distributed in a high body volume. The total body clearance of Bot venom is relatively high in agreement with a low mean residence time. Antivenom immunotherapy experiments were carried out in the rabbit model, in order to select the most appropriate strategy for the adequate use of this treatment. The effects of the route, the dose and the delay of antivenom injection on Bot venom pharmacokinetic parameters and on the antivenom immunotherapy efficacy were then studied. These studies indicated in particular that: (1) the injection of a minimal neutralizing antivenom dose is required for a complete and permanent neutralization of circulating venom antigens; this dose is named minimal (threshold) efficacious antivenom dose; (2) the intramuscular route is not the most appropriate way for antivenom injection; and (3) a delayed antivenom immunotherapy remains efficacious especially on the neutralization of the remaining circulating venom. In short, these experimental studies show that early intravenous injection of an appropriate antivenom dose (at least the threshold efficacious dose) is the indicated way for a rapid and permanent neutralization of circulating scorpion venom toxins.

[Hydatid pulmonary embolism. Two case reports]. / Embolies pulmonaires hydatiques. A propos de deux cas.

Hydatid pulmonary embolism is an uncommon condition resulting from the rupture of a hydatid heart cyst or the opening of a visceral hydatid cyst (often in the liver) into the venous circulation. We report two cases of hydatid pulmonary embolism following rupture of a hydatic cyst in the right ventricle. One case progressed to chronic cor pulmonale. We examine the pathophysiological mechanisms as well as the clinical, therapeutic and evolutive aspects.

[Bronchoesophageal fistula with late revelation]. / A propos d'une fistule broncho-oesophagienne de révélation tardive.

Bronchoesophageal fistula is an uncommon clinical problem which can either occur as a congenital or acquired condition. A 40-year-old male had productive cough with production of sputum mixed with food particles and cough when eating and drinking. There was no weight loss nor weakness. Clinical examination led to the diagnosis of a fistula between the lower esophagus and the Nelson bronchus associated with bronchiectasis. The congenital nature of this fistula was suggested by the clinical, operative and pathology findings. Postoperative recover was uneventful. Esophageal respiratory tract fistula presenting in adult life are rare and can cause severe debilitation and suppurating lung disease. Surgical treatment provides complete resolution of the symptoms. Endoscopic obliteration can be considered as an alternative to surgery.

[Costal chondrosarcoma. 4 cases]. / Chondrosarcome costal. 4 observations.

BACKGROUND: Tumors of the rib cage are uncommon and malignant in 29% of the cases. Chondrosarcoma predominates, accounting for 40% of all cases of malignant costal tumors. CASE REPORTS: Four patients (3 women, 1 man, mean age 28.2 years) were hospitalized for costal chondrosarcoma. Pain and tumefaction dominated the clinical presentation. Calcifications suggested the diagnosis in 3 cases. Curative surgery was performed in all cases. Postoperative radiotherapy was unable to improve prognosis in 2 patients. DISCUSSION: Chondrosarcoma of the ribs is characterized by a strong potential for invasive extension. Diagnosis is suspected on the basis of imaging findings and confirmed at pathology. Surgery is required. Chemotherapy and radiotherapy do not improve prognosis significantly.

[Tuberculosis of the thoracic wall. Presentation of 4 personal cases and review of the literature]. / La tuberculose de la paroi thoracique. Mise au point à partir de 4 observations personnelles et d'une revue de la littérature.

The thoracic wall is an uncommon localization for tuberculosis, accounting for an estimated 1 to 5% of all cases of bone and joint tuberculosis which themselves account for 15% of all extrapulmonary localizations. Four patients were hospitalized for tuberculosis of the thoracic wall. The first patient, aged 22 years, had sternal tuberculosis with multiple bone localizations. The second patient was 37 years old and had a cold abscess of the peristernal soft tissues with several other bone localizations devoid of clinical manifestations. A third 37-year-old patient had a cold intercostal abscess revealed by a mass in the upper left quadrant of the left breast. In the last patient, 50 years old, tuberculosis of the ribs was associated with a cold tumor of the knee. Together with cases reported in the literature, these observations demonstrate the difficult diagnostic situation presented by tuberculosis of the thoracic wall. Treatment is based on long-duration multi-drug therapy. Surgical resection is rarely indicated. Cure was achieved in our four cases.

Molecular characterization, antigenicity and immunogenicity of anatoxic polymeric forms conferring protection against scorpion venoms.

Two polymeric forms of Buthus occitamus tunetanus (Bot) G-50 and Androctonus australis hector (Aah) G-50 were obtained by controlled polymerization with glutaraldehyde. Their mol. wts, determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and exclusion high-performance liquid chromatography using radiolabelled toxin, ranged from 14,000 to 90,000 and 90,000 to 100,000 for Aah G-50 and Bot G-50, respectively. Modification of about 20% of the lysine residues yielded completely detoxified Bot G-50 fractions which retained the antigenic cross-reactivity with the native G-50 fraction, venom and toxins. High levels of specific antibodies against venoms and toxins were generated by immunization with prepared polymeric forms because absorbance values higher than 3 units were regularly observed by enzyme-linked immunosorbent assay with immune sera dilutions of 1/10,000. In vitro protection experiments demonstrated that immune sera from mice, horse and monkeys efficiently neutralized either Aah or Bot venom. Depending on the adjuvant and animal model species used, the neutralizing titre estimated by subcutaneous injection in mice varied between 20 and 40 LD50/ml. The in vivo protection assays showed that immunized mice could resist the challenge by six times the LD50 amounts of the toxic fraction. This protection was found to be long-lived. It was concluded that G-50 polymeric forms are highly detoxified and immunogenic, and should be useful for the production of potent polyvalent antivenom against scorpion toxins. They could also be considered for further studies towards the development of vaccine candidates.

Vaginal leiomyoma: the female prostate.

We report one case of vaginal leiomyoma revealed by dysuria operated with success. Our observation are discussed with the review of the literature data.