Efficacy of Growth Hormone Treatment in Children With Chronic Kidney Disease: Tunisian Experience.

OBJECTIVE: To study the effect of using recombinant human growth hormone (rhGH) in growth retarded children with chronic kidney disease (CKD). METHODS: This was a non-randomized controlled study over 2 years including children in CKD stages 4-5 suffering from growth retardation. Children were divided into rhGH-treated or non-rhGH treated groups. RESULT: A total of 70 children (35 in each group) were enrolled. While the mean (SD) height of 35 children with CKD had increased from 109.5 (26) cm to 116 (26) cm (mean growth velocity 6.5 cm/year; P=0.09) prior to rhGH therapy, the same was found to increase from 116 (26) cm at the start of therapy to 125 (25) cm after one year of therapy (P=0.02). CONCLUSIONS: Therapy with rhGH was helpful in catch-up growth in Tunisian children with CKD.

End-stage renal disease in Tunisian infants: Etiology and outcome.

End stage renal disease (ESRD) in infants has particular features in terms of etiologies and therapeutic modalities. The aim of our study is to describe the etiologies and the ESRD outcomes among Tunisian infants. This retrospective study was conducted over 15 years (from January 1998 to December 31, 2013) in the Pediatric Department at Charles Nicolle Hospital. In total, 157 pediatric patients had ESRD. The mean incidence was 4.25 million children. The study involved 24 infants; the sex ratio was equal to 2. The mean age at diagnosis of ESRD was 8 months (range, 1-21 months). Growth retardation was noticed in 14 patients. The main causes were Congenital Anomalies of the Kidneys and Urinary Tract (9 infants) and hereditary renal disease (9 infants). All patients were treated with peritoneal dialysis; 16 infants presented peritonitis. Mortality rate was about 28%. The leading causes of death were cardiovascular diseases and infections.

[Profile of basal cell carcinomas of the scalp after radiotherapy for tinea capitis (about 63 cases)]. / Profil des carcinomes basocellulaires du cuir chevelu secondaires a une radiothérapie pour teigne (a propos de 63 cas).

The induction of basal cell carcinoma (BCC) of the scalp by X-ray therapy for tinea capitis is well known. The aim of the study was to specify the epidemiological, clinical and histological characteristics of this disease. In a retrospective study, we collected data from the files of 63 patients, with a history of radiotherapy for tinea capitis, followed between January 1995 and December 2004. Fifty one men and 12 women with a total of 108 BCC of the scalp are reported (1.76 lesion per patient and 1.13 cm on average of diameter). The mean age at the occurrence of the BCC was 45.5 years. Thirty seven percent of BCC occurred on the occipital area; 28.7% were in the parietal site. The most frequent clinical aspect was the nodular BCC (51%) and the cicatricial BCC (35%). Histological study showed a nodular aspect in 74 % and pigmentation in 62% of cases. It is concluded that BCC of the scalp following X-ray therapy for tinea capitis have some clinical and histological particularities. It represents the most frequent tumour developing on irradiated scalp.

Primary Hodgkin's disease of the nasopharynx: a rare but bona fide disease.

We report an uncommon case of Hodgkin's disease confined to the nasopharynx. An isolated polypoid mass of the nasopharynx was observed in a 41-year-old man presenting with increasing bilateral nasal obstruction. Histological study revealed a mixed cellularity type of Hodgkin's disease. Immunohistochemical analysis revealed CD30 and LMP1 expression and a lack of reactivity to CD15, CD3 and CD20. Serological tests excluded recent infection with Epstein-Barr virus. HD of nasopharynx is rare, but has to be recognized as such in view of appropriate treatment.

[Intraoperative brachytherapy in the management of keloids. Apropos of 114 cases] . / Place de la curiethérapie dans le traitement des chéloïdes. A propos de 114 cas.

PURPOSE: Keloid scars are unsightly, especially when located on the face or bare zones. The purpose of this study was to evaluate the therapeutic results of intraoperative brachytherapy in the management of keloids. MATERIAL AND METHODS: This retrospective study was based on the study of 82 patients with keloids treated in Salah Azaiz Institute (Tunisia) between 1982 and 1994 (65 women and 17 men). The mean age of patients was 23.4 years (+/- 8.4). A total of 114 lesions have been treated with surgical resection and intraoperative brachytherapy using an iridium source placed under the surgical scar. The length of iridium was chosen with the result that the radioactive thread exceeded 5 mm on each side of the surgical scar. The iridium source was loaded less than six hours after resection. Average iridium activity was 1.5 +/- 0.3 mCi/cm. Average iridium length was 56.8 +/- 34 mm. The referred isodose chosen for the target volume included the surgical scar and a margin of 5 mm around the iridium source, which was placed under the surgical scar. The average administered dose was 20.4 Gy (+/- 3.2 Gy). RESULTS: The 2-year local control rate was 87% for the whole group of lesions treated (n = 114). Local control rate of keloids processed by resection and intraoperative brachytherapy as the first treatment (59 cases) was 96% at two years. This rate was better than the local control of lesions that had been previously treated with anterior surgical resection (84% in 55 cases). For the latter group, lesions treated with a dose of more than 20 Gy had better local control, but the difference was not statistically significant (87 vs. 65% at two years, P = 0.41). CONCLUSION: Intraoperative brachytherapy is effective for improving local control of keloids and preventing a recurrence. A rigorous technique and an adequate dose according to previous surgical treatment allows very good results.

[Choice of methods for reconstruction of the cheek after carcinologic excision based on a retrospective study of 32 cases in 8 years from 1980 to 1987 at the Gustave Roussy Institute]. / Choix des méthodes de reconstruction de la joue aprés exérèse carcinologique au vu d'une étude rétrospective de 32 cas sur 8 ans de 1980 à 1987, à L'institut Gustave Roussy.

In this article, after reviewing the different possibilities for cheek reconstruction consecutive to carcinologic excision, we specify the choice method for closure, according to the anatomical type of substance loss incurred. In all cases, endobuccal skin covering is needed. --As regards small lesions, there is no such thing as "the" ideal flap. --As far as tegumental cheeks are concerned, the deltopectoral flap is the choice one. --In case of mucous reconstruction, submental flaps afford elegant solutions. --With large lesions, musculocutaneous flaps are best used. Lastly, it seems that the first surgical treatment (excision, curage and plasty) followed or not by radiotherapy, depending on anatomopathological findings, brings acceptable and prompt restoration of function and morphology.

[2 cases of vascular syndrome of the cranial nerves of ischemic origin]. / Etude de deux cas de syndrome vasculaire des nerfs crâniens d'origine ischémique.

The authors report the cases of two patients who had sudden unilateral alternating and regressive attacks of the cranial nerves. The first patient, a 63 year old diabetic woman, suffered regressive paralysis of the right third nerve, followed two months later by paresthesia of the same side of the face, accompanied by difficulty in swallowing and dysarthria. Six months later, she developed a right facial paralysis while pharyngeal and lingual involvement entirely disappeared. Right carotid angiography revealed stenosis of the middle meningeal artery. Nine months later she developed left-sided ophthalmoplegia followed by a homolateral facial paralysis. The second patient, a 24 year old woman, developed homolateral regressive attacks of the II, V, VII and VIIb, and VIII nerves during recovery from herpes zoster of the right geniculate ganglion. Doppler studies showed inversion of the flow in the right ophthalmic artery. The pathogenesis of these multiple paralyses of the cranial nerves is discussed, a possible cause being ischaemic attacks of the vascular territories of the cranial nerves.