Mégaduodénum: à propos de deux cas

Megaduodenum is a rare condition. It may be idiopathic or secondary to visceral myopathy or neuropathy. The clinical manifestations vary from total latency to severe pseudo-obstruction. Recurrent urinary infections are common. The diagnosis is easily made by radiology and manometry revealing a motor disorder of the esophagus, small intestine, and anorectum. Surgical treatment poses specific technical problems related to the presence of biliarypancreatic confluence and head of the pancreas. The aim of this study is to describe the clinical manifestations; radiological and manometric abnormalities observed during megaduodenum and discuss therapeutic modalities. We report two patients: the first a 27-year-old man, operated for upper gastrointestinal stricture in another center where a large gastric dilatation was observed with a permeable pylorus. A lateral side anastomosis was performed between the duodenum and the second jejunal loop. The patient was readmitted to our department 4 years later for recurrence of the same symptoms. The former intraoperative duodenojejunal anastomosis was permeable. A total duodenal diversion was performed. The second patient a 22-year-old man, had a brother who is dead in the first year.. This case is associated with ophthalmologic disorders, facial dysmorphism, and a Barrett’s esophagus. The patient received a total duodenal diversion with satisfactory results, the blood karyotype showed no chromosomal abnormalities.     

Primary plasmacytoma of the testis with no evidence of multiple myeloma: a new case report and literature review

Plasmacytomas of the testis are extremely rare tumours, especially when occurring in the absence of a previous or concurrent diagnosis of multiple myeloma. We report a new case of solitary testicular plasmacytoma, with immunohistochemical studies showing monoclonal cytoplasmic production of IgG lambda light chains, in a 51-year-old man who had no evidence of multiple myeloma 3 years after the orchiectomy.     

Adénocarcinome gastrique du jeune tunisien: à propos de 18 cas

Abstract

Gastric adenocarcinoma in young patients is considered as a cancer among the old. Its occurrence among the youth is rather rare and reputed to be of a bad prognosis.

Objective

To study the epidemiological, clinical, anatomopathological, therapeutic and prognosis characteristics of gastric adenocarcinoma among the youth.

Material and methods

A retrospective study was carried out between January 1990 to December 2004, during which 157 patients were researched for gastric adenocarcinoma. The young patients were defined according to an age inferior or equal to 40. In order to be able to highlight this study, we compared the group of young patients (group I = GI) to the rest of the patients of the series (group II = GII).We used the TNM-classification as well as the OMS-classification. We regrouped the stage T1 with T2 and the stage T3 with T4, and the tumors that were averagely differentiated with the ones that were the least differentiated. Likewise, the treatment was considered as curative as the quality of the removal was of the type R0 and the tumors of the cardia and the pan-gastric ones were regrouped with the lesions of the body as proximal cancer. The variables were analyzed with the software SPSS 8.0.

Results

We have retained 18 cases studies consisting of 12 women and six men. The average deadline of the diagnosis was eight months within GI vs nine months within GII. The tumor was located at the level of the antrum in seven cases (38%). The average size was 4.8 cm within GI vs 5.7 cm within GII. Treatment carried out was a subtotal gastrectomy in six cases (33 vs 52.9%) and a total gastrectomy in 12 cases (66.6 vs 47.1%). The treatment was judged to be curative within 17 patients (94.4 vs 71.9%). The adenocarcinoma was little or averagely differentiated in 88.9% of the cases. The component with the bezel-like cells was found among ten patients (55.5 vs 35%). A nervous sheathing was found in three cases (16.7 vs 19.5%) and some vascular embolisms were found in four cases (22.2 vs 22.3%). Five patients represented a recurrence (29.4 vs 23.7%). The survival rate after five years was 49.5 vs 38.3%.

Conclusion

Gastric adenocarcinoma among the youth is significantly much more common among women. It is characterized by its histological type which is little or averagely differentiated as well as by the frequency of the component of independent cells. Despite these pejorative features, the quality of the removal is not affected at all and the global follow up to five years is similar in the two groups of patients.     

Prevalence of celiac disease serological markers in Tunisian type 1 diabetic adults

OBJECTIVE: to evaluate the prevalence of celiac serological markers; anti-transglutaminase (ATGt), anti-endomysium (AE), anti-gliadin (AGD) and anti-reticulin (AR) antibodies; in type 1 diabetic Tunisian adults. SUBJECTS AND METHODS: 261 type 1 diabetic patients aged from 16 to 60 years were enrolled in this prospective study. IgG and IgA transglutaminase and gliadin were measured with ELISA. IgA AE were tested by indirect immunofluorescence using 2 substrates; monkey oesophagus and human umbilical cord. AR were detected by indirect immunofluorescence on rat liver, kidney and stomach. Sera IgA level was measured by turbidimetry. RESULTS: 83/261 of diabetics were positive for at least one antibody, 5.7% had ATGt-A, 3.4% AE on monkey esophagus, 3.1% AE on umbilical cordon, 18% AGD-A, 19.5% AGD-G and 3.1% AR. There was an excellent concordance between AE and ATGt (r = 0.9). Out of the 261 diabetics, 5 had an IgA deficiency and one of them has IgG AE and ATGt. CONCLUSION: serological markers of celiac disease seem to be frequent in diabetics. Nevertheless, diagnosis must be confirmed by histological studies which allow us to know the real prevalence of celiac disease in diabetic adults.     

Polymorphisms in the ITS rDNA regions for differentiating strains of the Trichophyton mentagrophytes complex in Sfax‐Tunisia

The Trichophyton mentagrophytes complex is the main cause of superficial mycoses in humans and animals. Molecular research has provided useful insights into the taxonomy of this complex to overcome the challenges with conventional diagnostics. The aim of this study was to identify, type and differentiate anthropophilic and zoophilic species of the T. mentagrophytes complex. Sixty clinical samples identified as T. mentagrophytes by morphological characteristics were isolated using polymerase chain reaction‐restriction fragment length polymorphism and sequence analysis of the internal transcribed spacer (ITS) regions. The identification of our strains by conventional methods was confirmed using polymerase chain reaction (PCR) sequencing in 93.34% of the cases. The strains under investigation were recategorised as T. rubrum (Tr2711). In addition, PCR products were independently digested with the restriction endonucleases, MvaI and HinfI, to produce a single dominant profile for T. interdigitale. ITS sequence analysis revealed a polymorphism in the ITS1 and 5.8S regions. Analysis of the consensus sequences distinguished four types of genotypes among our T. interdigitale species. Moreover, ITS type I was the dominant genotype characterising the anthropophilic variant of T. interdigitale. The phylogenetic study showed that only 5% of our strains were zoophilic. PCR sequencing was useful for distinguishing anthropophilic and zoophilic species of T. interdigitale, in which the differentiation is relevant because it helps to prescribe the correct treatment and to identify the surrounding source of infection.     

Letter: Intestinal heterotopia in urethral caruncle

We report a case of urethral caruncle with intestinal heterotopia in a 26-year-old woman. This entity is rarely reported.     

Epidemiology of dermatophytoses in Sfax, Tunisia

The distribution of dermatophytes varies in different countries and geographical areas depending on several factors. To determine the frequency of aetiological agents and the clinical variants of dermatophytoses, we carried out a study between 1998 and 2007. Out of 25 432 subjects suspected to have superficial mycoses, 9960 (39.2%) were affected with dermatophytoses; 14957 positive samples were obtained. The mean age was 35.7 years (range: 21 days to 97 years). Sex ratio was 0.9. Our patients were from urban regions in 81.9% of cases. The most common type of infection was onychomycosis (30.3%), followed by tinea pedis (24.8%), intertrigo (21.7%), tinea corporis (11.4%) and tinea capitis (9.6%). Fifteen patients had generalised dermatophytosis. Hadida and Schousboe disease was diagnosed in one case with lethal evolution. The most isolated dermatophyte was Trichophyton rubrum (74.5%), followed by T. violaceum (7.9%), T. mentagrophytes (7.5%), Microsporum canis (3.8%), Epidermophyton floccosum (0.7%) and T. verrucosum (0.54%). Other species were occasionally isolated: T. schoenleinii , T. tonsurans , M . audouinii and M. ferrugineum . The prevalence of dermatophytoses remains high in our country (996 cases/year). Trichophyton rubrum is the predominant causal agent. However, zoophilic agents become more prevalent. Epidemiological surveys are an essential tool for developing strategies for infection control.