Bone lesions in multiple myeloma: variation and value of radiologic classification in prognosis

In this report, we studied the frequency, the types and the prognosis value of the Durie and Salmon's classification of radiological bone lesions in multiple mycloma. Our study concerned 52 patients presenting multiple myeloma, defined according to South West Oncology Group criteria, collected during nine years (1988-1996). Radiological anomalies were noted in 89% of the cases. When we compared the medial survival and the 5 years survival rate in the different groups, we found a statistically significant difference with a better survival for groups 0,1,2 considered all together as compared to group 3 patients (p = 0.0155), (71% versus 37%). According to our series, prognostic value is obviously significant when comparing groups 0, 1, and 2 to group 3.     

Pancreatic sarcoidosis

Pancreatic involvement in sarco?dosis is exceptional. We report a case of pancreatic sarco?dosis diagnosed during the etiologic work-up done for a pancreatic mass associated to a polyadenopathy. Under corticotherapy evolution is favorable with regression of the pancreatic lesions.     

Tobacco use in Tunisia: behaviour and awareness

OBJECTIVE: To assess tobacco use and the awareness of and attitudes towards tobacco and its control in the adult population of Tunisia. METHODS: A cross-sectional study was conducted in 1996 of a representative national sample of 5696 subjects aged 25 and over. Data were collected by means of a questionnaire in Arabic. FINDINGS: Tobacco use was reported by 30.4% of the respondents, of whom 24.6% smoked cigarettes and 5.8% consumed traditional tobacco, i.e. snuff, chewing tobacco and/or water pipe tobacco. Whereas 55.6% of men used tobacco, only 5.2% of women did so. Among men the proportion of tobacco users diminished with age as the rate of cessation increased. Among women, smoking peaked in the 35-54 age group. The proportion of men consuming traditional tobacco alone increased from 2.4% in the 25-34 age group to 20.4% in the 55+ age group; the corresponding values for women were 0.1% and 14.3%. Tobacco use was more widespread in rural than in urban areas and was relatively high among poorly educated men from economically deprived backgrounds. The use of tobacco was believed to be harmful to health by 98.6% of the respondents. Over 90% of the interviewees were aware that tobacco played a part in the development of heart disease. However, there were some gaps in awareness. A fear of cancer was expressed by 85% of the respondents, whereas only 5.6% were fearful of accidents. CONCLUSIONS: Informational and educational campaigns relating to tobacco control should be directed at individuals and communities, taking into account the gaps in awareness of the effects of tobacco on health.     

Detection of infectious HIV in circulating monocytes from patients on prolonged highly active antiretroviral therapy

The existence of a reservoir of resting CD4+ T cells harboring latent replication-competent HIV has been demonstrated in patients on prolonged highly active antiretroviral therapy (HAART). Latently infected tissue macrophages may constitute a second HIV reservoir. The pool of these cells may be maintained by incoming infected monocytes from blood and/or by in situ viral replication. In this study, the presence of infectious HIV was investigated in highly purified monocytes from 5 patients receiving HAART with undetectable plasma viral load for up to 16 months. HIV was detected in freshly isolated monocytes and recovered following Staphylococcus aureus Cowan strain 1 (SAC) or lipopolysaccharide (LPS) activation. No new drug resistance-associated mutation was found in monocyte-associated HIV. These results demonstrate the long-term persistence of infectious virus in cells of the monocyte-macrophage lineage in patients receiving HAART. These cells are capable of releasing infectious virus under appropriate stimulations.     

Chronic osteomyelitis of the metacarpals. Report of a case

Chronic osteomyelitis of the hand is uncommon and affects the metacarpals in only 3% of cases. We report a case of chronic osteomyelitis involving two metacarpals, and we present a review of the relevant literature. CASE-REPORT: A 41-year-old man with a 5-year history of psoriatic arthritis was admitted for a swelling over the dorsum of the left hand. At admission, he was in good general health and had no fever. In addition to the swelling, he had synovitis of the right ankle and psoriasis over the hands and elbows. The spine and sacroiliac joints were normal to physical examination. The erythrocyte sedimentation rate was 110 mm/h, the C-reactive protein level was 48 mg/l, and the leukocyte count was 9600/mm3. A radiograph of the hands disclosed a bone-within-bone image in the second and third metacarpals of the left hand and arthritis of the left carpal joints. A fluid collection over the dorsum of the left hand was visualized by ultrasonography. Aspiration recovered serous fluid that contained no organisms by microscopic examination or culture. Investigations for tuberculosis and a serological test for HIV infection were negative. Computed tomography showed a florid periosteal reaction encasing the diaphyses of the second and third metacarpals and enclosing bony sequestra; abnormal carpal bone architecture and thickening of the soft tissues related to joint effusions were seen also. The diagnosis was chronic osteomyelitis of the metacarpals. Two antimicrobials active against staphylococci were given and the bony sequestra were removed surgically. Histological examination of the operative specimens showed nonspecific osteitis. After 3 months of treatment, the outcome was favorable. CONCLUSION: Chronic osteomyelitis of the metacarpals is exceedingly rare but results in severe functional incapacitation and major social and economic burdens. Our case illustrates an unusual pattern with involvement of two metacarpals in the same hand. An early diagnosis followed by prompt treatment increases the likelihood of a favorable outcome.     

Usefulness of endoscopic ultrasonography for diagnosis between multivesicular hydatic cyst and serous cystadenoma of the pancreas. Case report

Hydatid cyst of the pancreas is very rare. However, it should be suspected in every case of pancreatic cyst, especially in hydatid countries where hydatic cyst disease is endemic. In the paper we report the first case of a multivesicular hydatid cyst of the pancreas explored by endoscopic ultrasonography. Endoscopic ultrasonography is very reliable in the investigation of pancreatic cystic tumors. However it did not allow us to define semiological criteria capable of permitting a differential diagnosis between a hydatid cyst and serous cystadenoma. Per-echoendoscopic transduodenal puncture might improve the efficiency of this procedure with of hydatid cysts of the head of the pancreas.     

Improvement in seizure control and quality of life in medically refractory epilepsy patients converted from polypharmacy to monotherapy

In a retrospective chart review, we identified 35 patients with medically refractory epilepsy (MRE) who had been converted from polypharmacy to monotherapy and maintained on monotherapy for at least 12 months. None of the 35 patients had worsening of their seizure frequency after the conversion to monotherapy. Fourteen of the 35 patients (40%) became seizure-free. Nine of 35 patients (26%) had a 50% reduction in seizure frequency. Five of 35 patients (14%) had a 75% reduction in seizure frequency. Twenty-eight (80%) of 35 patients participated in a quality-of-life questionnaire. Quality of life was rated as better on monotherapy as compared with polypharmacy in a number of domains: memory loss, concern over medication long-term effects, difficulty in taking the medications, trouble with leisure time activities, and overall state of health. This improvement reached statistical significance. Conversion to monotherapy in patients with MRE may be successful in achieving a reduction in seizure frequency and an improvement in quality-of-life parameters. A prospective, randomized trial is necessary to validate these findings.     

Epidemiological,clinical and parasitological data concerning intestinal amebiasis in northern Tunisia

In order to evaluate the principal characteristics of the intestinal amoebiasis in the north of Tunisia, one retrospective study review all cases diagnosed in principal gastroenterologic sections of the hospitals of Tunis. Twenty height cases of intestinal amoebiasis, 10 of which have an inflammatory bowel disease associated were included. Watery stools containing blood and mucus were the most important symptoms (25 cases). The endoscopic exam showed for all the cases non specific lesions. The diagnosis was based on histologic exam in 21 cases, on the positivity of serologic tests in 3 cases and on the presence of E. histolytica/dispar cysts in stools in 6 cases. In two cases, the diagnosis was made by therapeutic test.     

Synthesis of new N-substituted pyrrolidin-2-ones as cyclic analog of gamma-aminobutyric acid

Some new N-substituted pyrrolidin-2-ones, cyclic analogs of baclofen and of 3-(5-methylbenzo[b]furan-2-yl)-gamma-aminobutyric acid, have been prepared starting from corresponding pyrrolidinones and characterized.