An animal model of testicular toxicity by cyclosporine: evaluation and protection

CyclosporineA (CsA) improves the survival of patients who benefited from transplantation. However, its use is generally limited by its side effects. The aim of our study was to measure, in an experimental model, the changes of the testosterone plasma levels after 21 days of CsA treatment and to explain the mechanism of this modification. After treatment, the levels of CsA, testosterone, corticosterone, transaminases were measured. The cytotoxic effect of CsA was evaluated by microscopic observation. The experimental study showed that CsA had no effect on the plasmatic levels of hepatic enzymes - alanine aminotransferase, aspartate aminotransferase and gamma-glutamyl-transferase – because their plasma concentrations in treated rats did not differ from those of the sham group. The plasma concentration of corticosterone was not modified, the plasma level of testosterone decreased when the dose of cyclosporine was increased to 4 mg/kg/day. The photonic microscope observation showed that the number of Leydig cells was increased and the electronic microscope observation showed mitochondria alteration. The treatment by CsA and trimetazidine did not correct the alteration caused by CsA. N-benzyl-N'-(2-hydrox-3, 4-dimethyloxybenzyl)-pipeazine did not protect the mitochondrial function but partially protected mitochondria structure from the deleterious effect induced by CsA. The decrease of the plasma level of testosterone induced by CsA was due to the inhibition of the mitochondrial 20–22 desmolase which blocked the formation of the testosterone precursor and the destruction of the mitochondria structure.     

Synchronous occurrence of colonic intraepithelial neoplasia and small bowel stromal tumour

We report the diagnosis of synchronous gastrointestinal stromal tumours affecting the small bowel and intraepithelial neoplasia of the colon in a 52-year-old patient. After surgical resection of the two tumours outcome was favourable. We discuss the causality of this association, based on a literature review of the few previously published cases.     

Musculoskeletal disorders among Tunisian hospital staff: Prevalence and risk factors

Aim of the workMusculoskeletal disorders (MSD) represent a significant occupational problem among hospital staff; however, data on musculoskeletal health of hospital staff are sparse. This study sought to determine the prevalence of MSD, their epidemiologic data and the associated risk factors.MethodsA previously self administered questionnaire sought information on demographics, prevalence and pattern of MSD, associated risk factors was employed as the survey instrument. A total of 520 questionnaires were distributed to hospital staff but only 433 questionnaires was valid. Eighty-seven of the returned questionnaires were excluded because of incomplete data.ResultsThe prevalence of MSD among hospital staff was 65.4%. Musculoskeletal disorders occurred mostly in low back (74.5%), neck (38.1%), and knees (31.1%).Factors associated to MSD were age (P < 0.001), female gender (P < 0.001), years of service (P < 0.001) as well as prolonged standing or sitting (P = 0.016 and 0.023, respectively). No significant association was found between repetitive movement, uncomfortable postures, heavy load handling, working on night shifts, stress and the presence of MSD.ConclusionA high proportion of hospital staff reported MSD at some body site with the low back being injured most often. Education programs on prevention and coping strategies for musculoskeletal disorders are recommended for hospital staff in order to reduce the rate of occupational hazards and also promote efficiency in patient care.     

Micropapillary carcinoma of the urinary bladder: a case report and review of the literature

Micropapillary carcinoma is an uncommon variant of urothelial carcinoma with high metastatic potential. The presence of micropapillary carcinoma component in bladder biopsies should alert urologists to its aggressive behaviour. We report the case of a 70-year-old man who presented with macroscopic hematuria lasting 2 weeks. Magnetic resonance imaging revealed a bladder tumour in the dome area extended to perivascular adipose. The transurethral biopsy showed a high-grade micropapillary carcinoma with muscle invasion. Radical cystectomy with lymph node dissection was then performed. The pathological examination revealed a high-grade purely micropapillary carcinoma invading the perivesical adipose. No tumour recurrence or metastasis were reported at the 6-month follow-up.     

Prognostic aspects of scintigraphy and MRI during the first 6 months of reflex sympathetic dystrophy of the distal lower limb: a preliminary prospective study of 4 cases]

PURPOSE: The appearance of scintigraphic and magnetic resonance imaging during the evolution of reflex sympathetic dystrophy of the foot is not well known and subject to controversies. The purpose of this preliminary study is to compare these two types of investigation during the first 6 months of evolution. METHODS: 4 non-selected patients with a diagnosis of acute reflex sympathetic dystrophy of the foot (no more than 2 months of evolution and more than 3 out of 6 clinical criteria suggesting a "warm" phase) were studied prospectively. A clinical evaluation, scintigraphy and magnetic resonance imaging (MRI) were performed at diagnosis and after 3 and 6 months. All available examinations (n = 22) were analyzed independently by independent observers. RESULTS: Clinically 3 of 4 patients developed or previously had another site of sympathetic dystrophy confirmed by total body scintigraphy. After 6 months 2 of 4 patients still have a "warm" dystrophy. Bone scanning showed localized or diffuse tracer uptake and MRI showed bone and soft tissue edema when the sympathetic dystrophy was and/or remained clinically "warm". MRI bone edema moved from one location to another in 3 of 4 patients during the follow-up. There was a good correlation between bone scan and MRI images. In "warm" dystrophy, MRI was positive 5 out of 7 times and scintigraphy in all cases. Bone edema and tracer uptake faded simultaneously although the latter was more diffuse and more persistent than the former. CONCLUSION: MRI as well as bone scintigraphy are suitable for the diagnosis of warm dystrophy of the foot. Both exams remain positive when the dystrophy is still "warm" after 6 months. The radiographic evolution after 6 months still has to be evaluated.     

SAPHO syndrome masquerading as metastatic bone disease

A 46-year-old woman who had had a right mastectomy for breast carcinoma a month before underwent bone scintigraphy. The examination revealed multiple pelvic, vertebral and sternal hot spots suggestive of bone metastases. Standard X-rays and CT confirmed the presence of bony lesions but they were not typical of bone metastases. As the radiographic appearance was reminiscent of SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis), bone biopsies were performed. Histology showed fibrosis and hyperostosis but no tumour cells. On further questioning, the patient revealed she had had palmar pustulosis and sacroiliitis some years earlier. The purpose of the case report is to show that accurate diagnosis of SAPHO syndrome requires careful clinical and radiological examinations.     

Pulmonary hypertension in sickle cell anemia. A case report

We report the case of a 33-years-girl with SCA and severe PH. She developed six month before admission, non productive cough and dyspnea. Physical examination at admission revealed shortness of breath and right heart ventricular failure. Electrocardiography showed sinus rhythm and an incomplete left bundle branch block. Chest roentgenography revealed cardiomegaly with cardiothoracic index at 0.66 and pulmonary infiltrates. Laboratory tests revealed an anemia with hemoglobin of 7.1 g/dl, white blood cell count of 12,500/mm, moderate renal failure (cretininemia = 178 mumol/l) and hypoxemia with oxygen pressure of 60 mmHg. Hemoglobin electrophoresis revealed on heterozygous SCA. Echocardiography revealed dilatation of right heart cavities and a systolic pulmonary artery pressure of 60 mmHg. A perfusion lung scintigraphy demonstrated multiple subsegmental perfusion defects. PH is a common complication of adult patients with SCA. Appropriate therapies and strategies for prevention of PH in SCA are unknown. Further research exploring therapies such as oxygen, nitric oxide, prostacyclin and hydroxyurea are indicated.     

Renal amyloidosis followed more than 5 years: report of 12 cases

Renal involvement with amyloidosis is common but causes patient survival to be poor, rarely reaching 5 years. In this study, we retrospectively reviewed clinical and biological characteristics as well as treatments and outcomes of patients with renal amyloidosis followed for more than 5 years. Between 1975 and 2003, 485 patients were diagnosed with renal amyloidosis including only 12 patients who were followed more than 5 years. The six men and six women of mean age 42.4 years (range 18 to 66 years) displayed renal signs of lower limb edema in all cases; hypertension in four cases, proteinuria on urinalysis in all cases with microscopic hematuria in five cases. Biological tests showed nephrotic syndrome in 11 patients, normal renal function in nine patients, and renal failure in three patients whose mean creatinine was 481.6 micromol/L (range 294 to 726). The amyloidosis was AA type in 11 cases and non-AA in one case. An etiologic survey revealed spondylarthropathy in one patient, pulmonary tuberculosis in two patients, chronic bronchitis in three patients, hepatic hydatic cyst in one patient, Mediterranean familial fever in two patients, Crohn's disease in one patient, Hodgkin's lymphoma in one patient, and multiple myeloma in one patient. Specific treatment was initiated with colchicine in seven patients. At a 110-month mean follow-up (range 53 to 153 months), remission of nephrotic syndrome was observed in four cases, progression to chronic renal failure in two patients, and to end-stage renal failure in five cases (range 53 to 196 months), with stabilization of renal function in seven patients. In conclusion, primary amyloid disease should be optimally suppressed in patients with renal involvement. The role of this treatment in remission of renal amyloidosis is not well established. This efficacy of the treatment has been demonstrated in some patients with improved survival.     

Gastric cancer with lymphoid stroma: a rare form associated with Epstein-Barr virus. Five cases

We report the cases of 5 patients with gastric cancer with lymphoid stroma, aged from 40 to 66 years. The tumor was located in the upper and the middle third of stomach in four patients. Using in situ hybridization, the tumor was Epstein-Barr virus-positive in all patients whereas immunohistochemical analysis was negative. Four patients had total gastrectomy associated in two cases with splenectomy and caudal pancreatic resection. The last patient had subtotal gastrectomy. One patient was lost to follow-up. After a mean follow-up of 31 months, 4 patients are alive and free of local recurrence.