False penile fracture: report of 16 cases

We determined the value of diagnostic and therapeutic approaches of false penile fractures and the outcome of treatment. We retrospectively reviewed 16 cases of presumed penile fracture with a negative surgical exploration. Clinical presentation, technique of treatment and outcome were noted. The mean age was 39 years (17-64). Nine patients were injured during sexual intercourse. All the patients presented with the presumptive diagnosis of penile fracture. False penile fracture was evoked in one patient presenting a new erection. Surgical penile exploration was carried out for all the patients without any radiological explorations. It revealed nonspecific dartos bleeding in 10 cases and avulsed superficial dorsal vein in six cases requiring venous ends ligation. All the patients regained penile appearance and potency. We can hardly distinguish false penile fracture from 'true' penile fracture with certainty either clinically or radiologically, thus, surgical exploration is mostly necessary. The prognosis is excellent.     

The hypolipidaemic activity of aqueous Erica multiflora flowers extract in Triton WR-1339 induced hyperlipidaemic rats: a comparison with fenofibrate

In the present study, an aqueous extract from Erica multiflora L. (Ericaceae) flowers was evaluated for its hypocholesterolaemic and hypotriglyceridaemic activities using Triton WR-1339 induced hyperlipemic rats as experimental model. Hyperlipideamia was developed by intraperitonial injection of Triton (200mg/kg body weight). The animals were divided into control (CG), hyperlipidaemic (HG), hyperlipidaemic plus herb extract (HG+EmE) and hyperlipidaemic plus fenofibrate (HG+FF) treated groups. Intragastric administration of Erica multiflora extract (0.25 g/100g body weight) to the rats caused a significant decrease on their plasma lipid levels (quantified using enzymatic kits). At 7h after treatment, plasma total cholesterol, triglycerides and LDL-cholesterol were decreased by 47%, 95% and 67%, respectively, but the change of HDL-cholesterol level was not significant. However, the hypolipidaemic effect of fenofibrate was limited to triglycerides and LDL-cholesterol, which were lowered by about 92% and 41%, respectively. At 24h after treatment, Erica multiflora extract reduced plasma total cholesterol by 68.5% and triglycerides by 91%. HDL-cholesterol was not significantly increased and LDL-cholesterol was lowered by 80.5%. In fenofibrate treated rats, only plasma triglyceride concentrations were lowered by 82%, while the other lipid parameters were not significantly changed indicating that this aqueous herb extract may contain products that lower plasma lipid concentrations and might be beneficial in treatment of hyperlipideamia.     

Rosai-Dorfman disease of the gastrointestinal tract: report of a case and review of the literature

Rosai-Dorfman disease (RDD) is a rare, acquired disease of unknown etiology that affects primarily children and young adults. It is characterized by a proliferation of distinctive histiocytes in the lymph nodes and/or extranodal sites. Involvement of the gastrointestinal tract is rare. We report a case of RDD in a 60-year-old woman who presented with hematochezia and was found to have RDD of the rectum presenting as a rectal mass. This report highlights the current pathogenetic mechanisms, immunohistochemical markers, and the gastrointestinal manifestations of RDD.     

Primary small intestinal lymphoma: epidemiological, histological and therapeutic transition in Tunisia

IntroductionPrimary small intestinal lymphoma (PSIL) is the second Non-Hodgkin lymphoma (NHL) of the digestive tract (after gastric NHL).PurposeTo evaluate during the past 28 years the epidemiological, anatomoclinical and therapeutic changes of PSIL in Tunisia through an acquired experience of more than a quarter of a century.MethodsOur retrospective study included patients with histologically confirmed small intestinal lymphoma from 1981 to 2008 in Tunisia at Salah Azaiz Institute. The cohort of 210 patients was divided into two groups: A group from 1981 to 1992 (152 patients) and B group from 1993 to 2008 (58 patients). We analysed the epidemiological, anatomoclinical, histological, and therapeutic characteristics.ResultsWe observed a significant decrease in the annual incidence of PSIL but also a significant transition of diffuse immunoproliferative small intestinal disease (IPSID) also known as “Mediterranean” PSIL, which were progressively replaced by “Western” lymphomas. Laparotomy with or without a debulking surgery, largely performed in group A, has disappeared at the cost of a primary chemotherapy (p < 0.001). Five-year actuarial global and relapse free survivals were respectively 60.5 and 57.3%.ConclusionPSIL in Tunisia were subjected to a triple transition: epidemiological, histological and therapeutic     

Factors predictive of elevated serum CA125 levels in patients with epithelial ovarian cancer

Our objective was to identify factors that correlate with high CA125 (cancer antigen 125) concentrations in Tunisian women with epithelial ovarian cancer and to introduce recommendations for reporting and interpreting individual CA125 assay results. We analyzed repeated serum CA125 levels, by the immunoenzymatic assay using an AxSym CA125 kit, in 90 patients who were treated for ovarian cancer from 1994 to 2006 in CHU Farhat Hached Sousse Tunisia. Using a logistic model, we found that carcinosis is significantly predictive of high levels of serum CA125 (p = 0.005). A woman's age (> or = 45 years, p = 0.016) and menopausal status (postmenopausal patient, p = 0.034) are also predictive of increased CA125 concentration. Patients with serous histological subtype have higher CA125 values (p = 0.001). Presence of ascites is associated with high serum CA125 values and thus could be considered as a predictor of high serum CA125 concentration (p = 0.023). The International Federation of Gynecology and Obstetrics stage and primary tumor size are not significant predictors of CA125 concentrations (p > 0.05). We conclude that clinically significant parameters should lead to the best interpretation of rising CA125 levels and consequently to more appropriate management of epithelial ovarian cancer patients.     

Effect of Energy Expenditure and Training Status on Leptin Response to Sub-Maximal Cycling

We examined the leptin response and related hormones during and after two sub-maximal exercise protocols in trained and untrained subjects. During this study, plasma concentrations of leptin [Lep], insulin [I], cortisol [C], growth hormone [GH], glucose [G] and lactate [La] were measured. 7 elite volleyball trained players (TR) and 7 untrained (UTR) subjects (percent body fat: 13.2 ± 1.8 versus 15.7 ± 1.0, p < 0.01, respectively) were examined after short and prolonged sub-maximal cycling exercise protocols (SP and PP). Venous blood samples were collected before each protocol, during, at the end, and after 2 and 24 h of recovery. SP and PP energy expenditures ranged from 470 ± 60 to 740 ± 90 kcal for TR and from 450 ± 60 to 710 ± 90 kcal for UTR, respectively. [Lep] was related to body fat percentage and body fat mass in TR (r = 0. 84, p < 0.05 and r = 0.93, p < 0.01) and in UTR (r = 0.89, p < 0.01 and r = 0.92, p < 0. 01, respectively). [Lep] did not change significantly during both protocols for both groups but was lower (p < 0.05) in all sampling in TR when compared to UTR. Plasma [I] decreased (p < 0.01) and [GH] increased (p < 0.01) significantly during both SP and PP and these hormones remained lower (I: p < 0.01) and higher (GH: p < 0.01) than pre-exercise levels after a 2-h recovery period, returning to base-line at 24-h recovery. Plasma [La] increased (p < 0.01) during both protocols for TR and UTR. There was no significant change in [C] and [G] during and after both protocols for all subjects. It is concluded that 1) leptin is not sensitive to acute short or prolonged sub-maximal exercises (with energy expenditure under 800 kcal) in volleyball/ anaerobically trained athletes as in untrained subjects, 2) volleyball athletes showed significantly lower resting and exercise leptin response with respect to untrained subjects and 3) it appears that in these anaerobically trained athletes leptin response to exercise is more sensitive to the level of energy expenditure than hormonal or metabolic modifications induced by acute exercise.

Key points

• Trials concerning acute exercise and leptin indicated discrepant results.
• Acute exercise with energy expenditure higher than 800 kcal can decrease leptinemia.
• Elite volleyball players presented decreased leptin levels than untrained subjects.

Key words: Hormones, anaerobic training, acute exercise, body fat.     

Association between the -2518G/A polymorphism in the monocyte chemoattractant protein-1 (MCP-1) gene and myocardial infarction in Tunisian patients

BACKGROUND: Monocyte chemoattractant protein-1 (MCP-1; gene name CCL2) has been suggested to play an important role in the initiation of atherosclerosis by recruiting monocytes to sites of injured endothelium. Recently, single nucleotide polymorphisms (SNPs) in the MCP-1 regulatory region have been identified. Controversial results regarding the association of the -2518G/A polymorphism of the MCP-1 gene with coronary artery disease (CAD) have been reported. In the present study, we examined a possible association between the -2518G/A polymorphism of the MCP-1 gene and myocardial infarction (MI) in a sample of the Tunisian population. METHODS: A total of 319 Tunisian patients with MI and 467 healthy controls were included in the study. The SNP of the MCP-1 gene was determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. RESULTS: Patients with MI had significantly higher frequency of the AG+GG genotypes compared to controls [42.9% vs. 35.8%; OR (95%CI), 1.34 (1.00-1.79); p=0.04]. The MI patient group showed a significant higher frequency of the G allele compared to the controls [0.242 vs. 0.195; OR (95%CI), 1.31(1.02-1.68), p=0.03]. The association between the -2518G/A polymorphism of the MCP-1 gene and MI was no longer significant after adjustment for other well-established risk factors. CONCLUSION: The present study showed a significant but not independent association between the -2518G/A polymorphism of the MCP-1 gene (presence of G allele) and MI in the Tunisian population.     

Is serum transthyretin a reliable marker of nutritional status in patients with end-stage renal disease?

ObjectiveTo test the value of serum transthyretin (TTR) concentration as a nutritional marker in renal patients.MethodsThe study included 115 renal patients, out of which 35 are on conservative treatment, 50 on hemodialysis and 30 renal transplant recipients, and 31 healthy control subjects. Serum TTR, albumin, transferrin, C-reactive protein (CRP) and α1 anti trypsine (AAT) were assessed by immunoturbidimetry, and vitamin A by HPLC. Linear regression models were applied to test the association between serum TTR and body mass index (BMI).ResultsSerum TTR concentrations were normal, but serum vitamin A, CRP and AAT concentrations were significantly higher in patients. In renal patients, serum TTR was positively and independently related to BMI and was significantly lower in malnourished than well-nourished patients (367 ± 91 vs. 417 ± 130 mg/L; p = 0.05). The risk of serum TTR < 300 mg/L was higher in malnourished patients [OR, 4.82 (1.78–13.2); p = 0.001].ConclusionSerum TTR concentrations were at normal range in renal patients despite evidence of malnutrition and inflammation. However, they were related to BMI and were significantly lowered in malnourished patients. Thus, serum TTR would reflect nutritional status in renal patients. However, the cutoff of malnutrition should be raised to 300 mg/L.     

Does minor histocompatibility antigen HA-1 disparity affect the occurrence of graft-versus-host disease in tunisian recipients of hematopoietic stem cells?

INTRODUCTION:

Minor histocompatibility antigen HA‐1 (MiHAg‐HA‐1) disparity between a patient and his or her human leukocyte antigen (HLA) genoidentical donor has been widely associated with an increased risk of graft‐versus‐host disease following allogeneic hematopoietic stem cell transplantation.

OBJECTIVE:

To examine the effect of HA‐1 disparity on the incidence of both acute and chronic graft‐versus‐host disease in Tunisian recipients of hematopoietic stem cells.

METHODS:

A total of 60 patients and their 60 respective sibling hematopoietic stem cell donors were enrolled in this study. All patients prophylactically received cyclosporine A and/or methotrexate for graft‐versus‐host disease. An HA‐1 genotyping assay was performed with the SSP‐PCR method, and HLA‐A*0201‐ and/or HLA‐A*0206‐positive samples were identified using the Luminex HLA typing method.

RESULTS:

The Luminex HLA typing assay showed that 54 patients were positive for either the HLA‐A*0201 or HLA‐A*0206 alleles. Among these cases, six pairs were mismatched for MiHAg‐HA‐1. Both acute and chronic graft‐versus‐host disease occurred in four mismatched patients (Fisher''s p‐values were 0.044 and 0.170, respectively). A univariate logistic regression model analysis showed that only acute graft‐versus‐host disease may be affected by recipient MiHAg‐HA‐1 disparity (p: 0.041, OR: 6.727), while chronic graft‐versus‐host disease correlates with both age and recipient/donor sex mismatch (p: 0.014, OR: 8.556 and p: 0.033, OR: 8.664, respectively).

CONCLUSION:

Our findings support previously reported data suggesting a significant association between HA‐1 disparity and the risk of acute graft‐versus‐host disease following hematopoietic stem cell transplantation.     

Information-processing under incremental levels of physical loads: comparing racquet to combat sports

AIM: Skillful performance in combat and racquet sports consists of proficient technique accompanied with efficient information-processing while engaged in moderate to high physical effort. This study examined information processing and decision-making using simple reaction time (SRT) and choice reaction time (CRT) paradigms in athletes of combat sports and racquet ball games while undergoing incrementally increasing physical effort ranging from low to high intensities. METHODS: Forty national level experienced athletics in the sports of tennis, table tennis, fencing, and boxing were selected for this study. Each subject performed both simple (SRT) and four-choice reaction time (4-CRT) tasks at rest, and while pedaling on a cycle ergometer at 20%, 40%, 60%, and 80% of their own maximal aerobic power (Pmax). RESULTS: RM MANCOVA revealed significant sport-type by physical load interaction effect mainly on CRT. Least significant difference (LSD) posthoc contrasts indicated that fencers and tennis players process information faster with incrementally increasing workload, while different patterns were obtained for boxers and table-tennis players. The error rate remained stable for each sport type over all conditions. Between-sport differences in SRT and CRT among the athletes were also noted. CONCLUSIONS: Findings provide evidence that the 4-CRT is a task that more closely corresponds to the original task athletes are familiar with and utilize in their practices and competitions. However, additional tests that mimic the real world experiences of each sport must be developed and used to capture the nature of information processing and response-selection in specific sports.