Diagnostic contribution of HBME-1 and anti-cytokeratin-19 antibodies in thyroid pathology: a retrospective study of 163 cases

The objective of our study was to estimate the expression of 2 antibodies HBME-1 and anti-cytokeratin-19 and their diagnostic importance in thyroid pathology. MATERIAL AND METHODS: 163 thyroid lesions were retrospectively examined by immnohistochemistry. RESULTS: 92% (46/50 cases) of papillary carcinomas expressed HBME-1 as well as 50% (8/16 cases) of follicular carcinomas and 15% (6/40 cases) of follicular adenomas. 8 insular carcinomas, 5 anaplastic carcinomas, 20 cases of Basedow disease and lymphocytic thyroiditis, and the 24 cases of nodular goiters did not express it or very focally. Anti-cytokératine-19 marked 92% of papillary carcinomas, 56.2% of follicular carcinomas, 100% of the medullar carcinomas and 45% of follicular adenomas. Whereas the cases of anaplastic carcinomas, Basedow disease, thyroiditis and the cases of nodular goiters were negative or focally marked. CONCLUSION: HBME-1 is an excellent marker for papillary carcinoma which can be helpful in the diagnosis of its follicular variant; the association with anti-cytokératine-19 increases its specificity.     

Maternal and foetal prognostic during severe toxemia

Severe gravidic toxemia gives heavy maternal and foetal morbidity and mortality. The purpose of our study is to loosen the factors of bad maternal and foetal prognostic. It's a retrospective study about 100 cases of severe and complicated gravidic toxemia repertorieted in the maternity of Military Hospital of Tunis. Maternal morbidity is dominated by the complications of hypertension and a blood disorders. We raised 4 cases of eclampsia, 9 cases of retro placental hematome and 5 cases of HELLP syndrome. We don't deplore any maternal death. Perinatal mortality is 28.8%. The rate of delay intra-uterine growth was 43.8% and the prematurity 65.9%. More toxemia appears early during pregnancy more maternal and foetal prognostic is compromised.     

Focus on the various techniques of anaesthesia in ophthalmologic surgery

Ophthalmologic surgery is not a vital one. It mostly concerns patients in extreme ages: children and old people. The risk of anaesthesia mainly depends on the health conditions of the patient. General anaesthesia through use of intravenous drugs alters the balance of the endocrine and sympathetic systems. Tracheal airway intubation constitutes an added constraint and stress especially for the vascular system. Retrobulbar anaesthesia is not devoid of risks: ptosis, diplopic, orbit haematoma, lesion of the optic nerve, eye perforation, vascular occlusion, intra arterial injection, neurologic and cardiovascular toxic effects of local anaesthetics, are all ever present risk Topical anaesthesia with its various variants (single topic or associated with intracameral injection, subconjunctival, circumferential perilimbal, subtenon) represents an interesting alternative for it is simple, less toxic and harless. In our experience, this method is indicated in surgery of eye's anterior segment. We find it safe, efficacisious and economical. Regional anaesthesia is preferred to general anaesthesia especially in the surgery of dacryocystitis and ptosis. General anaesthesia in stell indicated in case of children.     

Preoperative concurrent chemotherapy and radiation therapy in cervix cancer: preliminary results

This is a retrospective study of patients treated for cervix cancer staged IB2, IIA or IIB with bulky tumor (> 4cm). Treatment was concurrent radiotherapy (45Gy with 1,8Gy daily fraction) and chemotherapy (5 cycles of Platinum 40mg/m2/week). All patients underwent Brachytherapy (15Gy on the reference isodose according to Paris system) followed by surgery (radical abdominal hysterectomy and bilateral pelvic lymphadenectomy: Piver 3) Between October 1999 and December 2002, forty five patients were treated in this protocol. Median age was 46 years (21- 68). Histology was squamous cell carcinoma in 93% and glandular carcinoma in 7%. Average external radiation dose was 44Gy (20-50). Ninety three percent of patients had at least 3 cycles of chemotherapy and 46,5% received the planned 5 cycles. On the operative specimens, there was 62,5% complete response and only 7 pelvic node involvement (17,5%). Four postoperative complications were noted (one vascular injury, one urinary fistula, one phlebitis and one lymph collection). Preoperative combined radiotherapy and chemotherapy in the early bulky stages of uterine cervix cancer is well tolerated and "gives" a high rate of sterilisation. There was no increase in surgical morbidity.     

Sedative practice in intensive care units results of a Maghrebian survey

OBJECTIVES: sedation is central to the management of intensive care patients. The aim of this study was to establish the current sedation practice in Maghrebian intensive care units (ICUs). The use of sedation policies with or without a written protocol, the use of scoring systems, the influence of costs on drug choice, the most common drugs for sedation and the use of neuromuscular blocking agents. METHODS: a self-administered questionnaire composed of 20 items was sent to 138 intensivists in the Maghreb working in 25 teaching hospitals and 16 private clinics. RESULTS: 50 of 138 questionnaires were returned (response rate = 36.2%). Midazolam and Fentanyl were the main sedative agents used (respectively 98% and 87%) less than 14% of the ICUs used the Propofol mainly in the first 48 hours. A sedation policy was adopted in 63.6% with a written protocol in 20% of cases. Sedation scoring systems were noted in 14.3% of cases (RAMSAY scale in 100%). Economic aspect was important for 64.6% of ICUs. DISCUSSION: sedation may seem secondary in the initial management of intensive care patients, only 63% of our respondents had a sedation policy and 20% a written protocol though its use is thought to improve outcome and reduce costs. Economic aspect was important for the choice of the drug to use (64%), this may explain the preferential use of Midazolam 98% in association with an analgesic (Fentanyl: 85%) while Propofol is used only in 14% though pharmacoeconomic studies may be in fact in favor of the latter. Neuromuscular blocking agents are less frequently used (16%) mainly because of the risk of complications.     

Sarcomas of the small intestine

Sarcomas of the small intestine are rare, clearly differentiated, malignant, mesenchymatous tumours that can be of smooth muscle, Schwann cell or fibroblastic origin. From a clinical point of view, the pain and abdominal mass are the 2 types of symptoms that frequently reveal the disease. In rare cases, sarcomas of the small intestine are manifested by an acute complication. No imaging method can clearly confirm the diagnosis. Before immunohistochemistry, differential diagnosis was made on undifferentiated mesenchymatous "stromal" tumours, which are also rare. Exeresis must be complete and without perforation of the tumour because of the risk of locoregional relapse. The benefits provided by chemotherapy and radiotherapy are limited because of the low mitotic activity of the tumour cells and its weak vascularisation. Long-term survival is limited by poor prognosis criteria: high grade malignancy, size greater than 5 cm, tumour extension, perforation of the tumour, quality of surgical resection and histological type.     

Gastrointestinal manifestations in severe scorpion envenomation

OBJECTIVES: To evaluate the type and incidence of gastrointestinal manifestations secondary to scorpion envenomation and their prognostic significance. PATIENTS AND METHODS: All patients admitted to our ICU for scorpion envenomation were included in this retrospective chart review of a 13-year period (1990 - 2002). RESULTS: During the study period, 951 patients were admitted for scorpion envenomation and 72 (7.6%) died. Ages ranged from 0.5 to 90 years with a mean of 14.7 +/- 17.4 years. Gastrointestinal symptoms were present in 700 patients (73.6%): nausea in 24 (2.5%), vomiting in 687 (72.2%) and diarrhea in 41 patients (4.3%). At univariate analysis, the presence of diarrhea was associated with a fatal outcome (P < 0.05). Diarrhea was also correlated with other indicators of severe envenomation and poor prognosis: respiratory failure (P = 0.01), neurological failure (P < 0.0001), liver failure (P < 0.0001) and low blood pressure requiring catecholamine support (P = 0.02). The multivariate analysis showed that young age (age less than 5 years), fever > 38.5 degrees C, neurological failure and pulmonary edema were independent factors of severity. Digestive disorders were more frequent in children and in this subgroup diarrhea appeared to be associated with poor outcome. In a subset of patients for whom data were available, fatal cases demonstrated significantly higher liver enzymes levels on admission. CONCLUSION: In Tunisia, gastrointestinal symptoms are often observed in severe scorpion envenomations, especially in young patients. In children, diarrhea and elevated liver enzymes are associated with poor prognosis.     

Prognosis of traumatic head injury in South Tunisia: a multivariate analysis of 437 cases

BACKGROUND: This study aimed to determine predictive factors of mortality after posttraumatic brain injury. METHODS: A retrospective study conducted over a 3-year period (1997-1999) involved 437 adult patients with head injury admitted to the intensive care unit of a university hospital in Sfax, Tunisia. Basic demographic, clinical, biologic, and radiologic data were recorded at admission and during the intensive care unit stay. RESULTS: This study included 393 men (90%) and 44 women with a mean age of 36 +/- 17 years. Traffic accidents were the main cause of trauma (85.6%). In 58% of the cases, the injury was serious (Glasgow Coma Score, <8). The mean simplified acute physiology score was 39 +/- 15, and the mean Injury Severity Score was 34.5 +/- 17. Of the 437 patients, 127 (29.1%) died. According to multivariate analysis, the factors that correlated with a poor prognosis were age older than 40 years (p < 0.01), simplified acute physiology score exceeding 40 (p < 0.001), Glasgow Coma Score lower than 7 (p = 0.03), intracranial mass lesion (p = 0.02), a cerebral herniation (p < 0.001), diabetes insipidus (p < 0.001), and blood sugar level higher than 10 mmol/L (p < 0. 001). CONCLUSIONS: In Tunisia, head injury is a frequent cause of hospitalization, comprising 14.4% of all adult admissions. It is observed most often among young patients involved in traffic accidents. The short-term prognosis is poor, with a high (29%) mortality rate, and determined by demographic, clinical, radiologic, and biologic factors. Prevention is highly advised.     

Mechanical ventilation in intensive care units: indications, modalities and complications. Results of a prospective multicenter survey in Tunisia

The survey was performed during the month of March 1998 and concerned 9 ICUs located in teaching hospitals. To be included each ICU had to MV for more than 12 hours were included in the study and had a 28 day follow-up in the ICU or until hospital discharge. Collected parameters were indications of MV, modalities of MV and of weaning, complication and outcome at hospital discharge. Assist-control ventilation was the most used ventilation modality (69.8%). Weaning of MV was performed in 63% of the study patients and was based on a once-a-day attempt of spontaneous breathing through a T-piece (59.5%) and a combination of intermittent mandatory ventilation with pressure support (IMV-PS: 27%) or pressure support alone (11.2%). Mean length of hospital stay was 19.7 +/- 15.9 days of which 11.6 days were spent in the ICU. Fifty nine patients (54%) were alive at discharge form the ICU of whom 4 ultimately died during their hospital stay. MV practice as well as ICU facilities are not homogenous in Tunisia. Recommendations and guidelines should be built in order to standardize MV practice in Tunisia.     

Potter's reno-facial syndrome

Potter's reno-facial syndrome is a rare innate abnormality. We bring 4 observations repertoried at the maternity of military hospital of Tunis over a period of 6 years (1997 - 2002). The purpose of our work is to determine after a review of the literature the echographic and foetopathologic characteristics, and the forecast of this syndrome. The frequency of the bilateral renale agenesis is of 0.27 per thousand. Positive diagnosis bases essentially on the ultrasound of the 2th, or the 3-th trimester. The signs of appeal are essentially the oligoamnios associated to an hypotrophy. The caryotype is systematic to eliminate an associeted chromosomic abnormality. Foetopathologic exam is usefull for the diagnosis. Main abnormality except the urinary pathology is the lung hypoplasia. Therapeutic interruption of the pregnancy in this situation not compatible with the extra-uterine life., only type IV authorize the development of the pregnancy according to echographic data and of foetal urinaire biochemistry. We insist on the early practice of the morphological ultrasound between 20 - 22 weeks for the diagnosis of foetal abnormalities and the place of the genetic advice in association with the geneticist in the coverage of the couple.