Breast cancer in Tunisia: clinical and epidemiological study

This study has been realized to determine epidemiological profile and clinicopathologic aspect of breast cancer in Tunisia. We have counted and analyzed all cancers of the breast diagnosed in Tunisia with proof pathologic or to defect cytologic of malignancy, between first January 1994 and 31 December 1994. In the course of this year, 689 new cases of mammary cancers have been diagnosed at the women. The average patient age was 50.0 years, the incidence standardized on the age of the cancer of the breast in Tunisia was 16.7/100,000 women. The average size of the tumor was 49.5 mm (35.8 mm at patients processed in private clinics and 50.7 mm at patients processed in the public hospitals). According to TNM classification of 1988, 7.2% of tumors were classified T1, 48.9% T2, 18.5% T3, and 23.4% T4 (6.2% T4d and 16.1% T4b). 22.1% of tumors were M1. 3.3% were in situ carcinoma. For the infiltrants cancers, the grade II SBR has been the most frequent (53.6%). On the therapeutic plan, the conservative processing has been practiced only at 17.6% of patients. The cancer of the breast in Tunisia rest again relatively little frequent, and its clinic profile resides alarming. The inflammatory cancer notion of the breast (equal T4d) intimately linked to Tunisia overestimates probably the reality. Cancers that were classified "PEV" in many publications would be in reality only for most of locally evolved and neglected cancers.     

Measurement of KAP concerning hepatitis B among secondary school students in Alexandria

Hepatitis B infection is a serious health problem throughout the world. Success in the prevention of this disease with its fatal consequences depends to a large extent on the adolescents' level of knowledge and their awareness about it. As well as their attitude and different risk behavior they might practice at this age. The aim of the present study was to assess the secondary school students' level of knowledge about hepatitis B and to record their perceptions, attitudes and practices towards it. Also to identify their health locus of control towards the disease. The studied sample included 643 students of both sexes representing different senior levels in one educational sector in Alexandria. The used technique was self-administered questionnaire. Results revealed that (55.2%) of the studied sample had fair level of knowledge about hepatitis B Girls had more negative attitude towards the disease than boys. About one half of the students (50.4%) were not vaccinated against the disease. Also, the majority of students had internal health locus of control regarding hepatitis B. It is recommended to integrate knowledge about hepatitis B within formal and informal school programs. Community campaigns for vaccinating the adolescents against the disease should be carried out.     

Internal abdominal hernias. Report of 8 cases]

Internal abdominal hernias are rare. There unexpected discovery at laparotomy confront the surgeon at anatomic diagnosis problem. 8 cases of internal abdominal hernias were observed between 1989 and 1998: transmesenteric in 3 cases, mesosigmoidal in 2 cases, paraduodenal in 2 cases, needing intestinal resection. Hernia foramen were sutured in all of cases without hernial sac's resection. The results of the present series were excellent without recurrence. Literature review show that internal hernias were responsible of complex anatomic and surgical presentations. The primary task of the surgeon is not so much to establish the diagnosis of internal hernia but intestinal occlusion to decide at time urgent operation.     

A Two-Scale Asymptotic Analysis of a Time-Harmonic Scattering Problem with a Multi Layered Thin Periodic Domain

The scope of this paper is to show how a two-scale asymptotic analysis, based on a superposition principle, allows us to derive high order approximate boundary conditions for a scattering problem of a time-harmonic wave by a thin and tangentially periodic multi-layered domain. The periods are assumed of the same order of the thickness. New terms like memory effect and variance-covariance ones are observed contrarily to the laminar case. As a result, optimal error estimates are obtained.     

Place de la radiothérapie dans le traitement du rétinoblastome : à propos de 40 cas

PurposeThe aim of this study is to analyze the results and the complications of radiotherapy in the treatment of retinoblastoma.Patients and methodsBetween 1994 and 2004, 40 children received radiotherapy for a retinoblastoma in Salah Azaiz Institute. The average age of the patients was 36 months (four to 132 months). There were 16 girls and 24 boys. Sixteen children presented a bilateral disease and 24 children a unilateral disease. Twenty eyes and thirty-six orbital cavities in 40 children with retinoblastoma were treated by radiotherapy. One child with a unilateral anterior retinoblastoma was treated with 106 ruthenium brachytherapy. External radiotherapy has been used to treat the 39 patients. In 20 cases the irradiation was conservative and in 36 cases postoperatively. The latter (n = 36) presented at least one risk factor of relapses noted in the histological examination. The average dose was 44 Gy (1.8 to 2 Gy per fraction, five fractions weekly). This radiotherapy was associated with chemotherapy in 24 cases.ResultsThirty-five children were followed with an average follow-up of 53 months (3–108 months). The average delay of relapses was of 10 months (two to 26 months). We found four orbital relapses and seven metastasis in nine children. The conservation of the eye with a useful visual field was noted in 18 cases among the 20 conservative irradiated eyes. The major therapeutic complication was the growth defect of the bones face. A femoral bone sarcoma was noted five years after the end of the irradiation and chemotherapy in one case.ConclusionIf the radiotherapy offers the advantage of the functional conservation and the improvement of the local control, its indications are more and more restricted in favor of the other therapeutic methods (chemotherapy, thermochemotherapy) and this considering the iatrogene risk. The development of new techniques of brachytherapy and the progresses of the conformational radiotherapy appear to reduce considerably this risk.     

Les carcinomes endocrines à petites cellules de la vessie: à propos d’une observation

Introduction

The small cell carcinoma of the bladder is a rare entity representing 0.5% of the whole bladder tumours, it is highly aggressive. It is characterized by a very high metastatic potential. The treatment is multidisciplinary associating the surgery and chemotherapy and, sometimes, the radiotherapy in order to improve the forecast of the disease and the survival of the patients.

Observation

Wereport a case of endocrine carcinoma of the bladder in a 64-years-old patient. The immuno-histochemical study showed the positivity of the tumoral cells for the chromogranine, the synaptophysine, TTF-1, the cytokeratine and a negativity for the specific antigen of the prostate (PSA). The patient was treated by chemotherapy only. The evolution was marked by the death of the patient eight months after the diagnosis.

Conclusion

The CPC of the bladder represents a particular histological entity being quickly aggressive and metastatic, with a severe forecast and a potentially effective intensive treatment, thus requiring a multidisciplinary assumption of responsibility.