From diagnosis to treatment of gluteus medius tendon tear of the hip: a case report]

OBJECTIVE: To report a case of spontaneous gluteus medius tear repaired surgically in a 42-year-old woman patient without any other antecedent other than diabetes. PATIENT AND METHODS-RESULTS: Trochanteric pain evolving for 7 months led to scintigraphy objectifying a hyperfixation of the trochanter and ultrasonography showing an inflammatory gluteus medius tendon. These examinations were supplemented by magnetic resonance imaging and tomodensitometry visualising the tendon rupture but no marked fat degeneration of the muscle despite atrophy of this one. Surgical exploration confirmed the presence of a major rupture of the gluteus medius tendon, which was reinserted through an osseous trench. Rehabilitation involved protecting the tendon, by an installation of the member in abduction and passive mobilization from the third postoperative day, with a move to partial support on day 45. The result after 16 months was excellent, the patient returning to work 8 months after the surgery without any residual pain. CONCLUSION: The spontaneous rupture of the gluteus medius, often ignored, can occur in young subjects and induce limited function, often well corrected by reinsertion surgery.     

Qualité des supports de communication de crise lors de la pandémie de la COVID-19 au Grand Maghreb

ObjectiveTo objectively assess the quality of “crisis communication” media, during the COVID-19 pandemic, in the three Greater Maghreb countries (Tunisia, Algeria, Morocco).MethodsA compliance audit for press releases and epidemiological bulletins was analyzed against a quality benchmark, which had been specifically designed by the authors. This framework, made up of five dimensions and 50 items, graded (0/1), was applied by two researchers in preventive medicine. Multiplying the scores by a coefficient of two resulted in a partial score of 20 points for each dimension and a total score of 100 points for the checklist taken as a whole. The quality of the communication media was considered to be good when exceeding the thresholds of 15/20 for the different dimensions and 75/100 for the entire grid.ResultsA total of 141 information media were included in this audit (Tunisia: 60; Algeria: 60; Morocco: 21). The overall median quality score for these media was only 56/100 (IIQ: [46–58]), without major variability between countries. The most appreciated dimension was “maintaining the confidence of the population”, with an overall median score of 14/20 (12/20 for epidemiological bulletins and 16/20 for press releases). The most poorly rated dimension was “strengthening community participation”, with a median score of only 4/20 (6/20 for epidemiological bulletins and 4/20 for press releases).ConclusionThe quality of the Maghreb crisis communication media during COVID-19 was insufficient in most of its dimensions and items, particularly from a psychosocial standpoint. Reinforcement of the capacities of communication officers to develop information material and supports during health crises is indispensable and should be considered as an urgent matter.     

Diagnostic and therapeutic advantages of rigid ureteroscopy: retrospective study of 304 cases

Uretroscopy has become a common tool for the diagnosis and management of the upper urinary tract. Between April 1994 and Decembre 1999, 304 ureteroscopy procedures were performed. The most common therapeutic procedure was stone manipulation in 299 cases (distal ureter 259 cases, mid-ureter 23 cases, lumber ureter eight cases and staged in nine cases). Procedure was made by a rigid ureteroscope 8.5 Ch or 11.5 Ch. Dorinia was used in 175 cases (57.5%) with or without fragmentation by ultrasound. Therapeutic ureteroscopy was also used to remove a double-J stent that had migrated into the pelvic ureter in one case and in three cases of ureteral tumor. It was used in one case to confine the extrinsic compression of a ureteral stenosis. Median follow up was 12 months (6-36 months). The overall success rate was 87.6%. Results are comparable in men and women (P = 0.8). Success rate was 90% in single lithiasis and 76.2% in case of numerous stones (P = 0.0094). There was a statistically significant difference in success rate between stones 15 mm or under in size (89% stone-free) and those 15 mm (66% stone-free) or larger. In conclusion, rigid ureteroscopy is a minimally invasive and reliable technique for the management of ureteric calculi and for the diagnosis and treatment of other ureteric lesion.     

Association of a common genetic variant (insertion/deletion) in ACE gene with prostate cancer susceptibility in a Tunisian population

BackgroundAngiotensin‐converting enzyme (ACE) plays a pivotal role in several pathologies including cancers. The association of insertion/deletion (I/D) polymorphism of the ACE gene with prostate cancer (PC) risk remains controversial. We aimed to investigate for the first time, to our Knowledge, in North Africa the potential relationship between ACE I/D polymorphism with PC susceptibility and clinical outcomes of PC patients.MethodsThis case‐control study included 143 healthy individuals and 124 patients diagnosed with PC. Using genomic DNA, the samples were genotyped for ACE I/D polymorphism by polymerase chain reaction (PCR).ResultsWe found that The D allele is significantly associated with an increased risk of PC and D/D + D/I genotypes were at 3 times increased risk of PC ([p = 0.005], OR = 2.95, IC 95% = 1.26–7.09) compared with I/I genotype (p = 0.003, OR = 0.3, IC 95% = 0.12–0.74). We observed an association between D/D and D/I genotypes with advanced age (≥70 years) (p = 0.014; r ² = 0.22). Furthermore, there is a significant prediction of advanced Gleason score ≥8 based on epidemiological parameters and ACE genotype (p = 0.000; R² = 0.349), although no significant association was observed with stage and metastasis.ConclusionThe ACE I/D polymorphism is likely to predispose to PC and could play a role in PC progression and aggressiveness.     

A new functional imaging technique for the early functional evaluation of antiangiogenic treatment: dynamic contrast-enhanced ultrasonography (DCE-US)

Dynamic contrast-enhanced ultrasonography (DCE-US) using a second-generation contrast agent and perfusion software is a new technique enabling a quantitative assessment of solid tumor perfusion using raw linear data. Clinical trials have shown that it can be used to assess the anticancer efficacy of antiangiogenesis treatment, for which conventional, size-based efficacy criteria are unsuitable. Reduction in tumor vascularization can easily be detected in responders after 1 or 2 weeks and is correlated with progression-free survival and overall survival. DCE-US is supported by the French National Cancer Institute (INCa), which is currently studying the technique in metastatic breast cancer, melanoma, colon cancer, gastrointestinal stromal tumors and renal cell carcinoma, as well as in primary hepatocellular carcinoma, to establish the optimal perfusion parameters and timing for quantitative anticancer efficacy assessments.     

The results of anterior cruciate ligament reconstrution by bone--patellar tendon--bone technique. A series of 40 cases

We reviewed retrospectively 40 patients treated surgically for rupture of anterior cruciate ligament. The technique used was arthroscopy bone patellar tendon reconstruction. The mean age of patients was 27 years. The operative delay was 27.2 months in average. Functional and anatomic result was evaluated with a mean follow up of 24 months. 80% of patients were classified IKDC A or B. Sports activity was resumed after 6.6 months in average. Results depented meniscus lesions and operative delay. Reconstruction of anterior cruciate ligament with bone patellar tendon bone is a reliable technique. Operative delay should be as short as possible to prevent meniscus lesion and aggravation of laxity.     

Profile of antimicrobial resistance of agents causing urinary tract infections in children

OBJECTIVE: The management of urinary tract infection in children faces the problem of the emergence of resistant strains to antibiotics. The aim of this study is to precise the frequency of the different germs and their susceptibility to antibiotics. METHODS: We report a retrospective study concerning 200 cases of urinary tract infection hospitalised in the paediatric department of Monastir between January 1995 and December 2000. There were 58 boys and 142 girls aged between two months and 14 years with a mean age of 5 years. The frequency of urinary tract infection is 1.85%. RESULTS: The most common causative agent is Escherichia coli in 75.5% of cases, followed by Proteus mirabilis (10%) then by Klebsiella pneumoniae (6%). Escherichia coli is predominant in girls, whereas Proteus mirabilis and Klebsiella pneumoniae are likely encountred in boys. Of all the strains, 96% are resistant to ampicillin, amoxicillin and cefalotin, 67% to amoxicillin + clavulanic acid and 34% to cotrimoxazole. A resistance to ampicillin, amoxicillin and cefalotin is noted in 96% of the germs. The resistance is of 67% for amoxicillin + clavulanic-acid and of 34% for cotrimoxazole. However, third generation cephalosporins and aminoglycosides remain usually active on the majority of strains incriminated in these infections a part from Pseudomonas.     

Estrogen and progesterone receptor assay in paraffin-embedded breast cancer--reproducibility of assessment

Immunohistochemical (IHC) assays are routinely used for determining the estrogen receptor (ER) and progesterone receptor (PgR) status of women with breast cancer. The present knowledge of reproducibility of the subjective IHC assessment is limited. The purpose of this study was to evaluate the interobserver reproducibility in IHC assessment of 127 (ER) and 126 (PgR) cases of primary breast cancer. The slides were independently re-assessed by 22 pathologists from nine hospitals. A simple assessment protocol was used with a cut-off value > 10% stained nuclei, regardless of staining intensity. The concordance was high, with a kappa value of 0.78 for ER and 0.72 for PgR. Since some of the 22 pathologists considered one or several sections to be inevaluable, the evaluation comprised three groups (< or = 10% vs. > 10% vs. not evaluated). Although the percentage of positive cases varied among the 22 pathologists (ER: 57%-79%; PgR: 41%-66%), the overall concordance was good for both ER and PgR (kappa = 0.78 and 0.72, respectively). A further improvement in concordance should be possible to achieve through training.     

Isolated, spontaneous hematoma of the kidney. Report of 2 cases

Spontaneous hematoma under the renal capsula is a rare pathology. The authors report two cases with one male and one female aged respectively of 50 and 63 years. The symptomatology is presented by right renal aches associated with repetitive and total hematuria in male and atypical abdominal aches in female. The radiological explorations (IVP, renal sonography and Computered Tomography) had conclude in a renal cancer in the two cases. The diagnosis is made by the pathologic study. Some etiology may be searched such as malignant tumor, an angiomyolipoma, vascular abnormalities and disturbance to the hemostasis. If no etiology is find, a nephrectomy or a simple supervision can be discussed.