Diabetes following kidney transplantation. Report of 35 cases

Post-transplant diabetes mellitus (PTDM) is a frequent complication of renal transplantation. It has a prevalence rate ranging from 3 to 46%. We undertook a retrospective study of 175 nondiabetic renal transplant recipients to determine the prevalence rate, clinical characteristics, and risk factors of PTDM in kidney transplant recipients in our region. Thirty five patients (20%) developed PTDM, 50% were diagnosed by 3 months post transplantation. Eight patients (22.8%) were insulin recurrent. PTDM was independent of kidney source, family history of diabetes, age, sex, incidence of acute rejection, body weight gain, steroid or cyclosporine dose, use of beta-blockers and cytomegalovirus infection. Acturial 5 years survival was 79.4% in the diabetic compared to 80.5% in the control group. Patient survival was similar in the two groups. We conclude that PTDM is frequent in our patients. No significant risk factors of PTDM were identified in this study.     

Increasing evidence for a human breast carcinoma virus with geographic differences

BACKGROUND: An early immunologic study suggesting that a virus similar to the mouse mammary tumor virus (MMTV) was associated highly with breast carcinoma in Tunisian patients, compared with patients in the United States, led the authors to examine different breast carcinoma populations by using more current molecular techniques. METHODS: Thirty-nine paraffin blocks were selected for sequencing of the 250-base pair segment of the MMTV from patients with breast carcinoma who were seen and treated at the Institut Salah Azaiz in Tunisia. Fifteen of those blocks were examined under code by a second laboratory, which used a different methodology and was blinded to the results of the first laboratory, and 14 blocks were analyzed successfully. RESULTS: The comparison of Tunisian patients and patients from other countries clearly showed a significantly higher proportion of tumors with MMTV-like sequences in the Tunisian series of patients. There was complete reproducibility of data between the two laboratories. Using the results from the first laboratory and similar studies from the literature, detection of the MMTV-like env gene sequence showed an important geographic pattern with a significantly higher percentage of positive patients with breast carcinoma in Tunisia (74%) compared with patients with breast carcinoma in the United States (36%), Italy (38%), Australia (42%), Argentina (31%), and Vietnam (0.8%) CONCLUSIONS: The findings provided increased evidence for a human breast carcinoma virus with geographic differences in prevalence. The geographic differences were compatible with studies of MMTV in wild mice; thus, the data were plausible biologically.     

Laparoscopic gastric banding: a minimally invasive surgical treatment for morbid obesity: prospective study of 500 consecutive patients

OBJECTIVE: To evaluate early and late morbidity of laparoscopic adjustable gastric banding for morbid obesity and to assess the efficacy of this procedure by analyzing its results. SUMMARY BACKGROUND DATA: Laparoscopic adjustable gastric banding is considered the least invasive surgical option for morbid obesity. It is effective, with an average loss of 50% of excessive weight after 2 years of follow-up. It is potentially reversible and safe; major morbidity is low and there is no mortality. METHODS: Between April 1997 and June 2001, 500 patients underwent laparoscopic surgery for morbid obesity with application of an adjustable gastric band. There were 438 women and 62 men (sex ratio = 0.14) with a mean age of 40.4 years. Preoperative mean body weight was 120.7 kg and mean body mass index (BMI) was 44.3 kg. m. RESULTS: Mean operative time was 105 minutes, 84 minutes during the last 300 operations. Mean hospital stay was 4.5 days. There were no deaths. There were 12 conversions (2.4%), 2 during the last 300 operations. Fifty-two patients (10.4%) had complications requiring an abdominal reoperation. Forty-nine underwent a reoperation for minor complications: slippage (n = 43, incisional hernias (n = 3), and reconnection of the catheter (n = 3). Three patients underwent a reoperation for major complications: gastroesophageal perforation (n = 2) and gastric necrosis (n = 1). Seven patients had pulmonary complications and 36 patients experienced minor problems related to the access port. At 1-, 2-, and 3-year follow-up, mean BMI decreased from 44.3 kg. m to 34.2, 32.8, and 31.9, respectively, and mean excess weight loss reached 42.8%, 52%, and 54.8%. CONCLUSIONS: Laparoscopic adjustable gastric banding is a beneficial operation in terms of excessive weight loss, with an acceptably low complication rate. It can noticeably improve the quality of life in obese patients. Half of the excess body weight can be effortlessly lost within 2 years.     

Breast cancer in women under 30 years of age

Summary Conflicting opinions exist concerning clinical and pathological presentation, as well as evolution and prognosis, of breast cancer in young women. The roles of associated pregnancy and lactation on these parameters is also unclear. These two conditions are studied in the present work through the comparison of two breast cancer patient age groups: patients under the age of 30 (Group A) and premenopausal patients aged 45–49 (Group B).Rapidly growing and/or inflammatory breast cancer (rapidly progressing breast cancer: RPBC) — a special form of Breast Cancer with a poor prognosis very frequent in the Tunisian breast cancer population — was more often present among Group A patients. This difference is a consequence of the more frequent association of this breast cancer group with pregnancy or lactation; nearly all the cases of breast cancer associated with pregnancy or lactation are RPBC. For breast cancer without the pregnancy/lactation association, the younger group generally shows poorer histological grading and more severe evolution.The number of patients in our study is not really sufficient to allow statistically significant conclusions, but it does seem clear that young age and associated pregnancy/lactation are aggravating factors in Tunisian breast cancer patients.     

Impact des facteurs psychosociaux sur la santé mentale du personnel de nettoyage

Purpose

To describe the relationship between psychosocial factors and mental health among housekeepers.

Giant condyloma (Buschke-Löwenstein tumor). A case report

Buschke-L?wenstein tumor (BLT), or giant condyloma acuminatum, is a rare sexually transmitted disease. The virus responsible for condyloma is human papillomavirus, usually serotype 6 or 11. A BLT is always preceded by condyloma acuminatum and may occur at any age after puberty. It is characterized by invasive growth and recurrence after treatment, and malignant transformation is possible. We report the case of a 44-year-old male patient with a 2-year history of a penoscrotal Buschke-L?wenstein tumor.     

Mathematical Modeling of Electrocardiograms: A Numerical Study

This paper deals with the numerical simulation of electrocardiograms (ECG). Our aim is to devise a mathematical model, based on partial differential equations, which is able to provide realistic 12-lead ECGs. The main ingredients of this model are classical: the bidomain equations coupled to a phenomenological ionic model in the heart, and a generalized Laplace equation in the torso. The obtention of realistic ECGs relies on other important features—including heart–torso transmission conditions, anisotropy, cell heterogeneity and His bundle modeling—that are discussed in detail. The numerical implementation is based on state-of-the-art numerical methods: domain decomposition techniques and second order semi-implicit time marching schemes, offering a good compromise between accuracy, stability and efficiency. The numerical ECGs obtained with this approach show correct amplitudes, shapes and polarities, in all the 12 standard leads. The relevance of every modeling choice is carefully discussed and the numerical ECG sensitivity to the model parameters investigated.