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BACKGROUND: The cyclooxygenase-2 (cox-2) pathway is now recognized to be important in human cancer development and progression. The gene for cox-2 carries a common single nucleotide polymorphism, T8473C, located within a potential functional region in the 3'-UTR of cox-2 gene was identified. We have investigated the frequencies of cox-2 genotypes in Tunisian population to determine whether that polymorphism was associated with the risk of nasopharyngeal carcinoma (NPC) in Tunisian population. MATERIAL AND METHODS: One hundred and eighty-nine NPC patients were compared to 237 healthy controls. RESULTS: The cox-2 T8473C polymorphism was significantly associated with NPC (P=0.031). The CC-genotype and C allele were more frequent in control compared to patients group [CC: OR=0.37; P=0.013; 95% CI: 0.17-0.81; C: OR=0.72; P=0.032; 95% CI: 0.53-0.97]. Multivariate logistic regression analyses revealed that the CC-genotype was associated with a significantly decreased risk of NPC (P=0.013). Tumor sizes, histologic grade, presence of primary lymph node metastases, age or sex were not associated with cox-2 genotypes. CONCLUSION: We conclude that the CC-genotype and C allele of cox-2 T8473C gene polymorphism are associated with decreased risk of nasopharyngeal carcinoma in a Tunisian population.

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The interleukin 12 (IL-12) cytokine, encoded by polymorphic genes, plays a central role in the T helper 1 cell-mediated immunity against tumors. We investigated whether the 3' untranslated region +1188 A/C polymorphism (rs 3212227) influences the nasopharyngeal carcinoma (NPC) risk in Tunisian patients. DNA analysis of 247 patients and 284 healthy individuals showed a higher frequency of the 1188 C allele and the CC genotype in patients than in controls (P = 0.00001 and P = 0.00005) suggesting that the C variant allele is associated with the susceptibility to NPC. Additional testing showed that the homozygous CC genotype is also associated with advanced stage of the tumor extension at presentation (P = 0.022). Our data suggest that the impaired production of IL-12 behaves as a risk factor for NPC occurrence and progression.

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OBJECTIVE: Respiratory allergies are the most common occupational diseases in the world. The aim of this study was to determine the prevalence of rhinitis and asthma among apprentices exposed to cotton dust in the clothing industry and to describe their epidemiologic and clinical profiles. SUBJECTS AND METHODS: We carried out a descriptive study of 600 apprentices in a textile and clothing vocational training centre in the Monastir area. The investigation comprised a questionnaire exploring risk factors and symptoms appearing during their training. Subjects who developed allergic respiratory symptoms at the work-place underwent a clinical examination, rhinomanometry and investigation of their allergic status and respiratory function. RESULTS: One hundred twenty apprentices (20%) developed allergic respiratory reactions due to exposure to textile dust (exclusively cotton) during their training, with a positive withdrawal-re-exposure test. Conjunctivitis (14.3%) and rhinitis (8.5%) were the most frequent allergic symptoms. Twenty eight apprentices (4.6%) presented symptoms of asthma. Rhinitis was associated with asthma in 45% of cases. Two cases of asthma were diagnosed clinically at the work-place following their exposure to textile dust. The prick test performed in 120 symptomatic apprentices was positive in 41.6% of cases. There was sensitization to pollens in 29 cases and to dermatophagoides in 13 cases. Cotton and wool allergy was noted in two cases. Allergic symptoms developing during the training were significantly more frequent in the atopic group, and they varied according to the intensity of textile dust exposure. CONCLUSION: In the textile and clothing industry the frequency of respiratory disorders caused by allergens remains high, especially in atopic apprentices who constitute a population at high risk.

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With the purpose of illustrating a particular circumstance of giant macroprolactinoma diagnosis, we report the case of a 54-year-old woman who was seen in the Endocrinology department with the suspected diagnosis of hyperthyroidism in presence of unilateral exophthalmos. The patient reported headaches during the last year and secondary amenorrhea since she was 38 years old. The ophthalmologic examination confirmed the unilateral left exophthalmos, which was associated with oculomotor paralysis and vision loss. The computed tomography demonstrated a great mass of the sella extending in all directions and destroying the bone. The hormonal investigation confirmed the diagnosis of prolactinoma, with a level of 8723 ng/ml, and revealed hypopituitarism. The start of bromocriptin treatment was followed by a fall in the prolactin level to less then 200 ng/ml in 1 month. This case is particular regarding the giant macroprolactinoma in a woman discovered by an unusual visual complication.

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Nasofrontal fistulas, also called nasofrontal dermal sinuses, are very rare and found for the most part in children. This congenital malformation may be revealed by local infection or neuromeningitis, making this a serious disorder. We report one case of nasofrontal dermal sinus diagnosed in an 11-month-old girl, which was complicated by left fronto-orbital infection. Through this case, the authors stress the role of imaging methods in confirming the diagnosis and looking for associated cysts (dermoid and epidermoid).

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For a long time the imaging diagnosis of spine disease was based on conventional radiology (plain radiography, myelography and arteriography). The recent employment of MRI had changed the study of spine disease thanks to an excellent contrast and a multiplanar approache. In fact, nowadays MRI is the most sensible technic for a combined study of spine container and contents and medullar tissue.

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Even in endemic countries, the primitive pleural hydatid cyst is exceptionnal and it's very difficult to distinguish from other pleural and parietal cystic masses all the more the immunologic tests are negative. We report the case of a primitive pleural hydatid cyst diagnosed in 43 years old man. Throug this case, imaging features are emphasized.

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Hemangioma is a benign vascular tumor composed of angioblastic cells. The adrenal gland localization is very rare, with only fifty cases reported in literature. We report a case of adrenal gland hemangioma diagnosed in a 55-year-old woman who presented a cervical neoplasm. The non-specific imaging features, the tumor size and the clinical context led to mandatory surgical resection. The pathological examination established the diagnosis of adrenal gland hemangioma.

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Pituitary is the most important gland of the organism which can be affected by many diseases, especially by adenomatous processes. Classically macroadenoma, microadenoma and picoadenoma are described, according to the size of the pituitary adenoma. The diagnosis of microadenoma was long considered a highly difficult task and that of picoadenoma was impossible by computed tomography. Recently, the high resolution of multiplanar MRI has enabled the diagnosis of microadenomas measuring less than 3 mm (picoadenoma). For macroadenoma, MRI not only contributes to diagnosis but is particularly important to assess the extension and to detect possible complications. The aim of our study is to illustrate MRI features in pituitary adenoma.

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Clubbed fingers are classically associated with chronic cardiac and pulmonary affection. Pachydermoperiostosis, a rarer aetiology, is a hereditary affection which is difficult to diagnose in its incomplete form. We relate a Tunisian case report. Our patient consulted for joint manifestations. The diagnosis of Pachydermoperiostosis was set up on 3 out of the 4 Borochowitz criteria. The osteoarticular manifestations mainly led to differential diagnosis with secondary hypertrophic osteoarthropathy. The underlying pathogenic mechanism of this disease still remains unclear.

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Elastofibroma dorsi is a rare benign and slow growing fibro-proliferative lesion of unknown pathogenesis. It has a characteristic location (periscapular region) and a specific imaging appearance (songraphy, CT, MRI) allowing accurate prospective diagnosis. The recognition of this benign lesion avoids unnecessary biopsy and/or surgery. We report three cases of elastofibroma dorsi illustrating the characteristic features on sonography, CT and MRI. Involvement was bilateral in two cases.

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The 5,10 methylene tetrahydrofolate reductase (MTHFR) is an enzyme that catalyzes the irreversible reduction of 5,10 methylene tetrahydrofolate into 5 methyl tetrahydrofolate. It is coded by a gene where several polymorphisms have been identified. The most common is the C677T polymorphism described as presenting an heterogeneous worldwide distribution and associated with different disorders such as cardiovascular and cancerous diseases. The aim of this work was to determine the allelic and genotypic frequencies of the C677T polymorphism among a Tunisian healthy population. The study concerned 185 subjects apparently healthy. It was carried out by the PCR/RFLP method, using the restriction enzyme Hinf I. The results has showed an allelic frequency of 17.8% with a genotype frequency of 5.4%. These values are intermediate between those observed in Africa and those observed in Western countries. They must be considered in the evaluation of the clinic significance of a predisposition to diseases.

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Chronic recurrent multifocal osteomyelitis (CRMO) is a recognized condition that usually affects children and adolescents. It's characterized by insidious onset of local swelling and pain in affected bones. Clinical, biological and especially radiological abnormalities are suggestive of septic osteomyelitis, so the diagnosis is delayed. Bone biopsy with culture is certainly necessary to rule out bacterial osteomyelitis and bone tumor. Authors report the case of a 27-years old man in whom the diagnosis of CRMO was done after 14 years course.

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BACKGROUND: Despite their relative rarity, increased awareness of tuberculous sacro-iliitis is necessary. Indeed, diagnosis is usually delayed, because of the non specific clinical features and the difficulty to explore the sacro-iliac joint. OBJECTIVE: To study the characteristics of sacro-iliac joint tuberculosis. MATERIALS AND METHODS: A retrospective study of 22 cases of tuberculous sacro-iliitis collected between 1987 and 2003 in four university hospital centres. All our patients were explored clinically and radiologically. Microbiology, biochemical and serologic tests were also performed. RESULTS: 13 cases were confirmed bacteriologically or histologically and for the remaining nine cases evidence of tuberculous sacroiliitis was based on clinical, biological, radiological features and outcome on treatment. Inflammatory pain was present in almost all cases, and a collected abscess in 11 cases. Standard radiographs were also in all cases and ultrasound and CT scan showed an abscess in 8 patients. The average duration of treatment was nine months. The outcome was excellent in the majority of cases. CONCLUSION: Sacro-iliac joint is difficult to explore and has recently beneficiated of technical improvement in imaging and diagnostic. Medical treatment of tuberculosis sacro-iliitis is often sufficient.

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Our prospective study interested 41 patients, from 13 to 70 years old, and present a nasopharyngeal carcinoma confirmed histologically, during the period going from September 1999 to March 2000, and 45 healthy controls. A blood sample was collected from each patient before any treatment, as well as controls to measure serum LDH and its isoenzymes. Two groups of patients were selected after a period varying from 12 to 37 months with a mean of 29 months: 29 with favourable evolution, 12 with non favourable evolution. The mean serum total LDH and its isoenzymes values were significantly higher in patients than those in controls with values of variable p of 0.001 to 0.05. A significant correlation was found between ganglionnary extension and serum values of total LDH, LDH3 and LDH5. No significant difference were observed between the means serum total LDH before treatment and the clinical evolution of patients. Diagnostic contribution of total LDH is limited, by its ubiquitary character, but could constitute for LDH3 a good marker of the disease progression.

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Metastatic tumors of the pituitary gland are not commonly diagnosed during life in cancer patients. The occurrence of symptomatic lesions is also very unusual and difficult to differentiate clinically and radiologically from pituitary adenomas. We report a case of pituitary metastasis which was the prime manifestation of a small cell lung carcinoma in a 40-year-old man. This cancer was revealed by diabetes insipidus and a hypopituitarism.

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UNLABELLED: Clinical manifestations of hypothalamic-pituitary Langerhans'cell histiocytosis are commonly, diabetes insipidus and sometimes growth hormone deficiency. Their morphologic characteristics on magnetic resonance imaging are absence of posterior pituitary hyperintensity and thickening of the pituitary stalk. Pituitary stalk transection is characterized on magnetic resonance imaging by the absence of pituitary stalk visibility, hypoplasia of the anterior hypophysis and ectopic posterior pituitary hyperintense signal. This syndrome has been shown to be associated with either isolated growth hormone deficiency or multiple anterior pituitary hormone deficiency, but normal posterior pituitary function. CASE REPORT: We report our experience with a six-year-old boy who had been treated for three years for a multisystem Langerhans'cell histiocytosis with diabetes insipidus and who was admitted because of short stature. Endocrinological examinations demonstrated a profound growth hormone deficiency and a partial central hypocorticism. Magnetic resonance imaging showed pituitary stalk transection and a midline anomaly of the brain (Arnold Chiari type I malformation). CONCLUSION: Although, some events of his perinatal history lead to the hypothesis of a malformative origin, the progression of Langerhans' cell histiocytosis affected tissues to fibrosis, suggest that this disease is the cause of the patient's hypothalamohypophyseal lesions.

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The authors report a case of eosinophilic granuloma involving the roof and the lateral wall of the left orbit in a 5-year-old boy. The clinical presentation and especially the imaging features (computed tomography and MRI) suggested a malignant tumor and the final diagnosis was obtained by fine needle aspiration biopsy with histopathologic examination. Despite its alarming radiologic appearance, there was spontaneous healing of the eosinophilic granuloma with restitution ad-integrum of the bone.

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Acute pancreatitis caused by hydatic cyst of the liver was rarely reported. The authors report a new case of hydatic pancreatitis characterized by visualization of hydatid membranes in the biliary tract without any biliary stone or alcoholic consumption.

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