Search

Typical medullary carcinoma of the breast is a rare histological form of breast carcinoma. It represents less than 5% of all breast cancer. It is known for its favourable prognosis. Considering the rarity of the series we could retrieve, we aimed at underlining the particularities of this pathology.Retrospective study about 33 cases of typical medullary carcinoma managed at the Salah-Azaïz Institute during a period of six years between 1994 and 1999.The mean age was 47.5 years. The left breast was concerned in about 55% of cases. Mean tumoral size was 46mm. Sixty-one percent of our patients were treated by radical surgery. Seventy-three percent undergo radiotherapy, 57% chemotherapy and 42% hormonotherapy. The five-year free-disease survival was about 85%.Typical medullary carcinoma of the breast is a rare histological form of breast carcinoma. Its treatment is similar to the other breast cancers. Our results agree with the different published studies and confirm its favourable prognosis.

Therapeutic results of Hodgkin disease (HD) have improved by the use of combined radio-chemotherapy. However, this association can increase the risk of on-term effects including secondary cancers. In a retrospective study, we collected secondary breast cancer (BC) in patients previously treated with chemoradiotherapy for Hodgkin disease at Salah-Azaïz institute of Tunis.Between 1975 and 2003, seven patients (six women and one man) treated for HD subsequently developed BC. Mean age at diagnosis of HD was 21 years (12-29). The first treatment was combined chemotherapy (MOPP-ABVD) and radiotherapy for all patients. Radiotherapy was delivered with cobalt 60 with large fields. The median dose was 41.3 Gy (2 Gy/fraction in 6 patients and 3.3 Gy in one).The breast tumours occurred after a median delay of 204 months (132-276). According to the TNM classification, we showed two stage T2, one stage T3, two stage T4b and two stage T4d. The mean clinical size was 47 mm (25-80 mm). All patients had infiltrating carcinoma. Axillary node histological involvement was found in 6 cases. All patients were treated by mastectomy and chemotherapy. Only one patient had a locoregional irradiation. Median survival was 26.5 months (12-48). Four patients died and three are still alive at respectively 24, 31 and 144 months.According to the previous data, breast cancer represents 6.3 to 9% of all second cancers occurring after HD treatment. We conclude that especially young women and girls treated for HD should be carefully monitored. We suggest that secondary BC be sometimes treated by conservative radiosurgical approach.

Schwannoma is a rare nervous tumor developed on schwan cells. Only 22 cases of breast schwannoma have been published since 2005. It usually appears as a breast lump having clinical and radiological characteristics suggestive of kindness. Its diagnosis is histological. Its treatment is surgical. Through two observations and a review of the literature we would try to remind the characteristics of this tumor.

To report the indications and early and late catheter-related complications in a Tunisian unit of paediatric oncology.This prospective study has been performed in a paediatric oncology unit of the Salah Azaïz Institute between 1989 and 2005. It concerns 58 girls and 57 boys with a median age of 7.9 years(4 months to 18 years) treated for cancer disease predominantly lymphoma (22%), sarcoma (23.2%) or leukaemia (8.5%) proposed for insertion of a central venous catheter (CVC).Excluding 2 insertion failures (1.6%), we placed 123 CVC (double for 10 patients), 43 (35%) exteriorised (EC) and 80 (65%) connected to an implantable site (IS). Catheters were placed in the subclavian vein in 59.2% of cases vs 32% for internal jugular vein and 8.8% for femoral vein. Early complications included 15 cases of multiple punctures (12%), 4 cases of pneumothorax (3.2%) and 6 of arterial punctures (4.8%) originating a cervical subcutaneous haematoma in 1 patient (0.8%). Late complications were represented by infection in 7 cases (5.7%). We observed 2 cases of intracardiac catheter migration due to catheter disconnection from the IS (1.6%) and 2 cases of thrombosis (1.8%). The mean life of CVC was longer for IS (305.2 days) than for EC (64.4 days).Implantable sites are effective progress for venous access in children with cancer. They improved the quality of care in pediatric oncology.

The antidiphtheria immunity of the Algerian population is not well known. Thus, a study was carried out on 1755 blood samples, in 1998 to better assess this vaccinal status. Three epidemics occurred in Algeria, in the years 1993, 1994, 1995, and then immunization sensitizing campaigns were introduced in September 1995.The procedure that was used was based on the immunoenzymatic method, the reagents of which were ready for use. The interpretation of our results and vaccinal policy deduction were performed according to the VIROTECH Diphtheria ELISA technique which offers five classes in antitoxin titers: I.0.1 IU/ml basic immunization immediately. II. 0.1-1.0 IU/ml booster immunization immediately. III. 1.0-1.4 IU/ml booster vaccination 5 years later. IV. 1.5-2.0 IU/ml booster vaccination 7 years later. V.2.0 IU/ml booster vaccination 10 years later.In our series, 17.03% of the samples had a titer0.1 IU/ml considered as insufficiently protective, an immunization was therefore recommended. 59.82% had titers ranging between 0.1 and 1 IU/ml, 5.98% had titers ranging between 1 and 1.4 IU/ml, 3.36% had titers ranging between 1.5 and 2 IU/ml, and 13.79% had titers2 IU/ml.

Remember the clinical, morphologic and histological particularities of mammary tuberculosis. Discuss clinical and radiological diagnostic problems caused by this localization, as far as breast cancer is concerned.This is a retrospective study concerning 65 women suffering from mammary tuberculosis, diagnosed at Salah Azaiez Institute between January 1980 and December 2001.In this series, mammary tuberculosis represents 0.2% of the declared tubercular localizations and 0.3% of the mammary pathologies treated at the institute. The mean age of our patients was 36 years (19 to 79). Clinical findings were misleading. In 60% of cases the aspect was of a malignant tumor, in 24.6% of cases of a benign nodule and in 16.4% of cases of an abscess. The mammography concluded to a malignant lesion in 49% of cases. The fine needle aspiration achieved at 8 patients was negative in 6 cases and brought back the caseum in the 2 others. The diagnosis has been made, for all our patients, after histological study when we found typical tuberculosis lesions on pieces of tumorectomy, or biopsy. The diagnosis of tuberculosis was established; all patients had an anti-tuberculosis medical treatment in a department of infectious diseases out of the institute.Clinical and radiological features of mammary tuberculosis are very confusing and cause a diagnostic problem with breast cancers. In front of symptoms evoking tuberculosis, biopsies must be done to eliminate an eventual cancer.

We report a case of pseudotumoral pelvic actinomycosis with lumbosacral spinal involvement in a 21 year-old woman. The radiological work-up showed a pseudotumoral left ovarian lesion extended to sacral spine, which involved the fifth lumbar vertebra. Diagnosis of actinomycosis was established in histopathological examination of the tubo-ovarian mass under laparotomy. After four months of treatment with ofloxacin and rifampicin evolution was marked by improvement of general health and infection, associated to a progressive recovery of motricity of the lower limbs. Early diagnosis of pelvic actinomycosis may prevent the occurrence of rare but severe neurological complications of this disease.

Gigantomastia is a very rare entity of undetermined aetiology that may be due to hormonal imbalance, decreased hormonal catabolism or hypersensitivity of the target organ. It poses the problem of surgical treatment, which can be exceptionally radical of necessity. We report a case of a 32-year-old woman of whom volume and vasculocutaneous complications required a simple bilateral mastectomy to treat a recurrence of gigantomastia occurring some months after a mammoplasty. Most of the cases of gigantomastia found in the literature are associated to the pregnancy or puberty and very rare cases of spontaneous gigantomastia were listed.

Breast myoepithelioma is rare. The case of a 61-year-old female is reported here. The tumor was clinically, radiologically and macroscopically demarcated. Diagnosis was based on histological and immunohistochemical studies. At the time of diagnosis the tumor consisted of myoepithelial cells with few cellular atypias and a low mitotic activity. Tumor cells expressed vimentin, actin, S100 protein and cytokeratin. No local or distant metastases were found. The patient had been treated initially with a large excision of tumor. Local recurrences detected one year after initial surgery and showed a similar morphology and immunoreactivity with higher mitotic activity. Mastectomy with axillary dissection was performed. Neither recurrences nor distant metastases detected two years later. Myoepithelial tumors which are generally considered as benign or low-grade lesions can give rise to a wide range of clinical evolution.

To collect second cancers in patients treated for Hodgkin disease (HD) during adolescence and young adulthood at Salah Azaïz Institute of Tunis.We consider as second cancer all tumours other than HD observed in patients after treatment for HD.Twenty-five patients among 614 treated for HD between 1975 and 1991 developed 26 secondary tumours (4.2%). There were 17 males and eight females (sex ratio 2:1). Mean age at the diagnosis of HD was 32.5 years (12-56). HD was stage II (eight cases), stage III (14) and stage IV in three. The first treatment was combined chemotherapy and radiotherapy in 22 cases and only chemotherapy in three cases (stage IV). Radiotherapy was delivered with Cobalt 60 by large fields. Mean dose was 41.3 Gy (2 Gy/fraction in 21 and 3.3 in one). Chemotherapy was MOPP (13), MOPP and vinblastine (four), MOPP-ABVD (five), ABVD (two) and vinblastine only in one. Mean delay of second tumours was 114.5 months (40-276). There was five acute myeloid leukaemia, two digestive non-Hodgkin lymphomas, five nodal high-grade lymphomas, three breast cancers (one in man associated with thyroid cancer), five lung cancers (three non-small cell and two of small cell type), two gastric tumours and one rectal cancer, one synovialosarcoma of the knee and one malignant Schwannoma of the neck. Median survival was 12.5 months (2-48). Twenty-one patients died and four are still alive with 8, 12, 24 and 48 months of follow-up.Second cancer risk after treatment for HD is not low. Risk factors and preventive strategies are discussed.

In this study, we isolated and identified five strains of Yersinia pestis during an epidemic occurred in west of Algeria in June 2003. The bacteriological identification was confirmed by bacteriophage susceptibility. All these strains belonged to the biovar Orientalis (they did not ferment glycerol but did reduce nitrate to nitrite) which caused the current pandemic. The in vitro activities of antimicrobial agents used to treat plague and recommended for prophylaxis, showed that they are active against all strains. The comparison of these strains by plasmid profile analyse demonstrated that all isolates had three plasmids: 110, 70 and 9.5 kb, which are present in Y. pestis strains.

Diabetic fibrous mastoplasty or diabetic fibrous breast disease is a benign condition rarely observed. First described in 1984, it can lead to misdiagnosis because it simulates breast cancer. Diabetic fibrous mastoplasty usually occurs in patients with autoimmune disorders, particularly in patients with longstanding and complicated insulin-dependent diabetes mellitus. We present a case of fibrous mastoplasty in a patient with insulin-dependent diabetes mellitus known for 17 years. The clinical and radiological features and the clinical course are illustrative. We discuss the different pathogenic theories put forward.

Hepatitis-associated aplastic anemia (HAAA) is a variant of bone marrow failure that usually follows an acute attack of hepatitis. It usually affects children and young adolescents and is uncommon in adults. The causative factor in the majority of cases remains unknown. The efficacy of immunosuppressive regimens suggests autoimmunity as a key mechanism of HAAA. Although rare, seronegative autoimmune hepatitis can be a cause of bone marrow failure. A 43-year-old Caucasian male patient with a past medical history of hypertension was admitted due to abdominal pain of two-week duration and progressive jaundice. He denied alcohol, smoking, illicit drug use, foreign travel, recent bites, scrapes, or injuries. His medications included hydrochlorothiazide, lisinopril and hydrocodone/acetaminophen. On physical exam, there was right upper-quadrant tenderness and notable jaundice but no hepato-splenomegaly. Admission laboratory data showed transaminitis and pancytopenia without neutropenia. The white blood cell count was 3.7×103/µl, hemoglobin 13.6 mg/dl, platelets 69×103/µl, ALT 2451 IU/l, AST 1573 IU/l, total bilirubin 7.7 mg/dl, alkaline phosphatase 185 IU/l and lipase 172. Further investigations included serological markers of viral hepatitis which were negative. Urine histoplasma and Cryptococcus antigens were negative. Anti-nuclear, anti-smooth muscle, anti-LKM and anti-mitochondrial antibodies were negative. Serum immunoglobulins, ceruloplasmin, acetaminophen level, DIC panel and anti-tissue transglutaminase (anti-tTG) IgA were normal. Liver ultrasound, endoscopic ultrasound, and MRI of the liver did not show any acute process. A liver biopsy showed autoimmune hepatitis (AIH). Four weeks later, pancytopenia worsened with severe neutropenia, but showed significant improvement in transaminases. Laboratory data showed white blood cell count of 1.1×103/µl, absolute neutrophil count 418, hemoglobin 10.7 mg/dl, platelets 19×103/µl, ALT 164 IU/l, and AST 50 IU/l. Peripheral blood workup for pancytopenia was unremarkable. Bone marrow biopsy showed aplastic anemia. The patient was started on steroids, cyclosporine, and anti-thymocyte globulin (ATG). His counts improved after staring immunosuppressive therapy and his liver function returned to normal. Cyclosporine was stopped because patient developed microangiopathic hemolytic anemia. Three months after initiation of therapy, his counts were stable and immunosuppressive therapy was stopped. He required no further therapy or transfusion. Aplastic anemia (AA) may develop in as many as 1 in 3 cases of seronegative clinically identifiable hepatitis. In most cases, the hepatitis is self-limiting, but the liver disease may be prolonged or recurrent. AA is characterized by diminished number or total lack of hematopoietic precursors in the bone marrow. In most cases, stem-cell failure is acquired as a consequence to exposure to ionizing radiation, environmental chemicals, drugs, or viruses. However, in some patients AA seems to be immune mediated, with active destruction of blood-forming cells. Up to 13% of patients are diagnosed with autoimmune hepatitis and have no typical antibodies or hypergammaglobulinemia at presentation. Our patient was seronegative for known hepatotoxic viruses. Although he had negative autoantibody markers, liver biopsy showed autoimmune hepatitis, thus confirming the diagnosis of seronegative autoimmune hepatitis (SAIH). Clinically, the disease presented as a protracted hepatitis with episodes of jaundice and very high transaminases. Usually bone marrow failure follows SAIH, but in our case the patient had mild bone marrow failure on admission and severe hepatitis. It is unknown whether the immune mediated mechanism targets the liver and bone marrow simultaneously or aplastic anemia is a consequence of SAIH. The hepatitis and aplastic anemia responded well to immunosuppressive therapy which confirmed autoimmunity as the etiology of aplastic anemia and hepatitis in our patient. The major pathogenic mechanisms leading to the liver injury and bone marrow destruction in SAIH patients seem to have an immune nature. Patients with SAIH should be monitored carefully, and in the presence of cytopenia directed to hematologist. Early treatment of SAIH with corticosteroids could prevent development of end stage liver disease and aplastic anemia. Disclosures No relevant conflicts of interest to declare.

Perfusion lung scintigraphy is vital to guide the diagnosis even without a ventilation scintigraphy. A customised strategy could be useful to optimise the use of perfusion scintigraphy when not coupled with a ventilation scintigraphy. We report about a retrospective study on 300 patients received in our department for suspected lung migrations. The patients underwent a perfusion scintigraphy only: a normal scintigraphy would discard the diagnosis when achieved between 6 and 72 hours after the accident. On the other hand, the evidence of one or two perfusion defects would allow to maintain the pulmonary embolism suspicion and establish an effective heparinic treatment. A second control comparative scintigraphy, a few weeks after the first one, very often confirms the diagnosis, allows the assessment of the heparinotherapy and if necessary, indicate to stop it.

To evaluate the insertion and use of implantable central venous accesses in medical oncology at the Institute Salah Azaïz.From January 1992 to June 2000, 205 patients including 179 adults (118F/61M) and 26 children aged 7 months to 72 years (mean 37 years) required the insertion of an implantable port (IP). Tumoral pathology was dominated by metastatic breast carcinoma (93/179), digestive cancer (42/179) and paediatric cancer (26 cases).Excluding 3 initial failures, we inserted 205 IP for 202 patients. The supraclavicular anatomic way (Yoffa) was used in 156/205 cases and the subclavicular (Aubaniac) for the resting 32 cases with a jugular conversion in 17 cases. Initial complications were represented by 6 arterial puncture (2.9%), 3 pneumothorax (1.5%) and 1 catheter migration in the right pulmonary artery. Median life duration of the material was 210 days (3 to 1460 days) for adults and 185 days (3 to 1460 ays) for children. Mean life duration for the 205 IP was 240 days +/- 239 (3 to 1460 days) with a total of 49,200 IP-days. We explanted 17 IP for infection (8 cases), cutaneous ulceration (8 cases) and actinomycin extravasation (1 case). We observed 6 cases (2.9%) of subclavian and jugular thrombosis treated by anticoagulants and conservation management of the port. Presently, 58 patients are alive with IP in place.Implantable ports represent a useful option in medical oncology for patients treated with prolonged chemotherapy and adjuvant treatments such as antibiotics, transfusion. This method allows a good comfort for the patients and also the treating team but requires a prealable training for the nursing team.

The identification and antibiotic sensibility of 188 strains of streptocoques pyogenes had been performed from 1994 to March 1998. We were interested on active antibiotics against streptocoques pyogenes: beta lactamins (penicillin-ampicillin) and macrolids (erythromycin). The aim of this study is to reveal resistances and calculate percentages of resistant strains to these antibiotics. The WHO recommend to treat streptococcal sore throat with penicillin, and with erythromycin when there is a proved inhibility to the penicillin. No penicillin resistant streptocoques pyogenes has been found in the world, that concords with our study: all strains (188 sp.) are penicillin sensitive. Macrolids resistant strains of streptocoques pyogenes has been described by a lot of countries with different distributions. In our study global percentage of resistant strains to erythromycin is 24% and 29% for throat specimen.

We have evaluated the activity of a new fluoroquinolone, trovafloxacin (CP-99,219), against 434 strains; 24 of them are resistant to ciprofloxacin. Against gram-negative bacteria, trovafloxacin has the same activity as the others fluoroquinolones. Against gram-positive bacteria, this antibiotic agent is very active. (MIC = 0.016 to 0.5 microgram/ml); Streptococcus is the most sensitive species. The ciprofloxacin resistant strains are also resistant to trovafloxacin.

Hodgkin's disease is now curable in more than 50% of cases, due to its chemo- and radio-sensitivity. However, treatment exposes to a risk of secondary cancer varying from 1 to 10% depending on chemoradiotherapy doses and schedules. We report a case of secondary breast cancer associated with a secondary thyroid cancer observed in a 24-year-old man treated when he was 13 years old by vinblastin and radiation for stage IIA, a Hodgkin's disease.

To report the results of seric neuron specific enolase in pediatric neuroblastoma.Our retrospective study concerns 21 children treated in our institution from 1992 to 1998 for neuroblastoma. Seric NSE was determined by immunoenzymology technique at different stages of the disease and the treatment.Mean value for the 39 dosages of the whole patients was 127.9 ng/ml with a sensitivity of 56%, five patients has presented normal values. Mean value for the 18 patients in stage IV was 132.38 ng/ml. We also observed in 3 patients, an evolution of the seric NSE parallel to this of the disease under chemotherapy.NSE represents a moderate sensitive and specific tumor marker for pediatric neuroblastoma. However, it represents a good value in prognosis and follow-up after chemotherapy.

The authors report a case of pseudomyxoma peritonei associated with an appendicular and ovarian mucinous tumor. They emphasize the rarity of bilateral ovarian and appendicular involvement and they discuss the problem of the origin of the primary tumor and evaluation of the prognosis.

We report a case of minimal deviation adenocarcinoma of the uterine cervix in a 32 year old women who present a Peutz Jeghers syndrome. This patient also had fibroadenoma of the breast and dystrophic mastopathy. This case represent an example of predisposition to developing tumors of the Peutz Jeghers syndrome.

Two epidemic outbreaks of cholera occurred in eastern Algeria in 1994. Sixteen strains of Vibrio cholerae El Tor were isolated from stools and contaminated water. Studies to determine antibiotic sensitivity documented multiresistance in these strains. Minimal inhibiting concentrations ranged from 6 to 32 micrograms/ml for chloramphenicol, from 8 to 24 micrograms/ml for tetracycline except minocycline, and from 15 to 32 micrograms/ml for furanes. Higher values were found for other antibiotics such as trimethoprime (1,500 micrograms/ml), streptomycine (128 micrograms/ml) and sulfamides (128 micrograms/ml). High-grade resistance of Vibrio cholerae El Tor to streptomycine and trimethoprime in association with resistance to 0:129 suggests that transposon is the underlying genetic factor. All resistance markers were located on a single structure that can be transferred to a Escherichia coli receptor and belongs to an Inc J incompatibility group. The fact that plasmid DNA could not be visualized on agarose gel after extraction is also evidence for a transferable transposon.

Leiomyosarcomas of the digestive tract are very rare in children. They must be differentiated from benign tumors (leiomyoma, schwannoma...) and from other malignant tumors, sometimes with the aid of immuno-histochemical study.A five-year old girl suffered from an abdominal mass associated with fever and alteration of the general condition. An ileal tumor, 8 cm in diameter, was resected. Histological and immunohistochemical studies (anti-vimentin antibodies, anti-actin antibodies and PS100) confirmed the diagnosis of leiomyosarcoma. Uncomplete adjuvant chemotherapy failed to prevent relapse of the tumor.This case confirms the bad prognosis of such a tumor.

Within a multifactorial etiology of cancers and a bio-psycho-social approach of patients, considering, among the risk factors, those related to personality in a preventive view, the authors investigate, by an epidemiologic methodology, for a correlation between break-down phenomena and the development of a cancer. The study was carried out at the Salah Azaïez Institute in 1992 and included 707 patients aged from 15 to 82 years, 44% presenting a malignant tumour. For a retrospective evaluation of break-down semiology, the study is based on DSM-III criteria of break-down diagnostic. Search for a clinic/psychic diagnostic relation reveals the difficulty of coexistence between break-down signs and the development of a cancer. That difficulty increases in case of an organised break-down.

The authors report 5 cases of breast angiosarcoma collected in the Salah Azaiz Institute of Tunis, the only oncology center in this country, between 1969 and 1990. They enumerated 4,000 malignant breast tumors during this period; i.e. an incidence of 1.25%, higher than that in the world literature (0.4%). The mean age of patients was 44. Three were post-menopausal, and two were of childbearing age, one of whom was pregnant. This rare tumor is virtually limited to women. Affection is scarce, it affect's almost exclusively women. It generally present as a painless, ill-defined mass, without regional lymphadenopathy. The diagnosis of angiosarcoma is difficult since the histologic appearance is sometimes identical to that of a hemangioma. Hence the value of very thorough histologic examination of the entire operative specimen. Treatment is based upon mastectomy. The usefulness of adjuvant chemotherapy and/or radiotherapy is uncertain. The prognosis remains gloomy despite early diagnosis and treatment. The authors attempt in this study to identify the various features of this serious and uncommon condition, based upon the rare published cases in the world literature.

Microcyst adenomas of the pancreas are rare tumours with characteristic cysts lining the cubic and cylindric epithelia with a clear cytoplasm rich in glycogen. Unlike, mucinous cyst adenomas, there is no tendency toward malignancy. We report a case in a 58-year-old woman and emphasize the importance of precise pre- or per-operative diagnosis in order to avoid excessive exeresis for benign tumour. Certain authors propose abstention and follow up.

Seven cases with echinococcal infection of the ovary, including 3 on both sides, were collected at the Salah Azaiz Institute of Tunis during a period of 23 years. This localisation is rare, even in an endemic country. The aetiology and pathogenesis of this affection may give rise to many different clinical signs, problems with pre-operative diagnosis. It is important to follow up these cases after operation in order to sport recurrences. The objective of surgical treatment is to achieve cure of both the hydatic cyst of the ovary and the primitive cyst simultaneously. Following this treatment, two difficulties may arise: the first one is preoperative rupture of the cyst; the second concerns fertility in these young women after two-sided salpingo-oophorectomy. Finally, when a pelvic cyst is observed systematic hydatic serology must be performed.

Granular cell tumors of the breast are rare. The clinical presentation, the poor macroscopical delimitation and the infiltrating appearance of the tumor cells between the mammary lobules and within the adipose tissue may lead to a diagnosis of carcinoma, especially on frozen section. The authors present two cases of granular cell tumor of the breast occurring in two women aged 19 and 59 respectively. Before surgery, the diagnosis was that of a malignant tumor. In both cases, frozen section suggested the diagnosis of a granular cell tumor, which was confirmed by immunohistochemical study in one patient.

During a nosocomial epidemic of Salmonella mbandaka in Algeria, 99 strains were isolated from specimens. Study of 22 of them revealed minimum inhibiting concentrations ranged from 4 to 32 micrograms/ml for cefotaxime, 2 to 32 micrograms/ml for ceftazidime and 2 to 16 micrograms/ml for ceftriaxione. The mechanism underlying resistance was enzymatic with production of broad-spectrum beta-lactamase enzyme. Clavulinic acid at a dose of 2 micrograms/ml restored the activity of hydrolyzed beta-lactamases. Resistance to all antibiotics including cefotaxime was due to a single plasmid structure. The plasmid did not belong to any known compatibility group. All strains studied contained a plasmid of 26MDa and produced TEM-1 and TEM-2 beta-lactamases. Strains resistant to cefotaxime also synthetized a broad-spectrum beta-lactamase derived from TEM.

Nalidixic acid and three fluoroquinolones were tested on 389 strains belonging to 13 bacterial species, all isolated in Algeria. Ofloxacin, norfloxacin and pefloxacin have the same activities on E. coli, Acinetobacter and S. aureus. Norfloxacin has the best activity on Proteus, Enterobacter, Shigella and Klebsiella. Norfloxacin and ofloxacin have the same activities on S. typhi, Salmonella and choleric Vibrio. Norfloxacin has the same activity than pefloxacin on P. aeruginosa. It is necessary to prescribe a quinolone in the right way and to consider the pharmacokinetic properties.

Serotyping of Listeria has contributed to bring to light on the origin of outbreaks listeriosis; on the other hand, it is also an additional expression for the identification of Listeria genus. In order to get better in this field, we have produced five factors sera: I, I/II, V/VI, VI, VII.

It concerns comparative studies between two children groups: One group who had previous RAA. A second group who had anginas only. This work shows the interest to associate two streptococcal serologic tests (ASLO, ASD) in order to increase the number of recent diagnostic streptococcal infectious. The remaining immunity is missing in children less than 5 years old; more than 50% of above 10 years an antistreptococcal answer although they have not streptococcus infections presently.

During 1967 to 1985, three cases of listeriosis were reported in Algeria; at that time Listeria monocytogenes caused several thousand cases of meningitis and sepsis in the world. In order to determine the frequency and bacteriologic characteristics of strain isolated in Algeria, a prospective investigation was carried from 1985 to 1989 in humans and animals samples. Sensitivity tests to antibiotics (MIC) point out that all isolates strains are resistant to cephalosporins (first and third generation), but are susceptible to Ampicillin and Gentamicin which ought to constitute the treatment basis of listeriosis.

A epidemic of enteric pathogens bacteria occurred in december 1989 and caused two deaths in a nursery. There were many investigations between december 1989 and september 1990 trying to clarify this epidemic context. A new serovar of Salmonella had for the first time been isolated from babies' feces in Algeria. Salmonella m'bandaka has been identified in more than 50% of analysis. During an hygienic investigation in this nursery the above Salmonella m'bandaka was isolated in a open physiologic solution flask.

We report the isolation of 10 strains of enterobacteriaceae with a new quinolone's resistance. This resistance was detected by a diminution of inhibition's diameter around the disk of pefloxacin , and confirmed by the determination of Minimal Inhibiting Concentrations (M.I.C.). These strains, moreover multiresistant to multiple antibiotics, were isolated from patient's urines with repetitive urinary tract infections (paraplegics, lithiasic patients). None of this patients was treated by new quinolones. The incorrect use of old quinolones is probably responsible for the selection of this new quinolone's resistance.

We report here an isolation of bacteria genus Nocardia, Nocardia farcinica, in a dialysis liquid of a renal insufficiency patient treated by continuous ambulatory peritoneal dialysis (C.A.P.D.). Real peritonitis was due to infection with this bacteria, eliminated after an adapted antibiotherapy. This observation is interesting first because of the rare occurrence of Nocardia's peritonitis in the patients on CAPD, and secondly in relation with the species of Nocardia, Nocardia farcinica, less known than Nocardia asteroides but not less pathogenic.

Summary Neonatal meningococcal meningitis has rarely been describedin North Africa. We report the first case observed in Algeria. The origin of this infection was not established and could be prenatal, pernatal, or postnatal with contaminated vaginal flora.

Methicillin-resistant Staphylococcus aureus (MRSA) poses a serious therapeutic problem worldwide, and its frequency in most African countries has not been reported. This study was aimed at determining the prevalence and antibiotic susceptibility patterns of MRSA in eight large hospitals (>500 beds) in Africa and Malta, from 1996 to 1997. Susceptibility to methicillin (oxacillin) and to other drugs was determined by E test (AB Biodisk, Solna, Sweden) on a total of 1440 clinical isolates of S. aureus. Methicillin resistance was detected in 213 (15%) of the 1440 isolates tested. The rate of MRSA was relatively high in Nigeria, Kenya, and Cameroon (21-30%), and below 10% in Tunisia, Malta, and Algeria. All MRSA isolates were sensitive to vancomycin, with MICs≤4mg/L. The isolates were also highly sensitive to ciprofloxacin, except in Kenya, Morocco, and Tunisia, where relative resistance to this drug was noted. Susceptibility to rifampin and fusidic acid seems to be correlated with the clinical use of these compounds. Only 46% of 59 MRSA strains analyzed were susceptible to rifampin, fusidic acid, and ciprofloxacin. The majority (>60%) of MRSA strains were multiresistant. There is a need to maintain surveillance and control of MRSA infections in Africa.

The distribution of R plasmids in six drug-resistant Salmonella typhi strains and four S. paratyphi B strains isolated from human in Algeria was studied. All strains but one S. typhi harbored one conjugative R plasmid. Plasmids belonging to the incompatibility groups FIme, B, W or P were found in the S. typhi strains and those belonging to groups FIme or B were found in the S. paratyphi B strains. The epidemiological surveillance of R plasmids shows that the drug resistance of these strains is not the result of the epidemic spread of particular strains of Salmonella.

The plasmids characterized in Algeria generally belong to the C and F1 me compatibility groups. With the exception of Vibrio cholerae el for the two groups are found in many bacterial species. Plasmids belonging to group C are the only stable in Vibrio cholerae el tor. The possibility that epidemics of Vibrio cholerae el tor carrying C plasmids might be observed, should not be excluded. On the other hand, it is presently impossible to guess what will be the future epidemic plasmid in Salmonella typhi and paratyphi B.

Carcinoma of the cervix is still common in Tunisia, where it occupies second place among malignant diseases in women. Accounting for 17% of the female population of the National Cancer Institute of Tunis, it is preceded only by breast cancer (27%). Study of the factors concurrent with the origin of carcinoma of the uterine cervix seems to indicate that its decrease is secondary to the lowered average age at marriage, to the fall in the reproduction rate among the population at large, and to improved socio-economic conditions among the poorer classes. Study of clinical features observed during two separate periods of 10 years shows a modification in the physiognomy of this cancer, with, notably, a larger frequence of lower stages (45% of stage II in 1984 vs 20% in 1974) and a slight tendancy towards the discovery of smaller non - or early - infiltrating tumors (4% in 1984 vs 0% in 1974). Efforts must continue to be made in the domaine of early detection, especially among the "high risk" population.