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Various characterization techniques were used to study the composition of the glass series xAl2O3-(40 - x)CaO-10Na2O-50P2O5 (with 0 ≤ x ≤ 10) in terms of chemical durability, X-ray diffraction, IR spectroscopy and scanning electron microscopy (SEM). The improved chemical durability was attributed to the replacement of easily hydrated P-O-P bonds by covalent and resistant Ca-O-P and Al-O-P bonds. However, the change in the dissolution rate (DR) versus time showed a marked decrease in chemical durability with increasing the Al2O3 content to the detriment of the CaO content. The X-ray diffraction analysis of glasses annealed at 550°C and 660°C for 48 hours indicated the presence of pyrophosphate phases and predominant metaphosphates or cyclic metaphosphate phases when the Al2O3 content was ≤7.5 mol%. Nevertheless, both, X-ray diffraction and IR spectroscopy confirmed the structural tendency change from metaphosphate (Q2) and pyrophosphate structural units (Q1). Toward short isolated orthophosphate units (Q0) when the Al2O3 content above 7.5 mol%. SEM micrographs illustrated that the number of crystallites increased in the glass network when the Al2O3 content increased at the expense of the CaO content. An increase in the Al2O3 content to 10 mol% led to the formation of a larger number of crystallites of different sizes, dominated by small crystallite sizes assigned to short isolated orthophosphate groups. This phenomenon led to a decrease in chemical durability and seems to be a favorable factor for the formation of the apatite layers which enclose the glass, in a SBF solution test, able of regenerating bone tissue in biomedical application.

Resume Introduction Les kystes cœlomiques intrathoraciques sont des tumeurs benignes tres rares d’origine embryonnaire tapissees par un mesothelium. Ils sont le plus souvent asymptomatiques, decouverts de facon fortuite sur une radiographie thoracique et sont principalement localises dans l’angle cardiophrenique realisant les kystes pleuropericardiques. Observation Un homme âge de 50 ans a ete adresse pour des douleurs thoraciques gauches atypiques depuis deux ans. L’examen physique et la radiographie thoracique etaient sans particularite. La tomodensitometrie thoracique a montre la presence d’un kyste du mediastin superieur et posterieur au niveau de la gouttiere costovertebrale gauche. Compte tenu de sa localisation atypique et de son caractere symptomatique, une kystectomie par thoracotomie posterolaterale a ete realisee permettant de poser le diagnostic de kyste cœlomique ectopique. Le patient rapporte une disparition des douleurs thoraciques apres la resection chirurgicale, avec un recul de 3 ans. Par ailleurs, le scanner thoracique a visualise une artere sous-claviere retro-œsophagienne qui est une anomalie des arcs aortiques d’origine congenitale de decouverte fortuite. A notre connaissance, l’association de ces deux anomalies congenitales n’a jamais ete rapportee auparavant dans la litterature. Conclusion La localisation ectopique du kyste cœlomique dans le mediastin posterieur et superieur au niveau de la gouttiere costovertebrale gauche est tres rare, imposant sa resection chirurgicale a la fois a visee diagnostique et therapeutique d’autant plus qu’il est symptomatique.

Various characterisation techniques were used to study the composition of the glass series 55-P2O5-2Cr2O3-(43-x) Na2O-xPbO (with 8 ≤ x ≤ 38; mole %) in terms of chemical durability, IR spectroscopy and scanning electron microscopy (SEM). The change in the dissolution rate as a function of time when the studied glasses were kept submerged in distilled water at 90°C for 20 days showed an improvement in the chemical durability when Na2O content was substituted to PbO content. IR spectroscopy revealed a structural change from ultraphosphate groups to pyrophosphate, orthophosphate and probably ring metaphosphate groups. SEM revealed the existence of two phases: a vitreous phase and a crystalline phase. The presence of Cr2O3, even in small amounts, seems to play an important role in the formation of crystallites in the glass network. The improved chemical durability is attributed to the replacement of the easily hydrated Na-O-P and P-O-P bonds by covalent and resistant Pb-O-P bands. Both the increase in PbO content and in the Pb + Cr/P ratio causes an increase in the number of covalent Pb-O-P and Cr-O-P bonds, making the glass structure more rigid. The increase of the covalent Pb-O-P bands leads to a clear evolution of the structure and chemical resistance, caused by grain-boundary resistance as a result of glass crystallisation. The IR spectra indicate that the increase in PbO content favours the formation of isolated PO3-4 orthophosphate groups at the expense of pyrophosphate groups. The radical change in the structure from ultraphosphate groups to pyrophosphate and orthophosphate groups seems to be the cause of the formation of crystallites. The existence of crystallites in these glasses results in a marked improvement in their chemical durability. However, when the crystallites exceed a certain limit, the equilibrium between the glass bath and these crystallites is no longer maintained; we notice, once, a decrease in the chemical durability.

Introduction Bien qu’elle soit indispensable, la bronchoscopie rigide a ete longtemps delaissee au profit de l’endoscopie souple. Cette technique n’est redevenue disponible dans le secteur public tunisien que depuis quelques annees. Le but de notre travail etait d’evaluer cette nouvelle activite d’endoscopie interventionnelle. Methodes Il s’agit d’une etude retrospective descriptive incluant tous les patients qui ont subi une bronchoscopie rigide, pris en charge dans le service de pneumologie et d’endoscopie interventionnelle (pavillon 2) de l’hopital A.-Mami de l’Ariana. Resultats L’activite a demarre en janvier 2016. A ce jour, nous avons effectue 64 bronchoscopies rigides pour 41 patients adultes. La bronchoscopie rigide etait indiquee pour une extraction de corps etranger chez 3 patients et pour une desobstruction de stenose tracheale acquise dans tous les autres cas. Tous les patients presentant une stenose tracheale ont eu une desobstruction mecanique dont 7 etaient laser assistee et 7 avec mise en place d’une prothese endotracheale. Nous ne rapportons aucune complication au decours de l’intervention. Un echec a ete note dans 2 cas (3 %) a cause d’une difficulte d’intubation dans 1 cas et un corps etranger inaccessible dans un autre cas. L’evolution immediate etait favorable dans tous les cas. Toutefois, 11 patients ont recidive leur stenose (29 %), necessitant un complement de traitement par laser dans 2 cas, la mise en place d’une prothese dans 3 cas et une resection-anastomose dans 6 cas. Conclusion L’endoscopie interventionnelle est un moyen therapeutique indispensable dans la prise en charge de nos patients. Elle permet, dans plusieurs cas, d’eviter une tracheotomie inutile ou une chirurgie lourde et surtout constitue dans certains cas le seul moyen therapeutique qui permet de preserver le pronostic vital du patient.

The prognosis of patients with non-small cell lung cancer (NSCLC) with brain metastasis (BM) is dark. The aim of our study was to analyze the prognostic factors after the onset of BM and to evaluate the current management of BM.We conducted a retrospective study that included 100 patients diagnosed with primary NSCLC with BM. Survival was analysed using Kaplan Meier curve.Univariate survival analysis was performed to assess the prognostic value of sex, age, gender, performance status, histologic type, tumor size, BM features and treatment modality of primary lung tumor and BM.The median age was 57 years; 94% of the patients were male. Most patients (85%) had a PS of (0-1). BM were unique in 54% of cases, symptomatic in 40% of cases and synchronous in 72% of cases. Chemotherapy was administered to 78% of patients; pulmonary tumor surgery was performed in 5% of patients. BM surgery and panencephalic irradiation were performed in 13% and 86% of patients, respectively. The median overall survival after NSCLC diagnosis was 13.33 months. The median overall survival after BM was 10.6 months. The Control of the primary tumor was the only factor associated with better overall survival (64.95 months Vs 10.6 months (p=0.02)).Pulmonary tumor control with complete surgical excision is predictive of better overall survival in patients with NSCLC and BM.

Castleman disease (CD) or angiofollicular lymph node hyperplasia is a rare lymphoproliferative disorder characterized by lymph node hyperplasia of uncertain etiology. CD is divided clinically into unicentric (localized to one region of the body) considered as a benign disease and multicentric with less favourable prognosis. We describe a case of intrathoracic unicentric CD revealed by a chronic non-productive cough in a 50-year-old non-smoker female. Chest computed tomography revealed a bulky right hilar mass with intense homogenous contrast enhancement. The patient underwent a right upper lobectomy and mediastinal lymphadenectomy. Histopathology was consistent with hyaline-vascular (HV) type CD. The patient remained asymptomatic throughout the subsequent 6-months of follow-up.

Malnutrition is so commonly associated with cancer disease. Our work aims to highlight the impact of malnutrition on the survival and toxicity of chemotherapy in patients with advanced stages of non-small cell lung cancer (NSCLC).A retrospective study including 60 patients followed for NSCLC stage IIIB and IV, between January 2007 and December 2013. An evaluation of the impact of malnutrition was carried out according to different markers (weight loss, body mass index (BMI), albumin and NRI score).The mean age was 59. Taking Weight loss10 % as a criterion of malnutrition, 22% of patients were malnourished. Based on a BMI lower than 18.5 Kg/m², 14% of patients were malnourished. Ganglionic extension, anemia and hypoalbuminaemia were associated with malnutrition (p=0.016; p=0.02 and p=0.03 respectively). The Overall survival (OS) was 2.65 months and 6.95 months (p0.0003) in malnourished and non-malnourished groups. The definition of malnutrition can also be based on an albumin level35 g/l. According to this criterion, 55% of the patients were undernourished. Anemia and lymphopenia were associated with malnutrition respectively (p=0.002; p=0.001). The OS was 4.45 months and 8.42 months respectively in malnourished and non-malnourished groups (p0.0002). NRI score100 and97.5 (moderate to severe malnutrition) was found in respectively 100% and 74 % of patients. The OS was 4.67 months and 9.12 months respectively in moderate to severe malnutrition (NRI97.5) and mild malnutrition groups (NRI≥97.5) (p0.001).Malnutrition was common in patients with advanced stage of NSCLC and was associated with poor prognosis.

Sarcoidosis is a systematic, granulomatous disease of unknown cause which can affect any organ in the body. Pulmonary involvement is the most common. Musculoskeletal manifestations of sarcoidosis are less common affecting 10-25% of patients and chronic arthritis occurs rarely. We report the case of sarcoidosis revealed by left knee chronic and destructive monoarthritis with only asymptomatic pulmonary involvement in a Caucasian male miner exposed to silica. The patient was treated with corticosteroids during 2 years after diagnosis. In addition, arthroplasty with total left knee prosthesis was performed. The patient is well without any recurrence of symptoms of the musculoskeletal system for a 2 years follow-up period after surgery.

Inflammation markers have been shown to predict prognosis during cancer including non-small cell lung cancer (NSCLC). In particular, C-reactive protein (CRP) and Neutrophil to Lymphocyte Ratio (NLR) have been investigated. The aim of our work is to study the combination of these two markers in optimizing prognostication in advanced NSCLC. We conducted a retrospective study that included all patients diagnosed with primary NSCLC stage IIIB or IV in our respiratory department from January 2005 to January 2013.A total of 142 male patients were included. Most of them (80.3%) had a Performance Status (PS) 0-1. Median progression-free survival (PFS) was 4.6 months (95% confidence interval (CI) 3.9-5.3) and median overall survival (OS) was 8.9 months (95%CI7.7-10.1). Survival analysis showed that CRP10 mg/l and NLR3.87 were predictive of better prognostic (respectively p= 0.015 and 0.049), along with chemotherapy use (p0.0001), PS2 (p=0.009) and age65 (p=0.013). In addition, combined use of NLR and CRP was significantly associated with OS (p=0.0009). Median OS for patients having both high NLR (≥3.87) and CRP (≥10 mg/l) was 6.7 months. It was significantly shorter than patients having only one elevated inflammatory marker (8.8 months; p=0.025).High CRP and NLR (≥10 mg/l and ≥ 3.87 respectively) were associated with poorer survival in advanced NSCLC. Their combined use maximizes their prognostic value.

Recent studies have identified that inflammation had a significant association with cancer development and progression.To explore the relationship between ALI score and prognosis of metastatic non-small cell lung cancer (NSCLC).we conducted a retrospective study of 41 patients with metastatic NSCLC diagnosed between January2010 and January2012. ALI was calculated as body mass index x serum albumin/neutrophil to lymphocyte ratio. Patients were divided as low inflammation (ALI≥23.2) and high inflammation (ALI23.2) groups.Mean age was 56.3 years, 100% were male, and 49% had adenocarcinoma. The overall survival was 8.9months. Median ALI was 23.2. The median overall survival was 6.7 months and 11.3 months respectively in patients with ALI score23.2 and ≥23.2 (p=0.043). On multivariate analysis, ALI score23.2 remained significantly associated with worse outcome.Lower ALI (23.2) was significantly associated with worse overall survival in metastatic NSCLC. The assessment of the ALI is inexpensive and widely available; it could help in identifying patients with poor prognosis in clinical routine practice.

Few studies have been conduct¬ed to determine prognostic factors of second-line chemotherapy. The aim of this study was to determine the prognostic factors for survival in patients receiving second-line treatment for advanced NSCLC.We retrospectively reviewed the records of 71 patients with metastatic NSCLC who received second-line chemotherapy from January 2006 to January 2013.The mean age was 57 years. All patients were male. The performance status was 0 or 1 in 90.1% of cases. Sixty-four patients received a first line platinum-based chemotherapy. The second line chemotherapy regimen was docetaxel in 31 cases and pemetrexed in 18 cases. Fourteen patients (19.71%) had received third-line chemotherapy. The median overall survival was 13.5 months. Age older than 65 years (p=0.025), advanced T stage (T4 versus T3 and T2; p=0.01), advanced N stage (N3 versus N2 and N1; p=0.001), lower level hemoglobin (p=0.05) and non-responders who showed progression with first-line chemotherapy (p=0.04) were significant negative predictors in univariate analysis for overall survival (OS). The multivariate analysis showed that age≥ 65 years (HR=2.15; 95% CI[1.26-2.44]), advanced N stage (HR=2.273; 95% CI [1.26-2.44]) were independent prognostic factors for OS.Age and advanced N stage were important factors in predicting the outcome of advanced NSCLC patients who were undergoing second-line chemotherapy.

Malignant peripheral nerve sheath tumors (MPNST) are rare nervous tumors usually located in the posterior mediastinum in the paravertebral gutters. We report the case of a non-smoking 62-year-old man who was admitted with a 4 months history of cough, hoarseness and shortness of breath. Physical examination noted a superior vena cava syndrome. CT scan of the chest revealed a right anterior and middle mediastinal mass compressing the superior vena cava, the ascending aorta, the right pulmonary artery, invading the superior root of the pulmonary vein and the right auricle. Flexible bronchoscopy showed extrinsic compression of the right main bronchus, the right upper lobe bronchus and intermedius bronchus. The patient underwent surgical biopsy of the mass by mediastinoscopy. Histological examination revealed a malignant peripheral nerve sheath tumor. The patient received a single cycle of chemotherapy (ifosfamid-adriamycin). Clinical course was marked by the fast worsening of the dyspnea and the general state. Patient died three weeks after the cure of the chemotherapy. This case is original by the exceptional clinical presentation of MPSNT with a superior vena cava syndrome and the very rare location of this tumor in the anterior and middle mediastinum.

La Presse Medicale - In Press.Proof corrected by the author Available online since mardi 24 novembre 2015

Introduction: C-reactive protein (CRP) is an inflammatory mediator that could be elevated in malignant conditions. The aim of our study is to assess the relationship between CRP and response to chemotherapy in patients with advanced non-small cell lung cancer (NSCLC). Methods: This is a retrospective study including 142 patients with advanced NSCLC (stage IIIB and IV) diagnosed between January 2005 and January 2013. Prior to chemotherapy, a CRP level higher than 10mg/l is related to cancer if a decrease of 50% is noted after two cycles of chemotherapy. An initial CRP level that decreases by 50% after antibiotics is related to an infection. Results: The average age was 60 years. The median level of CRP was 47.9 mg/l. Only 16.9% of patients had a CRP level lower than 10mg/l. Correlations between CRP level and BMI (r=-0.34, p=0.0001), tumor size (r=0.25, p=0.039), smoking (r=0.17, p=0.04) and serum albumin level (r=-0.66; p Conclusion: CRP could be taken into account with RECIST criteria to evaluate the response to chemotherapy in advanced NSCLC.

Introduction: Brain metastases (BM) are a common complication for patients with non-small-cell lung cancer (NSCLC) and a significant cause of morbidity and mortality. The aim of this study was to evaluate the management of BM for patients with NSCLC. Methods: This was a retrospective study including 100 patients with BM of NSCLC hospitalized in our service between January 2009 and December 2015. Results: Median age was 57 years, 94 patients were male. Ninety patients (90%) were smokers. The performans status was Conclusion: Survival remains poor for patients with NSCLC and BM. However, aggressive therapy of both the lung primary tumour and the BM may provide a survival advantage.

The influence of CaO on the glass forming characteristics and properties of Na2O-CaO-ZnO-P2O5 glasses has been investigated. According to the studies that we performed on phosphate based glass within system xCaO-(40-x)ZnO-15Na2O-45P2O5 (10 ≤ x ≤ 30; mol%), it was found that the increase of CaO and substitution of ZnO can give a good chemical durability. Both Cristallographies X-ray and IR spectroscopy have confirmed the structure change when the CaO content increases in the glass. This change results in the formation of metaphosphate and/or rings of metaphosphate groups at the expense of pyrophosphate. So it indicates the formation of Ca-O-P bonds in the network glass that replaces hydrated P-O-Na and P-O-P bands. The phosphate chains units can be bonded together in rings forming meta-phosphate groups. These rings likely lead to the formation of agglomerates of crystalline phases, which is the main cause of the increase in the chemical durability of the glasses when the CaO content increases. The latter may lead to wider use of these materials, especially in the biomedical field.

Introduction Malgre les strategies mises en œuvre pour la lutte nationale contre la tuberculose, cette maladie represente encore aujourd’hui un probleme de sante majeur dans notre pays. Il est donc important d’identifier les facteurs qui ont un impact sur l’adherence au traitement. Parmi ces facteurs, les troubles anxio-depressifs ont ete rarement etudies. Methodes Nous avons mene une etude prospective de fevrier 2017 a juin 2017, recrutant 50 patients traites (a la periode d’attaque ou d’entretien) et suivis aux pavillons I, II, IV et C de l’hopital Abderrahmane-Mami de l’Ariana, pour une tuberculose pulmonaire bacillifere. L’evaluation de l’anxiete et de la depression a ete faite par le score Hospital Anxiety and Depression scale (HAD). Resultats L’âge moyen de nos patients etait de 42 ans. Quatre-vingt-douze pour cent des malades etaient de sexe masculin. L’evaluation du score HAD a ete faite entre la premiere semaine et 2 mois de traitement chez 32 % des patients, entre 2 et 4 mois chez 32 % des cas, entre 4 et 6 mois dans 20 % des cas et a plus de 6 mois de traitement chez 16 % des malades. Le score moyen d’HAD etait de 14,2. Quarante-huit pour cent des patients n’avaient pas de syndrome anxio-depressif (score HAD entre 0 et 8) ; 2 % avaient un score entre 8 et 11 et 50 % des malades avaient un syndrome anxio-depressif certain (score HAD entre 11 et 35). Le score HAD etait correle au delai de negativation des bacilloscopies (p = 0,03), au delai de nettoyage radiologique (p = 0,03) et a la survenue de rechute (p = 0,0003). Conclusion Le depistage et la prise en charge des troubles anxio-depressifs chez les tuberculeux s’imposent afin d’ameliorer l’observance therapeutique et le pronostic de la tuberculose.

Introduction L’anemie chimio-induite (ACI) est definie par un taux d’hemoglobine (Hb) Methodes Une etude retrospective incluant 97 patients atteints de CBPNPC aux stades avances ayant recu au moins une premiere ligne de chimiotherapie sur une periode de 6 ans (allant de janvier 2010 a janvier 2016). Resultats La moyenne d’âge etait de 59,5 ans. Tous les patients etaient de sexe masculin. Le performance status etait 0–1 dans 84 % des cas. Un tabagisme etait note dans 96 % des cas. Le type histologique le plus frequent etait l’adenocarcinome dans 54 % des cas suivi par le carcinome epidermoide dans 24 % des cas. Au bilan pre-therapeutique, le taux moyen d’hemoglobine (Hb) est de 12,53 g/dL (extremes : 6–16,8). Trente-sept patients (38 %) avaient une anemie pretherapeutique (Hb 12 g/dL), 39 (65 %) avaient developpe une anemie chimio-induite ACI : 21 apres le premier cycle et 11 apres le deuxieme cycle de chimiotherapie. Il s’agissait d’une anemie legere a -modere grade 1/2 dans 97 % des cas. Le taux d’Hb moyen etait de 11,49 g/dL ; 10,83 g/dL et 10,72 g/dL respectivement apres le premier, le deuxieme et le troisieme cycle de chimiotherapie. L’administration d’une cure de chimiotherapie etait responsable de la baisse de l’Hb de 1,83 g/dL en moyenne. Une transfusion sanguine etait pratiquee chez 19 patients. L’erythropoietine n’etait prescrite vu sa non-disponbilite. La presence d’ACI etait associee a une survie moindre (la survie globale chez les patients ayant developpe une ACI etait de 5,85 mois vs 7,47 mois pour les patients non anemique ; p = 0,18). Conclusion L’ACI est une complication frequente au cours des cancers bronchiques et elle est dotee d’une mortalite elevee. Des traitements d’appoint a la chimiotherapie comme l’erythropoietine (EPO) pour l’anemie se sont developpes. Des recommandations nationales devraient etre elaborees afin de favoriser leur prescription pour les ACI aux cours des CBNPC.

Introduction La tuberculose est une maladie contagieuse causee par le Mycobacterium tuberculosis. Elle pose un probleme de sante public en Tunisie. Le profil Bacteriologique apres deux mois du traitement antituberculeux pourrait influencer la prise en charge et le pronostic. Methodes Une etude retrospective portant sur des patients suivis dans notre service pour tuberculose pulmonaire du janvier 2015 au juin 2017. Deux groupes ont ete compares : G1 : Patients ayant un frottis positif a 2 mois du traitement antituberculeux (29 patients) G2 : patients ayants un frottis negatif a 2 mois du traitement antituberculeux (89 patients). Resultats Cent dix-huit patients ont ete inclus. Tous les patients etaient de sexe masculin. Les bacilloscopies etaient positives a l’examen direct et a la culture chez tous les patients. L’âge moyen etait 43,5 ans (19 au 88 ans). Le diabete etait note chez dix-huit patients (16,6 %). Quatre-vingt pour cent des patients etaient des tabagiques actifs. L’ethylisme etait note dans 21 % des cas. Neuf pour cent des patients avaient des antecedents d’incarceration. Un frottis positif a l’examen direct et a la culture a 2 mois du traitement antituberculeux etait note chez 29 patients (26,8 %). Les facteurs associes etaient le diabete (G1 = 4 %, G2 = 6 % ; p = 0,001), l’incarceration (G1 = 16,7 % vs G2 = 13 % ; p = 0,001), les images radiologiques etendues (G1 = 51,5 % vs G2 = 36,1 % ; p = 0,001) et l’observance therapeutique. Une correlation statistiquement significative entre le traitement antituberculeux dissocie, comparativement a l’association de drogues fixes et le retard de negativation des bacilloscopies n’a pas ete retrouvee. Conclusion La presence du diabete, incarceration et l’etendue des images radiologiques sont des facteurs predictifs de retard de negativation des bascilloscopies a deux mois. Ces patients meritent une prise en charge particuliere.