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Recent discovery showing the presence of microRNAs (miRNAs) in the circulation sparked interest in their use as potential biomarkers. Our previous studies showed the diagnostic potential of miR-451 as a serological marker for inflammatory breast cancer (IBC), miR-337- 5p and miR-30b for non-inflammatory breast cancer (non-IBC). The aim of this study is to investigate the prognostic values of circulating miRNAs by comparing the amounts of 12 circulating miRNAs in the serum of IBC and non-IBC from Tunisian breast cancer patients, and by determinating whether correlated pairs of miRNAs could provide useful information in the diagnosis of IBC and non-IBC patients. TaqMan qPCR was performed to detect circulating expression of miRNAs in serum of 20 IBC, 20 non-IBC and 20 healthy controls. Nonparametric rank Spearman rho correlation coefficient was used to examine the prognostic value of miRNAs and to assess the correlation profile between miRNAs expression. Further, a large number of miRNAs were highly correlated (rho>0.5) in both patients groups and controls. Also, the correlations profiles were different between IBC, non-IBC and healthy controls indicating important changes in molecular pathways in cancer cells. Our results showed that miR-335 was significantly overexpressed in premenopausal non-IBC patients; miR-24 was significantly overexpressed in non-IBC postmenopausal patients. Patients with previous parity had higher serum of miR-342-5p levels than those without. Furthermore, patients with HER2+ IBC present lower serum levels of miR-15a than patients with HER2- disease. Together, these results underline the potential of miRNAs to function as diagnostic and prognostic markers for IBC and non-IBC, with links to the menopausal state, Her2 status and parity.

La fraude qui correspond a une intention deliberee d’alterer les donnees englobe aussi le plagiat. Fraude et plagiat sont souvent regroupes sous le terme d’inconduite scientifique. Cette inconduite se differencie de l’erreur commise sans mauvaise intention et des biais qui correspondent a une erreur dans le recrutement ou l’interpretation des donnees. En cancerologie, quatre fraudes ont eu des retentissements importants. Le Dr Poisson a falsifie des donnees concernant ses patientes incluses dans des essais du NSABP. Les Drs Hermann et Brach ont ete accuses de manipulation de graphiques et de tableaux. Le Dr Bezwoda n’a pas recueilli le consentement de ses malades et il a, entre autres, applique des protocoles de chimiotherapie differents de ceux qu’il avait publies. Le Dr Sudbo est alle jusqu’a inventer des patients dans une etude epidemiologique. La prescription de medecines alternatives non prouvees censees guerir le cancer est consideree comme une inconduite scientifique. Les limites entre erreur et fraude ne sont pas toujours claires. Les consequences sont desastreuses pour le progres scientifique, pour le grand public qui perd confiance et pour l’institution qui a couvert la recherche. La frequence de la fraude en cancerologie est difficile a estimer compte tenu de sa rarete relative. En sciences, elle est estimee de 2 a 5 %. La prevention de la fraude necessite des mises en garde et la vigilance des coauteurs ainsi que celle des institutions universitaires et hospitalieres dont la responsabilite est engagee. Certains pays comme les Etats-Unis ont mis en place une institution ou une delegation specialisee qui analyse les suspicions de fraudes et rend son verdict sur la realite de la fraude et ses consequences. L’incitation a la delation est encouragee par certains, il n’est pas sur qu’elle soit efficace. Il ne semble pas que les fraudeurs presentent une personnalite particuliere, la plupart recherchent la reconnaissance de leurs pairs pour obtenir postes et credits.

Porous fluorapatite ceramics were fabricated using poly vinyl butyral as a porosifier. The conditions of specimens heat treating were optimized. The effects of preparation conditions involving poly vinyl butyral particle concentration, sintering time, and forming pressure (die-pressing technique) on the resultant pore size/structure as well as the pore size distribution were investigated. The experimental results showed that the Fap ceramics with controlled pore characteristics such as pore volume fraction, pore size and pore structure are achievable. It provides the possibility to design Fap ceramics with diverse porosities simulating that of natural bone.

Background To reduce tobacco smoking is, in Tunisia, a public health priority. The tobacco cessation consultation is one of the interventions to fight against the tobacco epidemic; it is a new activity developed in the Salah-Azeiz Tunis cancer centre. The objective of this work is to evaluate the impact of the consultation on the smokers after one year of activities and to analyse the prognostic factors of tobacco cessation in order to improve the efficacy of such an activity in the future, in Tunisia. Methods The cessation methods were based on cognitive and behavioral therapies associated with nicotine patch, delivered free of charge. During one year (July 2003 to June 2004), 340 smokers were attended. Data on their smoking status and psychological characteristics were collected using a standardized questionnaire. Results The patients were mostly men (79%), these smokers did not present important anxiodepressive troubles, 68% thought that they were able to quit easily. The majority (57%) smoked more than 20 cigarettes a day and was nicotinodependant (Fagenstrom > 7). Half of this population had already intended to stop, they declared to smoke mostly because of stress. The global cessation rate after a median follow-up of 32 weeks is 27%. The cessation rate lasting six months for 83 patients followed regularly was 23%. The good prognostic factors of cessation, after multivariate analysis, were (when taking out from the model the regular follow-up), to be confidant on the possibility to stop (OR = 0.87 [0.78–0.97]). On the contrary, a high score (>7) for Fagerstrom test (OR = 1.9 [1.1–3.4), the use of smoking to fight against stress (OR = 1.08 [1.0–1.2) and a smoking environment at home (OR = 4.5 [1.1–18.9]) were prognostic of a failure in quitting smoking. Conclusion These results show that the cessation rate, which is still too low as compared with the literature, could be increased by a better follow-up of smokers associated with an information campaign on the existing possibilities to quit smoking in Tunisia.

This study aimed to identify prognostic factors for outcome in Tunisian patients with nonmetastatic inflammatory breast cancer (IBC) receiving multimodality therapy.From 1994 to 2000, 100 patients with nonmetastatic IBC were reviewed. Patients underwent neo-adjuvant chemotherapy including anthracyclines (99%), then mastectomy (93%) when feasible, radiotherapy (83%) and adjuvant chemotherapy (84%). Sixty patients (60%) had hormone therapy.Median age at diagnosis was 44 years (range 23-71). Seventy patients had premenopausal status (70%). Ten cases occurred during pregnancy (10%). Body mass index indicated overweight or obesity in 76 patients (76%). After neo-adjuvant chemotherapy, pathologic complete response (pCR) rate was 20%. Median time of follow-up for surviving patients was 44 months. Median progression-free survival (PFS) was 19 months and overall survival (OS) 30 months. Factors associated with improved survival were no pregnancy (P = 0.0095), estrogen receptor positivity (P = 0.028), tumor size5 cm (P = 0.021), clinical complete response (cCR) (P = 0.022), pCR (P = 0.011), negative nodes (P = 0.053) and hormone therapy (P0.001). In multivariate analysis, cCR, negative nodes and hormone therapy were independently associated with better OS and PFS. Factors predictive to pCR were age45 years, negative nodes and cCR.Tunisian patients with IBC have particular epidemiologic characteristics, with earlier disease and context of overweight and obesity, but prognostic factors are similar to those reported in the literature. Hormone therapy seems to improve patient outcome.

Breast cancer, the most commonly diagnosed cancer in women, is the second leading cause of cancer death in women worldwide. To investigate the contribution of BRCA1 gene mutations to familial breast cancer in Tunisia, 32 unrelated patients who had at least one first degree relative affected with breast and/or ovarian cancer were analysed. BRCA1 mutation analysis was performed by DNA sequencing of all BRCA1 exons. We identified four different BRCA1 frameshift mutations: c. 4041delAG, c. 2551delG and c. 5266dupC already been described and one novel mutation, c. 211dupA, observed in two unrelated families. C. 5266dupC has previously been found among Jewish Ashkenazi and Eastern European populations. Our study describes it in Arabic/Berber population. Five out of thirty two familial cases had deleterious BRCA1 mutations. Fifteen additional cases carried unclassified variants (UV) or single nucleotide polymorphisms (SNPs). Our study is the first molecular investigation on the role of BRCA1 in hereditary breast cancer in North Tunisia.

Hereditary breast cancer accounts for 3-8% of all breast cancers, with mutations in the BRCA1 and BRCA2 genes responsible for up to 30% of these. To investigate the prevalence of BRCA1 and BRCA2 gene mutations in breast cancer patients with affected relatives in Tunisia, we studied 36 patients who had at least one first degree relative with breast and/or ovarian cancer Thirty-four 34 patients were suggestive of the BRCA1 mutation and two were suggestive of the BRCA2 mutation, based on the presence of male breast cancer detected in their corresponding pedigrees. Four mutations in BRCA1 were detected, including a novel frame-shift mutation (c.211dupA) in two unrelated patients and three other frameshift mutations - c.4041delAG, c.2551delG and c.5266dupC. Our study is the first to describe the c.5266dupC mutation in a non-Jewish Ashkenazi population. Two frameshift mutations (c.1309del4 and c.5682insA) were observed in BRCA2. Nineteen percent (7/36) of the familial cases had deleterious mutations of the BRCA1 or BRCA2 genes. Almost all patients with deleterious mutations of BRCA1 reported a family history of breast and/or ovarian cancer in the index case or in their relatives. Our data are the first to contribute to information on the mutation spectrum of BRCA genes in Tunisia, and we give a recommendation for improving clinical genetic testing policy.

Resume Le cancer du sein constitue la premiere pathologie maligne chez la femme tunisienne. Le delai entre le premier symptome et le diagnostic est souvent tres long, ce qui explique la predominance des tumeurs volumineuses et l'atteinte ganglionnaire frequente. Cette situation a ete exploitee pour l'analyse de la rupture de tolerance vis-a-vis de l'anti-oncogene p53. Notre etude a porte sur 108 patientes âgees de 23 a 67 ans, colligees au service de chimiotherapie de l'ISA (institut Salah-Azaiez de Tunis) du mois d'avril au mois de juillet 2002. Nous avons etudie l'alteration de la p53 dans le cancer du sein par deux approches : serologique (anticorps anti-p53 circulants) et immunohistochimique (accumulation intratumorale de la p53). Nos resultats montrent que la p53 est alteree dans environ 40 % des cancers mammaires. L'immunohistochimie positive correle avec le grade histologique eleve de la tumeur, alors que l'envahissement ganglionnaire ainsi que l'absence de recepteurs hormonaux sont associes a une serologie anti-p53 positive. La rupture de tolerance vis-a-vis de la p53 semble dependre de plusieurs facteurs ce qui implique que la serologie anti-p53 ne presente pas un interet diagnostique dans le cancer du sein pour les patientes tunisiennes.

Resume Les auteurs rapportent un cas d’hemangio-endotheliome epithelioide des tissus mous survenu chez un homme de 35 ans qui presentait une masse douloureuse du bras droit evoluant depuis deux ans et ayant augmente progressivement de taille. L’imagerie revelait un processus tumoral expansif, mal limite, de 7 cm de grand axe, siegeant au niveau de la loge musculaire interne du bras droit. L’examen histologique de la piece de tumorectomie et l’etude immuno-histochimique ont permis de porter le diagnostic d’hemangio-endotheliome epithelioide des tissus mous. L’evolution postoperatoire a ete marquee par la recidive tumorale au niveau du bras et du creux axillaire droit avec apparition de multiples nodules de permeation au niveau de la paroi thoracique controlaterale et un epanchement pleural droit malgre une chimiotherapie et une radiotherapie adjuvantes. Le patient est decede apres un recul de 2 ans.

Resume Les metastases dans la moelle epiniere sont extremement rares et surviennent chez 0,1 a 0,4 % des patients cancereux. Nous rapportons le cas de metastases intramedullaires survenant chez un patient de 42 ans, 12 mois apres le diagnostic initial d’un adenocarcinome du poumon. Le patient etait sous chimiotherapie de troisieme ligne pour une progression tumorale locale et metastatique ganglionnaire et osseuse. Le patient a consulte pour une faiblesse avec trouble de la marche. L’IRM a permis de retenir le diagnostic de metastases intramedullaires. Une radiotherapie sur la moelle associee a une corticotherapie a ete debutee. Un traitement par therapie ciblee a ete indique. Le patient est decede trois mois apres le debut du traitement. Notre objectif est de rapporter un nouveau cas de metastase dans la moelle epiniere d’un adenocarcinome pulmonaire en insistant sur sa rarete ainsi que ses difficultes diagnostiques et therapeutiques a travers une revue de la litterature.

It was previously shown that letrozole (Femara) was significantly more potent than anastrozole (Arimidex) in inhibiting aromatase activity in vitro and in inhibiting total body aromatisation in patients with breast cancer. The objective of this study was to compare letrozole (2.5 mg per day) and anastrozole (1 mg per day) as endocrine therapy in postmenopausal women with advanced breast cancer previously treated with an anti-oestrogen. This randomised, multicentre and multinational open-label phase IIIb/IV study enrolled 713 patients. Treatment was for advanced breast cancer that had progressed either during anti-oestrogen therapy or within 12 months of completing that therapy. Patients had tumours that were either positive for oestrogen and/or progesterone receptors (48%) or of unknown receptor status (52%). The primary efficacy endpoint was time to progression (TTP). Secondary endpoints included objective response, duration of response, rate and duration of overall clinical benefit (responses and long-term stable disease), time to treatment failure, and overall survival, as well as general safety. There was no difference between the treatment arms in TTP; median times were the same for both treatments. Letrozole was significantly superior to anastrozole in the overall response rate (ORR) (19.1% versus 12.3%, P=0.013), including in predefined subgroups (receptor status-unknown, and soft-tissue- and viscera-dominant site of disease). There were no significant differences between the treatment arms in the rate of clinical benefit, median duration of response, duration of clinical benefit, time to treatment failure or overall survival. Both agents were well tolerated and there were no significant differences in safety. These results support previous data documenting the greater aromatase-inhibiting activity of letrozole and indicate that advanced breast cancer is more responsive to letrozole than to anastrozole as second-line endocrine therapy.

Secondary tumours to radio- and/or chemotherapy have rarely been reported after treatment for head and neck cancers. We report a case of mandibular fibrosarcoma observed 7 years after chemoradiotherapy for undifferentiated nasopharyngeal carcinoma in a patient treated when 20 years old.

Resume Objectif : Evaluer notre experience a l’institut Salah Azaiz concernant la pose et le maniement des sites implantables en cancerologie medicale. Patients et methodes : De janvier 1992 a juin 2000, nous avons indique la pose de 208 voies veineuses centrales (VVC) par voie sous-claviere avec site d’injection sous-cutane chez 179 patients adultes (118F/61H) et 26 enfants (14F/12G) dont l’âge moyen etait de 37 ans (7 mois a 72 ans). Les indications etaient essentiellement celles d’une chimiotherapie de longue duree ou en perfusion continue ou vesicante pour metastases ou recidives de tumeurs du sein (93/179), cancer digestif (42/179) ou cancer pediatrique (26 cas). Resultats : En dehors de trois echecs initiaux, 205 SI ont ete poses chez 202 patients (double chez trois d’entre eux). La veine sous-claviere a ete ponctionnee par voie percutanee sus-claviculaire (voie de Yoffa) dans 156/205 cas et sous-claviculaire (voie d’Aubaniac) dans 32 cas, du cote gauche dans 153 cas et droit dans 52 cas. La conversion en jugulaire interne a ete effectuee chez 17 patients. Les incidents initiaux ont consiste en six ponctions arterielles (2,9 %), trois pneumothorax (1,5 %) et une migration de catheter dans l’artere pulmonaire droite. La duree mediane de maintien du materiel etait de 210 jours pour les adultes (3 a 1460 j) et de 185 jours pour les enfants (3 a 1100 j). La duree d’implantation a ete de 49 200 site-jours. Nous avons procede a l’explantation de 17 sites (8 %), pour infection (huit cas), ulceration cutanee (huit cas) ou extravasation d’actinomycine D (un cas), six cas (2,9 %) de thromboses veineuses sus-claviculaires et jugulaires ont ete traites par anticoagulants et attitude conservatrice du site. Actuellement, 58 patients sont vivants avec leur site en place. Conclusion : L’utilisation des catheters veineux centraux relies a un site implantable permet en general un maintien prolonge du materiel ameliorant ainsi le confort du patient et de l’equipe soignante. Le prix eleve de ce materiel est amorti apres une utilisation frequente et prolongee.

The calcining and sintering behaviour of fluorapatite synthesised by precipitation has been studied. During the calcination process, in the temperature range 400–900°C, the specific surface area decreases with a rise in temperature. Below 715°C, the decrease is associated with grain growth according to a superficial diffusion mechanism. Above this temperature, several mechanisms may take part in the coarsening. Sintering of fluorapatite is performed between 690 and 1320°C, under an argon atmosphere when the gas atmosphere is not fittingly dried; hydroxyfluorapatite can be formed during sintering. Densification appears to be governed by grain growth. At moderate temperatures coarsening leads to dense bodies. A relative density of about 97% is obtained at 1020°C. Above 1100°C densification is hindered by coarsening which becomes important and much quicker when the liquid phase is formed at 1180°C.

Since the few data exploring a possible association between Epstein–Barr virus (EBV) and breast cancer are conflicting, we investigated this association together with the influences of geographical areas. 509 breast cancers were sampled from areas with varying risks of nasopharynx carcinoma (NPC) such as North Africa (Algeria and Tunisia, high-risk area); southern France (Marseille, intermediate-risk area); and northern Europe (northern France, the Netherlands and Denmark; low-risk areas). Polymerase chain reaction (PCR) of a subregion of EBV BamHIC encoding the EBERs demonstrated that 31.8% of the tumours contained the viral genome. No significant differences were observed among the geographical areas. However, positive samples showed higher loads of the EBV genome in the NPC high- and intermediate-risk areas than in the low-risk areas. EBV type 1 was the dominant strain. In situ hybridization studies using a35S-labelled riboprobe for EBER1 and a laser capture microdissection, combined with quantitative PCR, showed that EBV localization was restricted to some tumour epithelial cell clusters. EBV could not be detected in the stroma. Considering the whole population covered, the presence of the EBV genome was not correlated with age, menopausal status, tumour, size, nodal status or histological grade. © 2001 Cancer Research Campaign http://www. bjcancer.com

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.

Fluorapatite (Fap) is prepared by precipitation method and sintering in the temperature range 640–1365°C. Linear shrinkage starts at about 715°C and the material reaches its final density at 890°C. Above this value, grain growth becomes important and induces an intragranular porosity which is responsible for density decrease. At 1180°C, a liquid phase is formed as a result of the formation of a binary eutectic between Fap and fluorite contained in the powder as impurity. This liquid phase further promotes the coarsening process and induces formation of large pores at high temperatures.

Intramedullary spinal cord metastases are extremely rare and affect 0.1 to 0.4% of all cancer patients. We report the case of intramedullary metastases in a 42-year-old patient, 12 months after the initial diagnosis of a lung adenocarcinoma. The patient was on third-line chemotherapy for a progressive disease with node and bone metastases. He complained of weakness and difficulty walking. The MRI permitted confirmation of the diagnosis. Corticotherapy was started and the patient underwent radiotherapy. A targeted therapy was indicated. The patient died three months after the initiation of this treatment. The aim of this paper is to report a new case of intramedullary spinal cord metastases from a pulmonary adenocarcinoma, focus on its rarity and diagnostic and therapeutic difficulties through a review of the literature.

The goal of this study is to analyze certain epidemiologic characteristics of breast cancer in Tunisia and to foresee the consequences that will arise from the trends in incidence of this cancer. Data obtained from the North-Tunisia Cancer Registry (NTCR) and from the Salah AZAIZ Institute (SAI) Registry is used to estimate the different incidence rates and to compare these rates with those of other countries. In 15 years the crude incidence rate for breast cancer in the North Tunisia almost doubled to reach 21.5 cases/100,000 women per year during 1994-1998. The high rate of this cancer among women younger than 35 years (11%) could be related to a relatively low incidence among post-menopausal women. The clinical profile of breast cancer remains quite alarming: 40.2% of cases have a tumor with a clinical diameter equal or greater than 5 cm. Birth cohort effect, also know as the generation effect, is expected to lead to an increase of cancer incidence in the future. The rather high number of young cases is a source of additional cost on social and financial level. The priority is now to solve the problem of late diagnosis it has aggravated the prognosis of this cancer in Tunisia.

To reduce tobacco smoking is, in Tunisia, a public health priority. The tobacco cessation consultation is one of the interventions to fight against the tobacco epidemic; it is a new activity developed in the Salah-Azeiz Tunis cancer centre. The objective of this work is to evaluate the impact of the consultation on the smokers after one year of activities and to analyse the prognostic factors of tobacco cessation in order to improve the efficacy of such an activity in the future, in Tunisia.The cessation methods were based on cognitive and behavioral therapies associated with nicotine patch, delivered free of charge. During one year (July 2003 to June 2004), 340 smokers were attended. Data on their smoking status and psychological characteristics were collected using a standardized questionnaire.The patients were mostly men (79%), these smokers did not present important anxiety-depressive troubles, 68% thought that they were able to quit easily. The majority (57%) smoked more than 20 cigarettes a day and was nicotine-dependent (Fagenström7). Half of this population had already intended to stop, they declared to smoke mostly because of stress. The global cessation rate after a median follow-up of 32 weeks is 27%. The cessation rate lasting six months for 83 patients followed regularly was 23%. The good prognostic factors of cessation, after multivariate analysis, were (when taking out from the model the regular follow-up), to be confidant on the possibility to stop (OR=0.87 [0.78-0.97]). On the contrary, a high score (7) for Fagerström test (OR=1.9 [1.1-3.4), the use of smoking to fight against stress (OR=1.08 [1.0-1.2) and a smoking environment at home (OR=4.5 [1.1-18.9]) were prognostic of a failure in quitting smoking.These results show that the cessation rate, which is still too low as compared with the literature, could be increased by a better follow-up of smokers associated with an information campaign on the existing possibilities to quit smoking in Tunisia.

We report a case of epithelioid hemangioendothelioma observed in soft tissue in a 35-year-old man who presented a painful mass of the right arm which progressed in size for two years. Imaging revealed a 7-cm poorly limited expansive tumor process located in the medial muscle compartment of the right arm. Surgical resection was performed. Histological and immunohistochemical examination led to the diagnosis of soft tissue epithelioid hemangioendothelioma. The tumor recurred in the right arm and the right axillary fossa with development of multiple nodules in the contralateral thoracic wall and pleural effusion. Adjuvant chemotherapy and radiotherapy were performed, but the patient died at two years.

This national survey aims to evaluate opioid availability and prescription by pharmacists in Tunisia and to examine pharmacists' attitude regarding Tunisian law. We surveyed a sample of 300 pharmacists randomly selected from the National Council of Pharmacists list and using the random table. This study started in September 1999 by sending to pharmacists a confidential questionnaire asking about the importance, the rate of sale and the availability of analgesics in their pharmacy. It also tried to determine pharmacists' opinions regarding Tunisian law. A total of 157 pharmacists out of 300 responded to the survey (52 per cent), 95 per cent were working in pharmacies and 15 per cent in hospitals. Analgesics were estimated to be important to very important in their work in 84 per cent and less important in 16 per cent of cases. They were given under advice with great importance in 85 per cent of cases and with less importance in 15 per cent of cases. Analgesic self-medication was frequent in 95 per cent of cases and rare in 4 per cent of cases. Analgesics of levels 1 and 2 were often to always available in 97 per cent of cases and rarely available in 1.5 per cent of cases. Some 84.7 per cent of pharmacists had opioid supplies and 8.9 per cent had no opioids in stock and 6.4 per cent hadn't given a response. 30 per cent of pharmacists think that the 7 days law for opioid prescription should be modified and 66 per cent think it should not, fearing illicit use, fraud and dependance. Pharmacists think that the minimal list of opioids to be stocked in a pharmacy is sufficient because of low demand.

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.

Secondary tumours to radio- and/or chemotherapy have rarely been reported after treatment for head and neck cancers. We report a case of mandibular fibrosarcoma observed 7 years after chemoradiotherapy for undifferentiated nasopharyngeal carcinoma in a patient treated when 20 years old.

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.

In spite of the progress of the imagery in ophthalmology, the retinoblastoma remains in some particular cases, difficult to make. Moreover, the therapy sanction is often heavy. The lactate dehydrogenase (LDH) dosage in aqueous humor is an invasive technique conceivable when there are diagnosis problems particularly in retino-blastoma of old children and in affections simulating retino-blastoma. The purpose of this work is to lay out three observations where the LDH dosage enabled to keep the retinoblastoma diagnosis in one 8-year old child and eliminate it in two children having pseudoglioma with spontaneous evolution allowing to confirm the non-tumoral nature of the affection. Thus, the technique of LDH dosage has been reliable for the 3 cases which we have introduced. The authors compare the reliability of the different cytochemical techniques during the retinoblastoma diagnosis.

We report the results of a prospective Tunisian study using primary chemotherapy followed by conservative surgery in primitive limb osteosarcoma. From January 1988 to January 1998, 56 patients affected by limb osteosarcoma entered in a prospective study of neoadjuvant chemotherapy with the T10 protocol before surgery with a conservative intent. Initial work-up include: clinical exam with tumor measurements, chest and limb X-rays, limb CT-scan or MRI, chest CT-scan, bone scintigraphy and hematological and renal biological exams. Patients receive pre- and post-operative chemotherapy according to the T10 modified protocol. Fifty-six patients (33 M/23 F) with a mean age of 19 years (8 to 28) are included. Mean clinical and radiological tumor size is around 14 cm. Main histologic type is classic osteosarcoma (50% of cases) and 10 patients (9%) presented with initial metastasis; 42 patients on 56 receive the whole pre-operative protocol. Treatment is well tolerated excluding 18 episodes of mucositis, 29 of leucopenia (grade 3), 7 of thrombopenia (grade 3), 4 of cutaneous toxicity, 2 of pulmonary toxicity and 3 of nausea-vomiting. We observe 36% of good histological responders and 64% of bad responders to primary chemotherapy, 27 patients on 49 operated (53%) have a conservative surgery and 18 (47%) a radical surgery. With a median follow-up of 51 months (8 to 128), 29 patients remain alive free of disease (15/17 GR and 14/30 BR), 2 are alive with disease, 2 died by toxicity, 14 died by progressive disease and 9 are lost to follow-up with evolutive disease. Five year disease-free survival is 55% for the 46 non metastatic patients. In univariate analysis, seric alkaline phosphatase level (p = 0.0014) and histological response to chemotherapy (p = 0.0218) are significant factors for prognosis.

Primary gastric MALT non-Hodgkin's lymphoma is rare in immunocompetent children. To our knowledge, only two cases have been previously described. We report two cases of gastric MALT lymphoma associated with Helicobacter pylori. Clinico-pathological features are similar to those observed in adults. The relationship between the microbial infection and non-Hodgkin's lymphoma development is discussed.

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 effect of fluorapatite addition on the mechanical properties of tricalcium phosphate – 50 wt% zirconia composites was investigated during the sintering process. The Brazilian test was used to measure the mechanical resistance of bioceramics. The mechanical properties of composites increase with the sintering temperature and with fluorapatite additive. At 1400°C, the fluorapatite additive ameliorates the densification and the mechanical resistance of tricalcium phosphate – 50 wt% zirconia composites. The 31P magic angle spinning nuclear magnetic resonance analysis of tricalcium phosphate – zirconia composites sintered with fluorapatite additives reveals the presence of tetrahedral P sites.

The aim of the present study is to investigate the clinical features and the risk factors characteristic of choroidal metastasis, which is known as the most common malignant neoplasm of the adult eye.A systematic ophthalmologic examination together with angiography and echography were performed in 106 patients with carcinoma.10% of patients showed choroïdal metastasis. Breast and bronchogenic carcinoma were the most common primary tumor. 82% of cases died within a mean 6.5 months. Clinical, angiographic, echographic and histopathologic features of such metastasis were described.The importance of an early diagnosis of such metastasis are raised.

Human alpha heavy chain disease is characterized by the production of abnormally short alpha IgH chains. In previously published cases it has been found that the malignant cells produce abnormal alpha mRNA, lacking VH and CH1 sequences and composed of a leader sequence peptide, sequences of variable length (69 to 84 bp) and of unknown origin, followed by normal CH2 and CH3 sequences. In this study we established the nucleotide sequence of alpha mRNA for six cases of alpha heavy chain disease. We observed that all six alpha mRNA lack the VH and CH1 sequences as do those previously described. They also contain in-frame inserts of unknown origin between the leader peptide and the normal CH2 and CH3 coding sequences. These inserts are of variable length (42 to 105 bp) and they are unrelated. These results suggest the existence of a common mechanism defect leading to deletions/insertions in alpha heavy chain disease rather than a specific interaction between alpha 1 IgH gene with a unique defined molecular species.

A case of primary hepatic leiomyosarcoma is documented with the use of intermediate filament and actin isoform antibodies. The majority of the tumour cells were positive with alpha smooth muscle actin antibody and about 20% with anti-desmin antibody indicating their smooth muscle nature. A review of the literature revealed 16 previously documented cases.

We have studied the configuration of genes encoding for the heavy and light chains in the tumoral cells of 6 patients affected by alpha heavy chain disease (alpha HCD). The results showed the presence of rearrangement of the alpha heavy chain as well as the kappa light chain genes whereas the lambda genes were in germinal configuration. Thus, these results suggest the presence of a monoclonal compound in the tumoral cells in the alpha HCD.

Malt lymphomas are lymphomas developed from mucosa associated lymphoid tissue and may involve many sites such as the gastrointestinal tract, salivary glands, thyroid gland lung, breast and female genital tract. Histologically, their diagnosis is based upon the existence of four elements: centrocyte-like cells that are responsible for lymphoepithelial lesions that are sometimes very difficult to demonstrate reactive or residual follicles and plasma cells. We study 2 cases of gastric Malt lymphoma and one of alpha heavy chain disease involving the small intestine and the stomach and we try to define the common features of Malt lymphoma, alpha chain disease and non-secretary IPSID, which all present the clinical tetralogy mentioned above.

Kaposi’s sarcoma (KS) is a rare tumor but its incidence is higher following renal transplantation and especially among people of Arab, Jewish and Mediterranean ancestry. We report 3 cases among 120 recipients of renal transplants followed-up for at least 3 years.

The authors report their experience of pleural talcage under thoracoscopy in 21 cases of lymphomatous pleurisy. This represents 9.6% of the total number of cancerous pleurisies treated with talc over four years. A successful result with talcage was achieved in 84% of cases. The success of failure of talcalge seems to depend on the macroscopic appearance (the existence of masses or nodules) as well as an abundance of pleural liquid, all constitute unfavourable factors. On the other hand the lymphoma (Hodgkins or non Hodgkins) does not seem to have any unfavourable effect.

The aim of this retrospective study is to detennine prognostic factors for response to CT and survival, in patients (pts) treated with neoadjuvant CT and radiotherapy (RT) for locoregionally advanced non-metastatic NPC. From February 1988 to December 1992, 100 untreated pts received 3 courses of CT regimen with Cisplatin 100 mg/m2 Day l and Adriamycin 30 to 50 mg/m2 Day l for group I (36 pts), 50 to 75 mg/m2 for group II (39 pts) and 75 to 90 mg/m2 for group III (25 pts), repeated every 3 weeks, followed by locoregional RT. Response was assessed after 1 cycle of CT, before and after RT, by the measurement of node areas. Pts characteristics: 70% were men, median age 36.6 years (11 – 66 yrs); T1T2 = 26 pts, T3 = 25, T4 = 49, N2 = 39, N3 = 61; histology; UCNT = 64, non-UCNT = 36. All characteristics were well balanced in the 3 groups. The mean response rate after I cycle was 54.9%, after 3 cycles 78.8%. After RT, we observed 83% of CR, 14% PR and 3% of failure. Twenty seven pts relapsed. With a mean follow up of 27 month, the 3-yrs overall survival (OS) was 73.5% and disease free survival (DFS) 64.2%. Age, sex, node area, histology, T, N, Adriamycin dose-intensity, clinical response to CT, duration of RT and delay between CT and RT were variables studied in univariate and multivariate analysis (Cow model). In univariate study, the factors influencing significatively as and DFS were response after 3 cycles of CT (P Conclusion High dose Adriamycin regimen seems to improve the response rate to CT, which is correlated to as and DFS. Further studies with dose escalation of Adriamycin and growth factors should be done to increase the survival of the bad prognostic pts.

Although GTD is uncommon, it is extremely important because of the high degree of curability with adapted treatment. It is becoming important to preserve young patients (pts) fertility. We reviewed the productive history ofall pts who received chemotherapy (CT) for a GTD at ISA, between January 1982 and December 1993. Only 34 pts had subsequent pregnancies: 19 had molar pregnancies (MP) and 15 choriocarcinomas (CC). The mean age was 27 years (range 17–38). Pts with CC received a combined regimen of CT with Vincristin and Methotrexate 9 pts and Etoposide and Actinomycin 6 pts. All those with MP were treated by a CT associating (Methotrexate and Vincristin). All of them entered a complete remission, 7 after a salvage CT. MP n = 15 CC n = 19 Number of pregnancies 28 29 Normal term pregnancies 18 23 Spontaneous abortion 3 1 Ectopic pregnancy 0 1 Placenta Acreta 0 0 Premature birth 1 1 Congenital malformations 3 3 Conclusion It is actually important to achieve 2 objectives in treating pts with GTD: first to cure them, second to preserve their fertility.

Between 1981 and 1985, the authors studied 21 Tunisian patients with alpha chain disease. Twenty of 21 underwent laparotomy. According to Galian et al. six patients were classified Stage A, two Stage B, and 13 Stage C. The therapeutic regimen included the following: (1) Antibiotics: In the case of intestinal bacterial overgrowth (IBO), antibiotics selected by their antibiograms were delivered; in absence of IBO, metronidazole plus ampicillin were first given. The antibiotic treatment was changed in case of therapeutic failure. (2) Chemotherapy: From 1981 to 1983 a cyclophosphamide, Adriamycin (doxorubicin), teniposide (VM-26), prednisone (CHVP) protocol (Adriamycin 35 mg/m2, teniposide 50 mg/m2 day 2, cyclophosphamide 300 mg/m2 days 2 through 4, prednisone 40 mg/m2 days 1 through 10) was used. After 1983 bleomycin 15 mg, Adriamycin 30 mg, vinblastine 10 mg were given on day 15. Serum immunoelectrophoresis and immunohistochemical study of duodenojejunal specimens were made on a 3-month and 6-month basis, respectively. Survival curve analysis was made according to Kaplan and Meier. Results were as follows: (1) Stage A: Six patients were first treated by antibiotics alone; two complete responses (CR) persisting 42 and 55 months later were observed, respectively. The four antibiotic failures were submitted to further chemotherapy with four subsequent failures and two deaths. (2) Stage B-C: Chemotherapy led to nine CR with one precocious relapse, a salvage chemotherapy allowing to one more CR. (3) All stages mixed, percentage of survival reached 90 +/- 12% at 2 years and 67 +/- 25% at 3 years, all patients alive beyond 3.5 years being disease-free.

This study deals to produce tricalcium phosphate - fluorapatite composites sintering at various temperatures ( 1300 ∘ C , 1350 ∘ C and 1400 ∘ C ) and with different alumina additives amounts (2.5 wt%, 5 wt%, 7.5 wt%, 10 wt% and 20 wt%). The characterization of samples before and after sintering was investigated, using X-ray diffraction, infrared spectroscopy, scanning electronic microscopy and by analysis using 31P and 27Al nuclear magnetic resonance. Mechanical properties have been measured by Brazilian test. The evolution of composite rupture strength was studied as a function of sintering temperature. The effect of sintering on the mechanical properties was measured with the change in composition and microstructure of the composite. The mechanical resistances of composites were increased with the temperatures and with concentrations of alumina. At 1350 ∘ C , the mechanical resistance reaches its maximum value with 5 wt% Al2O3 (13.6 MPa) whereas the optimum density is about 90% with 2.5 wt% Al2O3.