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A post-acne hyperpigmentation index (PAHPI) has been developed in the United States to better compare therapeutic modalities. Our aim in this study was to validate the PAHPI score in patients with skin type VI from sub-Saharan Africa.The study was conducted in Dakar, Senegal. Twenty-one patients with Fitzpatrick skin type VI, aged 17 to 55 years, presenting hyperpigmentation secondary to acne were included. Ongoing use of skin bleaching products or acne treatments was allowed. Four trained dermatologists rated the patients using the PAHPI. A narrow-band reflectance spectrophotometer (Mexameter MX-18, Cologne, Germany) was used to measure the degree of pigmentation of involved and adjacent skin on 6 representative facial lesions.The average inter-rater reliability (weighted Kappa) showed substantial agreement for intensity (0.67), moderate agreement for number (0.53) and fair agreement for lesion size (0.28). Inter-rater reliability for the total PAHPI was excellent for both day 1 and day 2 (interclass correlation coefficient of 0.87 and 0.85, respectively; P0.0001). Intra-rater reliability for total PAHPI ranged from 0.83 to 0.93 (P0.0001). PAHPI scoring thus demonstrated excellent reliability both between and within raters. The association was moderate to substantial for all raters on both days (range for rho on day 1: 0.531 to 0.815; range for rho on day 2: 0.448 0.762). The correlations between the Mexameter (Courage and Khazaka) measurements and PAHPI scores showed moderate to substantial agreement.Although tested primarily in African American women to date, PAHPI is also valid for patients from sub-Saharan Africa.

Inkjet printing inks frequently contain polar liquids of low volatility such as glycerol or poly(ethylene glycols) in addition to the main solvent water. The deposition of these liquids on paper sheets induces swelling of the cellulose fibers, which leads to an overall, anisotropic deformation of the sheet. We characterized the corresponding strain components by means of a grid projection method and white light interferometry. For pure water, most of the hydroexpansion strain vanishes again after drying is complete. However, for aqueous solutions of non-volatile co-solvents, a large fraction of the deformation persists after the water has evaporated. Because swelling occurs only after liquid enters the cellulose fibers, monitoring the dynamics of expansion provides insight into the pore-fiber distribution of co-solvents. The corresponding timescales of pore-fiber transport strongly depend on the co-solvent concentration, as a sufficient quantity of water is needed to plasticize the fiber walls.

Purpose The aims of this study were: determination of the CTV to PTV margins for prostate and pelvic lymph nodes. Investigation of the impact of registration modality (pelvic bones or prostate) on the CTV to PTV margins of pelvic lymph nodes. Investigation of the variations of bladder and rectum over the treatment course. Investigation of the impact of bladder and rectum variations on prostate position. Patients and methods This study included 15 patients treated for prostate adenocarcinoma. Daily kilo voltage images and weekly CBCT scans were performed to assess prostate displacements and common and external iliac vessels motion. These data was used to calculate the CTV to PTV margins using Van Herk equation in the setting of a daily bone registration. We also compared the CTV to PTV margins of pelvic lymph nodes according to registration method; based on pelvic bone or prostate. We delineated bladder and rectum on all CBCT scans to assess their variations over treatment course at 4 anatomic levels [1.5 cm above pubic bone (PB), superior edge, mid- and inferior edge of PB]. Results Using Van Herk equation, the prostate CTV to PTV margins (bone registration) were 8.03 mm, 5.42 mm and 8.73 mm in AP, ML and SI direction with more than 97% of prostate displacements were less than 5 mm. The CTV to PTV margins ranged from 3.12 mm to 3.25 mm for external iliac vessels and from 3.12 mm to 4.18 mm for common iliac vessels. Compared to registration based on prostate alignment, bone registration resulted in an important reduction of the CTV to PTV margins up to 54.3% for external iliac vessels and up to 39.6% for common iliac vessels. There was no significant variation of the mean bladder volume over the treatment course. There was a significant variation of the mean rectal volume before and after the third week of treatment. After the third week, the mean rectal volume seemed to be stable. The uni- and multivariate analysis identified the anterior wall of rectum as independent factor acting on prostate motion in AP direction at 2 levels (superior edge of, mid PB). The right rectal wall influenced the prostate motion in ML direction at inferior edge of PB. The bladder volume tends toward significance as factor acting on prostate motion in AP direction. Conclusions We recommend CTV to PTV margins of 8 mm, 6 mm and 9 mm in AP, ML and SI directions for prostate. And, we suggest 4 mm and 5 mm for external and common iliac vessels respectively. We also prefer registration based on bony landmarks to minimize bowel irradiation. More CBCT scans should be performed during the first 3 weeks and especially the first week to check rectum volume.

Intramedullary spinal cord metastases (ISCM) is a rare, but devastating complication of malignant disease. Prognosis is poor, with an overall median survival (OS) of 4 months from the time of diagnosis. Yet, ISCMs are being increasingly diagnosed, related to advances and increased use of imaging and therapies that prolong survival in patients with cancer. Prompt and accurate diagnosis of ISCM is necessary for effective treatment, and magnetic resonance imaging (MRI) is the preferred imaging technique. The optimal management of these patients is controversial because of the multitude of clinical circumstances and the lack of controlled studies on the efficacy of the different therapeutic approaches. Increased awareness of this rare entity may lead to an earlier diagnosis at a stage when neurological deficits are reversible, and therefore, more effective palliation may be achieved. Therefore, we carried out this retrospective research of 3 observations of ISCM, associated with a detailed review of the literature describing the diagnostic, therapeutic and evolutionary characteristics of this special rare entity.

In the present work, polyaniline-titanium (IV) oxide (PANI-TiO2) nanocomposites have been synthesized by solidstate (solvent-free) oxidative polymerization method of aniline as a monomer under green condition using both iron (III) chloride hexahydrate (FeCl3·6H2O) and ammonium peroxydisulfate (APS) as two different type of the oxidants as well as various modes and increasing of the ratios of monomer to oxidant. The structural and morphological of the nanocomposites have been characterized using kinetic and microscopic analysis. The electrical conductivities, cyclic voltammetry, bandgap energy (Eg), and morphology of the nanocomposites are mainly dependent on the type of oxidants and reaction conditions. Also, the nanocomposites were shown electro-active and functional properties. The I–V characteristics of PANI-TiO2 in an Al/(PANI-TiO2)/TiO2/FTO solar cell are achieved by drawing the plot of the I–V curves. It is noted that nanocomposites with different conditions were shown similar FT-IR and UV-Vis spectra with different morphologies. The TEM images in different conditions showed a thin layer of TiO2 nanoparticles in the outer wall of the nanotube when the APS was used as the oxidant, while when the FeCl3 was used as the oxidant, the TiO2 nanoparticles have been distributed on a plantain leaf of PANI matrix. The XRD results confirm completely results obtained from TEM. As a result, the nanocomposites with both methods showed a good P–N junction between TiO2 and PANI.

The Rif is among the areas of Morocco most susceptible to landslides, because of the existence of relatively young reliefs marked by a very important dynamics compared to other regions. These landslides are one of the most serious problems on many levels: social, economic and environmental. The increase in the frequency and impact of landslides over the past decade has demonstrated the need for an in-depth study of these phenomena, allowing the identification of areas susceptible to landslides. The main objective of this study is to identify the optimal method for the mapping of the area susceptible to landslides in municipality of Oudka. This area has been marked by the largest landslide in the region, caused by heavy rainfall in 2013. Two Statistical Methods i) Regression Logistics (LR) ii) Artificial Neural Networks (ANN), were used to create a landslide susceptibility map. The realization of this susceptibility map required, first, the mapping of old landslides by the aerial photography, the data of the geological map and by the data obtained using field surveys using GPS. A total of 105 landslides were mapped from these various sources. 50% of this database was used for model building and 50% for validation. Eight independent landslide factors are exploited to detect the most sensitive areas: altitude, slope, aspect, distance of faults, distance streams, distance from roads, lithology and vegetation index (NDVI). The results of the landslide susceptibility analysis were verified using success and prediction rates. The success rate (AUC = 0.918) and the prediction rate (AUC = 0.901) of the LR model is higher than that of the ANN model (success rate (AUC = 0.886) and prediction rate (AUC = 0.877). These results indicate that the Regression Logistic (LR) model is the best model for determining landslide susceptibility in the study area.

Adolescence is an important developmental period marked by a transition from primarily parental-controlled eating to self-directed and peer-influenced eating. During this period, adolescents gain autonomy over their individual food choices and eating behavior in general. While parent-feeding practices have been shown to influence eating behaviors in children, little is known about how these relationships track across adolescent development as autonomy expands. The purpose of this qualitative study was to identify factors that impact food decisions and eating autonomy among adolescents. Using the food choice process model as a guide, four focus groups were conducted with 34 adolescents. Focus group discussion was semi-structured, asking teens about influences on their food choices across different food environments, their involvement with food purchasing and preparation, and perceived control over food their choices. Focus group transcripts were analyzed using deductive and inductive code creation and thematic analysis. This study found six leading influences on adolescents' food choices and identified additional factors with prominence within specific environmental contexts. This study distinguished a broader spectrum of factors influencing adolescent food choice that extend beyond “convenience” and “taste” which have previously been identified as significant contributors. The degree of control that teens reported differed by eating location, occasion, and social context. Finally, adolescents demonstrated various levels of engagement in behaviors related to their eating autonomy. Identifying the emergent themes related to adolescent autonomy was the first step toward the goal of developing a scale to evaluate adolescent eating autonomy.

Gaming has increasingly become a part of life in Africa. Currently, no data on gaming disorders or their association with mental disorders exist for African countries. This study for the first time investigated (1) the prevalence of insomnia, excessive daytime sleepiness, anxiety and depression among African gamers, (2) the association between these conditions and gamer types (i.e., non-problematic, engaged, problematic and addicted) and (3) the predictive power of socioeconomic markers (education, age, income, marital status, employment status) on these conditions. 10,566 people from 2 low- (Rwanda, Gabon), 6 lower-middle (Cameroon, Nigeria, Morocco, Tunisia, Senegal, Ivory Coast) and 1 upper-middle income countries (South Africa) completed online questionnaires containing validated measures on insomnia, sleepiness, anxiety, depression and gaming addiction. Results showed our sample of gamers (24 ± 2.8 yrs; 88.64% Male), 30% were addicted, 30% were problematic, 8% were engaged and 32% were non-problematic. Gaming significantly contributed to 86.9% of the variance in insomnia, 82.7% of the variance in daytime sleepiness and 82.3% of the variance in anxiety [p

Residual stresses induced during quenching of aluminum alloys cause dimensional instability and distortion. In this study, the effects of different concentrations of polyalkylene glycol (PAG) quenchants on residual stresses and mechanical properties of 2024 aluminum alloy were investigated. Surface residual stresses were measured by using hole-drilling strain-gauge method. Also, mechanical properties and microstructure of the heat-treated samples were analyzed using hardness measurements, tensile tests, and transmission electron microscopy. Results showed that quenching into a 15% polymeric solution and aging at 190 °C for 12 h cause 50% reduction in residual stress as compared with quenching in water at 20 °C and naturally aging. Moreover, tensile strength decreased by 104 MPa (~ 20%) in compared with the T6 sample.

In this study, a cryogenic thermal treatment is developed and its effects on mechanical properties and precipitates are investigated. Water-quenched samples were immersed in liquid nitrogen and reheated in hot oil at 180°C or boiling water for 5 min. Finally, the samples were artificially aged at 190°C for 12 h. The results indicated a notable increase of about 75 MPa in the ultimate tensile strength in comparison to T6 heat-treated alloy. TEM observations revealed that the S(S′) precipitates were fine and uniformly distributed in the microstructure due to reheating in hot oil and subsequent aging treatment.

Spin coated thin films of pure Poly Vinyl Alcohol (PVA) and PVA mixed with porous SiC microparticles were prepared in order to be used in an optical device. An electroless method was used for producing porous silicon carbide powder under UV irradiation was investigated. The electroless process was chosen because it does not require electrical contact during etching like in anodic one. Silver nanolayer coated SiC particles was formed by polyol process prior the etching and served both as an anode, catalyst and mask for the reduction of a chemical oxidant. The etchant was composed of HF and different oxidants in water. Various porous morphologies are presented and studied as a function of etchant concentration, oxidant type, etching time, and wavelength of irradiation. Morphological, optical and photoluminescence characterizations of SiC micropowder embedded in PVA matrix and deposited as thin films on glass substrates are reported. We concluded that the chemical etching conditions of SiC powder seems to have a large impact on the resulting properties. We noticed that thin film based on SiC powder etched under UV light of 254 nm using K 2 S 2 O 8 as oxidant, at reaction temperature of 80 °C for t = 40min exhibited the best photoluminescence property.

Residual stresses induced during quenching of aluminum alloys cause distortion and have a negative effect on their properties. The purpose of this study is to reduce the residual stresses and improve mechanical properties by using a novel cryogenic treatment. Water quenched samples were cooled down by immersion in liquid nitrogen at −196 °C, following by rapid heating in hot oil at 180 °C and finally they were artificially aged. Residual stresses was measured by the hole drilling strain gauge method. The mechanical properties and microstructure of a heat treated samples were investigated by means of hardness measurements, tensile tests and transmission electron microscopy. The results showed that this treatment can relieve up to 71% of the residual stresses compared to 29% related to the traditional cryogenic treatment that used boiling water as the reheating medium. In addition, there is a considerable increase of about 75 MPa in the ultimate tensile strength in comparison to the T6 heat-treated alloy. TEM observations revealed that the S′ precipitates were fine and uniformly distributed in the microstructure due to deformation during reheating in hot oil.

In this study, Morphological, optical and photoluminescence characterizations of nanostructured SiC micropowder embedded in PVA matrix and deposited as thin films on glass substrates are reported. we prepared the porous SiC microparticles/PVA thin films by spin coating method. The average size of SiC microparticles were 7 μm. An electroless method was used for producing porous silicon carbide powder under UV irradiation. Silver nanoparticles coated SiC powder was formed by polyol process. The etchant was composed of aqueous HF and different oxidants. Various porous morphologies were obtained and studied as a function of oxidant type, etching time, and wavelength of irradiation. We concluded that the chemical etching conditions of SiC powder seems to have a large impact on the resulting properties. We noticed that the best photoluminescence property was achieved when SiC powder was etched in HF/K2S2O8 at reaction temperature of 80 °C for t = 40min and under UV light of 254 nm.

The logistic regression (LR) and multivariate adaptive regression spline (MarSpline) are applied and verified for analysis of landslide susceptibility map in Oudka, Morocco, using geographical information system. From spatial database containing data such as landslide mapping, topography, soil, hydrology and lithology, the eight factors related to landslides such as elevation, slope, aspect, distance to streams, distance to road, distance to faults, lithology map and Normalized Difference Vegetation Index (NDVI) were calculated or extracted. Using these factors, landslide susceptibility indexes were calculated by the two mentioned methods. Before the calculation, this database was divided into two parts, the first for the formation of the model and the second for the validation. The results of the landslide susceptibility analysis were verified using success and prediction rates to evaluate the quality of these probabilistic models. The result of this verification was that the MarSpline model is the best model with a success rate (AUC = 0.963) and a prediction rate (AUC = 0.951) higher than the LR model (success rate AUC = 0.918, rate prediction AUC = 0.901).

Resume But Traduire et adapter l’echelle Francaise DESS en arabe dialectal Tunisien et etudier sa validite par un pre-test sur un echantillon de personnes tunisiennes polyhandicapees (PPH). Methodes L’etude s’est deroulee en 2 etapes : (1) traduction-adaptation ; (2) pre-test de la version traduite aupres de 30 PPH, afin d’evaluer sa validite (par les tests non parametriques appropries) et sa coherence interne (calcul du coefficient de Cronbach dont la limite d’acceptabilite est de 0,7). Resultats Quarante-deux cotations ont ete obtenues pour 30 patients. La validite d’apparence est satisfaisante : la grille a ete bien percue par l’investigateur dans 38/42 cotations (90 %). Le temps de remplissage de la grille n’a pas depasse 10 minutes dans 34/42 cotations (81 %). Des difficultes de comprehensions de l’enonce de 5 items ont ete signalees par 8 destinataires (19 %). Pour les 10 patients qui ont beneficie de 2 cotations, le score moyen est significativement plus bas apres administration d’antalgiques ( p = 0,005), temoignant d’une bonne validite de construit discriminante. La validite de construit divergente a ete verifiee en l’absence de liaisons statistiquement significatives entre les scores totaux et d’autres parametres independants par hypothese (sexe, âge, degre d’autonomie, deficit moteur, cause du handicap, mode de recrutement). Le coefficient alpha de Cronbach est de 0,82 temoignant d’une bonne coherence interne. Conclusion La version pre-finale de l’echelle adaptee est valide, fiable et utilisable en un temps acceptable aupres des aidants des PPH. Une etude future multicentrique permettra la precision d’autres qualites psychometriques de la version finale.

Gaming has increasingly become a part of life in Africa. Currently, no data on gaming disorders or their association with mental disorders exist for African countries. This study for the first time investigated (1) the prevalence of insomnia, excessive daytime sleepiness, anxiety and depression among African gamers, (2) the association between these conditions and gamer types (i.e., non-problematic, engaged, problematic and addicted) and (3) the predictive power of socioeconomic markers (education, age, income, marital status, employment status) on these conditions. 10,566 people from 2 low- (Rwanda, Gabon), 6 lower-middle (Cameroon, Nigeria, Morocco, Tunisia, Senegal, Ivory Coast) and 1 upper-middle income countries (South Africa) completed online questionnaires containing validated measures on insomnia, sleepiness, anxiety, depression and gaming addiction. Results showed our sample of gamers (24 ± 2.8 yrs; 88.64% Male), 30% were addicted, 30% were problematic, 8% were engaged and 32% were non-problematic. Gaming significantly contributed to 86.9% of the variance in insomnia, 82.7% of the variance in daytime sleepiness and 82.3% of the variance in anxiety [p

This paper analyzes how a deep cryogenic process changes the microstructure and mechanical properties of a medium-carbon low-alloy steel. The light microscopy, microhardness testing, and transmission electron microscopy reveal that η-carbide and martensite are constituent phases of deep cryogenic treated (DCT) steel, while the microstructure of conventional heat-treated (CHT) steel consists of cementite, martensite, and retained austenite. Transmission electron microscopy also shows that the particles of η-carbide have the shape of ultra-fine globules in DCT martensite. The η-carbides grow in a Hirotsu and Nagakura orientation relationship to the martensitic matrix that enables highly coherent interphase boundaries. The results of the mechanical tests, including tensile and Charpy impact tests, show that the deep cryogenic process can improve toughness in terms of elongation (~12.81%), tensile fracture energy (~266 MPa), and the ductile–brittle transition temperature (~−17.2 °C). The results of fractography are also consistent with the improvement in toughness. It is also found that the strength and macrohardness values are increased. Unlike CHT steel, discontinuous yielding is observed in DCT steel. Moreover, there is no change in Young’s modulus due to the deep cryogenic treatment.

Calculation of the primary circuit's coolant activation due to fission products (FPs) has been investigated for the eastern-type pressurized water reactor (VVER1000-V446). The reactor has been considered under normal full power operational condition for the first fuel cycle. Determination of the reactor coolant activity is based on time-dependent fission product core inventories. ORIGEN2.1 code has been used to determine the time-dependent fission product core inventories. The fission products activity in the primary coolant is calculated using a set of ordinary differential equations (ODEs) which governs the FPs concentration in the primary coolant. Results for 87 FPs have been calculated. The results of these calculations have been found to agree well with the corresponding available values found in the Final Safety Analysis Report (FSAR) of the Bushehr Nuclear Power Plant (BNPP).

In this paper we generalize an infeasible interior-point method for linear optimization to horizontal linear complementarity problem (HLCP). This algorithm starts from strictly feasible iterates on the central path of a perturbed problem that is produced by suitable perturbation in HLCP problem. Then, we use so-called feasibility steps that serves to generate strictly feasible iterates for the next perturbed problem. After accomplishing a few centering steps for the new perturbed problem, we obtain strictly feasible iterates close enough to the central path of the new perturbed problem. The complexity of the algorithm coincides with the best known iteration complexity for infeasible interior-point methods. Keywords: Horizontal linear complementarity problem (HLCP), infeasible-interior-point method, central path. MSC: 90C33, 90C51

Purpose Three-dimensional conformal radiotherapy (3D-CRT) has become a standard of radiotherapy in the treatment of prostate cancer because of its benefits in terms of safety compared to the conventional technique. We report in this work the experience of the unit of radiotherapy of the Mohamed V Military Hospital in order to assess the degree of technical mastery and identify gaps to provide the best patient care.

Background: Implanted venous access devices or permanent central venous access systems (PCVASs) are routinely used in oncologic patients. Complications can occur during the implantation or use of such devices. We describe such complications of the PCVAS and their management. Methods: Our retrospective study included 1,460 cases in which PCVAS was implanted in the 11 years between January 2002 and January 2013, including 810 women and 650 men with an average age of 45.2 years. We used polyurethane or silicone catheters. The site of insertion and the surgical or percutaneous procedure were selected on the basis of clinical data and disease information. The subclavian and cephalic veins were our most common sites of insertion. Results: About 1,100 cases (75%) underwent surgery by training surgeons and 360 patients by expert surgeons. Perioperative incidents occurred in 33% and 12% of these patients, respectively. Incidents (28%) included technical difficulties (n=64), a subcutaneous hematoma (n=37), pneumothoraces (n=15), and an intrapleural catheter (n=1). Complications in the short and medium term were present in 14.2% of the cases. Distortion and rupture of the catheter (n=5) were noted in the costoclavicular area (pinch-off syndrome). There were 5 cases of catheter migration into the jugular vein (n=1), superior vena cava (n=1), and heart cavities (n=3). No patient died of PCVAS insertion or complication. Conclusion: PCVAS complications should be diagnosed early and treated with probable removal of this material for preventing any life-threatening outcome associated with complicated PVCAS.

Introduction et but de l’etude La generalisation de la radiotherapie conformationnelle avec modulation d’intensite (RCMI) a permis une meilleure conformation du traitement aux volumes cibles, et ainsi une meilleure epargne des organes critiques. Ces techniques sont tres prometteuses dans le contexte particulier des tumeurs de la tete et du cou. Le but de notre etude etait de comparer chez 15 patients atteints d’un cancer de la sphere ORL deux types d’irradiation conformationnelle avec modulation d’intensite, avec boost sequentiel ou avec boost integre. Materiel et methodes Deux techniques d’irradiations ont ete utilisees chez chaque patient : arctherapie avec un boost sequentiel ou avec un boost integre (simultaneous integrated boost [SIB]). Tous les patients inclus dans l’etude ont recu en concomitance 40 mg/m2 de cisplatine chaque semaine. Les plans etaient compares en se basant sur la distribution de dose au volume cible previsionnel et sur l’histogramme dose–volume des organes a risque : parotides, moelle, tronc cerebral, nerfs optiques et chiasma. Resultats et analyse statistique L’âge moyen des patients etait de 55,6 ans [35,75–64,5 ans]. Le site de la tumeur primitive etait le cavum pour sept patients, l’oropharynx pour quatre, la cavite buccale pourquatre. Le stade tumoral etait : II chez six patients (soit 40 %), III chez six (soit 40 %), et IV chez trois (soit 20 %). La distribution de dose dans les volumes cible previsionnels etait similaire entre les deux techniques. La RCMI avec boost integre permettait de mieux proteger les nerfs optiques ainsi que le chiasma optique avec une dose mediane de 42 Gy et 38 Gy respectivement contre 43,7 Gy et 40 Gy respectivement dans le bras avec boost sequentiel. Conclusion La technique de RCMI avec boost integre permet une couverture similaire des volumes cibles par rapport au boost sequentiel. Elle offre une meilleure epargne aux organes a risque et raccourcit la duree du traitement d’une semaine.

Resumen El objetivo de este trabajo es concienciar sobre el desarrollo de sarcoidosis tras el tratamiento antineoplasico para evitar errores de diagnostico con los estudios de FDG-PET/CT. Se presentan los casos de 3 mujeres tratados de cancer de mama, cuello uterino y estomago, que desarrollaron sarcoidosis al finalizar el tratamiento antineoplasico. La utilidad del FDG-PET/CT esta en la localizacion de organos candidatos a biopsia diagnostica, pero no sirve para distinguir un tumor maligno y lesiones inflamatorias o granulomatosas.

Resume Le cancer broncho-pulmonaire constitue l’un des cancers les plus frequents au Maroc et represente le premier cancer chez l’homme. Actuellement, la tomographie par emission de positons couplee a la tomodensitometrie (TEP/TDM) au FDG, est decrite comme etant l’examen d’imagerie le mieux adapte pour evaluer l’extension initiale de ce type de cancer dans sa variete non metastatique a distance. Notre serie confirme les donnees de la litterature, montrant la superiorite de la TEP/TDM comparativement a la TDM seule dans le bilan d’extension initial des cancers bronchiques non a petites cellules (CPNPC).

Background: Completion surgery after chemoradiotherapy (CRT) in management of locally advanced cervical cancers (LACC) still controversial. The aim of this study was to compare disease-free and overall survival rates in patients who had completion surgery and who were therefore treated conservatively by exclusive concomitant chemoradiotherapy (CCRT). Materials and methods: This is a retrospective study from January 2005 to December 2014 included 130 patients with LACC, managed by standard CCRT followed by brachytherapy at the radiotherapy department of Military Hospital Mohamed V of Rabat in Morocco. Inclusion criteria were the following: Biopsy-proven carcinoma of the cervix, FIGO stage IB2 to IVA and treatment with CCRT followed by brachytherapy. All patients had good response to standard CCRT, with a clinical decrease in tumor volume of more than 50%. Patients were divided into two groups depending on the authors practice: Group 1 consisted of patients without completion surgery who had theoretically a good response to standard treatment and Group 2 consisted of patients treated by completion surgery with pelvic control on final pathology. One hundred and two patients are included in Group 1 and 28 in Group 2. The mean age of the patients was 50.9 years (range 29–82). Squamous cell carcinoma 115 (89.8%) was the leading histological type. Tumor size was 4.77 ± 1.44 cm clinically and 46.72 ± 15.42 mm in MRI. The parametrial was invaded in 113 (87.6%) of cases and the pelvic lymph nodes were suspected in 29 (23%) of cases. Major of patients whom underwent a completion surgery showed a complete response on final pathology. Overall, 20.8% (27/130) of patients had a recurrence, with a median time to recurrence of 8 months [2-55]. With a mean follow-up of 44 months (2 to 118), the local control rate was 68.5% (n=89) and 20 (15.4%) patients were lost to follow-up. The overall survival (OS) at 5 years in Group 1 and 2 was respectively 59.8% and 88.9% and the relapse-free survival (RFS) was respectively 73.3% and 88.9%. A significant benefit of completion surgery was seen only in OS (p=0.011). Conclusion: completion surgery after CCRT has a place in the multimodality management of locally advanced cervical cancer with significant benefice in local control and OS.

Resume Le carcinome de primitif inconnu (CAPI) est la metastase d’une tumeur maligne epitheliale dont l’origine reste inconnue. Le carcinome bronchique en est le plus frequemment a l’origine (45 %), cependant, dans plus d’un quart des cas, son origine reste inconnue et le choix therapeutique justifie une precision histopathologique souvent apportee par l’immuno-histochimie. Nous presentons un cas rare de metastase cerebrale revelatrice d’un cancer pulmonaire inconnu au terme d’un bilan exhaustif. Il s’agit d’un patient âge de 53 ans, tabagique chronique, qui a presente un an et demi auparavant, de facon brutale, une perte de connaissance apyretique avec crise tonico-clonique de resolution spontanee. L’examen clinique etait sans particularites. L’imagerie cerebrale par resonance magnetique objectivait la presence de deux formations tissulaires parietales dont les biopsies stereotaxiques avec etude histologique et immuno-histochimique etaient en faveur de metastase d’un adenocarcinome d’origine bronchopulmonaire. Un bilan etiologique a la recherche du primitif pulmonaire est reste negatif (radiographie du thorax de face, scanner thoracique et fibroscopie bronchique avec prelevements perendoscopiques). Le reste du bilan etiologique a la recherche d’un autre primitif est reste negatif. Le diagnostic d’un adenocarcinome bronchopulmonaire avec metastase cerebrale etait donc retenu. Le patient a beneficie de deux seances de radiotherapie cerebrale (gamma kniff) avec regression des deux formations nodulaires. Nous n’avons pas administre de traitement specifique et nous avons preconise la surveillance tres rapprochee du patient qui est reste stable au bout d’une annee et demie. A travers cette observation, nous insistons sur l’interet de l’examen histologique et immuno-histochimique du carcinome de primitif inconnu (CAPI) pour pouvoir poser le diagnostic, orienter la therapeutique et determiner le pronostic.