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In recent genome-wide association studies, genetic variants in TCF7L2, SLC30A8, HHEX, LOC387761, and EXT2 were associated with risk for type 2 diabetes mellitus (T2DM). We aimed at investigating the association of these single-nucleotide polymorphisms (SNPs) with T2DM and defining their corresponding allelic and genotypic combinations in the Tunisian population. We also tried to determine the effect of R325W of SLC30A8 on the modeled structural properties of the protein.Five SNPs were genotyped in 331 T2DM Tunisian patients and 403 healthy subjects by polymerase chain reaction-restriction fragment length polymorphism. A model of residues 318-366 of the SLC30A8 protein was built by homology modeling.LOC387761 provided the strongest evidence for replication, where rs7480010 presented a risk of 2.41 with T2DM, followed by rs1111875 in HHEX (odds ratio=1.95) and rs13266634 in SLC30A8 (odds ratio=1.59). None of the two other SNPs previously reported was associated. The highest risk of T2DM was 3.1, obtained by the genotype combination of the three associated SNPs. Modeling of the cytoplasmic part of the SLC30A8 protein showed that the R325W change might affect the electrostatic potential of the SLC30A8 protein.We concluded that the SLC30A8, HHEX, and LOC387761 are more likely to represent the genuine signals of T2DM in the Tunisian population.

Autoimmune thyroid diseases (AITDs) including Graves disease (GD) and autoimmune hypothyroidism (AH) are associated with TNF genes polymorphisms. TNF molecules bind to TNFRI and TNFRII. No genetic association was reported between TNFR and AITDs. In this study, we have analysed two polymorphisms in TNFRI gene (TNFRI+36A/G SNP and a microsatellite (GT) 17 (GA) n ) and one polymorphism in TNFRII gene (TNFRII +676 T/G). All these polymorphisms were studied in a large Tunisian family with high prevalence of AITDs, and on a case-control sample of 91 GD patients and 165 controls. The present study was undertaken to investigate the genetic association of these polymorphisms with AITDs development. We reported the implication of TNFRIA3 allele in AITDs pathogenesis in familial and case control studies, respectively ( χ 2 = 4.13, p = 0.042; χ 2 = 9.26, p c = 0.005). In addition, Case-control study has revealed for the first time that TNFRII+676G allele was associated with GD ( χ 2 = 11.53; p = 0.0007). Two TNFRI haplotypes were found to be associated with GD: TNFRI+36G-A8, TNFRI+36A-A3 ( χ 2 = 88.07; p = 6.32 × 10 −21 , χ 2 = 16.78; p = 4.2 × 10 −5 , respectively). Our data showed that TNFRI polymorphisms have an important role in AITDs pathogenesis in both familial and case-control samples and that TNFRII was rather implicated in GD development in the Tunisian population.

Background Genome-wide analyses of the genetic predisposition to type 2 diabetes mellitus (T2DM) in different isolates and populations have identified regions of interest called non insulin-dependent diabetes mellitus (NIDDM) 1, 2, 3 and 4. At the NIDDM1 locus (2q37.3), calpain-10 ( CAPN10 ) encodes for a ubiquitously expressed protease implicated in the two fundamental pathophysiological aspects of T2DM. This is a report of the results of a study of the association of four CAPN10 polymorphisms with T2DM in the Tunisian population. Participants and methods A total of 222 T2DM patients with a diabetes duration of 10 years or more and 206 healthy controls were enrolled to analyze the frequency distribution of four CAPN10 polymorphisms (UCSNP-43, UCSNP-19, UCSNP-110 and UCSNP-63) using polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP) in the Tunisian population. We also investigated the association of T2DM with different haplotypes and haplotype combinations. Results Only the A allele of UCSNP-43 showed an association with T2DM (odds ratio, OR=1.86). We also identified a novel combination of haplotypes (121/221) defined by three polymorphisms (UCNSP-43, -19 and -63) that is associated with an increased risk of T2DM (OR=2.38). Conclusion In this study involving the Tunisian population, we identified genetic variants within CAPN10 that are linked with T2DM and a novel haplotype combination, 121/221, associated with an increased susceptibility to T2DM.

Ocular findings in Alport syndrome: 32 case studies N. Hentati, D. Sellami, K. Makni, M. Kharrat, J. Hachicha, A. Hammadi, J. Feki Background: Alport syndrome is an inherited disease resulting in kidney failure, hearing loss, and ocular abnormalities. The purpose of this study was to describe the incidence and type of ocular abnormalities and to determine inheritance of this syndrome in our population. Patients and methods: A total of 32 patients, from ten different families in South Tunisia, underwent a complete ocular examination. Inheritance was determined using pedigrees and genotyping. Results: The best corrected visual acuity was 7.6/10. Biomicroscopy showed polymorphous dystrophy in 3%, anterior lenticonus in 28 %, lens opacities in 3%, cataract in 19%, and retinal flecks in 37%. The genetic survey found five families with X-linked Alport syndrome, four families with recessive autosomal disease, and one family with dominant autosomal disease. Discussion: Ocular abnormalities have been reported in 9%–82% of Alport syndrome patients. They are rare in childhood and increase in frequency and severity with age. The types of ocular defects described mostly involve the lens, the retina and more rarely the cornea. The most common changes are anterior lenticonus and perimacular retinal flecks. In approximately 85%, Alport syndrome is X-linked. In the remaining 15%, the transmission is autosomal recessive and exceptionally autosomal dominant. Conclusion: Ocular examination is a precious help for Alport syndrome diagnosis. It can also determine the prognosis of nephropathy.

Objective: Diabetic nephropathy (DN) is a long-term complication of both type 1 and type 2 diabetes. Genetic studies on DN have been of little help so far, since several genetic association studies have shown conflicting results. Here we report the findings of a case-control study on five SNPs in the glucose transporter 1 (GLUT1) gene. The study investigated the association of five GLUT1 genotypes and haplotypes with DN.Research design and methods: All subjects, 126 DN (cases) and 273 type 2 diabetes (controls), were genotyped using the polymerase chain reaction restriction fragment length polymorphism.Results: The TT and the AA genotypes of the Haell and Enh2 SNP1, increased the risk of DN. The study also identified CGT as the highest risk haplotype (4.4-fold) followed by CAT with an increased risk of DN of 2.6-fold.Conclusions: The GLUT1 gene confers susceptibility to DN in type 2 diabetes patients in the Tunisian population.

Introduction La nephronophtise est une nephropathie interstitielle familiale a transmission autosomique recessive. Elle s′associe parfois a des manifestations ophtalmologiques dont la retinopathie pigmentaire (RP), realisant le syndrome de Senior Loken. Nous rapportons les manifestations oculaires observees et les resultats de l’analyse genetique au sein de trois familles. Patients et methodes Vingt-deux sujets appartenant a trois familles ont eu un examen ophtalmologique complet comportant une acuite visuelle, un examen a la lampe a fente, un examen du fond de l’œil et un electroretinogramme, et pour l’etude genetique, nous avons effectue les techniques de genotypage et de sequencage. Resultats Vingt-deux sujets, dont 9 atteints de la nephronophtise, ont eu un examen ophtalmologique. Une retinopathie pigmentaire a ete retrouvee chez 3 patients. L’etude genetique a montre que les deux patientes de la famille 1 presentaient la deletion homozygote du gene NPHP1, tous les patients de la famille 3 etaient lies a NPHP4 et presentaient une deletion des exons 2 et 3. Les resultats du patient appartenant a la famille 2 sont en cours. Conclusion La nephronophtise s’associe parfois a des manifestations ophtalmologiques dont la RP realisant le syndrome de Senior-Loken. Elle a ete retrouvee chez 33 % des patients. L’etude genetique permet parfois d’eviter le recours a la ponction renale quand la deletion homozygote du gene NPHP1 est confirmee.

Endometriosis is a common condition affecting the female genital tract, but involvement of the ileum is very rare. Its symptoms are vague and are similar to other benign and malignant disorders, and radiographic findings lack specificity. We report the case of a 23-year-old woman presenting with acute intestinal obstruction for whom preoperative diagnosis favoured acute appendicitis. Laparotomy revealed ileal stenosis. A partial small bowel resection was performed. Pathological examination diagnosed ileal endometriosis. Endometriosis may be a cause acute abdominal pain in women, and should be considered in differential diagnosis. Difficulties in establishing its diagnosis are discussed.

Alport syndrome is an inherited disease resulting in kidney failure, hearing loss, and ocular abnormalities. The purpose of this study was to describe the incidence and type of ocular abnormalities and to determine inheritance of this syndrome in our population.A total of 32 patients, from ten different families in South Tunisia, underwent a complete ocular examination. Inheritance was determined using pedigrees and genotyping.The best corrected visual acuity was 7.6/10. Biomicroscopy showed polymorphous dystrophy in 3%, anterior lenticonus in 28%, lens opacities in 3%, cataract in 19%, and retinal flecks in 37%. The genetic survey found five families with X-linked Alport syndrome, four families with recessive autosomal disease, and one family with dominant autosomal disease.Ocular abnormalities have been reported in 9%-82% of Alport syndrome patients. They are rare in childhood and increase in frequency and severity with age. The types of ocular defects described mostly involve the lens, the retina and more rarely the cornea. The most common changes are anterior lenticonus and perimacular retinal flecks. In approximately 85%, Alport syndrome is X-linked. In the remaining 15%, the transmission is autosomal recessive and exceptionally autosomal dominant.Ocular examination is a precious help for Alport syndrome diagnosis. It can also determine the prognosis of nephropathy.

Background T2DM is a complex metabolic disease. Genetic studies on T2DM have been of little help so far because several genetic association studies have shown conflicting results. In this study, we report the findings of a case-control study on three SNPs in the GLUT1 gene. For this, we investigated the association of GLUT1 genotypes and haplotypes with T2DM. Research Design and Methods All 273 T2DM subjects (cases) and 343 healthy subjects (controls) were genotyped using the polymerase chain reaction restriction fragment length polymorphism. Results Results showed that the GT genotype of XbaI SNP could increase the risk of susceptibility to T2DM to 2.4 and that TAT is a ‘risk haplotype’ conferring a risk of 3.4 to T2DM. Conclusion The TAT haplotype of the GLUT1 gene confers susceptibility to T2DM in the Tunisian population. Copyright © 2008 John Wiley & Sons, Ltd.

A genome-wide screen has shown linkage to the GRD-2 locus in Graves' disease (GD). Furthermore, a positional candidate gene maps to this locus; the CD40 gene has been reported to be associated and may predispose to the disease. The aim of this study was to replicate/reject the GRD-2 and to determine if the single nucleotide polymorphism (SNP) of the CD40 (CD40 C/T-1) confers susceptibility to GD.The present study examined a dataset of 11 families with GD using 10 microsatellite markers and a case-control study consisting of 76 sporadic GD patients and 66 healthy subjects to determine the implication of the GRD-2. Both non-parametric linkage and association tests were performed. Genotyping of the CD40 C/T-1 was carried out using a polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP).The intrafamilial association and the case-control study showed no association between CD40 C/T-1 and GD. In addition, a high percentage of the C allele (96.9%) of CD40 SNP among control data was observed. The linkage analyses showed that the highest non-parametric LOD score was 1.67 at the D20S119 marker and the maximum attainable LOD score was 1.66. This result provides interesting evidence for linkage between GRD-2 and GD.The CD40 gene seems to be not associated with GD in the Tunisian population, whereas the GRD-2 locus could harbour other candidate gene(s) to the genetic susceptibility of GD.

Introduction Les phacomatoses sont des maladies dues a une anomalie precoce du developpement embryonnaire, associant des atteintes de plusieurs organes, comme le rein, la peau et l’os. Patients et methodes Nous rapportons deux cas de sclerose tubereuse de Bourneville (STB) et un cas de neurofibromatose type 1 (NF1), chez lesquels une atteinte renale a ete objectivee. Resultats Observation 1 : patiente âgee de 25 ans, suivie depuis l’âge de 9 ans pour une NF1, avec presence de multiples tâches cafe au lait diffuses. La patiente a presente une hypertension arterielle (HTA) avec hypokaliemie. Les investigations ont conclu a un hyperaldosteronisme secondaire du a une stenose serree bilaterale des arteres renales. La patiente a eu une angioplastie de l’artere renale droite avec succes primaire. L’evolution a ete marquee par la persistance de l’HTA avec normalisation de la kaliemie. Observation 2 : patiente âgee de 54 ans, suivie depuis l’âge de 30 ans pour une sclerose tubereuse de Bourneville (STB) revelee par des convulsions en rapport avec des nodules sous-ependymaires diffus bilateraux et calcifies. Devant la decouverte d’une HTA avec une insuffisance renale avancee, une echographie renale a montre deux reins dedifferencies sieges de multiples formations kystiques, ainsi qu’un bourgeon tissulaire echogene, vascularise au Doppler, tres evocateur d’un angiomyolipome. L’evolution a ete marquee par l’aggravation rapide de la fonction renale. Observation 3 : patiente âgee de 31 ans, ayant une epilepsie depuis l’âge de 21 ans avec a la TDM cerebrale des tubers cerebraux, corticaux et sous-corticaux, ayant porte le diagnostic de STB. La patiente a presente une hematurie macroscopique avec une insuffisance renale avancee. L’echographie renale a objective deux reins augmentes de taille, sieges de multiples kystes bilateraux. L’evolution vers le stade terminal a ete rapide. Discussion L’atteinte renale au cours des phacomatoses est heterogene et frequente, dominee par les kystes et les angiomyolipomes, surtout au cours de la STB. La stenose des arteres renales survient dans un 1 % des cas au cours de la NF1. Conclusion La prise en charge des phacomatoses necessite une collaboration multidisciplinaire.

Introduction La neurofibromatose type 1 (NF1) est une phacomatose a tropisme neurocutane. L’atteinte vasculaire est dominee par les anevrysmes cerebraux. Cependant, l’atteinte des arteres renales est possible. Nous rapportons un cas de NF1 associe a une stenose des arteres renales. Observation Patiente âgee de 25 ans, suivie en pediatrie depuis l’âge de 9 ans pour une neurofibromatose type 1, diagnostiquee devant la presence de multiples tâches cafe au lait diffuses associees a des neurofibromes. La patiente a presente, au cours de son suivi, une HTA avec hypokaliemie. La fonction renale etait normale. Le dosage des derives methoxyles etaient normaux. L’aldosteronemie etait elevee, avec un dosage de l’activite renine plasmatique eleve, ayant conclu a un hyperaldosteronisme secondaire du a une stenose serree bilaterale des arteres renales. La patiente a beneficie d’une angioplastie de l’artere renale droite avec succes primaire. L’evolution a ete marquee par la persistance d’une hypertension arterielle bien equilibree sous inhibiteur calcique et un anti-aldosterone avec normalisation de la kaliemie. Discussion La neurofibromatose type 1 (NF1) est la phacomatose la plus frequente. Son mode de transmission est autosomique dominant. Elle survient surtout pendant l’enfance. Elle peut toucher tous les organes avec cependant une predilection pour l’atteinte neurocutanee, caracterisee essentiellement par les tâches cafe au lait et les neurofibromes. L’atteinte vasculaire est rare mais possible. La stenose des arteres renales survient dans un 1 % des cas, responsable d’une hypertension arterielle et d’un hyperaldosteronisme secondaire. Le diagnostic differentiel se pose avec le pheochromocytome. Un suivi particulier est justifie afin de deceler ces complications et les traiter rapidement. Conclusion La stenose des arteres renale est une complication rare mais possible au cours des neurofibromatoses type 1. Sa prise en charge necessite une collaboration multidisciplinaire.

Nephronophthisis is a familial interstitial nephropathy with an autosome recessive mode of transmission. In some cases, it is associated with ocular manifestations such as retinitis pigmentosa in Senior-Løken syndrome. We report ocular abnormalities and genetic results in three affected Tunisian families.Twenty-two members of these three families underwent a complete ophthalmologic examination (visual acuity, slit lamp biomicroscopy, ophthalmoscopy, and retinal electrophysiology). For genetic study, all individuals were genotyped and underwent a genomic sequence.Twenty-two subjects, nine of whom presented nephronophthisis, were included in this study. Retinitis pigmentosa was found in three cases. Our genetic study demonstrated that patients belonging to family 1 had homozygous deletions in NPHP1, all affected individuals from family 3 were linked to NPHP4 and presented a deletion in exons 2 and 3. Results are pending for patients in family 2.Senior-Løken syndrome is a rare hereditary disease that combines familial juvenile nephronophthisis and retinitis pigmentosa. This association was described in the literature in 39%-43% of cases. In our study, it was approximately 33% of cases. The genetic study can sometimes obviate the need for renal puncture, especially when the homozygous deletion of NPHP1 gene is confirmed.

Introduction L’etiologie de l’obesite est multifactorielle resultant de l’interaction de facteurs environnementaux et genetiques. Chez l’homme, de nombreux genes candidats ont ete etudies a la recherche du ou des genes de susceptibilite a l’obesite. Materiels et methodes Notre travail consiste a une etude d’association cas (obeses)/temoins (sujets sains) effectuee sur 109 patients obeses et 52 sujets sains. Nous avons etudie deux polymorphismes : le premier G2548A situe au niveau de la region promotrice, et le deuxieme A19G situe au niveau de la region 5’UTR de l’exon 1. Resultats L’analyse du polymorphisme G-2548A du gene de la leptine chez les obeses et les temoins a revele que la frequence de l’heterozygote G/A etait significativement plus eleve chez les patients, suggerant que le genotype G/A pourrait etre un determinant majeur implique dans la survenue et le developpement de l’obesite dans la population tunisienne. S’agissant du polymorphisme A19G, aucune association significative n’a pu etre determinee, toutefois, le risque relatif de l’obesite associe au polymorphisme A19G du gene de la leptine pourrait etre confondu au genotype A/G. Par ailleurs, notre etude a pu demontrer une association statistiquement significative entre l’haplotype GG et le risque de developper une obesite suggerant que l’effet d’un variant genetique peut devenir majeur s’il interagit avec d’autres variants genetiques et/ou avec des facteurs environnementaux concomitants. Conclusion Ces resultats suggerent que le gene de la leptine a subi une selection naturelle, ayant pour resultat une difference significative de la repartition geographique des frequences des polymorphismes G-254A et A19G. La frequence de l’allele A, retrouvee pour chaque polymorphisme dans notre etude, pourrait suggerer que le fond genetique de la population tunisienne est proche de celui des populations europeennes, africaines et asiatiques.

We studied nucleolar organizers (Ag-NORS) in 20 cases of ocular limbic tumours of which 7 were Bowen disease or intraepithelial carcinoma and 13 were invasive carcinomas. The NOR-Index, reflecting cellular activity, increased from intraepithelial carcinoma (3.97) to microinvasive (5.45) and invasive carcinoma (5.81). Results of Nor-Index, reflecting proliferation, was in agreement with other technics such as immuno-labelling with Ki67 and PCNA antibodies.

We report a retrospective multicentric study of 20 cases of sclero-corneal limbus tumours carcinome including 9 cases of Bowen's disease and 11 squamous cell carcinomas. These cases were observed over two 10 and 20-year periods in two pathology departments. Epidemiological, clinical, pathological and therapeutic data as well as the clinical course were studied and the results compared with a large review of the literature. The mean age of the patients was 38 years for Bowen's disease and 47 for carcinoma. Two young subjects, 5 and 22 years, had xeroderma pigmentosum and had Bowen's disease and an epidermoid microinvasive carcinoma, respectively. All of the patients with Bowen's disease were men and were more than 90% of the patients with carcinoma. Tumour size was greater in carcinomas (7 to 10 mm) than in Bowen's disease (1 to 5 mm). All tumours were unilateral. Clinical manifestations included irritative or inflammatory reactions in one-fourth of the patients with Bowen's disease and in one-third of those with carcinoma. Pathology examination revealed an intact basal membrane separating healthy tissue from Bowen's lesions which showed disrupted cell architecture mostly involving the medial layers of the epithelium in 37% of the cases. All of the lesions were treated by exeresis. No recurrence has been observed after a follow-up of 1 month to 2 years for Bowen's disease and 1 year (maximum) for squamous cell carcinomas.

The authors report a case of lipomatous naevus present for 35 years, and therefore probably congenital, in a 48 year old female patient. This bulging lesion was 2.5 cm in diameter with a slightly encephaloid appearance. The authors reviewed the limited literature on the subject in order to more clearly define this hamartomatous lesion which has a constant histological appearance, but very variable clinical and macroscopic features.

Introduction L'epidemie du diabete et son impact dans les complications renales en particulier la nephropathie diabetique (NPD), representent une preoccupation importante. La NPD est de nos jours la cause majeure d'insuffisance renale terminale. L'incidence de l'insuffisance renale chronique terminale chez les patients avec diabete de type 2 a augmente de facon dramatique au cours de ces dernieres annees. Le developpement de cette complications : non seulement du controle glycemique mais aussi de la predisposition genetique. Plusieurs etudes ont examine le transporteur du glucose (GLUT1) comme etant gene candidat qui peut conferer une susceptibilite a la NPD. Ces investigations se sont focalisees pour tester si le polymorphisme d'un seul nucleotide (XbaI) du GLUT1 est associe a la NPD en utilisant des cas temoins. Nous avons ainsi pense a l'etude de la susceptibilite du polymorphisme XbaI chez les patients diabetiques de type 2 avec nephropathie diabetique. Materiels et methodes Trois groupes du sujets ont ete preleves : 126 patients diabetique de type2 avec nephropathie, 273 diabetiques de type2 sans nephropathie et 343 sujets temoins afin de les genotyper pour polymorphisme d'un seul nucleotides XbaI en utilisant la technique de fragmentation par PCR. L'association statistique etait basee sur la frequence des alleles, et des genotypes chez les patients et les cas controles qui ont ete compares en utilisant x 2 Ap Resultats Une difference significative dans la distribution du genotype entre les patients avec NPD versus diabetique de type2 sans NPDet cas controle a ete donnee pour le polymorphisme d'un seul nucleotide XbaI. Conclusion Le gene GLUT1 peut conferer une susceptibilite a la NPD chez les patients diabetiques dans la population tunisienne.

Introduction Le syndrome d’Alport est une affection hereditaire caracterisee par l’existence d’une nephropathie hematurique progressive qui peut s’associer a une surdite de perception et des anomalies oculaires. Le but de notre etude est de determiner les caracteristiques epidemiologiques, cliniques et therapeutiques de ces anomalies oculaires et d’identifier les modes de transmission au sein de notre population. Materiels et Methodes Notre population comportait 32 patients atteints de syndrome d’Alport, appartenant a 10 familles. Tous nos patients ont beneficie d’un examen ophtalmologique complet avec angiographie retinienne selon les indications. L’etude genetique etait realisee par l’etude des arbres genealogique des 10 familles et le genotypage au sein de 5 familles. Resultats Nous avons trouve une meilleure acuite visuelle corrigee moyenne de 7,6/10, une atteinte corneenne a type de dystrophie posterieure polymorphe dans 3 %, une atteinte cristallinienne dans 47 %, un lenticone anterieur dans 28 %, une association de lenticone anterieur et de lenticone posterieur dans 3 %, des opacites cristalliniennes dans 3 %, une cataracte dans 19 %, une atteinte retinienne dans 37 %. L’etude genetique a trouve une transmission selon le mode dominant lie a l’X dans 5 familles, selon le mode autosomique recessif dans 4 familles et selon le mode autosomique dominant dans une famille. Discussion Les atteintes oculaires associees a ce syndrome sont rapportees dans 9 a 82 % selon les series. Elles augmentent en frequence et en severite avec l’âge. Elles peuvent concerner le cristallin, la retine et plus rarement la cornee. Les lesions caracteristiques sont le lenticone anterieur et les ponctuations retiniennes maculaires. Le lenticone anterieur est considere comme un marqueur de gravite de l’atteinte renale. Conclusion L’examen ophtalmologique peut presenter une aide precieuse au diagnostic du syndrome d’Alport. Il permet de prejuger du pronostic de la nephropathie.

The authors present 16 cases of malignant ovarian tumors in childhood, censed in Pasteur Institute - Tunis. These tumors are scarce, and present in the literature only 3% of the malignant tumors in childhood. In this series, germ cell tumors are the most frequent and present 81.25% of these cases, of which 43.75% of dysgerminoma. Gonadal stromal tumors are more scarce (6.25%). The prognosis of these tumors was transformed by the radiation therapy in dysgerminoma, and the chemotherapy in the other germ cell tumors. These tumors must be diagnosed and treated early.

The endosalpingosis is a benign affection which is in the most often asymptomatic. It means the presence of tubal mucosa in ectopic location; often in the tubal wall; the pelvic peritoneal and adjacent lymph node. We present here a colic endosalpingosis case with intestinal occlusion. We review in this purpose the literature, and discuss the etiopathogenicity. It shows that a previously tubal affection can have a great part in the birth of this pathology.

The stomach fibro-inflammatory-polyp is distinguished from the eosinophilic granuloma by some authors because of their geographic assessments. It is an inflammatory affection represented by a pseudo tumoral lesion. We present a case concerning a woman, 62 years old, who presented since 10 years a Biermer anaemia; a neoplastic affection was suspected, and then denied by histopathologic exam. We shall discuss the pathogenic and therapeutic data proposed by the literature. Recently, the treatment of this benign lesion consists in endoscopic resection. There no recurrence or malignant degeneration.

The authors present a retrospective study of 287 pulmonary cytologic exams censed in Pasteur Institute - Tunis between 1970 and 1986. These 287 exams consist of 145 bronchic aspiration liquids and 142 spittles. A systematic exam was practiced in patients presenting a pulmonary symptomatology suggesting little or not at all broncho pulmonary cancer. 40 of these exams present cancerous cells (15 cases) or suspected cancerous cells (25 cases). The biopsy confirms a malignant tumor in 25 patients (5%). These results should urge us toward a cytologic exam not only in adults presenting any respiratory symptomatology, but also in subjects at high risk, especially smokers. Localising the tumor is necessary for the biopsy. This biopsy will lead us to determine the histologic type and consequently the adequate therapy.

The authors present four cases of malignant mesothelioma of pleura. Mean of age of our patients is 34 years. Two of them are men, the two others are women. The histologic study shows that our cases are represented by one of epithelial type, one of sarcomatoïd type and the two last of mixed biphasic type. The authors insist, in the basis of literature data, in the importance of the positive and differential diagnosis concerning the primitive and secondary epithelial tumors of the lung. The means of diagnosis are represented currently by cytology and histopathology and also by cytochemistry and immunohistochemistry.

The non-hemodynamic pulmonary oedema by increase alveolo-capillary permeability or Adult Respiratory distress Syndrome (ARDS), has many causes and determine an acute insufficiency respiratory who needed mechanic ventilation. It can above all progressing to interstitial fibrosis after deadly. The writer present lesional pulmonary oedema case which evolved to fibrosis in a 17 old patient. This patient has been operated for duodenal ulcer with bi-vagotomy and antrectomy and presented a post operatory shock. The particularity of this observation is The fibrosis evolution to an cartilaginous metaplasia. The lesional pulmonary oedema has usually serious prognosis because the mortality is from 50 to 80% in the literature review.

The authors do a clinical anatomic study showing 102 cases of lung primitives cancers to be diagnose in 60% cases on biopsy and 40% on operation'piece. The matter in boundless majority of cases is carcinoma 92%, themselves overlooked by squamous cells carcinoma 55%, forwarded by adenocarcinoma 20%, small cells carcinoma represent 11% of cases and large cells carcinoma 7%. The mean age of occur is 55 years and any cases of carcinoma is observed at persons under 30 years of age. 94% of person are masculine. The majority of tumors 58% cases present themselves as bulky masses exceeding 6 cm of diameter. The authors insist in this study on necessity of early diagnosis when the therapeutic will be curative.

A retrospective study interesting 582 anatomoclinical cases of gastric malignant tumors was realised in two anatomo-pathological services of Tunis from 1970 to 1985. The average age of patients is 55 years old, with extensive ranges from 17 to 85 years old. The authors point out significative male predominance 64.6% of cases. The ulcered form is the most frequent, about 3.8% of macroscopic aspect cases. Among these last, the authors find 26.7% of ulcerating and polypoid form with invasive characteristics, and 18.83% of linitis plastica. The pyloric area localisation is the most frequent, 68% of cases. Diffuse tumors are observed in 8.47% of cases and numerous stomach localisation in 0.82% of cases. 84% of histological aspect are represented by adenocarcinoma, the most frequent of them (35%) is well differentiated type, then the poorly differentiated (20%) and atypic form (19.75%). Frequency of lymphosarcoma reaches 14.7%, the first is the centroblastic form, then lymphoblastic and lymphoplasmocytic forms. Concerning evolution, gastric cancer is an infiltrative tumor: serosal surface is attempted in 69.5% of cases, and during the first chirurgical act half cases show lymph nodes metastasis.