Mohamed Chebil

Prognostic factors of recurrence after vesicovaginal fistula repair.

Purpose:  We evaluate the prognostic factors of recurrence in patients after the surgical repair of vesicovaginal fistula.

Modelling nonpoint source pollution by nitrate of soil in the Mateur plain, northeast of Tunisia

In order to quantify groundwater contamination by nitrate diffuse pollution in Mateur plain (northeast of Tunisia), it is necessary to evaluate the amount of pollutants, rejected at soil surface as fertilizer or as farm discharge, that passed through the unsaturated zone. For this purpose, we used two methods: the first one is to determine a vulnerability map of Mateur aquifer through the empirical DRASTIC method. The second method consists of determining the average water flows of percolation to the aquifer and the amount of nitrate lixiviation by using Leaching Estimation Chemistry Mode (LEACHM): a one-dimensional difference element model. In order to obtain annual average values, we have been simulating many profiles with the same average daily data to obtain a constant annual recharge and nitrate mass reaching the aquifer. Integrating these results on the whole plain allowed us to produce maps of the groundwater recharge and their nitrate concentrations. The results of nonpoint agricultural pollution modelling are compared to those of index method DRASTIC. We noticed a good correlation between LEACHM simulation and DRASTIC index results. Water table depths, surface soil permeability, and soil texture are the most important factors governing nitrate leaching to groundwater.

Le neuroblastome rétropéritonéal chez l'adulte : à propos d'un cas et revue de la littérature

Retroperitoneal neuroblastoma is a rare embryonic tumor of the sympathetic nervous system that is specific to the child. In this study, the case is reported of an infant who underwent median laparotomy at the age of 14 months for a tumor which occupied the left half of the abdomen. The lesion was large, hard, and not very mobile. It was considered to be unresectable, and the histological findings after biopsy showed it to be a neuroblastoma. Radiotherapy was then initiated, which successfully reduced the tumor size. A second investigation at the age of three years detected an unresectable tumor of 5 cm. A further biopsy was performed, and the histological findings showed the lesion to be a partially developed ganglioneuroblastoma. The patient has been followed up regularly by ultrasonography which has shown no increase in tumor size. She is now 20 years old, and is asymptomatic. The last computed tomography scan visualized a 62-mm retroperitoneal mass with no metastases. Surgery was decided against in favor of regular monitoring. This case is particular due to the prolonged survival of the patient, regression of histological stage, and reduction in size of the tumor after radiotherapy. It is remarkable that the diagnosis of neuroblastoma was made when the patient was 14 months old, and that she is still alive at 20 years old.

Réactions systémiques après traitement endovésical par le BCG : à propos de 4 cas

Local Bacillus Calmette-Guerin (BCG) immunotherapy is an effective and widely used treatment for superficial bladder carcinoma. Local side effects are frequent, whereas systemic side effects are rare, but more serious. We report four cases of systemic BCG reaction. Although uncommon, this infectious complication of BCG therapy should always be considered in the appropriate clinical setting. The best approach to minimize this complication is a strict compliance with precautions and a close and rigorous surveillance of this drug.Local Bacillus Calmette-Guerin (BCG) immunotherapy is an effective and widely used treatment for superficial bladder carcinoma. Local side effects are frequent, whereas systemic side effects are rare, but more serious. We report four cases of systemic BCG reaction. Although uncommon, this infectious complication of BCG therapy should always be considered in the appropriate clinical setting. The best approach to minimize this complication is a strict compliance with precautions and a close and rigorous surveillance of this drug.

Place du traitement endoscopique des urétérocèles compliquées de l'adulte

Resume Introduction L’ureterocele est une malformation congenitale rarement diagnostiquee chez l’adulte. Son traitement, indique dans les formes compliquees ou symptomatiques, n’est pas univoque. Notre but a ete d’evaluer les resultats de la meatotomie endoscopique par incision semi-circulaire. Materiel et methode Etude retrospective de 26 dossiers de patients adultes ayant un ureterocele, traites entre janvier 1987 et decembre 2004. Resultats L’âge moyen de notre population etait de 41 ans. Le sexe ratio etait de 1,7/3. Trente-deux ureteroceles intravesicales ont ete diagnostiquees dont six etaient bilaterales. Dix-huit ureteroceles etaient compliquees de calcul in situ, neuf etaient compliquees de dilatation moderee en amont et trois avaient les deux complications. Deux ureteroceles etaient asymptomatiques et non compliquees, justifiant l’abstention therapeutique. Le traitement endoscopique a ete realise dans 30 cas consistant en une meatotomie en “bouche souriante” avec traitement d’eventuel calcul associe. Aucun incident operatoire n’a ete note. Les suites operatoires etaient simples. Une amelioration clinique et radiologique a ete obtenue chez 23 patients controles. Deux patients, parmi 12 controles par une urethrocystographie retrograde, ont eu un reflux vesico-ureteral grade I qui a disparu a 6 mois. Aucune stenose meatique n’a ete notee. Conclusion La meatotomie endoscopique apparait comme le traitement de choix des ureteroceles compliquees ou symptomatiques de l’adulte. C’est une technique mini invasive, facile, reproductible et efficace.

Le synovialosarcome primitif de la verge

Le synovialosarcome represente un sous-type rare des sarcomes des tissus mous. Son apparition au niveau de la verge est exceptionnelle et seulement deux cas ont ete rapportes dans la litterature auparavant. Nous rapportons un nouveau cas de synovialosarcome de la verge chez un jeune patient de 27 ans, en essayant par l’entremise d’une revue de la litterature de discuter des aspects radiologiques, histologiques, immuno-histochimiques, therapeutiques et pronostiques de cette tumeur exceptionnelle.

Akt activation correlates with the tumor aggressiveness in Tunisian patients with bladder cancer

Various studies in western countries found Akt amplification to be a frequent event in human cancers, including bladder, but the correlation with clinicopathological features is controversial. Such studies have not been reported in African populations, including Tunisians. The purpose of this study was to assess expression of the phosphorylated/activated forms of Akt in tumors from Tunisian patients with bladder cancer and to correlate its expression with pathological and clinical parameters of the disease. The study included 72 patients of whom 34 were diagnosed as low- to medium-grade and 35 as high-grade; 30 were muscle stage and 39 non-muscle stage. Primary tumors from these patients, normal adjacent tissues, or bladder cancer cell-lines were analyzed for Ser473 phosphorylated Akt expression by Western blot. Seventy-two percent of primary tumors from patients with bladder cancer had increased levels of p-Akt. The p-Akt levels in patients with high-grade bladder cancer were significantly elevated compared to patients with low- or medium-grade bladder cancer. In invasive carcinoma, the p-Akt level was significantly higher than in superficial non-invasive bladder tumors. Concerning the influence of tobacco on Akt activation, no significant differences of p-Akt expression were found between non-smoker and smoker patients. Altogether, our results suggest that Akt activation can provide useful prognostic information and that tobacco represents a serious risk factor for recurrence in a cohort of Tunisian patients.

Apport de l’étude du cycle cellulaire et du contenu en ADN par cytométrie en flux dans le pronostic des tumeurs superficielles de la vessie : expérience tunisienne

L’etude clinicopathologique des tumeurs superficielles (pTa/pT1) de la vessie renseigne sur des facteurs pronostiques tels que la taille tumorale, le caractere uni ou multifocal, le grade et le stade tumoraux. Ces facteurs sont actuellement a la base de la decision therapeutique mais ne permettent pas de prevoir le pronostic avec certitude. Plusieurs techniques ont contribue a une meilleure connaissance de ces tumeurs, mais n’ont cependant pas permis de maitriser les incertitudes pronostiques. Ces dernieres decennies ont vu le developpement de l’etude du cycle cellulaire et du contenu en ADN par cytometrie en flux, apportant un element pronostique supplementaire dans differents types de tumeurs. Nous nous sommes proposes d’etudier l’apport de cette technique dans l’evaluation du pronostic des tumeurs vesicales superficielles. Cette etude a porte sur 65 patients porteurs de TSV (pTa / pT1), ayant un suivi minimum de deux ans en cas de non recidive et en cas de recidive ayant eu une deuxieme resection avec analyse des copeaux. La cytometrie en flux a ete appliquee sur le materiel de resection endoscopique des tumeurs initiales fixe au formol et inclus en paraffine par simple marquage de l’ADN a l’iodure de propidium. A l’issue de l’etude cytometrique, 35 (54 %) tumeurs etaient aneuploides et 30 (46 %) etaient diploides. Pour les tumeurs diploides, la moyenne de la phase S etait de 14,94 % (de 2,72 % a 33,4 3 %) ; celle de la phase G2M etait de 8,3 % (de 1 % a 18 %). La presence d’un pic ADN-aneuploide avait une valeur predictive de recidive et de progression en stade, avec des risques relatifs respectifs de 12 et 6,85. Elle etait egalement correlee au grade et au stade histologiques. En revanche, les valeurs des phases S et G2M n’avaient pas de valeur pronostique.