Effect of Helicobacter pylori eradication therapy on the response of MALT-Gastric lymphoma.

INTRODUCTION: The link between gastric mucosa-associated lymphoid tissue lymphoma (LG-MALT) and chronic Helicobacter Pylori (HP) infection had led to a real revolution in the management of the disease. AIMS: To study the results of the HP eradication therapy and to clarify its place in the tumor response. METHODS: A descriptive retrospective bicentric study, between January 2007 and December 2016, including patients with LG-MALT treated in the gastroenterology departments of Sahloul hospital in Sousse and Habib Bougtafa hospital in Bizerte, and having received treatment for eradication of HP. RESULTS: Sixty-three patients were included. The male/female sex ratio was 1.42. The average age was 58 years. The symptomatology was dominated by epigastric pain (96.8%). On digestive endoscopy, the most frequent location and appearance were gastric antrum (39.6%) and ulcerations (89%). The lymphoma was classified as stage IE and IIE1 in 81% and 19% of cases, respectively. The HP status was positive in all patients. The HP eradication rate was 82.5% after three anti-HP treatment courses. Complete remission of lymphoma was obtained in 81% of patients at 18 months. Non-response to HP eradication therapy was observed in 19% of patients. Non-responder patients had a longer diagnostic delay (p=0.02), more diffuse endoscopic involvement (p=0.001) and a more frequent appearance of large gastric folds (p=0.001). CONCLUSION: The course of LG-MALT is determined by the treatment for the eradication of HP. Its success promotes remission of lymphoma.

EncephalApp Stroop Test for covert hepatic encephalopathy screening in Tunisian cirrhotic patients.

Background: Covert hepatic encephalopathy (CHE) is underdiagnosed and is difficult to detect. The EncephalApp Stroop test is validated for its screening. The aim of the study was to define Tunisian norms for the test based on healthy controls norms and to estimate the prevalence of CHE in cirrhotic Tunisian patients. Methods: A prospective, multicenter, cross-sectional study was conducted. Ambulatory or hospitalized cirrhotic patients aged 40 years and over were recruited at 11 centers. Healthy subjects aged 40 years and over were recruited at 8 centers. We used a translated Arabic version of the streamlined EncephalApp Stroop test. The task has two components: "Off" and "On" state depending on the discordance or concordance of the stimuli. Results: 142 patients were included. The mean age was 57.26 years [40-86]. 40 (28.17%) of cirrhotic patients who were included were diagnosed as having a minimal hepatic encephalopathy or CHE. Among the ineligible patients, 22 had overt hepatic encephalopathy. If we consider these patients, the overall prevalence rate of CHE was around 24.39% in cirrhotic patients. It was more frequent in women (34.21% vs 25.96%), and in patients whose level of school education is between 6 and 13 years. Its prevalence does not appear to be affected by gender, MELD score, etiology of cirrhosis and age group of patients, as these variables were independent with respective p according to the chi-square test 0.413; 0.736; 0.663 and 0.1. The stroop times (On / Off and On + Off) correlated significantly with each other, are associated significantly and positively with age (respective Pearson coefficients: 0.578; 0.567 and 0.6). The more the age increases, the more the stroop response times increases (p > 10 -3). Conclusions: EncephalApp Stroop test was an efficient screening tool for CHE in Tunisian cirrhotic patients.

Basal follicle stimulating hormone level correlated to age is a good prognostic criterion for the outcome of intracytoplasmic sperm microinjection.

BACKGROUND: Age and increased FSH serum level in women are prognosis criteriae associated with decreased fertility. OBJECTIVE: The aim of this study was to investigate whether age-specific FSH concentration can be a predictor of the outcome of ovarian stimulation in women undergoing IVF. METHODS: A total of 676 women undergoing their first IVF cycle over a 3-year period were included in this retrospective cohort study. Patients were grouped according to age (< or ≥  38 years), and within each age range, patients were grouped into bFSH quartiles (< or ≥  9.6 mUI/L). We have considered four study groups: group A (Age < 38 years and FSH < 9.6 m UI/l), group B (Age < 38 years and FSH ≥ 9.6 m UI/l), group C (Age ≥ 38 years and FSH < 9.6 m UI/l), group D (Age ≥ 38 years and FSH ≥ 9.6 m UI/l). The outcome measures in each group included: consumed quantity of gonadotrophin, poor response, cycle cancellation, oocyte yield, number of embryos obtained, embryonic quality (grade 1 embryo), as well as, fertilization, implantation, clinical pregnancy and childbirth rates. Analysis of the Results compares laboratory parameters and ICSI Results, based on a statistical analysis that is essentially descriptive. RESULTS: High bFSH levels in young patients (< 38 years) predicts a higher poor response (p < 0.0001), higher stopped cycles (p < 0.0001), lower oocyte yield (p < 0.0001) and lower embryos obtained (p < 0.0001) in IVF cycles but does not translate to either lower pregnancy, childbirth or implantation rates. In old women high FSH level does not influence ICSI outcome but may increase poor response (p <0.01) and stopped cycles (p < 0.0001). In each age group, the rate of spontaneous miscarriage does not increase according to FSH level. The pregnancy rate and child birth rate are better in young women with high FSH levels than in older women with normal FSH levels (p < 0.05). CONCLUSION: The findings of this study suggest that basal FSH concentrations when correlated to age is a good predictive factor of ovarian response for assisted reproductive treatment. In young women a high FSH level may affect laboratary parametres but not pregnancy rate. In old women normal FSH level does not improve ICSI outcome but may increase "avorted" cycles. Pregnancy rate and child birth rate are better in young women with high FSH levels than in older women with normal FSH levels.

Seminal vesicle agenesis: An uncommon cause of azoospermia.

Seminal vesicle malformations are a rare cause of obstructive azoospermia, often associated with other internal genitalia and upper urinary tract birth defects. We report 5 new cases of seminal vesicle agenesis in men presenting with hypospermia and azoospermia. Imaging showed seminal vesicle unilateral agenesis in all patients. The remaining seminal vesicle was hypoplastic in 3 cases, dilated in 1 case and with abnormally thick content in another case. Vas deferens agenesis was observed unilaterally in 2 patients and bilaterally in 2 other patients. No renal malformations were detected. Genetic study showed in all cases a 46 XY karyotype without any microdeletions. A single heterozygous cystic fibrosis transmembrane regulator gene mutation was diagnosed in 1 man, but not found in his partner. Intracytoplasmic sperm injection using sperm from a testicular biopsy was performed in 3 couples, without success.

[Basal fsh level is only predictive of the quantitative aspect of the ovarian response]. / Le taux basal de FSH à j3 du cycle est un facteur prédictif de l'aspect quantitatif de la réponse ovarienne à la stimulation.

BACKGROUND: Determination FSH and LH at day 3 of the menstrual cycle predicts the response to stimulation. AIM: To evaluate the value of FSH and LH measurements compared with women's age in predicting qualitative and quantitative ovarian response to gonadotrophin stimulation. METHODS: 305 patients underwent at least one intra cytoplasmic sperm injection (ICSI) cycle. The levels of FSH and LH at day 3 were determined in an earlier cycle. A good quantitative ovarian response was defined as ³3 oocytes retrieved and 3 embryos obtained. A good qualitative ovarian response was defined as a percentage of mature oocytes ³75% and immature ones²15% of the total number of oocytes retrieved with at least one top quality embryo obtained. RESULTS: Receiver operating characteristic (ROC) curves were generated for FSH, LH and female age. FSH is better than female age in predicting the number of oocytes retrieved (respectively ROCAUC=0.77, p=10-3 versus ROCAUC=0.73, p=10-3) and the number of embryos obtained (ROCAUC=0.69, p=10-3 versus ROCAUC=0.66, p=10-3). LH is non predictive. None of the three tested parameters was predictive of the fertilization and pregnancy rates. An FSH cutoff was calculated and a value of 7.8mUI/ml is associated with a sensitivity of 73% and a specificity of 70% for the prediction of ovarian response to controlled stimulation. CONCLUSION: Basal FSH level predicts good quantitative rather than qualitative response. LH is non predictive. FSH and LH do not predict pregnancy rate. Patients having high FSH levels should not be excluded from IVF/ICSI treatment.

Progressive alcohol-induced sperm alterations leading to spermatogenic arrest, which was reversed after alcohol withdrawal.

This is a report of a 6-year follow-up of a male patient's semen parameters during heavy chronic alcohol intoxication and after withdrawal. A slowly progressive negative impact of alcohol could be observed: isolated moderate teratozoospermia was firstly noted followed by oligoasthenoteratospermia. Then a severe worsening resulted in cryptozoospermia and ultimately in azoospermia. At this moment, the histological analysis of a testicular biopsy revealed a maturation arrest of the germinal cells at the pachytene stage with no mature sperm cells. Alcohol withdrawal was then obtained, allowing a very fast and drastic improvement of semen characteristics; strictly normal semen parameters were observed after no more than 3 months. Taking into consideration these data, patients should be questioned about their alcohol intake before assisted reproductive technology and should be informed about this adverse effect. Moreover, this case report emphasizes how quickly benefits can be obtained after withdrawal, even in the case of heavy chronic alcohol intake.

Successful pregnancy by insemination of spermatozoa in a woman with a human seminal plasma allergy: should in vitro fertilization be considered first?

OBJECTIVE: To raise the possibility that pregnancy can be obtained by assisted reproductive techniques in patients with human seminal plasma allergy. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A woman consulted for a 3-year primary infertility. She reported lack of intercourse because of a seminal plasma allergy. INTERVENTION(S): One intrauterine insemination associated with antihistamine treatment was performed with carefully washed spermatozoa. RESULT(S): Immediately after the insemination, the patient had an allergic reaction treated by steroids. Fortunately, this single attempt led to a successful pregnancy, and the patient gave birth to a healthy girl. CONCLUSION(S): Pregnancies can be obtained in patients with seminal plasma hypersensitivity by means of intrauterine insemination. However, serious complications may occur after performing intrauterine insemination, which is not a totally reliable method to prevent an allergic reaction. Thus a multidisciplinary team should follow such patients carefully and watch for the potential risks and side effects. In vitro fertilization may represent the more cautious option.

Management of the hepatocellular carcinoma.

BACKGROUND: The hepatocellular carcinoma, is detected sooner due to the progress of the hepatic ultrasound scan allowing an accessibility to curative treatment. This cancer treatment still remains difficult in Tunisia. AIM: To show the difficulties in the management of the hepatocellular carcinoma in Tunisia. METHODS: Patients hospitalized in the gastroenterology department of Habib Thameur Hospital, from 2002 until 2007, for a cirrhosis follow-up or for a hepatocellular carcinoma treatment were studied retrospectively. The data was summarized by descriptive statistics and analysed with SPSS version 10. RESULTS: Fifty-seven patients were registered in this study. There were 40 males with an average age of 66 years. The cirrhosis was post-viral C in 28 cases. The discovery of the carcinoma was systematic in 16 cases. Treatment was prescribed in only fifteen patients, in the other patients, treatment was not made because of the multifocal character of the hepatocellular carcinoma. Complications were cirrhosis decompensation (n=3), fever (n=3), portal thrombosis (n=1) and pleurisy (n=1). CONCLUSION: Regardless of the improvement of diagnostic and therapeutic means, 17.5% of our patients having a hepatocellular carcinoma were subjected to a curative treatment. An additional effort must be unfolded.