[Predictors of catheter-related bladder discomfort]. / Facteurs prédictifs de l'inconfort lié à la sonde vésicale.

INTRODUCTION: Establish a descriptive epidemiological profile of patients with Catheter Related Bladder Discomfort (CRBD) and identify its predictive factors. MATERIAL AND METHOD: Between June 2019 and December 2019, 300 patients have been evaluated. Different parameters were taken into account including: sex, age, body mass index (BMI), historical health data, duration and indications of the urinary catheterization, type of the transurethral catheter used, lubrication of the catheter and the existence of CRBD. We grouped our patients according to the intensity of CRBD syndrome. The various factors likely to be correlated with the occurrence of CRBD were subject of a univariate then multivariate analysis. RESULTS: 300 patients were included. The average age was 49 years (133 men and 167 women). 68 patients (22.6%) had history of urinary catheterization. 19% of patients were catheterized for acute urinary retention, while 81% were catheterized before surgery. The average duration of the urinary catheterization was 2.5 days. 54% showed CRBD symptoms, including more than 92% on the first day of the urinary catheterization. The significant risk factors in multivariate analysis were: the caliber of the catheter ≥18 Fr, the absence of lubrication, laparotomy, age <50 years, Cesarean and urinary catheterization medical history. CONCLUSION: This study identified various factors incriminated in the occurrence of CRBD. The role of the hospital practitioner is to prevent this syndrome by reducing predictive factors, particularly the technical ones. LEVEL OF EVIDENCE: 3.

Correlation between CT and anatomopathological staging of kidney cancer.

Our Moroccan context is experiencing an increase in the frequency of renal tumors. This trend can be explained by the generalization of the use of imaging, in particular abdominal ultrasound, which has become almost systematic among general practitioners (Godley and Ataga, 2000 [1]). The specificity of kidney cancer is anatomopathological heterogenicity: histological type, nuclear grade, tumor stage, these elements constitute the most important prognostic factors. Renal biopsy appears to be a safe and reliable solution with a low risk of tumor seeding and complications, however it cannot provide all the detailed histological information needed. Hence the interest in the abdominal scanner. The abdominal scanner is the reference examination for the evaluation of renal tumors, it diagnoses the tumor, specifies these characteristics, it assesses the loco regional, venous extension. The objective of our study is to correlate pathological and CT findings of 70 kidney cancer in order to determine the reliability of CT in kidney cancer and its extension.

[Ketosis-prone atypical diabetes mellitus: report of two cases]. / Diabète atypique avec tendance à la cétose ou diabète "Africain": à propos de deux cas.

An atypical presentation of diabetes mellitus was described in black subjects, initially in adolescents by Winter et al. then, in adult populations. The principal characteristics of "African" diabetes are an acute onset with severe hyperglycemia and ketosis, and a clinical course of type 2 diabetes mellitus. In the subsequent clinical course after initiation of insulin therapy, prolonged remission is often possible with cessation of insulin therapy and maintenance of appropriate metabolic control. In the subsequent clinical course after initiation of insulin therapy, prolonged remission is often possible with cessation of insulin therapy and maintenance of appropriate metabolic control. The molecular mechanisms underlining the insulin secretory dysfunction are still to be understood and may involve glucolipotoxicity processes. The HLA alleles associated with susceptibility to type 1 diabetes were reported of high frequency in some populations with this form of diabetes, in the absence of makers of pancreatic beta cell autoimmunity. The aim of the present review is to discuss two cases of African diabetes and review the specific diagnostic, metabolic, pathogenic and management features of this atypical diabetes.

[Cushing's syndrome due to a pulmonary carcinoid]. / Syndrome de Cushing révélateur d'un carcinoïde pulmonaire.

Cushing paraneoplasic syndrome is a rare cause of hypercorticism. We report a case of 35 year-old man presenting with Cushing's syndrome characterized by severe signs of hypercorticism and hypokalemia. Endocrine investigations were suggestive of an hypercortisolism linked to an ectopic adrenocorticotropic (ACTH) secretion, both at baseline (mean ACTH levels=275 pg/ml, urinary free cortisol excretion=3.898 mmol/24 h) and after pharmacodynamic testing (lack of inhibition of ACTH by dexamethasone). Thoracic tomodensitometric examination revealed a 15 mm tumor corresponding to a neuroendocrine pulmonary carcinoid with positive immunostaining for chromogranin A. Postoperative ACTH measurement was undetectable, plasma cortisol and free urinary cortisol were also decreased after tumor resection suggesting complete tumor removal. This case report illustrates the characteristics of paraneoplasic Cushing syndrome due to ACTH secreting pulmonary neuroendocrine carcinoid.

[Tuberculous osteoarthritis of the foot in the diabetic: not unrecognize this diagnostic trap. About one case]. / Ostéoarthrite tuberculeuse du pied chez le diabétique : piège diagnostique à ne pas méconnaître. A propos d'une observation.

Osteoarticular tuberculosis is the fourth leading extrapulmonary localization of tuberculosis. The disease has a progressive course and is often diagnosed in the stage of bone destruction, causing an important diagnostic problem in diabetics with nervous osteoarthropathy. We report the case of a 23-year-old patient with multicomplicated diabetes type 1, treated for pulmonary tuberculosis who consulted after a trauma distended the left ankle. Bone biopsy was performed because of the diagnostic doubt between diabetes and infectious osteoarthropathy. Pathology reported active tuberculosis. Osteoarticular tuberculosis is still a severe disease because of the functional prognosis that requires early diagnosis, a difficult task in some conditions particularly in the diabetic where the disease may mimic nervous osteoarthropathy. Bone biopsy should be performed if there is a doubt.

Hyperandrogenism-Insulin Resistance-Acanthosis Nigricans Syndrome.

Introduction. Female hyperandrogenism is a frequent motive of consultation. It is revealed by hirsutism, acne or seborrhea, and disorders in menstruation cycle combined or not with virilisation signs. Several etiologies are incriminated but the hyperandrogenism-insulin resistance-acanthosis nigricans syndrome is rare. Observation. A 20-year-old girl, having had a five-year-old secondary amenorrhea. The exam revealed a patient, normotensive with a body mass index at 30 kg/m(2) and a waist measurement of 120 cm, a severe hirsutism assessed to be 29 according to Ferriman Gallwey scale, virilisation signs of male morphotype, clitoridic hypertrophy and frontal alopecia, and an acanthosis nigricans behind the neck, in the armpits and elbows. The assessment carried out revealed testosteronemia at 1.28 ng/mL, which is more than twice the upper norm of the laboratory. Imaging studies were negative for both ovarian and adrenal masses. The retained diagnosis is HAIR-AN syndrome probably related to ovarian hyperthecosis and she was provided with androcur 50 mg/day and estradiol pills 2 mg/day and under hygiene-dietetic conditions. Conclusion. This case proves that HAIR-AN syndrome could be responsible for severe hyperandrogenism with virilisation signs. It must be retained after discarding the tumoral causes and when there are signs of insulin resistance.

The N-terminal adenosine triphosphate binding domain of Hsp90 is necessary and sufficient for interaction with estrogen receptor.

To understand how the molecular chaperone Hsp90 participates in conformational maturation of the estrogen receptor (ER), we analyzed the interaction of immobilized purified avian Hsp90 with mammalian cytosolic ER. Hsp90 was either immunoadsorbed to BF4 antibody-Sepharose or GST-Hsp90 fusion protein (GST.90) was adsorbed to glutathione-Sepharose. GST.90 was able to retain specifically ER, similarly to immunoadsorbed Hsp90. When cells were treated with estradiol and the hormone treatment was maintained during cell homogenization, binding, and washing steps, GST.90 still interacted efficiently with ER, suggesting that ER may form complexes with Hsp90 even after its activation by hormone and salt extraction from nuclei. The GST.90-ER interaction was consistently reduced in the presence of increasing concentrations of potassium chloride or when cytosolic ER-Hsp90 complexes were previously stabilized by molybdate, indicating that GST.90-ER complexes behave like cytosolic Hsp90-ER complexes. A purified thioredoxin-ER fusion protein was also able to form complexes with GST.90, suggesting that the presence of other chaperones is not required. ER was retained only by GST.90 deletion mutants bearing an intact Hsp90 N-terminal region (1-224), the interaction being more efficient when the charged region A was present in the mutant (1-334). The N-terminal fragment 1-334, devoid of the dimeric GST moiety, was also able to interact with ER, pointing to the monomeric N-terminal adenosine triphosphate binding region of Hsp90 (1-224) as the region necessary and sufficient for interaction. These results contribute to understand the Hsp90-dependent process responsible for conformational competence of ER.

[Screening for diabetic retinopathy with ophthalmoscopy: the contribution of non-ophthalmologist practitioners seems possible]. / Dépistage de la rétinopathie diabétique par l'ophtalmoscopie: la contribution du médecin non ophtalmologiste paraît possible.

Diabetic retinopathy is a severe and frequent complication of diabetes. Screening and early treatment of retinal lesions avoid blindness, but diagnosis is often established too late. The purpose of our study was to compare the concordance between the results of examination of fundus oculi whether performed by a previously trained non ophthalmologist physician at diabetes day center or during a routine ophthalmology consultation. Results were classified a posteriori in order to have binary response (presence of the lesion, absence of the lesion). Ninety six eyes were examined. Results of these examinations were compared using the kappa test agreement (kappa). The concordance was good for the majority of retinal lesions. The concordance in the results suggests that the contribution of non ophthalmologist physicians to the screening of diabetic retinopathy is possible and could facilitate the selection of patients who require specialized and elaborate ophthalmologic exploration.

[Malignant lymphoma on a gastric stump]. / Lymphome malin sur moignon gastrique.

We report a case of lymphoplasmocytic and immunoblastic gastric remnant lymphoma occurring in a 51 year-old male. This patient had undergone subtotal gastrectomy for a gastric peptic ulcer at age 37. Histologic findings in the initial gastric specimen showed a dense lymphoid infiltrate surrounding the ulcer within the gastric mucosa. This proliferation was grouped into distinct follicles, and was compatible with pseudo-lymphoma. The progression of pseudo-lymphoma to malignant lymphoma is suggested.

[Intraepithelial carcinoma and invasive carcinoma of the sclero-corneal limbus. Anatomo-clinical study apropos of 20 cases]. / Carcinome intraépithélial et carcinome invasif du limbe scléro-cornéen. Etude anatomo-clinique à propos de 20 cas.

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.

[Ag-NORS and non-pigmented tumors of the sclerocorneal limbus. Apropos of 20 cases]. / Ag-NORS et tumeurs non pigmentées du limbe scléro-cornéen. A propos de 20 cas.

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.

[Primary lymphoma of the thyroid gland]. / Lymphome malin primitif de la thyroïde.

Malignant primary lymphoma of the thyroid gland is a rare disease generally occurring women in the 6(th) or 7(th) decade of life. The principal clinical sign is giant goiter rapidly leading to sings of compression, raising the question of differential diagnosis with anaplastic cancer. The radiological findings in our patient were suggestive of malignancy due to the locoregional invasion. Immunohistochemistry study of the surgical specimen was required to reach the definitive diagnosis of thyroid gland primary lymphoma. Diagnosis of malignant primary lymphoma of the thyroid gland made at the stage of extensive locoregional extension compromises prognosis. Our patient died after one session of chemotherapy.

[Incidence of factors favoring recurrent foot ulcers in diabetic patients]. / Etude de la fréquence et des facteurs favorisant les récidives des ulcères de pied chez les patients diabétiques.

BACKGROUND: Patients with foot ulcers have a high risk of relapse and amputation. Several studies have reported that 28 to 51% of amputated diabetics will have a second amputation of the lower limb within five years of the first amputation. The purpose of this study was to assess the incidence of factors favoring relapse within two years. MATERIAL AND METHODS: One hundred ten diabetic patients were treated for foot lesions in the Casablanca Ibn Rochd university hospital between 1997 and 2000. Ninety of these patients attended review consultations. RESULTS: There were 42 cases of relapse (46.6%). Male gender predominated in the relapse patients with a sex ratio of 3.2. Mean age at relapse was 55 years; 71.5% of the patients had type 2 diabetes. Lesions observed were neuropathic ulcer (n=23), arterial ulcer (n=6), infected wounds (n=13). Revealing factors were burns and wounds. The main risk factors were neuropathy (n=23, 52%), neuroarteriopathy (n=12, 31%), peur arteriopathy (n=6, 12%). Patients who relapsed (n=42) were significantly different from patients who did not relapse (n=48) for gender, presence or absence of neuropathy, and presence or absence of arteriopathy. DISCUSSION: Secondary preventive measures against these risk factors, medical care, and specialized follow-up were satisfactory in these patients. our findings illustrate the importance of specialized management of diabetic patients with foot lesions. Adequate care of the lesions and preventive measures against risk factors are needed.

[Rabies in Tunisia. A comparative study of results from the last 36 years]. / La rage en Tunisie. Etude comparative des résultats des 36 dernières années.

The author presents an evaluation of rabies control during the last 36 years. He discusses especially the problem of vectors, diagnosis, vaccine and treatment, taking into account the 1982-1987 National Campaign for Animal Rabies Control. He notes an improvement of the situation with a significant decrease in the rate of positivity among the biter animals. He considers, however that this rate remains relatively too high to allow the prevention of disease persitance in the country. He suggests the continuation of the efforts undertaken to control biter animals and eventually the extension of the campaign to the regional level.

[Charles Nicolle and the accomplishments of his scientific thought]. / Charles Nicolle et les acquis de sa pensée scientifique.

The author presents in this study the achievements of the scientific thought of Charles Nicolle, chiefly on the basis of two notions: the asymptomatic diseases and the destiny of infectious diseases. Recalling the factors which prevailing about the career of Charles Nicolle, he shows that the asymptomatic diseases became a fundamental notion in infectious pathology as human, animal, viral, bacterial and parasitic diseases. The notion allowed him to open the study of pathogen agents on the fields of the environment, so enriching the epidemiology, the prophylaxis and the medical ecology. After the notion of specificity of microbes pointed out by Pasteur, Charles Nicolle enlarged their implications and conceived the infinite complexity of microbes. The first he introduced in microbiology the notion of mutation and foresaw the birth, the evolution and the death of the infectious diseases. Not so long time after and now these anticipations has been proved.

[The Academy of Medicine of France: history and activities. Remarks and reflections]. / L'Académie de Médecine de France: historique et activités. Propos et réflexions.

The author presents the Academie de Médecine de France its structure, its history and its fundamental activities. He evokes and proposes some ideas about the medical problems concerning Tunisia and countries of Maghreb.

[Preliminary note on the study of seawater pollution of the Saharan coast of Tunisia]. / Note préliminaire à l'étude de la pollution du milieu marin sur les côtes sahéliennes de la Tunisie.

The study to an analyse of 726 samples of sea water, taken monthly (1977-1978) at 23 stations. At the basis of the data concerning the NPP of total coliformas, 75,5% of the samples point out a clean water for the bathing place, 11,04% = "acceptable" and 9,96% = "dirty". Considering the data about the MPP of fecal coliformas and of fecal streptocques, the sanitary state is reported in 94,23% "clean for the bathing place", 1,77% "acceptable" and 4% dirty.

[The bacterial pollution of coastal waters of the southern suburbs of Tunis]. / La pollution bactérienne des eaux littorales de la banlieue sud de Tunis.

The authors present in this paper a study of the bacterian pollution of inshored waters of southern suburbs of Tunis, on the basis of 180 samples collected in 15 different stations, 15 monthly (one for each station). Two districts have been considered: Ez-Zahra and Hammam-Lif. The two districts are submitted to an important bacterian pollution, mainly due to human factor but also to geographical and geomorphological data, to physico-chemical parameters and to some biological characters.

[Bacterial pollution of the littoral waters of the northern suburbs of Tunis]. / La pollution bactérienne des eaux littorales de la banlieue nord de Tunis.

The authors present in this paper a study of the bacterial pollution of inshore waters of northern suburbs of Tunis, on the basis of 180 sampled collected in 15 different stations, 15 monthly (one for each station). Three districts have been considered: Raouad-Gammarth, La Marsa-Carthage and La Goulette. This last district is mostly submitted to the bacterial pollution, caused by its neighbourhood of the lagoon of Tunis "reserve of pollution" and of the city of Tunis.