Screening for childhood lead poisoning in the industrial region of Fez, Morocco.

The study objectives were to estimate lead poisoning prevalence among children living next to an industrial area, to compare it to that in a control population, and to establish clinical and biological follow-up of the poisoned children. This is a descriptive cross-sectional study including 150 children (exposed and unexposed) performed between January 2012 and April 2013. It was meant to determine blood lead levels (BLLs) in children considered to be an exposed population (EP N 90), living in the industrial area Ain Nokb Fez compared with BLLs of children of other areas belonging to the same city supposed to be unexposed [UP (N = 60)]. A sociodemographic questionnaire was obtained, and a blood lead analysis was performed. Clinical and biological follow-up has been performed of poisoned children. The sample consisted of 90 EP children with an average age of 6.82 ± 3.32 years and male-to-female sex ratio (SR) of 1.5 and 60 UP children with an average age of 6.45 ± 3.29 years and an SR of 1.2. Among the 150 children recruited, the average of BLLs was 58.21 ± 36 µg/L (18-202.3 µg/L). The average of BLLs in EP children (71 ± 40 µg/L) was statistically greater (p < 0.0001) than that registered in UP children (38 ± 13 µg/L). All poisoned children belonged to the EP group at a prevalence of 21.1 %. The clinical and biological examinations of poisoned children showed a few perturbations such as anemia, hypocalcaemia, and deficiencies in magnesium and iron. No renal disease or objective neurological disorders were observed. In the follow-up of the children with BLL ≥100 µg/L (19 cases). BLL monitoring showed a significant decrease in average of blood concentration ranging from 136.75 ± 32.59 to 104.58 ± 32.73 µg/L (p < 0.0001) and in lead poisoning prevalence (p < 0.001), which decreased to 7.8 % from 21.1. Our study showed a high prevalence of lead poisoning (21.1 %) in EP children. The relocation of the industrial site associated with corrective and preventive measures has contributed to a decrease of exposure and lead poisoning prevalence in the aforementioned population.

[Eosinophilic fasciitis, morphea and vitiligo in a single patient]. / Association fasciite avec éosinophilie, morphées et vitiligo.

BACKGROUND: Fasciitis with eosinophilia (FE), or Shulman syndrome, is a rare disease of unknown origin for which the nosological profile has not been clearly defined. It is clinically characterised by oedema and induration of the limbs with hypereosinophilia. It may be associated with morphea, in which case it carries a poor prognosis, or other diseases, particularly autoimmune conditions. Herein, we report a case of fasciitis associated with eosinophilia, morphea and vitiligo. PATIENT AND METHODS: A 45-year-old male patient followed up for vitiligo for 20 years had been presenting swelling and induration of the skin on all 4 limbs for the previous 7 months associated with morphea on the trunk. Treatment consisting of systemic corticosteroids and methotrexate was initiated and displayed a certain degree of efficacy. DISCUSSION: The association of morphea/fasciitis with eosinophilia is a classical finding; the presence of vitiligo raises the question of possible association between these different disorders.

[Epidemiological and pathological features of cancer in Fez Boulemane region, Morocco]. / Aspects épidémiologiques et anatomopathologiques des cancers dans la région de Fès-Boulemane (Maroc).

In Fez-Boulemane, Morocco, there is no cancer registry so there is a lack of information about the incidence and characteristics of cancer in the region. In this retrospective study we examined the epidemiological and pathological features of 5532 cases of cancer collected from the Department of Pathology in Hassan II University Hospital of Fes from 2004 to 2010. The mean age of the patients was 53.5 years and 52% were male. Digestive cancers and skin cancers were the most common. Digestive cancers were predominantly colorectal and stomach. Cancers of the urinary bladder and colorectal cancers were the leading cancers in men accounting respectively for 9% and 8% of all male cancers. In women, cancers of the breast (62%) and uterine cervix (22.6%) predominated. As a first step in cancer control in our area, establishment of a regional cancer registry is recommended.

Prevalence and distribution of Helicobacter pylori cagA and vacA genotypes in the Moroccan population with gastric disease.

Helicobacter pylori infection is the etiologic agent of various gastric pathologies. The severity of disease outcome has been attributed to some H. pylori genotypes, which varies geographically. In Morocco, there are no data regarding the pattern of H. pylori genotypes; therefore, this is the first prospective study conducted in our country to investigate the genotype profiles (vacA and cagA) of H. pylori in patients with gastric pain. Endoscopic biopsies were obtained in patients attending the gastroenterology department of the Hospital University Hassan II of Fez for gastric pain and were directly used for H. pylori detection and genotyping by polymerase chain reaction (PCR). The SPSS software program was used to study the genotype correlation to different clinical outcomes. A total of 429 patients were included in this study, with an infection rate of 69.9%. cagA was detected in 42.3% of cases. However, vacA genotyping reveal a large predominance of s2m2. Infection with multiple strains was detected in 10.8% of cases and incomplete vacA was observed in 31.5%. In Morocco, vacA s1m1 was significantly associated to peptic ulcer diseases, while s2m2 was associated to gastritis. Moroccan H. pylori vacA genotype profiles differ from the Latin American, European, and South African profiles, with more similarities to the North African profile. Because of the small number of cases with gastric cancer, no correlations with H. pylori have been studied, so, further studies will be required in order to highlight the effects of those genes on this disease.

[Buschke-Lowenstein tumor associated with scrotal melanoma. A case report]. / Tumeur de Buschke-lowenstein associé à un mélanome scrotal. À propos d'un cas.

Buschke-Lowenstein tumour (BLT) is a giant condyloma acumina, which is rare entity and represents only 1% of all populace. It is a rare viral disease, essentially transmitted by sexual intercourse, characterized by a potential for malignant transformation, invasion and recurrence after treatment. We report a case of BLT associated with perinea-scrotal melanoma. This association was never described in the literature. The purpose of our case report is to discuss the clinical and pathological appearances of these two entities and to outline the recent studies of molecular biology, which can explain this association.

[Epidemiological and biologic profile of breast cancer in Fez-Boulemane, Morocco]. / Le profil épidémiologique et biologique du cancer du sein à Fès-Boulemane (Maroc).

In a retrospective study of 265 patients with breast cancer over 3 years (January 2007-September 2009) we examined the epidemiological profile of breast cancer to determine the impact of biological and prognostic factors on survival over 3 years and on the epidemiology of this cancer. Estrogen (RE), progesterone (RP) and human epidermal growth factor receptors (HER2) were evaluated and RE/RP/HER2 status determined. The patients were young (median age 45 years). Invasive tumours were found in 95.5% of the women. The average tumour size was big [3.6 (SD 2.6) cm] and only 14% were histological grade 1. Large tumour size and high histological grade were independent of patient's age. Overall survival at 3 years was only 49% for the RE-/RP-/HER2- subtype and 75% for the RE-/RP-/HER2+ subtype, while it was 96% for the RE+/RP+/HER2- subtype. The young age, large tumour size and high histological grade in our population suggest a lack of awareness of women about breast cancer.

[Tripe palms and a hypertrophic osteoarthropathy syndrome revealing a neuroendocrine carcinoma of the lung]. / Pachydermatoglyphie associée à une ostéoarthropathie hypertrophique révélant un carcinome neuroendocrine du poumon.

BACKGROUND: Tripe palms is a rare cutaneous paraneoplastic syndrome, primarily evocative of lung and gastric neoplasia. Association of many paraneoplastic diseases has also been reported. PATIENTS AND METHODS: A 49-year-old man with a history of alcoholism and smoking addiction reported haemoptysis and thoracic pains present for one year. The physical examination showed left lung condensation. The skin examination revealed a thickened yellowish keratoderma with exaggerated skin ridges and digital clubbing. A diagnosis of paraneoplastic tripe palms was made, prompting repetition of the biopsy which ultimately revealed a neuroendocrine carcinoma. Skeletal scintigraphy showed periosteal proliferation with hypertrophic osteoarthropathy. COMMENTS: "Tripe palms" or "osteoarthritic acanthosis" is a paraneoplastic syndrome. It involves an acquired keratoderma taking on a yellow velvety appearance with accentuation of dermatoglyphic lines. Malignancy is discovered in over 90% of individuals with tripe palms. If malignancy is isolated, it mostly involves the lung (53%). Gastric cancer is associated in 77% of cases if the condition is associated with acanthosis nigricans. In approximately one third of cases, the keratoderma may resolve, generally after treatment of the tumour. The association of many paraneoplastic syndromes has also been reported, in particular digital clubbing and hypertrophic osteoarthropathy. At least 90% of cases of hypertrophic osteoarthropathy in adults occur in patients who have or will eventually develop a malignancy. It is characterized by periostosis of long bones, joint pain, and clubbing, and it is often seen on bone scintigraphy during staging of lung carcinoma.

[Cutaneous tuberculosis: a 36-case series from Morocco]. / Tuberculose cutanée: trente-six observations au Maroc.

Tuberculosis is still endemic in Morocco. Cutaneous tuberculosis is the fifth most common form after pleuropulmonary, glandular, digestive and urogenital tract tuberculosis. The purpose of this single-center prospective study is to describe all cases of cutaneous tuberculosis treated between May 2006 and June 2009. Diagnosis was suspected based on clinical, immunological and histological features. The main clinical presentations, i.e., scrofuloderma and gumma, were consistent with endemicity of tuberculosis in Morocco. Since definitive diagnosis by detection of the tubercle bacillus was rarely possible, therapy was usually undertaken presumptively based on clinical and laboratory findings and therapeutic response.

[Mucoepidermoid carcinoma of the parotid gland in young children]. / Carcinome mucoépidermoïde de la glande parotide chez le petit enfant.

INTRODUCTION: Mucoepidermoid carcinoma of the parotid gland is a rare malignant tumor mostly affecting adults. It accounts for 1 to 3 % of head and neck malignant tumors. It is very rarely observed in children under 10 years of age. OBSERVATION: A four-and-half-year-old boy was brought to consultation in our department, in June 2006, for a left cervical swelling having progressively increased over the previous two years. Cervical US confirmed the presence of a 2.3cm long tumor of the left parotid area, hyperechogenic and heterogenic, associated to a homolateral lymphadenopathy in the jugular and carotid region (zone II), 2cm in diameter. A total parotidectomy preserving the facial nerve was performed. The biopsy extemporaneous histological examination suggested a low-grade mucoepidermoid carcinoma. Surgery was completed by functional neck dissection. DISCUSSION: Our four-and-half-year-old patient was one of the youngest cases ever reported. Malignant parotid gland tumors are very rarely observed in children: less than 19 cases have been published worldwide. Its occurrence in a young child under ten years of age is very rare. Mucoepidermoid carcinoma accounts for one third of all malignant parotid gland tumors.

[Ischemic fasciitis. A case report]. / La fasciite ischémique. A propos d'un cas.

Ischemic fasciitis, also called atypical decubital fibroplasia, was recently described as a distinctive fibroblastic proliferation occurring predominantly in elderly, bed-ridden individuals. It is very rare. Forty cases only are reported in the literature. We report the observation of a 50-year-old patient, having an antecedent of prolonged confinement, who presents since 1 year a tumefaction compared to the higher end of the tibia of soft consistency with inflammatory signs in glance. The pathologic examination shows a pseudo tumoral lesion of ischemic fasciite type. Through this observation, we suggest to review the various problems of diagnostic differentials in particular with a sarcoma of soft tissues and to discuss the anatomoclinic features of this recent description lesion.

[Intravascular papillary endothelial hyperplasia of the ankle: a case report]. / Hyperplasie endothéliale papillaire intravasculaire de la face antérieure de cheville : à propos d'un cas.

Intravascular papillary endothelial hyperplasia (IPEH) is an unusual, benign, non-neoplasic, vascular lesion characterized histologically by papillary fronds lined by proliferating endothelium. This lesion has the propensity to occur in the skin and the subcutis. Many histological features are similar to those of low-grade angiosarcoma, a common, but more serious condition. Clinical and histological differentiation is important to avoid overtreatment of this benign lesion. We report a case of cutaneous IPEH in the ankle of a 30-year-old girl, which was successfully treated by excision. The pathologic findings, differential diagnosis and a review of recent literature are discussed.

[Subcutaneous plexiform schwannoma of the forearm. A case report]. / Schwannome plexiforme sous-cutané de l'avant-bras. A propos d'un cas.

Plexiform schwannoma is an exceptional schwannoma subtype. It's a benign nerve sheath tumor. Mainly, it's solitary, asymptomatic and slowly growing nodule that occurs in the subcutis or dermis. Histology gives the diagnosis. The authors report a case of solitary superficial plexiform schwannoma of the right forearm of a patient aged 22. A review of literature is done.

[Solid pseudotumoral tubo-ovarian actinomycosis. A case report in Morocco]. / Une actinomycose pseudo-tumorale tubo-ovarienne. A propos d'une observation marocaine.

Tubo-ovarian actinomycosis is a rare location for infection by actinomyces. Only around 50 cases have been described in the world literature since 1963. Diagnosis can be difficult due to the highly misleading solid pseudotumoral appearance of this infection. The purpose of this report is to describe the case of a 40-year-old patient with an intrauterine device who presented abdomino-pelvic pain associated with guarding in the right iliac fossa. Pelvic ultrasound revealed an ovarian mass. Histological examination of the surgical specimen after annexectomy demonstrated tubo-ovarian actinomycosis. Based on this case involving a rare clinical form of the actinomycosis, we review the various clinical aspects of this infection and underline the importance of histology in achieving diagnosis. We also provide a general review of the literature.

[T-cell lymphoma revealed by a mononeuritis multiplex: case report and review of literature]. / Lymphome T révélé par une mononeuropathie multiple: étude d'un cas avec revue de la littérature.

INTRODUCTION: Lymphoma occasionally affects the peripheral nervous system. Neuropathy usually appears in patients with known lymphoma but rarely represents the initial manifestation of underlying malignancy. We report a case in which mononeuritis multiplex (MM) was the dominant feature in the clinical presentation of a peripheral T-cell non-Hodgkin lymphoma (NHL). OBSERVATION: A 32-year-old man suffered from an asymmetric progressive sensory-motor peripheral neuropathy. The left peroneal nerve was affected first, then the left median nerve after one month, followed by the left trigeminal nerve ten months later. The electrophysiological study confirmed the diagnosis of axonal sensory-motor MM. Mediastinal adenopathies, splenomegaly, pancytopenia and inflammatory syndrome were also found. An osteo-medullary biopsy showed a T-cell NHL. Nerve biopsy study found an inflammatory lymphoid infiltration without malignant cell supporting the hypothesis of an inflammatory pathogenic process. Chemotherapy including cyclophosphamide, hydralazine, vincristine and prednisone were administered monthly during 8 months. No improvement was obtained. DISCUSSION: It must be emphasised that this case is an uncommon one. On the one hand, NHL is rarely associated with MM and on the other hand, it can exceptionally be revealed by a MM. We were able to find 30 reported cases of distal neuropathy revealing a NHL including, 8 mononeuritis simplex, 9 MM and 13 polyneuropathies. Polyradiculoneuritis cases were excluded from this study because the neuropathy is usually caused by a meningeal infiltration. The neuropathy was in the majority of the cases chronic and axonal. The lymphoma was more often B-cell than T-cell. The B-cell lymphoma was frequently associated with a poor prognosis. All mechanisms were present with a predominance of neurolymphomatosis.

[Role of cervical smear in the diagnosis of cervical cancer in Fes-Boulemane region of Morocco]. / La place du frottis cervico-vaginal dans le diagnostic du cancer du col utérin au Maroc, région Fès-Boulemane.

A retrospective study was conducted between 2000 and 2003 on 1620 women (mean age 39.6 years) in northern Morocco to determine the incidence of cervical cancer and assess the value of cervical smear in the diagnosis. Patients were interviewed using a questionnaire before carrying out a gynaecological examination and taking a cervical smear sample. Of the total sample, 23.1% had an abnormal cervical smear, of whom 5.6% showed intraepithelial lesions, both low and high grade. The women presenting with cervicitis represented the highest percentage with suspect smears (30.8%); 90.9% of the smears showing high grade lesions were histologically confirmed as cervical cancer. A screening programme is a matter of urgency in northern Morocco.

[Femoral metaphyso-diaphyseal chondroblastoma: a case report]. / Chondroblastome métaphyso-diaphysaire du fémur: à propos d'un cas.

Chondroblastoma is a rare benign tumor of cartilage tissue accounting for less than 1% of all bone tumors. The epiphysis of long bones is the typical localization, often extending to the metaphysis. Metaphyseal, metaphysodiaphyseal or pure diaphyseal forms are exceptional. We report a case in a 15-year-old boy who presented a metaphyso-diaphyseal chondroblastoma of the distal portion of the left femur. The inaugural signs were pain and limited joint motion. We discuss the anatomic aspects and the clinical course of this rare tumor and present current knowledge of the histogenesis.