Oxidative damage and histopathological changes in lung of rat chronically exposed to nicotine alone or associated to ethanol.

Smoking is the most important preventable risk factor of chronic obstructive pulmonary disease and lung cancer. This study was designed to investigate oxidative damage and histopathological changes in lung tissue of rats chronically exposed to nicotine alone or supplemented with ethanol. Twenty-four male Wistar rats divided into three groups were used for the study. The nicotine group received nicotine (2.5mg/kg/day); the nicotine-ethanol group was given simultaneously same dose of nicotine plus ethanol (0.2g/kg/day), while the control group was administered only normal saline (1 ml/kg/day). The treatment was administered by subcutaneous injection once daily for a period of 18 weeks. Chronic nicotine administration alone or combined to ethanol caused a significant increase in malondialdehyde (MDA) level, superoxide dismutase (SOD) activity and catalase (CAT) activity in lung tissue compared to control rats suggesting an oxidative damage. However, these increases were mostly prominent in nicotine group. The histopathological examination of lung tissue of rats in both treated groups revealed many alterations in the pulmonary structures such as emphysema change (disappearance of the alveolar septa, increased irregularity and size of air sacs) and marked lymphocytic infiltration in perivascular and interstitial areas. However, the changes characterized in the nicotine group (pulmonary congestion, hemorrhage into alveoli and interstitial areas, edema) were more drastic than those observed in the nicotine-ethanol group, and they can be attributed to a significant degree of capillary endothelial permeability and microvascular leak. Conversely, the ethanol supplementation caused an appearance of fatty change and fibrosis in pulmonary tissue essentially due to a metabolism of ethanol. Finally, the lung damage illustrated in nicotine group was more severe than that observed in the nicotine-ethanol group. We conclude that the combined administration of nicotine and ethanol may moderate the effect of nicotine administered independently by counteractive interactions between these two drugs.

Maxillary alveolar bone ridge width augmentation using the frame-shaped corticotomy expansion technique.

Maxillary alveolar ridge expansion performed by intercortical bone splitting is a seducing alternative surgical procedure for alveolar bone widening. The aim of this technique is to gain enough bone width to be able to place a dental implant simultaneously. This technique avoids a second surgical site for bone graft harvesting. However there are risks of surgical failure caused by unintended bone fracture during expansion and implant placement, or by insufficient bone widening for implant insertion. To limit these risks, we have published expansion techniques using various corticotomies. These corticotomies are achieved according to bone anatomy, most of them remote from implant position. Bone fractures are guided during the bone expansion and the implant placement, avoiding cortical bursting. Wider and safer bone movements can be achieved allowing to place the forecasted implant with adequate dimensions, axis, and cervical position on the bone ridge. Our technique increases the success rate of both the bone volume expansion and the dental implant placement, and improve the functional and aesthetic result of implant and prosthesis restoration. Four main types of bone expansion movement using corticotomies have been described: expansion with apical cortical hinge, cortical translation, bi-cortical osteotomy, and frame-shaped corticotomy. Our subject is the alveolar bone width augmentation with the frame- shaped corticotomy expansion technique, which allows to place an implant in a narrow and concave alveolar bone, with a straightened axis, without modifying its cervical position on the bone ridge arch. A series of 10cases with a 1 to 5year surgical follow-up is studied. Implants were all placed in the same stage and their supported prosthesis successfully made. Peculiarities and interest of this technique are discussed.

[Peutz-Jeghers' syndrome with malignant development in a hamartomatous polyp: report of one case and review of the literature]. / Dégénérescence inaugurale d'un polype hamartomateux au cours du syndrome de Peutz-Jeghers: à propos d'un cas avec revue de la littérature.

The malignant potential of hamartomatous polyps in Peutz-Jeghers' (PPJ) syndrome has been debated. Although it is a very rare event, these polyps can become malignant, as demonstrated by this report. One case of colonic adenocarcinoma associated with Peutz-Jeghers' syndrome is described in a 62-year-old woman. The patient had colonic carcinoma which developed in a hamartomatous polyp. The malignant development of this colonic hamartomatous polyp arising in Peutz-Jeghers' syndrome was pathologically confirmed at surgery. This case also shows a sequence of hamartoma-dysplasia-carcinoma in a hamartomatous polyp without adenomatous changes. This suggests that hamartomatous polyps in Peutz-Jeghers' syndrome may develop into adenocarcinoma and may be a precursor of gastrointestinal carcinomas. STK 11 is a tumor suppressor gene regulating the development of hamartomas, and this somatic mutation promotes gastrointestinal cancer at later stages in Peutz-Jeghers' syndrome.

[Cardiovascular risk factors in Algeria. Analysis of the subgroup from the "Africa/Middle East Cardiovascular Epidemiological" Study]. / Facteurs de risque cardio-vasculaires en Algérie. Une analyse du sous-groupe de l'étude « Africa/Middle East Cardiovascular Epidemiological ¼.

OBJECTIVES: This cross-sectional epidemiological study aimed at determining the prevalence of cardiovascular risk factors (CVRF; including obesity, dyslipidaemia, hypertension, diabetes and smoking), among patients from the Algerian sub-population of the "Africa/Middle East Cardiovascular Epidemiological" study attending general practitioners at primary healthcare facilities, and stratified according to their environment (rural/urban), sex and age. PATIENTS AND METHODS: The study sites, located in 10 wilayas (administrative regions), were situated in urban and rural areas (rural populations defined as living at least 50km away from urban centres, or lacking access to suburban transport). RESULTS: Four hundred and ten subjects (262 female, 148 male) were enrolled; 287 subjects were from an urban environment and 123 from a rural environment. Mean age was 50.4 years. Ninety one point eight percent of patients had ≥1 CVRF; 48.2% had ≥3 CVRF. Prevalence for the different CVRF was: 61.7% for dyslipidaemia; 39.5% for hypertension; 25.0% for diabetes; 10.0% for smoking, 70.0% for abdominal obesity and 32.0% for a body mass index ≥30kg/m2. CONCLUSION: The high prevalence of all CVRF observed in the Algeria sub-group, especially among the rural population, should encourage us to develop a carefully planned strategy for primary prevention, opportunistic screening and early management, in both urban and rural settings, and with particular attention to young adults. These actions should involve all state bodies and those active in civil society, in order to guarantee full achievement of set goals. The ACE trial is registered under NCT01243138.

Responses of Hexaplex (Murex) trunculus to selected pollutants.

Cadmium, copper and zinc concentrations (in whole soft body and in tissues) were measured in Hexaplex trunculus collected from the Bizerta lagoon in Tunisia. An evaluation of the biological effects of the most toxic metals (cadmium and copper) and of two organics (carbofuran and lindane), present in the sediments of the Bizerta lagoon, was attempted by measuring biomarkers (acetylcholinesterase: AChE, catalase: CAT and glutathione S-transferase: GST activities) in animals experimentally exposed for 48 or 72 h. The concentration ranges as follows: Zn>Cu>Cd. Copper concentrations are highly variable (8.0 to 235 microg g(-1) d.w.) whereas cadmium (range 1.35-4.86 microg g(-1)) and zinc (range 360-1320 microg g(-1)) concentrations are less variable. The digestive gland and the gill take up more metal than the muscle. AChE activity in H. trunculus is decreased by exposure to carbofuran or the mixture carbofuran and cadmium, in the digestive gland and muscle and by copper and by lindane in the digestive gland. AChE is generally inhibited by carbamates but some other compounds may also decrease this activity as observed in this paper. An increase in CAT activity associated with a decrease in GST activity is noted in the muscle of H. trunculus exposed to cadmium, to carbofuran and to the mixture of cadmium and carbofuran, and in the digestive gland of animals exposed to lindane. These pollutants may act upon glutathione and decrease the GST activity that cannot detoxify them and CAT activity has a protective effect. On the contrary, copper increases CAT and GST activities in the digestive gland of exposed gastropods; these enzymes seem to cooperate and play together their rôle of anti-oxidant enzymes. If H. trunculus is not a bioindicator species for metal concentrations, due to a high variability in metal concentrations, nevertheless the biochemical responses to pollutants (cadmium, copper, carbofuran and lindane) represented by AChE, CAT and GST activities may act as biomarkers of exposure in this species.

[Extrapalpebral sebaceous carcinoma]. / Carcinome sébacé extra-palpébral.

UNLABELLED: Extra ocular sebaceous carcinoma is a rare carcinoma of the skin known to have difficulties of diagnosis because of its polymorphism of clinical and histopathological findings. His prognosis depends of the precocity of the diagnosis. This neoplasm is aggressive in 29%, lymph node and visceral metastasis aren't rare. REPORT: A 62-year-old male had a dome-shaped and ulcerated tumor located on the left temple. The lesion appeared after eight months ago. It suspected a squamous cell carcinoma. The histologic findings revealed a sebaceous carcinoma in his mixed and moderately differentiated type. COMMENTS: Sebaceous carcinoma exhibits a variety of histologic growth patterns and diverse clinical presentations that the diagnosis is often difficult. We discuss incidence as well as clinical, histological and established the diagnosis and the prognosis of this aggressive neoplasm.

A puzzling ovarian tumour: pregnancy luteoma with diffuse endometriosis.

BACKGROUND: Pregnancy luteoma is a distinctive non-neoplastic hormone dependent lesion arising in pregnancy and mimicking an ovarian tumour. Fewer than 200 cases have been described in the English-language literature. Its clinical and morphological features are characteristic and must be considered in order to prevent diagnostic misinterpretation. To the best of our knowledge the association of pregnancy luteoma with endometriosis has not been reported in literature to date. CASE REPORT: A 30-year-old pregnant woman with no particular past medical history, consulted her gynaecologist at 17 weeks gestation for routine check-up. The patient was asymptomatic and did not show any signs of virilization. Ultrasonography disclosed a left adnexal heterogeneous mass measuring 7 cm in diameter with intramural vegetations. The right ovary was unremarkable. The patient underwent salpingo-oophorectomy considering the imaging findings were suspicious for malignancy. Histologically, the lesion was constituted of large sheets of luteinized polygonal cells with abundant eosinophilic cytoplasm and small round nuclei devoid of atypia and mitotic figures. In addition, there were several ectopic endometrial glands surrounded by abundant decidualized or edematous stroma. Immunohistochemically, these glands were immunoreactive for cytokeratin 7. The final pathological diagnosis was pregnancy luteoma associated with diffuse endometriosis. CONCLUSIONS: Because of its relative rarity, pregnancy luteoma is likely to be clinically misinterpreted and overtreated, as in the present case.

Neuroglial heterotopia of the scalp.

Heterotopic glial nodules of the scalp are non hereditary congenital malformations composed of mature brain tissue isolated from the cranial cavity. The majority of these lesions are found in the nasal region and occur rarely on the scalp. They are frequently diagnosed in newborn infants. However, they may rarely be found in adults. The pathogenesis of these lesions remains unknown. We describe the case of a temporal scalp nodule in a 50 year-old man. At the time of the excision, the mass was not associated with intracranial connection. Histological examination revealed neural tissue staining with S100-protein and the glial fibrillary acidic protein (GFAP).

[Duodenal metastatic leiomyosarcoma of the uterus. A case report]. / Métastase duodénale d'un leiomyosarcome utérin. A propos d'une observation.

The digestive metastases of uterine leiomyosarcoma are rare. We report a case of a duodenal tumor detected in a 50 year-old woman, 3 years after she underwent a total hysterectomy for uterine leiomyosarcoma. The stenosing duodenal mass was thought to be a mesenchymal tumor. A pancreaticoduodenectomy was performed. The resected lesion was morphologically similar to the uterine leiomyosarcoma. In fact, the histopathological study confirmed a submucosal tumor with typical features of the uterine leiomyosarcoma. Immunohistochemistry was performed and it showed negative CD117 and CD 34. Markers displayed positivity for actin smooth muscle and desmin. Considering the patient history and the immunohistochemical observations, we diagnosed a duodenal metastasis of uterine leiomysarcoma. Through this exceptional observation we want to emphasize the epidemiological and the pathological features of the metastatic uterine leiomyosarcoma. We will also point out the progress of tumoral cells and the histopathological distinctive criteria with a primitive digestive mesenchymal tumor.

Jejunal lymphangioma: an unusual cause of intussusception in an adult patient.

Adult intussusception is a relatively rare clinical entity. Almost 90% of cases of intussusception in adults are secondary to a pathologic condition that serves as a lead point. Lymphangioma of the small bowel is an unusual tumour that has been rarely reported to cause intussusception. In this paper, we present a rare case of adult intussusception due to jejunal lymphangioma. A 22-year-old female patient with a medical history significant for anaemia presented with intermittent colicky abdominal pain, diarrhoea and oedema of the inferior limbs for the past three months. Ultrasonography and CT scan revealed a typical target sign with dilated intestinal loops. At laparotomy, a jejuno-jejunal intussusception was found. Partial resection of the jejunum was performed. Macroscopic examination of the surgical specimen revealed a pedunculated polyp measuring 2 cm in diameter. Histological sections of the polyp revealed in the lamina propria and submucosal layer of the jejunum several markedly dilated thin-walled lymphatic spaces lined with single layers of flat endothelial cells. The final pathologic diagnosis was submucosal lymphangioma. This case report indicates that intussusception, although rare in adults, should be considered in the differential diagnosis of abdominal pain. Moreover, it should be taken into consideration that lymphangioma is one of the possible lesions that can cause intussusception.

[Idiopathic granulomatous hypophysitis: clinical apppearance and imaging]. / Hypophysite granulomateuse idiopathique: aspects cliniques et radiologiques.

Idiopathic granulomatous hypophysitis is a chronic inflammation of the pituitary gland. It is a rare occurrence and is diagnosed only on pathologic examination. We report a case of a 23-year-old female patient presenting with polyuria and polydipsia associated with a pituitary failure and hyperprolactinemia. MRI study showed a space occupying lesion of the pituitary gland with a marked enhancement after gadolinium injection. Pituitary biopsy was consistent with the diagnosis of idiopathic granulomatous hypophysitis. The aim of this work is to discuss the different clinical and radiological aspects of the disease with a special emphasis on differential diagnosis.

[Synovial lipoma arborescens]. / Lipomes arborescents de la synoviale.

The synovial lipoma are uncommon articular tumors of unknown origin. We report two cases of synovial lipoma arborescens arisen in a man and a woman respectively 41 and 27 years old. Both had already consulted for a tumefaction progressively increasing in volume. It was accompanied in the first case by a laxity in the knee joint. Radiography and arthroscopy showed an important hyperplasia of the articular synovia. A total synovectomy was performed in both cases. The synovia had a hairy aspect and was extremely thickened. It weighted 1.5 kg in the first case and its section had a fatty aspect. The histological examination confirmed the diagnosis of synovial lipoma arborescens. The observed aspect of the two tumors and particularly their volume, which was very important in the first case are arguments in favor of their tumoral nature.

[Endometrioid carcinoma of the Fallopian tube arising in tubo-ovarian endometriosis. A case report]. / Carcinome endométrioïde in situ et primitif de la trompe développé sur une endométriose tubo-ovarienne. A propos d'une observation.

The primitive endometrioid carcinoma of the fallopian tube is exceptional. Only three cases have been reported in the literature. Its rise on tubal endometriosis like for the ovary needs to meet the strict histological criteria established by Sampson and Scott in 1953. We report one case observed on a patient aged 45 years, who needed a total hysterectomy with bilateral annexectomy for menometrorrhagias associated to uterine leiomyomas which resisted to medical treatment. The finding of a primitive intra-epithelial endometrioid carcinoma of the left fallopian tube developed on bilateral tubo-ovarian endometriosis was fortuitously found during histological examination. Our observation seems to be unique since it shows an evident filiation between the lesions of tubal endometriosis and the adjoining endometrioid carcinoma contrary to the similar unique case reported in the literature where the link between the two lesions has not been demonstrated.

[Adrenocortical insufficiency in renal amyloidosis]. / L'insuffisance surrénale au cours de l'amylose rénale.

Renal involvement in amyloidosis leads to chronic renal failure. Prognosis is poor. Although amyloid deposits are frequent in adrenal glands, symptomatic adrenal dysfunction is uncommon. We report the case of a 63-year-old man with chronic renal failure (serum creatinine: 202 micromol/L) subsequent to amyloidosis who was referred to our unit for vomiting, dehydration despite a persistent nephrotic syndrome, acidosis, hyponatremia (121 mmol/l) and hyperkaliemia (7.1 mmol/l). A synacthen test was performed and disclosed adrenal insufficiency. Despite the initiation of substitution therapy, the patient died one month later from Addisonian crisis. Features of adrenal insufficiency may be masked by those of chronic renal failure, emphasizing the importance of adrenal explorations in patients with chronic renal failure due to amyloidosis.

[Desmoid cervical tumour following the placing of an internal jugular catheter]. / Tumeur desmoïde cervicale après pose d'un cathéter jugulaire interne.

INTRODUCTION: A desmoid tumour is a rare fibroblastic tumour and generally located in the abdomen. However, it can also develop on surgical scars. OBSERVATION: A 36 year-old woman on chronic dialysis consulted for a cervical mass on the left side that was progressively increasing in volume, on the site of a scar of an internal jugular catheter placed 7 months earlier. Histological analysis of a sample of this mass concluded in a benign fibroblastic proliferation and led to the diagnosis of a desmoid tumour. Study of the patient's history revealed that a left jugular catheter had been placed on two occasions to be used for the hemodialysis approach, the lesion provoked by the latter would explain the development of the desmoid tumour. COMMENTS: The potential severity of this tumour is related to its proximity with the carotid, trachea and base of the skull. In general, desmoid tumours, rare benign tumours of the connective tissue, exhibit a complex multifactor etiopathogenesis. A surgical trauma can often trigger-off such tumours.

[Acute renal insufficiency in Boutonneuse Mediterranean fever: description of three cases]. / Insuffisance rénale aiguë au cours de la fièvre boutonneuse méditerranéenne: description de trois observations.

Boutonneuse fever is a bacterial infection caused by Rickettsia conorii. It occurs mainly in countries around the Mediterranean basin. Most cases are benign. However severe forms with major morbidity and a high mortality risk have been described. Severe forms often involve altered mental status, hepatic cytolysis, hemostatic disturbances, pneumopathy, and kidney failure. The causes of renal complications are unclear. The purpose of this report is to describe three cases of boutonneuse fever associated with acute kidney failure due to different underlying mechanisms, i.e., acute renal function failure, acute tubular necrosis, and extracapillary glomerulonephritis. While the first two mechanisms of kidney failure have been reported frequently in association with Boutonneuse fever, extracapillary glomerulonephritis has, to our knowledge, been mentioned only once. This case supports speculation that Rickettsia conorii has a toxic effect on glomeruli.

[Basal cell carcinoma arising in a seborrheic keratosis: a case report]. / Carcinome basocellulaire developpe sur une kératose séborrhéique: á propos d'une observation.

Seborrheic keratosis are one of the most common benign epidermic tumors in clinical practice. Malignant transformation is exceptional and occurs by the involvement of human papilloma virus. We report a case of seborrheic keratosis of the armpit in a 55 year-old woman whose biopsy revealed the presence of a basal cell carcinoma.

Neuroendocrine tumours of the pancreas: a clinicopathological study of nine cases including six insulinomas.

BACKGROUND: Pancreatic neuroendocrine tumours (pNET) are relatively uncommon, accounting for 1-2% of all pancreatic neoplasms. They are characterised by varying clinical presentation, tumour biology and prognosis. AIM: To provide an updated overview on clinicopathological features, treatment and outcome of pNET. PATIENTS AND METHODS: In our retrospective study, we reviewed 9 cases of pNET that were diagnosed at the Pathology Department of Mongi Slim Hospital over an 11-year period (2003- 2013). Relevant clinical information and microscopic slides were available in all cases and were retrospectively reviewed. The latest WHO classification (2010) was adopted. RESULTS: Our study group included 3 men and 6 women (M/F ratio 0.5) with an age between 20 and 75 years (mean = 52 years). Pancreatic neuroendocrine tumours ranged in size from 0.5 to 10 cm (mean 4 cm). The sites of pNET were the head of the pancreas (n = 4), the body of the pancreas (n = 3) and the tail of the pancreas (n = 2). Enucleation of the tumour was performed in five cases, Three patients underwent distal pancreatectomy and splenectomy, whereas only one patient had central pancreatectomy. Histopathological examination of the surgical specimen coupled with immunohistochemical study established a diagnosis of pNET grade 1 (G1) in seven cases and grade 2 (G2) in two cases. CONCLUSION: Pancreatic neuroendocrine tumours are a heterogeneous group of neoplasms with distinct tumour genetics, biology and clinicopathological features. Accurate clinical and pathologic diagnosis is an important first step in developing an appropriate management plan.

Coexistence of lobular granulomatous mastitis and ductal carcinoma: a fortuitous association?

A 77-year-old female patient with a medical history significant for hypertension and epilepsy presented with right breast pain of 6-months duration. Examination revealed a hard sub-areola tender mass with irregular borders associated with mild right nipple retraction. Mammography showed a 2.2 x 2.4 cm stellate mass of the right breast. Ultrasound-guided core biopsies of the tumour were performed. Pathological examination revealed a grade II infiltrating ductal carcinoma. The patient underwent right radical mastectomy with homolateral axillary lymphadenectomy. Histological examination of the surgical specimen revealed grade II infiltrating ductal carcinoma concomitant with granulomatous lobular mastitis. To the best of our knowledge, the coexistence of granulomatous lobular mastitis and ductal carcinoma has been described only twice in the English language literature. The theory that chronic inflammation leads to cancer is well documented. Whether our patient had developed cancer from granulomatous lobular mastitis or otherwise is a matter of debate until more cases are encountered and more research is done in the area of breast cancer pathogenesis with regards to it arising from granulomatous lobular mastitis.

Pancreatic heterotopia of the small intestine: two case reports.

The presence of heterotopic pancreas is unusual with an estimated incidence of 0.2% of upper abdominal operations. Heterotopic pancreas occurs predominantly in the stomach, duodenum and proximal jejunum. Isolated pancreatic heterotopia of the ileum is very rare and is usually found in a Meckel's diverticulum. In most cases, these heterotopias are asymptomatic and are only incidentally detected upon pathological examination or autopsy. In this paper, the authors report two cases of pancreatic heterotopia involving, respectively, the duodenum and ileum that were fortuitously discovered on a surgical specimen and during laparotomy for unrelated causes.