Surgical resection with neoadjuvant chemotherapy for iliac Ewing's sarcoma in adult females: A rare case report highlighting multidisciplinary approaches and promising outcomes.

INTRODUCTION ET IMPORTANCE: The iliac origin Ewing's sarcoma is a highly malignant primitive bone tumor. Its occurrence in adults is very rare. The prognosis for this tumor in adult patients is unfavorable and has a high rate of local recurrence. The main treatment goals include preventing local recurrences and distant metastases. A secondary objective is to maintain the quality of life by avoiding major amputative surgery. The primary aim of this report is to underscore the rarity and significance of the combination of surgery with neoadjuvant chemotherapy for better outcomes. CASE PRESENTATION: We present a rare case of Ewing's sarcoma of the right ilium without metastasis in a 50-year-old woman, treated with initial chemotherapy followed by extensive local marginal resection of the pelvic lesion, complemented by perimeter radiotherapy, and concluded with additional chemotherapy. The patient's progress has been satisfactory, with no recurrence observed during a 6-month follow-up period. CLINICAL DISCUSSION: The Ewing's sarcoma of the pelvis, being more aggressive than in other locations, presents an unfavorable prognosis, especially in cases of delayed diagnosis associated with large tumors and micrometastases. Therapeutic advancements, such as neoadjuvant chemotherapy, precise radiotherapy, and sophisticated preoperative planning, contribute to improving survival rates. Early diagnosis of Ewing's sarcoma of the ilium remains a challenge due to subtle changes difficult to detect on radiographs and nonspecific clinical symptoms. Ewing's sarcoma of the pelvis has an unfavorable prognosis due to the lack of a major anatomical barrier to tumor spread in this region. The treatment of this disease requires a multidisciplinary approach involving oncologists, radiation oncologists, surgeons, and radiologists. The effectiveness of surgery depends on the possibility of complete resection without excessive morbidity. The clarity of surgical margins influences the prognosis, although the presence of distant metastases remains the worst prognostic factor, with a limited long-term survival of 20 % despite aggressive treatment. Histological grades do not determine the prognosis, and long-term survival is generally reported between 60 % and 70 %, emphasizing the crucial importance of early detection and appropriate therapeutic intervention. CONCLUSION: In summary, the case of Ewing's sarcoma in the right ilium highlights the rarity and challenges associated with this highly malignant bone tumor. Despite the unfavorable prognosis often linked to delayed diagnosis in the pelvic region, a multidisciplinary approach, including surgical resection along with neoadjuvant chemotherapy and precise radiotherapy, shows promise in improving outcomes. The satisfactory progress of the patient over 6 months underscores the potential effectiveness of this treatment plan.

[Circadian and septadian variation in sudden cardiac death : Autopsy registry of the Tunisian North]. / Variation circadienne et hebdomadaire de la mort subite d'origine cardiaque : registre autopsique du nord de la Tunisie.

INTRODUCTION: Several studies have suggested a circadian and septadian pattern of incidence of sudden cardiac death with a morning peak and a Monday peak. OBJECTIVE: To analyze the circadian and septadian pattern of occurrence of sudden cardiac death in the eight northern Tunisian governorates. METHODS: We prospectively collected epidemiological and autopsy data of sudden cardiac death victims occurring in the northern region of Tunisia between January 2013 and December 2019. RESULTS: The population included 1834 men (79.6%) and 468 women (20.4%) with a mean age of 56.5 ± 14 years. Smoking (53.9%) was the most prevalent cardiovascular risk factor. One-fifth (20.9%) of victims had known heart disease, and 3% had a family history of sudden death. ischemic heart disease was the leading cause of sudden death (46.8% of cases). One- fourth (25.7%) of autopsies were negative. Analysis of the circadian pattern of occurrence of sudden cardiac death identified a peak (36.1%, p < 0.001) between midnight and 6 am. This nocturnal excess mortality was significant (p < 0.001) and independent of sex (34.1 % in men and 43.8 % in women) and cause of death (39.3 % of cases of sudden ischemic death and 33.3 % of cases of nonischemic death). Moreover, there was a significant septadian variability in the occurrence of sudden death (p: 0.0015), with a peak on Friday (15.8 %, p: 0.042). CONCLUSION: This study showed a peak of sudden death between midnight and 6 am, and on Fridays, confirming the modification of the classic circadian and septadian pattern of sudden death occurrence. These results may help optimize the deployment of emergency mobile teams and structures during the most vulnerable periods.

[Sudden cardiac death in women, data from the northern Tunisian sudden cardiac-death registry]. / La mort subite cardiaque chez la femme, registre du nord de la Tunisie.

BACKGROUND: Sudden cardiac death is a major public health problem. Epidemiological and clinical differences according to gender have been described in sudden cardiac death. The aim of this study was to examine the gender differences between autopsy findings and circumstance of occurrence associated with sudden cardiac death. METHODS: We prospectively collected epidemiological and autopsy data of victims of sudden cardiac death occurring in the northern governorates of Tunisia between January 2013 and December 2019. Symptoms preceding death, circadian, weekly and seasonal variations of sudden death were also analyzed. RESULTS: The study population included 1834 men and 468 women with a mean age of 56.5±14.2 years. All cardiovascular risk factors except smoking were significantly more frequent among women but ischemic heart disease was the most common cause of death in men (51.3 %, versus 28 %, P<0.001). Women were more likely to have a negative macroscopic autopsy than men (34 % versus 23.6 %, P<0.001). Chest pain preceding sudden death was more frequent in male (24 % versus 13.2 %, P<0.001). In contrast, women were more likely to have dyspnea (8.1 % versus 15.6 %, P<0.001). Sudden death in women occurred indoors more often than in men (63.9 % versus 54.5 %, P<0.001) and also more often during night (midnight to 6 am). We also recorded an excess cardiac mortality in winter in both sexes. CONCLUSIONS: Women had considerably more cardiovascular risk factors and more commonly negative macroscopic autopsy. Death occurred indoors and during night more often than in men.

Severity of hypoxic ischemic encephalopathy correlates with increased expression of angiogenin in neonates.

BACKGROUND: Angiogenin is a small protein encoded by the ANG gene. It is activated by tissue hypoxia, and is known to be a potent stimulator of angiogenesis. The role of angiogenic factors in the pathogenesis of HIE is poorly understood, yet, angiogenin may be part of the molecular mechanisms underlying HIE. OBJECTIVE: Our objective was to explore the predictive value of angiogenin as a biochemical marker in early hypoxic ischemic encephalopathy staging. STUDY DESIGN: We prospectively studied 36 full term HIE neonates and 20 non- asphyxia neonates. Cord blood samples from all subjects immediately at delivery were withdrawn. Neurological examination and grading of HIE were performed during the first day of life. RESULTS: Concentrations of cord blood angiogenin were increased in infants with asphyxia when compared txht o controls (P = 0). Within the asphyxia group, the median cord blood angiogenin was significantly higher in stage III encephalopathy patient compared to stage I and stage II (p = 0). There was a negative correlation between pH, HCo3 level and angiogenin in stage II and stage III. CONCLUSION: Angiogenin helps in assessing the severity of HIE in neonates and is promising marker predicting the stage of hypoxia-ischemia so treatment may be initiated earlier.

Novel glycoconjugated squaraine dyes for selective optical imaging of cancer cells.

Novel glycoconjugated squaraine dyes were synthesized, which exhibited excellent internalization in tumor cells and are potent fluorogenic imaging probes for tumor selective optical imaging.

Nonunion of Fractures of the Ulna and Radius Diaphyses: Clinical and Radiological Results of Surgical Treatment.

Aseptic nonunion of the radius and ulna is a major complication of forearm fractures, accounting for 2% to 10% of all forearm fractures. The aim of our study is to evaluate the functional and radiological results of surgical treatment of diaphyseal aseptic nonunion of the radius and ulna, with autologous bone grafting, decortication and internal plate fixation. A series of 21 patients (26 nonunions) was retrospectively reviewed, the average age was 35 years with a mean of 31,58 years (range 12-44 years). The fractures included isolated radius (n=6) and ulna (n=10), and both radius and ulna (n=5). The Grace and Eversmann score was used to evaluate our results. Fifteen had very good results, five good and one average. Consolidation of the two bones was attained in 6.2 months. Therefore, the functional prognosis of the upper limb imposes the need for an adequate treatment. This management strategy has enabled us to have satisfactory results. However, the best treatment of nonunion remains the preventive treatment with an optimal management and care of the forearm fractures.

Articular fracture of the base of the thumb metacarpal: Comparative study between direct open fixation and extrafocal pinning.

The treatment of intra-articular fractures of the base of the first metacarpal bone should aim to anatomically reduce the articular surface, restore the initial length of the first metacarpal and preserve the opening of the first web space. These objectives appear to be achievable with a well-conducted surgical treatment. In a retrospective study, we reviewed a series of 38 cases, which compared open reduction and internal fixation (ORIF) and extrafocal pinning to determine which option provided the best reduction and functional recovery in young, manual workers. Direct fixation was better at restoring the configuration of the joint, regardless of the age and sex of the patients and the fracture type. This complete reduction is associated clinically with better function. Thumb opposition was statistically better in fractures treated by ORIF. Thumb retroposition was better in the cases treated by ORIF, but not significantly. ORIF appears the best technique for treating intra-articular fractures of the base of the first metacarpal, as it results in better functional recovery.

Enteral L-Arginine and Glutamine Supplementation for Prevention of NEC in Preterm Neonates.

Objective. Evaluating the efficacy and safety of arginine and glutamine supplementation in decreasing the incidence of NEC among preterm neonates. Methods. Prospective case-control study done on 75 preterm neonates ≤34 weeks, divided equally into L-arginine group receiving enteral L-arginine, glutamine group receiving enteral glutamine, and control group. Serum L-arginine and glutamine levels were measured at time of enrollment (sample 1), after 14 days of enrollment (sample 2), and at time of diagnosis of NEC (sample 3). Results. The incidence of NEC was 9.3%. There was no difference in the frequency of NEC between L-arginine and control groups (P > 0.05). NEC was not detected in glutamine group; L-arginine concentrations were significantly lower in arginine group than control group in both samples while glutamine concentrations were comparable in glutamine and control groups in both samples. No significant difference was found between groups as regards number of septic episodes, duration to reach full oral intake, or duration of hospital stay. Conclusion. Enteral L-arginine supplementation did not seem to reduce the incidence of NEC. Enteral glutamine may have a preventive role against NEC if supplied early to preterm neonates. However, larger studies are needed to confirm these findings. This work is registered in ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT01263041).

[Surgical treatment of acral melanoma: a report of eight cases]. / Traitement chirurgical du mélanome acral: à propos de huit cas.

Acral melanoma represents 3 to 15% of all cutaneous melanoma. In Morocco, this location is predominant. Through our study, we intend to analyze the therapeutic aspects of acral melanoma, while focusing on the epidemiological, clinical, pathological and prognostic profile of acral melanoma cases listed in osteoarticular surgery department of the CHU Hassan II of Fez in the period from January 2009 to December 2012. The mean age of the patients was 63 years, with slight predominance of women. The most commonly involved location was plantar region (including the heel) and pigmented color was the most common. The concept of micro trauma was found in almost half of our patients. Plantar localization was the most commun lesion. Inguinal lymph nodes attended three patients and one patient had deep lymph nodes. Only one of them had a lymphadenectomy. Nodular melanoma os the most found histological type in our study with a Breslow thickness of 8.5mm on average, and Clark level IV is found in the majority of cases. Excision of the tumour was performed in all patients. It was estimated wide in all cases. Five patients received reparative surgery consisting of flap coverage. This study has proved a high incidence of poor prognostic factors clinically and histologically.

Single dose recombinant erythropoietin versus moderate hypothermia for neonatal hypoxic ischemic encephalopathy in low resource settings.

OBJECTIVE: To determine the safety and efficacy of single dose systemic recombinant human erythropoietin (rEPO) in neonates with perinatal hypoxic Ischemic Encephalopathy (HIE), and its effect on serum brain-derived neurotrophic factor (BDNF) and neuron-specific enolase (NSE). METHODS: Forty-five full-term neonates; 30 with perinatal HIE and 15 controls were studied. HIE neonates were randomized into three intervention groups (first 6 h of life): 10 received single subcutaneous 1500 U/kg rEPO at day-1, 10 subjected to hypothermia for 72 h and 10 received supportive care. BDNF and NSE measured during first 6 h and day 5 postnatal. Daily Thompson's score, MRI brain and neuromuscular function scale for survivors at 3 months of age were done. RESULTS: Hypothermia group had best survival especially with stage-II Sarnat scale, followed by rEpo and supportive group. BDNF day-5 was significantly higher in each group compared to controls. MRI score and neuromuscular function score were non-significantly lower in the hypothermia group compared to rEPO. CONCLUSIONS: Therapeutic hypothermia was superior to single dose rEpo for neuro-protection in HIE especially in patients with stage-II Sarnat scale. Therapeutic effect of combined rEPO multiple dosing and modest hypothermia therapy should be studied.

Rhodium catalyzed oxidative coupling of salicylaldehydes with diazabicyclic olefins: a one pot strategy involving aldehyde C-H cleavage and π-allyl chemistry towards the synthesis of fused ring chromanones.

An efficient one pot strategy for the synthesis of cyclopentene fused chromanone derivatives through the direct oxidative coupling of salicylaldehydes with bicyclic olefins in the presence of a rhodium-copper catalyst system is described. This is the first report on the ring opening-ring closing of bicyclic hydrazines via metal catalyzed oxidative coupling reaction.

[Aseptic non-union of humeral shaft fractures treated by plating and bone grafting. Report of 20 cases]. / Pseudarthrose aseptique de la diaphyse humérale traitée par plaque vissée et autogreffe osseuse (à propos de 20 cas).

Although aseptic non-union of humeral shaft fractures is generally considered to be an exceptional complication, rates in the literature have varied from 1 to 10%. The aim of this retrospective study was to study the results of treatment by plating and bone grafting for aseptic non-union of humeral shaft fractures. The retrospective study gathered 20 patients, the mean age was 41 years. The most common fracture site was the middle third. For the follow-up evaluation, we used the Steward and Hundley score. According to this score, we noted: 13 very good results, five good results and two poor results. Management of non-union of the humerus should be optimal at immediate surgery. The best treatment of non-union of the humerus is its prevention by correct management of the initial fracture.

[Radiocarpal dislocation (about nine cases)]. / La luxation radiocarpienne (à propos de neuf cas).

Radiocarpal dislocation is an uncommon entity in traumatolgy. The purpose of this study was to detail the pathogenesis of radiocarpal dislocation and describe its complications and treatment. Nine radiocarpal dislocations were reviewed retrospectively. Dorsal displacement was observed for seven dislocations, anterior displacement for two dislocations. All were associated with fractures of the radial styloid. Treatment was always surgical. At last follow-up (mean 3 years), the overall functional outcome was satisfactory. The Green and O'Brien (modified by Cooney) score was excellent for three patients, fair for four, and mediocre for two. Two cases of radiocarpal degeneration were observed at last follow-up. Intracarpal and/or distal radio-ulnar lesions must be stabilized in order to limit the risk of future degeneration.

[Surgical treatment of proximal humeral fractures anatomical plate versus palm tree pinning (26 cases)]. / Le traitement chirurgical des fractures de l'extrémité supérieure de l'humérus : plaque anatomique versus embrochage en palmier, à propos de 26 cas.

BACKGROUND: The aim of this study is to compare functional and radiological results of two surgical techniques in treatment of proximal humeral fractures. PATIENTS AND METHODS: A prospective study was performed, which included 12 patients operated for a proximal humeral fracture by open reduction and internal fixation using an anatomical humeral plate, and another group of patient (14 patients) treated for the same lesion using a palm tree pinning technique of Kapandji. The comparison of results of the two techniques was based on three parameters: the time of healing, quality of reduction, and the functional result. The global mean age was 48.6 (±13,7), and the sex ratio (M/W) was 1. RESULTS: Statistical analysis of functional and radiological results showed no superiority of one technique over another; so the mean time of healing was 6.1 (± 0.7) weeks in the group treated by plate, and 6 (± 0.7) weeks in the group treated by pinning (P=0.5), the mean absolute Constant score was respectively 86 (±10.4) and 90.92 (±2.5) (P=0.09), and the mean measuring of cephalic angle was respectively 46.91 (±17.68) and 55.71 (±19.48) (P=0.24). CONCLUSION: Univariate analysis showed no statistically significant association between endpoints and the two surgical techniques studied. Therefore the study showed no statistical superiority of one surgical technique over another.

Functional outcome of midclavicular fracture fixation utilising a reconstruction plate.

BACKGROUND: Clavicular fractures are common injuries. The aim of this study is to present results of surgical treatment of midclavicular fracture managed with open reduction and internal fixation (ORIF) with superior reconstruction plating. This study involved 34 patients, with mean age of 31 years, with completely displaced midclavicular fractures, 28 on the right and 6 on the left, stabilized by contoured plate. One patient developed an early wound infection, which was successfully managed by surgical debridement. The average time of union was 14 weeks, with one case of nonunion. The average constant score was 95.33 with SD 3.4 in one year follow up. Plate fixation of completely displaced midshaft clavicular fracture provides stable fixation and improves the functional outcome. KEY WORDS: Clavicle fracture, Open reduction and internal fixation, conservative treatment, surgical treatment.

[Sudden death during sport activity in Tunisia: autopsy study in 32 cases]. / La mort subite au cours d'une activité sportive en Tunisie : à propos d'une série autopsique de 32 cas.

PURPOSE: To develop profile of the victims and to study circumstances, causes of death and autopsy findings. METHODS: Retrospective study of cases of sudden death in sport activity whose autopsy was performed in forensic department of Tunis, between January 2005 and December 2009. RESULTS: During study period, 32 cases of SD in sport activity were recorded. These are amateur athletes predominantly male (84% of cases). Victims are aged between 15 and 79 years with an average age of about 33.16 years. Young subjects whose age is less than 35 years representing 68.7% of cases. 9.3% of victims had a family history of SD and 18.7% of cases had a known cardiac history. The sports most involved are running (40.6% of cases), football (31.3% of cases) and dance (12.5% of cases). Sixty-nine percent of victims died during sports activities. Presence of witnesses was noted in all cases; however, none of these witnesses has begun resuscitation. Cause of death was cardiac in 84.4% of cases. In young athletes, hypertrophic cardiomyopathy is the leading cause (nine cases), followed by arrhythmogenic right ventricular dysplasia (three cases). Among other causes, there is the myocardial bridge, congenital anomalies of the coronary arteries, aortic dissection and dilated cardiomyopathy. Beyond 35 years, coronary artery diseases represent the cause of death (nine cases). Only case of death secondary to non-cardiac disease occurred after a severe asthma attack. In four cases (12.5%), no cause of death was identified after a complete autopsy accompanied by further investigations. The cause of the death was imputed to a rhythmic pathology. CONCLUSION: This is the first study dealing with autopsy in SD in sport have provided a specific profile of victims. Other studies on larger samples and using standardized autopsy protocols are needed.

A shoulder-hand syndrome revealing a lung cancer.

Shoulder-hand syndrome is a reflex sympathetic dystrophy which is usually associated with minor trauma, fracture or surgical procedures on bones, or follows peripheral nerve injury. In the present report, we describe a patient who developed sympathetic dystrophy which revealed a lung cancer. Reflex sympathetic dystrophy, therefore, should be considered an occasional manifestation of a paraneoplastic syndrome warranting a thorough search for underlying malignancy.

[Anterior traumatic axial disruption of the middle carpal joint. Case report with literature review]. / Séparation traumatique axiale de la médiocarpienne à déplacement palmaire. À propos d'un cas avec revue de la littérature.

We report a case of traumatic axial disruption of the radial mid carpal joint. This unusual type of scaphotrapezo-trapezoïdal dislocation occurred after falling from a height. We performed open reduction and wire fixation. At 12months follow-up, functional outcome was satisfactory with good muscle strength (clamping force, grip strength and pinch grip: 90% compared to the opposite side) and good range of motion was preserved. Work was resumed at the tenth week. Radial midcarpal disruption is uncommon. It includes the separation of the trapezium, trapezoïdal, first and second and third metacarpal bones from the remaining wrist. This pattern of carpal derangement has not been previously described in the literature. Mechanism of the injury and treatment are discussed.

[Floating elbow: retrospective study and review of literature]. / Le coude flottant : étude rétrospective et revue de la littérature.

The floating elbow represents an uncommon combination of lesions in traumatology. Few studies have described this lesion especially in adults. Over a period of 6 years, 12 floating elbows were reviewed retrospectively. One osteoporotic elderly patient was treated conservatively. Reduction and internal fixation using different implants was performed in the other patients. Consolidation was obtained at the humerus at 3 months (2.5-3.5 months) on average, and 2.6 months (2-3 months) at forearm bones. According to the classification of Lange and Foster, our functional results were good in 67% of cases, fair in 17% and poor in 16% cases. Good functional prognosis of the upper limb requires rapid and adequate management of floating elbows. Internal fixation followed by early rehabilitation is recommended. The choice of surgical acts depends on the location of fractures. This strategy gave satisfactory results.

Predictive value of vascular endothelial growth factor in preterm neonates with intraventricular haemorrhage.

OBJECTIVE: Intraventricular haemorrhage (IVH) is a major problem in premature infants. Our objective is to assess the early predictive value of vascular endothelial growth factor (VEGF) for development of IVH and management of its squeal in preterm neonates. METHODS: We prospectively studied 150 preterm neonates (PT) less than 34 weeks gestation. Fifty of them completed the study. 30/50 developed IVH during follow up, and 20 did not. First 24 hours, and 3(rd) day serum samples were collected. Cerebrospinal fluid (CSF) samples were withdrawn for 10 IVH patients. RESULTS: Serum VEGF; both samples were increased in IVH compared to non-IVH group (P=0.001). PHVD-group (n=10) had higher VEGF in both samples than resolved IVH (P=0.004), (P=0.005). While, VEGF increased in the IVH group 2(nd) sample compared to 1(st) (P=0.000), it decreased in non-IVH group, P=0.033). Each 1 unit increase in 1(ST) VEGF increased the risk of occurrence of IVH by 1.6%. 3(rd) day VEGF at a cut-off value of 135 pg/ml is 96% sensitive and 100% specific to predict PHVD. Serum VEGF inversely correlated with TLC, pH, PO(2) and HCO(3), and positively correlated with PCo(2) and FiO(2). CONCLUSION: Serum VEGF predicts development of IVH and PHVD in PT neonates. Also, high CSF level of VEGF could predict the need for permanent shunt placement.