A randomized trial of induction docetaxel-cisplatin-5FU followed by concomitant cisplatin-RT versus concomitant cisplatin-RT in nasopharyngeal carcinoma (GORTEC 2006-02).

Background: Concomitant chemotherapy (CT)-radiotherapy (RT) is a standard of care in locally advanced nasopharyngeal carcinoma (NPC) and a role for induction CT is not established. Methods: Patients with locally advanced NPC, WHO type 2 or 3, were randomized to induction TPF plus concomitant cisplatin-RT or concomitant cisplatin-RT alone. The TPF regimen consisted of three cycles of Docetaxel 75 mg/m2 day 1; cisplatin 75 mg/m2 day 1; 5FU 750 mg/m2/day days 1-5. RT consisted of 70 Gy in 7 weeks plus concomitant cisplatin 40 mg/m2 weekly. Results: A total of 83 patients were included in the study. Demographics and tumour characteristics were well balanced between both arms. Most of the patients (95%) in the TPF arm received three cycles of induction CT. The rate of grade 3-4 toxicity and the compliance (NCI-CTCAE v3) during cisplatin-RT were not different between both arms. With a median follow-up of 43.1 months, the 3-year PFS rate was 73.9% in the TPF arm versus 57.2% in the reference arm [hazard ratio (HR) = 0.44; 95% confidence interval (CI): 0.20-0.97, P = 0.042]. Similarly the 3 years overall survival rate was 86.3% in the TPF arm versus 68.9% in the reference arm (HR = 0.40; 95% CI: 0.15-1.04, P = 0.05). Conclusion: In conclusion, several important aspects can be emphasized: the compliance to induction TPF was good and TPF did not compromise the tolerance of the concomitant RT-cisplatin phase. The improved PFS and overall survival rates needs to be confirmed by further trials.

Influence of warm-up duration and recovery interval prior to exercise on anaerobic performance.

The purpose of the study was to determine the impact of different active warm-up (AWU) durations and the rest interval separating it from exercise on anaerobic performance. Eleven male physical education students (22.6 ± 2.52 years; 179.2 ± 4.3 cm; 82.5 ± 9.7 kg; mean ± SD) participated in a cross-over randomized study, and they all underwent the Wingate test after three AWU durations: 5 min (AWU5), 15 min (AWU15) and 20 min (AWU20), with recovery (WREC) or without a recovery interval (NREC) separating the AWU and anaerobic exercise performance. All the AWUs consisted of pedalling at a constant pace of 60 rpm at 50% of the maximal aerobic power. The rest interval between the end of warm-up and the beginning of exercise was set at 5 min. During the Wingate test, peak power (PP), mean power (MP) and the fatigue index (FI) were recorded and analysed. Oral temperature was recorded at rest and at the end of the warm-up. Likewise, rest, post-warm-up and post-Wingate heart rate (HR) and rating of perceived exertion (RPE) were recorded during each session. The ANOVA showed a significant effect of recovery interval, warm-up duration and measurement point on RPE scores (P<0.001). Although the effect of AWU duration on MP and PP was significant (P<0.05), the effect of the recovery interval on both parameters was not significant (P>0.05). Moreover, the analyses showed a significant interaction between recovery interval and AWU duration (P<0.001 and P<0.05 for MP and PP respectively). The AWU15 duration improves the MP and PP when associated with a recovery interval prior to exercise of 5 min. However, the AWU5 duration allows better improvement of power output when the exercise is applied immediately after the warm-up. Consequently, physically active males, as well as educators and researchers interested in anaerobic exercise, must take into account the duration of warm-up and the following recovery interval when practising or assessing activities requiring powerful lower limb muscle contractions.

A novel BRCA2 in frame deletion in a Tunisian woman with early onset sporadic breast cancer.

BACKGROUND: Breast cancer is increasing among young women in Tunisia. Germline mutations in the BRCA1/2 genes are associated with a high risk for breast cancer development. However, the true contribution of BRCA1/2 mutation in sporadic breast cancer is not well documented. Our aim is to identify the BRCA2 mutation spectrum in Tunisian young women with breast cancer. METHODS: Screening the BRCA2 gene was performed using DHPLC, DNA sequencing and PCR-RFLP. RESULTS: We identified, in a woman diagnosed with early onset breast cancer, and without family history, a novel in frame deletion 5456delGTAGCA in the exon 11 of the BRCA2 gene which causes a loss of two residues Ser1743-Ser1744. The absence of this deletion in the patients' parents suggests that it is a de novo variant. Furthermore, we screened 108 sporadic cases, 50 familial cases, and 60 controls for the identified del6bp using PCR-RFLP. None of them carried this deletion suggesting that this variant is not a benign polymorphism and probably rare in our population. With regards to the position of the Ser1743-1744 in the BRCT domain, sequence alignment revealed that the Ser1743 is conserved among several species, which may reflect its importance in the BRCA2 function. A modeling of the wild-type and mutated BRC5-BRC6 domain revealed that the deletion of the 2 Serine residues might affect the structure of this BRCA2 domain. CONCLUSIONS: A novel in frame deletion 5456del6bp in BRCA2 gene was identified in an early onset woman with breast cancer and without family history.

[Prognostic factors in metastatic colorectal cancer in Tunisia: A retrospective study of 130 patients]. / Facteurs pronostiques des cancers colorectaux métastatiues (CCRM) en Tunisie. Etude retrospective à propos de 130 patients.

BACKGROUND: The survival of patients with a metastatic colon cancer has improved with palliative chemotherapy, targeted therapies and surgery. Several prognostic factors influencing the survival of these patients were identified in the literature represented mainly by clinical factors: general condition, number and site of metastases, rate of white blood cells, initial carcinoembryonic antigen (CEA) rate, hemoglobin level, and therapeutic factors mainly represented by resection of metastases. AIM: To evaluate within a Tunisian retrospective study the significant prognostic factors on survival of metastatic colorectal cancer (MCRC). METHODS: We collected retrospectively 130 patients with MCRC treated in Sfax from january 2000 to December 2007. Uni and multivariate analysis were performed according to cox model for the following factors : Age or > 40 years, gender, synchronous vs metachronous metastases, disease-free survival (DFI) 1 > 1year, tumor site(colon vs rectum), performance status or PS ( 0-1or 2-3), white blood cells count (< or > 103/ml3 , haemoglobin rate (Hb) or > 11g/dl, seric carcinoembryonic antigen rate (CEA) < vs > 10 ng/ml, number of metastatic sites (single vs multiple), site of metastatic site (liver vs extrahepatic) and resection or not of the metastatic localizations. RESULTS: Statistical analysis showed for univariate analysis the positive impact of : PS 1, (Hb) rate > 11 g/dl, CEA) < 10 ng/ml and resection of metastases, while in in multivariate analysis, they were : a good PS and Hb > 11 g/dl. CONCLUSION: Our retrospective study confirmed the known prognostic impact of simple clinical tools like a good performance Status and Hb > 11 g/dl, a (CEA) rate lower than 10 ng/ml and resection of metastases which were identified by several other series such as predictive factors of a better survival in patients with metastatic colorectal cancer.

Hydrolyzed porcine mucosa in broiler diets: effects on growth performance, nutrient retention, and histomorphology of the small intestine.

The effect of including hydrolyzed porcine mucosa sprayed into soybean meal (HPM) in the diet was studied in broilers. In experiment 1 (pen study), 1,080 one-day-old chicks were used in a completely randomized design with 8 treatments arranged as a 4 × 2 factorial with 4 levels of HPM (0, 2.5, 5.0, and 7.5%) and 2 levels of Lys (1.23 and 1.38%). From d 1 to 22, HPM inclusion quadratically improved BW gain (BWG, P < 0.01) and feed conversion ratio (FCR, P < 0.01). From d 1 to 8, birds fed 1.38% Lys had higher BWG (P < 0.05) and better FCR (P < 0.05) than birds fed 1.23% Lys but only a trend (P < 0.08) for improved BWG was detected from d 1 to 22. From d 22 to 37, a period in which all birds received a common finisher diet, growth performance was not affected by the previous starter diet. In experiment 2 (battery study), birds were fed for 37 d the same diets used in the starter period of experiment 1. Broilers fed HPM had higher BWG (linear, P < 0.05; Quadratic, P < 0.05) than birds fed control diet, and birds fed 1.38% Lys had higher BWG (P < 0.01) than birds fed 1.23% Lys. From d 1 to 22, BWG (P < 0.05) and ADFI (P < 0.01) increased quadratically and FCR improved linearly (P < 0.05) with HPM inclusion. Also in this period, BWG was higher at the higher Lys level (P < 0.01). Diet did not affect intestinal histomorphology of broilers on d 8 or nutrient retention on d 22. We conclude that the inclusion of 2.5 to 5% HPM in the diet improved growth performance of broilers from d 1 to 22. An increase in Lys from 1.23 to 1.38% improved growth performance up to 15 d of age, but not thereafter. Diet did not affect villus histomorphology or nutrient retention of the small intestine.

[Rectal stromal tumor: about a case]. / Tumeur stromale rectale: à propos d'une observation.

Gastro-intestinal stromal tumors are uncommon mesenchymal tumors. There are localized preferentially in the stomach. The rectal localization is exceedingly rare. Through a new case of rectal stromal tumour as well as a review of the literature, we propose to focus on clinical, radiological and therapeutic particularities of this rare entity.

Influence of feed form and source of soybean meal on growth performance, nutrient retention, and digestive organ size of broilers. 2. Battery study.

Two experiments were conducted to determine the apparent ileal digestibility (AID) of the amino acids (AA) of 4 commercial soybean meals (SBM) from the United States (USA-1, 48.1% CP and USA-2, 46.2% CP), Brazil (BRA, 47.6% CP), and Argentina (ARG, 46.3% CP) and the effects of the inclusion of these SBM in diets in mash, crumble, or pellet form on growth performance, total tract apparent retention of nutrients, and digestive organ size in broilers reared in cages from 1 to 25 d of age. In experiment 1, the AID of Lys was higher (P < 0.05) for the USA-2 than for the BRA SBM, with the SBM from USA-1 and ARG being intermediate. In experiment 2, 12 diets were arranged as a 3 × 4 factorial with 3 feed forms (mash, crumbles, and pellets) and the 4 sources of SBM used in experiment 1. The feeds were isonutritive and the AID of the AA of the SBM obtained in experiment 1 was used for diet formulation. Broilers fed mash had lower (P < 0.001) ADFI and ADG and poorer (P < 0.001) feed-to-gain ratio than broilers fed crumbles or pellets but source of SBM did not affect growth performance. Nitrogen retention was higher (P < 0.01) in birds fed mash than in birds fed crumbles or pellets at all ages. The total tract apparent retention of nutrients was lower (P < 0.05) for the BRA and ARG SBM diets than for the USA-1 and USA-2 SBM diets. Gizzard empty relative weight (% BW) was higher and gizzard pH lower for broilers fed mash than for broilers fed crumbles or pellets (P < 0.001). The results indicate that crumbling or pelleting of the diets improved growth performance of broilers from 1 to 25 d of age. Diets formulated with analyzed rather than calculated AID of AA of the SBM sources resulted in similar broiler performance.

Ileal digestibility of amino acids of unheated and autoclaved pea protein concentrate in broilers.

The effects of autoclaving 2 varieties of micronized (fine grinding) pea protein concentrate (PPC) on the ileal digestibility (ID) of CP and amino acids (AA) were studied in broilers. There was a control diet based on fermented soybean meal (FSBM) and 4 extra diets in which the FSBM was substituted on a CP basis by PPC from 2 different pea cultivars (PPC-1 and PPC-2), either unheated or autoclaved. Chicks were fed a common diet from 1 to 17 d of age and, then, their respective experimental diets from 18 to 21 d of age. Each treatment was replicated 6 times. Autoclaving reduced trypsin inhibitor activity (TIA) but had little effect on the saponin content of the PPC. The apparent ID (AID) of CP was similar for the FSBM and the unheated PPC and lower for both than for the autoclaved PPC. Autoclaving improved (P < 0.001) the AID of CP (87.6 vs. 82.2%) and most indispensable AA (e.g., 92.1 vs. 88.8% for Lys and 83.6 vs. 76.5% for Thr) of the PPC. The improvement in CP and AA digestibility with autoclaving varied with the PPC used and was consistent with the reduction in TIA observed (9.4 to 2.8 mg/g for PPC-1 vs. 9.1 to 5.3 mg/g for PPC-2). The standardized ID (SID) of most indispensable AA was similar for the FSBM and the PPC-2 and higher for both than for the PPC-1 (P < 0.05). For Lys, the lowest SID value was observed for the FSBM and the highest for the PPC-2 either unheated or autoclaved. It is concluded that the ID of the AA of the PPC improved with heating and was in general higher for the autoclaved PPC than for the FSBM. Consequently, heat processed PPC is a good alternative to FSBM and unheated PPC in starter diets for broilers.

Effects of energy concentration of the diet on productive performance and egg quality of brown egg-laying hens differing in initial body weight.

The influence of AME(n) concentration of the diet on productive performance and egg quality traits was studied in Hy-Line brown egg-laying hens differing in initial BW from 24 to 59 wk of age. Eight treatments were arranged factorially with 4 diets varying in energy content (2,650, 2,750, 2,850, and 2,950 kcal of AME(n)/kg) and 2 initial BW of the hens (1,733 vs. 1,606 g). Each treatment was replicated 5 times (13 hens per replicate), and all diets had similar nutrient content per unit of energy. No interactions between energy content of the diet and initial BW of the hens were detected for any trait. An increase in energy concentration of the diet increased (linear, P < 0.05; quadratic P < 0.05) egg production, egg mass, energy efficiency (kcal of AME(n)/g of egg), and BW gain (P < 0.05) but decreased ADFI (linear, P < 0.001) and feed conversion ratio per kilogram of eggs (linear, P < 0.01; quadratic P < 0.01). An increase in energy content of the diet reduced Haugh units and the proportion of shell in the egg (P < 0.01). Feed intake (114.6 vs. 111.1 g/hen per day), AME(n) intake (321 vs. 311 kcal/hen per day), egg weight (64.2 vs. 63.0 g), and egg mass (58.5 vs. 57.0 g) were higher for the heavier than for the lighter hens (P < 0.01), but feed conversion ratio per kilogram of eggs and energy efficiency were not affected. Eggs from the heavier hens had a higher proportion of yolk and lower proportion of albumen (P < 0.01) and shell (P < 0.05) than eggs from the lighter hens. Consequently, the yolk-to-albumen ratio was higher (P < 0.001) for the heavier hens. It is concluded that brown egg-laying hens respond with increases in egg production and egg mass to increases in AME(n) concentration of the diet up to 2,850 kcal/kg. Heavy hens had higher feed intake and produced heavier eggs and more egg mass than light hens. However, feed and energy efficiency were better for the lighter hens.

Effect of crude protein and fat content of diet on productive performance and egg quality traits of brown egg-laying hens with different initial body weight.

A trial was conducted to study the influence of CP and fat content of the diet on performance and egg quality traits of brown egg-laying hens from 22 to 50 wk of age. The experiment was conducted as a completely randomized design with 8 treatments arranged factorially with 4 diets and 2 initial BW of the hens (1,592 vs. 1,860 g). Three of these diets differed in the CP content (16.5, 17.5, and 18.5%) and included 1.8% added fat. The fourth diet also had 18.5% CP but was supplemented with 3.6% fat instead of 1.8% fat. Each treatment was replicated 4 times, and the experimental unit consisted of 21 hens allocated into groups of 7 in 3 adjacent cages. All diets were isocaloric (2,750 kcal of AME/kg) and met the recommendations of brown egg-laying hens for digestible Arg, Ile, Lys, Met, Thr, Trp, TSAA, and Val. Productive performance and egg quality were recorded by replicate every 28 d. For the entire experimental period, diet did not affect any of the productive performance traits studied, but the heavier hens had higher ADFI (120.6 vs. 113.9 g; P < 0.001), egg production (92.5 vs. 89.8%; P < 0.01), and egg weight (64.9 vs. 62.4 g; P < 0.001) than the lighter hens. Initial BW did not affect feed conversion per kilogram of eggs or hen mortality, but BW gain was higher (289 vs. 233 g; P < 0.01) and feed conversion ratio per dozen of eggs was better (1.52 vs. 1.57; P < 0.01) for the lighter than for the heavier hens. None of the egg quality variables studied was affected by dietary treatment or initial BW of the hens. It is concluded that brown egg-laying hens, irrespective of their initial BW, do not need more than 16.5% CP to maximize egg production, provided that the diet meets the requirements for key indispensable amino acids. Heavier hens produce more eggs that are larger than lighter hens but feed efficiency per kilogram of eggs is not affected.

[Primary choriocarcinoma of the maxillary gingival]. / Choriocarcinome gingivo-mandibulaire primitif.

INTRODUCTION: Primary non-gestational extragonadal choriocarcinomas are uncommon and their head and neck localization more exceptional. OBSERVATION: We report on a primary choriocarcinoma case of the mandibular gingivae in a 26-year-old woman who presented with pulmonary and renal metastasis. Complete response (clinical, biological and radiological) was achieved with combined chemotherapy according to APE regimen associating actinomycin, cisplatin and etoposid. The patient was free of disease 4 years after therapy completion. DISCUSSION: Primary gingival mandibular choriocarcinoma is very rare. Clinical presentation is atypical; diagnosis is based on histopathological examination and positivity for HCG. Our case report showed high chemo-sensitivity and comparable outcome to the other localizations.

Effects of the main cereal and type of fat of the diet on productive performance and egg quality of brown-egg laying hens from 22 to 54 weeks of age.

The influence of the main cereal and type of supplemental fat in the diet on productive performance and egg quality of the eggs was studied in 756 brown-egg laying hens from 22 to 54 wk of age. The experiment was conducted as a completely randomized design with 9 treatments arranged factorially, with 3 cereals (dented corn, soft wheat, and barley) and 3 types of fat (soy oil, acidulated vegetable soapstocks, and lard). Each treatment was replicated 4 times (21 hens/replicate). All diets were formulated to have similar nutrient content, except for linoleic acid, which ranged from 0.8 to 3.4% depending on the combination of cereal and fat source used. This approach allows for the estimation of the minimum level of linoleic acid in the diets that maximizes egg weight. Productive performance and egg-quality traits were recorded every 28 d, and the BW of the hens was measured individually at the beginning and at the end of the experiment. No significant interactions between main factors were detected for any of the variables studied. Egg production, egg weight, and egg mass were not affected by dietary treatment. Body weight gain was higher (P < 0.05) for hens fed corn or wheat than for hens fed barley, and also higher for hens fed lard than for hens fed soy oil or acidulated vegetable soapstocks. Egg quality was not influenced by dietary treatment, except for yolk color, which was greater (P < 0.001) for hens fed corn than for hens fed wheat or barley, and greater for hens fed lard than for hens fed soy oil or acidulated vegetable soapstocks. We concluded that brown-egg laying hens do not need more than 1.0% of linoleic acid in their diet (1.16 g/hen per d) to maximize egg production and egg size. The 3 cereals and the 3 fat sources tested can replace each other in the diet provided that the linoleic acid requirements to maximize egg size are met.

[Acute occlusion with fever in a Tunisian woman]. / Syndrome occlusif fébrite aigu chez une tunisienne.

The purpose of this report is to describe a case of idiopathic segmental infarction of the great omentum, in a Tunisian woman, who presented with acute right hypchondrial pain simulating cholecystitis. Abdominal CT scan is the modality of choice. If symptoms resist medical treatment or complications occur, laparoscopic excision is the best therapeutic technique.

Influence of source of soybean meal and lysine content of the diet on performance and total tract apparent retention of nutrients in broilers from 1 to 36 days of age.

The influence of soybean meal (SBM) source and total Lys content of the diet on performance and total tract apparent retention of nutrients was evaluated in broilers from 1 to 36 d of age. There were 6 treatments arranged factorially with 2 sources of SBM [regular SBM with 46.3% CP (R-SBM) and high-protein SBM with 48.6% CP (HP-SBM)] and 3 Lys:AME(n) ratios (Lys:ME; 380, 415, and 450 mg of total Lys:1,000 kcal of AME(n) from 1 to 21 d; and 312, 338, and 364 mg of total Lys:1,000 kcal of AME(n) from 22 to 36 d of age). From 1 to 36 d of age, broilers fed the HP-SBM diets had higher ADG and better feed:gain ratio (F:G) than broilers fed the R-SBM diets (P < or = 0.001). Both ADG and F:G improved (P < or = 0.05) with increases in the Lys:ME ratio. From 1 to 21 d of age, ADG and F:G (P < or = 0.001) were improved when the Lys:ME ratio increased and the benefits were more pronounced with the diets based on R-SBM. From 22 to 36 d of age, increasing the Lys:ME ratio from 312 to 338 increased ADG (P < or = 0.05) and F:G (P < or = 0.01), but no further improvements were observed when the ratio was increased to 364. The total tract apparent retention of DM and gross energy of the diets were higher (P < or = 0.05) for the HP-SBM than for the R-SBM diets. An increase in the Lys:ME ratio reduced organic matter and N retention (P < or = 0.05). The improvements in growth performance and nutrient retention observed in broilers fed the HP-SBM diets with respect to those fed the R-SBM are consistent with a better availability of nutrients of the high-protein meal. In addition, the results indicate that Lys requirements of broilers are at least, 30, 20, and 8% higher from 1 to 10, 10 to 21, and 21 to 36 d of age, respectively, than current NRC recommendations.

[Intestinal perforation in a Tunisian woman: peritonitis due to a fishbone]. / Un coup de poignard abdominal chez un tunisien: péritonite par arête de poisson.

Diagnosis of foreign body perforation of the gastrointestinal tract can be difficult. The purpose of this report is to describe a case of acute peritonitis after perforation of the ileum by a fish bone that was detected by computed tomography.

[Intrauterine device and pelvic tumor: two case reports of pelvic actinomycosis with pseudotumor from tropical zones]. / Dispositif intra-utérin et tumeur pelvienne: 2 observations sous les tropiques d'actinomycose pelvienne pseudotumorale.

Pelvic actinomycosis is a rare chronic disease caused by actinomycete species. The pseudotumorous form is the most common and often leads to misdiagnosis. The purpose of this report is to describe two cases of pelvic actinomycosis involving women with a history of intrauterine contraceptive device (IUD) use. Diagnosis was based on pelvic mass and the findings of surgery undertaken for suspicion of an advanced ovarian tumor with hepatic metastasis in one case and for a tumor of the right ovary in the other case. Diagnosis was confirmed by histological examination of a biopsy specimen in the first case and of the surgical specimen (right ovariectomy) in the second case. Long-term antibiotic therapy was effective in both patients. Based on these two cases and review of the literature, discussion focuses on diagnostic pitfalls, natural course, and therapeutic options for this particular infection.

A new gastric impedancemeter for detecting the development of a visceral edema: a proof-of-concept study on an experimental endotoxemic shock.

Visceral congestion and edema are important features of advanced heart failure. Monitoring the evolution of fluid content in the gastric wall might provide an index of the development of this phenomenon and therefore constitute an innovative marker to early detect acute decompensated heart failure episodes. The evolution of the fluid content in the gastric wall is measured using a device implanted in the submucosa layer of the fundic region of the stomach. The device composed of two electrodes measures the bioimpedance values that reflects the water content of the tissue.An in-vivo experiment in a pig was carried out to validate the feasibility of detecting the gastric bioimpedance variations during the development of an experimental acute visceral edema caused by an endotoxemic shock. Our preliminary results confirm the possibility to monitor the bioimpedance variations due to moderate changes in tissue water content (10%) with a two-electrode configuration device implanted in the submucosa of the stomach.

[A case of thyroid metastasis of an unusual cancer]. / Un cas de métastase intrathyroïdienne d'un primitif inhabituel.

Nasopharyngeal carcinoma affects preferentially young adults and is characterized by a high rate of node and visceral metastases that explains a part of therapeutic failure. We report a case of thyroid metastasis of a nasopharyngeal carcinoma. A 50-year-old patient had been treated of a nasopharyngeal carcinoma (T4 N2M0). Four years after a concomitant chemoradiotherapy, he presented with a compressive mass in the thyroid loge associated to cervical nodes. He underwent a total thyroidectomy and the definitive result concluded to an carcinome indifférencié de type nasopharyngé (UCNT) thyroid metastasis. A new concomitant chemoradiotherapy was delivered and consequently the tumor disappeared. Secondly, several node recurrences occurred. Metastasis of UCNT in thyroid gland is exceptional. Several problems are related to its aetiopathogenesis and to its treatment that is not systematized in the literature. The prognosis like for all metastatic forms of nasopharyngeal cancer is unfavorable.

[The value of radiotherapy in the treatment of aggressive and localised gastric lymphomas]. / Intérêt de la radiothérapie dans le traitement des lymphomes gastriques agressifs localisés.

PURPOSE: To evaluate the treatment results of localised aggressive gastric lymphomas with favourable prognosis using chemotherapy and radiotherapy. PATIENTS AND METHODS: Between February 1993 and December 2004, nine patients with primary gastric high-grade lymphoma have been treated by the Lymphoma Committee of Sfax (Tunisia). The sex ratio was 1.5. The mean age was 44.9 years. Histological type was the large cell B lymphoma in 100% of the cases. Disease was stage I in eight cases and stage II in one case (Ann Arbor Classification). The treatment consisted in primary chemotherapy followed by radiotherapy of the stomach with or without regional nodes (40 Gy). RESULTS: After treatment, all patients had complete remission. With a mean follow-up of 55.7 months, one patient was lost to follow-up; the other patients were alive with complete remission. No major acute toxicities or late effects were found. Overall survival was 100% at five years. CONCLUSION: Chemotherapy associated with radiotherapy can be proposed to patients having localised and aggressive primary gastric lymphoma with favourable prognosis, since this treatment is well tolerated and provides satisfactory control of the disease.

[Pure colloid carcinoma of the breast: anatomoclinical study of seven cases]. / Carcinome colloïde pur du sein : étude anatomoclinique de sept cas.

PURPOSE: Breast mucinous carcinoma is a particular histological form characterized by the extracellular production of mucus. The pure form is rarely reported and its prognostic is better than the other types of the breast cancer. The aim of the present study was to discuss the various anatomoclinical, therapeutic aspects and the prognostic factors of the pure mucinous carcinoma of the breast. PATIENTS AND METHODS: We report seven cases diagnosed over a period of 11 years (1993-2003) in the laboratory of anatomy and pathological cytology of the university hospital of Sfax. A review of the clinical files with immunohistochemistry study (hormonal receptor, synaptophysine, chromogranine, Bcl2, Ki67, P53 and Her-2/neu (C-erbB-2)) were carried out for all the cases. RESULTS: pure colloid carcinoma of the breast accounted for 0,5% of the whole of the breast cancers. The average age of patients was 69 years. At the time of the diagnosis, four tumours were classified T4, one T3, two T2, two N1 and one N3; no patient had presented metastasis (M0) according to pTNM classification. The echomammography showed regular contours mass in four cases. The anatomopathological study showed that the neuroendocrine differentiation was found in two cases, all the tumours had presented positivity for the hormonal receptors (oestrogen and progesterone) and negativity for the other antibodies, two cases exhibited the Bcl2 positivity and negativity for the other antibodies. An adjuvant radiotherapy was carried out for all the patients. The average duration of follow-up was of 33 months; the evolution was marked by the occurrence of metastases in two cases. CONCLUSION: The pure colloid carcinoma of the breast constitutes a particular morphological entity which deserves to be individualized; neuroendocrine differentiation of these tumours must be required. Their forecast is relatively favourable.