Correlation between CT and anatomopathological staging of kidney cancer.

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

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

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

Hyperandrogenism-Insulin Resistance-Acanthosis Nigricans Syndrome.

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

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

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

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

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

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

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

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

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

The heat shock protein 90 antagonist novobiocin interacts with a previously unrecognized ATP-binding domain in the carboxyl terminus of the chaperone.

Heat shock protein 90 (Hsp90), one of the most abundant chaperones in eukaryotes, participates in folding and stabilization of signal-transducing molecules including steroid hormone receptors and protein kinases. The amino terminus of Hsp90 contains a non-conventional nucleotide-binding site, related to the ATP-binding motif of bacterial DNA gyrase. The anti-tumor agents geldanamycin and radicicol bind specifically at this site and induce destabilization of Hsp90-dependent client proteins. We recently demonstrated that the gyrase inhibitor novobiocin also interacts with Hsp90, altering the affinity of the chaperone for geldanamycin and radicicol and causing in vitro and in vivo depletion of key regulatory Hsp90-dependent kinases including v-Src, Raf-1, and p185(ErbB2). In the present study we used deletion/mutation analysis to identify the site of interaction of novobiocin with Hsp90, and we demonstrate that the novobiocin-binding site resides in the carboxyl terminus of the chaperone. Surprisingly, this motif also recognizes ATP, and ATP and novobiocin efficiently compete with each other for binding to this region of Hsp90. Novobiocin interferes with association of the co-chaperones Hsc70 and p23 with Hsp90. These results identify a second site on Hsp90 where the binding of small molecule inhibitors can significantly impact the function of this chaperone, and they support the hypothesis that both amino- and carboxyl-terminal domains of Hsp90 interact to modulate chaperone activity.

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

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

The molecular chaperone Hsp90 can negatively regulate the activity of a glucocorticosteroid-dependent promoter.

Hsp90, a molecular chaperone required for the functioning of glucocorticosteroid receptor (GR), ensures, by direct interaction, the conformational competence of the steroid-binding pocket. In addition to having this positive function, Hsp90 maintains steroid receptors in an inactive form in the absence of hormone. However, neither the participation of Hsp90 once the pathway has been activated by the ligand nor the importance of increased Hsp90 levels in determining the amplitude of the response has ever been assessed directly. Here, by increasing the Hsp90/GR ratio in the nuclear compartment, we found an attenuation of the response to glucocorticosteroids that was not due to a nonspecific or toxic effect of the Hsp90 modified by nuclear targeting. Since this negative effect was more pronounced at high levels of hormone, when receptor and Hsp90 are maximally dissociated, the possibility of an interaction between Hsp90 and GR, already activated to a DNA-binding form, was directly investigated. Indeed GR, after in vivo activation by ligand, was still able to reassociate with Hsp90, suggesting that this interaction plays a role in vivo, possibly in receptor recycling. Moreover, the GR binding to its DNA response element was inhibited by an excess of Hsp90, pointing to a function of Hsp90 in the nuclear compartment. It is thus proposed that an increased Hsp90/GR ratio influences the responsiveness to ligand at a step that is after receptor activation. This increased ratio may be of pathophysiological relevance in the different circumstances that lead to an elevated level of nuclear Hsp90.

Heat-induced oligomerization of the molecular chaperone Hsp90. Inhibition by ATP and geldanamycin and activation by transition metal oxyanions.

It has been previously reported that heat shock protein 90 (Hsp90) oligomerizes at high temperatures and displays concomitantly a novel chaperone activity (Yonehara, M., Minami, Y., Kawata, Y., Nagai, J., and Yahara, I. (1996) J. Biol. Chem., 271, 2641-2645). In order to better define these oligomerization properties at high temperatures and to know whether they are influenced by modulators of Hsp90 function, heat-induced oligomerization of highly purified dimeric Hsp90 has been investigated over a wide range of temperature and protein concentrations by native polyacrylamide gel electrophoresis and size exclusion chromatography. Whereas below 50 degreesC, the dimeric form is maintained over a large range of concentrations, at the critical temperature of 50 degreesC, a sharp transition from dimeric to higher order oligomeric species takes place within minutes, in a highly ordered process, suggesting that a conformational change, leading to the appearance of a new oligomerization site, occurs in Hsp90 dimer. Moreover, at and above the critical temperature, the extent of oligomerization increases with Hsp90 concentration. Formation of high order oligomers at high temperatures is sensitive to modulators of Hsp90 function. ATP and geldanamycin, both known to bind to the same pocket of Hsp90, are inhibitors of this process, whereas molybdate, vanadate, and Nonidet P-40, which are thought to increase surface hydrophobicity of the protein, are activators. Thus, oligomerization of Hsp90 at high temperatures may be mediated through hydrophobic interactions that are hindered by ligands and favored by transition metal oxyanions. The fact that the heat-induced oligomerization of Hsp90 is affected by specific ligands that modulate its properties also suggests that this process may be involved in cell protection during heat shock.

Production and characterization of a monoclonal antibody able to discriminate galectin-1 from galectin-2 and galectin-3.

Antisera raised against galectin-1 exhibit crossreactivities with other galectins or related molecules. In order to overcome this problem, a monoclonal antibody to human brain galectin-1 was obtained by selecting clones without reactivity toward galectin-3. This mAb specifically bound galectin-1 of various animal origins but neither galectin-2 nor galectin-3. Western-blotting analysis of soluble human brain extracts after 2D gel electrophoresis revealed only the two most acidic isoforms of galectin-1. The ability of this mAb to bind galectin-1/asialofetuin complexes indicates that its epitope is not localized in the carbohydrate recognition domain of galectin-1. This particularity induces with efficiency its monospecificity.

Purification and characterization of a human brain galectin-1 ligand.

Our previous studies have characterized an endogenous lectin from human brain identified as galectin-1. A soluble ligand of galectin-1 was purified from human brain by affinity chromatography and preparative electrophoresis. The purified ligand (termed HBGp82, for human brain galectin-1-binding polypeptide of 82,000 daltons) has an apparent molecular mass of 82 kDa and is glycosylated by N-linked biantennary complex structures. HBGp82 was partially characterized by microsequencing of peptide fragments. Similar peptides were found in a heat shock of protein of 90,000 daltons, hsp90. However, comparison of apparent molecular weights and matrix-assisted laser desorption mass spectrometry clearly showed that HBGp82 differs to some degree from hsp90.

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

We report a retrospective multicentric study of 20 cases of sclero-corneal limbus tumours carcinome including 9 cases of Bowen's disease and 11 squamous cell carcinomas. These cases were observed over two 10 and 20-year periods in two pathology departments. Epidemiological, clinical, pathological and therapeutic data as well as the clinical course were studied and the results compared with a large review of the literature. The mean age of the patients was 38 years for Bowen's disease and 47 for carcinoma. Two young subjects, 5 and 22 years, had xeroderma pigmentosum and had Bowen's disease and an epidermoid microinvasive carcinoma, respectively. All of the patients with Bowen's disease were men and were more than 90% of the patients with carcinoma. Tumour size was greater in carcinomas (7 to 10 mm) than in Bowen's disease (1 to 5 mm). All tumours were unilateral. Clinical manifestations included irritative or inflammatory reactions in one-fourth of the patients with Bowen's disease and in one-third of those with carcinoma. Pathology examination revealed an intact basal membrane separating healthy tissue from Bowen's lesions which showed disrupted cell architecture mostly involving the medial layers of the epithelium in 37% of the cases. All of the lesions were treated by exeresis. No recurrence has been observed after a follow-up of 1 month to 2 years for Bowen's disease and 1 year (maximum) for squamous cell carcinomas.

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

We studied nucleolar organizers (Ag-NORS) in 20 cases of ocular limbic tumours of which 7 were Bowen disease or intraepithelial carcinoma and 13 were invasive carcinomas. The NOR-Index, reflecting cellular activity, increased from intraepithelial carcinoma (3.97) to microinvasive (5.45) and invasive carcinoma (5.81). Results of Nor-Index, reflecting proliferation, was in agreement with other technics such as immuno-labelling with Ki67 and PCNA antibodies.

Development of screening methods for detection of carbohydrate-binding proteins by use of soluble glycosylated polyacrylamide-based copolymers.

Mammalian endogenous carbohydrate-binding proteins (lectins) play fundamental roles in a variety of mechanisms of interactions both at the molecular and cellular levels. We have investigated the binding of one of them (human brain lectin) to soluble acrylamide copolymerized with derivatives of either lactose (O-beta-lactosyloxyallylallylaminoacrylamide copolymer) or D-mannose (D-alpha-mannosyloxyallylallylaminoacrylamide copolymer) in direct enzyme affinoassays, in an attempt to develop simple procedures for detection and estimation of its carbohydrate-binding activity. Biotinylated plant lectins were utilized as reference standards. Affinoassays employed the polymer dotted on nitrocellulose and the polymer coated on microtiter plates as well as detection of bound biotinylated lectin by streptavidin/horseradish peroxidase reagent. Both assays provided reproducible binding, inhibitable by specific sugars. The microtiter plate assay is well suited to sensitive detection of the negative endogenous lectin by competition with biotinylated brain lectin. We conclude that the use of derivatized acrylamide in dotting and microtiter plate assays may prove practical for detection of endogenous lectins and that such polymers may serve as model substances in the study of biological partners of these carbohydrate-binding proteins.

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

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

[Bronchial cytology in the diagnosis of broncho-pulmonary cancer in Tunisia]. / Apport de la cytologie bronchique dans le diagnostic du cancer broncho-pulmonaire en Tunisie.

The authors present a retrospective study of 287 pulmonary cytologic exams censed in Pasteur Institute - Tunis between 1970 and 1986. These 287 exams consist of 145 bronchic aspiration liquids and 142 spittles. A systematic exam was practiced in patients presenting a pulmonary symptomatology suggesting little or not at all broncho pulmonary cancer. 40 of these exams present cancerous cells (15 cases) or suspected cancerous cells (25 cases). The biopsy confirms a malignant tumor in 25 patients (5%). These results should urge us toward a cytologic exam not only in adults presenting any respiratory symptomatology, but also in subjects at high risk, especially smokers. Localising the tumor is necessary for the biopsy. This biopsy will lead us to determine the histologic type and consequently the adequate therapy.