Adolescents and young adults with classical Hodgkin lymphoma in northern Tunisia: insights from an adult single-institutional study.

PURPOSE: The aim of this study was to extensively describe the epidemiological, clinical and therapeutic outcomes of adolescents and young adults (AYA) population with classical Hodgkin Lymphoma (cHL). Then, a comparison between AYAs and adults and between the subgroups of AYAs treated with the same adult protocol was accomplished to further inform on optimal therapy approach of choice for adolescent patients. MATERIAL AND METHODS: In this mono-centric, retrospective study, we reviewed the medical records. We analyzed 112 consecutive North Tunisian patients, including 66 AYAs (15 to 39 years) and 46 adults (≥40years) affected by cHL treated from 2000 to 2015 at Salah Azaiez Institute. Then, we performed a comparative analysis between AYA and 46 adult patients and a subgroup analysis between adolescents and young adults. All patients were treated according to the national protocol for HL, edited by the Tunisian Society of Hematology. The treatment included chemotherapy and involved-field radiotherapy (RT) at a dose of 20 or 30 Grays (Gy) for responders and 36Gy for non-responders. RESULTS: AYA patients presented with adverse features with nodular sclerosis subtype (p=3.88×10-02) and mediastinal mass involvement (p=9.40×10-04). At a median follow-up of 51 and 32 months for AYAs and adults, respectively, no statistical difference in terms of 3 and 5-years overall survival (OS) and event-free survival (EFS) was shown. Using the Kaplan-Meier method, in AYAs, the ABVD regimen has an impact on 3-years EFS (p=4.63×10-02). The 36Gy RT was associated with the best 3-years EFS (p=9.24×10-03). Besides, AYA patients with advanced-stage had the worst 3-years OS (76%) (p=2.41×10-02). Although the adolescents and young adults shared similar clinical presentation, we noted that the adolescent group had the worst 3-years EFS (48%), but the best 3-years OS (91%). We identified 15% of primary refractory patients and a rate of toxicity of 5.3% in AYA. CONCLUSION: The treatment approach used is well tolerated by adult patients. However, the AYA patients and particularly adolescent subgroup had more advanced disease at diagnosis and should be treated more intensively in dedicated units. RT dose<36Gy and ABVD chemotherapy were associated with lower EFS in this population.

Adrenal gland hemangioma: A rare case of the incidentaloma: Case report.

BAKGROUND: Adrenal glands hemangiomas are rare, benign and non-functional tumors. They are often discovered as incidentalomas either during imaging or autopsies. Nearly 70 cases were reported in the literature. CASE REPORT: We report a case of a non-functional adrenal hemangioma (AH) that was incidentally found on abdominal ultra sonography (US) during the routine control of diabetes of a 58 year-old man. Imaging with US and Computed tomography (CT) showed an heterogeneous and partially calcified 6 cm tumor of the right adrenal gland. The mass was surgically excised and the histological examination concluded to an adrenal haemangioma. CONCLUSION: Although rare, AH should be included in the differential diagnosis of the adrenal neoplasmas.

In vitro evaluation of the probiotic potential of Lactobacillus salivarius SMXD51.

Lactobacillus salivarius SMXD51 was previously isolated from the cecum of a Tunisian poultry and found to produce a bacteriocin-like substance highly active against the foodborne pathogen Campylobacter jejuni. The aim of this study was to examine some probiotic properties of the strain: acid and bile tolerance, capacity of adhesion, stimulation of immune defences (IL-6, IL-8, IL-10 and ß-defensin 2), and modulation of the barrier integrity. The results showed that L. salivarius SMXD51 can tolerate gastrointestinal conditions (acid and bile), adhere to intestinal cells and stimulate the immune system. The bacterium strengthened the intestinal barrier functions through the increase of the transepithelial electrical resistance (TEER) and reinforcement of the F-actin cytoskeleton. One hour pretreatment with L. salivarius SMXD51 protected against Pseudomonas aeruginosa PAO1-induced decrease of TEER and damage of the F-actin cytoskeleton. Our results highlight that L. salivarius SMXD51 fulfils the principle requirements of an efficient probiotic and may be seen as a reliable candidate for further validation studies in chicken.

[Pancreatic cystadenocarcinoma revealed by an acute pancreatitis and exploratory surgery. A rare case report]. / Cystadenocarcinome du pancreas revele par une pancreatite aigue et de decouverte operatoire. A propos d'un cas rare.

Cystadenocarcinoma of the pancreas is a rare malignant tumor. It may appear as a typical pseudocyst on ultrasonography or CT scan. It is exceptionally revealed by an acute pancreatitis. Authors report a new case of cystadenocarcinoma of pancreas misinterpreted as pancreatic pseudocyst complicating acute pancreatitis. The diagnosis was established at laparotomy by discovering a locally advanced tumor of pancreatic tail with hepatic and peritoneal carcinosis metastasis.

Lactococcin MMFII, a novel class IIa bacteriocin produced by Lactococcus lactis MMFII, isolated from a Tunisian dairy product.

A novel bacteriocin, lactococcin MMFII, produced by Lactococcus lactis MMFII isolated from a Tunisian dairy product had been identified. The bacteriocin was purified to homogeneity from fresh overnight M17 broth culture by sulfate ammonium precipitation, cation-exchange chromatography, sep-pack chromatography and two steps of reverse-phase chromatography. The purified bacteriocin was heat stable, pH resistant and protease sensitive. Its amino acid sequence, obtained by Edman degradation, revealed a 37-amino acid peptide with two cysteine residues in positions 9 and 14 and a calculated mass of 4144.6 Da. Laser desorption mass spectrometry analysis gave a molecular mass of 4142.6, suggesting the presence of a disulfide bond within the purified bacteriocin. Lactococcin MMFII contains the N-terminal YGNGV consensus motif and is active against Listeria. Thus, it belongs to the class IIa bacteriocins figuring the first example of such a bacteriocin produced by a lactococcal strain.

Chemical synthesis, molecular modeling, and antimicrobial activity of a novel bacteriocin, MMFII.

A new antimicrobial peptide, referred to as MMFII, was purified to homogeneity from lactic acid bacteria Lactococcus lactis, which were isolated from Tunisian dairy product. The complete amino acid sequence of the peptide has been established by amino acid analysis, Edman sequencing, and mass spectrometry and verified by solid-phase chemical synthesis. MMFII is a single-chain 37-residue polypeptide containing a single intramolecular disulfide bond, i.e., TSYGNGVHCNKSKCWIDVSELETYKAGTVSNPKDILW. It shares ca. 35% sequence identity with Leucocin A, a class IIa bacteriocin. Modeling based on the 3-D of Leucocin A shows three beta strands located in the N-terminal region (Thr1-Tyr3, Val7-Asn10, Lys13-Ile16) and an alpha helical domain from Asp17 to Asn31. When plotted as an alpha-helical wheel, the central alpha-helix of MMFII does not exhibit an amphipathic helical structure. The synthetic MMFII (sMMFII), obtained by the solid-phase method, was shown to be indistinguishable from the natural peptide. sMMFII is active against Lactococcus cremoris and Listeria ivanovii bacteria, whereas no activity was detected for any of the synthetic N-terminal truncated MMFII analogs Cys9-Trp37, Trp15-Trp37, and Val18-Trp37.

Treatment of liver metastases with moderate peritoneal carcinomatosis by hepatectomy and cytoreductive surgery followed by immediate post-operative intraperitoneal chemotherapy: feasibility and preliminary results.

BACKGROUND/AIMS: Peritoneal carcinomatosis (PC) discovered during hepatectomy is usually a contraindication to resection. A potentially efficient treatment of PC is the resection of the macroscopic disease and the treatment of the residual microscopic disease with immediate post-operative intraperitoneal chemotherapy (IPIC) (before the entrapment of cancer cells inside the fibrin deposit which rapidly cover the injured tissues). Feasibility and survival results of this treatment, combined with major hepatectomy, have never been evaluated. The purpose of this study is to report tolerance and preliminary results in patients with liver metastases synchronous to moderate PC, treated with hepatectomy, complete cytoreductive surgery, and IPIC. METHODOLOGY: Twelve patients with liver metastases and moderate PC from miscellaneous origins, underwent: 1) hepatectomy (9 of them were major hepatectomies); 2) complete cytoreductive surgery of the PC resecting between 20 and 150 nodules; and, 3) IPIC, for 5 days, according to histology. RESULTS: There was no mortality. Morbidity was mainly due to four transient biliary leakages (33%) and there was no systemic complication due to the chemotherapy. After a median follow-up of 14.4 months, there was no detectable recurrence of the PC. Preliminary results concerning survival are promising with 7 patients without recurrent disease. CONCLUSIONS: When a minimal or moderate PC is discovered during laparotomy for liver resection of metastases, the combination of hepatectomy with complete cytoreductive surgery of the peritoneal disease, followed with IPIC is logical and feasible. This aggressive treatment is well tolerated although the frequency of biliary leakage seems to be higher than that after standard hepatectomy. No recurrence of the peritoneal disease was detected and survival results are very promising.

[Esophagectomy for epidermoid cancer discovered during evaluation of ENT cancer]. / Oesophagectomie pour cancer épidermoïde découvert lors du bilan d'un cancer ORL.

UNLABELLED: The treatment of synchronous esophageal and head and neck carcinomas is difficult. MATERIAL AND METHOD: Retrospective study of 33 patients treated with esophagectomy for an intrathoracic squamous cells carcinoma discovered during pan-endoscopy for a synchronous head and neck cancer. RESULTS: In 7 cases (21%) it was advanced (pT3-4) esophageal cancers. The hospital mortality was 9%. Five year survival was 18% without stabilization of the survival curve, 60% of patients died of recurrence of tumor. CONCLUSION: Esophagectomy is suitable for usT1-2 tumors if surgery is also indicated for the head and neck tumor. Radiochemotherapy is indicated for advanced usT3-4 esophageal tumors or when the treatment of the head and neck tumor is not surgery.