Pancreatic heterotopia in mesentery.

INTRODUCTION: The pancreatic heterotopia of fortuitous operational discovery remains rare because of the medical imagery progress. We report a mesenteric localisation of aberrant pancreas identified during the assumption of responsibility of an abdominal emergency. OBSERVATION: A 26-year-old man was allowed with the urgencies for an acute obstruction of the small bowel. Surgical exploration revealed a distal support an ileo-parietal adherence near to an inflammatory hearth of appendicular origin. We noted, in addition to the mesentery of the first jejunal loop, a bilobate mass of glandular-like tissue with a pancreatic aspect. The adjacent jejunal handles were macroscopically healthy. The Pathological examination of the mass confirmed the existence of a mixed glandular exocrine and endocrine origin of pancreatic tissue, type I of the Heinrich's classification. CONCLUSION: This rare topographic entity of fortuitous discovery underlines the need for a meticulous surgical exploration of the abdominal cavity particularly in urgency when a summarized radiological assessment does not permit a complete morphological study.

Historical biogeography of the North American glacier ice worm, Mesenchytraeus solifugus (Annelida: Oligochaeta: Enchytraeidae).

North American ice worms are the largest glacially-obligate metazoans, inhabiting coastal, temperate glaciers between southcentral Alaska and Oregon. We have collected ice worm specimens from 10 new populations, completing a broad survey throughout their geographic range. Phylogenetic analyses of 87 individuals using fragments of nuclear 18S rRNA, and mitochondrial 12S rRNA and cyctochrome c oxidase subunit 1 (CO1) identified 18 CO1 haplotypes with divergence values up to ~10%. Phylogeographic interpretations suggest a St. Elias Range, Alaskan ancestry from an aquatic mesenchytraeid oligochaete during the early-Pliocene. A gradual, northward expansion by active dispersal from the central St. Elias clade characterizes a northern clade that is confined to Alaska (with one exception on Vancouver Island, British Columbia), while a distinct southern clade representing worms from British Columbia, Washington and Oregon was likely founded by a passive dispersal event originating from a northern ancestor. The geographic boundary between central and southern clades coincides with an ice worm distribution gap located in southern Alaska, which appears to have restricted active gene flow throughout the species' evolutionary history.

[Nephrotic syndrom with focal and segmental glomerulosclerosis in Dakar: epidemiological and clinicopathological characteristics (about 134 cases)]. / Le syndrome néphrotique avec hyalinose segmentaire et focale a Dakar: aspects épidémiologiques et anatomocliniques (a propos de 134 cas).

Focal and segmental glomerulosclerosis (FSGS) is common and non-specific patterns of glomerular injury encountered in human renal biopsies. Cortico-resistant nephrotic syndrome is the main manifestation. We report epidemiological, clinical and pathological aspects of FSGS in Dakar. We report the results of a retrospective study about focal segmental glomerulosclerosis (FSGS) identified from 258 kidney biopsies performed in the medical clinic 1 of A. Le Dantec hospital from January 1993 to December 2003. FSG is found in 134 cases (52%), membranous glomerulonephritis in 32 cases (12,4%), minimal change disease in 20 cases (7.7%). Ninety eigths files were exploitable. FSGS has male gender predominance with a sex ratio of 3. Median age of patients is 28 years (15 and 79 years). Symptomatology is dominated by oedema in 86 cases (87,7%), hypertension in 12 cases (12.2%), hematuria in 5 cases (5.1%), nephrotic proteinuria in 65 cases (66,3%) and no nephrotic proteinuria in 33 cases (33.6%), renal failure in 25 cases (25%)and leucocyturia in 18 cases (18%). FSGS involving more than 50% of glomeruli is encountered in 41 cases (42%), severe interstitial fibrosis is associated in 26 cases. Different pathological aspects are: classical FSGS in 88 cases (88.7%), FSGS " collapsing" in 7 cases (7.1%), FSG "tip-lesion" in one case, FSGS associated to membranous glomerulosclerosis in 2 cases and to diabetic glomerulosclerosis in one case. FSGS is primitive in 88 cases (89,8%) and secondary in 10 cases (10.2%). FSGS is the most common primitive glomerulopathy in Dakar. Nephrotic syndrome is the main manifestation of this disease. Collapsing FSGS is not correlated with the HIV Infection.

[Undifferentiated Carcinoma of the Nasopharynx in Dakar, an Area Supposed to be Non-Endemic: about 13 Cases]. / Carcinomes indifférenciés du nasopharynx à Dakar, une zone supposée non endémique : à propos de 13 cas.

Undifferentiated carcinoma of the nasopharynx (UCNT) has variable incidence throughout the world. Senegal is supposed to be a non-endemic zone. There is a constant connection with the Epstein-Barr virus. In this work, the authors study and discuss the pathological aspects of undifferentiated carcinoma of the nasopharynx in 13 cases. They also seek to make the link between this cancer and the presence of an Epstein-Barr virus infection in these patients. This is a retrospective series of cases involving patients with UCNT, diagnosed on histological basis in Dakar and confirmed by immunohistochemistry. An EBV search was performed on these cases through in situ hybridization by the EBER probe. 15 cases diagnosed on histological basis were able to benefit from immunohistochemistry, and 13 cases were confirmed, ie 87%. The mean age was 28.37 years with extremes of 5 and 56 years. The male sex predominated, with a sex ratio of 8/3. The macroscopic lesions were of ulcerous-budding type for cases revealed by a mass of the cavum. The histological aspect resulted in a proliferation of atypical undifferentiated cells, with large, clear, strongly nucleated nuclei, with eosinophilic cytoplasm, scarcely abundant. The stroma was of the lymphoid type. In situ hybridization with the EBER probe showed moderate or intense diffuse scarring of the tumor cells for 10 cases, ie 77%. The number of cases noted in our study taking into account the period of 10 years considered, is indicative of the rare nature of this type of cancer in Dakar. While globally, Epstein-Barr Virus is consistently associated with UCNT, for some of our cases we have not been able to highlight EBV, suggesting the possible involvement of other risk factors, such as HPV.

Les auteurs étudient et discutent les aspects anatomopathologiques du carcinome indifférencié du nasopharynx (UCNT) au Sénégal à propos de 13 cas. Ils recherchent par ailleurs à faire le lien entre ce cancer et la présence d'une infection par le virus d'Epstein-Barr (EBV) chez ces patients. Il s'agit d'une série rétrospective de patients porteurs d'UCNT, diagnostiqués sur base histologique à Dakar sur 10 ans, et confirmés par l'immunohistochimie. Une recherche d'EBV a été effectuée sur ces cas en hybridation in situ par la sonde EBER. Quinze cas diagnostiqués sur base histologique ont pu bénéficier de l'immunohistochimie et 13 cas ont été confirmés, soit 87 %. L'âge moyen était de 28,37 ans avec des extrêmes de 5 et 56 ans. Le sexe masculin prédominait, avec un sex-ratio de 8/3. Les lésions macroscopiques étaient de type ulcéro-bourgeonnant pour les cas se révélant par une masse du cavum. L'aspect histologique se traduisait par une prolifération de cellules indifférenciées atypiques, aux noyaux volumineux, clairs, fortement nucléolés, aux cytoplasmes éosinophiles, peu abondants. Le stroma était de type lymphoïde. L'hybridation in situ avec la sonde EBER montrait un marquage diffus modéré ou intense des cellules tumorales pour 10 cas, soit 77 %. Le nombre de cas notés dans notre étude, tenant compte de la période de 10 ans considérée, est révélateur du caractère rare de ce type de cancer à Dakar. Si à l'échelle mondiale, le virus d'Epstein-Barr est constamment associé à l'UCNT, pour certains de nos cas nous n'avons pas pu mettre en évidence EBV, suggérant l'implication possible d'autres facteurs de risque, tel que le papillomavirus humain (HPV).

Discoveries about tubercolosis from autopsies: topographical and morphological profiles of lesions in dakar (Senegal).

Tuberculosis is endemic in Senegal. It is rate of increase and high mortality rate make it a major public health problem. The aim of this study was to describe the topographic, macroscopic, and microscopic aspects of tuberculosis lesions responsible for deaths in Dakar. This is a retrospective study of 158 autopsy reports, collected over 10 years, of deaths due to tuberculosis. The diagnosis of tuberculosis was essentially macroscopic; only equivocal cases had histological analysis. The average age at death was 47 years, and nearly all patients were men (all but 5). The largest percentage of deaths were in the 56-60 year old age group (21.6%, n = 34). Cachexia (70.3%), pallor (44.3%), and hemoptysis (20.9%) were found in the external examination of these corpses. Autopsy of the viscera showed pulmonary disease in 98.7% of cases (n = 156), both bilateral and extensive. Renal and pericardial disease were rare, found in respectively 3.8% and 2.5% of cases. Macroscopic aspects of tuberculosis were various and often related. Miliary tuberculosis (81%), small nodule tuberculosis (76.6%), and tuberculomas (62%) were the lesions most commonly encountered. Histologic analysis showed these lesions were of different ages. Tubercles (Koster follicles) were found consistently. Caseous necrosis was pathognomonic. Tuberculosis remains a deadly disease in Dakar, it mainly affects men and older individuals.

[Pathological profiles of retinoblastoma in Senegal]. / Aspects anatomopathologiques du rétinoblastome au Sénégal.

OBJECTIVES: Describe the macroscopic and microscopic profiles of retinoblastoma (RB) in Senegal and correlate histological criteria with progression to establish severity factors. METHODOLOGY: We realized a retrospective study over 10 years (January 2005-December 2014). Only patients (n=67) who underwent histological analysis of the enucleation specimen (n=68) were followed until the end of the study. RESULTS: The tumor measured an average of 3.8cm (2/4.5). Endophytic tumor development was observed in 55 cases (80.8%), exophytic in 6 cases (8.9%) and mixed in 7 cases (10.3%). Retinal detachment was present in 13 cases (19.2%). The RB was well differentiated in 11 cases (16.2%), moderately differentiated in 31 cases (45.6%) and undifferentiated in 26 cases. Optic nerve (ON) invasion was present in 18 cases (26.5%). The tumor was extraretinal in 37 cases (54.4%). The anterior chamber was invaded in 6 cases (8.8%). The global survival at 2 years was 84% and 70% at 5 years. On multivariate analysis, well differentiated tumors and stage pT1 were associated with remission. Retrolaminar ON invasion, massive choroidal invasion and stage pT3 were risk factors for recurrence. Poor tumor differentiation, invasion of the ON resection margin, tumor invasion through the sclera, and stage pT4 were predictive of death. CONCLUSION: The pathologist is a principal actor in the management of RB because his account guide the post-surgical management strategy.

[Human papilloma viruses: other risk factor of head and neck carcinoma]. / Les papillomavirus humains : un autre facteur de risque des carcinomes des voies aérodigestives supérieures.

Head and neck carcinoma (HNC) occupy the sixth place as the most frequent type of cancer worldwide. Next to alcohol and tobacco intoxication, other risk factors (RF) are suspected, including the human papilloma viruses (HPVs). The aim of this study was to highlight the prevalence of HPVs and histo-epidemiological characteristics of HNC HPV+ in Senegal. This is a prospective, multicenter preliminary study of 18 months (January 1, 2012-June 30, 2014). The cases of HNC histologically confirmed in Senegal were then sent to the bio-pathology department of the Curie Institute in Paris to search HPVs. In the 90 included cases, the PCR technique was successful in 54 cases (60%). HPVs were found in seven cases, that is, a prevalence of 13%. HPVs were associated with 5 cases of hypopharyngeal carcinoma and 2 cases of carcinoma of the oral cavity. Patients with HNC HPV+ had a median age of 42 years against 49 years for HPV-patients. Three patients (42.8%) with HPV+ carcinomas were smokers. Of the 47 HPV-patients, 40 patients (87.1%) had alcohol intoxication and/or smoking. The concept of oral sex was refuted by all our patients. Squamous cell carcinoma was the only histological type found. HPV+ cell carcinoma showed no specific histological appearance. HPVs are another certain RF of HNC in Senegal. The major therapeutic and prognostic impact of HPVinduced cancers requires the systematic search of the viruses by the PCR technique.

Hormone replacement therapy. Knowledge, attitudes and practices of women attending a gynaecology outpatient clinic in Trinidad.

A questionnaire was used to assess the knowledge, attitudes, and practices of a sample of 218 outpatients attending the Port of Spain General Hospital Gynaecology Outpatient Clinic. The questionnaire investigated women's knowledge of menopause, risks and benefits of Hormone Replacement Therapy (HRT), their attitudes concerning HRT and menopause as well as practices of postmenopausal women with respect to HRT. Comparisons were made between women of differing menopausal status, educational background and ethnicity. The results showed that overall knowledge was lacking regardless of menopausal status, ethnicity or educational background. Less educated women were more inclined to believe that HRT was inappropriate principally because they regarded the menopause as a natural process (p = 0.023). Only 24% of postmenopausal women were practicing some form of HRT. A minority (7%) had previously been undergoing the therapy but had stopped. Most postmenopausal women (69%) simply never considered treatment because the majority had never heard about HRT. The main source of patient information was from the clinic they were attending. This study reveals low awareness of menopausal information and therapeutic options in a Trinidadian population. A targeted education programme may substantially fill this void.

Dental imaging centers.

Dedicated dental imaging centers have been providing valuable imaging services to the dental community for many years. The centers feature specialized and sophisticated imaging equipment and highly trained personnel and provide photographic and radiographic services for the community. This article discusses selected sophisticated imaging equipment found in dental imaging centers and discusses current and anticipated future services provided by the centers. These future services include the construction of patient-specific interactive three-dimensional models to be used for diagnosis, treatment planning, treatment simulations, communication, and evaluation of treatment outcomes.

[Tuberculoid leprosy revealed by active ulcerative colitis: a case report]. / Une rectocolite hémorragique révélant une lèpre tuberculoïde.

Leprosy is endemic in Senegal. In 2011, there were 73 new cases reported in Dakar. The circumstances of discovery are often dermatologic or neurologic. Few case reports describe an association with chronic inflammatory colitis, probably fortuitous. We report the case of a 30-year-old woman who had a tuberculoid leprosy revealed by active ulcerative colitis. Treatment according to the WHO protocol of leprosy, combined with corticosteroids and then methotrexate, resulted in healing of the leprosy and remission of the colitis.

SU-F-BRCD-06: Multiple Anatomy Optimization of Accumulated Dose.

PURPOSE: Multiple anatomy optimization (MAO) utilizing deformable dose accumulation on entire 4DCT data sets is implemented to overcome ambiguity between optimal dose defined on a single anatomy and optimal accumulated dose resulting from dose delivery to moving and deforming anatomy. METHODS: Six lung cancer patients are planned using two methods of radiotherapy optimization: the internal target volume (ITV) envelope method and MAO, which simultaneously optimizes a single fluence for delivery to all 10 breathing phases such that the accumulated dose satisfies the plan objectives. Target dose is constrained to 70 Gy. The ITV-plan is optimized on a single breathing phase with the planning target volume defined as the ITV; the MAO target is the moving CTV. MAO is compared to single image ITV optimization based on the accumulated dose assuming equal monitor-units to each phase. Dose-volume differences between single image estimations and 10-image accumulation are examined. RESULTS: Single image optimal dose distributions overestimate target V70 by 4.2%±3.1% (average, one standard deviation) and in five of six cases ipsilateral lung V20 is underestimated (1.4%±0.9%). For these five cases, MAO increases V70 by 2.8%±2.5% (maximum of 6% increase in V70) and reduces ipsilateral lung V20 by up to 3% (average decrease of 1.2%±1.3%). Contralateral lung V20, esophagus V25, and heart V30 are also reduced by up to 5%, 3%, and 3%. For the sixth case, lung tumor motion is on the order of the dose voxel size (3mm), and MAO did not improve upon the ITV plan. CONCLUSIONS: Dose-volume optimization on a stationary image does not ensure accumulated dose coverage to the moving CTV. Multiple anatomy optimization can remove dose ambiguity and improve plan quality. P01CA11602 and Philips Medical Systems.

Adherence to an antibiotic policy and sensitivity testing recommended for rational antibiotic prescribing in a tertiary care institute in Trinidad - Poster abstract

OBJECTIVE: To determine the use of antimicrobials in inpatients at the Eric Williams Medical Sciences Complex (EWMSC), Trinidad. DESIGN AND METHODS: Adult and paediatric patients admitted to the general medical and surgical wards for at least 1 week and receiving antibiotics for at least 3 consecutive days during the period January 1 to March 15, 1999 were eligible for study. Patient data collected included demography, concomitant therapy and length of stay. The details of dosing and relevant clinical history were noted from treatment charts and from interviews of the physicians where indicated. RESULTS: Of 967 patients who were admitted to the hospital during the study period, 83 were eligible for the study. Of the 158 courses of antibiotics that were prescribed, 81 (51.3 percent were for therapeutic intervention and 77 ( 48.7 percent) were for prophylaxis. Sixty-five percent (65 percent) of courses were combination therapy and only only 35 percent involved a single agent. The á-lactams were the most frequently prescribed class of antimicrobial drugs (70.3 percent). None of the 11 resident doctors who were interviewed knew of the hospital's antibiotic policy. CONCLUSIONS: Antimicrobial prescribing was nearly always empirical, the hospital's antibiotic policy was not adhered to and the laboratory was not used as a tool to facilitate antimicrobial prescribing. The Pharmacy Services at the institution should play a more active role in monitoring compliance with the hospital's Antibiotic Policy.(Au)

Hormone replacement therapy: a survey of knowledge, attitudes, and practices of women attending gynaecological out-patient clinics of the General Hospital, Port-of-Spain, Trinidad

A questionnaire was used to assess the knowledge, attitudes and practices of a consecutive sample of 218 out-patients, aged 30 to 65 years, attending the Gynaecological Out-patient Clinic of the General Hospital, Port-of-Spain over 15 clinic days. Two-thirds of the sample were premenopausal and the rest were postmenopausal. A structured questionnaire was administered to collect data on demographics and menopausal status, knowledge of menopause, risks and benefits of hormone replacement therapy (HRT), attitudes concerning HRT and menopause and practices of postmenopausal women with respect to HRT. Data were analyzed by the F-test or X test. Comparisons were made between women of differing menopausal status, educational background and ethnicity, The results showed that 92 percent of the sample had "some" or "little" knowledge and this was true regardless of menopausal status, ethnicity or educational background. The less educated women, compared with women of higher education, were inclined to believe that natural methods were more appropriated than HRT for menopausal management (p=0.023). Only 24 percent of the postmenopausal women were practising some form of HRT while 7 percent who had previously received HRT had stopped. Most of the postmenopausal women (69 percent) had never replaced their hormones simply because they had never considered the treatment. Most women (>90 percent) had never heard about HRT.(AU)

Hormone replacement therapy - knowledge, attitudes and practices of women attending a gynaecology outpatient clinic in Trinidad

A questionnaire was used to assess the knowledge, attitudes and practices of a sample of 218 outpatients attending the Port of Spain General Hospital Gynaec Outpatient Clinic. The questionnaire investigated women's knowledge of menopause, risks and benefits of Hormone Replacement Therapy (HRT), their attitudes concerning HRT and menopause as well as practices of postmenopausal women with respect to HRT. Comparisons were made between women of differing menopausal status, educational background and ethnicity. The results showed that overall knowledge was lacking regardless of menopausal status, ethnicity or educational background. Less educated women were more inclined to believe that HRT was inappropriate prinicpally because they regarded the menopause as a natural process (p = 0.023). Only 24 percent of postmenopausal women were practicing some from of HRT. A minority (7 percent) had previously been undergoing the therapy but had stopped. Most postmenopausal women (69 percent) simply never considered treatment because the majority had never heard about HRT. The main source of patient information was from the clinic they were attending. This study reveals low awareness of menopausal information and therapeutic options in a Trinidadian population. A targeted education programme may substantially fill this void.(Au)

Hormone replacement therapy. Knowledge, attitudes and practices of women attending a gynaecology outpatient clinic in Trinidad

A questionnaire was used to assess the knowledge, attitudes, and practices of a sample of 218 outpatients attending the Port of Spain General Hospital Gynaecology Outpatient Clinic. The questionnaire investigated women's knowledge of menopause, risks and benefits of Hormone Replacement Therapy (HRT), their attitudes concerning HRT and menopause as well as practices of postmenopausal women with respect to HRT. Comparisons were made between women of differing menopausal status, educational background and ethnicity. The results showed that overall knowledge was lacking regardless of menopausal status, ethnicity or educational background. Less educated women were more inclined to believe that HRT was inappropriate principally because they regarded the menopause as a natural process (p = 0.023). Only 24 of postmenopausal women were practicing some form of HRT. A minority (7) had previously been undergoing the therapy but had stopped. Most postmenopausal women (69) simply never considered treatment because the majority had never heard about HRT. The main source of patient information was from the clinic they were attending. This study reveals low awareness of menopausal information and therapeutic options in a Trinidadian population. A targeted education programme may substantially fill this void.