[Management of scrotal cysts usingCO2 laser: Two cases and a literature review]. / Traitement des kystes épidermoïdes du scrotum par laser CO2 : deux cas et revue de la littérature.

BACKGROUND: Epidermal cyst is a common cutaneous lesion that may be located in the scrotum and is seen especially in young and middle-aged men. This entity is not only chronic but can also affect the patient's appearance, thus having an impact on their quality of life. Surgical excision is the classical procedure to remove such cysts, but it can be time-consuming and leave unpleasant scars. In this report, we included patients with scrotal cysts treated with the CO2 laser. PATIENTS AND METHODS: This study reports on two patients referred with epidermal scrotal cysts in whom CO2 laser was used in superpulse mode at 10 to 10.8W and with a pulse duration of 20ms. The session was performed after local anesthesia with lidocaine. One to two 10-minute sessions were required to treat all cysts. All the patients were satisfied with the cosmetic results and no complications or recurrences were observed at follow-up. We also treated a patient with a single scrotal cyst in the same way, with excellent results. DISCUSSION: A literature review was performed using the Medline database. It revealed only two case reports involving scrotal cysts treated with laser using Nd-YAG laser and Diode Laser. There is no reported use of CO2 laser in the treatment of scrotal cysts. Its use in superpulsed mode in the cases we describe is innovative. This procedure appears to be a safe, tolerable, and efficacious approach for the removal of epidermal scrotal cysts resulting in excellent cosmetic results and without recurrence.

[Male sexuality after external continent urinary diversion type Mitrofanoff]. / Étude de la sexualité masculine après dérivation urinaire externe continente de type Mitrofanoff.

OBJECTIVE: To evaluate the influence of continent external urinary diversion type Mitrofanoff on male sexuality. MATERIAL AND METHODS: Between 1992 and 2011, 140 patients underwent continent urinary diversion type Mitrofanoff at an academic hospital. Among 76 men, 46 were interviewed about their sexuality after this operation. This study was performed using a set of validated questionnaires (IIEF, DAN PSS and Urolife), grouped by the model of the CTMH. Patients were divided according to their marital status: group 1: patients married before surgery (15 cases), group 2: patients married after surgery (7 cases) and group 3: singles (24 cases). RESULTS: In the first group, the functional dimension of sexuality was positive with an overall score of 81%, the sexual discomfort score was assessed at 26 % and the sexual satisfaction score was 77%. In the second group, sexual function was considered conserved in all cases with a satisfaction score estimated at 98%. These patients reported a feeling of well-being following the disappearance of urinary incontinence with integrity of their body images. In contrast, in the last group, relatively impaired sexual function was noted (65%) with a satisfaction score estimated at 59%. These disorders were multifactorial, mainly related to neurological causal pathology. CONCLUSION: To our knowledge, this is the first study about male sexuality in patients with a continent urinary diversion type Mitrofanoff. Marital status has a major role in the sexuality of these patients. A prospective study with pre- and postoperative evaluation will better clarify the factors affecting sexuality in these patients.

[Treatment of keloid with phenol: a new therapy]. / La phénolisation: un nouveau traitement des chéloïdes.

PURPOSE: Evaluation of a new treatment for keloid scars using a 40% phenol solution in accordance with a predefined protocol. PATIENTS AND METHODS: A retrospective study was made of the files of 25 patients treated with phenol from June 2010 to March 2012. RESULTS: The keloids were located predominantly on the trunk (48%) and upper extremities (34%). The total number of keloids was 52, with a median size of 11.16 cm(2). Phenol was the sole and first-line treatment in 40% of cases. Patient adherence to the protocol of phenol was noted in 81% of cases. The mean number of phenol sessions was 14.2. Seventy-two percent of patients were satisfied with the treatment. Mean regression in keloid size of 75.5% was noted. A change in local keloid pigmentation was observed in 75% of patients. Local adverse reactions (itching, infection, ulceration) were seen in 6 patients (28.6%). No cases of systemic signs of phenol were observed. After mean follow-up of 12.8 months, no recurrence of keloids was noted. CONCLUSION: Use of phenols in the topical treatment of keloids appears valuable since it is easy to apply and provides good results with few side effects.

46,XX male syndrome with mullerianosis of the urinary bladder: A new clinical entity.

Müllerianosis of the urinary bladder is a rare entity characterized by the presence of an admixture of at least two types of müllerian tissue in the muscularis propria of the bladder. We report the case of a 43-year-old male patient presented for urological evaluation due to episodes of total gross hematuria. Physical examination revealed ambiguous external genitalia. Abdomiopelvic CT scan revealed a tumor at the level of the bladder floor. Transurethral resection of the bladder lesions was done and histopathological studie confirmed the diagnosis of müllerianosis. Karyotype analysis showed a 46 XX male syndrome.

[Impetigo herpetiformis (two cases)]. / L'impétigo herpétiforme (deux cas).

UNLABELLED: The hepetiformis impetigo is a pustulosis dermatosis. It is rare and specific to pregnancy. It can menace the prognostic of the mother and the child. This entity is actually considered as a pustulor psoriasis. We report two cases. CASES REPORTS: Two patients, respectively, aged 24 and 21, presented erythematous, pustular and extensive plaques for which the diagnosis of hepetiformis impetigo was clinically and histologically posed. For the first patient, the lesions appeared in the two pregnancies and were more severe and foetal repercussions (oligoamnios and hypotrophy) during the second pregnancy. For the second patient, the pregnancy was complicated with premature interruption of the membrane, giving birth to a deed fetus and causing an aggravation of the cutaneous lesions. The treatment was oral steroid followed by acitretin for the first patient, however, for the second patient; the treatment was by local steroid associated with UVB during the pregnancy. Then, acitrétine was used and was efficient. CONCLUSION: Our two cases show the importance of gynaecological control in order to avoid complications which can be sometimes fatal. They also show the importance of local steroid associated with UVB which constitute another therapeutic alternative in the treatment of hepetiformis impetigo.

[Intramedullary pinning of diaphyseal fractures of both forearm bones in adults: 46 cases]. / Embrochage centromédullaire des fractures diaphysaires des deux os de l'avant-bras chez l'adulte.

PURPOSE OF THE STUDY: The goal when treating shaft fractures of the forearm bones is to obtain good bone healing with good preservation of upper limb function. We report a retrospective (1995-2004) consecutive series of patients aged 32 years on average (range 16 to 92 years) who presented 46 shaft fractures of both forearm bones. MATERIAL AND METHODS: Using Hackethal's classification by sixths, the fracture involved the 3rd and 4th sixth in 39 cases (84.7%) for the radius and 33 (71.7%) for the ulna. Seventeen (37%) patients were trauma victims with multiple injuries. Fourteen fractures (30.4%) were open and all fractures were treated: 11 stage I (23.9%), two stage II (4.3%) and one stage III (2.3%). Intramedullary pinning was used in all cases for the radius and the ulna. In 27 patients (58.6%) pinning was achieved without open access to the focus. Pin diameter was 2.5mm for 38 cases (82.6%). Self-controlled rehabilitation exercises were started immediately without complementary immobilization. Outcome was assessed in 41 patients with a mean follow-up of 18 months (range three months to seven years). RESULTS: Functional outcome, according to Tscherne and Oestern, was very good or good in 31 cases (75.5%). For 35 cases (85.4%) bone healing was achieved at mean 3.5 months for the radius and four months for the ulna. Retarded healing was noted in four cases (9.7%) for the ulna. For the 41 patients reviewed, 11 (26.8%) presented axial misalignment of one of the forearm bones with an angle strictly greater than 10 degrees for three. There were six patients with nonunion (14.6%), of both bones in two and one in four. Radioulnar synostosis was observed in four cases (9.7%). No infections or recurrent fractures were noted. DISCUSSION: The localization of the fracture line affected the outcome. Among the four cases with a fracture in the 5th sixth of the radius, two developed misalignment with an angle strictly greater than 10 degrees and one presented a secondary displacement which required revision on day 15 for plate-screw fixation of the radius. This might be due to the spreading corticals of the distal radius where pin stabilization would be less effective than for fractures in the 3rd or 4th sixths where the corticals run parallel. Outcome was less satisfactory when the fracture focus was opened. Four of the six nonunions and three of the four synostoses occurred among the 19 patients who had open pinning. This might be due to loss of the fracture hematoma. Analysis of the type of fixation has shown that our best results were obtained when we used a single 2.5 mm elastic pin. For the cases where we used a smaller pin (2 mm), we had three major misaligments, one nonunion involving both bones and one recurrent dislocation of the radial head. There were no infections or recurrent fractures in this series where the pin was removed in 27 patients (65.6%) at mean one year. CONCLUSION: Intramedullary pinning is an attractive alternative for the treatment of shaft fractures involving both forearm bones in adults. Best results are obtained if the fracture (situated outside the 5th sixth) can be stabilized without opening the focus with a single 2.5 mm pin. This method combines the advantages of closed osteosynthesis, that is, a simple nontraumatic procedure decreasing the risk of suppuration, and early return of function, limiting postoperative immobilization. It enables early sturdy bone healing with a low risk of recurrent fracture.

[Expression of c-kit in North African nasopharyngeal carcinomas: correlation with age and LMP1]. / Expression de c-kit dans les carcinomes nasopharyngés nord africains, corrélations avec l'âge et LMP1.

PURPOSE: To determine the level and prognostic significance of c-kit expression in the two age groups of North African nasopharyngeal carcinomas. PATIENTS AND METHODS: A retrospective study of 99 NPC specimens from Tunisian patients was investigated by immunohistochemistry. Immunohistochemical data were correlated with Epstein-Barr virus LMP1 expression and pathological, clinical and survival parameters. RESULTS: c-kit was detected in 79% of the cases for patients under 30 years of age (juvenile form) but in only 56% of specimens in patients over 30 years (P=0.039) and was significantly over-expressed for patients with lymph node involvement (P=0.015). LMP1 score was 5.78 (+/-1.84) for c-kit negative tumors compared to 8,23 (+/-2.39) for c-kit positive tumors (P=0.002). Multivariate analysis including age, lymph nodes involvement and LMP1 expression as co-variables, showed that only age (P=0.027) and LMP1 expression (P=0.005) were significantly correlated to the c-kit expression. CONCLUSION: c-kit is highly expressed in the juvenile form of North African nasopharyngeal carcinomas. There is a significant association between LMP1 and c-kit expression. The contrasted levels of C-kit expression in the two age groups strengthen the hypothesis that these clinical forms result from distinct oncogenic mechanisms.

[Clinical polymorphism of cutaneous leishmaniasis in centre and south of Tunisia]. / Polymorphisme clinique de la leishmaniose cutanée du centre et sud tunisien.

The cutaneous leishmaniasis (CL) is an affection which is quite well known in Tunisia. The zoonotic cutaneous leishmaniasis caused by Leishmania major by far the more frequent, is endemo-epidemic in the centre and south of the country. It is characterized by clinical polymorphism. The aim of our study is to precise the different clinical aspects of the CL in our region through a prospective study of 102 cases. The average age was 37.8 years old (from 4 to 78 years old) with a slight female predominance. All of our cases lived or stayed in an endemic zone. Various clinical forms were noted in our series. The ulcerated and crusted form was predominant: 54,9% of the cases, the lupoid form was noted in 15.7% of the cases and the sporotrichoid form was observed in 18.6% of the cases. Other rare forms were noted (papular erysipeloid, verrucous, vegetant, erythematous, ulcerated, necrotic and linear) were noted in 25.5% of the cases. Our series is characterized by the multiplicity of clinical forms. Besides, the classical form (ulcerated and crusted form), other clinical form can be individualised: lupoid, loco regional spreading (sporotrichoid form, satellite papules). Some atypical forms can be found which are due to variation of host immune responses and to the strain of the parasites involved.

[Subacute cutaneous lupus erythematosus in childhood: a case report]. / Lupus érythémateux subaigu de l'enfant: à propos d'un cas.

Subacute cutaneous lupus erythematosus is extremely rare in childhood. We report the case of a 7 year-old girl who presented annular erythematous infiltrated lesions on sun exposed areas since the age of 2 months. Histopathologic examination showed orthohyperkeratosis, epidermal atrophy, widespread hydropic degeneration of epidermal basal cell layer, and a dermal lymphohistiocytic infiltrate. The lupus band test was negative. The immunological investigations (antinuclear antibodies) were negative. Treatment with antimalarials, topical steroids and sun protection allowed clearance of the cutaneous lesions. Lesions relapsed after antimalarials discontinuation and sun exposure. Four years later, at the age of 11, the antinuclear antibodies became positive. The diagnosis of subacute cutaneous lupus erythematosus is based on the clinical aspect of lesions, topography, histological finding, evolution and immunological profile of the patient.

[Myositis ossificans circumscripta: the contribution of imaging]. / La myosite ossifiante circonscrite: apport de l'imagerie.

OBJECTIVES: Illustrate the specific and nonspecific aspects of myositis ossificans circumscripta (MOC) in standard imaging, cross-sectional imaging (sonography, CT, and MRI), and bone scintigraphy. PATIENTS AND METHODS: Eight patients presenting with MOC (three men and five women) were explored using standard radiography (eight cases), sonography (seven cases), scintigraphy (four cases), CT (six cases), and MRI (four cases). RESULTS: Standard x-rays and sonography of the soft tissue showed a well-defined mass containing calcifications in 75% of the cases. The CT scan diagnosed MOC in four cases, showing calcified masses separated from the adjacent bone by a clear radiotransparent border or afferent peripheral tumoral calcifications highly suggestive of MOC. MRI was nonspecific. Bone scintigraphy showed hyperfixation in the four cases imaged. CONCLUSION: Standard x-rays were useful to demonstrate the calcifications of MOC and to identify their relation with the subjacent bone. Sonography and bone scintigraphy were interesting in monitoring the lesion's maturation. In addition to early detection of calcifications, CT can precisely localize the lesion before surgical ablation. MRI is a very sensitive technique in detecting small lesions at an early stage, but it is nonspecific and does not remove the necessity of biopsy to eliminate the possibility of a malignant disease.

Neuroendocrine Testicular Tumors: A Systematic Review and Meta-Analysis.

PURPOSE: The purpose of this study is to study the main epidemiological, clinical, para clinical, pathological, therapeutic, and evolutionary features of patients with testicular neuroendocrine tumors (TNET). MATERIALS AND METHODS: Nine case series and sixteen case reports were identified by searching PubMed database and qualified for inclusion in this study. We added the data of one case treated in the department of urology in Habib Bourguiba Hospital in Sfax, to the published cases. RESULTS: A total of 132 cases were collected. Median age at diagnosis was 39 years old (range 10- 83 years). The most common presenting symptom was either a testicular mass or a swelling in 38.46% of cases. Carcinoid syndrome was documented in 10.60% of patients. The clinical examination revealed a palpable mass in 44.70% of patients. This mass was painless and firm in most cases. Serum tumor markers (ß-gonadotrophine chorionique humaine, α-feto protein, and lactate dehydrogenase) were within normal limits in all patients except in one case. Most testicular neuroendocrine tumors (76.52%) were primary and pure. The tumors were positive for chromogranin (100%), synaptophysin (100%) and cytokeratin (93.10%). Metastases were detected at time of diagnosis in eight cases (6.06%). The main treatment was radical orchiectomy performed in 127 patients (96.21%). The 5-year overall survival rate was 78.70% and the 5-year specific survival rate was 84.30%. CONCLUSION: The diagnosis of testicular carcinoids is based on the immunohistochemistry study. The treatment of choice for these tumors is radical orchiectomy. Somatostatin analogues were reported to be effective in patients with carcinoid syndrome.

[Radiographic diagnosis of dislocated inverted shoulder prosthesis: two cases of unrecognized dislocation]. / Diagnostic radiologique des luxations de prothèse d'épaule inversée: à propos de 2 luxations passées inaperçues.

Dislocation of inverted shoulder prostheses are rarely described in the literature. Diagnosis is relatively difficult as illustrated by two cases reported here which went unrecognized. The problem is the absence of any clear clinical sign of dislocation and the rather difficult interpretation of the radiographic images. We propose a method for analyzing the radiographic images which can be used to confirm the absence of dislocation on the AP view.

[Screw fracture after sliding hip screw fixation of an intertrochanteric fracture]. / Fracture de la vis cervicale d'une vis-plaque à glissement. A propos d'un cas à 1, 5 an de recul.

Although no cases have been reported to date, fracture of a sliding hip screw on a screw-plate fixation is a real entity since material watch registries have revealed two non-published cases. We report an illustrative case. A 67-year-old man was hospitalized for a right intertrochanteric fracture. The patient was treated with a sliding hip screw plate fixation (short cannon, 105 mm screw). On the eighth postoperative day, fracture impaction was present with complete loss of impaction reserve associated with secondary discrete divergence in the cannon-screw alignment. Weight-bearing was postponed until the 45th postoperative day. At three months, bone healing had not been achieved. A clear image was also visible at the plate end of the cannon. The patient complained of persistent pain but there were no signs of infection. At the fifth month, the patient fell from the standing position and standard x-rays visualized the nonunion of the intertrochanteric fracture plus a infratrochanteric diaphyseal fracture line in addition to a fracture of the sliding hip screw. The plate screws were intact. The patient underwent revision osteosynthesis with a Medoff plate. Fracture of a sliding hip screw is a rare event. In the present case, the mechanism involved an insufficient impaction reserve and use of a short cannon. Treatment requires extraction of the distal fragment of the screw and a new cemented osteosynthesis.

[Biermer disease disclosed by mucous ulcerations]. / Le cas clinique du mois. Ulcérations muqueuses révélatrices d'une anémie de Biermer.

Pernicious anemia rarely induces mucous membranes lesions, wich, exceptionally reveal the disease. We report a case of a 64-year-old man who presented a clinical history of recurrent painful ulcerations of the buccal, genital and ocular muosa. He also had peripheral sensory nerve impairement of the legs. The diagnosis of pernicious anemia was made after a 19 year course. Cobalamin supplementation induced an improvement of the mucous membrane lesions and of the anemia, but recurence occurred each time the treatment was stopped. Our observation is particular by the multiple mucous membrane involvement revealing pernicious anemia and by the ocular lesions which had never been previously reported.