Interest of Thin Skin Flaps in the Treatment of Postburn Cervical Contractures: About Five Cases.

OBJECTIVES: The use of thin skin flaps in the reconstruction of postburn cervical contractures associated with functional impacts. MATERIAL AND METHODS: We conducted a descriptive observational study on about five patients who had reconstruction of postburn cervical contractures using various thin skin flaps in a plastic surgery department. The follow-up period was ranged from 12 to 18 months. We determined the characteristics of the retraction according to the Vandenbussche classification, the indications of the flaps, and the functional and aesthetic results. RESULTS: Most of our patients were young adults presenting segmental retraction of the neck associated with moderate functional impact. The occipito-cervico-dorsal flap was used in three cases. The occipito-cervico-shoulder flap was used in two cases. The aesthetic and functional results were satisfactory for all patients, but a "neck-collar" aspect of the cervical-chin angle was noticed. CONCLUSION: Postburn cervical contractures remain frequent. Their reconstruction is a difficult process as it is ideally done with a skin similar to the original one. The use of thin skin flaps seems to be an excellent option.

[Benign tumors of the soft tissue of the hand, about 70 cases]. / Les tumeurs bénignes des parties molles de la main, étude clinique à propos de 70 cas.

Through a retrospective study of 70 cases of benign soft tissue tumors in the orthopedic traumatology department of the military hospital of Tunis over a 12-year period from January 2005 to December 2016, we have compared our findings to those of the literature in an attempt to identify epidemiological notions relevant to daily medical practice as epidemiological data on benign tumors of the soft parts of the hand remain few and sometimes discordant. The authors report a series of 70 active, young adults, mostly female, with a swelling at the level of the hand as the most common reason for consultation. The middle finger and index finger were the most affected fingers at equal frequencies. The key supplementary examination was the ultrasound of the soft parts. All patients were treated with a complete surgical biopsy of their tumor followed by a histological study of the surgical specimen. Three cases of recidivism were noted. Through this study, the frequency of tumors of the soft parts of the hand in a particular population (Tunisian military agents) is emphasized. Moreover, this study allowed us to confirm the data of the literature concerning the dominance of the digital localization. On the other hand, this study reports that the giant cell tumor is the most common histological type in the study population.

Geotrichum capitatum septicemia: case report and review of the literature.

Geotrichum capitatum is an uncommon cause of invasive infections in immunocompromised patients, particularly those with hematological malignancies and severe neutropenia. The aim of this study was to report the cases of invasive geotrichosis in our hospital. It is a retrospective study of invasive geotrichosis diagnosed in the Laboratory of Parasitology-Mycology of the UH Habib Bourguiba, Sfax, from January 2005 to August 2013. Six cases of invasive Geotrichum infections were diagnosed. There were three men and three women. The mean age was 35 years. Five patients have acute myeloid leukemia with a profound neutropenia, and one patient was hospitalized in the intensive care unit for polytraumatism. Clinically, the prolonged fever associated with pulmonary symptoms was the predominant symptom (n = 5). Geotrichum capitatum was isolated in one or more blood culture. Two patients had urinary tract infections documented by multiple urine cultures positive for G. capitatum. Five patients received conventional amphotericin B alone or associated with voriconazole. The outcome was fatal in four cases. Invasive geotrichosis is rare, but particularly fatal in immunocompromised patients. Approximately, 186 cases have been reported in the literature. The prognostic is poor with mortality over 50 %. So, early diagnosis and appropriate management are necessary to improve prognosis.

[Creation and report of the Tunisian Fanconi Anemia Registry (TFAR)]. / Création et rapport du registre tunisien de l'anémie de Fanconi (TFAR).

INTRODUCTION: Fanconi anemia (FA) is a genetically and phenotypically heterogeneous inherited disease. Many groups have established FA registries. In Tunisia, in collaboration with the Tunisian Fanconi Anemia Study Group (TFASG), we set up the Tunisian Fanconi Anemia Registry (TFAR). PATIENTS AND METHODS: We contacted all hematology and pediatrics departments to include their FA patients diagnosed between January 1983 and December 2008. The registry is available on the TFASG web site (www.fanconi-tunisie.net). RESULTS: Sorting the files brought out 142 patients belonging to 118 families. The mean age at diagnosis was 11 years. There was consanguinity in 86%, malformative syndrome in 91%, and pancytopenia at diagnosis in 69%. Of 28 patients, 95% belonged to the FANCA group. Androgen treatment was given in 109 cases and genoidentical bone marrow transplantation (BMT) in 27 patients. The diagnosis of a myelodysplastic syndrome was retained in 4%, acute leukemia in 6%, and a solid tumor in 2%. The median overall survival time in all patients is 17 years 5 months; it is significantly better in patients having received allografts (p=0.01). CONCLUSION: FA seems frequent in Tunisia, which is in part explained by the high consanguinity and endogamy in this country. Hematologic impairment is still the most frequent revealing circumstance of the disease. It is often severe or moderate and requires androgen treatment or bone marrow transplantation. BMT should be proposed to all patients with an HLA-compatible donor.

Clinical utility and prognostic value of galactomannan in neutropenic patients with invasive aspergillosis.

UNLABELLED: Invasive aspergillosis (IA) is a major cause of morbidity and mortality in profoundly neutropenic patients. Delayed diagnosis and therapy may lead to poor outcomes. AIMS: The objective of this study was to assess the performance characteristics of the galactomannan (GM) assay in serum and bronchoalveolar lavage specimens for the diagnosis of IA in neutropenic patients with hematological malignancies. We also evaluated the prognostic outcome. PATIENTS AND METHODS: A total of 1198 serum samples and 42 BAL from 235 neutropenic patients were tested with a GM elisa platelia test. We used Cox modeling of time to 6- and 12-week mortality for GM level at the time of diagnosis (GM0) and GM decay in the week following diagnosis in proven and probable IA patients with more than two GM values. RESULTS: There were three proven, 55 probable, and four possible cases of IA. The sensitivity and specificity of the GM test were 96.8% and 82.4% respectively. In BAL samples, sensitivity was 86% and the specificity 93%. BAL GM was more sensitive than microscopy (22.2%) and BAL culture (38.9%). Among patients with proven/probable IA, serum and BAL GM were in agreement for 92.8% of paired samples. The hazard ratio (HR) of GM0 and 1-week GM decay per unit increase in Aspergillus enzyme immunoassay (EIA) was 1.044 (95% CI, 0.738 to 1.476) and 0.709 (95% CI, 0.236 to 2.130) respectively. CONCLUSION: We found good correlation between the GM0 and GM decay combination and outcome of IA patients. The GM is a useful tool for diagnosis and monitoring of IA.

[Isolated extramedullary adnexal relapse of acute lymphoblastic leukemia: a case report]. / Rechute extramédullaire annexielle isolée d'une leucémie aiguë lymphoblastique : à propos d'un cas.

The occurrence of an isolated ovarian or pelvic relapse of acute lymphoblastic leukemia (ALL) in complete remission after chemotherapy has rarely been described. We report the case of a 12-year-old girl, treated for ALL, who developed an isolated left ovarian and fallopian tube localization without medullary or blood relapse 4 years after the end of the initial treatment. She presented with an isolated pelvic mass. The diagnosis was established by a CT-guided biopsy. The treatment consisted of a second course of chemotherapy and complementary surgery; a second complete remission was obtained.

[Molecular analysis of crossing-over in the CMH in two Tunisian families with aplastic bone marrow]. / Analyses moléculaires de recombinaisons localisées au niveau du CMH dans deux familles tunisiennes.

In order to select compatible human leucocytes antigens (HLA) donors for bone marrow graft, all the members of 76 families were typed by serology for HLA class I (A and B locus) and class II (DR, DQ locus) by polymerase chain-reaction-sequence-specific primes (PCR-SSP). The HLA typing interpretation revealed the existence of crossing-over in major histocompatibility (CMH) regions for two families, AB and AT, with aplastic bone marrow. The study of crossing-over site has needed the genotyping of seven short tandem repeat (STR) markers located on the short arm of chromosome 6 (D6S291, D6S273, TNFa, C1.2.C, C3.2.11, D6S265, D6S276), using ABI Prism 310 sequencer. HLA and STR Haplotypic analysis enabled us to confirm the crossing-over between locus B and DR in AB family and between locus A and B in AT family. Based in this study, we recommend to be careful in the interpretation of the results of HLA typing between donors and recipients of bone marrow. Complementary investigations should be accomplished for studying genetic abnormalities, which would be involved in this pathology.

[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.

[Evaluation of a prospective therapeutic protocol in adult patients with nonsevere aplastic anemia in South Tunisia]. / Evaluation d'un protocole thérapeutique prospectif des aplasies médullaires acquises non sévères de l'adulte dans le Sud tunisien.

INTRODUCTION: Immunosuppressive drugs are usually used in the treatment of acquired aplastic anemia (AAA). The aim of this study was to evaluate the efficiency of a prospective therapeutic protocol using cyclosporine and androgens in the treatment of adult patients with nonsevere AAA. METHODS: Twenty-nine patients diagnosed and treated at the University Hospital of Sfax (Tunisia), during a 10-year period (1991-2000) were included. In addition to symptomatic treatment (transfusion, antibiotics), all the patients received a specific treatment including two drugs: cyclosporine 5mg/kg per day and androgens 0,5mg/kg per day. RESULTS: The response rate at three, six and 12 months were 48, 75, and 87%, respectively. Survival rate was 52% at one year, and 37% at five and 10 years. The main toxicities were hepatic, renal, and hypertension, observed in 53, 16 and 15%, respectively. These toxicities were reversible in 65, 87 and 100% of the cases, respectively. CONCLUSION: The response and survival rates in our series are quite satisfactory when compared to those obtained with other immunosuppressive drugs (cyclosporine and antilymphocyte serum) in the literature. The addition of androgens in our patients seemed to potentiate the immunosuppression induced by ciclosporin, but secondary toxic effects were more common.

[Congenital factor XIII deficiency in the south of Tunisia]. / Déficit congénital en facteur XIII de la coagulation dans le sud tunisien.

Factor XIII deficiency is a rare autosomal recessive congenital disorder of haemostasis characterised by a plasmatic factor XIII level less than 1% in homozygote and bleeding as of the youth. We report a study about ten patients with congenital factor XIII deficiency from seven south-Tunisian families, there are seven females. Umbilical bleeding was common and only two patients had intracranial bleeding. The standard screening tests are normal. Factor XIII activity was less than 1% in all patients. A sub-unit A deficit was detected for the ten patients. Out hemorrhagic context, five patients receive regular prophylactic transfusion with fresh frozen plasma.

[Diagnostic and therapeutic aspects of lymphatic tuberculosis: apropos of 42 cases]. / Aspects diagnostique et therapeutique de la tuberculose ganglionnaire: à propos de 42 cas.

We report a retrospective study of 42 cases of lymph node tuberculosis. We noted symptoms of tuberculosis impregnation in 92%, cervical localization in 71%, positive tuberculin intra-dermo-reaction in 77%, and accelerated erythrocyte sedimentation rate in 73% of the cases. Koch bacillus was detected in expectoration, urine or gastric liquid at the rate of 11% of the cases. Lymph node function was suggestive in 4 out of 12 patients, showing giant cells with or without caseum. Lymph node biopsy, performed in 32 patients, was contributive in 94% of them. Another tuberculous localization was found in 14 cases mainly pulmonary (8 cases).