[Primary neuroendocrine tumors of the breast: a retrospective study of 21 cases and literature review]. / Tumeurs neuroendocrines primitives du sein: étude rétrospective de 21 cas et revue de la littérature.

PURPOSE: The aim of the present study was to discuss the epidemiology, clinical and pathologic features, treatment, and prognosis of primary neuroendocrine carcinomas of the breast. PATIENTS AND METHODS: We report 21 cases diagnosed over a period of 12 years (1995-2011) at the university hospital of Sfax. A review of the clinical data with pathology and immunohistochemistry study was carried out for all the cases. RESULTS: The average age was 62 years (34-86 years). At the time of the diagnosis, tumours were classified T1 and T2 (16 cases), N1 (11 cases) and M1 in two cases. The histological examination has shown 13 cases of solid neuroendocrine carcinoma, six cases of large cell type and two cases of atypical carcinoid. Grade I and II SBR were found in 18 cases. Eighty-one percent of the tumours were reactive for synaptophysin; all tumours were positive for chromogranin. Thirteen (61.9%) tumours were estrogen receptor-positive and 12 (57.5%) progesterone receptor-positive. Nineteen (90.5%) tumours were negative for HER2/neu. Overall five-year survival was 72.7%. All patients had surgical treatment with modified radical mastectomy in 13 cases. Adjuvant treatment was indicated according to histopronostic elements. CONCLUSION: For primary neuroendocrine carcinoma of the breast, multivariate analysis identified three predictive factors for mortality: disease stage, histological grade and lymph node involvement.

[Sexuality of the couple during pregnancy stemming from a medically assisted procreation]. / Sexualité du couple lors de grossesse issue d'une procréation médicalement assistée.

OBJECTIVE: We studied the impact of pregnancy stemming from a medically assisted procreation on the sexuality of the couple. PATIENTS AND METHODS: Our study was forward-looking realized in the maternity of Sfax on duration of nine months. Its methodology is based on a questionnaire distributed to 40 women and on a review of the literature. RESULTS: Our patients continued to have a sexual activity during their pregnancy in the majority of the cases (at least 65% of the cases) but with a decrease of libido in 80% of the cases as well as a net decrease of the frequency of the sexual intercourse. DISCUSSION AND CONCLUSION: In front of these difficulties of the consequent sexual life noticed also in the literature, a psychological support of these couples is so recommended that a sexologic care adapted to the particular context of the medically assisted procreation countered justified.

[Peripartum cardiomyopathy: incidence, pathogenesis, diagnosis, treatment and prognosis]. / Myocardiopathie du péripartum : incidence, physiopathologie, manifestations cliniques, prise en charge thérapeutique et pronostic.

INTRODUCTION: Peripartum cardiomyopathy (PPCM) is a rare and life-threatening disease of unknown aetiology. The primary objective of this review was to analysed aetiopathogeneses, clinical presentation and diagnosis, as well as pharmacological, perioperative and intensive care management and prognosis of this pathology. METHODS: We undertook a systematic review of the literature using Medline, Google Scholar and PubMed searches. RESULTS: Unlike other parts of the world in which cardiomyopathy are rare, dilated cardiomyopathy is a major cause of heart failure throughout Africa. Its aetiopathogenesis is still poorly understood, but recent evidence supports inflammation, viral infection and autoimmunity as the leading causative hypotheses. This diagnosis should be limited to previously healthy women who present with congestive heart failure (CHF) and decreased left ventricular systolic function in the last month of pregnancy or within 5 months after delivery. Recently, introduction of echocardiography has made diagnosis of PPCM easier and more accurate. Conventional treatment consists of diuretics, vasodilators, and sometimes digoxin and anticoagulants, usually in combination. Patients who fail to recover may require inotropic therapy. In resistant cases, newer therapeutic modalities such as immunomodulation, immunoglobulin and immunosuppression may be considered. Prognosis is highly related to reversal of ventricular dysfunction. Compared to historically higher mortality rates, recent reports describe better outcome, probably because of advances in medical care. Based on current information, future pregnancy is usually not recommended in patients who fail to recover normal heart function. CONCLUSION: PPCM is a rare but serious form of cardiac failure affecting women in the last months of pregnancy or early puerperium. Its aetiopathogenesis is still poorly understood. Introduction of echocardiography has made diagnosis of PPCM easier and more accurate. Prognosis is highly related to reversal of ventricular dysfunction.

[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.

SERRS study of the DNA binding by Ru(II) tris-(Bipyridyl) complexes bearing one carboxylic group.

Surface enhanced resonance Raman scattering (SERRS) is shown to be a satisfying method to study the interaction between DNA and ruthenium complexes [Ru(bpy)(2)(Hcmbpy)][PF(6)](2), where Hcmbpy = 4-carboxy-4'-methyl-2,2'-bipyridine. Such metallic complexes are known for their fluorescence properties. To validate this spectroscopic approach we have checked that i) at a given lambda(ex), silver colloidal SERRS spectra of Ru complexes closely resemble resonance Raman spectra in aqueous solutions, intensity excepted, and ii) the DNA fragments are not altered when they are adsorbed on the Ag nanoparticles surface. This investigation shows that the intensity of the Ru complexes SERRS spectra is reduced in the presence of DNA, in particular for the specific bands assigned to the Hcmbpy ligand. This collapse demonstrates that the Ru complexes bind DNA through the Hcmbpy moiety, and intercalation is suggested as the binding mode. The DNA binding by the enantiopure Ru complexes (Delta or Lambda) is more efficient than by the racemic complexes.

Cobalt-Induced C-N and C-C Bond Formation via Metal-Stabilized alpha-CF(3) Carbenium Ion.

An alpha-CF(3)-carbenium ion stabilized by a bimetallic [Co-Co] cluster was prepared and isolated in good yield, starting from the corresponding alcohol by action of HBF(4)/Et(2)O. C-N and C-C bonds with nitrogen and carbon nucleophiles could be easily formed. Subsequent decomplexation gave the free substituted beta-CF(3) alkynes in good yields.

Cobalt-complexed conjugated diyne salts: a family of rigid masked dielectrophiles. Syntheses, structures, and double nucleophilic substitutions.

A family of dicationic diyne salts of the general formula [(Co2(CO)6)2-mu,eta2,eta2-(Nu-CH2C(triple bond)C-C(triple bond)CCH2-Nu)][BF4]2 [Nu = SMe2 (3); Nu = NC6H7, 3-picoline, (5); Nu = NC9H7, quinoline (7)] were prepared and fully characterized. Three X-ray molecular structures of 3, 5, and the neutral starting material 2,4-hexadiyne-1,6-diol complex [(Co2(CO)6)2-mu,eta2,eta2-(HO-CH2C(triple bond)C-C(triple bond)CCH2-OH)] (1) are presented. Complex 1 crystallizes in the triclinic space group P1 with a = 14.722(2) A, b = 14.571(3) A, c = 14.722(2) A, alpha = 105.17(1) degrees, beta = 113.30(1) degrees, gamma = 99.20(1) degrees, and Z = 4. Complex 3 crystallizes in the monoclinic space group P2(1)/n with a = 12.758(3) A, b = 13.360(3) A, c = 20.494(3) A, beta = 91.44(1) degrees, and Z = 4, and compound 5 also crystallizes in the monoclinic space group P2(1)/n with a = 9.426(2) A, b = 21.739(5) A, c = 18.704(3) A, beta = 94.86(1) degrees, and Z = 4. The X-ray structures provide us with valuable information on the arrangement of the Co2-alkyne units, which have a cis geometry and are in sharp contrast to that observed generally for diyne-tetracobalt compounds. Complex [(Co2(CO)6)2-mu,eta2,eta2-(Me2S-CH2C(triple bond)C-C(triple bond)CCH2-SMe2)][BF4]2 (3) reacts with N-, S-, and P-centered nucleophiles and affords the related substituted complexes in high yields. The stability and reactivity of the disulfonium diyne complex 3 toward nucleophiles are compared to those of the analogous disulfonium-yne complex [(Co2(CO)6)2-mu,eta2,eta2-(Me2S-CH2-C(triple bond)C-CH2-SMe2)][BF4]2 (4).

Unusual Me-O Bond Cleavage in a Metalated Crown-Ether: X-ray Molecular Structure of (5-Methoxy-4,6-dimethyl-1,3-xylylene-2-one)-15 Crown-4 Complex of Pentamethylcyclopentadienyl Iridium.

The reaction of [(C(5)Me(5))Ir(Solvent)(3)][BF(4)](2) (1) with (2,5-dimethoxy-4,6-dimethyl-1,3-xylylene)-15 crown-4 (2) affords the metalated crown-ether complex [(eta(5)-C(5)Me(5))Ir(eta(6)-C(18)H(28)O(6))][BF(4)](2) (3) in 88% yield. Complex 3 undergoes a facile Me-O bond cleavage to give the related semiquinone form of the metalated crown-ether [(eta(5)-C(5)Me(5))Ir(eta(5)-C(17)H(25)O(6))][BF(4)] (4). A single-crystal X-ray structure determination of complex 4 is reported. Complex 4 crystallizes in the monoclinic space group P2(1)/m with a = 8.187(5) Å, b = 17.193(4) Å, and c = 10.900(3) Å, alpha = 90 degrees, beta = 109.68(1) degrees, gamma = 90 degrees, and Z = 2. The structure provides us with valuable information about the nature of the eta(5)-semiquinone form of the metalated crown-ether and reveals that, surprisingly, the Me-O unit close to the crown chain is the one that undergoes hydrolysis. A rationale consistent with the experimental results is advanced.

Syntheses and affinities of novel organometallic-labeled estradiol derivatives: a structure-affinity relationship.

Two series of novel estradiol derivatives, including cationic species, labeled with organometallic fragments Cr(CO)3, Cp*Ru+, or Cp*Rh2+ [Cp* = eta 5-C5(CH3)5] either in the 17 alpha-position or on the A-ring were synthesized, and their relative binding affinities (RBA) for the estradiol receptor were determined. The Ru(II) and the Rh(III) cationic derivatives were obtained as stable salts with the following counter anions (BF4-, PF6-, CF3SO3-). The satisfactory RBA values obtained for most complexes belonging to the 17 alpha series confirm that this position tolerates the presence of bulky neutral species. For instance, complex 4, in which the organometallic fragment Cr(CO)3 was attached to the phenyl ring of the 17 alpha-phenylethynyl fragment, exhibited an RBA value of 24%, very similar to that of the uncomplexed estrogen derivative 3. Surprisingly, the analogous cationic species 6 had no affinity for the estradiol receptor. This unprecedented result shows that the hormone binding site of the estrogen receptor does not tolerate the presence of a positive charge in the 17 alpha-position of the steroid. On the other hand, the alpha-face of the A-ring of estradiol did tolerate positively charged organometallic fragments bearing bulky substituents although the RBA value tended to decrease with increasing charge. The counterion in these cationic derivatives also affected binding affinity. For instance, the Ru(II) species 7a containing an CF3SO3- ion exhibited a reasonable RBA value (5.8%) compared to analogous species 13 with a PF6- ion (RBA of only 0.1%). Moreover, the triflate counteranion preserved the phenolic form of the A-ring of the estrogen derivative whereas the PF6- derivative was unstable and rapidly converted into the dienonylic form in buffer. The compared RBAs of the neutral and cationic species illustrate the preferences of the receptor hormone binding site in accepting or rejecting species of hydrophobic or hydrophilic character.