[Correlation between detrusor thickness, intravesical prostatic protrusion and maximum urinary flow in the monitoring of benign prostatic hyperplasia]. / Corrélation entre épaisseur du détrusor, index de protrusion prostatique et débit urinaire maximal dans le suivi de l'hypertrophie bénigne de la prostate.

INTRODUCTION: Detrusor thickness (DT) and intravesical prostatic protrusion (IPP) are closely related to bladder outlet obstruction. The aim of our study was to look for correlation between DT, IPP and maximum urinary flow (Qmax). METHODS: It is a prospective, observational study including men over fifty managed for benign prostatic hyperplasia. Low urinary tract symptoms were assessed with the International Prostatic Symptom Score (IPSS). Pelvic ultrasound was performed for all patients measuring prostatic volume, bladder volume, post- void residual, DT and IPP. Uroflowmetry was performed for all patients, Qmax was noted. Qmax equal or less than 15ml/s was considered pathologic. RESULTS: Sixty patients were included for our study. Strong negative correlation was noted between DT, IPP and Qmax (r=-0.59, r=-0.61 respectively). Patients with pathologic Qmax had higher DT and IPP than those with normal Qmax, the difference was significant (P<0.01). Threshold values predicting pathologic Qmax were 3mm for DT and 7mm for IPP. ROC analysis reveals for DT an AUC of 0.84 (95% CI 0.76-0.92) and for IPP an AUC of 0.88 (95% CI 0.80-0.97). CONCLUSION: Detrusor thickness and intravesical prostatic protrusion have strong negative correlation with Qmax. These parameters could be an alternative to Qmax measurement if uroflowmetry is unavailable. LEVEL OF EVIDENCE: Grade B.

Tunisian Consensus document on magnetic resonance imaging in patients with intracardiac devices.

INTRODUCTION: Patients with ferromagnetic cardiac devices, particularly cardiac implantable electronic devices (CIED) such as pacemakers or implantable cardioverter defibrillators, are often inappropriately deprived of magnetic resonance imaging (MRI) for safety reasons. This consensus document is written by a multidisciplinary working group involving rhythmologists, interventional cardiologists, echocardiographists and radiologists. Its objective is to establish good practice recommendations to optimize the management of patients with cardiac devices requiring MRI examination, while ensuring their safety and facilitating their access to MRI.

Bilateral Sub-deltoid Bursitis in a Patient Receiving Infliximab for Crohn's Disease.

BACKGROUND: Infiximab has been shown to be effective in inducing and maintaining remission of intestinal bowel diseases. Infiximab has been associated with many adverse events. Articular manifestations are commonly reported, but they are of variable clinical expression and aetiology. Among them, inflammatory bursitis has rarely been described. OBJECTIVE: Herein a case of inflammatory bursitis in a patient with Crohn's disease after switching to biosimilar infliximab is reported. CASE REPORT: A 41-year-old man with Crohn's disease evolving from 3 years was referred to infliximab therapy at a dose of 5mg/kg because of an aggressive resistant perineal fistula. After 14 infusions of infliximab, the treatment was switched to infliximab biosimilar using the same dose and frequency of administration. Forty-eight hours after the second infusion, he developed an acute onset of muscle pain and stiffness on both of his shoulders. A musculoskeletal ultrasound was performed and revealed a hypoechoic widening of both subacromial bursae. It was more severe on the left side. DISCUSSION: The diagnosis of non-infective sub-acromial bursitis secondary to infliximab infusion was made as the patient's symptoms resolved rapidly without any antibiotics. Infliximab was definitively stopped and adalimumab was introduced. CONCLUSION: Musculoskeletal side effects of infliximab infusion are uncommonly reported. Among them, bursitis has been reported in only a few cases. Ultrasonography can help early diagnosis of bursitis. The time of occurring of this reaction regarding infliximab infusion, screening of Antibodies to Infliximab (ATI) and clinical outcome after drug discontinuation are the main helpful arguments.

Focal Mass-Forming Autoimmune Pancreatitis Mimicking Pancreatic Cancer: Which strategy?

Autoimmune pancreatitis (AIP) is a rare form of chronic pancreatitis that predominantly affects men in their fifth and sixth decades and often presents with obstructive jaundice and pancreatic enlargement. It is relatively easily diagnosed by characteristics of diffuse swelling of parenchyma and irregular narrowing of the main pancreatic duct. However, focal mass-forming AIP is hard to distinguish from pancreatic cancer. Problematic issue : How to differentiate a focal AIP from a pancreatic cancer and avoid a heavy and unnecessary surgical treatment?. Summary of the observation : We report three cases of mass-forming autoimmune pancreatitis that were preoperatively suspected to be pancreatic cancer, and review their clinical, radiological and histological features. We emphasize on the strategy of diagnosis and we try to understand the histopathological features of this disease. Conclusion : In patients with obstructive jaundice suggestive of pancreatic carcinoma, AIP should be considered in the differential diagnosis to avoid unnecessary laparotomy or pancreatic resection. To the best of our knowledge, this report is from the rare publications to present a histopathological comparison of mass-forming AIP with the adjacent uninvolved pancreatic tissues.

Evaluation of an interactive teaching method in the teaching of Pulmonology.

INTRODUCTION: For several years, interactive teaching has proved its effectiveness in learning. At the Faculty of Medicine of Tunis (FMT), the interactive sessions are sessions of clarification, illustration, application, and participation (CIAP). AIM: To evaluate pneumology CIAP session in the acquisition of learning by first-year students of the second cycle of medical studies (SCMS1). METHODS: It was a cross-sectional study carried out at the FMT during the academic year 2016-2017 and included students from SCMS1. CIAP session subject was "The chronic respiratory failure". A pre-test and a post-test, with the same subject, were distributed during the session. Knowledge acquisition was evaluated by comparing the scores assigned to the tests. An evaluation of the students' satisfaction with the session progress was made. RESULTS: Ten students attended the CIAP session. The mean score of the pre-test was 2.1 ± 0.7 over 10 points. A statistically significant (p = 0.003) increase in the score was observed for the post-test, which increased to 4.8 ± 0.2. For the evaluation of the session by the students, the best scores were assigned for the items evaluating the achievement of objectives and the facilitation of the session by the teacher (1.9 points).The lowest score was given for the item evaluating the time required for the session (1 point). CONCLUSION: The interactive teaching method "CIAP" was beneficial in terms of learning, as demonstrated by the statistically significant improvement of the post-test score compared to the pre-test and the satisfaction of the students at the end of the session. Moreover, the involvement of all the stakeholders (students, teachers, and institutions) is necessary for the success of this teaching.

[Treatment of idiopathic varicocele: comparative study of three techniques about 128 cases]. / Traitement de la varicocèle idiopathique : Étude comparative de trois techniques à propos de 128 cas.

BACKGROUND: Several modalities of varicocele treatment are available, however, no therapeutic technique showed its superiority with regard to the other one. AIM: To compare the results of three techniques of varicocelecomy. METHODS: Retrospective Analytical and comparative study of 128 patients treated by of three techniques of varicocelectomy: the open surgery by retro peritoneal way for 42 patients (GI), the varicocelectomie coelioscopique for 41 patients (GII) and the antegrade scrotal sclerotherapy done for 45 patients (GIII), between march 2001 and January 2009.The mean age was 28 years. The main motive for consultation was represented by the painful varicocele in 67 % of the cases, followed by the hypofertility in 20.3 % of the cases and the association both in 12,5 % of the cases. The varicocele was in leftsider in 71.1 % of the cases, to the right side in 5.4 % of the cases and was bilateral in 23.43 % of the cases. Varicocele was infra-clinical at 6 patients, grade 1 in 16 sides, grade 2 in 105 sides and grade 3 in 31 sides. The numeration, the mobility as well as the morphology of sperm cells were comparable between the three groups Results: The global rate success was 81.2 %, with the highest rate found in the group III which was treated by antégrade scrotal sclerotherapy (84.4 %). The improvement of the parameters of the spermogramme was noted in the three groups, however a statistically significant difference was found only in patients treated by antégrade scrotal sclerotherapy; it mainly concerned numeration and the mobility of spermatozoides. The highest rate of pregnancy was recorded in patients treated by antégrade scrotal sclerotherapy (13.3%). The main postoperative complications were hydrocele (16%) followed by testicular hypotrophy (3 patients). CONCLUSION: Three techniques of varicocele treatment, offer either a similar success rate, and improvement of parameters of the sperm cells. However, antegrade scrotal sclerotherpy seem to be the best treatment of first intention in proposed, regarding its efficiency, of the ease of its realization, its moderate cost and its feasibility in case of recurrence if varicocele was treated with open way'GIII).

[Isolated splenic metastasis revealing colon cancer]. / Métastase splénique isolée révélant un cancer du colon.

Splenic metastasis of colon cancer is uncommon especially when isolated. In fact, they are usually associated to multi visceral location. Malignant melanoma, cancer of breast and lung and ovarian carcinoma are the most common cancer which metastases in spleen. Splenic metastasis of colon cancer is rare and exceptionally isolated. Ten cases of isolated splenic metastasis in colon cancer are reported in literature. We report a new case of intra splenic kystic metastasis revealing an asymptomatic sigmoid cancer in a 63 years old patient.