Antioxidant activities, anticancer activity and polyphenolics profile, of leaf, fruit and stem extracts of Pistacia lentiscus from Tunisia.

Plant derived compounds have played an important role in the development of several clinically useful anticancer drugs. The aim of the present study was 1) to evaluate for the first time the anti-proliferative activity of a polyphenol enriched extract obtained from leaf, fruit and stem of Tunisian variety of Pistacia lentiscus against two cultured cancer cells, and 2) to carry out a phytochemical analysis of vegetable extracts particularly by determining the chemical composition of phenolics (total polyphenols, flavonoids and condensed tannins content in solvents with varying polarities), 3) to  evaluate the antioxidant activity and identify the major compounds by RP-HPLC. Leaf extract using methanol/water (8:2) showed the highest polyphenol content (124.1 mg GAE/g DW). Moreover, total antioxidant capacity, reducing power and antiradical capacities against DPPH were maximal in leaf extracts with IC50 significantly lower than that standard (BHT). In MTT assay, methanol (8:2) extract exerted the most potent cytotoxic effect. The leaf extract exhibited an important antiproliferative activity (IC50: 135.67 ± 2.5 and 250.45 ± 1.96 µg/ml in CaCo2 and AGS cells respectively) but the infusion extracts of fruit stems and leaves were inactive. The RP-HPLC analysis revealed the presence of several phenolic compounds in P. lentiscus leaf, fruit and stem including tannic acid, gallic acid, digalloyl quinic acid derivative, quercetin and   p-coumaric acid as major phenolics. The high phenolic content and the important antioxidant activities of P. lentiscus extract could be a useful source of natural products and may be increasingly important for human consumption, prevention of damages caused by oxygen free as well as for the agro-food, cosmetic and pharmaceutical industries.

Unilateral orbital mass as an unusual presentation of IgG4-related disease.

IgG4-related diseases are a recently recognized systemic syndrome characterized by mass-forming lesions, in mainly exocrine tissue, that consist of lymphoplasmacytic infiltrates and sclerosis, which may mimic malignant neoplasm due to clinical and imaging features. We report an unusual case of a 62-year-old woman who presented with a left orbital mass, which histologically revealed to be an IgG4-sclerosing disease.

[Pediatric mandibular ameloblastic fibro-odontoma]. / Fibrome odonto-améloblastique de l'enfant.

INTRODUCTION: Ameloblastic fibro-odontoma (AFO) is a very rare mixed odontogenic tumor (2% of all odontogenic tumors). It is considered as a non-extensive non-aggressive tumor but recurrence and malignant transformation remain possible. We report a voluminous AFO in a child. CASE REPORT: A 7-year-old boy presented with a right mandibular and facial swelling. The panoramic radiograph and CT scan revealed a voluminous unilocular radiolucent lesion (10 cm) with an impacted tooth that involved the ramus area and the angle of the right mandible. Enucleation and curettage was performed with a good outcome. There was no recurrence at ten months. DISCUSSION: This case is exceptional because of the young patient's age, the large tumor diameter, and the good outcome after ten months. This tumor occurs more often in the posterior region of the mandible and is frequently seen in the first two decades of life. The diagnosis is made on radio-clinical data and may be confirmed by histology. A surgical treatment with complete tumor removal is recommended to prevent recurrence.

[Prognostic factors and survival of metastatic colorectal cancer in the Sousse University Hospital (Tunisia): comparative study of two treatment period of 200 patients]. / Facteurs pronostiques et survie des cancers colorectaux métastatiques au CHU de Sousse (Tunisie): etude comparative de deux périodes de traitement de 200 patients.

UNLABELLED: Between 1994 and 2005, 200 patients with metastatic colo-rectal cancers were treated in the Sousse CHU (Tunisia), we analysed two groups of patients, the group 1 was treated in the period after 1999 (N = 64), the group 2 was treated in the period between 1999 and 2005 (N = 136). PATIENTS AND METHODS: Mean age of the patients was 50 years, localisation of metastases was liver in 67.3% of cases, 23% of patients had multiple metastases, 44% of cases developed metastases after a median period of 11.4 months. All patients had received first line of chemotherapy, the regimen of chemotherapy was in the group 1, Fufol in the majority of cases (76%), the regimen of chemotherapy was in the group 2, simplified LV5FU2 associated to irinotecan in the majority of cases (83%), 28% of all patients received second line of chemotherapy. RESULTS: The median survival was 13.8 months in the group 1 and 19 months in the group 2. Overall survival rates at 2 years were 35% and 42% (p = 0.02) in group 1 and 2, respectively. Prognostic factors for a better survival using univariate analysis were: normal ACE (P < 0.01), normal liver analysis (P < 0.001), response after 3 cycles of chemotherapy (P < 0.0005), resection of liver metastases (P < 0.05). The multivariate analysis (cox model) revealed only one independent factor: radiologic response after 3 cycles of chemotherapy (P < 0.03). CONCLUSION: The prognostic of patients with metastatic disease is poor, although palliative chemotherapy after the recent advances and the use of new drugs have been shown to be able to prolong survival and to improve the quality of life over best supportive care. This study report amelioration of prognostic and survival of metastatic colorectal cancers in Tunisia.

[Primary digestive tract lymphoma in central region of Tunisia: anatomoclinical study and therapeutic results about 153 cases]. / Les lymphomes primitifs du tube digestif (LPTD) dans le centre tunisien: étude anatomoclinique et résultats thérapeutiques à propos de 153 cas.

Primary gastro-intestinal lymphoma (PGIL) is the most common type of extra-nodal non Hodgkin's lymphoma. Their clinical and histological presentations are heterogeneous depending on the site of the lesion. There is no consensus regarding the role of surgery and chemotherapy in the therapeutic approach. In our country epidemiology of the disease is unknown with IPSID being the most frequent type. We report anatomo-clinical features and prognostic factors of PGIL and compare intestinal to gastric forms in our region. This is a retrospective study of 153 cases of PGIL in adults diagnosed and treated in the department of medical oncology in Farhat Hached Hospital between 1994 and 2006. The median age was 52 years and the sex-ratio 2.1. Tumor sites were gastric (67%), intestinal (26%) and gastrointestinal (7%). Abdominal pain (87%) followed by vomiting and diarrhoea (37 and 15%) were the most common symptoms. Performance status (PS) < 2 was seen in 80% of patients, high grade lymphoma in 70.5% of cases and B phenotype was noted in 85%. MALT lymphoma accounts for 50% of cases, and IPSID for only 5% of PGIL. About 47.5% of cases were stage IE, 138 patients had chemotherapy with an objective response rate of 77%. Only 46% of patients had surgery (14 for surgical complication, 6 for residual tumor after chemotherapy and 22 to have histological diagnosis). The five-year overall survival (OS) was 62%. In high grade lymphoma patients favorable prognostic factors for OS included young age < or = 60 years, PS < 2, normal serum LDH, hemoglobin > 12 g/dL, B phenotype, localised stage (IE-IIE1), anthracycline-based chemotherapy regimen, achieving complete or partial response to induction chemotherapy and no relapse. In multivariate study only relapse and PS were significant prognostic factors for OS. In low-grade lymphoma patients, none of these factors had a significant correlation with OS: age < or = 60 years, PS < 2, stage (IE-IIE1), response to induction chemotherapy, relapse. Compared to gastric lymphomas, intestinal cases occurred at a younger age, frequently with diarrhoea, weight loss, and occlusion. They are more often high-grade, T phenotype and have locally advanced stage (IIE); surgery is more common in this group. We conclude that stomach is the main site of PGIL in our region, intestinal lymphoma is less frequent and IPSID has become rare. Recent progress in chemotherapy has allowed good therapeutic results with a conservative approach. Surgery may be performed in case of emergency or for residual lesions after medical treatment.

Diabetes mellitus as an early symptom of pancreatic cancer diagnosed three years later.

We present a case of a 40-year-old man with strong family history of diabetes. His pancreatic ultrasonography was normal at the discovery of his diabetes. Anti-pancreatic antibodies were negative. The patient was treated by insulin and continued to loose weight. His diabetes remained unstable during the follow-up. Three years later, a pancreatic adenocarcinoma was diagnosed which was locally advanced and could not be removed surgically. This observation argues among several mechanisms explaining diabetes in subjects with pancreatic cancer, in favor of tumor-derived diabetogenic substance and suggests that diabetes mellitus could reveal pancreatic cancer even in the presence of conventional risk factors of type 2 diabetes.

[Fractured zygoma: a review of 356 cases]. / Les fractures de l'os zygomatique : à propos de 356 cas.

INTRODUCTION: Fractures of the zygomatic complex with its accompanying functional and esthetic deficits are a fairly common phenomenon in the practice of maxillofacial and plastic surgery. The purpose of this paper is to provide a review, based on collected data, on the topic of "fractured zygoma". The review is presented under the headings of epidemiology, fracture patterns, treatment modalities and complications. Throughout the paper comparison is made with published data from around the world. METHODS: A 10-year retrospective audit was undertaken of all hospitalized patients, at the department of maxillo facial and plastic surgery in Charles Nicolle Hospital (Tunisia), who had sustained a fractured zygoma from 1995 to 2004. RESULTS: A total of 356 fractures were sustained. Patients in the third decade of life (34%) recorded the highest incidence. The sex distribution is markedly higher for males than for females (9/1). Road traffic accidents (31%) were the predominant etiology. Tetrapod fractures (43.7%) were the most frequent type of fractures followed by zygomatic arch fractures (34.53%). Cases were managed by either closed or open reduction. Percutaneous reduction was the commonest technique employed. However, in unstable fractures necessitated open reduction, transosseous wiring was the most frequently employed fixation. Patients were followed-up routinely, for an average of nine months. Inferior orbital nerve dysfunctions were seen in 8.7% of cases. DISCUSSION: Epidemiological findings are similar to those reported in the literature. Males sustained more fractures than females and road traffic accidents were the commonest cause of zygomatic fractures. Open reduction and internal fixation is advocated for the unstable, markedly displaced or comminuted fractures.

[Chemotherapy-induced febrile neutropenia: about 200 episodes. Clinical, microbiological and therapeutic characteristics]. / Les neutropénies fébriles chimio-induites : à propos de 200 épisodes. Profil clinique, microbiologique et thérapeutique.

Cytotoxic chemotherapy suppresses the haematopoietic system, febrile neutropenia is the most serious haematological toxicity associated with the risk of life-threatening infections. We present a retrospective study of 200 episodes of febrile neutropenia in 128 patients treated in department of medical oncology. The aim of this study was to determinate the clinical, therapeutic and evolutive characteristics in patients treated essentially for solid tumors. Among these patients, 72% of them have at least two episodes, the median age was 34 years with extremes six and 75 years. It has been noticed that 26.3% of patients have diabetes, the dominate neoplasm was solid tumors in 79.7%, 65% of patients have received preventive colony-stimulating factors, 83% have received preventive buccal disinfection with antifungic. The median duration of hospitalisation was 12 days, the median delay of febrile neutropenia was 10 days with extremes two and 31 days, median duration of febrile neutropenia was 5.45 days with extremes one and 24 days. Among these cases, 9.45% of them have nadir zero, 68% of patients have clinical documented infections, ORL in 47% of cases. According to the study, 12% of cases have documented microbiological fever, the sites was urinary in 33% of cases, blood in 33% of cases, derm in 30% of cases. The microbe was staphylococcus negative coagulase in 37.5% essentially in blood and derm, the Escherichia coli in 20.8% essentially in urinary and blood. First line antibiotherapy was cefotaxim associated with amikacine in 93.5%, second line antibiotherapy was association of imipenam and amikacine in 82% of cases. Among these cases,7% of them have received anti-staphylococcus, and antifungic treatment in 50% of cases. The thermic defervescence was obtained in median delay of 2.8 days. We have noted nine deaths (22% of cases). Recent surveys indicate that neutropenia remains a prevalent problem associated with substantial morbidity, mortality and costs. The colony-stimulating have used effectively in a variety of clinical settings to prevent or treat febrile neutropenia and to assist patients receiving dose-intensive chemotherapy.

Particularites du cancer du sein dans le centre tunisien

Il s'agit d'une etude retrospective a propos 1135 cas de cancer du sein colliges dans le centre tunisien sur une periode de 12 ans (janvier 1990 a decembre 2001). L'age moyen des patientes etait de 49;6 ans. La taille tumorale clinique moyenne etait de 49;9 mm; 43des tumeurs etaient classees T2; 50des patientes avaient une adenopathie axillaire homolaterale et 17presentaient une metastase d'emblee. Le taux de survie a 5 ans etait de 66et la survie moyenne de 43;7 mois. Les facteurs pronostiques significatifs etaient : le delai de consultation; la taille tumorale; l'atteinte ganglionnaire; les metastases; le stade T4d; le type histologique de la tumeur primitive; le grade SBR; les embolies vasculaires et lymphatiques; la rupture capsulaire et le traitement conservateur

[Malignant renal tumors before one year of age. Experience of a North African pediatric surgery service]. / Tumeurs rénales malignes avant l'âge d'un an. Expérience d'un service de chirurgie pédiatrique nord Africain.

UNLABELLED: The malignant tumours of the kidney are not very frequent during the first year of life and pose diagnostic and therapeutic problems. The aim of this work is to make an analysis of the epidemiologic, clinical and anatomo-pathological characteristics of these tumours during the first year of life and a development on the therapeutic methods and their results. MATERIAL AND METHODS: [corrected] This is a retrospective study of 8 observations of malignant tumours of the kidney whose first symptomatology appeared during the first year of life. RESULTS: The malignant tumours of the kidney observed before the one year age constituted 18% of the tumours of the kidney in the child. A female prevalence was noted with a sex-ratio of 0.6. The assessment of extension found cutaneous (one case), ganglionic (one case) and pulmonary (two cases) metastases. First chemotherapy was prescribed to five patients. The surgery consisted on a widened nephrectomy in seven cases and a tumorectomy for an infant presenting a nephroblastomatosis. The tumour corresponded to a nephroblastoma in seven cases and a rhabdoide tumour in the last case. Mortality was high (50%) caused by the toxicity of chemotherapy in three cases and an advanced stage of cancer in one case. CONCLUSION: Renal tumoral pathology occurring in infants less than one year of age poses true etiologic and therapeutic problems. The high frequency of the nephroblastoma and the absence of benign tumour in our series encourage us to evocate more often the malignant renal tumours and to practice per cutaneous biopsies in case of diagnostic doubt.

[Fetal rhabomyomatous nephroblastoma. Report of 2 cases and review of the literature]. / Le néphroblastome rhabdomyomateux foetal. A propos de deux cas et revue de la littérature.

OBJECTIVE: Fetal rhabdomyomatous nephroblastoma is a particular and very rare histologic variety of nephroblastoma. The aim of this work is to study the principal clinic, therapeutic and evolutive characteristics of the fetal rhabdomyomatous nephroblastoma through two personal cases and a review of the literature. PATIENTS AND METHODS: This is a retrospective study of two observations of fetal rhabdomyomatous nephroblastoma treated in the pediatric surgery departement of Monastir (Tunisia) among 47 cases of nephroblastoma. The diagnosis was confirmed in the two cases by the histologic examination. RESULTS: The two patients were a six and a sixteen months old boy and girl. They were admitted for a voluminous mass occupying the left half-abdomen. The radiologic and biologic explorations load, in the two cases, to the diagnosis of left nephroblastoma. After a first chemotherapy that did not induce a reduction of the tumoral volume, a widened left nephrectomy was performed for the two patients. The histologic examination of the two pieces of nephrectomy concluded to a fetal rhabdomyomatous nephroblastoma with existence in the second case of an extension of the lesions to the renal pelvis and ureter in the form of a pseudo-botryoïde tumor. The tumor was classified stage I in the first case and stage II N0 in the second. The treatment was completed by an adapted post operative chemotherapy according to the SIOP 9 protocol. The two patients are currently in complete remission with an overview of six years and half. CONCLUSION: The fetal rhabdomyomatous nephroblastoma is a special histologic form of nephroblastoma that is characterized by the paucity of pulmonary metastasis, the absence of response to chemotherapy and the possibility of tumoral extension in the renal pelvis and ureter. His prognosis is similar to the classical nephroblastoma.

[Breast cancer prognosis in Tunisian women: analysis of a hospital series of 729 patients]. / Pronostic du cancer du sein chez les femmes tunisiennes: analyse d'une série hospitalière de 729 patientes.

The objective of this study was to identify the anatomical-clinical aspects and determine the prognostic factors for breast cancer in the central region of Tunisia. This retrospective study involved 729 patients suffering from breast cancer, proven either by histology or cytology, diagnosed and treated between January 1990 and June 1998 at the F. Hached University Hospital in Sousse, Tunisia. The patients' average age was 50 years (ranging from 22-91). The average size of the cancer at the time of diagnosis was 49.1 mm; 90% were invasive duct carcinoma with high histo-prognostic SBR grade (level II-III: 86%). The overall survival rate was 50.5% after five years, and 50% after seven years. Using univariate analysis, significant predictive value was found with the following factors: tumor size, the clinical ganglionic level, metastases at diagnosis, the number of nodes invaded, nodal capsular rupture and lymphatic embolism, SBR grade and the delay in seeking consultation. The multivariate analysis (Cox model) isolated two prognostic factors: the initial size of the tumor (p = 0.001) and metastases at the time of diagnosis (p = 0.01). The study's results indicated that breast cancer prognosis in Tunisia remains poor primarily due to late diagnosis.