[Secondary breast cancer after treatment for Hodgkin's disease. About seven cases]. / Cancer du sein secondaire après traitement pour maladie de Hodgkin. A propos de sept cas.

OBJECTIVE: Therapeutic results of Hodgkin disease (HD) have improved by the use of combined radio-chemotherapy. However, this association can increase the risk of on-term effects including secondary cancers. In a retrospective study, we collected secondary breast cancer (BC) in patients previously treated with chemoradiotherapy for Hodgkin disease at Salah-Azaïz institute of Tunis. PATIENTS AND METHODS: Between 1975 and 2003, seven patients (six women and one man) treated for HD subsequently developed BC. Mean age at diagnosis of HD was 21 years (12-29). The first treatment was combined chemotherapy (MOPP-ABVD) and radiotherapy for all patients. Radiotherapy was delivered with cobalt 60 with large fields. The median dose was 41.3 Gy (2 Gy/fraction in 6 patients and 3.3 Gy in one). RESULTS: The breast tumours occurred after a median delay of 204 months (132-276). According to the TNM classification, we showed two stage T2, one stage T3, two stage T4b and two stage T4d. The mean clinical size was 47 mm (25-80 mm). All patients had infiltrating carcinoma. Axillary node histological involvement was found in 6 cases. All patients were treated by mastectomy and chemotherapy. Only one patient had a locoregional irradiation. Median survival was 26.5 months (12-48). Four patients died and three are still alive at respectively 24, 31 and 144 months. DISCUSSION AND CONCLUSION: According to the previous data, breast cancer represents 6.3 to 9% of all second cancers occurring after HD treatment. We conclude that especially young women and girls treated for HD should be carefully monitored. We suggest that secondary BC be sometimes treated by conservative radiosurgical approach.

[Epidemiological features and complications of central venous catheters in pediatric oncology: prospective study about 125 cases]. / Profil épidémiologique et complications des voies veineuses centrales en oncologie pédiatrique: à propos de 125 cas.

OBJECTIVE: To report the indications and early and late catheter-related complications in a Tunisian unit of paediatric oncology. PATIENTS AND METHODS: This prospective study has been performed in a paediatric oncology unit of the Salah Azaïz Institute between 1989 and 2005. It concerns 58 girls and 57 boys with a median age of 7.9 years(4 months to 18 years) treated for cancer disease predominantly lymphoma (22%), sarcoma (23.2%) or leukaemia (8.5%) proposed for insertion of a central venous catheter (CVC). RESULTS: Excluding 2 insertion failures (1.6%), we placed 123 CVC (double for 10 patients), 43 (35%) exteriorised (EC) and 80 (65%) connected to an implantable site (IS). Catheters were placed in the subclavian vein in 59.2% of cases vs 32% for internal jugular vein and 8.8% for femoral vein. Early complications included 15 cases of multiple punctures (12%), 4 cases of pneumothorax (3.2%) and 6 of arterial punctures (4.8%) originating a cervical subcutaneous haematoma in 1 patient (0.8%). Late complications were represented by infection in 7 cases (5.7%). We observed 2 cases of intracardiac catheter migration due to catheter disconnection from the IS (1.6%) and 2 cases of thrombosis (1.8%). The mean life of CVC was longer for IS (305.2 days) than for EC (64.4 days). CONCLUSION: Implantable sites are effective progress for venous access in children with cancer. They improved the quality of care in pediatric oncology.

[Pelvic pseudotumoral actinomycosis with multisegmental lumbosacral root failure. A case report]. / Actinomycose pelvienne pseudotumorale avec atteinte multiradiculaire lombosacrée. A propos d'un cas.

We report a case of pseudotumoral pelvic actinomycosis with lumbosacral spinal involvement in a 21 year-old woman. The radiological work-up showed a pseudotumoral left ovarian lesion extended to sacral spine, which involved the fifth lumbar vertebra. Diagnosis of actinomycosis was established in histopathological examination of the tubo-ovarian mass under laparotomy. After four months of treatment with ofloxacin and rifampicin evolution was marked by improvement of general health and infection, associated to a progressive recovery of motricity of the lower limbs. Early diagnosis of pelvic actinomycosis may prevent the occurrence of rare but severe neurological complications of this disease.

[Clonidine and anesthesia]. / Les indications de la clonidine en anesthésie.

The alpha2-adrenoceptor agonists have several beneficial actions during the perioperative period. They exert a central sympatholytic action, improving haemodynamic stability in response to endotracheal intubation and surgical stress, reducing the anesthetic and opioid requirements and causing sedation, anxiolysis and analgesia. Furthermore, alpha2-adrenoceptor agonists may offer benefits in the prophylaxis and treatment of perioperative myocardial ischaemia. Recent alpha2-adrenoceptor agonists with short duration of action (dexmedetomidine and mivazerol) are adapted for the administration to patients at high risk for coronary artery disease during surgery. The alpha2-adrenoceptor agonists have an analgesic action at several sites of the peripheral and central nervous system as well as the prolongation of epidurally or intrathecally administered local anesthetics and opioids.

[Pulmonary scintigraphy with MAA-Tc 99m perfusion in the diagnosis of pulmonary embolism]. / La scintigraphie pulmonaire de perfusion AU MAA-TC 99M dans le diagnostic de l'embolie pulmonaire.

Perfusion lung scintigraphy is vital to guide the diagnosis even without a ventilation scintigraphy. A customised strategy could be useful to optimise the use of perfusion scintigraphy when not coupled with a ventilation scintigraphy. We report about a retrospective study on 300 patients received in our department for suspected lung migrations. The patients underwent a perfusion scintigraphy only: a normal scintigraphy would discard the diagnosis when achieved between 6 and 72 hours after the accident. On the other hand, the evidence of one or two perfusion defects would allow to maintain the pulmonary embolism suspicion and establish an effective heparinic treatment. A second control comparative scintigraphy, a few weeks after the first one, very often confirms the diagnosis, allows the assessment of the heparinotherapy and if necessary, indicate to stop it.