[The usefulness of elastase measurement in the sperm for the diagnosis of urogenital male inflammation and infection]. / Intérêt du dosage de l'élastase dans le liquide séminal pour le diagnostic de l'inflammation et de l'infection du tractus urogénital masculin.

BACKGROUND: Genital tract inflammation is a frequent cause of infertility among men, usually clinically silent with only leukocytospermia defined as the presence of white blood cells (WBC)>1.106/ml in semen. During the inflammation process, granulocytes discharge large amounts of proteases such as elastase. The elastase linked to its inhibitor in the form of a complex the elastase α1-protease inhibitor in semen is suggested as a potential marker of genital tract inflammation. AIM: To assess the measurement of elastase as a biomarker of genital tract inflammation by comparing this technique with the detection of leukocytospermia according to the WHO guidelines. METHODS: This study interested 83 infertile men attending the andrology center for semen analysis. Leukocytospermia was assessed by a peroxydase test and elastase concentration by immunoassay in the seminal plasma. RESULTS: An elevated elastase was found in 38% of men. A similarity was found between leukocytospermia and elastase in 79% of cases, kappa coefficient concordance with leukocytospermia is good (0.78). The sensitivity of the elastase is 100%, the specificity= 75%. The positive predictive value is 47%, the negative predictive value is 100% with a Youden index=0.75. All patients with leukocytospermia>1.106/ml had an elastase>250ng/ml, 73% of them a concentration>1000 ng/ml. In the group of patients with no leucocytospermia, 75% had elastase<250ng/ml, 21% had concentration between 250 and 1000ng/ml and 4% (3 patients) a concentration>1000ng/ml. CONCLUSION: Seminal elastase is a more sensitive marker than leucocytospermia in the diagnosis of male urogenital inflammation and infection.

[Clinicopathologic characteristics of low grade primary gastric non-Hodgkin's lymphomas: experience from a single center]. / Caractéristiques clinico-pathologiques des lymphomes gastriques primitifs de bas grade de malignité.

AIM: To report the clinicopathological data and the treatment outcomes in patients with primary gastric low grade non-Hodgkin's lymphoma. METHODS: We carried out a retrospective analysis of 16 consecutive patients (median age 46 and range 28-75 years) who presented to our department with histopathological diagnosis of primary gastric low grade non-Hodgkin's lymphoma. We analyzed clinical manifestations, endoscopic features, pathological features,Helicobacter pylori infection and treatment. RESULTS: Common symptoms included abdominal pain (87.5%),vomiting (62.5%), and gastrointestinal bleeding (25%). Endoscopic appearances were mainly ulcers and ulcerations (93.75%).Endoscopic biopsy confirmation rate reached 87.5% when biopsies were repeated. Helicobacter pylori detection rate was 75%. A total of 9 patients received surgeries. Three patients had chemotherapy and 8 patients had Helicobacter pylori eradication therapy. The range of follow-up was 2-74 months with a median of 27 months. A complete remission was obtained in 12 cases, whereas 1 patient died and 3 were lost of view. CONCLUSION: Eradication therapy may be offered as an initial treatment option in patients with low-grade gastric lymphoma.

[Monoclonal gammopathy and primary colonic mantle cell lymphoma]. / Une gammapathie monoclonale associée à un lymphome colique primitif à cellules du manteau.

The association of a monoclonal gammopathy (MG) with a B cell non-Hodgkin's lymphoma (NHL) is a well-known phenomenon. It has been recognized in many subtypes of primary gastrointestinal lymphoma but its association with primary colonic mantle cell lymphoma has never been yet described. We report a 65-year-old man who presented with an exudative ascites and constipation. Serum electrophoresis showed a monoclonal peak in the gamma region of 45g/L and immunoelectrophoresis confirmed the presence of monoclonal gammopathy of IgM kappa type. Bone marrow aspirate was normal. Radiologic and endoscopic investigations evidenced a primary colonic mantle cell lymphoma. Although the association of an MG with an NHL and, in particular, to a primitive digestive location appears a rare phenomenon, endoscopic investigations in patients with MG appears legitimate in the presence of any digestive sign.

[Proliferating Brenner tumor: case report]. / Tumeur de Brenner proliférante: à propos d'un cas.

Brenner tumors account for only 1 to 2% of ovarian tumors. Proliferating Brenner tumors are characterized by an epithelial proliferation, resembling superficial well-differentiated urothelial carcinomas. A single 29-year-old patient was operated for an ovarian tumor. On gross examination, the tumor, which originated in the left ovary, was cystic multilocular and presented polyoid excrescences. Definitive histological exam showed a papillary proliferation lined by transitional cells without stroma infiltration. Mucinous cells lined some cavities. The diagnosis of proliferating Brenner tumor was made. Clinical and pathological characteristics of this rare entity will be discussed.

[Bacteriospermia: Effects on semen parameters]. / La bactériospermie : effets sur les paramètres spermatiques.

OBJECTIVES: Bacteriospermia may result in male hypofertlity. Indeed, 60% of patients treated by Assisted Reproductive Techniques had a local infection or inflammation of genital tract. However, direct effects of bacteriospermia on semen parameters remain controversial. The aim of our work was to explore the effect of bacteriospermia on sperm parameters among patients consulting for hypofertility. METHODS: A retrospective comparative study of two groups: a group of 70 patients with bacteriospermia (group 1) and a control group of 70 patients without bacteriospermia (group 2). For these groups, we studied the standard semen parameters (seminal volume and viscosity and spermatozoa count, initial and secondary mobility, vitality and morphology). Comparison of these parameters was made by the Chi2 test and the Fisher test. RESULTS: The mean age of our population was 40.4±6.7 years. There was no significant difference between ejaculate average volume in the 2 groups (group B: 2.78mL versus group A: 2.92mL with P=0.2). Similarly, for the viscosity no difference was noted (P=0,68). The altered parameters in the presence of bacteriospermia were mean concentration and sperm motility (P=0.001 and P=0.049 respectively). The prevalence of secondary asthenospermia was higher in the presence of bacterospermia (P=0.006). No statistically significant differences were observed for morphology and vitality of spermatozoa (P=0.276 and P=0.075 respectively). The leucospermia was associated with bacteriospermia in 10% patients. Ureaplasma urealyticum was the germ most found (45.7%) followed by Streptococcus and Staphylococcacae (20.3% for each), Gram negative rods accounted for 12.9%, while Corynebacterium spp was isolated only in 4,3% patients. U. urealyticum was associated with hypospermia in 33% of cases (P=0.031). Spermatozoa motility was significatively decreased not only in the presence of this bacteria (FT=0.002) but also when cultures were positive for Streptococcus (0.04) and Corynebacterium (P<0.001). Morphological abnormalities were also noticed with Streptococcus with index of teratozoospermia of 46% versus 19% in the 2nd group (P=0.046). CONCLUSION: Bacteriospermia may impair sperm parameters. The treatment of this affection seems to improve sperm fertilizing potential. In addition, it could prevent contamination of culture media.

[Esophageal cancer with esophagotracheal fistula. Treatment by esophageal prosthesis. Report of two cases]. / Cancer de l'oesophage avec fistules oesotracheales. Traitement par protheses oesophagiennes. A propos de deux observations.

Esophageal cancer has a bad prognosis because of late diagnosis. The rate of Survival is very low. Palliative treatment is frequently made. The aim of the treatment is to allow feeding, and treat some complications likes breathing troubles. We report two cases of esotracheal fistulae secondary to esophageal cancer. The esophageal fistula was successfully treated by esotracheal prosthesis.

[Duplicate principal bile ducts. Two case reports]. / Duplicité de la voie biliaire principale. A propos de deux cas.

The duplicity of the way biliaire main is a rare abnormality. We report two observations revealed by episodes of angiocholite. The degrades cholangiopancreatography endoscopy allowed to wear diagnosis and to practise a therapeutic gesture.

[Menetrier's disease: a case report]. / Maladie de Menetrier: a propos d'un cas.

Menetrier's disease is an uncommon reason of hypertrophic gastropathy. The diagnosis is suspected when clinic, endoscopic and radiologic criteria are associated and is confirmed by histologic features which are a cryptric hyperplasia atrophy of gland of the fundus and an hypertrophy of the mucosa. The main complications of this disease are neoplasia and cachexia. The treatment of Menetrier's disease is first medical. Chirurgical treatment is indicated when bleeding or neoplasia occurred. In this paper, we report the case of patient who is 41 years old which, in spite of some therapeutic problems is in conformity with literature.

Early life stress triggers persistent colonic barrier dysfunction and exacerbates colitis in adult IL-10-/- mice.

BACKGROUND: It has become increasingly evident that disease flares in the human inflammatory bowel diseases are influenced by life stress. It is known that life stress can trigger disturbances in intestinal barrier function and activate proinflammatory signaling pathways, which are important contributors to intestinal inflammation and clinical disease; however, the exact mechanisms of stress-induced inflammatory bowel disease exacerbations remain to be elucidated. Here, we presented a model of early life stress-induced exacerbation of colitis in interleukin (IL)-10 mice. METHODS: C57Bl/6 wild-type and IL-10 mice were exposed to neonatal maternal separation (NMS) stress on postnatal days 1 to 18 and reared under normal conditions until 10 to 12 weeks of age. At this time, histopathology, colitis scores, intestinal barrier function, proinflammatory cytokine expression, and mast cell activity were evaluated. RESULTS: NMS increased the severity of colitis IL-10 mice indicated by greater colitis scores and colonic proinflammatory cytokine concentrations. NMS and IL-10 increased colonic permeability; however, NMS alone did not induce colitis. Increased mast cell activation and colonic tryptase release were observed in IL-10 mice exposed to NMS, indicating mast cell activation. CONCLUSIONS: This study demonstrates that colitis in IL-10 mice can be exacerbated by NMS stress. The precise mechanisms of enhanced colitis severity in NMS IL10 mice are unclear but persistent defects in intestinal barrier function likely play a contributing role. NMS serves as a novel model to investigate the mechanisms by which early life stress influences the development and course of inflammatory bowel disease in adulthood.

[Sarcoidosis and liver involvement: a case series of 25 patients]. / Sarcoïdose et atteinte hépatique : étude de 25 cas.

PURPOSE: Sarcoidosis is a systemic disease of unknown etiology that may affect many organs including the liver. Our aims were to determine the clinical, paraclinical and therapeutic characteristics of patients with liver sarcoidosis and to compare, on the one hand, the revealing hepatic involvement to the non-revealing form and, on the other hand, sarcoidosis with and without liver disease. METHODS: A retrospective and descriptive study over 14 years of 25 patients with liver involvement selected from 56 cases of systemic sarcoidosis. RESULTS: The study population was composed of 18 females and seven males. The mean age was 48.2 years. Liver involvement was the presenting manifestation in 56% of cases. The functional history was dominated by general signs and abdominal pain. Hepatomegaly was present in ten patients. Biological abnormalities were identified in 84% of the cases with cholestasis (80%) and cytolysis (36%). Abdominal tomography showed hepatomegaly in 68.4% of the patients. Hepatic impairment was histologically confirmed in 16 patients. Granulomas were located in portal region (18.8%), in lobular region (12.5%) and in both (56.2%). Necroinflammatory lesions were found in 56.2%, cholestatic lesions in 18.8% and vascular lesions in 6.3%. Portal fibrosis and cirrhosis were seen in 25% and 6.3%, respectively. Twenty-four patients were treated with corticosteroids with 1 mg/kg per day (66.7%) and 0.5 mg/kg per day (33.3%). Under treatment, the response was complete in 81% and partial in 9.5%. One patient had no response. The liver involvement was significantly associated with general signs, renal failure and lymphopenia. Abdominal pain, hepatomegaly and lymph node were significantly associated with the revealing form. CONCLUSION: Liver involvement is frequent in sarcoidosis and commonly asymptomatic. Hepatomegaly is the most common clinical sign. Biological disturbance are present in 20 to 40% of the patients. The treatment is based essentially on corticosteroid therapy.

[Morphometric analysis of the human endometrium during the implantation window. Light and transmission electron microscopy study]. / Analyse morphométrique de l'endomètre humain en période d'implantation. Étude en microscopie optique et en microscopie électronique à transmission.

OBJECTIVES: To perform a morphometric and ultrastructural analysis of the various cellular components that constitutes the endometrial epithelium during the implantation window. METHODS: Endometrial biopsies of six patients in ageing to procreate were realized during the implantation window and analyzed using light and transmission electron microscopy (TEM). RESULTS: During the implantation window, four endometrial cell types are identified in distinct proportions: microvilli-rich cells, pinopode cells, ciliated cells and others without apical differentiation. We highlighted important differences between surface and glandular epitheliums. Pinopode cells are present in all biopsies; they are more frequent in glands than surface. Their maximum expression in the glandular epithelium is at the day 20 and in the surface epithelium at the day 22. The pinopodes are present since day 19, they appeared fully developed with a maximum at day 22. Using TEM for ultrastructural analysis, we showed images of endocytosis and numerous secretory vesicles in epithelial cells of the endometrium. Their plasmic membrane present apical differentiations in the form of microvilli covered with a very developed cell coat indicating a high activity of exchange with the extracellular compartment. The endometrial cells exhibit extensive signs of communication between neighboring cells appeared to be preserved. CONCLUSION: Our data suggest each cell type and each cell structure as a very precise function in order to prepare the endometrium to be receptive.

[Association of Sjögren's syndrome and Plummer Vinson syndrome]. / Association d'un syndrome de Gougerot Sjögren et d'un syndrome de Plummer Vinson.

Dysphagia is a common complaint of patients with Sjogren's syndrome, but its mechanism remains a subject of controversy. The association of Sjogren's syndrome with Plummer-Vinson syndrome remains uncommon. We report a 56-year-old women who presented both disorders. The diagnosis of the Plummer-Vinson syndrome was based on the classic triad of dysphagia, iron-deficiency anaemia and oesophageal webs. The diagnosis of Sjogren's syndrome was based on the presence of three Fox criteria. This association should incite us to search for common immuno-genetic pathogenic factors between these two syndromes.

Predictive factors of glucocorticosteroid treatment failure in severe acute idiopathic colitis.

INTRODUCTION: The purpose of our study was to determine clinical, biological or endoscopic factors that could predict glucocorticosteroid treatment failure in acute colitis. PATIENTS AND METHODS: Fifty-four Tunisian Caucasian patients with acute idiopathic colitis (ulcerative colitis in 53 patients, Crohn's colitis in 1 patient) have been evaluated. Non-therapeutic response was defined as over 6 bowel movements per day, blood visible to the naked eye in stools on the fifth day after admission or the development of a complication inducing a resort to surgery. Predictive factors were assessed using bivariate and multivariate analysis. RESULTS: Thirty-nine patients (72.2%) had no medical response. In univariate analysis, predictive factors of therapeutic failure were: male sex, tobacco, previous history of colitis attacks, bowel movements per day over seven at admission and on day three, and pulse rate over 90/mn, temperature over 38 degrees C, systolic blood pressure below 11 on day 3 and on day 5 after admission. In multivariate analysis, bowel movements over seven per day on day 3 of hospitalization and male sex independently predicted a failure of glucorticosteroid treatment. CONCLUSION: Bowel movements per day over seven on day 3 of hospitalization and male sex were the independently predictive factors of failure of glucocorticosteroid treatment.