[Reasons of diagnostic delay of breast cancer in Tunisian women (160 patients in the central region of Tunisia)]. / Causes du Retard diagnostic du cancer du sein chez la femme Tunisienne: série de 160 patientes au centre Tunisien.

BACKGROUND: The diagnosis of breast cancer is, in Tunisia, still done at a late stage. AIM: To identify the principal obstacles against early diagnosis of breast cancer for patients consulting at advanced locally stage or with metastasis. METHODS: We have asked 160 patients with breast cancer showing local T3 or T4 evolution or metastasis at the time of diagnosis, about reasons for the late diagnosis of their breast cancer. RESULTS: The average delay in consultation was 11.6 months and the average size of the tumor was 6.3 cm. The cause of delays in diagnosis was, in 92.5% of cases linked to the patient, and in 24% of case to medical personnel. Two many causes found in patients were: a none-attribution of the symptoms as cancer (35%), and the absence of self-examination of the breasts (23.5%). A comparison of patients according to the cause of delay demonstrated that the distance from a medical centre is more frequent in the case of medical delays, the level of education is lower in patients who fail to carry out self-examination, the more frequent relevant family history of patients who have not attributed the symptoms to cancer, and the relative distance from a medical centre is more pronounced in women in difficult financial circumstances. CONCLUSION: Changing patient behaviour by public health education, besides professional educational programs could help to ovoid diagnosis delay of breast cancer in Tunisia and improve its outcome.

[Quality of life in patients with colo-rectal cancers at a Tunisian hospital center. A case control study of a population unhurt by cancer]. / Qualite de vie des patients traites pour cancers colo-rectaux au Centre Tunisien. Etude cas témoin avec une population indemne de cancer.

UNLABELLED: The aim of our study is to value the quality of life (QOL) in patients with colo-rectal cancers in the region of tunisian center and to compare it to the QOL in a healthy population unhurt of cancer. METHODS: Our population is made by 80 patients treated for coloractal cancers. The population witness includes 80 healthy individuals unhurt of cancers. The assessment of the QOL in patients is achieved with the specific colo-rectal cancer questionnaire: the FACT-C. The comparison of the QOL in the 2 populations is made by the general questionnaire of quality of life of Spitzer. RESULTS: The QOL in patients is good in 55% of cases, average in 44% of cases and bad in 11% of cases. The QOL is better in case of favourable socioeconomic conditions (p < 0,05), colic localization (p < 0.015), absence of metastases (p< 0.05), not mutilating surgery (p < 0.01) especially the absence of stoma (p < 0.001) and the restoring of the continuity (p < 0.002), absence of pain (p < 0.0001), absence of current treatment (p < 0.01). The comparison of the different domains of QOL between the 2 groups (patients and healthy) finds a better QOL in healthy group, in all domains except for the relational ship domain witch turned to be comparable for the 2 samples.

[Knowledge, attitude and behavior about the inherited predisposition to cancer. A survery of a population without any history of cancer in central Tunisia]. / Connaissances, attitudes et comportements vis a vis de la predisposition hereditaire aux cancers. Enquete aupres d'une population indemne de cancers dans le centre Tunisien.

The genetic bases of inherited predisposition to cancer are now established. The aim of our study is to value the knowledge, attitude and behavior of the general population about the inherited predisposition to cancer. Our study involved a population of 200 individuals. Without any history of cancer. The mean age of our population was 37.5 years (18 to 74 years). The education level was low in 62.5% of cases (illiterate or primary education). About knowledge: heredity was considered a predisposing factor to cancer by 42.5% of the respondents. About attitude: we noted a cancerophobia in 82% of cases. 86.5% of our respondents trought that an early diagnosis increased the chance of recovery. About behavior: 72.5% of the studied population wishd to know if they were predisposed to develop cancer. In case of pregnancy, 79% wished to know if the foetus wasa cancer gene predisposition carrier. 28% would keep this foetus in case of positive genetic testing. These results are encouraging to develop oncogenetic counselling in Tunisia.

[Quality of life in oncology]. / Qualite de vie en cancerologie.

The measure of the quality of life in cancerology appears more and more as a fundamental criteria in the evaluation of therapeutic results. The study of the quality of life obeys three types of aims: descriptive, correlational and explanatory, and therapeutic. For evaluation, scales for quality of life were introduced, these scales use a quotation technique with the help of questionnaires or linear analog self assessment. Questionnaires represent the mostly used method. They are composed of several questions or items having predetermined answers for which the patient should check or circle the choice corresponding best to his state. To be useable, a questionnaire must satisfy certain criteria of quality: reliability, validity and sensitivity. In spite of the remarkable progress during recent years in the evaluation of the quality of cancerous patient life, there still exists some conceptual and practical problems that are not yet solved.

[Perianal ulceration revealing Langerhans cell histiocytosis]. / Histiocytose langerhansienne révélée par une ulcération péri anale.

Langerhansian histiocytosis is a rare and heterogenous disease. Skin localisation is common but the lesion usually have typical aspect and topography. Peri anal localisation is rare. We report a case of isolated peri anal ulceration revealing a Langerhansian histiocytosis in a young patient.

[Diagnosis and treatment of primary germ cell tumors of the mediastinum. Report of six cases]. / Diagnostic et traitement des tumeurs germinales malignes primitives du mediastin. A propos de six cas.

Primary germ cell tumours of the mediastinum are rare. We report a retrospective study of six cases. Sex ratio was 2/1. The tumor site was the posterior mediastinum in two patients and anterior in the remaining cases. High level serum markers was noted in two patients. At histologic exam we found two cases of seminoma, one embryonal carcinoma, one case of yolk sac tumor and two cases of composite tumor. All patients had non metastatic but locally advanced disease at diagnosis. Three patients were treated with cisplatin based chemotherapy followed by radiotherapy or surgical resection of residual masses. Only one patient is still alive. As it is often reported in the literature, the prognosis of this disease is poor especially for non seminomatous tumours.

[Breast cancer in elderly women in Tunisia. Retrospective study of 106 patients older than 65 years]. / Le cancer du sein chez la femme âgée en Tunisie. Etude rétrospective à propos de 106 patientes de plus de 65 ans.

OBJECTIVE: To report the epidemiological profile, anatomo - clinic, prognostic and therapeutic of breast cancers in aged woman from the region of the Center of Tunisia. Our retrospective study concern 106 patients with mammary cancers treated between January 1990 and December 1997 at the Farhat Hached Hospital in Sousse (Tunisia). The mean age was 71 years (extremes 65-91), 66% of the patients had an age more than 75 years, the mean age at the menopause was of 50 years. The size middle clinic was of 50 mm, 45.3 % of tumors was classed T4, 39.6 % T3. 39.6% of patients have a clinical axillary adenopathis. 14.2% of patients have metastases at diagnostics. 62.5% of the cases have a high histo-pronostic grading. The prognostic factor analysis recovered in multivary survey two parameters significatifs for the survival: the size tumoral (p <0.005) and the presence of metastases at the time of the diagnosis (p <0.001). The biologic and evolutionary features of the cancer of the breast in the aged woman bring to consider the hormonal approach like the most logical, especially for the patients bearers of hormonosensibles tumors, of or the interest of the systematic dosage of the hormonal receptors.

[Not Available]. / Ostéosarcome primitif du rein avec évolution métastatique au foie. Etude de cas et revue de la littérature.

Primary osteosarcoma of the kidney is very rare. Its exact histogenesis remains unclear. It has a tendency to recur locally and metastasize, and the prognosis is very poor. We present a case of a 59-year-old woman with left flank pain and weight loss. Abdominal ultrasonography and bone scan revealed a large solid retroperi-toneal mass with calcifications. The patient underwent radical nephrectomy; microscopic examination showed atypical cells with the characteristic pattern of classic osteosarcoma with immature neoplastic osteoid. Ten months later, the patient developed metastatic lesions in the liver, without local recurrence or other sites of metastases. The patient is currently receiving chemotherapy with doxorubicin and cisplatin, with a follow-up in 17 months. The most important clinical findings, the pathogenesis and the treatment modalities of this rare neoplasm are discussed.

Postirradiation osteosarcoma of the maxilla: a case report and current review of literature.

Background. Radiation-induced sarcomas are well-known potential late sequelae of radiation therapy. They are of rare occurrence in jaw bones and are even rarer in the maxilla. Case report. We report a case of radiation-induced osteosarcoma involving the maxilla in a patient treated with radiotherapy for nasopharyngeal carcinoma 14 years ago. Despite neoadjuvant chemotherapy, surgical treatment could not be performed, and the patient received palliative chemotherapy. Conclusions. Radiation-induced osteosarcomas are aggressive and often elude early detection and timely intervention, rapidly leading to early demise of afflicted patients. Long-term patient follow-up and a high index of suspicion are crucial for timely intervention.

[Epithelial advanced ovarian carcinoma in the central region of Tunisia: therapeutic results and prognostic factors on 104 patients]. / Les tumeurs épithéliales malignes évoluées de l'ovaire dans le centre tunisien: résultats thérapeutiques et facteurs pronostiques à propos de 104 cas.

Between 1994 and 2004, 104 patients with epithelial advanced ovarian cancer were treated in the central region of Tunisia (81 stage III and 23 stage IV). Average age of patients was 54 years. Primary surgery was optimal (residue < 2 cm) in 40 cases (38,5 % of patients). Fifty nine patients were treated with neo adjuvant chemotherapy based on platinum, associated to paclitaxel in 19 % of cases. Interval debulking surgery interested 30 patients and was optimal in 66,7 % of cases. Global survive was 57 % at 2 years and 27 % at 5 years. Survival rate for patients treated with optimal debulking surgery was similar to that of those treated with initial optimal surgery. Prognostic factors for a better survive were : age < 40 years (p < 0,05), stage III (p < 0,01), a normal level of CA125 after surgery (p < 0,01), primary optimal initial surgery (p < 0,02) and response to neoadjuvant chemotherapy (p < 0,01). Prognosis of ovarian carcinoma is worse in Tunisia as like as in the world. In case of extensive tumor, the neoadjuvant chemotherapy before interval debulking surgery permits to improve survive and quality of life in some patients.

[Non-metastatic thrombosis of the superior sagittal sinus complicating Burkitt's lymphoma. A case report]. / Thrombose non tumorale du sinus longitudinal supérieur compliquant un lymphome de Burkitt. A propos d'un cas.

We report a case of non-metastatic superior sagittal sinus thrombosis complicating a Burkitt's lymphoma of the small bowel, and review similar cases of this cerebrovascular disorder associated with lymphoma.