Sfax, Tunisia
Sfax, Tunisia

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Charfi S.,CHU Habib Bourguiba | Charfi S.,University of Sfax | Sellami A.,CHU Habib Bourguiba | Affes A.,CHU Bourguiba | And 4 more authors.
International Journal of Colorectal Disease | Year: 2014

Purpose: Appendicitis is by far the commonest major emergency general surgical operation. Histopathological examination of the appendix is routinely performed. Methods: This study is a retrospective analysis of 24,697 appendectomies performed from January 2003 to December 2011. Pathological reports were analyzed for the following parameters: age, gender, and pathological diagnosis. Results: Appendectomy specimens represent 17 % of all pathological reports. Acute appendicitis was present in 19,637 (79.5 %) patients. The perforation rate was 6.3 % and was significantly higher in adult patients. The negative appendectomy rate was 15 % and was significantly higher in female and adult patients. The incidence of negative appendectomies had clearly decreased over the 9-year period distribution. Incidental unexpected pathological diagnoses were noted in 226 (0.9 %) appendectomy specimens. Neoplastic lesions were present in 171 cases (0.7 %); they include carcinoid, adenocarcinoma, and mucinous neoplasms. Conclusions: Routine pathological examination of appendectomy specimens is expensive. With advances in technology and imaging modalities, the diagnosis of acute appendicitis has improved, with a subsequent significant reduction in negative appendectomy. There are still a number of unusual diagnoses found in appendicectomy specimens supporting the continued use of routine histology. © 2014 Springer-Verlag.


Feki-Tounsi M.,University of Sfax | Olmedo P.,University of Granada | Gil F.,University of Granada | Khlifi R.,University of Sfax | And 2 more authors.
Environmental Science and Pollution Research | Year: 2013

Prior investigations identified an association between low-level blood arsenic (As) and bladder cancer risk among Tunisian men but questions remain regarding confounding by cadmium (Cd), a well-established bladder carcinogen. A case-control study of Tunisian men was re-examined to assess the levels of cadmium in blood and reparse the association between the simultaneous exposure to these metals and bladder cancer risk. Levels of blood Cd were significantly twice higher among cases than in controls (P < 0.05) and were positively correlated with smoking and age. Additionally, analysis of metal levels among non-smokers according to the region of residence showed very high blood Cd and As levels for the coastal regions of Sfax and central Tunisia. After controlling for potential confounders, for low blood As levels (<0.67 μg/L), the OR for blood Cd was 4.10 (95 % CI 1.64-10.81), while for higher levels (>0.67 μg/L), it was reduced to 2.10 (CI, 1.06-4.17). Adjustment for Cd exposure did not alter the risk associated to As exposure. This study is the first to report the relationship between Cd exposure and risk of bladder cancer occurrence in interaction with smoking and As exposure. Smoking is shown to be the main exposure source to Cd in the Tunisian population but also environmental pollution seems to be responsible of Cd exposure among non-smokers. Exposure assessment studies encompassing a wider population are needed. © 2013 Springer-Verlag Berlin Heidelberg.


Feki-Tounsi M.,University of Sfax | Olmedo P.,University of Granada | Gil F.,University of Granada | Mhiri M.-N.,CHU Habib Bourguiba | Hamza-Chaffai A.,University of Sfax
Environmental Science and Pollution Research | Year: 2014

The incidence of bladder tumors has been dramatically increasing since the 1970s, possibly as a consequence of ongoing environmental pollution. Previous studies have provided some evidence of an association between cancer and exposure to carcinogenic metals. In order to examine the association between levels of toxic metals in patients with bladder tumors and controls, the amounts of arsenic, cadmium, chromium, and nickel were measured in tumoral lesions and adjacent normal part of the bladder mucosa excised for carcinoma and compared with those in the bladder mucosa of volunteer subjects operated for non-neoplastic diseases. The quantification of metals in tissue was assessed by atomic absorption spectroscopy. In tumoral tissues of the excised bladder mucosa, content of Cr and Ni was significantly low compared to that of adjacent normal tissues and control tissues while that of As and Cd in normal tissues adjacent to the tumor were significantly elevated compared to controls. Though the sample size was small, the present study shows that concentrations of metals such as Cd, Cr, As, and Ni in bladder tissue may be used as a biomarker of exposure. On the basis of the results obtained in this study, high amounts of As and Cd in adjacent normal parts of the bladders with carcinomas compared to controls would strongly suggest possible, individual or synergistic, effects of these pollutants on enzymatic systems, priming an oncogenic pathway. © 2014, Springer-Verlag Berlin Heidelberg.


PubMed | CHU Hedi Chaker, Regional Laboratory of Hygiene, CHU Habib Bourguiba and University of Monastir
Type: Journal Article | Journal: International journal of mycobacteriology | Year: 2016

To evaluate patients profiles, demographics, clinical and therapeutic approaches and strategies in patients with tuberculous lymphadenitis (TBG).A retrospective study of all TBG-confirmed cases admitted in a tuberculosis-specific health care facility between 1 January 2009 and 16 June 2013.A total of 181 clinical files were examined. Mean age was 32years old; the female/male ratio was 1.78 to 1. Raw milk consumption was noted in 1/3 of patients. Most cases involved the head and neck region (83.4%), nodes involvement, including axillary (12 cases), and mediastinal (9 cases). Clinical symptoms were present in only 55.2%. Tuberculin skin test (TST) was conducted with 82.6% positive responses. Diagnostics confirmation was done with anatomical pathology in most of the patients; only 56 of them had any microbiology analysis done. Demonstration of acid-fast bacilli in microscopy from either fine-needle aspirates or biopsies was done in 17.5% of cases, and cultures yielded positive results in 27%. Treatment duration was varied. Paradoxical reactions were noted in 12% and persistent lymphadenopathy after treatment completion was noted in 10% of cases.TBG remains a disease of interest. Today, its diagnosis and management is still a problem despite its increasing worldwide incidence, and especially in this study area. Disease control should be strengthened in this country.


PubMed | University of Sfax, CHU Habib Bourguiba and University of Monastir
Type: | Journal: Annals of physical and rehabilitation medicine | Year: 2016

To determine the effect of completing a vestibular rehabilitation treatment protocol on postural balance, dizziness and quality of life in patients with peripheral vertigo.A prospective study concerning patients with instability due to unilateral peripheral vestibular disorder. The patients were evaluated with a clinical examination and a test of static and dynamic balance on the SatelThirty patients with mean age of 52.268.45years were included: 7men and 23women. Twelve patients had vestibular neuritis sequelae (46,7%), 10 otolith disorders (33,33%),and 6 Menieres disease (20%). An improvement in the intensity of dizziness, postural parameters and quality of life was considered (0.01) with the intervention. The main balance parameters (Long X and Long Y) have decreased after the rehabilitation protocol. This improvement was significant in the static condition eyes closed. The mean of Long X decreased from 489.05327.07 to 365.09268.82mm (P<0.001). The average Y Long decreased from 853.49734.19 to 569.08530.55 (P<0.001). We noted an improvement of vertigo condition (the mean total score of VSS decreased from 22.26.74 to 10.863.54 (P<0.001)) and the quality of life (the mean total score DHI has decreased from 37.68.35 to 18.15.56 (P<0.01).Postural balance and quality of life improve with postural rehabilitation and optokinetic stimulation in patients with peripheral vertigo. This technique must be applied as early as possible by a specialized physiotherapist to promote the elimination of the unpleasant symptoms related to this dysfunction.


Abrikossoff's tumour or granular cell tumor or is a benign neurogenic tumour. It is ubiquitous with the most frequently affected site is the head and neck region. Aims: To report a series of granular cell tumors and to discuss its clinicopathologic features and histogenesis. We report a series of nine cases diagnosed between January 2004 and December 2006 in the Pathology Department of the University Hospital of Sfax. We have collected the clinical aspects and we have proceeded on a pathological, cytochemical (PAS and PAS diastasis) and immunohistochemical study. Nine cases of TCG are presented: 5 females and 4 males. The median age was 33.9 years (extremes: 7 and 53 years). All tumours were unique. The most common localization was in the head and neck region (5 cases). The diagnosis was suspected using standard histologic criteria and confirmed by immunohistochemistry: tumour cells expressed vimentine (90%), S100 protein (100%) and neuron specifique enolase (80%). In all cases patients were treated by excisional resection and had a benign course with no evidence of recurrence (median follow up: 2 years). Granular cell tumours are rare neoplasm which must be recognised because they demonstrate a benign behaviour after their surgical excision. Histological features of granular cell tumours are commonly characteristic but some times they can be misdiagnosed as malignant tumours especially when the biopsy is superficial. The staining for neurogen markers and PAS are useful tools.


PubMed | CHU Habib Bourguiba
Type: Journal Article | Journal: Canadian journal of anaesthesia = Journal canadien d'anesthesie | Year: 2016

Amniotic fluid embolism is always a severe complication and generally occurs during labour or immediately after childbirth.We report the case of a patient falling victim to amniotic fluid embolism after the medical termination of her pregnancy at 24 weeks of amenorrhea following the discovery of a teratoma-carrying foetus. The amniotic fluid embolism diagnosis was strongly suspected in the face of the sudden onset of severe arterial hypotension, hypoxic respiratory distress, a coma state and disseminated intravascular coagulopathy immediately after the delivery. Additional tests were conducted to support the diagnosis: cytological testing of a peripheral venous sample and maternal broncho-alveolar lavage fluid, dosing of tryptase and alpha-fetoprotein levels as well as screening for insulin-like growth factor binding protein 1.Amniotic fluid embolism is a rare and difficult diagnosis, especially in unconventional settings, yet it can be facilitated by screening for amniotic markers and tryptase.


PubMed | CHU Habib Bourguiba
Type: Case Reports | Journal: Asian cardiovascular & thoracic annals | Year: 2015

A 13-year-old boy was admitted to our hospital with complaints of posterior chest pain and dyspnea. Computed tomography and magnetic resonance imaging of the chest revealed a mass in the posterior mediastinum, extending from T8 to T11 with intraspinal involvement. A percutaneous core needle biopsy confirmed the diagnosis of Burkitt lymphoma. He was treated according to the Lymphoma Malignancy B protocol 2001 arm C3, but he presented with liver and brain relapses and died 7.5 months after admission. Although lymphoma is rarely localized in the posterior mediastinum, it should be considered in the differential diagnosis of posterior mediastinal masses in children.


PubMed | CHU Hedi Chaker and CHU Habib Bourguiba
Type: Journal Article | Journal: Breast disease | Year: 2015

Breast cancer is the most frequent malignant neoplasm affecting Tunisian women. It represents 25 to 35% of all female cancers. There is no published study about the features of Her-2 overexpressing breast carcinomas in North African women.The aim of this study is to assess the prognostic significance of pathological features in a cohort of a Her-2 overexpressing breast carcinoma originating from the region of south Tunisia.This study investigated a series of 100 patients followed from January 2006 to December 2011 for a Her-2 positive invasive breast carcinoma. Pathological features included in this study were: histological type, histological grade, tumor size, vascular invasion, perineural invasion, mitotic index, lymph nodes stage, positive lymph node capsular effraction, inflammatory infiltrates, nipple involvement and hormone receptors status.Multivariate analysis showed that pT stage, pN stage, capsular effraction, vascular invasion, perineural invasion and Nipple involvement were independent prognostic factors for overall survival and disease free survival in patients free from distant metastasis at diagnosis. For patients with synchronous metastasis, there is no independent pathologic prognostic factor for survival.Our study demonstrates that pathological features are important prognostic factors for non metastatic Her-2 overexpressing breast carcinomas. This supports the idea that HER2-positive disease is a heterogeneous entity. We believe that these findings reinforce the need to identify molecular predictors of benefit and resistance to anti-Her-2 based therapies.


PubMed | CHU Habib Bourguiba
Type: Case Reports | Journal: Journal des maladies vasculaires | Year: 2015

Head injuries are described in the literature as a rare but possible etiology of cerebral venous thrombosis although no pathophysiological link has been identified. Trauma-related venous thrombi occurring in the brain produce a broad spectrum of clinical presentations. A purely psychiatric term is exceptional, leading to misinterpretation and late diagnosis. Positive diagnosis has been greatly improved by advances in magnetic resonance imaging with venous phase angiography, currently the gold standard exploration. We report the case of a patient who presented with post-trauma cerebral venous thrombosis revealed by psychiatric disorders.

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