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Hammam Sousse, Tunisia

Fekih M.,Service de gynecologie obstetrique | Mansouri-Hattab N.,Unite de Chirurgie Maxillofaciale | Bibi M.,Service de gynecologie obstetrique | Fekry T.,Unite de Chirurgie Maxillofaciale | And 3 more authors.
Journal Africain du Cancer | Year: 2010

Objective: The purpose of this study is to analyze the oncologic outcome of immediate reconstruction after mastectomy for breast cancer and the impact of adjuvant treatments on cosmetic results. Patients and methods: This retrospective study concerns 38 consecutive advanced abdominal flap with breast prothesis, realized immediately after mastectomy for breast cancer by one surgeon between 1997 and 2008. Results: The average retrospective period was 34.5 months. Recurrence was observed in three caseswithout late diagnosis. It was local in two cases and systemic in one case resulting in death 18 months after reconstruction. Breast tumor in these cases had several initial poor prognostic factors. Delayed scarring was noted in one case due to post-radiation cutaneous necrosis. Capsular contracture was also observed in two women who received postoperative radiotherapy. In our study, esthetic results were considered poor in three cases because of prothesis removal in these cases, acceptable in 10 cases, good in 20 cases, and excellent in 5 cases. Conclusion: Immediate breast reconstruction using advanced abdominal flap associated to a prothesis doesn't affect neither local and systemic recurrence rates nor overall survival. Cosmetic results are overall good. © 2010 Springer Verlag France. Source


Gara S.,Institute Salah Azaiez | Meziou S.,Institute Salah Azaiez | Mtar A.,Institute Salah Azaiez | Ghanem A.,Institute Salah Azaiez | And 4 more authors.
Tunisie Medicale | Year: 2012

Aim: To evaluate the prognostic value of preoperative serum carcino-embryonic antigen (CEA) level in patients with colorectal cancer. Methods: This retrospective study included 125 colorectal cancer patients aged from 14 to 87 years, surgically treated between January 2001 and December 2006. Preoperative serum CEA was measured by chemiluminescence assay. Results: within the patients, 57 were males and 68 females. They have tumours classified Dukes A in 2 patients, B in 24 patients, C in 53 patients and Dukes D in 46 patients. Median follow-up period was 24 months (range, 4 - 72 months). The relapse-free survival was significantly higher in patients with CEA < 5 ng/ml compared to CEA ≥ 5 ng/ml, (p < 0.0001). We observed significant differences in relapse-free survival between patients with CEA < 5 ng/ml and those with CEA ≥ 5 ng/ml among patients classified as Dukes stage B (p=0.007) and C (p < 0.0001). However, there was no significant difference in relapse-free survival among those classified as Dukes stage D. Cox multivariate analysis demonstrated that preoperative serum CEA level was a significant independent prognostic factor for relapse-free survival (hazard ratio: 6.49, 95% CI, 3.09 to 13.62, p < 0.0001). Conclusion: Preoperative serum CEA is a reliable predictor factor for recurrence in patients with CRC. CEA might be used in staging system and will be useful for therapeutic orientation in patients undergoing curative resection of CRC. Source


Landolsi A.,Service de Medecine Carcinologique | Chabchoub I.,Service de Medecine Carcinologique | Limem S.,Service de Medecine Carcinologique | Gharbi O.,Service de Medecine Carcinologique | And 9 more authors.
Bulletin du Cancer | Year: 2010

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 fiveyear overall survival (OS) was 62%. In high grade lymphoma patients favorable prognostic factors for OS included young age ≤ 60 years, PS < 2, normal serum LDH, hemoglobin > 12 g/dL, B phenotype, localised stage (IE-IIE1), anthracyclin-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 ≤ 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. ©John Libbey Eurotext. Source


Gharbi O.,Service de Medecine Carcinologique | Chabchoub I.,Service de Medecine Carcinologique | Limam S.,Service de Medecine Carcinologique | Hochlef M.,Service de Medecine Carcinologique | And 9 more authors.
Bulletin du Cancer | Year: 2010

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 desease 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. ©John Libbey Eurotext. Source


Landolsi S.,Service de Medecine Carcinologique | Gharbi O.,Service de Medecine Carcinologique | Zrig M.,Service dOrthopedie | Gribaa M.,Laboratoire Of Cytogenetique Et Of Biologie Of La Reproduction | And 5 more authors.
Annales de Biologie Clinique | Year: 2010

Li Fraumeni Syndrome (LFS) is a rare autosomal disorder characterized by a familial clustering of tumors. Analysis of several series of LFS families have shown that 70% of such families are attributable to germ-line mutations in TP53. We report the case of a patient who had a first degree family antecedent of cancer in young ages. At the age of 31 years, the patient was operated of bladder papillary superficial carcinoma; five years later, he was treated for a high grade pleomorphe sarcoma of the left thigh and treated by surgery, adjuvant chemotherapy and radiotherapy. At the age of 38 years, after abdominal pain, radiologic examination reveled pancreatic tumor with bone and lymphatic metastases. The patient died one month later from pulmonary embolism. Sequencing revealed a germiline mutation of this patient that was confirmed in a member of his family in codon 1009C>T, protein Arg337Cys, exon 10 of TP53 gene this mutation was revealed in his nephew (died at the age of 20 from bone sarcoma). Source

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