[Papillary carcinoma in a thyroglossal duct cyst, a case report: Which management]

Cysts of the thyroglossal duct are common but malignant degeneration is rare, occurring only in 1% of the cases. The most frequent histological type is papillary carcinoma. The clinical presentation of these cancers is generally nonspecific, diagnosis being established postoperatively using the Sistrunk method. Debate remains open concerning appropriate management strategies and post-therapeutic follow-up for this type of neoplasia. We report the case of a 45-year-old patient who underwent surgery for an anterior neck mass that had developed over three years. Histology favored multifocal papillary carcinoma in a thyroglossal duct remant. Total thyroidectomy was performed. The postoperative protocol, established empirically due to the absence of consensus, included radioactive iodine and hormone suppression even though the thyroid was intact. After one year of follow-up, outcome has remained favorable.

[Transfusion practice and attitudes]

During last years, blood transfusion and transfusion security were domains which have preoccupied health authorities, the population and health professionals. Beginning with the principle that blood transfusion is a care that must be under medical responsibilities, authors analyse physician's implication in this field. To reach this objective, a study interested 199 young physicians, working in two university hospitals in Tunisia. Results indicate that physician's knowledge about blood transfusion is insufficient to guarantee quality of this medical act. In terms of attitudes and practices, physicians are not really always implicated in the different stages of blood transfusion process. Intervention is limited to prescription and blood transfusion record card writing. Transfusion herself and monitoring were, in particular, delegated to nurses. So transfusion incidents were under--declared. Transfusion medicine must occupy important place in physicians curriculum. At hospital level, quality insurance process, based on audit, have to be implemented to obtain transfusion good practices, in a domain were risks are unfortunately not yet totally circumscribed.

[Psychological aspects and details of care of patients on hemodialysis]

Chronic renal failure and periodic hemodialysis, by the physical reach and the therapeutic imperatives that they mislead disrupt by several ways the universe of the patient. This one is confronted to changes, or even to aggressions that undergo his body, his domestic and socio-professional life, which is accepted in general with difficulty. Indeed, our survey that concerned 109 patients on chronic hemodialysis shows that the minor psychiatric pathology is frequent and can represent a source of problems as well for the patients that for the medical and nursing staff. Besides the analysis of minor psychiatric specificities revealed by a known measure instrument (the GHQ), this work insists on the importance to take account of this aspects with the aim to enhance management and holistic care of these patients.

[Influence of socio-professional factors on absenteeism of hospital personnel]

The goal of this work is to analyze the different reasons of absenteeism in hospital and to identify the socioprofessional characteristics of absentees, what would permit to guide a strategy on modes and content of a preventive action. The adopted methodology is a retrospective descriptive investigation carrying on absenteeism of the personnel working in academic hospital Farhat Hached of Sousse (Tunisia) during 1997. So, on the 1433 salaried employees, 1028 (71.7%), left once or more for different reasons. The global absenteeism rate is 4.03% and the mean absence by agent is equal to 14.7 days. Among the absences motives, illness predominate extensively with 55% of the whole. Maternity and postnatal leave constitute 30%, 8% for "Industrial accidents" of work stops. Whatever is the reason, we observes more absent women than absent men. This survey shows the importance of socioprofessional factors in genesis of absenteeism and, to reduce the problem, the necessity to improve conditions of work, moreover in his ergonomic, social and psychological aspects.