[Lesions classified ACR3 with the breast cancer screening mammography program of the Ariana area: features and problems encountered]

OBJECTIVE

This retrospective work is related to ACR3 mammograms of the program "Feasibility of breast cancer screening by mammography in Ariana Governorate" in order to evaluate the efficiency and short-term quality control of these probably benign lesions.

MATERIALS AND METHODS

Mammograms classified ACR3 raised the indication of further examination, futher mammogram (profile, expanded or compression). The monitoring and control period are explained to the patient by the radiologist.

RESULTS

6.6% mammograms were classified as ACR 3 with 71.3% under the age of 50 years. Breast is very dense in 20.5% of cases, and transparent in 6% of cases. Further exams has been performed in 94. 5% of cases with a profile in 52% of cases, enlarged in 22.1%, compression in 24.9% and ultrasound in 82.5%. The surveillance protocol was insufficient for 126 women lost to the 1st control, 32 women lost for the 2nd control and 19 women were lost to the 3rd control. After two years monitoring, 219 women were reclassified as ACR2 with a negative test. In 2 patients, we found an invasive ductal carcinoma at 4 months control.

CONCLUSION

ACR 3 mammograms are the most important operator dependent category. The diagnosis of probably benign lesion dependant of the analysis of images and requires a great experience of the radiologist and a comprehensive complementary examination. In this study, this assessment was often heavy in relation to the frequency of dense breasts itself in connection with the young age of patients. In addition, for this particular category, the need of training is important and in terms of public health cost, the management of ACR3 mammograms increases difficulties and cost of screening.

[Radiological protocol of large scale mammographic screeening for breast cancer in Ariana area of Tunisia]

We present the radiological protocol of the breast cancer screening program of Ariana state in Tunisia. Specifications of this protocol are largely inspired from the french model adapted to the socioeconomic Tunisian conditions. We explain the guidelines of the mammograph specifications, quality insurance of all the process, mammography procedure, double reading, complementary views and ultrasound indications and final results management.

[Retrospective results of ultrasonographically-guided biopsy the breast cancer screening program of the Ariana area of Tunisia]

OBJECTIVE

To report the results of breast ultrasonographically-guided fine needle aspirations and needle biopsies within the breast cancer screening program of L'Ariana state in Tunisia.

MATERIAL AND METHODS

Our retrospective study include 143 patients, with mammographically detected lesions, which underwent a diagnostic percutanous ultrasonographically guided procedures. 57 patients underwent a fine needle aspiration, 25 underwent a needle biopsy and 61 patients underwent both procedures.

RESULTS

Sensitivity and specificity of fine needle aspiration are of 84.2% and 98.5%. We report 13.5% of non contributive results. The needle biopsy have a sensitivity of 97.3% and a specificity of 100% with one false negative corresponding to an atypical ductal hyperplasia at the excisional biopsy.

CONCLUSION

Fine needle aspiration is a reliable method of accurately establishing a diagnosis. Needle biopsy is recommended for a preoperative lesion characterisation before adequate treatment.

[Experience of a multidisciplinary team in the management of superficial venous malformations: 99 cases]

BACKGROUND

Vascular malformations are heterogenous angiodysplasias.

AIM

The aim of this work is to study the epidemiological and clinical features of venous malformations (VM) as well as their multidisciplinary management.

METHODS

It is a retrospective study of patients having simple VM, seen at the multidisciplinary consultation of angiodysplasias of our hospital, over a 10 year period.

RESULTS

This study included 99 patients having VM. A female predominance was noticed. Average age was 18.5 years. VM had mainly cephalic location. All VM were treated with percutaneous sclerotherapy. Aesthetic results were excellent in the cases of small VM size.

CONCLUSION

VM are most frequent in cephalic region and cause aesthetic and functional handicaps. Percutaneous sclerotherapy is the treatment of choice for such a venous malformations, especially for small VM. VM are anomalies which can have serious complications. Their management has to be multidisciplinary in order to better precise the diagnosis and to take the adequate therapeutic decision.

[Arteriovenous malformations: study about 54 patients]

BACKGROUND

Arteriovenous malformation (AVM) are vascular anomalies that may threaten functional and vital prognosis. The aim of this study was to assess the managment of Arteriovenous malformation

METHODS

It is a retrospective study about 54 patients, having AVM, collected over a 7-year period.

RESULTS

Sex ratio MJF was 1.25; average age at the diagnosis was 25.4 years. Puberty, pregnancy and trauma, were the most important favoring factors for the development of AVM. Location was the head in 75% of the cases. Doppler ultrasound was the most indicated examination to confirm the diagnosis. In over than 70% of our patients, therapeutic abstention and follow-up were indicated. In the other cases, embolization, with or without surgery was the treatment. A patient died of massive haemorrhage. Treatment is necessary in complicated AVM. Follow-up (if abstention or after treatment) is mainly based on clinical and Doppler data.

CONCLUSIONS

AVM are anomalies that may be serious and their management must be multidisciplinary, to allow better therapeutic indications.

Aspect en IRM du neuro-behcet

PURPOSE

Describe the patterns and location of lesions seen on MR imaging in neuro-Behçet's disease.

OBSERVATIONS

33 patients with neuro-Behçet's disease (mean age: 27 years) imaged by MRI were reviewed. Most common neurologic symptoms included headaches and pyramidal signs. MRI examinations (Siemens Magnetom Impact 1 Tesla) included the following sequences: T1wi, T2wi, Flair, MPR-3D and MRA sequences.

RESULTS

Parenchymal lesions were identified in 21 patients. Brainstem, internal capsule, cerebral white matter, basal ganglia were involved respectively in 14, 10, 7, and 5 cases. Vascular thrombosis (venous: n=7; arterial: n=1) were observed in eight. MRI was normal in four patients.

CONCLUSION

This study shows the value of MR imaging for the exploration of parenchymal lesions of neuro-Behçet's and confirms the frequency of brainstem involvement.

[Osteoid osteoma of the coccyx: a case report]

The spine is a rare localization of osteoid osteoma and the coccyx even more exceptional. We report a case of osteoid osteoma of the coccyx in a young man who consulted for sacrococcygeal pain partially relieved with salicylates. Computed tomography of the region demonstrated a typical osteoid osteoma lesion. CT-guided localization enabled complete resection of the nidus as demonstrated by the CT of the operative specimen Pathology confirmed the diagnosis of osteoid osteoma. Outcome has been quite favorable at two years.

[Transverse fracture of the sacrum: value of imaging. A case report]

Transverse fractures of the sacrum with major displacement are rare and often misdiagnosed. A case of transverse fracture of the sacrum with cauda equina injury is reported. The diagnosis was not recognized initially. Conventional radiographs of the pelvis failed to demonstrate the fracture. True lateral sacral views and CT scan with reconstructions allowed analysis of the different sagittal fracture lines to facilitate surgical planning. These examinations should be considered in all patients with history of high energy trauma and clinical signs indicating lumbosacral injury.

[Post traumatic rupture in patients with uretero pelvic junction obstruction. Case report]

Authors report a case of post traumatic pelvic rupture occurring in an unknown ureteropelvic junction (UPJ) obstruction. Ultrasonography showed pyelectasia and fluid effusion in the anterior perirenal space. CT scan confirmed the diagnosis of UPJ obstruction and showed the rupture of the anterior pelvic wall communicating with a perirenal urinoma. The patient underwent a retrograde stenting for decompression and surgical drainage of the urinoma. Pyeloplasty was performed 4 months after injury. A follow up intravenous pyelogram showed good flow through the repair and the patient remaines asymptomatic 2 years after treatment. Post traumatic rupture of UPJ obstruction is a rare event with few reported cases in literature. Diagnosis is suggested on imaging studies. CT scan shows the rupture site in the ureteropelvic tract and guides percutaneous drainage.

L’imagerie dans la mucormycose rhinocérébrale

PURPOSE

Rhinocerebal mucormycosis is a rare life threatening fungal infection observed in immunocompromised patients. We report six cases of patients with rhinocerebral mucormycosis confirmed histologically. Our study confirms the necessity of early diagnosis when clinical and CT findings are suggestive.

MATERIALS AND METHODS

This is a retrospective study including 6 diabetic patients (3 women and 3 men) aged from 28 and 63 years. Five patients had ethmoiditis evolving for a few days (3 to 5 days), and one patient was in an ketoacidotic coma and had a severe infectious syndrome with purulent rhinorrhea evolving for 4 days. All of our patients underwent computed tomography (CT) scan of the paranasal sinuses. MRI was performed in two patients with neurological findings.

RESULTS

Unilateral ethmoido-maxillary sinusitis was noted in 5 cases. Only one case of pansinusitis was found. All patients presented orbital involvement. Cerebral involvement was noted in 4 cases (cerebral venous thrombosis: 2 cases; abscess: 2 cases; cerebral ischemia: 2 cases). The diagnosis of mucormycosis was based on endonasal biopsy. When available, MRI allowed a more precise evaluation of the orbital and cerebral extension.

CONCLUSION

Mucormycosis is an opportunist mycosis due to mucoralis fungus. It is very invasive with a highly aggressive potential in diabetic or immunocompromised patients. Imaging study particularly CT scan, plays an important role in diagnosis especially to evaluate cerebral extension.

[Intramural small-bowel hematoma due to anticoagulant therapy: a radiologic study; with regard to two cases]

We report two cases of spontaneous small bowel hematoma in two patients receiving long-term anticoagulant therapy. Plain abdominal film, ultrasound, CT-scan and oral barium examination were performed. Abdominal ultrasonography and CT-scan are in most cases relevant for the correct diagnosis of intra-mural small bowel hematoma. The diagnosis was based on the acknowledgment by the patient of anticoagulant drug consumption. Early diagnosis is crucial because most patients are treated nonoperatively with good outcome.

[Treating pain related to inoperable pancreatic cancer in tropical areas: the advantage of CT-guided celiac plexus block and splanchnic nerves neurolysis]

Many sub-Saharan African countries have recently acquired computed tomography scanners that make interventional radiology possible, especially for the treatment of cancer pain. We report the case of a patient with severe abdominal pain related to advanced pancreas cancer. After unsuccessful morphine treatment, he underwent CT-guided alcohol injection for neurolysis of the celiac plexus and splanchnic nerves. This report describes the technique and discusses its potential applications in tropical countries.

[The place of MRI in the hepatic tumors]

MRI semeiology of hepatic tumors was assessed with a retrospective study of 132 patients explored between May 1998 and December 2001. MR examinations were acquired with a one Tesla operating system. All images were acquired by a T2-weighted fast spin echo MR and dynamic flash MR with Gadolinium. Hemangiomas demonstrate characteristic signs in most cases, as was described in the literature. However, adenoma, hepatocellular carcinoma and metastases have various and less specific features.

[Double location of breast and spine tuberculosis. A case report]

We describe the case of a 38-year-old woman with breast tuberculosis associated with a second localization in the lumber spine. These features simulated breast cancer with vertebral metastasis. Clinical and imaging findings are described herein.

[Abdominal polyarteritis nodosa: angiographic features]

PURPOSE

Polyarteritis nodosa (PAN) is a systemic vasculitis of small and medium size arteries. The purpose of this study is to evaluate imaging findings, especially angiographic features, of 17 patients with abdominal involvement from polyarteritis nodosa.

PATIENTS AND METHODS

We reviewed the medical records and imaging findings of 17 patients with PAN involving the abdomen. All patients underwent digital subtraction angiography of the renal or visceral arteries completed by a post-angiographic KUB. Abdominal CT scan was available in three patients. All patients underwent muscle biopsy. A surgical biopsy of the gallbladder was obtained in one patient.

RESULTS

Multiple small aneurysms involving small and medium sized arteries were detected at angiography in 12 patients. CT showed a renal subcapsular hematoma in two patients and acute pancreatitis in one patient.

CONCLUSION

Involvement of gastrointestinal and renal arteries is frequent in polyarteritis nodosa. The diagnosis of PAN should be considered when multiple small-sized aneurysms are present at angiography even if biopsy is negative.

[Bone mineral density in patients with Crohn's disease. Contribution of bone densitometry in 53 cases]

Fifty-three patients with Crohn disease were included in a prospective study. Bone mineral density was measured at the femoral neck and lumbar spine by dual-energy X-ray absorptiometry. Ten variables were analyzed in search of an association with bone demineralization; Age, sex, nutritional state, smoking, duration of the disease, hormonal status, inflammatory syndrome, site of disease: ileal, colic or ileocolic, accumulated doses of corticoids and intestinal resection. A bone demineralization was observed in 58.5% of cases. The ileum location and the corticothérapie were predictives of bone demineralization. Crohn disease is a disease at high risk of bone demineralization. Predictors of the bone loss were smoking, long duration of the disease, ileal site and systematic corticotherapy.

[Cervico-facial lymphatic malformations in adults]

Lymphatic malformations are due to an abnormality in lymphatic development only rarely present in adults. Their prognosis is better than those of infants. We report 6 cases of lymphatic malformations of head and neck in adults reviewed from 1990 to 2001. The treatment was surgical in 5 cases. Surgical excision is the treatment of choice and reccurences are rare.

L’ectopie thyroïdienne : à propos de deux cas

Ectopic thyroid is a rare condition (1/4000 to 1/8000 among patients with hypothyroidism). The underlying etiological pathogenic mechanisms remain unknown. Diagnosis is established on the basis of imaging findings. We report two cases of hypothyroidism in adult females who had ectopic sublingual thyroid glands. The first patient was a 20-Year-old woman who had been treated for hypothyroidism since the age of 13 Years before the diagnosis of ectopic thyroid 7 Years later. In both patients, the thyroid gland was palpable. In the first patient the physical examination revealed an ectopic sublingual gland. Scintigraphy confirmed the diagnosis in both patients. The CT-scan and MRI were positive in the second patient. Hormonal substitution therapy using L-thyroixine was given.

[Splenic abscess: from diagnosis to treatment]

Splenic abscess are a rare and severe pathology causing difficulty in diagnosis and treatment. The Clinical presentation usually associated with abdominal pain in the left upper quadrant, fever and splenomegaly. Diagnosis will be confirmed by morphologic examination such as ultra sonography and computed tomography. Percutaneous drainage procedure made in first intention can be used either for curative purpose or to prepare patient for surgery. We report four cases of splenic abscess collected in our departement between 1997 and 2000 in which percutaneous drainage procedure was trial first. Two of them were successful and the others were completed by splenectomy.

[Vertebroplasty success in a case of aggressive hemangioma]

Vertebral hemangioma is a vascular tumor most oftenly asymptomatic and of casual radiological discovery. More rarely, it can be aggressive, causing neurological complications and therefore requiring a convenient and sustained therapy where vertebroplasty is of essential importance. In this context, we report a case of an aggressive vertebral angioma of L4 which was responsible for lumbocruralgy. She underwent verterbroplasty and then had a very good outcome. In this way we deal with the the different technics of vertebroplasty, their advantages compared to other therapeutic medical, and or surgical methods, as well as their complications.

[MRI in the diagnosis of Rathke's cleft cyst]

PURPOSE

Rathke's cleft cysts are non neoplastic lesions of the sellar area that seldom are symptomatic. Their incidence has been underestimated before magnetic resonance imaging (MRI). The aim of this work was to assess the value of MRI in the diagnosis and differential diagnosis of Rathke's cleft cyst based on a retrospective review of 12 cases and a review of the literature.

PATIENTS AND METHODS

We retrospectively reviewed the MRI features of 12 patients with Rathke's cleft cyst collected over 4.5 years. Patients included ten females and two males (mean age: 39 years). The most common presentation was the association of dysmenorrhea and pituitary dysfunction. MRI examinations were performed using a 1.5 Tesla system, T1 and T2 weighted sequences performed before and after Gd- DTPA injection. Signal intensity, shape, size and location of the lesion were analyzed.

RESULTS

In all cases, MRI examination showed a cystic lesion of variable size and signal intensity. The cyst was purely intrasellar in nine cases and a suprasellar extension was noted in three cases. Five patients underwent surgery providing pathological confirmation, four underwent routine follow-up and three were lost of follow-up.

CONCLUSION

We conclude that MRI is an efficient tool for diagnosis, allowing appropriate medical decision making.

[MRI of cerebral cortical dysgenesis]

PURPOSE

Cortical cerebral dysgenesis is a heterogeneous disorder of cortical development and organization. It is well known by neuropathologists and is becoming more important in the clinical setting, mainly due to MRI. Our purpose is to report the MRI features of cortical dysplasia in 30 patients and to propose a simple classification with review of the literature.

PATIENTS AND METHODS

It is a retrospective study of the MRI features of 30 cases of cortical dysgenesis. All patients were evaluated by electroencephalography and brain MRI using T1 and T2 weighted, inversion recovery T1 weighted, FLAIR and MPR 3D sequences with multiplanar reformations.

RESULTS

Twenty-nine patients were referred to the neurology department because of refractory epilepsy and one patient for mental retardation. Our patients were distributed in 4 groups: diffuse forms represented by agyria-pachygyria (4 cases), polymicrogyria (one case), and nodular heterotopias (5 cases), local bilateral forms represented by bilateral polymicrogyria (11 cases), unilateral forms represented by hemi-megalencephaly (one case), and focal cortical forms found in eight cases.

CONCLUSION

Neuroblast migration disorders are better known, mainly due to high resolution MRI techniques that by the quality of multiplanar study and a better differentiation between gray and white matter, allow a more precise diagnosis.

[Mammography screening of breast cancer in Tunisia. Results of first experience]

This article reports the results of a mammography screening program of breast cancer, realized in the department of Radiology, Charles Nicolle hospital. A free screening mammography with two incidences was offered to women aged from 40 to 70 years old. 2200 mammographies were realized from May 1995 till July 1997. Women having a positive test benefited of a diagnostic explorations in the same unity. The positive test rate was 24%. Predictive positive value was 31%. This program allowed to detect 10 subclinical cancers, corresponding to a rate of detection of 4.5 cancers for 1000 women. This program is a first experience which demonstrated the feasibility of the mammography screening to wide scale and allowed the medical and paramedical team to acquire an experience.

[Left paraduodenal internal hernia. A new case report]

OBJECTIVE

Remind the clinical and radiological features of the internal left para duodenal hernia.

MATERIALS AND METHOD

We report the case of a left para duodenal hernia in a 30 years old woman who suffers of an acute abdominal pain explored by ultra sonography, barium upper gastro intestinal radiography, computed tomography and MRI.

RESULTS

CT shows a well limited intra abdominal mass composed of small bowel wrapped in a bag of peritoneum, and moving to the left the mesenteric axis

CONCLUSION

Left internal para duodenal hernia is a rare phenomenon and is frequently non diagnosed. Spiral computed tomography allows us now, to make the diagnostic with a good sensitivity in the majority of cases.

[Value of imaging in GAPO syndrome]

GAPO syndrome is a rare genetic disorder. The term GAPO is the acronym for the manifestations: Growth retardation, Alopecia, Pseudoanodontia and Optic atrophy. We report the case of a 12 year-old boy with GAPO syndrome. Physical examination was remarkable for: dilated scalp veins with two flaccid masses of the vertex and the right mastoid area that was pulsatile with an audible bruit. Brain magnetic resonance imaging (MRI), magnetic resonance angiography (MRA) and cerebral angiography showed very prominent cortical veins, hypoplasia of the left transverse sinus, agenesis of the left jugular vein and left sigmoid sinus with 2 enlarged emissary veins underlying the palpable scalp masses. We suggest that brain MRI and MRA should be performed in patients with GAPO syndrome to detect anomalies of the intracranial venous circulation.

[Epidemiologic aspects of common gastrointestinal food toxin infections in the Bizerte region based on surveillance center analyses from 1994 to 1999]

The Common Food Toxin Infections has been subject of constant and exhaustive supervision watch over since 1994 in Bizerta. 77 centers in total has been recorded during the six last years (1994 to 1999) and have shown 738 patients. The evolution of incidental rate declared has been considered by annual fluctuations with extreme rates as 11.2 for 10,000 inhabitants in 1995 and 41.5 for 10,000 inhabitants in 1999. The classic season peak each year, and so 58.4% of centers has been notified during the months of July, August and September. The average size of centers is 9.5 persons with an extension of 02 to 40 persons. One death has been deplored a weak spreading rate of 0.14%. The hospitalization recommended for 106 patients (14.4%). About three quarters of the centers has been concerned by the familial. The cooked food is being at the top of contaminating food (49.3%).

A prospective randomized study of Chop versus Chop plus alpha-2B interferon in patients with intermediate and high grade non-Hodgkin's lymphoma: the International Oncology Study Group NHL1 Study

The addition of a brief alpha interferon regimen to each CHOP induction cycle, plus one year of alpha interferon thrice weekly maintenance therapy, has no early effect on response rates or survival in patients with Intermediate or High grade cell NHL.

BACKGROUND

The CHOP (Cyclophosphamide, Adriamycin. Vincristine, Prednisone) regimen is the most widely used first-line therapy for patients with Intermediate or High Grade (IG/HG) non-Hodgkin's lymphoma (NHL). Alpha 2b interferon (INF) enhances response rates and improves survival in low-grade NHL. The International Oncology Study Group (IOSG) conducted a prospective randomized study comparing CHOP alone or combined with INF in patients with IG/HG-NHL. The primary study aim was to compare the objective response rates in these patient cohorts.

PATIENTS AND METHODS

Patients with a confirmed diagnosis of measurable NHL of International Working Formulation (IWF) groups D to H histology were randomized to receive CHOP alone or CHOP with 5Mu INF s.c. for 5 days on days 22 to 26 of each 28 day cycle with INF 5 million units (Mu) given three times per week subcutaneously for 52 weeks in those patients who responded to CHOP plus INF.

RESULTS

The overall response rates were equivalent in both groups: CHOP alone (214 patients) 81% (complete 55%, partial 26%); CHOP plus INF (221 patients) 80% (complete 54%, partial 26%). At 36 months, the actuarial survival rate was equivalent in both groups.

CONCLUSIONS

There is no apparent early advantage in terms of response or survival conferred by adding the study INF regimen to CHOP therapy for patients with IG/HG-NHL.

[Carotid body tumors: contribution of the various imaging techniques. A report of six cases]

INTRODUCTION

Carotid body tumors are rare hypervascular lesions arising from neural crest paraganglion cells.

MATERIALS AND METHODS

We retrospectively analyzed the imaging features of six patients with carotid body tumors to precise their imaging characteristics in order to find specific signs and elaborate a strategy for diagnosis.

RESULTS

Imaging features detect the vascular nature of these tumors of the carotid space causing characteristic widening of the carotid bifurcation. Two patients had multiple (two or more) localizations and one had a family history of glomus tumor.

CONCLUSION

MRI with MRA is considered as the gold standard imaging technique for the evaluation of glomus tumors as it allows a multiplanar approach which is important in the preoperative study.

[Rheumatic spondylodiscitis in spondylarthropathies]

The involvement of enthesis like disc space is the typical lesion of spondylarthropathies. Out of 240 patients with spondylarthropathies, 10 (7 M, 3 W; mean age: 37 years) have spondylodiscitis, affecting a total of 13 disc spaces: 1 cervical, 2 thoracic, 10 lumbar. The mean duration of spondylarthropathy at the time of diagnosis of spondylodiscitis is 10 years. Spondylodiscitis has a variable clinical presentation: painful (6 cases), asymptomatic (4 cases). Its coexistence with typical radiographic signs of spondylarthropathy added to the exclusion of bacterial origin, permit to link it to spondylarthropathy. Its evolution is generally favourable.

[Pelvic ganglioneuroma. Case report]

Ganglioneuroma is a neurogenic tumor originating from autonomic ganglia. It most commonly occurs in patients younger than 20 years with a slight predominance of females. The pelvic localization is rare. Imaging can lead to diagnosis but it is not specific. The diagnosis can only be confirmed by the pathologic study. The authors report one case of pelvic ganglioneuroma diagnosed in an 11-year-old child who also had hypertension and renal failure.

[Therapeutic ligature of hypogastric arteries: color Doppler follow-up]

PURPOSE

To evaluate the interest of color Doppler sonography in the watching of therapeutic ligature of hypogastric arteries.

PATIENTS AND METHODS

Thirteen female patients presenting a serious haemorrhage in the post-partum and be in managed by bilateral hypogastric ligature, have undergone a systematic protocol of investigation involving a Doppler sonography in the fourth day after intervention and then monthly until repermeabilization of the internal iliac arteries.

RESULTS

In all cases, the first exam showed down-side the ligature, a flow inversion with an important pelvic collateral circulation. The next Doppler exams showed repermeabilization of the hypogastric arteries after an average interval of 5 months (extremes: 1 to 6 months).

CONCLUSION

Color Doppler showed the resolvent character of therapeutic ligature of the hypogastric arteries and may estimate with sufficient accuracy the interval of repermeabilization.

[Diabetic fibrous mastopathy]

Diabetic fibrous mastopathy was first described in 1984. This mastopathy usually occurs in patients with autoimmune disorders and often occurs in patients with insulin-dependent diabetes. Little is known about this benign condition. Clinically and radiologically, this entity may simulate malignancy. The presence of an underlying auto-immune disorder or diabetes may suggest the correct diagnosis. The authors report two cases of fibrous mastopathy and suggest that core biopsy could replace surgical biopsy for diagnosis.

[Contributions to the sociologic analysis of the impact of sickle cell disease on families from Northern Tunisia]

The improvement of the conditions of care and quality of life of people living with drepanocytosis now constitutes a major concern of health authorities and voluntary groups (associations of sick people and their parents). In order to examine the conditions and methods of care for children living with drepanocytosis in the Bizerte region of Northern Tunisia and to understand the problems and difficulties experienced by them and their families in their daily lives, an anthropological study was carried out in the region between January 16 and February 12, 1997. Thirty-three interviews were carried out with families of infected children. The interviews were semi-directive using a pre-established protocol (interview guide). Thirty interviews were then analysed. A multitude of information concerning various medical and psycho-social aspects of drepanocytosis in the region were revealed. The data were regrouped into the following categories: circumstances of discovering the illness; explicative model of the illness as perceived by the people interviewed; conditions and methods of care of the sick child; degree of satisfaction with the health care system; psychological profile of the children interviewed; educational level of the children interviewed; repercussions the illness has on the family; impact of the illness on household budget; suggestions and comments of the people interviewed. In light of the information collected, various actions have been proposed with the goal of improving the conditions of care and quality of life of people living with drepanocytosis in the region.

Uroplakin II gene is expressed in transitional cell carcinoma but not in bilharzial bladder squamous cell carcinoma: alternative pathways of bladder epithelial differentiation and tumor formation

Uroplakins (UPs) are integral membrane proteins that are synthesized as the major differentiation products of mammalian urothelium. We have cloned the human UP-II gene and localized it on chromosome 11q23. A survey of 50 transitional cell carcinomas (TCCs) revealed a UP-II polymorphism but no tumor-specific mutations. Immunohistochemical staining using rabbit antisera against a synthetic peptide of UP-II and against total UPs showed UP reactivity in 39.5% (17 of 43 cases) of conventional TCCs, 12.8% (5 of 39) of bilharzial-related TCCs, and 2.7% (1 of 36) of bilharzial-related squamous cell carcinomas (SCCs). The finding that fewer bilharzial TCCs express UPs than conventional TCCs (12.8 versus 40%) raised the possibility that the former are heterogeneous, expressing SCC features to varying degrees. Our data strongly support the hypothesis that urothelium can undergo at least three pathways of differentiation: (a) urothelium-type pathway; (b) epidermis-type pathway; and (c) glandular-type pathway, characterized by the production of UPs, K1/K10 keratins, and secreted glycoproteins, respectively. Vitamin A deficiency and mesenchymal factors may play a role in determining the relative contributions of these pathways to urothelial differentiation as well as to the formation of TCC, SCC, and adenocarcinoma, or a mixture thereof.