Paraplégie compliquant une plaie abdominale antérieure par arme blanche

Les traumatismes médullaires sont des complications rares des plaies  abdominales antérieures par arme blanche. Son diagnostic est difficile parfoisretardé. L'imagerie par résonance magnétique reste l'examen de choix. Le traitement dépend du tableau clinique et de la gravité de la souffrance médullaire. Le pronostic est corrélé à l'étendue et à la nature de la lésion médullaire. Nous rapportons un cas exceptionnel d'un traumatisme médullaire chez une patiente victime d'une plaie abdominale antérieure par arme  blanche

Cystadénome Papillaire de L’épididyme: Un Nouveau Cas

Le cystadénome papillaire de l’épididyme est une tumeur paratesticulaire bénigne rare. Se présentant comme une masse épididymaire uni ou bilatérale. Son association avec le syndrome de Von Hippel-Lindau est fréquente, en particulier dans les lésions bilatérales. Nous rapportons l’observation d’un patient âgé de 36 ans, qui présentait depuis un an des douleurs scrotales gauches, une grosse bourse chronique, sans fièvre ni signes fonctionnels urinaires. L’examen avait mis en évidence une masse testiculaire dure, irrégulière et indolore sans adénopathies inguinales ni masse abdominale. L’échographie scrotale avait montré une masse testiculaire gauche solide hypoéchogène bien limitée de 3 x 2,5 x 2,2 cm. Les marqueurs tumoraux étaient normaux (ßHCG : 2 UI/j, AlphaFoetoProteine : 2,94 UI/l). La masse testiculaire a été explorée à travers une incision inguinale gauche. A la palpation, c’était une tumeur testiculaire dure. Une orchidectomie gauche a été réalisée. L’examen anatomopathologique de la pièce d’exérèse avait conclu à un aspect morphologique et immunohistochimique d’un cystadénome papillaire séreux borderline paratesticulaire sans signe d’invasion. A travers notre observation et les données de la littérature, nous proposons de mieux définir le diagnostic clinique et anatomopathologique ainsi que le traitement de ces tumeurs testiculaires rares.Mots clés : épididyme, cystadénome papillaire

TOOKAD® Soluble focal therapy: pooled analysis of three phase II studies assessing the minimally invasive ablation of localized prostate cancer

Purpose: To evaluate the 6-month effects of the recommended drug and light dosage in focal vascular-targeted photodynamic therapy (VTP) using TOOKAD® Soluble in patients with localized prostate cancer (LPCa). Methods: We performed a pooled analysis of 117 men with LPCa, PSA <10 ng/mL, and Gleason score ≤7 (3 + 4), from 3 studies who received a 10-min intravenous infusion of a single dose of 4 mg/kg TOOKAD® Soluble, activated by a 753-nm light at 200 J/cm delivered in the prostate by transperineal fibres under transrectal ultrasound guidance. Primary endpoint was 6-month negative biopsies in the treated lobe(s). PSA was measured at month 1, 3, and 6. Magnetic resonance imaging was performed at day 7, month 3, and 6. International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-5) and adverse events were reported at day 7, month 1, 3, and 6. Results: Month 6 negative biopsy rate was 68.4 % in the overall evaluable population (N = 114) and 80.6 % for patients treated by hemiablation with light density index (LDI) ≥ 1 (N = 67). Mean prostate necroses at week-1 were 76.5 and 86.3 %, respectively. In both groups, PSA levels at month 6 decreased by 2.0 ng/mL. Small changes from baseline for IPSS and IIEF-5 indicated a slight improvement in urinary function and a slight deterioration in sexual function. Conclusions: Focal VTP treatment with TOOKAD® Soluble at 4 mg/kg and 200 J/cm resulted in a negative 6-month biopsy rate of 68.4 % for the whole population and 80.6 % for patients treated by hemiablation with LDI ≥ 1. The treatment was well tolerated. Two phase III studies will reach completion in early 2015

Determination of optimal drug dose and light dose index to achieve minimally invasive focal ablation of localised prostate cancer using WST11-vascular-targeted photodynamic (VTP) therapy

Objective: To determine the optimal drug and light dose for prostate ablation using WST11 (TOOKAD® Soluble) for vascular-targeted photodynamic (VTP) therapy in men with low-risk prostate cancer. Patients and Methods: In all, 42 men with low-risk prostate cancer were enrolled in the study but two who underwent anaesthesia for the procedure did not receive the drug or light dose. Thus, 40 men received a single dose of 2, 4 or 6 mg/kg WST11 activated by 200 J/cm light at 753 nm. WST11 was given as a 10-min intravenous infusion. The light dose was delivered using cylindrical diffusing fibres within hollow plastic needles positioned in the prostate using transrectal ultrasonography (TRUS) guidance and a brachytherapy template. Magnetic resonance imaging (MRI) was used to assess treatment effect at 7 days, with assessment of urinary function (International Prostate Symptom Score [IPSS]), sexual function (International Index of Erectile Function [IIEF]) and adverse events at 7 days, 1, 3 and 6 months after VTP. TRUS-guided biopsies were taken at 6 months. Results: In all, 39 of the 40 treated men completed the follow-up. The Day-7 MRI showed maximal treatment effect (95% of the planned treatment volume) in men who had a WST11 dose of 4 mg/kg, light dose of 200 J/cm and light density index (LDI) of >1. In the 12 men treated with these parameters, the negative biopsy rate was 10/12 (83%) at 6 months, compared with 10/26 (45%) for the men who had either a different drug dose (10 men) or an LDI of <1 (16). Transient urinary symptoms were seen in most of the men, with no significant difference in IPSS score between baseline and 6 months after VTP. IIEF scores were not significantly different between baseline and 6 months after VTP. Conclusion: Treatment with 4 mg/kg TOOKAD Soluble activated by 753 nm light at a dose of 200 J/cm and an LDI of >1 resulted in treatment effect in 95% of the planned treatment volume and a negative biopsy rate at 6 months of 10/12 men (83%)

Les entérobactéries sécrétrices de béta-Lactamases à spectre étendu en urologie à l’Hôpital Ibn Sina de Rabat

L’antibiorésistance croissante des bactéries responsables des infections urinaires limite le choix des antibiotiques en chirurgie urologique. Parmi ces germes sont retrouvées les entérobactéries productrices de bétalactamases à spectre élargi (EBLSE) dont la progression devient inquiétante. L’objectif de cette étude était de déterminer la prévalence des entérobactéries sécrétrices de BLSE dans les prélèvements d’urines en péri opératoire de chirurgie urologique. Il s’agissait d’une étude rétrospective réalisée au centre hospitalier universitaire Ibn Sina de Rabat sur une période de 19 mois. N’ont pas été inclus dans cette étude, les prélèvements urinaires réalisés à dans un laboratoire externe. Les données étaient traitées avec le logiciel SPSS, les comparaisons faites par test du Khi deux ou de Student avec un seuil de risque alpha fixé à 5%. Sur 830 prélèvements positifs 656 étaient des entérobactéries soit 79 % des germes isolés. E.coli représentait 53,2%, K.pneumoniae 28%, E.cloacae 7,8% et P.mirabillis 7%. Les producteurs de BLSE représentaient 17,5% de l’échantillon avec: E.coli (12,3%), K.pneumoniae (23,6%), E.cloacae (39,2%) et P.mirabillis (6,7%). On note une augmentation de la prévalence des entérobactéries BLSE entre 2008 et 2009 : respectivement de 14,4% à 22,3% des entérobactéries isolées; pour E.coli de 32,76% à 40,68% et pour K.pneumoniae de 34,48% à 42,37%. Plusieurs facteurs de risque d’acquisition des EBLSE sont rapportés dans la littérature, dont principalement l’utilisation antérieure d’antibiotiques par ces patients. Une politique de gestion rationnelle des antibiotiques en ambulatoire et au sein des établissements de santé contribuera à une réduction de l’émergence des germes résistant

Potentiating vascular-targeted photodynamic therapy through CSF-1R modulation of myeloid cells in a preclinical model of prostate cancer

Vascular-targeted photodynamic therapy (VTP) induces rapid destruction of targeted tissues and is a promising therapy for prostate cancer. However, the resulting immune response, which may play an important role in either potentiating or blunting the effects of VTP, is still incompletely understood. Myeloid cells such as myeloid-derived suppressor cells (MDSCs) and macrophages are often found in tumors and are widely reported to be associated with cancer angiogenesis, tissue remodeling, and immunosuppression. These cells are also known to play a critical role in wound-healing, which is induced by rapid tissue destruction. In this study, we investigated the effects of VTP on the recruitment of tumor-infiltrating myeloid cells, specifically MDSCs and tumor-associated macrophages (TAMs), in the Myc-Cap and TRAMP C2 murine prostate cancer models. We report that VTP increased the infiltration of myeloid cells into the tumors, as well as their expression of CSF1R, a receptor required for myeloid differentiation, proliferation, and tumor migration. As anti-CSF1R treatment has previously been used to deplete these cells types in other murine models of prostate cancer, we hypothesized that combining anti-CSF1R with VTP therapy would lead to decreased tumor regrowth and improved survival. Importantly, we found that targeting myeloid cells using anti-CSF1R in combination with VTP therapy decreased the number of tumor MDSCs and TAMs, especially M2 macrophages, as well as increased CD8 T cell infiltration, decreased tumor growth and improved overall survival. These results suggest that targeting myeloid cells via CSF1R targeting is a promising strategy to potentiate the anti-tumor effects of VTP

The Impact of the COVID-19 Pandemic on Healthy Lifestyle Behaviors and Perceived Mental and Physical Health of People Living with Non-Communicable Diseases: An International Cross-Sectional Survey

The huge burden and vulnerability imposed by non-communicable diseases (NCDs) during the COVID-19 pandemic highlighted how healthy lifestyle behaviors and the well-being of people living with NCDs need to be prioritized. The aim of our study is to better understand the impact of the COVID-19 pandemic on healthy lifestyle behaviors and perceived mental and physical health among adults living with NCDs, as compared to people without NCDs. We conducted a cross-sectional study using a global online survey through Qualtrics. Over four months, 3550 participants from 65 countries worldwide responded to the survey. The study included 3079 surveys with no missing data (complete survey responses) that were used for analysis. People with NCDs were more likely to report statistically significant worsening physical health (p = 0.001) and statistically insignificant worsening mental health (p = 0.354) when compared to pre-pandemic levels. They reported lower rates of smoking during the pandemic than those without NCDs, and a statistically significant (p &lt; 0.001) relationship was found between weight gain and NCDs. Therefore, the perceived physical and mental health, including changes in body weight and tobacco consumption, of people with NCDs were significantly impacted during the pandemic. In conclusion, this study indicates that the pandemic had a significant impact on perceived physical and mental health, changes in body weight, and tobacco consumption among people with NCDs