Osteolytic clear cell meningioma of the petrous bone occurring 36 years after posterior cranial fossa irradiation: Case report

Objective and importance While bone invasion and hyperostosis are frequent phenomena in meningiomas, primary intraosseous meningiomas are rare and their occurrence in the skull base is an extraordinary exception. Moreover, radiation-induced meningiomas represent a unique clinical dilemma given the fact that patients with these tumors had often received a prior full course of radiotherapy. Clinical presentation A 42-year-old man presented with a 3-month history of progressively worsening facial asymmetry. His medical history was consistent for a posterior cranial fossa irradiation at the age of 6 years for a non-confirmed brain stem tumor. On admission his Karnofsky performance status was graded as 50% and his neurological examination showed a complete right facial nerve paralysis and hearing impairment. Computed tomography and magnetic resonance imaging demonstrated an osteolytic tumor invading the whole right petrous bone without intracranial involvement. Intervention As the tumor reached the external auditory canal, a tissue sample was obtained locally. Pathological examination of the lesion identified a grade II clear cell meningioma and the patient was consequently addressed for an intensity modulated radiation therapy. His condition remained unchanged till the most recent follow-up examination, 8 months later. Conclusions To the best of our knowledge, a radiation induced osteolytic clear cell meningioma of the petrous bone has not been previously reported. As little literature exists regarding the use of adjuvant therapies for these tumors, intensity modulated radiation therapy remains an attractive treatment option in case of pervious irradiation and general status alteration

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

First report of eumycetoma of the hand in Tunisia

International audienceEumycetoma is a chronic, necrotizing infection of fungal origin that usually occurs on a lower extremity, especially the foot. We describe the first case in Tunisia of eumycetoma of the hand due to Pseudallescheria boydii. Case report. - A 48-year-old agricultural worker presented with a swelling and painless cutaneous nodules of the right hand and wrist that drained spontaneously. No trauma of the hand was noted. Examination of the hand revealed multiple crusted sinus tracts in the palm and on the back of the hand. The right hand appeared swollen and deformed. There was no adenopathy or fever. Radiographic examination showed bone involvement with destruction of the wrist bones. The diagnosis of eumycetoma was confirmed by histological evidence (stained sections) that showed granules containing fungal hyphae and positive culture for P boydii. Initially, treatment with ketoconazole (400 mg daily for 14 months) failed. The patient subsequently received itraconazole (400 mg daily for 18 months) and a marked improvement was obtained. Six years after treatment was stopped, there had been no recurrence, but bone involvement resulted in permanent deformity with wrist ankylosis. (C) 2010 Elsevier Masson SAS. All rights reserved

Leishmania infantum MON-1 : seul zymodème isolé chez les chiens leishmaniens en Tunisie

International audienceIso-enzymatic characterization of 19 Leishmania strains isolated from Tunisian dogs revealed that all correspond to Leishmania infantum MON-1. This confirms the role of dog as a reservoir of the commonest zymodeme responsible for human visceral leishmaniasis in the Mediterranean basin. However, and in spite of the high number of identifications, many zymodemes, mainly the dermotropic ones as Leishmania infantum MON-24, frequently reported in humans, had never been isolated from dogs. The study of their cultural characteristics may contribute to explain the particular iso-enzymatic profile of dogs strains.Dix-neuf souches de leishmanies, isolées chez des chiens originaires de différentes régions de la Tunisie, ont été typées par électrophorèse des iso-enzymes. Toutes se sont révélé correspondre à Leishmania infantum MON-1, confirmant la prédominance de ce zymodème chez cet animal. L’absence, aussi bien dans cette série que dans celles d’autres pays méditerranéens, de certains zymodèmes dermotropes, fréquemment rencontrés chez l’homme, pose le problème de leur réservoir. La multiplication des isolements chez les hôtes potentiels et l’étude de la cinétique en culture des différents zymodèmes pourraient apporter d’éventuelles réponses