Epidemiology, incidence and treatment of rectal cancer in young women case serie about 11 cases (case series)

Introduction

Rectal cancer constitutes, by its frequency and its gravity, a real concern of the public health in the world, it represents the eighth most frequent cancer. Its incidence is increasing in young people and in particular in women, in whom it remains a rare disease known for its poor prognosis.

The objective of our work is to highlight the epidemiological characteristics of rectal cancer in patients under 40 years of age, determine its incidence and outline the different therapeutic means.

Materials and methods

Our work is a retrospective study with a descriptive aim on a series of 11 female patients aged less than 40 years, operated for rectal cancer in the department of digestive cancer surgery and liver transplantation Casablanca Morocco, over a period of 7 years from January 2013 to December 2019.

Results

The average age of our patients was 34.8 years. The average diagnostic delay was 10 months. The most frequent clinical sign was rectorrhagia (90.9% of cases). On rectal examination, the tumor was inaccessible in 18.8% of cases and externalized in 9.09% of cases. It was located in the lower rectum in 36.36% of cases, the same for the middle rectum. Rectoscopy showed that the majority of tumors were circumferential (36.36%). The budding ulcerative aspect was the most frequently found with 7 cases or 63.63%. The histological study showed the predominance of lieberkühnian adenocarcinoma (63.63%). Thoracic-abdominal-pelvic CT scan showed liver metastases in only one patient (9.09%). Pelvic MRI showed invasion of the mesorectum in 5 cases (45.45%) and of the internal sphincter in 3 cases (27.27%). All our patients underwent laparotomy. Curative surgery was performed in 8 patients and 3 patients had palliative surgery. Preoperative radiotherapy was performed in 81.81% of cases. The evolution was marked by 27.27% of locoregional recurrences. The operative mortality was nil in our series.

Conclusion

Detection of patients with precancerous conditions, screening for cancer in subjects at risk (familial recto-colic cancer, familial recto-colonic polyposis and ulcerative colitis), suspicion of cancer in the presence of any proctological sign, early diagnosis and curative surgical resection preceded by radiotherapy are the means that can improve the prognosis of rectal cancer in young women.

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Rectal cancer constitutes, by its frequency and its gravity, a real concern of the public health in the world.

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It represents the eighth most frequent cancer.

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Its incidence is increasing in young people and in particular in women, in whom it remains a rare disease known for its poor prognosis.

Factors associated with changes in sexual behavior during Ramadan

Introduction

Previous studies have shown that the month of Ramadan has a negative impact on the sexual life of fasters. Sexuality during Ramadan seems monotonous, rather poor, leaving little room for foreplay, sensuality and diversification of the sexual repertoire.

Objectives

To examine the socio-demographic and religious factors associated with the change in the sexual lives of fasters

Methods

A cross-sectional study was conducted among married Muslim volunteers in Tunisia. The data was collected with an anonymous self-completed questionnaire, one week before Ramadan (W-1) and the fourth week of Ramadan (W4).

Results

We included 100 participants in this survey.The analytical study found a negative correlation between age and the frequency of coitus during Ramadan (r= -0.2, p= 0.04). The lenth of the marriage was associated with less communication about sexual satisfaction during Ramadan (P=0.01). Rural origin was associated with less tenderness (p=0.03) and shorter foreplay (p=0.03). Wearing the veil was associated with sexual abstinence in women during Ramadan (p=0.038) and not wearing it was associated with the cessation of oral sex (p=0.04). The practice of prayer was correlated to a lesser diversification of sexual positions (p=0.01) and to the withdrawal of certain sexual positions: posterior vaginal (p=0.01), lateral (p=0.02), Andromache (p=0.004).

Conclusions

Changes in the expression of sexuality during Ramadan are not consistent with religious dictates. These findings suggest that the perception of sexuality and its practices are motivated by tradition and culture much more than religion.

Disclosure

No significant relationships.

Tunisian’s largest Psychiatric emergency department in the context of the COVID-19 lockdown

Introduction

General Lockdown was first declared in Tunisia from March 20th to May 4th 2020 to contain the spread of COVID19 pandemic, the last sanitary lockdown period was declared from July 12th to august 1st in 2021. Psychiatric emergency access and consultation has been affected by the confinement. RAZI Hospital Emergency Department (RHED) is the only emergency department in Tunisia specialized in psychiatry. Thus making it the most representative psychiatric emergency health care service in Tunisia.

Objectives

To assess changes in patients flow and admission rates in RHED in the context of the COVID-19 lockdown

Methods

We examined emergency room records and the hospital’s computer admission database during the first and the last COVID19 lockdowns and compared it to the same period of the previous year.

Results

The number of consultations was significantly lower in 2020 lockdown (N = 577) compared the same period in 2019 (N = 1525) (p<10−3). We observed a drop in RHED emergency hospitalization rate from 45.57% to 29.81% during this study period. The number of consultations per day was significantly lower during the first lockdown (N= 12.44) compared to the last lockdown (N=26.61) (p<10−3), the hospitalization rate rose from 29.81% during the first lockdown to 44.36% during the last.

Conclusions

Fear of COVID19 contamination and lockdown limitation had a huge impact on RHED visits and admissions. Medical team had to adjust in order to prevent further delay in acute psychiatric care.

Disclosure

No significant relationships.

The sexual function of women with epilepsy: a comparative study

Introduction

Epilepsy is a neurological disease that interferes negatively with many areas of the patient’s life. Sexual dysfunction is a frequent comorbidity in epileptic patients. Quality of life is particularly affected in women, who are also culturally stigmatized because of their illness.

Objectives

To assess the sexual function of women with epilepsy compared to healthy women.

Methods

This was a case-control study of female patients with generalized epilepsy, carried out at the national institute of neurology in Tunisia in 2018. The controls were the patients’ companions in the department. They were matched by age with the cases. Sexual function was assessed by the female sexual function index (FSFI).

Results

We included 40 cases and 40 controls.Their averge age was 30.45years. In comparison to the controls,the women with epilepsy had less kids ( p=0.04) and more miscarriages (p=0.032). On the other hand, women with epilepsy presented more sexual dysfunctions (p=0. 03) and had a lower total score on the FSFI (p=0.015) as well as significantly lower scores in the domains “desire” (p=0.009), “orgasm” (p=0.026), “satisfaction” (p=0.001) and pain (p=0.015).

Conclusions

The findings of this study are consisting with the literature, the women with epilepsy in this survey had impaired sexual function. More attention should be paid to these sexual disorders, previously considered secondary or even neglected.

Disclosure

No significant relationships.

Sexuality in the Muslim community during Ramadan

Introduction

Ramadan is a holly month for Muslims. Able-bodied adults fast and abstain from sexual activities from dawn to sunset. These hasty lifestyle changes have a major impact on the sexual life of the Muslim community.

Objectives

To assess the impact of Ramadan on sexual activity in a Tunisian community.

Methods

A cross-sectional study was conducted among married Muslim volunteers in Tunisia. The data was collected with an anonymous self-completed questionnaire, one week before Ramadan (W-1) and the fourth week of Ramadan (W4).

Results

We included 100 person in this study. The sample consisted of 59 females and 41 males. The average age was 40.3 years. During Ramadan, sexual intercourse happened more often on weekends (p=0.009) and mostly during the second part of the night (p ˂0.001). Data suggest a disturbed sex life with less satisfaction about sexual life compared to W-1 (p<0.05). Monthly sexual intercourse frequency dropped from 5.76 coitus/month on W-1 to 3.27 on W 4 (p<0.05) and Duration of sex from 9.45 minutes to 6.85 minutes (p˂0.001). Couples communicated less about sex (p=0.004). Sexual abstinence was more frequent (p=0.016). Preliminaries were less performed (P=0.01) and were shorter (p˂0.001).Oral sex was less frequent as well as some sexual positions: fellatio (p=0.01) and cunnilingus (p=0.002), sexual positions of Andromache (P=0.002), posterior vaginal (P˂0.001) and lateral (P=0.001). The participants used less pornography (p=0.007).

Conclusions

This study demonstrated the deleterious impact of the lifestyles changes in Ramadan on the sexual life. Better sexual and religious education is recommended to prevent sexual dysfunctions.

Disclosure

No significant relationships.

Novel 6-aryl-7-alkyl/aryl-[1,2,4]triazolo[4,3-a][1,3,5]triazine-5(6H)-thiones, processes for their preparation, characterization and evaluation of their in vitro antioxidant activity

ABSTRACT. A series of nine new 6-aryl-7-alkyl/aryl-[1,2,4]triazolo[4,3-a][1,3,5]triazine-5(6H)-thiones (2a-i) were synthesized by a reaction of N-triazol-3-yl imidates (1) with three different isothiocyanate derivatives (RNCS)  in refluxing toluene. The structures of the final heterocyclic compounds were confirmed by 1H-NMR, 13C-NMR, FT-IR, elemental analysis, and mass spectral analysis. The target compounds (2a-i) were in vitro screened for their activity as antioxidants using DPPH (2,2′-diphenyl-1-picrylhydrazyl) and FRAP (ferric reducing/antioxidant power) methods. The results revealed that some triazolotriazine-5-(6H)thiones exhibited antioxidant activity ranging from moderate to high. The obtained findings revealed that the triazolotriazine-5-(6H)thiones (2g, 2h, and 2i) have superiority among all compounds, It is obvious that the presence of a hydroxyl group in the structure is essential for the antioxidant properties and should be taken into consideration in further design of structures with potential antioxidant properties.                     KEY WORDS: Imidates, Isothiocyanates, Antioxidant, Triazole, DPPH, FRAP   Bull. Chem. Soc. Ethiop. 2021, 35(3), 565-572. DOI: https://dx.doi.org/10.4314/bcse.v35i3.8

Fournier's gangrene: Seven years of experience in the emergencies service of visceral surgery at Ibn Rochd University Hospital Center

Introduction

This work aims to describe and discuss the epidemiological, clinical, therapeutic and evolution of Fournier's gangrene.

Materials and methods

Case series with retrospective data collection of patients treated for Fournier's gangrene between January 2010 and March 2017. The main etiologies, risk factors, postoperative complications outcomes and long term follow up results were analyzed.

Results

Eight four (84) patients were recruited. The average age of our patients was 49 years (with limits of 20–76), the male gender dominates our series (83.33%) with a sex ratio of 5 M/1W, the most frequently found risk factor was diabetes mellitus (37%). The most common etiology was anal abscesses (32%). The average time to consultation was 8 days (limits ranges from 3 to 30 days). All patients were admitted at a necrosis stage (100%). Anemia was identified in 85% of cases. The low platelets were noticed in 44.03% of cases. Hypoalbuminemia was found in 93% of cases. All patients (100%) benefited resuscitation initially and antibiotic therapy on their admission. They received emergency surgical debridement with a cleansing stoma. The average length of hospital stay was 13 days and complications occurred in 33% of cases. The mortality rate was 7.14%.

Conclusion

Fournier's gangrene is a medico-surgical emergency with a high morbidity and mortality rate. Early diagnosis as well as antibiotic therapy and the quality of debridement save the patients.

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Fournier's gangrene is a rare but severe disease.

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The diagnosis and treatment delay and lesions extension increase mortality.

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The treatment is multidisciplinary.

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Early diagnosis and treatment improve prognosis.

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Tobacco intoxication is suspected to be risk factor.

Abdominal textiloma mimicking as gastrointestinal stromal tumor: A case report

Introduction and importance

Gossypiboma or textiloma is a mass comprising of cotton matrix within the body left accidentally during a surgical procedure. The body may react to this foreign body through an exudative inflammatory reaction or an aseptic fibrotic reaction in order to encapsulate the cotton material and result into a mass.

Case presentation

We report a case of 65-year-old female. She was referred to our department due to 2 episodes of nausea and vomiting. She had history of open cholecystetomy 29 years ago, then cure for eventration one year after. On exploratory laparotomy there was a mass measuring 6 cm axis at the expense of segment 3 of the liver coming into intimate contact with the duodenum. Atypical segmental hepatectomy of segment 3 of liver was performed, and the histological report confirmed necrotic textiloma.

Clinical discussion

Textiloma represents a complication of all forms of surgery. It is a real, serious but preventable surgical complication, and could present with various complaints. Prevention of this condition can be achieved by meticulous count of surgical materials.

Conclusion

The embarrassment faced by the surgeon and the medico legal implications of this iatrogenic complication are tremendous and all preventive measures should be taken to avoid this as no excuse is justifiable.

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Gossypiboma is a mass comprising of cotton matrix within the body left accidentally during a surgical procedure.

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Gossypiboma is a serious but avoidable complication.

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It has serious medicolegal implications and negative impact on medical fraternity.

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Surgical and nursing team should be careful and ensure counts of surgical items during and at the end of surgery.

[Strangulated hernia below the umbilicus containing the liver: a case report]

Herniation of liver segments through defects in the anterior abdominal wall is rare. To our knowledge, only three cases have been described in the literature. This study reports the case of a 84-year-old man presenting to the emergency department with strangulated hernia of the linea alba showing dullness to percussion with protrusion of a sensitive and firm mass. Laboratory test results were normal. Abdominal CT scan showed herniation of liver segment through the linea alba with calculous cholecystitis. The patient underwent retrograde cholecystectomy with subhepatic Redon drain and repair of the herniation by overlapping suture, associated with two subcutaneous vacuum suction Redon drains. The post-operative suite was simple and the patient was discharged on the second post-operative day. Six months after surgery, our patient was healthy. Herniation of liver segments through defects in the anterior abdominal wall is rare. Patients usually show little evidence if clinical signs. Abdominal CT scan is essential to assess the viability of parenchymal liver cells. Patients´ management is studied on a case-by-case basis, it can be surgical or non-surgical. Herniation of liver segments is rare; few cases have been reported in the literature and, in these cases, patients showed little evidence of clinical signs. CT scan is essential to assess the viability of parenchymal liver cells.

Surgical management of recto-vaginal fistula (about 6 cases)

Introduction

Recto-vaginal fistula (RVF) is defined as a pathological epithelialized communication between the posterior wall of the vagina and the anterior wall of the rectum through the recto-vaginal septum. RVFs are rare and represent less than 5% of rectal fistulas. Occurring after childbirth or during a proctological pathology, they create a deep distress for the patients. The aim of our work is to analyze the epidemiological particularities and the risk factors of occurrence of RVF as well as the modalities and results of our therapeutic management.

Materials and methods

Our work is retrospective analytic and comparative concerning 6 cases operated in the department of general surgery 3 of the UHC Ibn Rochd of Casablanca for recto vaginal fistula or recidive over a period of 7 years from 2012 to 2018.

Results

The analysis of the results of our study allowed us to note: A frequency of occurrence of RVF of about 0.48%. The average age at diagnosis was 55 in our patients. The etiologies were dominated by post-radiation (33.33%) and post-operative (16.66%) RVFs. The predominant mode of delivery in our study was vaginal delivery (83.33%). The antecedents were dominated by pelvic irradiation in 50% of patients, and pelvic surgery for cervical cancer and/or rectal cancer (50%). The diagnosis was revealed by a vaginal stool output in all patients. Surgical treatment was performed in all our patients. The surgical technique of choice in our series was drainage by Stenon, in 83.33% of patients. A protective stoma was performed in all our patients studied, a colostomy in 66.66%, and an ileostomy in 33.33% of patients. The immediate postoperative evolution was excellent in all our patients, while the short- and medium-term evolution revealed the occurrence of recurrence in one third of the patients (33.33%). The treatment of choice for recurrence was the interposition of a pedicled fat flap of the labia majora, known as the modified Martius technique. The morbidity, represented mainly by recurrence, was 25%, with a mortality rate of 0%.

Discussion

The occurrence of RVF in all its etiologies seems to be infrequent. However, its real incidence remains poorly documented in the literature, it varies between 0.3% and 15.3%. RVFs are considered simple or complex depending on their size, location and etiology. The high or low location and the etiology of the RVF determine the choice of the approach during surgical management. The diagnosis is most often clinical. The examination will try to find the cause of the RVF and the associated lesions. RVF can be asymptomatic. The importance of the symptoms depends on the topography of the fistula, the diameter of the orifice, and the quality of the intestinal transit. No additional investigations are required to confirm the diagnosis of RVF, since the positive diagnosis is essentially clinical. However, in the case of a high or complex fistula, the clinician can support his or her pre-therapeutic assessment with the exploration of imaging data, especially those of the digestive opacification, MRI and pelvic CT. The causes of RVFs are multiple. However, their proportions are difficult to establish. Post-obstetrical RVFs, those due to Crohn's disease, and post-op are probably the most frequent. The literature describes a variety of surgical approaches and treatment options for RVF. However, there are no treatment recommendations. The available data are vague and do not define an optimal treatment. Medical treatment with antibiotics and sitz baths is often necessary to control the local infection. The surgical management of RVFs is complex and follows several principles. The therapeutic arsenal is very varied and constitutes a real “escalation”, ranging from simple drainage by suture to the radical treatment represented by abdominal-pelvic amputation. The results of the treatment of simple VF are excellent in all studies. The healing rate varies from 75 to 100% depending on the authors.

Conclusion

The results of this study confirm the low incidence of RVF, and show that vaginal delivery and a history of pelvic surgery (for rectal or cervical cancer) are the most frequent predictors of RVF. Thus, from a therapeutic point of view, medical treatment is always required, it allows the flow of the fistula to be reduced, which facilitates preparation for the surgical procedure.

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RVFs are rare and represent less than 5% of rectal fistulas

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The aim of our work is to analyze the epidemiological particularities and the risk factors of occurrence of RVF as well as the modalities and results of our therapeutic management.

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The surgical management of RVFs is complex

The impact of confinement on anxiety rates of the entourage of patients in the psychiatric hospital of Tunis

Introduction

The confinement did begot a recrudescence in the rate of stress within populations. Meanwhile, research targeting the mental health of the psychiatric patients’ accompanyings are scarce.

Objectives

Detect and evaluate anxiety levels of patients’ entourage during confinement.

Methods

It is a retrospective, descriptive and analytical study based on a random sample of People accompanying psychiatric patients from externals consultations service in the only Psychiatric Hospital in Tunisia. Data were been collected during the month of June 2020 via a 20 items questionnaire and a score HAD issued in Arabic.

Results

One hundred thirty five accompanyings were surveyed. The age group was predominantly between 51 and 60 with a sex ratio of 0.31. Near half was the parents. eighty seven were unemployed, 38 stopped working due to confinement and 10 have been worked normally. A pathological anxiety HAD score (>7) was found in 36 accompanyings (26, 67 %). Amongst them, 19 had manifested symptoms. Anxiety levels are significantly much higher in accompanyings of patients with personality disorders (p=0.053). Otherwise, 52, 6% of accompanyings who stopped working felt more under pressure than before lockdown. In contrary to those who did not worked before at all (29.9 %) and those who continued working (10%).

Conclusions

It seems that the entourage of mentally ill patients experience a continuous psychological distress, which was uncovered and marked in confinement period. Thus, it is necessary to establish screening programs, psychological education and early care to ensure their well-being.

Disclosure

No significant relationships.

Chromophobe renal cell carcinoma: A case report and literature review

INTRODUCTION

Chromophobe renal cell carcinoma, a distinct subtype of renal cell carcinoma (RCC) with characteristic light microscopic, histochemical, and ultrastructural features, typically has a favorable clinical course.

PRESENTATION OF CASE

A 45-year-old femele presented with abdominal pain. A physical examination found a palpable mass in the left upper quadrant of the abdomen. A CT scan of the abdomen showed a heterogeneously enhancing mass, with necrosis and calcifications contents betwen the liver and the right kidney. she underwent surgical resection. Partial nephrectomy was performed. Pathological diagnosis was Chromophobe renal cell carcinoma.

DISCUSSION AND CONCLUSION

Chromophobe RCC is a rare variety of kidney neoplasm that has recently been better characterized from a molecular and genetic perspective. Overall, it is considered to have a better prognosis, and is associated with earlier stage tumors and longer overall survival compared with clear cell RCC.

Spontaneous splenic rupture: A rare complication of acute myeloid leukemia. Report of a case

Introduction

Spontaneous rupture of the spleen (SPR) is a rare and severe affection, difficult to diagnose, with multiple causes such as: Infectious and hematologic affections which represent more than half of the cases. Among this subset of patients, acute myeloid leukemia is one of the causes.

Presentation of case

A 48-year-old man undergoing chemotherapy for acute myeloid leukemia presented with acute intense abdominal pain. Computed tomography showed Abdominal CT scan showed a splenic rupture with abundant hemoperitoneum and bilateral pleural effusion. The patient presented hemodynamic instability and was immediately operated, splenectomy were performed.

Discussion

Spontaneous rupture of the spleen usually presents as a severe abdominal syndrome, which may accompany non-specific symptoms.Two signs are suggestive of splenic rupture: Kehr's sign (left diaphragmatic irritation resulting in referred pain to the left shoulder) and Balance's sign (palpable tender mass in the left upper quadrant. Diagnostic methods of choice are computed tomography andultrasound. The prognosis is depending on the quality of care and the nature of the etiology. Splenectomy remains the cornerstone of the treatment of splenic rupture. It is important to include splenic rupture as a differential diagnosis for acute abdominal pain, especially in patients with hematologic malignancy, since early recognition and treatment increase patient survival and improve the prognosis.

Conclusion

Even if spontaneous splenic rupture is rare, every clinician should have in mind the reflex to think of it, especially in patients with hematologic malignancies.

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The objective of this study is to highlight the seriousness of this condition and the different diagnostic and therapeutic modalities.

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Spontaneous rupture of the spleen (SPR) is a rare and severe affection, difficult to diagnose.

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The prognosis is depending on the quality of care and the nature of the etiology.

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Splenectomy remains the cornerstone of the treatment of splenic rupture.

Non-functional retroperitoneal paraganglioma: A report of case with literature review

INTRODUCTION

Retroperitoneal paragangliomas are rare tumors, they arise from ganglia along the sympathetic and parasympathetic chain. We report a rare case of a non functional paraganglioma in whom surgical resection was performed.

PRESENTATION OF CASE

A 35 years-old female presented with chronic abdominal pain, A contrast magnetic resonance imaging (MRI) of abdomen showed a well-defined Left latero-aortic cystic retro-peritoneal surgical resection using laparotomy was performed, The patiente recovered well and was discharged three days after surgery. Histological examination and immunohistochemical revealed a retroperitoneal paraganglioma.

DISCUSSION AND CONCLUSION

Non-functioning retroperitoneal paragangliomas are rare and are most often Isolated. Radiological techniques including, Contrast-enhanced computed tomography (CT) and Magnetic resonance imaging (MRI) are useful for identifying and locating retroperitoneal paragangliomas. surgical excision is still the most effective treatment when it possible.

Retrorectal cystic hamartoma: A case report

Introduction

and importance: Retrorectal cystic hamartoma (RCH) is a rare congenital lesion of the presacral space, which is part of the vestigial cystic tumors often benign and predominantly in women. Generally asymptomatic, the appearance of symptoms such as pain or neurological disorders should raise suspicion of degeneration.

Case presentation

We report an unusual observation of a 62-year-old patient admitted for perineal pain evolving for 2 months associated with tenesma and chronic constipation. The digital rectal examination found a posterior bulge at 4 cm from the anal margin, without intraluminal lesion. Rectosigmoidoscopy had noted posterior extrinsic compression but no rectal tumor. Pelvic CT and MRI had shown a solidocystic formation of the retro-rectal and presacral spaces, related to an enteric cyst. The operation was performed by abdominal approach and the surgical exploration had found a bilobed cystic formation. The cystic mass was removed and the anatomopathological examination concluded that it was a cystic hamartoma with no sign of malignancy.

Clinical discussion

Retrorectal tumors develop in the space bounded anteriorly by the propria fascia of the rectum and posteriorly by the presacral fascia overlying the sacrum. Common in children and then often malignant, inversely, in adults, they are rare and most often benign tumors. They are generally asymptomatic with a predominance of females, unlike our observation where the patient was male with a symptomatology dominated by perineal pain and constipation. The discovery is incidental in the majority of cases, however, in some cases, these cysts may be revealed by complications. The lesion can be explored by transrectal or suprapubic ultrasound, MRI and CT scan. Rectoscopy and fistulography may complete the exploration in case of diagnostic doubt. The resection must be thorough and in monobloc because of the risk of recurrence and the approach depends on the location and the size of the lesion.

Conclusion

RCH is a rare benign lesion whose morphological characteristics seem quite stereotyped. A detailed postoperative anatomopathological examination allows the diagnosis to be made and, above all, to look for a site of malignant transformation. This is why a complete surgical removal is necessary to prevent recurrence.

Tokophobia or post-traumatic stress disorder ? about a tunisian case

Introduction

Pregnancy and delivery are considered to be an important transition stage in a woman’s life. Although this experience is emotionally rich, it varies from one person to another and each woman goes through it in her own way.

Objectives

discuss the psychiatric outcomes after a childbirth with somatic complications.

Methods

case report

Results

Mrs X is a 32 years old woman, she has no particular history of illness until she gave birth to her son. He is now three and a half years old and he is an outpatient at the child and teen psychiatry department in a Tunisian hospital. After her delivery, Mrs X had several physical and psychological complications. She was hospitalized in the cardiology department for cardiomyopathy of Meadows for three weeks among it one week in the medical reanimation ward because she needed respiratory assistance. Furthermore, she suffered of left femoral head’s necrosis for which she was operated, and a total hip prosthesis replacement was done. Psychologically, Mrs X. presented a postpartum depression which resolved in its own after 9 months. Ever Since the childbirth, the patient presents symptoms concording with post-traumatic stress disorder and symptoms that may be linked to a specific phobia (fear of birthchild or tokophobia).

Conclusions

In addition to the usual health care provided to women during pregnancy and after childbirth, looking for mental health disturbances and eventually referring them for psychiatric assessment is important specially for women who have experienced traumatic events during the pregnancy or the delivery

Conflict of interest

No significant relationships.

Lockdown: A chance to strengthen the relationship or to widen the gap for tunisian couples?

Introduction

General lockdown due to the outbreak of Corona virus is a major change in people’s lives. Some mental health professionals consider it as a traumatic event with potentially serious psychiatric repercussions, especially on married couples.

Objectives

Determine the consequences of the lockdown on married couples.

Methods

An online survey conducted on social media during Mai 2020.

Results

A total of 223 married persons filled our survey with 86,1% females. Marriage was traditional in 17%, through mutual friends and acquaintances in 0,4% and after a love story in 84,3%. Families were not consenting to the marriage in 5,4% and 28,7% of participants did not consider that they knew their partner enough prior to marriage. The mean duration of marriage was 2 years and 10 months. Having children was reported in 77,1%. Before the general lockdown, 1,79% described their relationship as “bad” compared to 5,82% during; sharing house chores raised from 56,44% to 68,44%. And taking care of children by both parents during the lockdown raised also from 55% to 67,22%. Frequency of sexual intercourse was the same in 57,4% and lower in 23,8%. The lockdown was an opportunity to discover new things in their partner for 28,4% and 19,7% did not consider the lockdown as a chance to spend more time with their partner.

Conclusions

The lockdown gave us a chance to study the impact of the absence of social life on married couples.

Disclosure

No significant relationships.

Optimization of morphine extraction method for the assay of its urinary 3-glucuronideconjuguate by gas chromatography-mass spectrometry

In the field of doping, a great interest is carried for the analysis of morphine, a powerful narcotic analgesic opiate which use is prohibited during competitions. In order to confirm the abnormal analytical result in our anti-doping laboratory, a sensitive and selective gas chromatography-mass spectrometry (GC-MS) method was performed for the quantification of urinary morphine. As sample preparation is a key step for the determination of drugs in biological samples, the aim of this work consists of the optimization of the urinary human sample pretreatment conditions before quantification by GC/MS. Enzymatic hydrolysis associated with liquid-liquid extraction constitute the major pre-treatment steps. Our study has first focused on the optimization of the extraction solvents then to enzymatic hydrolysis which morphine is released from its glucuronide conjugated form. Onboard premiums, a study involving the effect of "amount of enzyme", "incubation temperature" and "duration of hydrolysis" was conducted. This univariate study has enabled us to evaluate the influence of each of these operating variables on the area ratio of morphine to the internal standard (A_morphine/A_IS) response and to set the experimental fields for each one of them. Based on these results, an experimental design was established using the Box-Behnken model to determine, by multivariate analysis, the optimal operating conditions maximizing the "A_mophine/A_IS" response. After validation, the analysis of response surface makes it possible to set the optimum operating conditions, which the ratio "A_morphine/A_IS" is maximized. The retained conditions for enzymatic hydrolysis are 160μl of Escherichia coli glucuronidase enzyme during 6hours of incubation at a temperature of 36°C. The solvent mixture Methyl-t-Butyl Ether/isopropanol (4:1, v/v) was selected since it has improved morphine extraction from the urinary matrix allowing a gain of 50% when compared to that used in our routine laboratory. Our developed extraction method can be successfully applied for our forensic anti-doping analysis of morphin in human sample urine.

[Laparoscopic cholecystectomy in a patient with situs inversus]

La coeliochirurgie est la technique de référence pour le traitement de la lithiase vésiculaire symptomatique. Jusqu’à ce jour, seuls 42 cas de cholécystectomie laparoscopique chez des patients présentant un situs inversus ont été publiés. Ainsi, nous rapportons un nouveau cas d'un patient, suivi pour cardiopathie congénitale complexe à type de ventricule unique sur situs inversus et dextrocardie. C’est un patient qui était hospitalisé pour prise en charge chirurgicale de lithiase vésiculaire symptomatique. Une cholécystectomie laparoscopique était réalisée. La disposition des trocarts et l’abord chirurgical étaient complètement inverses et symétriques par rapport à l’abord laparoscopique normal.

Dyspareunia After Childbirth: Does Psychosocial Context Play a Role?

Introduction

Dyspareunia is defined as persistent or recurrent genital pain that occurs just before, during or after intercourse. Dyspareunia after childbirth is quite common and have a range of repercussions to women's lives, including their sexual functioning. It could be affected by different risk factors. While role of obstetric factors including mode of delivery has been largely investigated, the influence of psychosocial factors remains unclear.

Aims

Our purpose was to determine frequency of postpartum dyspareunia and identify related psychosocial factors.

Methods

Thirty women between 2 and 6 months postpartum were recruited in consultation of maternity and neonatology center of Tunis. Data were taken from medical file and questionnaire designed to record psychosocial data and postpartum sexual function.

Results

The mean age of women was 28.74 ± 8.4 years. Dyspareunia was reported by 43.33% of women. Dyspareunia was not associated to professional status. On the other hand, dyspareunia was significantly associated to fatigue (P = 0.024), lack of familial support (P = 0.03), conjugal conflicts (P = 0.01).

Conclusion

We have found an association between dyspareunia after childbirth and several psychosocial factors, pointing out the influence of social and psychological aspects in the sexual function in women. Thus, management of sexual disorders should take in consideration psychological dimension and involve an appropriate psychological care.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Existe-t-il un lien entre les traumatismes infantiles et la genèse de comportements impulsifs chez les patients bipolaires ?

Introduction

L’impulsivité est reconnue comme un facteur prédisposant aux conduites addictives et aux comportements suicidaires chez les patients bipolaires. Notre objectif était d’étudier l’impulsivité trait chez des sujets atteints de trouble bipolaire comparativement à des sujets témoins et déterminer si l’impulsivité trait identifierait un sous-groupe cliniquement distinct et homogène de trouble bipolaire. Le rôle joué par les expériences traumatiques infantiles sur le développement de comportements impulsifs chez les bipolaires a été également étudié.

Méthodes

Étude de type cas témoins, durant une période de six mois (juillet 2012–décembre 2012). Les patients atteints de trouble bipolaire de type I, II ou non spécifié en normothymie ont été recrutés au service de psychiatrie C de l’hôpital Razi. Les sujets témoins ont été recrutés dans le service d’ORL de l’hôpital militaire de Tunis. Les deux groupes ont été comparés pour l’âge, le sexe et le niveau d’éducation. Ils ont ensuite été comparés pour les scores de la Barratt Impulsivity Scale (BIS-10) et pour les scores du Childhood Trauma Questionnaire (CTQ).

Résultats

Les scores d’impulsivité totale et les sous-scores d’impulsivité motrice et cognitive des sujets souffrant de trouble bipolaire étaient significativement plus élevés que ceux des sujets témoins (avec respectivement p = 0,001; p = 0,005; p = 0,002). Il existait une différence statistiquement significative entre le groupe des bipolaires et des témoins en ce qui concerne le CTQ total (p < 10,3) et les sous-scores d’abus émotionnel (p < 10,3), de négligence physique (p = 0,01) et d’abus physique (p = 0,001) qui étaient plus élevés chez les patients. Il existait une corrélation entre le score total moyen au CTQ et le score total moyen d’impulsivité à la BIS-10 chez les sujets souffrant de troubles bipolaires (p = 004). L’impulsivité était associée à une enfance chargée d’évènements traumatiques, en particulier chez les patients bipolaires.

Conclusion

L’utilisation systématique d’un indicateur de l’impulsivité, en particulier le BIS, permettrait d’identifier les patients bipolaires à grand risque de conduites addictives et d’autres conduites à risques, afin de développer des mesures de prise en charge thérapeutique appropriées pour ces derniers vu leur mauvaise réponse au traitement.

A multiplex-PCR assay for identification of the quarantine plant pathogen Xanthomonas axonopodis pv. phaseoli

In this study we developed an algorithm to screen for all exact molecular signatures of the quarantine pathogen Xanthomonas axonopodis pv. phaseoli (Xap), based on available data of the presence or absence of virulence-associated genes. The simultaneous presence of genes avrBsT and xopL is specific to Xap. Therefore we developed a multiplex PCR assay targeting avrBsT and xopL for the molecular identification of Xap. The specificity of this multiplex was validated by comparison to that of other molecular identification assays aimed at Xap, on a wide collection of reference strains. This multiplex was further validated on a blind collection of Xanthomonas isolates for which pathogenicity was assayed by stem wounding and by dipping leaves into calibrated inocula. This multiplex was combined to the previously described X4c/X4e molecular identification assay for Xap. Such a combination enables the molecular identification of all strains of Xanthomonas pathogenic on bean. Results also show that assay by stem wounding does not give reliable results in the case of Xap, and that pathogenicity assays by dipping should be preferred.

Synthesis, spectroscopic characterization and X-ray structure of [1,2a]benzimidazol-2-yl amidine

[1,2a]Benzimidazol-2-yl amidine was synthesized by adding cyclopentanamine to iminoester in ethanol. The structure of amidine 1 was characterized by IR, 1H NMR, 1H-1H NOESY, 13C NMR, DEPT, XHCOR spectra, thermogravimetric analysis (TGA), differential thermal analysis (DTA), differential scanning calorimetry thermograms (DSC), elementary analysis as well as by X-ray diffraction. The single crystals suitable for X-ray measurement were obtained by recrystallization at room temperature. The amidine group of a model was found to have Z configuration in the crystal. This compound crystallizes in a P2(1)/n monoclinic unit cell with parameters a=12.679(2) Å, b=8.468(3) Å, c=13.108(2) Å, β=96.538(2)°, V=1398.2 Å3 and Z=4.

In vitro and in vivo efficacy of photofrin and pheophorbide a, a bacteriochlorin, in photodynamic therapy of colonic cancer cells

This study was designed to investigate the efficacy of photodynamic therapy (PDT) in treating colonic cancer in a preclinical study. Photofrin, a porphyrin mixture, and pheophorbide a (Ph a), a bacteriochlorin, were tested on HT29 human colonic tumor cells in culture and xenografted into athymic mice. Their pharmacokinetics were investigated in vitro, and the PDT efficacy at increasing concentrations was determined with proliferative, cytotoxic and apoptotic assessments. The in vivo distribution and pharmacokinetics of these dyes (30 mg/kg, intraperitoneal) were investigated on HT29 tumor-bearing nude mice. The inhibition of tumor growth after a single 100 J/cm2 PDT session was measured by the changes in tumor volume and by histological analysis of tumor necrosis. PDT inhibited HT29 cell growth in culture. The cell photodamage occurred since the time the concentrations of Ph a and Photofrin reached 5.10(-7) M (or 0.3 microg/mL) and 10 microg/mL, respectively. A photosensitizer dose-dependent DNA fragmentation was observed linked to a cleavage of poly(ADP-ribose) polymerase and associated with an increased expression of mutant-type p53 protein. PDT induced a 3-week delay in tumor growth in vivo. The tumor injury was corroborated by histological observation of necrosis 48 h after treatment, with a correlated loss of specific enzyme expression in most of the tumor cells. In conclusion, PDT has the ability to destroy human colonic tumor cells in vitro and in vivo. This tumoricidal effect is likely associated with a p53-independent apoptosis, as HT29 cells express only mutated p53. The current study suggests a preferential use of Photofrin in PDT of colonic cancer because it should be more effective in vivo than Ph a as a consequence of better tumor uptake.

Dual effect of laparoscopy on cell-mediated immunity

Laparoscopic influence on cell-mediated immunity and tumour evolution is controversial. The objective of the present study was to assess tumour growth and immune patterns after laparoscopy on an experimental study. Lewis rats, bearing an intrapancreatic ductal carcinoma randomly underwent one of the following 2-hour procedures: anaesthesia, laparotomy or CO(2) pneumoperitoneum. Cell-mediated immunity was investigated through determination of serum IL1beta concentrations by ELISA and TNFalpha, IL6 and iNOS gene transcriptions in blood white cells and peritoneal cells by RT-PCR 1 day after operation. Tumour growth and spread patterns were assessed on anatomopathological examination 2 weeks after surgery. Tumour growth and spread were unaffected no matter what procedure was applied, but port-site seeding occurred in half of the cases undergoing laparoscopy. No significant change in acute-phase protein response, represented by IL1beta serum concentration, was found after laparoscopy. TNFalpha, IL6 and inducible NO synthase gene transcriptions were enhanced in blood white cells and depressed in peritoneal immune cells after laparoscopy. In our experimental conditions, cell-mediated immune response to CO(2) pneumoperitoneum seems to be a good systemic immune activation and a less acute peritoneal immune response as opposed to control laparoscopy. This early impairment of peritoneal macrophage immune activity, observed after a long-lasting CO(2) pneumoperitoneum, might be responsible for the high rate of port site recurrence.

Human pancreatic carcinoma cells are sensitive to photodynamic therapy in vitro and in vivo

BACKGROUND

The aim of this study was to assess the efficiency of photodynamic therapy (PDT) on human pancreatic cancer cells in vitro and in an animal model.

METHODS

Human pancreatic tumour cell lines were submitted to PDT with pheophorbide a (Ph a), a chlorophyll derivative, in culture and after grafting into athymic mice. Ph a was tested in culture (10-10-10-5 mol/l) with a 5-J/cm2 energy treatment and on tumour-bearing Nude mice (30 mg/kg intraperitoneally) with a 100-J/cm2 PDT session. The effect of PDT was assessed in vitro using proliferative, apoptotic and clonogenic tests and in vivo on tumour growth and on the induction of tumour necrosis.

RESULTS

PDT inhibited tumour cell growth in culture by affecting DNA integrity. This tumour cell photodamage started at low concentration (10-7 mol/l) as corroborated by clonogenic and tumour growth tests. A strong necrosis was achieved in vivo with a single PDT session.

CONCLUSION

PDT destroyed human pancreatic carcinoma after low photosensitizer supply and weak energy application. It exerted this tumoricidal effect via apoptosis induction with a gentle protocol, and apoptosis and/or necrosis with a stronger protocol.

Increased tumor growth and spread after laparoscopy vs laparotomy: influence of tumor manipulation in a rat model

BACKGROUND

The use of laparoscopy for assessment and treatment of malignant tumors remains controversial. The aim of this study was to evaluate the impact of tumor manipulation during laparoscopy compared with that of conventional laparotomy on growth and spread of an intraperitoneal tumor in the rat in a randomized, controlled trial.

METHODS

Thirty 2-month-old male Lewis rats received a single-site intrapancreatic inoculation of a ductal adenocarcinoma. Fourteen days after cancer implanting, two groups of six animals each underwent a laparotomy (30 min 6 mmHg CO2 pneumoperitoneum). The tumor was manipulated in the one group, and exclusively visualized in the other. In two other groups, a midline laparotomy with (n = 6) or without (n = 6) tumor manipulation was performed. Animals in the control group (n = 6) underwent no procedure. Tumor volume, tumor mass, local regional invasion incidence, lymph node involvement, and liver and lung metastases were evaluated on 28-day tumors.

RESULTS

No difference in tumor growth and spread was observed between laparoscopy and laparotomy when tumor manipulation was not carried out. Tumor manipulation increased tumor growth significantly in the laparotomy group, but not in the laparoscopy one. Tumor metastases were correlated to tumor growth and increased significantly after manipulation in both groups. There was no port-site or conventional wound seeding in either the surgical procedure.

CONCLUSIONS

This study showed that manipulation is the main factor acting on tumor dissemination in both laparoscopy and laparotomy. Laparoscopic surgery had a beneficial effect on local tumor growth compared with laparotomy in the case of tumor manipulation. This beneficial effect of laparoscopic surgery may be related to a better preservation of immune function in the early postoperative period.

Effects of cholecystokinin octapeptide on a pancreatic acinar carcinoma in the rat

PURPOSE

To investigate the effects of increasing concentrations of cholecystokinin octapeptide (CCK-8) on a pancreatic acinar adenocarcinoma.

METHODS

Growth of the tumour was estimated in vivo on rats bearing a subcutaneous pancreatic carcinoma, and in vitro on primary cultured tumour cells. CCK receptors were characterized by binding assays.

RESULTS

CCK-8, administered for 12 successive days, exerted a biphasic action on tumour growth: a dose-dependent stimulation with low doses (0.1 and 0.5 microg/kg) and inhibition with high doses (2 and 4 microg/ kg) as shown by respective increases and decreases in tumor volume, protein, RNA and amylase contents. In cell cultures, [3H]thymidine incorporation was dose-dependently increased with 10-(10) to 10(-8) M CCK-8 and inhibited with 10(-7) M. Both effects were completely suppressed by the CCK-receptor antagonists CR 1409 and L 364,718 (10(-4) M). Binding studies showed the overexpression of two classes of CCK-A receptors of low and high affinity when compared to the normal pancreas which was less sensitive to CCK-8.

CONCLUSIONS

CCK-8 exerts a biphasic growth response on the acinar pancreatic carcinoma, mediated by two classes of CCK-A receptors overexpressed in the tumour.

Role of nitric oxide in pancreatic tumour growth: in vivo and in vitro studies

Nitric oxide (NO), an endogenous free radical, has been implicated in a wide range of biological functions. NO is generated enzymatically from the terminal guanidinonitrogen of L-arginine by nitric oxide synthase (NOS). Despite intensive investigations, the role of NO--either as the primary product of the L-arginine/NOS pathway or provided from the NO donor sodium nitroprusside (SNP)--in carcinogenesis and tumour cell growth remains unclear and controversial. The objective of this study was to examine the growth effects of NO on a ductal pancreatic adenocarcinoma in the rat and on a human pancreatic tumour cell line (HA-hpc2). In vivo, both SNP and endogenous induction of NO by endotoxins [lipopolysaccharide (LPS)] plus L-arginine significantly reduced the tumour growth. To investigate the mechanisms of NO anti-tumour growth action, the effects of either the SNP or L-arginine/NOS pathway were analysed on the HA-hpc2 cell line. Nitrite/nitrate production, NOS activity and iNOS expression [assessed by reverse transcription-polymerase chain reaction (RT-PCR)] were tested and related to growth (assessed by [3H]thymidine incorporation assay) and apoptosis (assessed by internucleosomal DNA cleavage). SNP exerted a dual effect on tumour cells: stimulation of the proliferation up to 1 mM and inhibition at higher concentrations. These effects were related to NO production. Both proliferative and cytostatic responses were inhibited by NO scavenger 2-phenyl-4,4,5,5-tetramethyl-hemidazoline-1-oxyl3-oxide (carboxy-PTIO). The marked apoptotic DNA fragmentation induced by SNP was also abolished by PTIO association. Unlike macrophages, the human pancreatic tumour cells did not seem to express intrinsically the L-arginine/NOS pathway. Macrophages were activated by HA-hpc2 cells as well as by LPS plus cytokines [interleukin (IL)-1beta plus tumour necrosis factor (TNF)-alpha and interferon (IFN)-gamma]. In HA-hpc2/macrophage co-cultures, NOS activity and inducible NOS (iNOS) transcription were stimulated, whereas an antiproliferative response was observed. These effects were related to both macrophage amount and NO production. Addition of LPS plus cytokines to co-cultures doubled iNOS activity, nitrite/nitrate production and tumoricidal effect. These data suggest the involvement of NO in pancreatic tumour growth and support the fact that generation of high levels of NO with potential production of endogenous reactive nitrogen intermediates may contribute to induction of apoptosis and tumour growth inhibition.

Effect of the gastrin-releasing peptide antagonist BIM 26226 and lanreotide on an acinar pancreatic carcinoma

The effects of a potent specific gastrin-releasing peptide receptor antagonist, BIM 26226 ([D-F5 Phe6, D-Ala11] bombesin (6-13) OMe), and the long-acting somatostatin analogue, lanreotide (BIM 23014), on the growth of an acinar pancreatic adenocarcinoma growing in the rat or cultured in vitro were investigated. Lewis rats bearing a pancreatic carcinoma transplanted s.c. in the scapular region, were treated with gastrin-releasing peptide (30 microg/kg per day), BIM 26226 (30 and 100 microg/kg per day) and lanreotide (100 microg/kg per day) alone or in combination for 14 successive days. Chronic administration of BIM 26226 and lanreotide significantly inhibited the growth of pancreatic tumours stimulated or not by gastrin-releasing peptide (GRP), as shown by a reduction in tumour volume, protein, ribonucleic acid, amylase and chymotrypsin contents. This effect was more pronounced with 100 microg/kg per day BIM 26226 than with 30 microg/kg per day. However, BIM 26226 and lanreotide, given together, did not exert any additive effect on GRP-treated and -untreated tumours. In cell cultures, both BIM 26226 and lanreotide (10(-6) M) inhibited [3H]thymidine incorporation in tumour cells induced or not by GRP, but no increased effect was observed after combined treatment with both agents. Binding studies showed that BIM 26226 had a high affinity for GRP receptors in tumour cell membranes (IC50 = 6 nM). These results from in vivo and in vitro experiments suggest that BIM 26226 and lanreotide are able to reduce the growth of an experimental acinar pancreatic tumour. Thus, these agents represent interesting steps toward the development of new approaches for treatment of pancreatic carcinomas.

Inactivation of p53 in normal human cells increases G2/M arrest and sensitivity to DNA-damaging agents

p53 mutations are found in about 70% of human cancers. In order to evaluate the role of these mutations in response to chemotherapeutic agents, it is important to distinguish between p53 response to DNA-damaging agents in normal and in tumour cells. Here, using normal human fibroblasts (NHFs), we show that cisplatin and UV radiation induce G2/M arrest which is temporally linked to p53-protein induction. To study the contribution of p53 to this G2/M arrest, we inhibited p53 induction in NHFs using p53 anti-sense oligonucleotides. Following exposure of NHFs to UV radiation, the inhibition of p53-protein induction leads to a greater accumulation of cells in the G2/M phase, but also to a decreased fraction of cells in the G1 phase. We propose that p53 does not induce G2/M arrest directly, and that the extent of this arrest may depend on the fraction of cells that do not stop at the G1 phase following exposure to DNA-damaging agents. Furthermore, inhibition of p53-protein induction leads to increased sensitivity of NHFs to UV radiation. These results suggest that inhibition of p53 protein enhances sensitivity to DNA-damaging agents in normal human cells.

In vivo laser-induced fluorescence imaging of a rat pancreatic cancer with pheophorbide-a

Laser-induced fluorescence (LIF) of pheophorbide-a (Ph-a) was used for imaging of a rat pancreatic tumor. Using a dimensionless function (the ratio of Ph-a fluorescence by bluish autofluorescence), the fluorescence contrasts between excised tumors and their paired pancreas were investigated up to 48 h after a 9 mg kg-1 Ph-a intravenous administration. Among five tested excitation wavelengths, 355 and 610 nm excitations gave the best distinctive contrasts, both 48 h after dye injection. The LIF imaging of six intrapancreatic tumors and six healthy pancreas was carried out in vivo using two laser excitations: 355 nm (Nd:YAG + tripling) for bluish autofluorescence and 610 nm (rhodamine 6G dye) for reddish autofluorescence and dye emission. Images were recorded through bandpass filters at 470 and 640 nm (autofluorescence) and at 680 nm (dye + autofluorescence) with an intensified charged-coupled device camera. Autofluorescence as Ph-a fluorescence images did not allow accurate LIF diagnosis of pancreatic carcinoma. An image processing, including for each pixel a computed division of Ph-a fluorescence (after subtraction of reddish autofluorescence) by bluish autofluorescence intensity generated poorly contrasted tumor images in five of six and false tumor localization in one of three of the tumor-bearing pancreas. A fitting of the digital 640 nm autofluorescence up to the mean 680 nm fluorescence intensity in pancreas prior to subtraction allowed a safe diagnosis to be made with well-contrasted tumor images. To assess automation ability of the processing, a same fitting coefficient (mean of individual values) was applied. In this way, false-negative (one of six) and false-positive (two of six) images were present in tumor-bearing animals as false-positive in one-half of the controls. A successful standardized procedure was then applied with a normalization of 640 and 680 nm pancreas intensities to a same set threshold prior processing. In opposition to thin-layered hollow organs, such as bronchial tube or digestive tract, LIF imaging of carcinoma inserted in a compact organ is exhausting. The use of a dye excitable in the red wavelength range (610 nm for Ph-a) may partly solve this problem, rendering LIF imaging more accurate and potentially automated.

Photodynamic imaging of a rat pancreatic cancer with pheophorbide a

Laser-induced fluorescence of pheophorbide a (Ph-a) was used for in vitro photodynamic imaging (PDI) of a rat pancreatic acinar tumor. A 400 nm excitation induced a 470 nm autofluorescence and a 678 nm dye fluorescence in tumors and their surrounding pancreas 24 h after a 9 mg kg-1 body weight Ph-a intravenous administration. With lower intensities in these blood-rich tumors than in pancreas, Ph-a fluorescence signals are unable to provide tumor images. A dimensionless function (the ratio of Ph-a fluorescence by autofluorescence, called Rt for the tumor and Rp for the pancreas) was used for fluorescence contrast calculation (C = Rt/Rp) between six tumors and their paired pancreas. Among five available laser excitation wave-lengths, only the 355 nm excitation gave a distinctive contrast (C = 1.5). The PDI of six intrapancreatic tumors and their intraperitoneal metastasis and of two control normal pancreas was thus performed ex vivo using a 355 nm excitation source delivered by a tripled Nd:YAG laser and a charged-coupled device camera. Fluorescence images were recorded at 680 nm (dye), 640 nm (background) and 470 nm (autofluorescence) through three corresponding 10 nm width bandpass filters. Computed division for each pixel of Ph-a fluorescence values by autofluorescence generated false color image. In this way, contrasted tumor images were obtained. But in five out of six animals false-positive images were present due to an autofluorescence decrease in some normal pancreatic areas. A 470 nm autofluorescence imaging on the same tumors gave in all cases false-positive image and false-negative in half of the cases. These observations suggest that autofluorescence alone is unable to achieve accurate PDI of pancreatic carcinoma and that using Ph-a as a PDI dye needs strong improvements.

Expression and characterization of gastrin-releasing peptide receptor in normal and cancerous pancreas

The biochemical and pharmacological characteristics of specific binding sites for gastrin-releasing peptide (GRP) were investigated in normal exocrine pancreas and in an azaserine-induced pancreatic carcinoma in the rat, under similar experimental conditions. Cells from both types of tissues contained rapid, reversible, temperature-dependent, and highly specific binding sites for GRP. Scatchard analysis of equilibrium data obtained with normal and tumor plasma membranes indicated a single class of high-affinity sites (KD = 0.42 +/- 0.06 and 0.35 +/- 0.05 nM, respectively), but the number of GRP receptors was significantly different (Bmax = 31 +/- 4.5 and 189 +/- 20 fmol/mg protein, respectively). Binding of 125I-GRP1-27 was sensitive to GTP analogues, suggesting that the GRP receptor is functionally linked to a guanyl regulatory protein; however, the wheat germ agglutinin-agarose purified receptor had lost this G-protein activity. Cross-linking of 125I-GRP1-27 either to normal and neoplastic cells or to crude membranes, solubilized membrane proteins, and partially purified receptors revealed the presence of a specific MW 75-kDa polypeptide. N-Glycanase treatment reduced this apparent MW to about 45 kDa. Together, these data suggest that normal and tumor pancreatic cells contain a specific GRP receptor that is expressed more on malignant pancreatic tissues.

Experimental pancreatic cancer in the rat treated by photodynamic therapy

Selective histological necrosis of experimental pancreatic carcinoma by photodynamic therapy (PDT) has been successful with haematoporphyrin derivatives and phthalocyanine as photosensitizers. This report describes the feasibility of PDT with pheophorbide A as the photosensitizer to treat azaserine-induced pancreatic rat carcinoma and analyses survival of the animals. An organ distribution study 24 h after pheophorbide A administration (9 mg/kg intravenously) gave a selectivity ratio of 13.5:1 between tumour and surrounding tissue. Light of 660 nm and 100 J/cm2 induced selective necrosis of the tumour. Six of nine rats were cured in 120 days whereas all 36 control animals died within 35 days (P < 0.01). The pancrease and hepatic pedicle were relatively unaffected by PDT, but the duodenum was injured.

Inhibition of growth of a transplanted rat pancreatic acinar carcinoma with CCK-8

Gastrointestinal hormones and neuropeptides are known to regulate growth of various normal gastrointestinal tissues and many cancers. Since cholecystokinin (CCK) is considered the most potent trophic factor for the exocrine pancreas, we studied its effect on growth of an acinar cell tumor, initially induced by azaserine and transplanted to the rat, in comparison with the normal pancreas. When tumors became palpable, rats were treated three times daily for 12 or 14 days with CCK-8 or NaCl 0.9% (controls) alone or in combination with the CCK receptor antagonist CR1409 (10 mg/kg) administered subcutaneously twice daily. Then tumors and pancreata were analyzed for their size, composition, and CCK receptors. Tumor volume, weight, and protein content, RNA, DNA, and enzymes decreased after CCK-8 treatment in a dose-dependent manner, the maximal effect being observed with 4-micrograms/kg treatment. This inhibitory effect was partially suppressed by CR1409, which by itself also reduced tumor growth, but to a lesser degree. CCK-8 exerted a stimulating effect on growth of the normal pancreas with low doses (1 and 2 micrograms/kg) and an inhibitory effect or no effect with a higher dose (4 micrograms/kg). CR1409 prevented this latter effect, but did not affect by itself the normal pancreas. These findings suggest that CCK-8 inhibits growth of an acinar cell tumor grafted to the rat; this effect is mediated by the occupation of specific CCK receptors present in high density on these cells. In contrast, CCK-8 exerts a biphasic effect on the normal pancreas as a function of its dose.

Gastrin-releasing peptide: in vivo and in vitro growth effects on an acinar pancreatic carcinoma

The mammalian gastrin-releasing-peptide (GRP) and its structural amphibian analogue, bombesin, are known to be trophic factors for the normal exocrine pancreas. This work investigates the possible role of GRP in the growth of an acinar pancreatic cancer transplanted to the rat and in primary tumor cell cultures. Moreover, this adenocarcinoma was tested for its content of specific bombesin/GRP receptors by using autoradiographic technics and in vitro binding assays with tumor cells. In Lewis rats bearing the pancreatic carcinoma transplanted s.c. in the scapular region, chronic administration of GRP at the dose 30 micrograms/kg/day for 15 successive days significantly increased the tumor volume, the final tumor weight, and amylase, protein, RNA and DNA contents. Autoradiographic studies showed that tumor tissue was GRP receptor positive with a high density. The biochemical characterization indicated that receptor positive tumor tissue had saturable and high affinity receptors with pharmacological specificity for GRP and its bioactive analogues. In primary tumor cell cultures, GRP increased the incorporation of [3H] thymidine in DNA in a dose- and time-dependent manner. There was a good correlation between the ability of GRP and its COOH terminal analogues to elicit DNA synthesis and their affinity for 125I-GRP binding sites. These results from in vivo and in vitro experiments demonstrated that GRP induces growth of pancreatic carcinoma by acting directly on specific membrane receptors present on the tumor cells.

Inhibition of the growth of transplanted rat pancreatic acinar carcinoma with octreotide

The effects of octreotide on transplanted azaserine-induced pancreatic acinar tumours were investigated in the rat. When tumours became palpable, rats were treated either with octreotide (40 micrograms/kg per day, by infusion) or NaCl 0.9% (controls) for 14 days. Tumours were then analysed for their size, composition and somatostatin receptors. Octreotide induced a 80% reduction in tumour growth rate during the first 2 days of treatment. This rate was less marked from day 4 to day 15. The tumour weight, protein, DNA, RNA and enzyme content were reduced in parallel by 50 to 60%. A homogeneous distribution density and a high affinity of somatostatin receptors were found by receptor autoradiography and in vitro binding assays in tumours of both groups. These findings indicate that octreotide reduces the growth rate of the transplanted pancreatic acinar tumour and may exert its inhibitory effect directly via specific somatostatin receptors on tumour cells.

Effect of prolonged administration of long-acting somatostatin on caerulein, CCK-8 and GRP induced pancreatic growth in the rat

This work investigates the effects of the long-acting somatostatin analogue, octreotide also named SMS 201-995 or Sandostatin, on pancreatic growth in function of the dose and duration of treatment. Octreotide was administered s.c. twice daily, while pancreatico-trophic peptides, caerulein and CCK-8 (1.8 nmol/kg b.wt.) or GRP (3.6 nmol/kg b.wt.) were administered s.c. three times daily. Octreotide (1,10,20 micrograms/kg b.wt.) administered for 4 days reduced pancreatic growth induced by caerulein in a dose-dependent manner. This effect, significant from 10 micrograms/kg, was more obvious with 20 micrograms/kg. At this latter dose, octreotide inhibited significantly the increase in pancreatic weight and protein, RNA, DNA and enzyme content induced by a 4- or 10-day treatment with GRP. A similar effect was observed after a 4-day treatment with CCK-8, but after a 10-day treatment only protein and enzyme contents were reduced. Octreotide by itself did not affect pancreatic size and composition after a 10-day treatment, but decreased enzyme content after a 4-day treatment. It is concluded that octreotide exerts an antitrophic effect on the rat exocrine pancreas which depends on the dose and duration of treatment and can be modulated by the trophic factor applied for a long-term.

Effect of a new CCK-receptor antagonist, CR 1409, on pancreatic growth induced by caerulein, CCK-8, bombesin and gastrin-releasing peptide in the rat

The effect of a peripheral cholecystokinin (CCK)-receptor antagonist, CR 1409, on pancreatic growth has been studied in the rat. 1.8 nmol/kg CCK-8 or caerulein and 3.6 nmol/kg bombesin or gastrin-releasing peptide (GRP) administered subcutaneously 3 times daily for 4 successive days increased pancreatic weight and its content in protein, enzymes and RNA but not in DNA, suggesting cellular hypertrophy. CR 1409 (10 mg/kg) administered intragastrically 30 min prior to peptides prevented pancreatic growth due to CCK-8 or caerulein but not that induced by bombesin and GRP. It is concluded that bombesin and GRP act on the exocrine pancreas directly rather than through the release of CCK.

Comparative effect of chronic bombesin, gastrin-releasing peptide and caerulein on the rat pancreas

This study was designed to compare, on a molar basis, the effect of chronic bombesin, gastrin-releasing peptide (GRP) and caerulein on pancreatic growth in the rat. These 3 peptides were administered s.c. 3 times daily for 4 days at the following concentrations: 0.036, 0.36, 3.6 and 7.2 nmol/kg of body weight. Bombesin and GRP induced pancreatic growth in a dose-dependent manner from 3.6 nmol/kg. This growth was characterized by an increase in pancreatic weight, its protein and RNA contents but not in DNA content suggesting cellular hypertrophy. Caerulein exerted a biphasic effect on pancreatic growth, inducing cellular hypertrophy at low doses since 0.36 nmol/kg and atrophy with the highest dose (7.2 nmol/kg). Bombesin and caerulein (until 3.6 nmol/kg) increased the pancreatic content in chymotrypsin more than in amylase. The 7.2 nmol/kg caerulein treatment depressed all enzyme activities while the same dose of GRP increased pancreatic lipase content. It is concluded that (1) bombesin and GRP are equipotent trophic factors for the pancreas; (2) caerulein is the most potent factor and exerts a biphasic effect on pancreatic growth; (3) pancreatic growth and synthesis and/or secretion of enzymes are not regulated through the same mechanism.