Background Signet-ring cell carcinoma of the stomach (SRCC) is a particular gastric cancer entity. Its incidence is increasing. Its diagnosis is pathological; it corresponds to adenocarcinoma with a majority of signet-ring cells component (> 50%). These histological features give it its aggressiveness characteristics. This has repercussions on the prognostic level and implications for the alternatives of therapy, especially since some authors suggest a potential chemoresistance. This survey aimed to identify the epidemiological, pathological, therapeutic, and prognostic characteristics of SRCC as a separate disease entity. Methods This was a retrospective study of 123 patients admitted for gastric adenocarcinoma to Habib Thameur Hospital in Tunis over 11 years from January 2006 to December 2016. A comparative study was performed between 2 groups: the SRCC group with 62 patients and the non-SRCC (non-signet-ring cell carcinoma of the stomach) with 61 patients. Results The prevalence of SRCC in our series was 50%. SRCC affected significantly younger patients (55 vs 62 years; p = 0.004). The infiltrative character was more common in SRCC tumors (30.6 vs 14.8%; p = 0.060), whereas the budding character was more often noted in non-SRCC tumors (78.7 vs 58.1%; p = 0.039). There was no significant difference in tumor localization between both groups. Linitis plastica was noted in 14 patients with SRCC against a single patient with non-SRCC (p = 0.001). The tumor size was more important in the non-SRCC group (6.84 vs 6.39 cm; p = 0.551). Peritoneal carcinomatosis was noted in 4.3% of cases in the SRCC group versus 2.2% of cases in the NSRCC group (p = 0.570). Total gastrectomy was more often performed in the SRCC group (87 vs 56%; p = 0.001). Resection was more often curative in the non-SRCC group (84.4 vs 78.3%; p = 0.063). Postoperative chemotherapy was more commonly indicated in the SRCC group (67.4 vs 53.3%; p = 0.339). Tumor recurrence was more common in the non-SRCC group (35.7 vs 32%; p = 0.776). The most common type of recurrence was peritoneal carcinomatosis in the SRCC group (62.5%) and hepatic metastasis in the non-SRCC group (60%; p = 0.096). The overall 5-year survival in the SRCC group was lower than in the non-SRCC group, with no statistically significant difference (47.1 vs 51.5%; p = 0.715). The overall survival was more important for SRCC in early cancer (100 vs 80%; p = 0.408), whereas it was higher for non-SRCC in advanced cancer (48.1 vs 41.9%; p = 0.635). Conclusion Apart from its epidemiological and pathological features, SRCC seems to have a worse prognosis. Indeed, it is diagnosed at a more advanced stage and has a worse prognosis in advanced cancer than non-SRCC. It is therefore to be considered as a particular entity of gastric adenocarcinoma requiring a specific therapeutic protocol where the place of chemotherapy remains to be more investigated.

The interferon (IFN) activity of sera from 19 patients with nasopharyngeal carcinoma (NPC) was determined by the plaque-reduction assay with vesicular stomatitis virus (VSV) in HeLa cells and compared to that of sera from matched healthy controls. High titers of interferon were detected in the sera of the NPC patients with a geometric mean titer (GMT) of 43 +/- 25 U/ml. The interferon activity of the patients' sera was acid- and heat-labile (pH = 2 and 56 degrees C for 1 hr) and could be neutralized by a goat antiserum to human IFN-gamma. Interferon titers of the patients, in contrast, to normal controls, were not correlated with natural killer (NK) activity which was abnormally low in the NPC patients. On the other hand, a high percentage of circulating cells co-expressing the LGL marker (HNK-I) and the OKT8 antigen was detected in parallel with high IFN levels in NPC patients.

Epstein-Barr Virus (EBV) is associated with two malignant diseases, African Burkitt's Lymphoma (BL) and Undifferentiated Nasopharyngeal Carcinoma (UNPC). North Africa is a geographical area with a high incidence of NPC. Our purpose in this study was to explore cell-mediated immunity of peripheral blood lymphocytes (PBL) from patients with UNPC and DNPC. We found an elevated percentage of OKT8 cells and of large granular lymphocytes (LGL) (30-35% HNK-I-positive cells) compared to PBL from healthy matched individuals. PBL from NPC patients contained 35% HLA-DR-positive and 30% Interleukin-2 (IL-2) receptor-positive circulating lymphocytes. PBL from NPC patients exhibited a normal proliferative response to phytohemagglutinin (PHA) and Concanavalin A (Con A) and an increased response to pokeweed mitogen (PWM). Natural killer (NK) activity towards K562 cells was low in our patients who, in addition, exhibited no lytic activity against HLA-matched EBV-transformed B cells. This lack of cytotoxicity against an EBV-transformed B-cell line cannot be explained by an impairment of IL-2 secretion, and is probably a result of the presence of high numbers of OKT8 suppressor T cells.

RésuméIntroductionLa cholécystectomie laparoscopique est le gold standard de la prise en charge des calculs vésiculaires symptomatiques. Il existe une importante controverse quant au fait de savoir si elle devrait être pratiquée en chirurgie ambulatoire ou dans le cadre d'une chirurgie avec hospitalisation d'une nuit pour ce qui concerne la sécurité des patients. Le but du travail est d’évaluer l'impact de la cholécystectomie laparoscopique en chirurgie ambulatoire versus en chirurgie avec hospitalisation d'une nuit sur les critères de jugement axés sur le patient, tels que la mortalité, les graves événements indésirables et la qualité de vie.MéthodesIl s’agit d’une étude transversale descriptive réalisée au sein du service de chirurgie générale de l’hôpital Habib Thameur, sur la période allant de Mai 2009 à Février 2010. Cette étude porte sur 67 malades porteurs d’une lithiase vésiculaire symptomatique ayant eu une cholécystectomie laparoscopique en ambulatoire (CLA). Étaient exclus de l’étude: les malades ASA III et IV, les diabétiques sous sulfamides ou sous insuline, les grands obèses, les malades de plus de 65 ans et moins de 18 ans, ceux avec un antécédent de chirurgie abdominale majeure, les malades suspects d’une lithiase de la voie biliaire principale, d’une cholécystite aiguë ou d’une pancréatite. Pour être traité par CLA, le malade devait résider à moins de 50 km de l’hôpital, et avoir la possibilité d’une présence adulte à ses côtés.RésultatsDix-sept patients étaient inclus puis exclus de notre étude devant la découverte per opératoire de signes de cholécystite aigue ou devant des difficultés de dissection amenant le chirurgien à mettre un drain de Redon en sous hépatique en fin d’intervention. Finalement, 50 patients ont été retenus: 7 hommes et 43 femmes d’âge moyen de 48 ans. L’intervention se déroulait selon les modalités habituelles. A la sortie de la salle de réveil, le patient était dirigé en secteur ambulatoire où une alimentation liquide était autorisée. Le malade était revu avant 19 h et la sortie décidée si une analgésie orale était possible, si une alimentation liquide était tolérée, s’il n’existait aucun trouble de la diurèse, et si le patient acceptait un retour à domicile avec un traitement antalgique et anti-inflammatoire à la demande. Trente neuf patients (78%) ont quitté l’hôpital et 11 ont été gardés. L’âge > à 45 ans, la durée de l’anesthésie > à 70 minutes et la fatigue post opératoire ont été identifié comme facteur de risque de sorties ratées. Aucune réadmission n’a été observée. Les patients qui ont pu être mis sortants ont été satisfaits du protocole de prise en charge avec des réponses majoritairement de type excellent et bon (94%).ConclusionLa chirurgie ambulatoire semble tout aussi sûre que la chirurgie avec hospitalisation d'une nuit dans la cholécystectomie laparoscopique avec un faible taux de complication et de réadmission chez des malades sélectionnés, et avec une réduction du coût de l’intervention.

Introduction ambulatory surgery is continuously expanding in global reach because of its several advantages. This study aimed to describe the experience of our department in outpatient hernia surgery, evaluate its feasibility and safety, and determine the predictive factors for failure of this surgery. Methods we conducted a monocentric retrospective cohort study on patients who had ambulatory groin hernia repair (GHR) and ventral hernia repair (VHR) in the general surgery department of the Habib Thameur Hospital in Tunis between January 1 st , 2008 and December 31 st , 2016. Clinicodemographic characteristics and outcomes were compared between the successful discharge and discharge failure groups. A p-value of ≤ 0.05 was considered significant. Results we collected data from the record of 1294 patients. One thousand and twenty patients had groin hernia repair (GHR). The failure rate of ambulatory management of GHR was 3.7%: 31 patients (3.0%) had unplanned admission (UA) and 7 patients (0.7%) had unplanned rehospitalization (UR). The morbidity rate was 2.4% while the mortality rate was 0%. On multivariate analysis, we did not identify any independent predictor of discharge failure in the GHR group. Two hundred and seventy-four patients underwent ventral hernia repair (VHR). The failure rate of ambulatory management of VHR was 5.5%: 11 patients (4.0%) had UA and 4 patients (1.5%) had UR. The morbidity rate was 3.6% and the mortality rate was zero. On multivariate analysis, we did not identify any variable predicting discharge failure. Conclusion our study data suggest that ambulatory hernia surgery is feasible and safe in well-selected patients. The development of this practice would allow for better management of eligible patients and would offer many economic and organizational advantages to healthcare structures.