Extraction, characterization and controlled release application of pectin-like/chitosan hydrogels system loaded Ciprofloxacin

INTRODUCTION

In recent decades, drug delivery applications have extensively utilized hydrogel systems based on natural polymers. Among the numerous biopolymer-based hydrogel drug delivery systems reported, a novel pectin-like substance was extracted from fig leaves and copolymerized with chitosan.

METHOD

The hydrogel was reformed into microspheres using glutaraldehyde (chemical cross-linker) and sodium hexametaphosphate (physical cross-linker). The extracted polysaccharide and the prepared hydrogels were characterized by FTIR, GC/MS, SEC/MALS/DRI as well as XRD, SEM, BET, and thermal analysis. SEM images revealed the formation of porous microspheres with an average size of 50 μm in diameter. Degrees of swelling in pH7 at 35°C have shown the hydrogels reached two to three times their weights. This has been reflected in their ability to load drugs or any other chemicals. The loading formula shows that hydrogels have maximum loading efficiency more than one-third of the weight of hydrogel. The antimicrobial ciprofloxacin was used as a model for loading on prepared hydrogels. The loaded hydrogels were tested for their biological activities against staphylococcus aureus (S. aureus) bacteria. The antimicrobial growth inhibition zone of the cultured (S. aureus) by ciprofloxacin-loaded hydrogel was followed, which shows controlled growth in inhibition zone sizes and for long time intervals. Results showed that the pectin-chitosan hydrogels exhibited significant antibacterial activity against gram - positive bacteria (S. aureus), with an inhibition zone of 45 mm for (CH-co-FLP)/GLU hydrogel.

RESULT

In vitro, the ciprofloxacin-loaded hydrogels were studied and the cumulative release of ciprofloxacin under suitable conditions was found in a controlled manner and kept release for a long time interval. Data exhibited that the cumulative release profile of ciprofloxacin from the hydrogel demonstrated sustained release over 48 hours, with a value of 6.9% released within the first 24 hours and 7.0 and 6.9% % released at the end of the study for the (CH-co-FLP)/GLU and (CH-co-FLP)/SMP hydrogels, respectively.

CONCLUSION

The novel pectin-chitosan hydrogels hold the potential to enhance the quality of life for numerous patients by minimizing the need for frequent intake of chronic medications.

Effect of Flavoring with Rosemary, Lemon and Orange on the Quality, Composition and Biological Properties of Olive Oil: Comparative Study of Extraction Processes

The goal of this work was to investigate the impact of the flavoring of some aromatic plants/spices, including rosemary (R), lemon (L) and orange (O) at the concentration of 5% and 35% (w/w) added by 2 methods (conventional maceration and direct flavoring), on quality attributes, chemical changes and oxidative stability of extra virgin olive oil (EVOO). Six flavored oils were obtained (EVOO + O, O + O, EVOO + R, O + R, EVOO + L and O + L). The physicochemical parameters (water content, refractive index, acidity and peroxide value, extinction coefficient, fatty acids, volatile aroma profiles, Rancimat test, phenols and pigments composition) of the flavored oils were investigated. Based on the results obtained, it was observed that flavoring with a conventional process provided increased oxidative stability to the flavored oils, especially with rosemary (19.38 ± 0.26 h), compared to that of unflavored oil. The volatile profiles of the different flavored oils revealed the presence of 34 compounds with the dominance of Limonene. The fatty acid composition showed an abundance of mono-unsaturated fatty acids followed by poly-unsaturated ones. Moreover, a high antioxidant activity, a significant peripheral analgesic effect (77.7% of writhing inhibition) and an interesting gastroprotective action (96.59% of ulcer inhibition) have been observed for the rosemary-flavored oil. Indeed, the flavored olive oils of this study could be used as new functional foods, leading to new customers and further markets.

[Digestive stomas: which professional impact?]

Introduction

les stomies digestives constituent l´aboutissement d´un certain nombre d´interventions chirurgicales. Elles peuvent être temporaires ou définitives. Le patient porteur de stomie se trouve confronté à des aléas d´ordre physique et psychologique. Il nécessite donc une adaptation aux changements et une acceptation de la situation qu´elle soit temporaire ou définitive. Le but de ce travail est d´évaluer l´impact des stomies digestives sur la qualité de vie des patients et leur retentissement professionnel.

Méthodes

il s´agit d´une étude rétrospective, menée de janvier 2010 à décembre 2014. Au cours de cette période 115 patients avaient eu des stomies digestives. Parmi ces patients, soixante étaient en âge d´activité professionnelle, avaient un emploi fixe et avaient repris leurs travail; ils constituent l´effectif de notre étude. Le recueil des données était réalisé par un questionnaire spécifique: le questionnaire généraliste SF-36 réalisé en post opératoire.

Résultats

le score moyen pour la qualité de vie globale pour les patients stomisés était 41. Quarante patients avaient une mauvaise qualité de vie avec un score SF-36 qui était inférieur à 50. Notre étude a démontré que les patients stomisés ont éprouvé des difficultés de fonctionnement dans des situations de travail. Quarante-huit patients décrivaient une gêne directement liée à la stomie lors de l´exercice de leurs activités professionnelles. Les causes évoquées étaient d´ordre physique dans 6 cas et d´ordre psychologique dans 3 cas. Six patients étaient mutés vers des postes plus adaptés à leur situation.

Conclusion

l´objectif de la prise en charge des patients porteurs de stomie digestive doit être la réintégration sociale et professionnelle adéquate. Ceci ne peut se concevoir qu´en impliquant le médecin de travail, le psychologue, le stomathérapeute et les associations dans cette prise en charge.

Pectic polysaccharides from edible halophytes: Insight on extraction processes, structural characterizations and immunomodulatory potentials

The preparation, chemical properties and bio-activities of polysaccharides derived from halophytes have gained an increasing interest in the past few years. Phytochemical and pharmacological reports have shown that carbohydrates are important biologically active compounds of halophytes with numerous biological potentials. It is believed that the mechanisms involved in these bio-activities are due to the modulation of immune system. The main objective of this summary is to appraise available literature of a comparative study on the extraction, structural characterizations and biological potentials, particularly immunomodulatory effects, of carbohydrates isolated from halophytes (10 families). This review also attempts to discuss on bioactivities of polysaccharides related with their structure-activity relationship. Data indicated that the highest polysaccharides yield of around 35% was obtained under microwave irradiation. Structurally, results revealed that the most of extracted carbohydrates are pectic polysaccharides which mainly composed of arabinose (from 0.9 to 72%), accompanied by other monosaccharides (galactose, glucose, rhamnose, mannose and xylose), significant amounts of uronic acids (from 18.9 to 90.1%) and some proportions of fucose (from 0.2 to 8.3%). The molecular mass of these pectic polysaccharides was varied from 10 to 2650 kDa. Hence, the evaluation of these polysaccharides offers a great opportunity to discover novel therapeutic agents that presented especially beneficial immunomodulatory properties. Moreover, reports indicated that uronic acids, molecular weights, as well as the presence of sulfate and unmethylated acidic groups may play a significant role in biological activities of carbohydrates from halophyte species.

Optimization of extraction with salicylic acid, rheological behavior and antiproliferative activity of pectin from Citrus sinensis peels

A Box-Behnken design was used to optimize extraction temperature, extraction time and concentration of the salicylic acid to obtain a maximum polysaccharide yield from Citrus sinensis peels. The optimal settings were: extraction time 3 h, extraction temperature 80 °C and concentration of the salicylic acid 1.5%. Under these conditions, the experimental yield and uronic acid content were 11.74% and 66.9% respectively. Preliminary characterization was performed via FT-IR, SEC/MALS/VD/DRI and GC-MS after hydrolysis. SEC analysis showed that the extracted polysaccharide had a weight average molar mass of 350 kDa and an intrinsic viscosity of 640 mL/g. The GC-MS results revealed that the extracted polysaccharide was composed of arabinose 56.7%, galactose 17.8%, xylose 13.8%, rhamnose 5.1%, mannose 2.5% and glucose 1.5% suggested a rhamnogalacturonan pectin type I with a degree of esterification of 50.9% (IRTF). The flow curve and the dynamic frequency sweep were obtained at 10, 20, 30 and 40 g/L in water and at 30 g/L in presence of CaCl₂ or NaCl at 1 mol/L. The solutions showed shear-thinning behavior fitted with Ostwald-De Waele model, except 10 g/L with a Newtonian behavior. The apparent viscosity and, the G' and G" moduli increase with PACO concentration in agreement with a slow-down of the dynamic chain. In the presence of CaCl₂ or NaCl the reduction of electrostatic repulsions between pectin chains decreases the rheological parameters. The effect is less sensitive with CaCl₂ due to intermolecular interactions. The antiproliferative activity of the extracted pectin on human Caco-2 and Hep-2 cells was very interesting with an IC₅₀ 1.4 and 1.8 μg/mL respectively.

Optimization of polysaccharides extraction from quince peels: partial characterization, antioxidant and antiproliferative properties

In this study, Box-Behnken Design was used to optimize the ultrasonic extraction of polysaccharides from quince peels (QPPs) by ascorbic acid and the effect of extraction temperature, extraction time and pH was evaluated. Under optimized conditions of temperature 90 °C, 60 min sonication time and pH = 3.26, the extraction yield, the galacturonic acid yield and the concentration of sample required to scavenge 50% of 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic) acid (ABTS) values of QPPs were respectively 10.25%, 3.86% and 1.35 mg/mL. The QPPs extracted under optimum conditions was characterized by Fourier transform infrared spectroscopy (FTIR), Nuclear magnetic resonance (¹H NMR) and Size exclusion chromatography (SEC/MALS/VD/DRI). The monosaccharide analysis revealed that arabinose was the most abundant, followed by galactose, glucose, mannose and xylose. Moreover, QPPs showed significant antioxidant activities (2,2-diphenyl-1-picrylhydrazyl (DPPH) and Ferric- reducing antioxidant power (FRAP)) and reduced viability of human Caco-2 and murine B-16 cell lines in a dose-dependent manner. Hence QPPs could be used as antitumor agent in functional foods andpharmaceutical industries.

Chemo-embolization in the treatment of hepatocellular carcinoma: should we switch to charged particles in our countries? About 102 procedures of a North African radiology center

BACKGROUND

Hepatocellular carcinoma (HCC) is a public health problem in african countries. The chemoembolization (CE) could represent the only therapeutic strategy. Two methods can be proposed: charged microparticles and lipiodol chemoembolization. The purpose of this study was to compare results, morbidity and survival between charged microparticles and lipiodol chemoembolization.

METHODS

A 5 years retrospective, study was conducted including 62 patients with HCC treated by chemioembolization. The efficacy of the treatment was evaluated for patients by performing a computed tomography four to six weeks after the act. We used « European Association for Study of the Liver » criteria to evaluate the therapeutic outcome.

RESULTS

A total of 102 sessions of chemoembolization were performed. This was a with charged microparticles in 70 cases (68.6%) and lipiodol chemoembolization in 32 cases (31.3 %). The difference was not significant between the two CE techniques (lipiodol and charged microparticles) in terms of complete and objective response and complications. The mean survival rate was 30 months ± 4 for all techniques combined, with no statistically significant difference in terms of survival time without recurrence between the two chemoembolization techniques.

CONCLUSION

The efficacy, morbidity and survival of the two CE techniques to lipiodol or microfilled particles are comparable. The selectivity of the technique is to be taken into consideration. For economic health purposes, the CE lipiodolée appears to be more adapted to the context of the developing African countries.

Laparoscopy for perforated duodenal ulcer: A morbidity score based on a cohort study of 384 patients

BACKGROUND

The Laparoscopic treatment of perforated ulcer is accompanied by a lesser morbidity and mortality compared with treatment by laparotomy. However, the morbidity of the laparoscopic approach is not nil (4%). It is influenced by pre and intraoperative factors. The aim of our work is to establish a morbidity score in patients undergoing laparoscopic surgery for acute peritonitis with perforated duodenal ulcer.

METHODS

This is a retrospective study conducted in a General Surgery Department. We included 384 cases of perforated duodenal ulcer operated laparoscopically over a fourteen-year period ranging from January 2000 to December 2014. We conducted a multivariate logistical regression analysis by step-by-step-descending method. From these independent factors we established a score using the ROC curves. The threshold with the best sensitivity and specificity for predicting morbidity was investigated. In all statistical tests, the significance level was set at 0.05.

RESULTS

The overall morbidity rate of our patients was 3.38% (13 patients). Multivariate analysis has identified five independent morbidity risk factors: temperature higher than 37.6° C, renal failure, age> 45 years, a number of stitches of two or higher and operating time to 75 minutes or longer. Our morbidity score took into account these 5 factors by integrating the intrinsic value of each factor. The threshold of the score having the best torque sensitivity specificity to predict morbidity was 10.

CONCLUSION

A morbidity score for perforated duodenal ulcer surgery performed by laparoscopy may be useful to organize the post-operativecare of these patients usually young and active. A lower score than the threshold predictive of morbidity could allow a rapid rehabilitation of these patients and a one day hospitalization management.

Phytochemical Analysis and Evaluation of the Antioxidant, Anti-Inflammatory, and Antinociceptive Potential of Phlorotannin-Rich Fractions from Three Mediterranean Brown Seaweeds

Phlorotannins, phenolic compounds produced exclusively by seaweeds, have been reported to possess various pharmacological properties. However, there have been few works on these compounds from Mediterranean seaweeds. In this study, we investigated the phytochemical analysis and pharmacological potential of phlorotannin-rich fractions from three brown seaweeds collected along the Tunisia coast: Cystoseira sedoides (PHT-SED), Cladostephus spongeosis (PHT-CLAD), and Padina pavonica (PHT-PAD). Phytochemical determinations showed considerable differences in total phenolic content (TPC) and phlorotannin content (PHT). The highest TPC level (26.45 mg PGE/g dry material (Dm)) and PHT level (873.14 μg PGE/g Dm) were observed in C. sedoides. The antioxidant properties of these three fractions assessed by three different methods indicated that C. sedoides displayed the highest total antioxidant activity among the three species (71.30 mg GAE/g Dm), as well as the free radical scavenging activity with the lowest IC50 value in both DPPH (27.7 μg/mL) and ABTS (19.1 μg/mL) assays. Furthermore, the pharmacological screening of the anti-inflammatory potential of these fractions using in vivo models, in comparison to reference drugs, established a remarkable activity of PHT-SED at the dose of 100 mg/kg; the inhibition percentages of ear edema in mice model and paw edema in rats model were of 82.55 and 81.08%, respectively. The content of malondialdehyde (MDA) in liver tissues has been quantified, and PHT-SED was found to remarkably increase the lipid peroxidation in rat liver tissues. In addition, in two pain mice models, PHT-SED displayed a profound antinociceptive activity at 100 mg/kg and has proved a better analgesic activity when used in combination with the opioid drug, tramadol.

Value of water enema computed tomography in elderly symptomatic patients

BACKGROUND AND STUDY AIMS

Colonoscopy remains the gold standard for the examination of the colon. However, its use in the elderly is not well tolerated, and there is often a need for general anaesthesia, thus increasing the risk, especially if there are co-morbidities. Water enema computed tomography has been suggested to be a satisfactory alternative as a non-invasive, fast and effective means for the diagnosis of colorectal supra-centimetric lesions. The aim of our study was to assess the performance of water enema computed tomography as first-line examination by calculating its negative predictive value (NPV) for the diagnosis of supra-centimetric lesions in symptomatic elderly referred to colonoscopy.

PATIENTS AND METHODS

This was a prospective study including 57 symptomatic patients older than 65 years. All patients were explored by water enema computed tomography at first, followed by colonoscopy, and responded to a questionnaire on the tolerance to the preparation and both procedures.

RESULTS

The mean age of patients was 73 years. The M:F sex ratio was 1.59. The most frequent indication for colonoscopy was bowel disorders associated with abdominal pain (30%). Water enema computed tomography allowed the diagnosis of tumours (n = 2), polyps (n = 6), diverticulosis (n = 7), inflammatory wall thickening (n = 1) and extra-colic lesions (n = 28). NPV of water enema computed tomography for supra-centimetric lesions was 96.5%. Sensitivity and specificity were 87.3% and 98%, respectively. However, for sub-centimetric lesions, water enema computed tomography had a low sensitivity estimated at 6%, specificity at 89.9%, positive predictive value at 91.9% and NPV at 27.7%.

CONCLUSION

Water enema computed tomography has proven to be a valuable and non-invasive method indicated as a first-line examination in case of colonic symptoms in the elderly to diagnose supra-centimetric lesions.

[Colon adenocarcinoma and synchronous type 1 papillary renal cell carcinoma: a unique association]

La découverte de tumeurs primitives synchrones à un cancer colorectal a fait l’objet de plusieurs publications. Cette association peut survenir de manière sporadique ou rentrer dans le cadre de syndromes cliniques bien définis tel que le syndrome de Lynch. L’association synchrone d’un cancer colorectal (CCR) et d’un carcinome à cellules rénales est rare. Elle est encore plus rare lorsque le carcinome à cellules rénales est de sous-type papillaire avec seulement 2 cas rapportés dans la littérature. L’association CCR et rénaux ne semble pas être liée à une anomalie des protéines du système MMR (MisMatch Repair) et n’intègre à ce jour aucun syndrome clinique. Nous rapportons le cas d’une femme âgée de 69 ans qui a simultanément présenté un adénocarcinome colique et un carcinome papillaire du rein de type 1, de découverte fortuite au cours du bilan d’extension du CCR. Nous discuterons la pathogénie ainsi que le pronostic de cette entité rarement décrite.

Extracapsular involvement in nodal metastasis as a prognostic factor in colorectal cancer

BACKGROUND

Extracapsular extension of nodal metastasis has recently emerged as an important prognostic factor in different malignancies. In colorectal cancer (CRC), only a limited number of studies have been published and its prognostic value has not yet been completely established.

AIMS

To assess the incidence of extracapsular invasion (ECI) in lymph node (LN) metastasis in colorectal adenocarcinoma and to investigate the correlation between this parameter and other clinico-pathological factors.  Furthermore, its effect on overall and disease free survival were evaluated.

METHODS

Seventy-five patients who underwent colorectal resection for adenocarcinoma with node metastasis were included in this study. Extracapsular invasion was evaluated by two pathologists. Associations between clinicopathologic factors, survival, and the nodal findings were evaluated. The 2009 pTNM staging of CRC was used.

RESULTS

Extracapsular invasion was identified in 45 patients (60 %). Average follow-up time was 25 months. Extracapsular invasion was correlated with pT stage> pT2 (p=0,015), pN stage > pN1 (p= 0,014), distant metastasis at diagnosis (p=0,005) and later (p=0,01) and with local recurrences (p=0,0001). Univariate analysis indicated that ECI tends to decrease overall survival but not significantly.  Multivariate analysis showed that age and synchronic metastasis were independent prognostic factors (HR = 2,03 and 2,24; p= 0,039 and 0,012 respectively). Patients with ECI had a significantly worse five-year disease-free survival than ECI-negative groups.

CONCLUSION

In patients with CRC, ECI in regional LNs would reflect an aggressive behavior. It would therefore be useful to include this parameter in standardized pathologic reports and future staging systems.

Resected colorectal cancer liver metastases : Prognostic study about 110 patients

INTRODUCTION

The prognosis of hepatic metastases in colorectal cancers is constantly being improved at the cost of multidisciplinary care, allowing each patient to have an adapted strategy. The prognostic factors make it possible to recognize patients needing further treatment after resection and closer monitoring.

OBJECTIVE

The aim of our study was to conduct a prognostic study to identify factors influencing survival at 5 years for patients operated of colorectal liver metastases.

METHODS

This is a retrospective study conducted over a period of 10 years (2005-2015). All patients operated for liver metastasis of colorectal cancers were included. The primary endpoint was overall survival. Secondary endpoints were recurrence-free survival and operative morbidity and mortality. The proportions were compared by the Chi 2 test. The survival curves were established according to the Kaplan-Meier method and the comparison of the curves according to the Logrank test. A univariate and then multivariate Cox model was used to determine prognostic factors. The significance level was set at 0.05.

RESULTS

Overall survival of our patients at 3 and 5 years was 49% and 32% respectively. Recurrence-free survival was 21% at 3 years and 15% at 5 years. In multivariate analysis, the hepatic resection margin <1 mm and the number of hepatic metastases ≥3 were independent factors correlated with survival.

CONCLUSIONS

colorectal liver metastases surgery improves patient survival. Some factors need to be sought to adapt care strategies.

[Solitary necrotic nodule of the liver: about two cases]

Les lésions hépatiques nodulaires sont majoritairement tumorales. Le nodule nécrotique solitire du foie est rare. Le diagnostic preopératoire est difficile. Il s'agit d'une femme âgée de 43 ans qui était opérée d'un adénocarcinome du rectum métastatique au foie opéré. Le scanner abdominal de surveillance a révélé un nodule hépatique d'allure métastatique. Le second cas est celui d'un homme de 56 ans, admis pour cholécystectomie avec découverte per-opératoire d'un nodule hépatique. Dans les deux cas, le nodule hépatique était sous capsulaire et a été réséqué. L'examen anatomopathologique posait le diagnostic de nodule nécrotique solitaire du foie. Le nodule nécrotique non spécifique du foie est une lésion qui doit être évoquée, même dans un contexte néoplasique. Une caractérisation par l'imagerie et une ponction biopsie des lésions hépatiques peut être utile.

[Strangled rectal prolapse in young adults: about a case and review of the literature]

Rectal prolapse is a rectal static disorder which involves rectal wall intussusception inducing its externalization through the anus. It usually affects children and the elderly. Its occurrence in young adults is rare. Strangulated rectal prolapse is also a rare complication. We report the case of a 30-year old patient who underwent emergency surgery for strangulated rectal prolapse. Emergency perineal rectosigmoidectomy (Altemeier repair) was performed with simple outcome.

Open liver trauma causing hepatico caval fistula successfully treated by embolization

Introduction

Traumatic arteriovenous fistula results from a breach of vascular integrity between a vein and an adjacent artery. Hepato caval fistula is a rare entity. Open surgical approaches have increasingly given way to radiological embolization techniques in the treatment of these arteriovenous fistulae, especially in intrahepatic locations.

Case report

We report the case of a patient diagnosed with a fistula, from the right branch of the liver artery to the right hepatic vein, developed following an open liver trauma. Successful embolization through the transarterial route was achieved with simple outcomes.

Conclusion

The interventional radiology for endovascular management has revolutionized the treatment of hepatic liver traumas. The conservative treatment is henceforth the common approach even if hepatic artery or hepatic veins are involved in case of arteriovenous fistula.

Gastric Schwannoma: A Case Report

Schwannomas are generally benign, slow growing tumors. They are rarely observed in the gastrointestinal tract with the most common site being the stomach. These tumors are usually asymptomatic. The preoperative diagnosis via endoscopy is a challenging issue due to the difficulty of differentiation from other submucosal tumors. A 54-year-old woman presented with epigastric pain persisting for the last 10 months. Upper endoscopy revealed an elevated submucosal mass of the gastric antrum. The overlying mucosa was normal. Biopsy specimens yielded only unspecific signs of mild inactive chronic inflammation. Endoscopic ultrasound examination noted a hypoechoic homogeneous mass lesion located in the gastric antrum. The mass appeared to arise from the muscularis propria, and there was no perigastric lymphadenopathy. A contrast-enhanced computed tomography scan identified a homogeneous round mass and arising from the antrum of the stomach. Submucosal tumor was suspected and surgical intervention was recommended. The patient underwent an elective laparoscopic partial gastrectomy. The histopathologic features and immunohistochemical-staining pattern were consistent with a benign gastric schwannoma. Our patient shows no recurrence with a follow-up of one year. The definitive diagnosis of gastric schwannomas requires immunohistochemical studies. Complete margin negative surgical resection, as in this case, is the curative treatment of choice. The clinical course is generally benign.

[Laparoscopic colectomy versus colectomy performed via laparotomy in the treatment of non-metastatic colic adenocarcinomas]

Introduction

La colectomie laparoscopique pour cancer colorectal constitue, de plus en plus, le traitement de référence. L’objectif de notre travail est de montrer que les résultats à court terme etla sécurité oncologique que procure la voie laparoscopique sont au moins équivalents à ceux de la laparotomie dans le traitement des adénocarcinomes coliques non métastatiques. Nous nous proposons également d’étudier l’impact de la courbe d’apprentissage sur les résultats de la laparoscopie dans ces cancers.

Méthodes

Il s’agit d’une étude rétrospective incluant tousles patients opérés pour des adénocarcinomes coliques résécablessur une période de 6 ans. La population de l’étude était répartie en 2 groupes, selon la voie d’abord utilisée initialement. Le groupe « OC » comprenait 35 patients opérés par laparotomie médiane et le groupe « LAC » comprenait 30 patients opérés par laparoscopie. Toutes les données étaient analysées au moyen du logiciel SPSS version 19.0.

Résultats

Notre étude n’a pas montré de différence significative dans les résultats à court terme entre les 2 groupes à savoir la morbidité per-opératoire, le séjour hospitalier, le séjour en milieu de réanimation ainsi que la morbi-mortalité postopératoire. Concernant les résultats à long terme, il n’y avait également pas de différence significative en termes de complications tardives, type de récidive, survie globale et survie sans récidive. La sécurité oncologique, attestée par les limites de résections et le nombre de ganglions prélevés, n’était pas significativement différente entre les deux groupes. Le temps opératoire était significativement plus long en laparoscopie (p < 0,001). Le taux de conversion était de 33%. Il est passé de 67% au cours des 2 premières années de l’étude à 13% au cours des 2 dernières années. La conversion de la laparoscopie en laparotomie n’avait pas d’impact significatif ni sur les suites opératoires précoces, ni sur la survie globale et la survie sans récidive.

Conclusion

La voie laparoscopique est une voie d’abord ayant des résultats à court et à long terme au moins équivalents à la laparotomie. La courbe d’apprentissage représentant un « passage obligé » n’a pas d’impact négatif sur les résultats du traitement laparoscopique des cancers coliques non métastatiques.

[Post traumatic anterior abdominal wall hernia]

La hernie post-traumatique de la paroi abdominale antérieure peut être méconnue dans un contexte d’urgence. Nous rapportons l’observation d’un patient âgé de 32 ans, avec un BMI à 30 Kg/m² ayant présenté une hernie de la paroi abdominale antérieure suite à un accident de la voie publique. Cette lésion était méconnue par l’examen clinique. La tomodensitométrie abdominale montrait un défect de 8 cm de la paroi abdominale antérieure. Le patient était opéré avec découverte d’un défect musculo-aponévrotique sur 12 cm. La réparation était réalisée par une suture par des points séparés. Les suites opératoires étaient marquées par une nécrose secondairement infectée de la peau. Elle avait bien évolué après cicatrisation dirigée. A 3 mois post-opératoire, le patient va bien avec une plaie cicatrisée et une paroi abdominale solide.

[The POSSUM: a good scoring system for predicting mortality in elderly patients undergoing emergency surgery?]

Introduction

Le POSSUM (Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity) est un score prédictif de mortalité qui est largement utilisé en chirurgie aortique élective et abdominale. Le but de notre étude est une validation du POSSUM chez le sujet âgé (>70 ans) opéré pour une urgence digestive. Nous nous proposons d'étudier les meilleurs seuils du POSSUM, composé d'un score physiologique et d'un score opératoire, pour prédire la mortalité dans cette population.

Méthodes

Il s'agit d'une étude rétrospective analytique de type cas témoin à partir d'une série de 291 patients d'âge ≥ 70 ans opérés pour une urgence digestive. Ces patients étaient répartis en deux groupes comportant 50 patients chacun. Le groupe "DC": patients décédés en post opératoire immédiat et le Groupe témoin "SURV" choisis par tirage au sort. Nous avons analysé la fiabilité du POSSUM pour prédire la mortalité et la morbidité. Par la suite, nous avons établi des courbes de ROC pour définir les seuils qui donnent le meilleur couple sensibilité/spécificité.

Résultats

Le score physiologique, le score opératoire et les taux de morbidité et mortalité prédits par POSSUM et la mortalité prédit par P-POSSUM représentaient des facteurs prédictifs de mortalité (P <0,0001). Les valeurs seuils du score physiologique et du score opératoire qui donnent le meilleur couple sensibilité/spécificité, étaient respectivement de 23 et 15.

Conclusion

Prédire la mortalité permet de cibler la prise en charge et d'informer le patient et sa famille des risques encourus.

Rectal adenocarcinoma: 154 cases prognosis study

BACKGROUND

during this century, therapeutic management of rectal cancer has known a lot of advances. Survival is still depending on factors related to the patient, the tumor or the surgeon.

AIM

The aim of our study is to report survival and prognosis factors of our patients managed for a rectal cancer.

METHODS

  We report an descreptive retrospective study about 154 patients. SPSS 19.0 version was used for the statistical analysis. Desriptive study was done using means, and pourcentage. Survival was analysed using Kaplan meier curve. In univariate analysis, we calculated the odd ratio in order to evaluate risk factors. Multivariate analysis used Cox model. Significancy was 0.05.

RESULTS

  Global survival was 52.4% at 3 years and 42.4% at 5 years. Free reccurence survival was 76%  at 3 years and 69.15% at 5 years. In univariate analysis, factors significantly influencing survival were age>70 years, CAE level, tumor perforation, TNM, tumor differentiation, peroperative blood transfusion, and reccurency. In multivriate analysis, only age > 70 years, T and local reccurency were independants factors influencing survival.

CONCLUSION

  A better knowledge of prognosis factors ead to a better management of this cancer with more adjuvant treatment indications and closer monitoring.

Rectal adenocarcinoma: 154 cases prognosis study

BACKGROUND

during this century, therapeutic management of rectal cancer has known a lot of advances. Survival is still depending on factors related to the patient, the tumor or the surgeon.

AIM

The aim of our study is to report survival and prognosis factors of our patients managed for a rectal cancer.

METHODS

  We report an descreptive retrospective study about 154 patients. SPSS 19.0 version was used for the statistical analysis. Desriptive study was done using means, and pourcentage. Survival was analysed using Kaplan meier curve. In univariate analysis, we calculated the odd ratio in order to evaluate risk factors. Multivariate analysis used Cox model. Significancy was 0.05.

RESULTS

  Global survival was 52.4% at 3 years and 42.4% at 5 years. Free reccurence survival was 76%  at 3 years and 69.15% at 5 years. In univariate analysis, factors significantly influencing survival were age>70 years, CAE level, tumor perforation, TNM, tumor differentiation, peroperative blood transfusion, and reccurency. In multivriate analysis, only age > 70 years, T and local reccurency were independants factors influencing survival.

CONCLUSION

  A better knowledge of prognosis factors ead to a better management of this cancer with more adjuvant treatment indications and closer monitoring.

Traumatic isolated perforation of lower oesophagus

One of the rarest cases of non-iatrogenic oesophageal perforation is falling from height. We report a case of a 26 year old man with oesophageal perforation resulting from a fall of 12 meter height. A pneumomediastinum in the absence of a pneumothorax and contrast extravasation from the oesophagus on CT evoked a perforation of the aerodigestive tract. No other injuries were seen. A non-operative management was pursued with good outcomes.

Huge Aneurysm of the Proper Hepatic Artery

Hepatic artery aneurysms are rarely diagnosed. It is mainly because of non specific symptoms. They are generally an incidental findings during imaging studies. They are usually detected in the sixth decade, predominantly in men. We report herein a case of an 80 year-old man with a huge hepatic artery aneurysm revealed by abdominal pain and chronic anemia. It was treated by embolisation. Hepatic artery aneurysms are second among visceral aneurysms. They may cause abdominal pain, jaundice and hemorrhagic events.

[Laparoscopy for perfored duodenal ulcer : conversion and morbidity factors: retrospective study of 290 cases]

BACKGROUND

feasibility and advantages of laparoscopic approach in performed duodenal ulcer have no longer to be demonstrated. Laparoscopic suture and peritoneal cleaning expose to a conversion rate between 10 and 23%. However less than laparotomy, morbidity of this approach is not absent.

AIM

This study aim to analyze factors exposing to conversion after laparoscopic approach of perforred duodenal ulcer. We also aim to define the morbidity of this approach and predictive factors of this morbidity Methods: Retrospective descriptive study was conducted referring all cases of perforated duodenal ulcer treated laparoscopically over a period of ten years, running from January 2000 to December 2010. All patients were operated by laparoscopy with or without conversion. We have noted conversion factors. A statistical analysis with logistic regression was performed whenever we have sought to identify independent risk factors for conversion verified as statistically significant in univariante. The significance level was set at 5%. Analytic univariant and multivariant study was performed to analyze morbidity factors.

RESULTS

290 patients were included. The median age was 34ans.T he intervention was conducted completely laparoscopically in 91.4% of cases. The conversion rate was 8.6%. It was selected as a risk factor for conversion: age> 32 years, a known ulcer, progressive pain, renal function failure, a difficult peritoneal lavage and having a chronic ulcer. Postoperative morbidity was 5.1%. Three independent risk factors of surgical complications were selected: renal failure, age> 45 years, and a chronic ulcer appearance.

CONCLUSION

Laparoscopic treatment of perforred duodenal ulcer expose to a conversion risk. Morbidity is certainly less than laparotomy and a better Knowledge of predictif's morbidity factors become necessary for a better management of this disease.

[What's new in rectal cancer?]

BACKGROUND

In recent years, multidisciplinary therapeutic management of rectal cancer has evolved. This progress had interest radio and chemotherapy.

AIM

To describe the main spots of the progress in the therapeutic strategies of the disease, surgical techniques and standardization of these techniques, particularly regarding locoregional extension in the mesorectum.

METHOD

Literature review.

RESULTS

Treatment of rectal cancer is multidisciplinary. On the surgical field, excision of the mesorectum (total mesorectal excision [TME]) has reduced local recurrence and the genitourinary sequelae. Meanwhile, chemoradiotherapy has become important. The standard now is to indicate to T3 T4 N+ tumors to decrease local recurrence without improving survival, however.

CONCLUSION

Advances in the management of rectal cancer with both imaging progress and therapeutic modalities have improved the prognosis and survival of this cancer.