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Hajri M, Talbi G, Bacha D, Ferjaoui W, Gharbi L, Khalfallah MT. A case of Peritonitis with pneumoperitoneum secondary to a spontaneous rupture of splenic abscess. Bangladesh J Med Sci 2022. [DOI: 10.3329/bjms.v21i2.58081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Sponteous rupture of a splenic abscess is rare and little described in the literature. It can cause peritonitis with pneumoperitoneum. Our case illustrates this exceptional complication in a 77 year-old diabetic patient who consulted for abdominal pain with asthenia. The abdominal computed tomography showed an acute peritonitis caused by with splenic abscess. Aeoporty was also observed. He was operated but died postoperatively for severe sepsis. Our case is rare and interesting. Indeed, a splenic abscess can be the cause of peritonitis, pneumoperitoneum and aeorportie.
Bangladesh Journal of Medical Science Vol. 21 No. 02 April’22 Page : 455-457
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Mohamed Hajri , Talbi G, Bacha D, Ferjaoui W, Gharbi L, Khalfallah MT. A case of Peritonitis with pneumoperitoneum secondary to a spontaneous rupture of splenic abscess. BANGLADESH JOURNAL OF MEDICAL SCIENCE 2021. [DOI: 10.3329/bjms.v20i3.52810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Sponteous rupture of a splenic abscess is rare and little described in the literature. It can cause peritonitis with pneumoperitoneum. Our case illustrates this exceptional complication in a 77 year-old diabetic patient who consulted for abdominal pain with asthenia. The abdominal computed tomography showed an acute peritonitis caused by with splenic abscess. Aeoporty was also observed. He was operated but died postoperatively for severe sepsis. Our case is rare and interesting. Indeed, a splenic abscess can be the cause of peritonitis, pneumoperitoneum and aeorportie.
Bangladesh Journal of Medical Science Vol.20(3) 2021 p.651-653
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Snene H, Badri I, Mehiri N, Ben Salah N, Blibech H, Aouina H, Belhadj S, Boussen H, Chaouch N, Charfi R, Fenniche S, Gharbi L, Ghrairi H, Hamzaoui A, Megdiche L, Merai S, Mezni F, Tritar F, Daghfous J, Marghli A, Louzir B. [Diagnostic and therapeutic management of operable bronchopulmonary carcinoid tumours]. Rev Mal Respir 2021; 38:249-256. [PMID: 33674138 DOI: 10.1016/j.rmr.2021.02.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 02/10/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Bronchial carcinoid tumours (CT), divided into typical carcinoid (TC) or atypical carcinoid (AC), are rare tumours whose therapeutic management remains unspecified. METHODS Retrospective study collecting cases of bronchial CT operated at the thoracic surgery department of Abderrahmane-Mami hospital of Ariana and recruited from the pneumology departments of Northern Tunisia, during a 12-year period. RESULTS Ninety patients were collected (74 cases of TC and 16 cases of AC). The mean age was 45 years and the sex ratio H/F=0.5. The chest X-ray was normal in 11 cases, as well as flexible bronchoscopy in seven cases. The tumour was classified: stage IA (10 cases), IIA (28 cases), IIB (31 cases), IIIA (15 cases) and IIIB (six cases). Surgery resulted in a complete resection in 78 patients, an extensive resection in six patients, and a conservative resection in six patients. Adjuvant chemotherapy was given in 10 patients. The survival was 84% at five years and 42% at 10 years. CONCLUSION The prognosis of CT depends directly on the histological subtype. It is excellent for TC after complete resection, unlike ACs that are similar to well-differentiated bronchial carcinomas.
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Affiliation(s)
- H Snene
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie.
| | - I Badri
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie
| | - N Mehiri
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie
| | - N Ben Salah
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie
| | - H Blibech
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie
| | - H Aouina
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Charles-Nicolle, Tunis, Tunisie
| | - S Belhadj
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, hôpital régional de Menzel-Bourguiba, Bizerte, Tunisie
| | - H Boussen
- Faculté de médecine de Tunis, université de Tunis El Manar, service d'oncologie médicale, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - N Chaouch
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie pavillon 2, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - R Charfi
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie, hôpital des forces de sécurité intérieur, Tunis, Tunisie
| | - S Fenniche
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie pavillon 4, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - L Gharbi
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie pavillon D, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - H Ghrairi
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie, hôpital Taher-Maamouri, Nabeul, Tunisie
| | - A Hamzaoui
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie pavillon B, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - L Megdiche
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie pavillon Ibn Nafis, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - S Merai
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie, CHU La Rabta, Tunis, Tunisie
| | - F Mezni
- Faculté de médecine de Tunis, université de Tunis El Manar, service d'anatomie pathologie, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - F Tritar
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie pavillon C, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - J Daghfous
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie
| | - A Marghli
- Faculté de médecine de Tunis, université de Tunis El Manar, service de chirurgie thoracique et cardiovasculaire, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - B Louzir
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie
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Bayar R, Baccouche S, Mzoughi Z, Chelbi A, Arfa N, Gharbi L, Mestiri H, Khalfallah MT. [Digestive stomas: which professional impact?]. Pan Afr Med J 2021; 38:118. [PMID: 33912288 PMCID: PMC8051210 DOI: 10.11604/pamj.2021.38.118.10700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 08/02/2017] [Indexed: 11/11/2022] Open
Abstract
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.
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Affiliation(s)
- Rached Bayar
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie.,Service de Chirurgie Viscérale, CHU Mongi Slim, Sidi Daoud, La Marsa, Tunisie
| | - Seifeddine Baccouche
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie.,Service de Chirurgie Viscérale, CHU Mongi Slim, Sidi Daoud, La Marsa, Tunisie
| | - Zeineb Mzoughi
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie.,Service de Chirurgie Viscérale, CHU Mongi Slim, Sidi Daoud, La Marsa, Tunisie
| | - Abdelkoddous Chelbi
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie.,Service de Chirurgie Viscérale, CHU Mongi Slim, Sidi Daoud, La Marsa, Tunisie
| | - Nafaa Arfa
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie.,Service de Chirurgie Viscérale, CHU Mongi Slim, Sidi Daoud, La Marsa, Tunisie
| | - Lassad Gharbi
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie.,Service de Chirurgie Viscérale, CHU Mongi Slim, Sidi Daoud, La Marsa, Tunisie
| | - Hafedh Mestiri
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie.,Service de Chirurgie Viscérale, CHU Mongi Slim, Sidi Daoud, La Marsa, Tunisie
| | - Mohamed Taher Khalfallah
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie.,Service de Chirurgie Viscérale, CHU Mongi Slim, Sidi Daoud, La Marsa, Tunisie
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Bacha D, Talbi G, Ben Slama S, Lahmar A, Gharbi L, Bouraoui S. Predictive factors for histological response to neo-adjuvant treatment in rectal cancers. Tunis Med 2019; 97:1284-1290. [PMID: 32173832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The complete histological response represents the goal of neo-adjuvant treatment of locally advanced rectal cancer. This objective is a real challenge requiring the research of predictive factors for this response, from the perspective of targeted therapeutic strategies. The results of the various studies focused on these predictive factors are discordant. AIM To seek a correlation between 7 prognostic factors tested in pre-therapy and the histological response to neo-adjuvant treatment. METHODS A retrospective study involving 44 patients with locally advanced rectal adenocarcinoma who received neo-adjuvant radiotherapy or radiochemotherapy. The 7 prognostic factors studied were clinical (age and sex), radiological (tumor size and parietal invasion) and histological (histological grade, vascular and nerve invasion) features. The complete histological response was defined by Bateman's tumor grade m-RCRG 1 and the absence of lymph node metastases. RESULTS A complete histological response was observed in 25% of cases (n = 11). In multivariate analysis, age> 60 years (OR: 1.14 and p = 0.028), male sex (OR: 21 and p = 0.045) and radiological wall invasion exceeding the subserosa (OR: 11 , 5 and p = 0.008) were significantly associated with the histological response. In contrast, none of the 3 histological factors tested were correlated with this response's intensity. CONCLUSION Age, gender, and pre-therapeutic parietal invasion could be used to select "good" and "poor" responders to neo-adjuvant treatment in locally advanced rectal cancers.
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Bacha D, Sassi A, Baccouche S, Talbi G, Slama SB, Gharbi L, Bouraoui S, Lahmar A. A disconcerting false gastric diverticulum mimicking malignancy. Pan Afr Med J 2019; 32:80. [PMID: 31223371 PMCID: PMC6560974 DOI: 10.11604/pamj.2019.32.80.18075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 01/15/2019] [Indexed: 02/04/2023] Open
Abstract
Gastric diverticula are the most uncommon form of gastrointestinal diverticula. They can either be of true or false type with different pathogenesis. They may be very challenging to diagnose as symptoms are nonspecific and imaging can simulate a malignant lesion. We report an unusual case of pre-pyloric diverticulum in a 69-year-old man, leading to severe gastric obstruction with a poor general condition. As subsequent endoscopy and imaging were alarming and couldn't exclude malignancy, the patient underwent an antrectomy. The final diagnosis was made on pathological examination. We discuss, through this case, the clinical and pathological features of gastric diverticula with an emphasis on the pathogenesis of this rare entity and the risk of a malignant transformation.
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Affiliation(s)
- Dhouha Bacha
- Department of Pathology, Mongi Slim Teaching Hospital La Marsa, University of Tunis El Manar, Faculty of Medicine, Tunis, Tunisia
| | - Asma Sassi
- Department of Pathology, Mongi Slim Teaching Hospital La Marsa, University of Tunis El Manar, Faculty of Medicine, Tunis, Tunisia
| | - Seifeddine Baccouche
- Surgery Department, Mongi Slim Teaching Hospital La Marsa, University of Tunis El Manar, Faculty of Medicine, Tunis, Tunisia
| | - Ghofrane Talbi
- Surgery Department, Mongi Slim Teaching Hospital La Marsa, University of Tunis El Manar, Faculty of Medicine, Tunis, Tunisia
| | - Sana Ben Slama
- Department of Pathology, Mongi Slim Teaching Hospital La Marsa, University of Tunis El Manar, Faculty of Medicine, Tunis, Tunisia
| | - Lassad Gharbi
- Surgery Department, Mongi Slim Teaching Hospital La Marsa, University of Tunis El Manar, Faculty of Medicine, Tunis, Tunisia
| | - Saadia Bouraoui
- Department of Pathology, Mongi Slim Teaching Hospital La Marsa, University of Tunis El Manar, Faculty of Medicine, Tunis, Tunisia
| | - Ahlem Lahmar
- Department of Pathology, Mongi Slim Teaching Hospital La Marsa, University of Tunis El Manar, Faculty of Medicine, Tunis, Tunisia
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Bacha D, Sassi A, Slama SB, Nefiss M, Gharbi L, Bouraoui S, Lahmar A. [Unexpected discovery of isolated osteochondroma in the pubic symphysis]. Pan Afr Med J 2019; 32:74. [PMID: 31223365 PMCID: PMC6560973 DOI: 10.11604/pamj.2019.32.74.18076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 01/15/2019] [Indexed: 11/13/2022] Open
Abstract
L'ostéochondrome est la tumeur osseuse bénigne la plus fréquente. Elle touche habituellement les métaphyses des os longs, particulièrement autour du genou et de l'humérus proximal. Il touche très rarement la symphyse pubienne avec fréquemment une symptomatologie atypique. Nous rapportons le cas d'un ostéochondrome de la symphyse pubienne empiétant sur la branche osseuse ilio-pubienne chez un homme de 35 ans, de découverte fortuite. Les explorations radiologiques, l'examen macroscopique et histologique confirment le diagnostic ainsi que l'absence de signe de malignité.
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Affiliation(s)
- Dhouha Bacha
- Service d'Anatomie et de Cytologie Pathologiques, Hôpital Mongi Slim, La Marsa, Tunis, Tunisie
| | - Asma Sassi
- Service d'Anatomie et de Cytologie Pathologiques, Hôpital Mongi Slim, La Marsa, Tunis, Tunisie
| | - Sana Ben Slama
- Service d'Anatomie et de Cytologie Pathologiques, Hôpital Mongi Slim, La Marsa, Tunis, Tunisie
| | - Mouadh Nefiss
- Service de Chirurgie Viscérale et Orthopédique, Hôpital Mongi Slim, La Marsa, Tunis, Tunisie
| | - Lassad Gharbi
- Service de Chirurgie Viscérale et Orthopédique, Hôpital Mongi Slim, La Marsa, Tunis, Tunisie
| | - Saadia Bouraoui
- Service d'Anatomie et de Cytologie Pathologiques, Hôpital Mongi Slim, La Marsa, Tunis, Tunisie
| | - Ahlem Lahmar
- Service d'Anatomie et de Cytologie Pathologiques, Hôpital Mongi Slim, La Marsa, Tunis, Tunisie
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Ben Halima A, Aouadi S, Laroussi L, Boukris M, Addad F, Kachboura S, Gharbi L. P856Prevalence of obstructive sleep apnea in patients with Aarial fibrillation and hypertension. Europace 2018. [DOI: 10.1093/europace/euy015.459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Ben Halima
- Cardiolgy department- Abderrahmen Mami Hospital, Ariana, Tunisia
| | - S Aouadi
- Abderrahmen Mami Hospital, Pneumolgy department, tunis, Tunisia
| | - L Laroussi
- Cardiolgy department- Abderrahmen Mami Hospital, Ariana, Tunisia
| | - M Boukris
- Cardiolgy department- Abderrahmen Mami Hospital, Ariana, Tunisia
| | - F Addad
- Cardiolgy department- Abderrahmen Mami Hospital, Ariana, Tunisia
| | - S Kachboura
- Cardiolgy department- Abderrahmen Mami Hospital, Ariana, Tunisia
| | - L Gharbi
- Abderrahmen Mami Hospital, Pneumolgy department, tunis, Tunisia
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Mzoughi Z, Fadhl H, Djebbi A, Talbi G, Romdhane H, Aloui W, Gharbi L, Khalfallah MT. Abdominal Emergency Surgery in the Elderly: How to Predict Mortality? J Clin Diagn Res 2018. [DOI: 10.7860/jcdr/2018/29179.11339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bacha D, Mzoughi Z, Belkacem O, Rejaibi S, Lahmar A, Gharbi L, Bouraoui S. Extracapsular involvement in nodal metastasis as a prognostic factor in colorectal cancer. Tunis Med 2017; 95:434-439. [PMID: 29512800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
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.
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Mzoughi Z, Djebbi A, Talbi G, Smati H, Bacha D, Ben Slama Mallouli S, Bouraoui S, Arfa N, Mestiri H, Gharbi L, Bayar R, Khalfallah MT. Resected colorectal cancer liver metastases : Prognostic study about 110 patients. Tunis Med 2017; 95:347-352. [PMID: 29509216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
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.
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Ben Slama S, Bacha D, Bayar R, Gharbi L, Lahmar A. Pancreatic resection for isolated metastasis from melanoma of unknown primary. Acta Gastroenterol Belg 2017; 80:323-324. [PMID: 29560703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- S Ben Slama
- Department of Pathology, Mongi Slim Hospital, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis
| | - D Bacha
- Department of Pathology, Mongi Slim Hospital, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis
| | - R Bayar
- Department of Surgery, Mongi Slim Hospital, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis
| | - L Gharbi
- Department of Surgery, Mongi Slim Hospital, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis
| | - A Lahmar
- Department of Pathology, Mongi Slim Hospital, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis
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Mzoughi Z, Bayar R, Khmiri H, Gharbi L, Khalfallah MT. [Post traumatic anterior abdominal wall hernia]. Pan Afr Med J 2016; 24:203. [PMID: 27795798 PMCID: PMC5072850 DOI: 10.11604/pamj.2016.24.203.9517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 04/15/2016] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Zeineb Mzoughi
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie, Service de Chirurgie Digestive et Hépatobiliaire, CHU Mongi Slim, La Marsa
| | - Rached Bayar
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie, Service de Chirurgie Digestive et Hépatobiliaire, CHU Mongi Slim, La Marsa
| | - Hamdi Khmiri
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie, Service de Chirurgie Digestive et Hépatobiliaire, CHU Mongi Slim, La Marsa
| | - Lassad Gharbi
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie, Service de Chirurgie Digestive et Hépatobiliaire, CHU Mongi Slim, La Marsa
| | - Mohamed Taher Khalfallah
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie, Service de Chirurgie Digestive et Hépatobiliaire, CHU Mongi Slim, La Marsa
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Mzoughi Z, Djebbi A, Bayar R, Hamdi I, Gharbi L, Khalfallah T. Traumatic isolated perforation of lower oesophagus. Trauma Case Rep 2016; 6:13-15. [PMID: 29942853 PMCID: PMC6013008 DOI: 10.1016/j.tcr.2016.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2016] [Indexed: 11/19/2022] Open
Abstract
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.
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Bacha D, Lahmar A, Gharbi L, Slama SB, Bouraoui S, Chatti S, Regaya SM. [Primary renal carcinoid metastasizing to distant sites 12 years after the initial diagnosis]. Pan Afr Med J 2016; 23:76. [PMID: 27217899 PMCID: PMC4862796 DOI: 10.11604/pamj.2016.23.76.9033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/19/2016] [Indexed: 12/02/2022] Open
Abstract
Les carcinoïdes primitifs du rein sont rares avec une centaine de cas rapportés dans la littérature. Sur le plan histologique, il s'agit d'une tumeur bien différenciée dont la morphologie rejoint souvent celle des carcinoïdes dans les autres localisations. Nous rapportons un cas de carcinoïde primitif du rein survenant chez un homme de 41 ans, découvert à la suite de métastases hépatiques. La tumeur était particulière par son architecture tubulo-papillaire, suggérant à tort le diagnostic de carcinome papillaire du rein. Ce diagnostic a été redressé 12 ans après, à la suite de l'apparition d'autres métastases hépatiques, osseuses et pulmonaires.
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Affiliation(s)
- Dhouha Bacha
- Service d'Anatomie et de Cytologie Pathologiques, Hôpital Mongi Slim, La Marsa, Tunisie
| | - Ahlem Lahmar
- Service d'Anatomie et de Cytologie Pathologiques, Hôpital Mongi Slim, La Marsa, Tunisie
| | - Lassad Gharbi
- Service de Chirurgie Générale, Hôpital Mongi slim, La Marsa, Tunisie
| | - Sana Ben Slama
- Service d'Anatomie et de Cytologie Pathologiques, Hôpital Mongi Slim, La Marsa, Tunisie
| | - Saadia Bouraoui
- Service d'Anatomie et de Cytologie Pathologiques, Hôpital Mongi Slim, La Marsa, Tunisie
| | - Samia Chatti
- Service d'Anatomie et de Cytologie Pathologiques, Clinique International Hannibal, Tunisie
| | - Sabeh Mzabi Regaya
- Service d'Anatomie et de Cytologie Pathologiques, Hôpital Mongi Slim, La Marsa, Tunisie
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Hefaiedh R, Sabbeh M, Miloudi N, Ennaifer R, Romdhane H, Belhadj N, Gharbi L, Khalfallah T. Surgical treatment of Crohn's disease: indications, results and predictive factors of recurrence and morbidity. Tunis Med 2015; 93:356-360. [PMID: 26644097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Crohn's disease management represents a major problem in gastroenterology and general surgery because it affects young subjects and has a major impact on their quality of life. The aims of our study were to identify the indications for surgery in Crohn's disease, the results and the complications of surgery in our series, and to identify possible predictive factors of recurrence and postoperative morbidity. METHODS A retrospective descriptive study including 38 cases of patients with Crohn's disease who underwent surgical treatment in the department of surgery in Mongi Slim Hospital, during the period between January 1992 and December 2011 was performed. RESULTS The occurrence of stenosis was the most common indication for surgical treatment in Crohn's disease in our series, and ileocecal resection was the most performed surgery. Twenty six patients (58%) received maintenance therapy after surgery. Twenty two patients relapsed and 13 had surgical management for recurrence. In univariate analysis, predictive factors of post operative morbidity in our study were leukocytosis, penetrating phenotype and intraabdominal sepsis. Ileocecal location was the only factor that significantly improved the incidence of recurrence. In multivariate analysis, only penetrating phenotype was a predictive factor or post operative morbidity. CONCLUSION Despite the development of medical treatment, surgical treatment keeps large indications for the management of complications of Crohn's disease. The surgery should be an alternative to immunosuppressive therapy. Currently, prevention postoperative recurrence is well codified, reducing the risk of complications.
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Hefaiedh R, Sabbeh M, Ennaifer R, Romdhane H, Ben Nejma H, Belhadj N, Gharbi L, Khalfallah MT. Percutaneous treatment versus hepatic resection for the treatment of small hepatocellular carcinoma. Tunis Med 2015; 93:132-137. [PMID: 26367399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Hepatocellular carcinoma is the first liver tumor worldwide. Therefore, it is a matter of debate whether surgical treatment or percutaneous treatment should be preferred for the treatment of patients with small hepatocellular carcinoma. The aim of our study was to compare the long-term outcome and the survival between surgically and percutaneously treated small hepatocellular carcinomas. MATERIAL AND METHODS A retrospective study was performed in the department of hepatology during a period of 2009-2012. The study included all patients carrying small hepatocellular carcinoma which were divided in: group 1 including patients who underwent surgical treatment, and group 2 including patients who underwent percutaneous treatment. RESULTS Among the 63 patients who were diagnosed for hepatocellular carcinoma, 28 carried a small hepatocellular carcinoma with a mean age of 63 years and sex-ratio of 0.64. Etiology of cirrhosis was viral in 96% cases. Surgical treatment (hepatic resection) was performed in 54% cases while percutaneous treatment was proposed for 46%: radiofrequency ablation in 69% and alcoholic injection in 31%. No major complications for both surgical and percutaneous treatment occurred in our study. The corresponding 6 months and 1- year overall survival rates for the surgical resection group and the percutaneous treatment group were 100%, 100%, 20%, and 52%, respectively (p=0,04). The disease free survival were not significantly different. CONCLUSION Our results showed the efficacy and safety of percutaneous ablation treatments (radiofrequency ablation and ethanol injection) in patients with small hepatocellular carcinoma.
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Miloudi N, Hefaiedh R, Marzouk I, Gharbi L, Khalfallah MT. Solid pseudopapillary tumor of the pancreas with concomitant Bochdalek's hernia. The first reported case. Tunis Med 2015; 93:184-186. [PMID: 26367409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Solid pseudopapillary tumors of the pancreas are rare. The diagnosis is difficult because of its clinical and radiological polymorphism. It was described in the literature that this entity can be associated with congenital malformation. We report an exceptional case associating solid pseudopapillary tumor of the pancreas to Bochdalek's hernia. CASE REPORT A 31 year-old woman presented with abdominal pain. Radiological findings (ultrasound, CT scan, MRI) showed a heterogeneous mass evoking a stromal tumor of duodenal origin associated to a hernia through the foramen of Bochdalek. The patient underwent tumorectomy without lymphadenectomy with a hernia repair. Pathology report confirmed the diagnosis of solid pseudopapillary tumor of the pancreas. The 3-years follow- up was uneventful. CONCLUSION Solid pseudopapillary tumor of the pancreas is a rare benign tumor with a good prognosis after resection. Recognition of the association of congenital malformation with solid pseudopapillary tumor of the pancreas is useful as it could have implications on the diagnosis and treatment.
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Ennaifer R, Elleuch N, Romdhane H, Hefaiedh R, Marsaoui L, Gharbi L, Belhadj N, Khalfallah T. Misdiagnosed anorectal malignant melanoma. Tunis Med 2015; 93:114-115. [PMID: 26337315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Gharbi L, Attaoui MA, Laghmani E, Marsaoui L, Khalfallah MT. Autoimmune pancreatitis. A report of 5 cases from Tunisia: diagnostic challenge. Tunis Med 2014; 92:639-644. [PMID: 25860681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND In this study, we aimed to review retrospectively the records of 5 patients who were treated in our hospital and to review the current approaches in diagnosis and management of autoimmune pancreatitis (AIP). METHODS The series of patients diagnosed with AIP during the last seven years (January 2006 - August 2012) was the basis of this study. All records were retrieved and analyzed. The diagnosis of AIP was established on the basis of imaging studies, serology, cytology and response to treatment. RESULTS Five patients were diagnosed with AIP pancreatitis during this 7-years period. Four of the 5 patients were males. The most common presenting symptom was abdominal pain (4/5). Two patients with the preliminary diagnosis of pancreatic mass underwent surgery. Histological analysis of the surgical resection did not reveal any malignancy. During the follow-up, one of them has developed Crohn's disease and Sjogren syndrome. One of the patients had obstructive jaundice and abdominal pain for several months. Abdominal contrast enhanced computed tomography (CECT) suggested the diagnosis of AIP, cholangitis with renal atrophy and retroperitoneal fibrosis. He was started on steroids to which he responded dramatically. One patient had been diagnosed as primary sclerosing cholangitis few months earlier on the basis of abdominal CECT features showing a dominant stricture in the common bile duct. During the follow-up, the diagnosis of AIP was suspected and finally established on the basis of repeated magnetic resonance imaging (MRI). The last patient had history of acute pancreatitis, obstructive jaundice and abdominal pain for 3 months. An abdominal CECT suggested autoimmune pancreatitis which was confirmed by MRCP. He was started later on steroids to which he responded significantly. IgG4 was done in all cases, high in four patients. CONCLUSION AIP is a disease with increasing incidence and characterized by lymphoplasmacytic cells infiltration and fibrosis. It is necessary to evaluate patients in terms of AIP serologically to avoid wrong diagnosis and the morbidity of surgery.
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Gharbi L, Attaoui MA, Mzoughi Z, Marsaoui L, Khalfallah MT. [Isolated hyperplastic gastric polyposis. A case report]. Tunis Med 2014; 92:507-508. [PMID: 25775295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Hefaiedh R, Cheikh M, Ennaifer R, Gharbi L, Hadj NB. Toxic megacolon complicating a first course of Crohn's disease: about two cases. Clin Pract 2013; 3:e24. [PMID: 24765512 PMCID: PMC3981266 DOI: 10.4081/cp.2013.e24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 04/10/2013] [Accepted: 04/29/2013] [Indexed: 11/23/2022] Open
Abstract
Toxic megacolon is a rare and serious complication of Crohn’s disease. Because of the associated high morbidity and mortality, early recognition and management of toxic megacolon is important. Through two cases of toxic megacolon complicating Crohn’s disease, we assessed the clinical, radiologic and therapeutic characteristics of this complication. A 35-year-old man presented a first course of Crohn’s disease treated with corticosteroid. He exhibited sudden severe abdominal pain and distension with shock. A plain abdominal radiography revealed toxic megacolon. He underwent medical therapy, but symptoms not relieved. The patient underwent subtotal colectomy with ileostomy. The resected specimen confirmed the diagnosis. Recovery of digestive continuity was performed. Endoscopic evaluation six months later did not shown recurrence. A 57-year-old man presented with severe acute colitis inaugurating Crohn’s disease, was treated with corticosteroid and antibiotics. He exhibited signs of general peritonitis. Computed tomographic examination revealed toxic megacolon with free perforation, showing prominent dilation of the transverse colon and linear pneumatosis. The patient underwent emergent subtotal colectomy and ileostomy. The final histological patterns were consisting with diagnosis of Crohn’s disease associated with cytomegalovirus infection. The patient underwent antiviral therapy during 15 days. Because of the high risk of postoperative recurrence, he underwent immunosuppressive therapy. Recovery of digestive continuity was performed successfully. Toxic megacolon in Crohn’s disease is a serious turning of this disease. We underscore the importance of early diagnosis of toxic megacolon and rapid surgical intervention if improvement is not observed on medical therapy.
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Affiliation(s)
| | | | - Rym Ennaifer
- Department of Gastroenterology , La Marsa, Tunisia
| | - Lassad Gharbi
- Department of Surgery, Mongi Slim University Hospital , La Marsa, Tunisia
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Abid SB, Hefaiedh R, Zghab S, Miloudi N, Gharbi L, Khalfallah MT. Pseudotumoral autoimmune pancreatitis mimicking a pancreatic cancer: a very difficult disease to diagnose. Clin Pract 2012; 2:e80. [PMID: 24765479 PMCID: PMC3981193 DOI: 10.4081/cp.2012.e80] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 08/29/2012] [Accepted: 08/30/2012] [Indexed: 12/16/2022] Open
Abstract
Autoimmune pancreatitis (AIP) is a rare disorder, although the exact prevalence is still unkown. It is a type of pancreatitis that is presumed to have an autoimmune aetiology, and is currently diagnosed based on a combination of 5 criteria. However, in this day and age, some patients with AIP are likely to be resected for the suspicion of malignancy. The authors report a case of pseudo-tumoral autoimmune pancreatitis, reviewing some literature about it and underlining the difficulty in the diagnosis. A 56-year-old patient was referred to our unit for upper abdominal pain. In his past medical history we note mellitus diabetes. The clinical examination was unremarkable. Laboratory data showed no abnormal values. Upper endoscopy showed antral gastritis. Transabdominal ultrasonography showed a hepatic steatosis and 5 angiomas. No computed tomography scan was made. Magnetic resonance imaging (MRI) showed 5 angiomas and a lesion of 20×20 mm of the pancreatic tail with decreased signal intensity on T1-weighted MR images, increased signal intensity on T2-weighted MR images. Due to concerns of pancreatic malignancy, the patient underwent open distal spleno-pancreatectomy. Histolo gical analysis of the resected specimen revealed no malignancy. Postoperatively, immunoglobulin G fraction 4 was slightly above of the upper limit of the normal range. After corticotherapy the patient is getting better. This case underlines the difficulties still encountered in the diagnosis of AIP. It has been frequently misdiagnosed as pancreatic cancer and caused unnecessary resection. In order to avoid unnecessary resections for an otherwise benign and easily treatable condition, it is urgent to refine diagnostic criteria and to reach an international consensus.
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Affiliation(s)
| | - Rania Hefaiedh
- Department of Surgery, Mongi Slim Hospital, Sidi Daoued LaMarsa, Tunisia
| | - Sameh Zghab
- Department of Surgery, Mongi Slim Hospital, Sidi Daoued LaMarsa, Tunisia
| | - Nizar Miloudi
- Department of Surgery, Mongi Slim Hospital, Sidi Daoued LaMarsa, Tunisia
| | - Lassad Gharbi
- Department of Surgery, Mongi Slim Hospital, Sidi Daoued LaMarsa, Tunisia
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Feki W, Azzabi S, Smadhi H, Baccar M, Amar J, Dahri B, Gharsalli H, Aouina H, Gharbi L, Bouacha H. Complications thromboemboliques au cours de la tuberculose pleuro-pulmonaire. Rev Mal Respir 2012. [DOI: 10.1016/j.rmr.2011.10.878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Feki W, Baccar M, Smadhi H, Dahri B, Amar J, Gharsalli H, Azzabi S, Aouina H, Gharbi L, Bouacha H. Évaluation de la prescription des antibiotiques chez les patients porteurs de cancer broncho-pulmonaire. Rev Mal Respir 2012. [DOI: 10.1016/j.rmr.2011.10.745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Feki W, Baccar M, Smadhi H, Dahri B, Gharsalli H, Amar J, Azzabi S, Aouina H, Gharbi L, Bouacha H. Les adénocarcinomes pulmonaires primitifs à localisation proximale. Rev Mal Respir 2012. [DOI: 10.1016/j.rmr.2011.10.747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Charrada-Ben Farhat L, Ben Yaâcoub I, Hamzaoui S, Gharbi L, Dali N, Ben Dridi M, Hendaoui L. Aspects radiocliniques trompeurs de la tuberculose abdominale. ACTA ACUST UNITED AC 2007; 88:1729-32. [DOI: 10.1016/s0221-0363(07)74054-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Abstract
Acute rhabdomyolysis is a clinical and biological syndrome generally with a toxic or traumatic cause. Only 5% of cases are infectious, and rarely in relation to a pneumococcal infection. We report two cases of acute rhabdomyolysis which developed in patients with severe Streptococcus pneumoniae pneumonia. No other cause could be identified in these two patients aged 32 and 37 years. Rhabdomyolysis was discovered in the first patient because of acute kidney failure and elevated serum transaminase levels. The second patient presented an inflammatory edema affecting the soft tissues. Blood cultures isolated a pneumococcus in both patients. The rhabdomyolysis regressed favorably in both patients despite the transient renal failure in the first patient. Prognosis is generally poor for rhabdomyolysis during the course of pneumococcal pneumonia, with increased morbidity and mortality for these infections. Early detection of bacteriemia enables rapid and adequate treatment and prevention of renal failure.
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Affiliation(s)
- H Aouina
- Service de Pneumologie, Hôpital Charles-Nicolle, boulevard du 9-Avril, 1006 Tunis, Tunisie.
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Gharbi L, Mannai S, Ghariani B, Mestiri H, Khalfallah MT. [Treatment of primary and secondary malignant tumor of the liver. Opinion of the surgeon]. Tunis Med 2006; 84:683-6. [PMID: 17294891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Hepatocellular carcinoma is the most frequent primitive cancer of the liver. This tumor mainly develops in cirrhotic liver that is a true precancerous state. Treatment can be surgical or not surgical. Orthotopic liver transplantation is the only treatment that definitively address both the metachronous occurrence risk of hepatocellular carcinoma and the underlying disease. Liver metastases from colorectal carcinomas are the most frequent secondary tumors. Only complete resection offers the potential for curative treatment of these metastases.
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Affiliation(s)
- Lassad Gharbi
- Service de chirurgie, Hôpital Mongi Slim, 2046 Sidi Daoud
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Gharbi L, Miloudi N, Ghariani B, Mannai S, Arfa N, Mestiri H, Khalfallah MT. [Is the presence of a gastric tumor a risk factor for multiple primary malignant tumors?]. J Chir (Paris) 2006; 143:271-3. [PMID: 17088734 DOI: 10.1016/s0021-7697(06)73689-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Mannai S, Kraïem T, Gharbi L, Haoues N, Mestiri H, Khalfallah MT. [Congenital cystic dilatation of bile ducts]. ACTA ACUST UNITED AC 2006; 131:369-74. [PMID: 16630531 DOI: 10.1016/j.anchir.2006.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2005] [Accepted: 03/15/2006] [Indexed: 11/29/2022]
Abstract
Congenital cystic dilatation of bile ducts is a rare condition. We report a retrospective study about 18 patients having congenital bile duct cysts. According to Todani's classification, 11 cases were type I and 7 were type V. Six patients from the first group had a pancreatobiliary maljunction. A total resection of the cyst was conducted in the type I cysts. Anatomopathologic examination showed an adenocarcinoma of a common bile duct cyst. In one case, a cancer of the gall bladder associated to a common bile duct cyst in another case. Three patients with segmental dilatation of intrahepatic bile ducts (type V) underwent liver resection. Four patients had a diffuse form, one of them was treated by percutaneous drainage, and in the other cases a hepatojejunostomy was performed. Postoperative course was complicated with acute cholangitis in these four cases. Percutaneous drainage and antibiotics allowed a positive outcome in most of the cases. In one case, secondary biliary cirrhosis occurred as a long-term complication. Congenital cystic dilatation of bile ducts is considered to be a precancer state. Enterocystic anastomosis is proscribed and the resection has to be as complete as possible.
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Affiliation(s)
- S Mannai
- Service de Chirurgie Générale, Hôpital Mongi-Slim, 1004 Tunis, Tunisie.
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Arfa N, Hamdani I, Gharbi L, Ben Abid S, Ghariani B, Mannai S, Mestiri H, Khalfallah MT, Mzabi SR. [Survival and prognostic factors of colorectal adenocarcinoma: analytic multifactor review of 150 cases]. ACTA ACUST UNITED AC 2006; 131:104-11. [PMID: 16443189 DOI: 10.1016/j.anchir.2005.12.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2005] [Accepted: 12/15/2005] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Prognostic factors have a pivotal role in clinical oncology. They are helpful in the selection of treatment; provide insights into the disease process and the therapic response. The number of possibility useful prognosis factors in the colorectal cancer is large. This study attempts to observe the survival of colorectal adenocarcinoma and to find prognostic factors and other variables potentially associated with outcome of colorectal adenocarcinoma. MATERIAL AND METHODS It's a retrospective study based on 150 patients with colorectal adenocarcinoma from 1990 to 2002. There were 150 patients aged of 58 years (median 61 years) with 1.4 sex-ratio. 84 patients had colon adenocarcinoma and 66 patients had rectal adenocarcinoma. In histological exam the adenocarcinoma was well differenced in 69 cases (46%), and undifferentiated in 17 cases (18, 3%). RESULTS Locoregional extension was found in 18 cases and metastatic extension in 45 cases with hepatic metastasis in 37 cases and pulmonary metastasis in 8 cases. There were 6 cases of peritoneal localized carcinosis and 6 cases of ovary metastasis. There were 6 patients (4%) Dukes stage I TNM, 61 stage II (40, 7%), 51 stage III TNM (34%) and 32 patients stage IV TNM (34%). All patients had surgical curative resection associated with adjuvant chemotherapy in 60 cases of colon adenocarcinoma and preoperative radiotherapy in 33 cases of rectal adenocarcinoma. After a follow up of 46 months, 52 patients was died (10 operative mortality), 35 patients were lost of view and 63 patients were still alive at the point date. Median survival was 20 months with 95% confidence interval: (4, 2-7, 8). Overall one year and 5 years survival were respectively 92,8% and 26,3%. Various prognostic factors had been identified through univariate (Kaplan-Meier) then multivariate (Cox) analyze. In addition to the clinical factors, we found of significant prognostic value undifferentiated adenocarcinoma and an elevated value of serum carcinoembryonic antigen>5 ng/ml.
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Affiliation(s)
- N Arfa
- Service de Chirurgie Générale, Hôpital Mongi-Slim, Sidi-Daoued, La-Marsa 2045, Tunis, Tunisie.
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Aouina H, Gharbi L, Ben Salah N, Ismaïl I, Azzabi S, Baccar M, Bouacha H. Adaptation de l’aide au sevrage tabagique au cours du mois de Ramadan. Rev Mal Respir 2006. [DOI: 10.1016/s0761-8425(06)72312-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Smati B, Ismail O, Boudaya MS, Baccari S, Djilani H, Mestiri T, El Mezni F, Gharbi L, Kilani T. [Huge benign lung tumor in a female smoker]. Rev Pneumol Clin 2005; 61:379-81. [PMID: 16449928 DOI: 10.1016/s0761-8417(05)84868-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
UNLABELLED Pulmonary sclerosing hemangioma is a rare, slow-growing, benign tumor. Its potential for progression and its histiogenesis remains controversial. CASE REPORT A routine chest X-ray revealed a right abdominal mass in 41-year-old woman. Search for a cause was negative. The patient underwent posterolateral thoracotomy for tumorectomy. Intraoperative pathology analysis revealed the benign nature of the tumor. No complication was observed postoperatively. The final pathological conclusion was sclerosing hemangioma of the lung. Pulmonary sclerosing hemangioma is a parenchymal tumor of the lung. The latest immunohistochemical studies of this lesion suggest a pneumocyte origin. Prognosis is good, but extension to lymph nodes may occur. Surgery is always required for cure, and must be associated with lymph node dissection for large tumors.
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Affiliation(s)
- B Smati
- Service de Chirurgie Thoracique et Cardiovasculaire, Hôpital de Pneumo-Phtisiologie Abderrahman-Mami, 2080 L'Ariana/Tunis, Tunisie.
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Ben Abid S, Gharbi L, Arfa MN, Mallouki I, Ghariani B, Mestiri H, Khalfallah MT. [Adrenal metastasis from a hepatocellular carcinoma with thrombosis of the inferior vena cava]. J Chir (Paris) 2005; 142:311-2. [PMID: 16292211 DOI: 10.1016/s0021-7697(05)80936-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- S Ben Abid
- Service de Chirurgie Générale, Hôpital Mongi Slim - La Marsa, Tunisie.
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Ayadi-Kaddour A, Chelly-Enneifer I, Goutallier-Ben Fadhel C, Saïgi E, Gharbi L, Lahmar-Boufaroua A, Ben Sassi L, Khalfallah MT, Mzabi-Regaya S. [Intestinal T cell lymphoma in coeliac disease. A case report]. Tunis Med 2005; 83:311-4. [PMID: 16044909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Primary intestinal T-cell lymphomas account for about 5% of all primary gastrointestinal lymphomas and are mostly associated with coeliac disease. Intestinal lymphomas are usually discovered during the 4th to 5th decade and constitute an exceptional complication of coeliac disease. This lymphoma is generally a high grade pleomorphic cell lymphoma with large cells. Our case concerned a 30 year old woman with a history of coeliac disease who developed a gastro-enteromesenteric lymphoma. Anatomopathological and immunohistochemical analysis showed an enteropathy associated T-cell lymphoma. We suggest that patients with coeliac disease unresponsive to a gluten free diet or with deteriorating clinical condition be investigated for complications such as enteropathy associated T-cell lymphoma. It is also important to avoid this complication by detecting asymptomatic form of coeliac disease that needs a gluten-free diet.
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Affiliation(s)
- Aïda Ayadi-Kaddour
- Service d'anatomie et de cytologie pathologiques, Hôpital Mongi Slim, La Marsa, Tunisie
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Gharbi L, Ismail I, Azzabi S, Baccar M, Kraoua S, Azzouz M, Aouina H, Bouacha H. 249 Corps étrangers intrabronchique à révélation tardive. Rev Mal Respir 2004. [DOI: 10.1016/s0761-8425(04)71875-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Arfa MN, Gharbi L, Zaafrani MR, Mbazaa M, Goutellier ben fadhel C, Mestiri H, Ben Ammar MS, Khalfallah MT. Cystic mesenchymal hamartoma of the liver report of a case and review of the literature. Hepatogastroenterology 2003; 50 Suppl 2:ccxlix-ccli. [PMID: 15244192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Mesenchymal Hamartoma (MH) of the liver constitutes the third or the fourth most common tumour of the liver in childhood and occurs most commonly in the first two years of life. It is often misdiagnosed clinically as a malignant tumour because of its rapid increase in size within a short period of time, or as a hepatic collections or abscess because of its cystic appearance. Although a benign lesion, MH may cause heart failure due to arteriovenous shunts, or death as a result of respiratory complications. A typical case of MH was recently encountered in a 6-years-old-boy. The patient presented with progres sive abdominal distension; surgery revealed a large mass arising from the right lobe of the liver. The mass was predominantly formed by fluid collections. Loose mesenchymal tissue and branched, tortuous bile ducts were the key diagnostic features. When predominantly cystic, MH may mimic lymphangioma both grossly and microscopically. Prudent examination of the cystic structures can establish a correct diagnosis.
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Affiliation(s)
- M N Arfa
- Department of surgery, Mongi Slim Hospital-La Marsa-Tunis, Tunisia
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Mlik K, Arfa MN, Zaafrani R, Gharbi L, Gouttelier Ben Fadhel C, Mestiri H, Mzabi Regaya S, Khalfallah MT. [Endometriosis: a rare cause of acute intestinal obstruction]. Tunis Med 2003; 81:972-5. [PMID: 14986536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
In the differential diagnosis of intestinal obstruction, the endometriosis is an uncommon disease, rarely reported preoperatively. Surgical objective is a total resection of endometriomas, to guarantee symptom relief and ovoid recurrence. In elective cases, preoperative GH-RH analogue hormonal treatment makes easier the surgical procedures. Conservative surgery of the ovaries is mandatory in premenopausal patients.
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Affiliation(s)
- Khaled Mlik
- Service de chirurgie générale, Hôpital Mongi Slim La Marsa
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Arfa MN, Bouzaiene H, Ben Farhat L, Gharbi L, Ghariani B, Mestiri H, Hendaoui L, Khalfallah MT. Intrahepatic Osler's disease: report of two cases and review of the literature. Hepatogastroenterology 2003; 50 Suppl 2:ccx-ccxiii. [PMID: 15244181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Osler-Weber-Rendu disease is a hereditary vascular disease with multiple manifestations. The liver is involved rarely. Vascular abnormalities include telangiectasis and arteriovenous fistulas, sometimes associated with fibrosis and cirrhosis. Hepatic arteriovenous shunting may include secondary portal hypertension, reduced liver function and high cardiac output. Two cases of Osler-Weber-Rendu disease with extensive hepatic arteriovenous fistulation were described in detail and we report on their clinical features. In the first patient, treatment was symptomatic since liver transplantation is not indicated because the patient was asymptomatic. Embolization treatment of hepatic arteries was indicated in the second patient because he had biliary disease and recurrent cholangitis secondary to vasculo-biliary shunts. Therapy with arterial embolization, banding, or ligature of hepatic arteries is still limited and provides unsatisfactory long-term results. Liver transplantation offers now another therapeutic option for patients with intrahepatic high shunting and secondary pulmonary hypertension.
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Affiliation(s)
- M N Arfa
- Department of Surgery and liver transplantation, Mongi Slim Hospital, La Marsa, Tunisia
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Fakhfakh R, Aouina H, Gharbi L, Hsairi H, Achour N, Lagrue G, Bouacha H. [Smoking dependence and symptoms of anxiety and depression among Tunisian smokers]. Rev Mal Respir 2003; 20:850-7. [PMID: 14743086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
INTRODUCTION The aim of this study was to describe the incidence of depression and anxiety, and their relationship with smoking dependence, in patients attending a Tunisian smoking cessation clinic. METHODS We studied 72 Tunisian smokers attending the smoking-cessation clinic at the Charle Nicolle Hospital in Tunis. Nicotine dependence was assessed by the Fageström Test for Nicotine Dependence. Anxiety and depression symptoms were measured using the HAD (Hospital Anxiety Depression) Scale. RESULTS The prevalence of anxiety and depression was 22.9% (16 patients) and 20% (14 patients) respectively with four patients (7.1%) exhibiting symptoms of both. Overall, 50% of the group had emotional morbidity with high HAD scores for depression or anxiety, or both. Smokers with symptoms of anxiety and/or depression had higher physical and psychological dependence, smoked more at times of stress, had a reduced quitting rate and endured more withdrawal symptoms than those smokers without anxiety or depression. CONCLUSIONS The data of this survey from Tunisia, a country that has just put in place a tobacco control strategy, underline the high rates of anxiety and depression that exist in patients attending a smoking cessation clinic. It confirms the association between anxio-depressive disorders and a high level of smoking dependence.
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Affiliation(s)
- R Fakhfakh
- Institut National de Santé Publique, Le Belvédère, Tunis, Tunisie.
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Rezgui L, Charfi M, Ben M'Rad S, Gharbi L, Dridi L, Arfa N, Khalfallah MT, Hendaoui L. [Isolated splenic metastasis revealing colon cancer]. Tunis Med 2003; 81:832-4. [PMID: 17722803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Splenic metastasis of colon cancer is uncommon especially when isolated. In fact, they are usually associated to multi visceral location. Malignant melanoma, cancer of breast and lung and ovarian carcinoma are the most common cancer which metastases in spleen. Splenic metastasis of colon cancer is rare and exceptionally isolated. Ten cases of isolated splenic metastasis in colon cancer are reported in literature. We report a new case of intra splenic kystic metastasis revealing an asymptomatic sigmoid cancer in a 63 years old patient.
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Affiliation(s)
- Lamia Rezgui
- Service de Radiologie, Hôpital Mongi Slim La Marsa
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Abstract
One hundred and five defunctioning loop colostomies were performed using a subcutaneous bridge support. Two complications were observed: a peristomal abscess and a bridge migration into the peritoneal cavity. This technique facilitates the fitting of stoma appliances. Glass bridge support can be removed under local anesthesia. This technique can be recommended in view of the good results.
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Affiliation(s)
- L Gharbi
- Service de chirurgie digestive, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
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Houry S, Gharbi L, Huguier M, Callard P, André T. [Undifferentiated embryonal sarcoma in the liver of adults]. Presse Med 1998; 27:518-20. [PMID: 9767962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Embryonic sarcoma of the liver is uncommon in adults. We report an unusual case presenting as a cyst-like formation of the liver. CASE REPORT The pre-operative and also the peroperative histology diagnosis was remodelled biliary cyst. The patient was treated accordingly. The final diagnosis of embryonic sarcoma of the liver was made when a local recurrence developed. The patient underwent hepatic resection followed by a chemotherapy and radiotherapy protocol. Tumor markers were measured within the tumor and gave a positive result for CA-125. DISCUSSION Diagnosis of cystic forms of embryonic sarcoma can be a quite difficult task. Radiological and histological aspects can be helpful. This report is the first case in which tumor markers were measured within the tumor.
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Affiliation(s)
- S Houry
- Service de Chirurgie digestive, Hôpital Tenon, Paris
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Gharbi L, Miladi M, Cherif I, Ferjani E, Fteriche F, Sebai F. [A rare cause of liver abscess]. Tunis Med 1994; 72:577-9. [PMID: 7778233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- L Gharbi
- Service des urgences Hopital La RABTA-Tunis
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