[Hyperbaric oxygen in the treatment of prineal Crohn's disease era of Infliximab: a renewal interest?]

Despite the growing number of therapeutic methods and the recent introduction of new drugs more active in the therapeutic arsenal, lesions of the ano-perineal Crohn's disease remains difficult to support. Hyperbaric oxygen [HBO] was made before the era of infliximab, an interesting therapeutic approach in which the current position remains unclear. To assess HBO efficacy in the treatment of anal fistulas refractory Crohn's disease. Literature review. Hyperbaric oxygen therapy was used in the 90's when the biotherapy was not part of the armamentarium for Crohn's disase. Research conducted has identified only nine publications evaluating the efficacy of hyperbaric oxygen therapy in the treatment of anal fistulas refractory Crohn's disease. Among the nine publications, we have retained only four: two clinical trials and two clinical cases. The total number of patients was 22: 12 women and 10 men. The average age of patients was 37 years. The average number of session was 42 sessions. Remission was observed in 15 patients [68.18%] whereas with Infliximab rate is 66%. Adverse events were observed in 2 patients [16.6%]. Indeed, instead of considering them as two different alternatives, it should be combined to obtain a synergy to increase response rates, shorten the healing and especially to decrease the recurrence rate. Only a prospective randomized controlled trial [with two arms: biotherapy versus biotherapy associated with hyperbaric oxygen therapy] could accommodate this technique in the armamentarium of perineal lesions of Crohn's disease

[Malignant intraductal papillary mucinous tumours of the pancreas: a three cases report]

Intra ductal papillary mucinous tumors of pancreas are rare and are characterized by a risk of malignant transformation. To clarify their clinical presentation and the performance of different imaging examinations to determine their benign or malignant and achieve their staging. We report three cases of degenerate intra ductal papillary mucinous tumors of pancreas. The combination of CT, the pancreato- MRI and duodenoscopy has led to the diagnosis in all cases. A pancreaticoduodenectomy were performed in two cases. The various imaging techniques allow better detection and analysis of the tumor including the evaluation criteria of degeneration. The treatment of these lesions is still surgery

[Mesenteric panniculitis simulating malignancy]

Panniculitis mesenteritis is a rare, benign, and chronic fibrosing inflammation disease with unknown aetiology that affects the mesentery of small bowel and colon. To report a new case of this entity and to highlight its diagnostic difficulties especially when it affects the mesocolon. A 37 years-old women presented with chronic abdominal pain; physical examination found mass of left ilaca fossa. Closcopy and abdominal CT scan showed a thickness of bowel wall with negative biopsies. The patient underwent a colectomy. Histologic examination concluded to the diagnosis of Mesenteric panniculitis without malignant lesion. Mesenteric panniculitis is a rare pathology which diagnosis is difficult to establish. It can simulate malignancy. A better knowledge of its clinical and radiological features could ovoid unecessary digestive resection

[ case of an acute pancreatitis after endoscopic band ligation of oesophageal variceal: a fortuitous association or an unusual complication?]

Endoscopic band ligation is considered as the gold standard of treatment for oesophageal varices. Fewer and often mild complications can occur. To report and to discuss an association between oesophageal variceal endoscopic band ligation and actue pancreatitis. We report the original case of a patient with cirrhosis and who had presented an acute pancreatitis 3 days after oesophageal variceal endoscopic band ligation. Common aetiologies of acute pancreatitis was eliminated. The evolution was favourable without specific treatment. To the absence of similar case reports, the association between oesophageal variceal endoscopic band ligation and acute pancreatitis observed in our patient remains rather fortuitous even though experimental studies can explain these association

[Early gastric adenocarcinoma]

the purpose of this study was to determine the epidemiological and clinical behaviour of the superficial adenocarcinoma of the stomach, to clarify its pathological characteristics, therapeutic as well as his its prognosis. Over a period of 14 years [1990-2004], 16 patients were operated for a superficial gastric adenocarcinoma among 155 gastric cancers treated during the same period in the service of general surgery [A] La Rabta. The superficial gastric adenocarcinoma represented 10.3% of our series. The mean age was 59 years. It was about 8 men and 8 women. Two patients was followed for a chronic stomach ulcer, a patient is followed for Biermer anaemia and another one for Menetrier disease. Among these cancers, 12 were intra mucosal and 4 invaded the submucousa. Lymph node involvement was present only in one case. The cancer was located in the antrium in 8 cases and was multifocal in 3 cases. One patient died in postoperative case because of a medical cause. The 5-year-overall survival was 65.6%. The recurrence had interested only one patient. the superficial gastric adenocarcinoma is rare. The follow up of precancerous states allows its diagnosis. The treatment is based on the gastric resection associated to the DI-type lymph node clearance. The multifocal character imposes a surveillance of the remaining gastric stump