[Relationship between subcutaneous adipose tissue expression of leptin and obesity in Tunisian patients]

The incidence of obesity has dramatically increased in overall the world. It is a consequence of imbalance between energy intake and energy expenditure. Leptin is a fat derived adipokine that has emerged over the past decade as a key hormone in the regulation of food intake and energy expenditure. Elevated leptin levels are found in obese humans, suggesting a role of leptin in regulating body weight and adiposity. The aim of this study was to investigate the change of leptin mRNA expression level and its correlation with obesity and several metabolic variables in Tunisian patients. Real time quantitative polymerase chain reaction [QPCR] analysis was carried out among two groups who underwent an abdominal surgery: controls [n=9] and obese patients [n=7]. Leptin mRNA expression in subcutaneous adipose tissue was markedly increased in obese patients [p<0.01]. It was positively correlated with measures of obesity waist circumference [WC] [r=0, 71, p<0.01] and body mass index [BMI] [r=0, 68, p<0.01]. Interestingly, leptin gene expression was also correlated to insulin resistance index [r=0, 72, p<0.01]. The present study is the first investigation of leptin regulation in subcutaneous adipose tissue of Tunisian population. Our data showed that leptin levels are higher in obese subjects than in control subjects. This indicates that the subcutaneous adipose plays an important role in impaired adipokine regulation, and consequently in developing metabolic disorder

[Odontogenic descending necrotizing mediastinitis]

Descending necrotizing mediastinitis [DNM] following an oropharyngeal infection is a rare disease with a rapid course and a mortality rate of up to 40%. The aim of this study, is to outline the diagnosis and the appropriate treatment of DNM. A retrospective study [1986-2007] of patients with DNM was made. Only patients with cervical cellulitis associated with DNM were included. Eight men and two women with an average age of 43 years were treated. Five had diabets. The average for diagnosis and treatment was eight days. In eight cases, we found a dental origin and in two cases a pharyngeal origin. The diagnosis of DNM was made thanks to cervico thoracic CT scan in six cases. In the others patients. they had at presentation clinical and radiological evidence of mediastinal diffusion. All patients were treated by broad spectrum antibiotherapy. All had cervical drainage. Mediastinal drainage was made by cervical approach in 2 two cases and via a right thoracotomy in eight cases. Eight patients died. Odontogenic DNM is a rare disease with rapid course Clinical diagnosis is difficult and early recognition with a lowi thresold for CT scanning is essential. CT is also useful for the treatment and in the post operative assessment. All affected tissue plane must be debrided. Surgical management and mediastinal drainage remain controversial about the indication of thoracotomy

[Primary carcnoid hepatic tumour: a case report]

Primary carcinoid tumour of the liver is rare and poses a diagnostic and management dilemma. Report a new cases. A 48 year-old patient man, with a 8-months history of abdominal pain and weight loss, was operated on in December 2000, in another centre with the diagnosis of caudate pancreatic cancer. At laparotomy, Resection was deemed to be not feasible. Histological examination of biopsy was for carcinoid tumor. The patient underwent post operative radiotherapy and four courses of chemotherapy and he was referred to our hospital. Physical examination was normal. Based on radiological examination, the diagnosis was endocrine tumor of the pancreas. The patient underwent relaparotomy, the lesion was independent from the pancreas but linked to the liver; the caudate lobe. Complete macroscopic resection was performed. Histological examination of operative specimen concludes to carcinoid tumor with invasion of hepatic margins. The patient underwent adjuvant chemotherapy; he was free from disease 6 months after surgery. The diagnostic of primary carcinoid tumors is based principally in the histopathological confirmation of neuroendocrine origin and the exclusion of non hepatic primary tumour. This requires preoperative imaging but most importantly a thorough laparotomy and rigorous follow-up. Surgical resection if possible is recommended

[Primary aorto-enteric fistula in a 52 -year- old man]

Aorto/ilio enteric Fistula [AEF] is defined is a communication between the aorta or iliac artery and any adjacent segment of the bowel. It may be primary or secondary. The former occurs in patients with intestinal or vascular disease and mostly complicates abdominal aortic aneurysm [AAA], whereas secondary aorto-enteric fistula is a dreadful complication of aortic reconstruction with vascular prosthesis. Of this study is to report this case of unusual presentation of PAEF as a rare cause of low enteric bleeding and discuss the path physiology, etiology, diagnosis and management of this entity. The authors report a case of 52-year-old man who presented with acute rectal bleeding. Esophago-gastro-duodenoscopy and colonoscopy were non diagnostic. Because of persistence of bleeding and hemodynamic instability, patient underwent urgent laparotomy. At surgery, diagnosis of primary aorto enteric fistula [PAEF] was made between the right iliac artery and the sigmoid complicating an iliac pseudo aneurysm. Direct repair of the vascular and digestive defects and sigmoidostomy were performed. The patient died two hours after surgery of cardiac arrest. AEF is a rare but a life threatening cause of GI bleeding. A delay in identification, as in our observation, may partly explain the high morality and morbidity