[ caroli's disease. Report of 16 cases]

Caroli's disease is a congenital dilatation of the intrahepatic biliary duct. To analyse and discuss diagnostic and therapeutics difficulties through 16 patients with Caroli's disease. Between January 1990 and September 2010, 16 patients underwent surgical procedure for Caroli's disease. Data recorded for each patient included clinical symptoms, biologic findings, previous biliary procedures, and the presenting symptoms. The distribution of the biliary lesions, the surgical procedure and the postoperative outcomes and follow up were detailed. The mean age was 55 years. the mean interval between the first symptoms and diagnosis was 27 months. Five of 16 patients had undergone 12 surgical or dneoscopic procedures prior to liver resection. Before the definitive diagnosis, 9 patients presented 15 episodes of acute cholangitis. The diagnosis was established preoperatively in 13 cases, 5 among them underwent previous biliary surgical procedures. The diagnosis was documented peroperatively in 2 cases and postoperatively in 1 case. The distribution of the biliary lesions was monolobar in 13 and bilobar in 3 patients. 13 patients underwent liver resection, in two cases we performed bilio-jejunostomy and the last one had endoscopic sphyincterotomy. There was no mortality and the overall postoperative morbidity is about 43%. The follow-up shows that 12 patients still alive with a mean follow up for 53 months, from whom only one patient have intrahepepatic lithiasis. The clinical course of Caroli's disease is often complicated by recurrent episodes of angiocholitis and requires iterative surgery. The hepatectomy which prevented septic complications and degenerescence is possible only in a restricted number of patients

[Abdominal cystic lymphangiomas-Report of three cases]

Cystic lymphangioma are rarely observed in the abdomen. Their incidence varies between 2 and 10% of all localisations. The diagnosis is based on histopathological exam but can be suspected by radiology. Laparoscopic removal of the cyst is possible offering many adantages. We report the case of abdominal cystic lymphangioma occurring in women respectively 60, 65 and 68 years aged. Abdominal pain was the main symptom. Diagnosis was suspected before surgery in two cases thanks to the radiological findings. In these two patients, the cyst was removed under laparoscopic surgery. The third patient was operated by laparotomy. The diagnosis was established on histopathological study. With a mean follow up of 36 months, there were no signs of recurrence

[Pancreatic insulinoma: diagnostic approach and therapeutic modalities]

The insulinoma is the most frequent neuroendocrine tumor of the pancreas. It is often a benign tumor but can expose to major hypoglycemia. The positive diagnosis is based on biological dosages. The topographic diagnosis can turn out difficult imposing the appeal to invasive explorations. The treatment is surgical and benefits at present from the contribution of the coeliochirurgie

Gastric stromal tumors, a retrospective - a study. About 19 cases

The purpose of this study is to define the therapeutic attitude to be adopted in front of a gastric stromal tumor, to estimate the results and to define the prognostic factors of these rare tumors. We report a retrospective study about 19 cases of gastric stromal tumors reported over a period of 12 years going from January, 1993 till December, 2004. All the patients were operated. Diagnosis was established by the histological and immunohistological study of gastric resection or biopsies. It was about 8 men and 11 women of whom the average age was of 62 years. The symptomatology was dominated by abdominal pain [63% of cases] and digestive bleeding [52% of cases]. A palpable mass was found in 16%of cases. The tumor location was antrum in 13 cases, fundus in 5 cases and under cardial in 1 case. A synchronous gastric and small intestinal locations was found in 1 case. The average tumoral size was 8.2cm ranging from 1.7 to 30cm. The tumor resection was achieved in 18 cases [95%]. It was widened to the adjacent organs in 1 case. Morbidity raised 5.2% and there was no operating death. At pathological examination the tumor was of weak rank of wickedness in 8 cases, high rank in 8 cases and in vague potential in 3 cases. The average follow-up was of 27 months [2 to 96 months]. During the postoperative follow-up, 3 cases of recurrence were diagnosed. The 2-year -overall survival was 83%. The prognostic factors influencing the overall survival were the high cellular density [p=0.01], local recurrence event [p=0.03] and high degree of malignancy [p=0.0002]. The treatment of gastric stromal tumors is surgical. Gastrectomy and wedge resections passing in macroscopically normal tissue are the mainstay of the treatment. Enucleating resection should be avoided. The lymph node dissection is not recommended. The new chemotherapeutic agents [the tyrosine kinase inhibitors] seem promising and could modify the current therapeutic attitude in the future

[Menetrier's disease - report of 6 cases]

This is a retrospective study and report of 6 cases of Menetrier's disease. The diagnosis is made preoperatively in three patients only. Four patients had an adenocarcinoma, an other patient had a dysplasia and another one a granulomatous gastritis. A total gastrectomy was performed in 5 cases, the remaining patient underwent a subtotal gastrectomy. One of patients died 45 days after surgery following surgical complications. In this study the stress is put on the difficulty of diagnosis, likelihood of degenerescence and the gastrectomy

Traitement preventif des hypotensions arterielles au cours de la rachianesthesie

The prevention of blood pressure fall during a conventional spinal anaesthsia is based on the use of adrenergic vaso-constrictor and/or vascular filling. The aim of our prospective study is to evaluate the respective efficiency of ephedrin and vascular filling in the preventive treatment. 100 patients who would submit a surgical treatment of a groin hernia were included in the study. Thses patients were divided into two groups: Group E [n = 50]: 10 ug Kg-1 min-1 of ephedrin received 5 min before the puncture; Group R [n = 50]: 8 ml Kg-1 of cristalloids received 20 min before the puncture. Within Group E, 18% of patients have developed a blood pressure fall against 42% within Group R. Stastiscally, the difference is significant [P < 0,05]. The preventive administration of ephedrine seems to be efficient in the reduction of the blood pressure fall incidence during the conventional spinal anaesthesia