[Complications of the Meckel's diverticulum, about 42 cases]

Our aim was to report the main complications of the Meckel's diverticulum. Our retrospective study concerns 42 cases of complicated Meckel's diverticulum, collected during one period of 18 active years from January 1988 to December 2005. The yearly impact is 2, 33 cases / year. We excluded the asymptomatic Meckel's diverticulum, of fortuitous discovery during intervention. The middle age of our patients is 25 years, with extremes going from 2 to 74 years. The sex-ratio is 3, 2. The diagnosis before intervention of the complicated Meckel's diverticulum was not evoked in any time. The clinical features were an acute intestinal closure in 22 cases, an appendicitis in 13 cases, an appendicular peritonitis in 6 cases, and an acute intestinal intussusceptions in one case. In any case, it is the surgical exploration that permitted to confirm the diagnosis of a complicated Meckel's diverticulum. The approach way was median in 27 cases, Mac Burney in 13 cases, and laparoscopic in 2 cases. The surgical exploration showed peritonitis in 16 cases, one diverticulitis in 23 cases, an acute intestinal intussusception in one case, a tumour in one case, and haemorrhagic diverticulum's ulcer in one case. The treatment consisted in a segmental resection of ileum with end to end anastomosis [37 cases] and a cuneiform resection [5 cases]. The histological exam showed heterotopy of gastric tissue in 12 cases, of pancreatic tissue in two cases, and a Burkitt's lymphoma on a diverticulum in one case. We noted a precocious death following a septic shock. The Meckel's diverticulum constitutes a most common benign malformation of the digestive tube. The prognosis is related extensively to the gravity of its complications that can benefit, not only of the contribution of the laparoscopic diagnosis, but also therapeutic

Endoscopic thoracic sympatecomy for hyperhidrosis

Hyperhidrosis is a benin affection representing a social and professional problems and occupational handicaps in young patient. Endoscopic thoracic sympathectomy thus provides a radical treatment for severe palmar and axillary hyperhidrosis. We describe the technique used in our institut and present results. From 1995 to 2002, 32 patients were operated on for hyperhidrosis. There were 17 mens and 15 women raging in age from 15 to 32 years. The intervention consisting on destruction by eJectrocoaguJation to the sympathetic trunk. There was no major complication and the mean postoperative hospital stay was 2 days. The disappearance of the palmar sweating was immediately after operation. 7 patients complained of compensatory sweating. Endoscopic thoracic sympathectomy for hyperhidrosis is a safe effect technique for treating palmar and axillary hyperhidrosis. Compensatry sweeting represent the major that necessite a preable information

[Nephrotic syndrome in diabetis: evolution and prognosis about 35 cases]

The objective of our study was to evaluate the prognostic factors in the nephritic diabetic syndrome and its evolution. We realized a retrospective study of 35 cases of diabetic patients hospitalized between 1985 and 1999 who presented with a nephrotic syndrome. They included 17 females and 18 males, their mean age was 43 years [extremes: 18-77 years] and the mean duration of their diabetes was 10 years [extreme: 0-25 years]. The diabetes was insulin-dependent [type1] in 19 cases and non insulin-dependent [type 2] in 16 cases. Retinopathy and neuropathy were presents in 88% and 83% of the cases respectively. Nephrotic syndrome was secondary to a diabetic nephropathy in 26 cases [74%] and to a non-diabetic nephropathy in 9 cases [26%]. The mean follow-up was 4 years for 22 patients. Evolution was marked by a rapid decline of the renal function in 14 cases [63.6%]. Factors of bad prognosis seem to be the following: male sex [11 cases out of 14; 78,5%], type 1 diabetes [10 cases out of 14; 71,4%], poorly controlled hypertension [10 cases on 12; 83,3%], smoking [5 cases out of 14; 35,7%], hyperlipidemia [11 cases out of 14; 78,5%] and nephropathy caused by the diabetic condition [11 cases out of 14; 78,5%]. Control of these risk factors is thus important to prevent the progression of nephrotic syndrome

results of Laparoscopic treatment of the gallbladder lithiasis about 500 cases

Laparoscopic cholecystectomy is at present the gold st and ard treatment of gallbladder lithiasis. Assesment of Laparoscopic cholecystectomy. Through a retrospective series of 500 laparoscopic cholecystectomies during a period going from January 1996 to March 2000, we tried to evaluate our experience by comparing our results to the literature data. There were 420 women and 80 men with a sex ratio of 0.19. Average age was 50 years. 16.2% of our patients were obese. 13 patients had a history of respiratory disease and 122 history of a cardiovascular pathology essentially arterial hypertension. All our patients benefited from at least one hepatobiliary ultrasound examination before the intervention. Antibioprophylaxy was administrated in 93.8% of cases. In 23 cases [4.6%], a conversion was necessary for different causes. We noted 11 surgical complications [2.2%] among which 2 required a surgical resumption, and 11 medical complications dominated by broncho-pulmonary infections. We had no death

[Late post-operative adhesive small bowel occlusions. About 258 cases]

This retrospective study reports a series of 258 patients operated on for late developing post-operative adhesive occlusions. The impact of anterior interventions on these occlusions. The impact of anterior interventions on the occlusions as well as the clinical and paraclinical patterns are discussed before any approach to the different therapeutic aspects of this complication. Previous surgery had an impact not by number of the operations performed [80% of patient had undergone only one intervention on the pelvis or abdomen] but essentially by the nature of the operations since most of the adhesions occurred following surgery on the appendix. The diagnosis should be made urgently on basis of findings yielded by physical examination and plain abdominal x-rays [ct-scan of the abdomen is hardly indicated for the absence of hydroaeric levels on the plain abdominal film does not definitely exclude the strangulation]. Laparoscopic adhesiolysis an adequate treatment in case of a single adhesion. This laparoscopic is an adequate treatment in case of a single adhesion. This laparoscopic procedure practised on 11 patients had to be transformed in 3 cases into an open laparoctomy. Resection rate was 11.6%. Mortality and morbidity rates were 2% and 17% respectively

[Fibrocystic mastopathy and Cancer of the breast. About 111 cases]

Objective: Our aim was to identify the predictive factors of degeneration of the fibrocystic mastopathy

Methods: This work is a retrospective survey of I 1 1 observations of isolated fibrocystic mastopathies or associated to a breast cancer among 542 women admitted for tumor of the breast during one period of 13 active years from 1991 to 2003. The diagnosis has been gotten by anatomo-pathologic exam in 95, 5% [106cas] on the operative piece and 4,5% [Scas] on a material of biopsy

Results: The fibrocystic mastopathy represented 30 % of the set of the benign tumors of the breast. They were associated to a breast cancer in 45 cases [40,5%]. The isolated benign fibrocystic mastopathy was observed in 66 cases with a middle age of 37 years. whereas the shapes associated to a breast carcinoma were noted in 45 cases. The middle age was 53 years. The non proliferative fibrocystic mastopathy is the most frequent histological type and repre-sent 54,6 % of the cases. The proliferative form with atypies was observed at 21 women [46,8%]. The carcinoma the more frequently associated to the fibrocystic mastopathy was the infiltrating canalled carcinoma in 91% of cases, with a pre-dominance of the 11 rank [SBR]

Conclusion: The discovery of a mastopathy must search a luteal failure and risk factors of breast cancer notably a proliferative shape of mastopathy with atypies

tumeurs mucosecretantes de l'appendice. A propos de 22 cas

The retrospective study presented in this article was realized on a series of 22 cases of mucus secreting tumor of the appendix compiled among 8373 appendicectomies. The clinical picture was dominated by an appendiceal syndrome [73%]. The diagnosis was made pre or preoperatively in 10 cases and it was only with to the systematic anatomopathologic exam that 12 other cases were discovered. The histological study of the appendectomy piece showed a retention mucocele [12 cases], a mucosal hyperplasia [8 cases] and a cystadenoma [2 caases]. For 5 patients, the diagnosis of peritoneal pseudomyxoma [4 cases] or extraperitoneal [1 case] was retained. All the patients underwent an appendicectomy, associated to an evacuation of the peritoneal gelatinous ascites for 5 patients among whom two underwent in more an omentectomie. Two cases of recurrence were recorded 5 months later

Tumeurs carcinoides de l'appendice. A propos de 46 cas

Carcinoid tumors of the appendix are rare. The appendix constitutes the most frequent localization of these tumors. We studied of a retrospective way all cases that had an appendectomy in the service of general surgery of sfax on a period of 7 years going from 1995 to 2001. during this period 9584 patients had an appendectomy in our service. Among which, 46 cases [0.48%] of carcinoid tumor of the appendix have been diagnosed. In more than 95% of cases, patients were admitted due to acute appendicitis; but none of them had the signs of the carcinoid syndrome. The treatment was a simple appendectomy in 44 cases [95%]. The right hemicolectomy was necessary in two cases, because of an invasion of the appendicular base in a case and a tumor greater than 2 cm in the other case. There is no reported case of lymph node or systemic metastasis. The authors discuss data in the literature and analyse the features of the clinical picture, diagnosis, and try to define a convenient attitude of treatment of these tumors

[Peripheral hypothyroidism and Cushing disease]

The presence of thyroid disorders in Gushing's syndrome is very common. These abnormalities demonstrate the effect of the cortisol on the different levels of hypothalamo-hypophyso-thyroid axis'. However, the association between primary hypothyroidism and Cushing s' syndrome is more rare. We report the case of a 55 year-old woman with a Gushing's disease because of pituitary macroadenoma. A primal]] hypothyroidism was diagnosed 8 years before in this patient because of obvious clinical features and was confirmed by decreased thyroid hormones levels and moderate TSH increase. Hypercortisolism induces a decrease in thyroid hormones, and changes in TSH wih less reactivity to TRH Suppression of hypercortisolism is associated with a normalisation of these functionnal thyroid disorders but also leads to an increase in autoimmune thyroiditis

[Congenital growth hormone deficiency: etiologic presentation of 13 cases]

Frequency of the congenital growth hormone [CH] deficiency is estimated to /4000 - 1/10.000 births. Its pathogenesis is multiple. We report 13 cases of congenital GH deficiency. Three cases [3 boys] are secondary to stalk interruption and GH deficiency is associated to ACTH deficiency in 2 cases and to gonadotropin deficiency in 2 cases but no patient has diabetes insipidus. shows a pituitary stalk interruption, an anterior pituitary hypoplasia and posterior pituitary ectopia. The causes of stalk interruption remain not clear. For the 10 other patients with congenital GH deficiency, genetic origin is suggested because of the clinical and biological presentation and by the normal MRI. GH deficiency is isolated in 5 cases in 10. We review the main mutations involved in GH deficiency [Prop-1, Pit-1, Lhx3 and Lhx4 genes]