[Management of complicated appendicitis at the Hotel-Dieu de France hospital in Beirut]

Objective : To study the effectiveness and evaluate the rate of success of the conservative treatment adopted at the Hôtel-Dieu de France [HDF] university hospital, in the case of complicated appendicitis with an abscess or inflammatory mass and to compare this management with the one described in the literature

Material and Methods: This retrospective observational and descriptive study is based on data from patients treated at the hospital Hôtel- Dieu de France between 2009 and 2013, for complicated appendicitis with an initial non-surgical management. Forty patients were included in this study. Data were collected from medical records of the patients

Results: The average age of patients was 47.93 years and 65% were male. Conservative treatment was effective in 90% of patients with early failure in 7.5% of cases and late failure [relapse after antibiotherapy discontinuation] in 2.5% of cases. Drainage was performed in 32.5 % of patients, and resulted in a significant extension of the average duration of the first hospitalization [10.92 days] compared to patients treated without drainage [5.81 days]. The total duration of antibiotic therapy in our study was 4.5 weeks on average. Twenty-nine patients [72.5%] were operated by laparatomy and 11 [27.5%] laparoscopically, with an average hospital stay shortened from 4.04 to 2.5 days with the laparoscopic technique. As for the pathological examination, 10% of patients presented a mucinous neoplasm. No intra-operative complications were noted. Similarly, none of the patients had postoperative intraabdominal complications

Conclusion : At Hôtel-Dieu de France [HDF] university hospital, the conservative treatment of complicated appendicitis with an abscess or an inflammatory mass, followed by an appendectomy a few weeks later, shows a high success rate [90%]

[Medium-term functional results of surgical lacura of Gastro-Esophageal Reflux]

Introduction: The evaluation of the quality of life [QoL] has now become an established parameter in clinical research, including analysis of the effectiveness of medical or surgical treatment. Therefore, the treatment of gastroesophageal reflux disease [GERD] not only aims to relieve symptoms, prevent complications, minimize undesirable side effects of treatment but also improve the QoL of patients

Material and Methods: Our series includes 51 patients [23 men and 28 women] whose average age was 37 years [range 17-62], treated surgically for GERD at University Hospital Hotel-Dieu de France between 2005 and 2012. Their QoL was evaluated before and after surgery [mean follow-up 4.5 years], retrospectively, using the GIQLI Questionnaire [gastrointestinal quality of life index], which comprises 36 items covering five dimensions: symptoms, physical condition, emotions, social integration and medical treatment

Results: Before the intervention, the GIQLI score was 89 +/- 9; after antireflux surgery, GIQLI score was 113 +/- 9 [p < 0.001]. The unit-variable statistical analysis revealed that the highest GIQLI scores were correlated with the lowest BMI [body mass index]. No statistically significant difference was recorded for the age, sex, and duration of medical treatment before surgery, the surgical indication, surgical technique and the surgical approach. Statistically significant improvement was noted in the following dimensions: symptoms, physical condition, medical treatment and social integration. A non-statistically significant improvement was observed at the level of the emotional dimension. 12% of operated patients resumed a regular medical treatment against reflux, 37% have resumed medical treatment on demand and 51% of patients have never taken medical treatment after the operation. Six patients were reoperated with an overall reoperation rate of 12%

Conclusions: Antireflux surgery significantly improves QoL of patients but does not guarantee the full exemption of medical treatment. In our series, patients with a normal BMI and patients with only the classic complaints of reflux [heartburn, regurgitation, belching] are the best candidates for antireflux surgery. Better patient selection could prove to be a way to improve the results in terms of QoL

Laparoscopic treatment of vaginal agenesis: Three cases

Ninety per cent of cases of con- genital vaginal agenesis are represented by the Mayer- Rokitansky-Kuster-Hauser syndrome, the remaining 10% being represented by the testicular feminization syndrome and vaginal aplasia. Numerous surgical methods for the treatment of vaginal agenesis have been described. Neovagina construction by sigmoid colpoplasty seems to be the best surgical option as regards the anatomical and functional out- come. We report the case of three patients oper- ated of neovagina construction with a sigmoid graft by a laparoscopic-perineal approach. The surgical intervention lasted for 330 minutes, 210 minutes and 150 minutes respectively for the three patients. There were no perioperative complications. The duration of hospitalization was respectively 7, 4 and 6 days. The length of the neovagina was 15, 14 and 18 cm without retraction on the follow-up at 2 and 6 months. The vaginal wall maintained its paten- cy allowing normal intercourse. The patients had normal sexual life after the surgery. Our results demonstrate the feasibility of laparoscopic-perineal neovagina construction by sigmoid colpoplasty when it is performed by experienced surgeons in gynecology and digestive laparoscopic surgery

effects of methyl methacrylate monomer on testosterone level in male rats. An experimental study

Methyl methacrylate [MMA] is commonly used in medicine and dentistry. The adverse effects of MMA are well described in the literature. Animal studies have largely confirmed the risks reported in clinical observations. There is no study indicating direct implication of MMA on male fertility mechanism. The purpose of this study was to determine whether MMA is able to modify the testosterone level. The target population consisted of 60 male Sprague-Dawley rats. They were closed in colony cages and divided into five groups: The first group [n = 15] designated as the control group and four experimental groups [n = 45]. Experiments were conducted by exposing the four experimental groups to MMA with water at different concentrations [4%, 8%, 16% and 32%] administered per os. The exposure duration was eight months. Blood was obtained before and at the end of the exposure and the measurement of the testosterone level was made by EIA test. The exposure of rats at a moderate concentration of MMA [16%] showed an increase in testosterone level of 60% [p = 0.003] while the other groups showed a decrease of testosterone level. The control group showed a decrease of 44.8% [p = 0.001], the rats exposed at 4% showed a decrease of 67.7% [p = 0.000], those exposed at 8% showed a decrease of 4.32% [p = 0.35], the rats exposed at 32% showed a decrease of 71.7% [p = 0.002]. Despite the fact that MMA at low concentration was rapidly hydrolyzed in blood due to the nonspecific carboxylesterase and metabolized at high concentration by the liver, its effects on testosterone level were significant. These preliminary results showed an interference of the MMA with the testosterone hormonal equilibrium that could be an interesting target for further investigations

Toxic effects of methyl methacrylate monomer on male genital tissue in vitro study in rats

Methyl methacrylate [MMA], a widely used monomer in dentistry and medicine has been reported to cause abnormalities or lesions in several organs. Experimental and clinical studies have documented that monomers may cause a wide range of adverse health effects such as irritation to skin, eyes, and mucous membranes, allergic dermatitis, stomatitis, asthma, neuropathy, disturbances of the central nervous system, liver toxicity, and fertility disturbances. The purpose of this study was to determine whether MMA mixed with water at four different concentrations is able to affect the histological structure of testicular tissues and seminal vesicle on male rats. The target population consisted of 60 male Sprague-Dawley rats. They were housed in colony cages and divided into five groups: The first group [n = 15] designated as the control group and four experimental groups [n = 45]. Experiments were conducted by exposing the four experimental groups to MMA administered per os mixed with water at different concentrations [4%, 8%, 16%, 32%]. The exposure duration was eight months. The testicles and the seminal vesicles were then extracted, dissected, fixed in Bouin liquid fixative and were submitted to the pathology laboratory [National Institute of Pathology] for histopathological examination. Seven out of 10 rats to which the MMA was administrated at a concentration of 32% showed partial seminal vesicle atrophy. The seminal vesicles in the remaining rats showed normal histology in all specimens. Testis, epididymis and vas deferens showed normal histology in all rats. The data in this study showed that MMA administered at high concentration is associated to seminal vesicle atrophy. These findings let us suggest that this effect could be the result of either a direct effect of MMA on testosterone levels [as shown in our first study], or through its possible action on other organs involved in testosterone metabolism and seminal vesicle trophicity such as the hypophysis

Retroperitoneal cystic lymphangiomas in adults: four case reports and review of the literature

Retroperitoneal location of cystic lymphangiomas in adult patients is rare. Their clinical presentation is not specific. Magnetic resonance imaging is the best radiological exam for the diagnosis. These tumors must be distinguished from mesenteric cysts which are more frequent and can degenerate. The authors report four cases of retroperitoneal cystic lymphangioma with a literature review

Subtotal or total colectomy as surgical treatment of left-sided occlusive colon cancer

The treatment of acutely obstructed carcinoma of the left colon and sigmoid still represents a matter of controversy. The aim of this study was to assess retrospectively the results of its management by emergency subtotal or total colectomy with primary anastomosis. Sixty-seven patients were reviewed. There were 42 males and 25 females. The mean age was 70.5 years [range: 26-87 years]. Mean operative time was 210 minutes. There were five synchronous colon carcinomas [75%] and 23 [343%] synchronous tubulous and tubulovillous adenomas. No death was noted in the series. Ten postoperative complications [15%] occurred in nine patients including one postoperative peritonitis without evidence of anastomotic leak, one alithiasic cholecystitis, one evisceration and two intra-abdominal abscesses. The mean hospital stay was 11.4 days. Fifty-eight patients were assessed at three and twelve months for functional results. No fecal incontinence was encountered. The mean number of bowel movements per 24 hours was 3.2 at three months and 2 at twelve months. All patients were satisfied with their quality of life. Twelve patients [20.7%] occasionally needed anti-diarrheic medications. Urgent subtotal or total colectomy with primary anastomosis is a safe and efficient procedure in the management of acutely obstructed neoplasm of the left colon. It allows to treat in one stage the cancer and the obstruction, bearing no mortality, acceptable morbidity and satisfactory postoperative functional results

Colorectal cancer in young patients: Presentation, clinicopathological characteristics and outcome

Previous studies have emphasized the increasing incidence of colorectal cancer [CCR] among young adults and suggest that they may have more aggressive disease and worse five-year survivals than their older counterparts. Describe the profile of sporadic colorectal cancer in young patients focusing on its prevalence, clinicopathological characteristics, prognostic and survival factors. Three hundred and twenty-five CCR patients were divided in two groups: Gl < 45 years and G2 > 45 years. 13.2% of patients were less than 45 years old. A family history of a first-degree relative with colorectal cancer was more frequent in young patients: 44.1% vs 18.2% [p - 0.025]. A significant delay in seeking medical care was noted in Gl patients: 29.7 weeks vs 18.6 weeks [p = 0.01]. A trend to have more aggressive stages III and IV at presentation was observed among young patients: 55.8% vs 48.6% [p = 0.8]. Mucin-producing tumors were more frequently observed in Gl group: 41.9% vs 12% [p = 0.000]. Mean survival was 76.9 months in Gl group and 91.7 months in G2 group [p = NS]. Five-year survival was 52% in Gl group and 58% in G2 group [p - 0.6]. Stage for stage comparison was not significant in determining survival. The only independent factors were delay in consultation, right location of the tumor, peritoneal carcinomatosis, and the need for chemotherapy. This study confirms that colorectal cancer in young patients is frequent. Despite more frequent occurrence of mucin-producing tumors, age is not by itself a worse outcome predictor

[Male breast cancer. Report of eight cases]

Male breast cancer is relatively rare. We report herein 8 cases with clinical, biological and therapeutic characteristics. A retrospective study included all male breast cancers in our institution between 1998 and 2004. Mean age of the 8 patients was 67 years [52 to 81 years]. Patients presented with a breast lump [n=4], nipple discharge [n=2], Paget disease's [n=1], and on physical exam in patient with colon cancer [n=1]. The cancer localized in the right side [n=7] or the left side [n=1]. The tumor localized in subareolar region [n=7] or in the right lower outer quadrant [n=1]. The tumor size was between 1 and 2 cm [n=2], or between 2 and 5 cm [n=6]. One patient had pleuro-pulmonary metastases. The surgical treatment consisted of modified radical mastectomy [n=6], total simple mastectomy [n=1], and lumpectomy [n=1]. The final pathology showed infiltrating ductal carcinoma [n=6], infiltrating papillary carcinoma [n=1], and ductal carcinoma in situ with mini-invasion [n=1]. The lymph nodes were positive in 83.3% of cases. The estrogen and progesterone receptors were positive in 100% and 83.3% of cases respectively. Adjuvant chemotherapy, hormonal therapy or both was given in 2 cases, 1 case, and 5 cases respectively. The follow-up ranged from 6 to 72 months. The patient with metastases died 7 months after the diagnosis. The other patients [n=7] remained free of disease. Male breast cancer is relatively rare with predominance of infiltrating ductal carcinoma. Modified radical mastectomy remains the optimal surgical treatment. Hormone receptors were positive in all our patients and hormonal therapy with Tamoxifen remains the cornerstone of adjuvant therapy

Place of enucleation in the surgical treatment of the hepatic hemangioma case report and review of the literature

Hepatic hemangioma is the most frequent benign tumor of the liver. It is often asymptomatic. If surgery is needed the best method will be enucleation of the hemangioma. We report a case of enucleation of a cavernous hepatic hemangioma with review of the literature