[Laparoscopic resection of gastric stromal tumors]

Gastro-intestinal stromal tumors [GIST] are the most common mesenchymal gastrointestinal tumors. The Gastric location represents 60% of cases [1,2]. Complete surgical excision remains the treatment of reference for the localized forms. This surgery can be made by laparoscopy when the lesion's size doesn't exceed 5 cm. Some principles must e respected: a mono-block complete surgical resection, with healthy margins and without effraction. This technique will be reserved for trained teams and for selected cases according to the size and location. We herein try to explain the surgical laparoscopic excision of gastric stromal tumors explaining

[Evaluation of nutritional status in lung cancer using bio-electrical impedance analysis and mini-nutritional assessment]

Malnutrition and cachexia were a frequent problem in lung cancer and increases the risks of morbidity and mortality in these patients. Bioelectrical impedance analysis [BIA] is easy, non-invasive and reproducible method that can be performed. Evaluate nutritional status in patients with primary lung cancer by Mini Nutritional Assessment [MNA], BIA and anthropometric values [weight, arm and calf circumferences] and correlate the nutritional parameters to severity of cancer and histopathology. The nutritional status of 73 cases of primary lung cancer was evaluated by anthropometric parameters, MNA test and impedencemetrie. According to body mass index [BMI], malnutrition, overweight and obesity were noted in 34,2%, 13,7% and 5,5%. According to BMI, free-fat mass index [FFMI] and fat mass index [FMI], the investigations occurred malnutrition and depletion of muscle in respectively 19,2% and 23,3% of cases. Fat depletion was noted in 21,9%. Overweight and obesity were detected in 6,8% and 5,5% of cases. Assessment by MNA, revealed that 28,7% of patients were already malnourished and 49,3% of patients were at risk of malnutrition. A significant correlation existed between the score of MNA and arm and calf circumferences, FFMI and FMI. FMI was significantly lower in group of patients with small lung carcinoma. Only FFMI allows early detection of malnutrition in cancer patients overestimated by measuring BMI and arm circumference was the better indicator of depletion of muscle

[ 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

[Diagnosis approach of pulmonary embolism]

Pulmonary embolism [PE] is a fairly common condition that can be fatal. The variability of presentation sets clinician up for potentially missing the diagnosis. Routine laboratory findings are nonspecific and are not useful in diagnosis of PE. Diagnosis is based on clinical prediction rule in combination with laboratory tests such as the D-dimers test leading to the realization of a confirming examination. To precise the confirming examinations of PE and propose an algorithm based on clinical prediction rules in combination with D dimmers. A Pub Med search was conducted using the following key words: pulmonary embolism computed tomography pulmonary angiography, scintigraphy and D Dimer. The study was based on a review of 18 studies including meta analysis, reviews and original articles referring recent strategy diagnosis of pulmonary embolism. Ventilation/ perfusion scan is a type of examination that is used less often because it is not a widespread technology. However, it may be useful in patients who have an allergy to iodinated contrast. Ultrasonography of the legs, also known as leg doppler, in search of deep venous thrombosis [DVT] may help the diagnosis approach particularly when other exams are not available or contraindicated. This may be a valid approach in pregnancy. The gold standard for diagnosing PE is pulmonary angiography. It is used less often due to wider acceptance of multi detector CT scans, which are non-invasive. A normal ventilation/perfusion scan rules out the diagnosis of PE with negative predictive value of 97%. There is no consensus in pregnancy. Finally, the MRI has a low and insufficient sensibility to diagnose PE. D Dimers, multidetector CT, ventilation/ perfusion scintigraphy and ultrasonography of the legs are the most useful examinations to diagnose PE. Many algorithms were established depends on medical experience and examination availability

Prognostic factors in gastric carcinoma after R0 resection with DH lymph node dissection. Tunisian experience

Curative resection with adequate lymph node dissection is the treatment of choice for gastric cancer. To determine the prognostic factors after R0 resection with DII lymph node dissection. We retrospectively assessed 126 patients who underwent R0 resection with DII lymph node dissection for gastric cancer [excluding the upper third of the stomach] in a single institution between 1991 and 2006 with median follow-up of 38.5 months [6 - 219]. Prognostic factors were assessed by Cox proportional hazard model. There were 45 women and 81 men. The median age was 60 years [21 - 87]. Four patients died [3.2%]. Postoperative hospital morbidity was 16.7%. The pathologic review of the slides revealed that 50% of the tumors were stage T3 [63 cases]. The median number of lymph node removed was 11 [8-40], 50% were involved. Five and 10 years survival rates were respectively 56.9% and 40.2%. In multivariable analysis, depth of wall invasion, lymph node involvement and more than 15 retrieved lymph nodes were found to be independent prognosis factors. After R0 resection with DII lymphadenectomy, depth of wall invasion, lymph node involvement and more than 15 retrieved lymph nodes were independent predictive factors for survival