problems therapeutiques poses par les syndrome de Gardner, a propos d'une famille Libanaise

Gardner's syndrome is an autosomal dominant disease characterised by the association of a polyposis coli with one or more of specific extracolonic manifestations. A Lebanese family is reported. Polyposis coli, desmoid tumors, gastroduodenal polyps, procreation counselling etc are difficult problems to manage in this syndrome

Les ruptures du duodenum retroperitoneal au cours des traumatismes fermes de l'abdomen

Duodenal retroperitoneal wound after blunt abdominal trauma is a well known, and a classical entity. Most of the patients are operated with delay and this lesion could easily be missed at laparotomy if not searched for. Mortality and morbidity are much higher if the diagnosis is delayed more than 24 hours. These lesions should be strongly suspected after any blunt abdominal trauma, and repeated clinical assessment is mandatory in the conscious patient. Gastrografine upper GI study and CT Scan are interesting diagnosis procedures when the patient is unconscious or should be anesthesized. At laparotomy, the presence of a central retroperitoneal hematoma should guide the surgeon to explore the duodenum. Treatment depends on the time of diagnosis, the severity of the wound, and the associated pancreatic lesions. The authors present five different cases of blunt duodenal trauma and a review of the literature

Valeur des signes cliniques et des examens para-cliniques dans le diagnostic de l'appendicite aigue

199 patients with a pre-operative diagnosis of Acute Appendicitis [A.A.] were operated at Hotel-Dieu Hospital between 1986 and 1990. 42 patients [21%] were misdiagnosed; with female predominance mainly between 10 and 30 years of age [41%, p<0,01]. In 13 of these 42 patients, laparotomy was justified for reasons other than A.A., this make our rate of negative laparotomy at 14,5%. Clinical signs and symptoms were not always reliable in the diagnosis of A.A. Typical sequence of pain was more reliable in men [100% of positive predictive value] than in women [79%, p<0,05]. CBC was normal in 12% of patients with A.A. Analgesic medication, like Pyrazolone derivative [Avafortan°] or Paracetamol, taken by 5 of our patients before the diagnosis of A.A., coincided with a normalisation of the CBC. In 33 patients, the surgeon was confused with the macroscopic appearance of the appendix, 10 of them [30%] turned out to be inflamed at the microscopic examination. The recent interest in diagnostic laparoscopy and the improved techniques in ultrasonography, will permit to improve diagnosing A.A. pre-operatively

Lithiase vesculaire asymptomatique

Since the introduction of routine abdominal echography silent gallstone has become a major medical concern. The management of a patient with silent gallstone is very controversed and routine cholecystectomy is not always beneficial. Aged and high operative risk patients should be treated conservatively literature review can identify subgroups of patients in whom cholecystectomy is justified :patients with micro or macro-lithiasis patients in whom oral cholecystography reveals multiple floating stones dyskinectic, not opacified or calcified gallbladder and patients receiving general anesthesia for other reasons than gallbladder disease