[Survival and causes of mortality of cirrhotic patients in Tunisian center a study of 114 patients]

The aim of this study is to determine the survival and the principal causes of death in our cirrhotic patients in whom the B and C viral infection represented the principal causes. It's a retrospective studs that includes 114 cirrhotic patients hospitalized between 2000 and 2005 in the department of hepato-gastro-enterology of sahloul. The mean age was of 53 years with extremes of 15 to 85 years; 65 were men 57%] and 49 were women [43%]. After a follow-up of 29, 4 months, 51 patients died [44, 7%]. The causes of death were hepatocellular carcinoma in 19 cases [16, 7%], hepatorenal syndrome in 17 cases [14, 9%], hepatic encephalopathy in 12 cases [10, 5%], infection of ascitis in I case and upper digestive hemorrhage in 2 cases [1, 8%]. The global survival of patients was 66%for 2 years and 47%for 5 years. The survival for 5 years of viral B cirrhosis was 34%, but it was 51%in non B viral cirrhosis but the difference was not statistically significant [p=0, 6]. The cirrhotic patients have a premature mortality in comparison to the general population. The hepatocellular carcinoma remains one of the principal causes of death, where the interest of early screening for degeneration

[Association of trichobezoard, gastric polyposis and splenomegaly]

Gastric trichobezoar is a rare disease, usually present as a mass of hair in the stomach, and rarely associated with a gastric polyposis. We report the case of a twenty year old girl admitted in our service to explore a chronic anaemia. Clinical exam reveals an epigastric mass and Splenomegaly. Endoscopy and radiology concluded to a giant trichobezoar with gastric polyps treated by gastrotomy and excision of the mass

[ sump syndrome - about a case report]

We report a case of Sump syndrome [SS] that occured in a 72 years old man that was operated 12 years before for a biliary lithiasis. He had a cholecystectomy with a choledocoduodenal anastomosis. This syndrome had been revealed by an angiocholitis presentation. Duodenoscopy revealed bezoars obstruction of choledocoduodenal anastomosis. Ablation of bezoars and endosopic extraction of lithiasis leaded to recovery after a follow up of 24 months

[Overlap syndrome autoimmune hepatitis=primary biliary cirrhosis. Comparative study with isolated autoimmune hepatitis results of a multicentric Tunisian]

Autoimmune hepatitis [AIR] and primary biliary cirrhosis [PBC] are two autoimmune diseases affecting the liver. Suggestive signs of the two diseases can however occur simultaneously or consecutively in the same patient leading to an overlap syndrome. The aim of our multicentric retrospective study was to study clinical, biological, immunological and histological features of 17 patients with overlap syndrome and to compare them with those of 62 patients with isolated autoimmune hepatitis. Overlap syndrome "AIH-PBC" accounts for 20,5%of patients with autoimmune hepatitis in our series. Our two groups were similar in age and gender. Clinically, in overlap syndrome group, a significantly higher prevalence of pruritus arid significantly lower prevalence of ascites were observed as compared to isolated AIH group. No significant differences were observed between the two groups of patients with regard to frequency of concurrent immune diseases. Biologically, serum alkaline phosphatase and garnma-glutamyl-transpeptidase were significantly higher in overlap syndrome than in patients with isolated AIH. Significantly more overlap syndrome patients were positive for anti-mitochondrial antibodies than isolated AIR patients. The patients with isolated AIR had a higher frequency of cirrhosis at presentation that the patients with overlap syndrome. The histologic profile was not different between isolated AIR and Overlap syndrome. Overlap syndrome "AIR-PBC" is not rare. Compared with isolated AIH, it is characterised by a higher frequency of clinical and biological signs of cholestasis, a higher frequency of antimitochondrial antibodies and the rarity of cirrhosis at the diagnosis of the disease

[Prevalence of celiac disease in patients with type 1 diabetes mellitus]

The aim of our study was to determine the prevalence of celiac disease in patients with type 1 diabetes mellitus. Between january 2004 and december 2005, 72 patients with type I diabetes mellitus and having pseudo ulcerous dyspepsia were included in this prospective study. Upper gastrointestinal endoscopy with proximal intestinal biopsies was performed in all patients. Patients with villous atrophy were tested for anti-gliadine antibodies, anti-endomysium antibodies and for anti-human tissue transglutaminase antibodies. Villous atrophy was observed in three patients [4, 1%]. It was subtotal in two cases and total in one case. Anti-gliadine antibodies, anti-endomysium antibodies and anti-human tissue transglutaminase antibodies were positive to three patients. The prevalence of celiac disease in patients with type 1 diabetes mellitus is high [4, 1%]. Early screening of celiac disease must be recommended to this diabetic population

[Diabetes in chronic pancreatitis- about 22 cases]

The aim of our study was to determine the diabetes profile in chronic pancreatitis, through an analysis of 22 chronic pancreatitis cases seen over 14 years in the service of gastroenterology. There were 6 men and 2 women. The average age is 50 years, the age oscillating between 20 and 67 years. The diabetes revealed chronic pancreatitis in 5 cases. These patients were alcoholic. The diabetes appeared in average after 4 years of evolution. Seven patients had pancreatic calcifications. This diabetes was insulin dependent in 4 cases. Through the reported cases, a literature review is done in order to point on features of diabetes when occurring with chronic pancreatitis

[Prevalence of helicobacter pylori infection in ulcerous duodenal disease of West center of Tunisia]

Determine the prevalence of helicobacter pylori infection in patients native of the west center of tunisia and having ulcerous duodenal disease: Descriptive study including 106 patients affected by no complicated duodenal ulcer having had one gastroscopy in the internal medecine department at Sidi Bouzid Hospital. Helicobacter pylori infection is defined by visualization of bacterium on gastric takings. the mean age of our patients was of 45.8 years with a light male predominance. Prevalence of helicobacter pylori infection was 97.1%. Antral location of the infection was observed in 56.6% of cases. Fundus and antral location of the infection was observed in the remaining cases. All patients have antral chronicle gastritis. In our study, the prevalence of helicobacter pylori in patients having duodenal ulcer is very high, justifying attitude therapeutics anti helicobacter pylori without systematic search of bacterium

[Malignant small intestine tumors - reporting of 22 cases]

Small intestine tumors represent less than 5% of digestive tract tumors. The goal of this work was to see the anatomoclinical, epide-miological, evolutive and therapeutic caracteristics of malignt tumors of the small intestine. We report a retrospective study which include files of patients with small intestine malight tumors proved by histology between 1992 and 2002. We report 22 cases [12 males, 8 females] with a mean age of 51 years. The circumstances of discovery of this patology were dominated by abdominal pains. The anatomopathological diagnosis was obtained by endoscopic biopsy in 14 cases, liver biopsy in 3 cases and analysis of operating piece in 5 cases. The more frequent histological nature was the adenocarcinoma. 64% of patients have metastatic cancer at the time of diagnosis. Surgery was realized in only 50% of cases