[Diabetic retinopathy in type 1 diabetes of short duration]

Diabetic retinopathy is the most specific complication related to diabetes. The position statement about diabetic retinopathy postulates that initial retinal exanimation should be performed within 5 years after the initial diagnosis. We report the case of a 26 years old type 1 diabetic woman with a severe non proliferative diabetic retinopathy discovered 10 months after the onset of clinical diabetes, The hypothesis of a Latent Autoimmune Diabetes in adults [LADA] seems to he plausible. This case report indicates again that a severe form of diabetic retinopathy can occur at the onset of type 1 diabetes and suggests that systematic ophthalmic examination should be performed at the onset of type 1 diabetes

[Obstructive anuria due to fungus balls. Report of 3 cases]

Fungus balls as a cause of upper urinary tract obstruction are rare, with less than 60 cases reported in the literature. We herein describe three cases or secondary anuria caused by Candida infection of the upper urinary tract. The first case was observed in a patient with a transplanted kidney, the second in a diabetic patient and the third in a. patient suffering from chronic Kidney failure. The treatment consisted of urinary drainage, identification of the infectious organism and appropriate antifungal treatment.

occlusive colo-rectal cancer

It is the most common progressive and revealing complication of colon cancer. This urgent situation becomes grave by combination of both cancer and occlusion. The surgean must deal with the blockage as well as the cancer. This action takes into account several parameters, not only the patient's clinical state but also the site and stage of the tumor. It is concerning 18 patients who had a colonic occlusive cancer, throught a period of 5 years. The parameters include the clinical state of the patient, and site and stage of the tumor. Of 123 colo-rectal cancer patients operated during this period, 18 cases were suffering from occlusion, represting 15%. Average age was 54 years, ranging from 31 to 78 years, divioed to 10 men and 8 women with sex ratio of 1, 2. The location was predommataly in the left colon with 13 cases, 4 cases in the right colon and 1 case in medium rectum. The right colon 1 cases in medium rectum. The right localisations were operated in a one stage operation while the left and rectal cases were carried out in 2 stage: 1 with primary colostomy and 13 with surgical colostomy the morbidity rate was at 19%. Early diagnosis, an adapted resuscitation procedure and a rapide surgical interferance with colostomy, can reduce the morbidity and mortality rate. Tumoral resection witn continous restauration is the most pratical urgent surgical interference. An appropriate care, manily the patient's rehydration and rapide surgical interferance will reduce mortality and morbidity rates. While the treatment or right colon cancer can be done by an one stage surgery, the left occlusive colon cancer as it is more urgent is managed case by case and we recomond a colostomy with or without the first resection

[Complications of the hepatectomies]

It is a retrospective study valuing the hepatectomies for all disconcerted indication. The interest is carried on the death rates, of morbidity and the middle length of hospitalization. On 5 years period [2001-2005], 81 patients have been have been included in our study. The indications of the hepatectomies were very disparate: 26 cases of hepatocellular carcinoma, 13 cases of benign tumors, [7 cases of hydatid cysts, 5 cases of gallbladder's carcinoma, 19 cases of hepatic metastases and one case of hepatic abscess. We analyzed the factors of mortality and morbidity. We noted a masculine predominance of 61%. The middle age was 50 years. The achieved interventions were: right or left hepatectomy in 32%des cases, sectorectomy or lobectomy in 39%of the cases and no typical resection in 29%of the cases. The rate of morbidity is of 28,3%, with 8 cases of ascitis, 5 cases of hemorrhages of the section slice, 3 cases of hepatocellular insufficiency, 2 cases of hematoma, 2 cases of parietal infection, one case of biliary wound, a case of hepatic encephalopathy and a case of reversible acute renal insufficiency on tubulo-interstitial necrosis. We deplore in our study a death rate of 3, 7%. The death rate and morbidity are influenced by the extent of the hepatic resection. This rate is in greatimprovement thanks to a better selection of the patients and indications. The use of the vascular clampage became widespread, and the resections parenchymateuses has been standardized, what decreased in a considerable way the complications in per and postoperative

[Hydatic cyst of the pancreas - a case report]

We report a new case of hydatid cyst of the pancreas. The diagnosis has been suspected on the radiological aspect then confirmed by serology. The treatment consisted in a resection of the prominent dome associated to drainage of the residual cavity. The post operative sequences were simple. To the light of this observation and data of the literature, the different clinical aspects, para clinical and therapeutic modalities of this very rare localization of hydatidosis are discussed

Microvascular complications in the type 2 diabetes: impact of the insulin therapy

When oral antidiabetics at optimal dosage have failed to maintain good diabetic control, insulin treatment has to be considered. The aim of this retrospective study is to evaluate over a 5 years period the incidence of progression in microvascular complications in 35 type 2 diabetes patients treated with insulin and compared to 35 controls treated with oral hypoglycemic agents. By 3-5 years, the "insulin" group had lower risks of progression in both complications: retinopathy [p=0,005] and neuropathy [p<0,05]. However, the incidence of progression in nephropathy was quite similar between the two groups. Our study confirms the long term results found in the literature about effects of insulin therapy on microvascular complications in diabetic patients

Poly unsasturated fatty acids, omega-3 and omega-6 structure role and alimentary sources

Long chain poly unsaturated fatty acids have structural and functional biological properties controlling many essential processes. Omega-3 with long chain acids constitute a class of fragile natural compounds which are active in prevention of age related diseases [cardiovascular, neurodegenerative and retinal affections]

[The diabetic diet of Tunisia: lived and recommendations]

Diet is essential for diabetes treatment. It must provide a balanced nutritional intake with adaptation to each patient. The aim of this study is to evaluate the spontaneous food consumption in a group of 150 type 2 diabetic Tunisian patients. Main food consumption abnormalities are an excessive caloric intake, an excess in glucid consumption, a saturated, fatty acids intake accounting for 26 +/- 6% of the lipid ration which is positively correlated with high LDL cholesterol levels [p=0,04], a ratio animal/vegetable proteins greater than I and an insufficiency in anti-oxidant vitamins. Thus, the qualitative analysis of the, food intake shows several anomalies which exposes our diabetic patients to a high cardiovascular risk; adapted recommendations appear to be necessary

[Gastric stomal tumor revelated by post traumatic rupture]

The rupture of stromal gastric tumour is an exceptional cause of hemoperitoneum. We report a case of ruptured stromal gastric tumor in the peritoneal cavity after a contusion of the left hypochondrial region in a 58 years old male patient operated in emergency for an acute anemia thought to be caused by a pathological rupture of the spleen. The emergency laparotomy revealed an exo-gastric tumor located in a fundus intimately linked with the spleen. Therefore, we realized a partial gastrectomy and the patient was treated by chemotherapy with Glivec [R] [imatinib]. The evolution was favorable for two years without recurrence. The traumatic rupture of a stromal gastric tumour is an exceptional event. The diagnosis is rarely evocated before intervention. It constitutes an predicative sign of malignancy. The circumstances of finding a stromal gastric tumour are not specific. However, their rupture indicates an urgent laparotomy in order to perform a hemostatic gastrectomy

Cancer colon and pregnancy

We are reporting a case of colonic adenocarcinoma in a 18 weeks pregnant woman aged 42 years. We realised a left segmental colectomy completed by an adjuvant chemotherapy after a normal delivery. For months later, bilateral ovarian metastases were diagnosed. Therfore, hysterectomy and a bilateral ablation of annexes with an omentectomy was done. The ovulation was good without recurrence for four months later. Discussion: The advised therapeutical attitde is to stop pregnancy before intervention during the first trimester, in the scond trimester surgical treatment is indicated regardless pregnancy, in the third trimester, it is necessary to wait until full pulmonary maturity of the foetus is reached, then intervene by a caesarian section and a curative surgical treatment at the same time. The diagnosis of cancer colon associated with pregnancy is difficult and needs a strong multidisciplinary collaboration. The prognosis of cancer colon is aggravated in pregnant women. It can not be improved except with an early diagnosis