[Molecular characterization of lynch syndrome in Tunisia]

High rates of early colorectal cancers [CRC] are observed in Tunisia suggesting genetic susceptibility. Nevertheless, up to now no molecular studies have been performed in the Tunisian population. To evaluate the clinical and genetic characteristics of Tunisian families suspected of hereditary nonpolyposis colorectal cancer [HNPCC] and to identify new tumoral markers for CRC susceptibility leading to distinguish patients with sporadic CRC from those with familial CRC, like HNPCC. 31 unrelated families suspected of HNPCC were screened for germline mutations in MMR genes. We have also analyzed tumoral phenotype and the genetic characteristics of tumors from 51 patients with CRC meeting the Bethesda criteria. 10 different germ line mutations, 8 of which were novel, were identified in 11 out of the 31 families [35.5%], 5 in MSH2 and 5 in MLH1. Our results showed that MUC5AC expression was more frequent in patients with family history of CRC [p=0.039]. The analysis of MUC5AC expression might be very beneficial in the detection of Tunisian patients with high susceptibility to CRC

Colonoscopy in elderly: feasibility, tolerance and indications: about 901 cases

Colonoscopy is the standard investigation for colonic disease, but clinicians often are reluctant to refer elderly patients for colonoscopy because of a perception of higher risk and a high rate of incomplete examinations. To evaluate feasibility and tolerance of this investigation in elderly and to review the most frequent indications of colonoscopy in these patients. A pilot retrospective study including 901 patients from January 2005 to December 2009; divided into two groups. Group [I] included patients 75 years old and more, group [II] included patients 45 years old or less. All those patients underwent colonoscopy at the gastroenterology department of Charles Nicole hospital. The 1st group included 231 patients, and the 2nd group included 670 one. A past history of colorectal cancer was more frequent in the group I [33.3% versus 9.90%; p<0.05] however history of chronic inflammatory bowel disease was more frequent in group II [0 versus 40.6%; p<0.05]. The main indication of colonoscopy was constipation in group II [6.1% versus 27%; p<0.05] and chronic diarrhoea in group I [42.9% versus 16.4%; p<0.05]. Bowel preparation was poor in 30.4% cases of the group I and 12.9% of group II [p<0.05]. The tolerance was similar in the two groups. The incomplete colonoscopy rate was higher in the group I [38.3% versus 23.4%; p<0.05]. The most frequent cause of colonoscopy interruption was the poor preparation in group I and the bad tolerance in group II. Diverticular disease, polyps and colorectal cancers prevailed in group I, whereas inflammatory bowel disease was current in group II. In elderly patients, colonoscopy is safe, well tolerated and offers a good diagnostic yield. Its non completion was essentially due to the poor preparation. Sedation did not seem essential. The optimisation of results of colonoscopy requires an improvement of quality preparation

[Prevalence and risk factors of thromboembolic complications in inflammatory bowel disease]

Patients with inflammatory bowel disease [IBD] are at increased risk of thromboembolic complications [TEC], which represent an important cause of morbidity and mortality. To assess the prevalence and risk factors of TEC in patients with IBD. We conducted a retrospective study including all the IBD patients in the gastroenterological department of Charles Nicolle hospital between 2000 and 2010. Only thromboembolic events that had been diagnosed by an imaging procedure were counted. A total of 266 patients with IBD were consecutively included. TE events occurred in nine patients [3.4%]; six men and three women. Their mean age was 31years [15-64 years]. Five patients had Crohn's disease and four had ulcerative colitis. The types of TEC were deep venous thrombosis of the leg in five cases with pulmonary embolism in one of them, cerebral venous thrombosis in two cases, portal thrombosis in one case and jugular vein thrombosis in one case. Active disease was present in all cases at the time TEC occurred. In our study, the prevalence of TEC is 3.4% in patients with IBD. Deep venous thromboses of the leg are the most common TEC and all our cases occurs during the active phase of IBD

[Correlation between liver biopsy and fibrotest in the evaluation of hepatic fibrosis in patients with chronic hepatitis C]

To assess the diagnosis value of Fibrotest in comparison with liver biopsy, for the evaluation of hepatic fibrosis in patients with chronic hepatitis C. This prospective study included in 2 years [2006-2007], consecutive patients with chronic hepatitis C native to treatment. Fibrotest and liver biopsy were performed. Receiver operating characteristics [ROC] curves, the sensitivity, specificity, positive and negative predictive values were used to assess the diagnostic value of Fibrotest in comparison with the METAVIR classification. We recruited a total of 65 patients: 28 males and 37 females [mean age: 50 years]; 92% of the patients had genotype 1. The histological fibrosis results were: 3. 1% F0; 24. 6% Fl; 32. 3%F2; 29. 2%F3 and 10.8%F4. The diagnostic value of Fibrotest in the detection of significant fibrosis [F2-F4] was 0.87. A score >0.5 has a sensitivity of 85.1%, a specificity of 72.2%, a positive predictive value of 88. 9%, and a negative predictive value of 65%. The diagnostic value of Fibrotest in the detection of cirrhosis [F4] was0.85. There were 13/65 cases of discordance [20%] for fibrosis, 4 cases were attributed to biopsy and 6 cases to Fibrotest. The discordance was unexplained in 3 cases. The size of biopsy<15mm [OR=2. 82, 95% CI, 1.3-6.07; p=0.008] and the stage of fibrosis F0, F1, F2 [OR= 3.35, 95% CI, 1.1-10.2; p=0.03] were considered as risk factors of discordance in multivariate analysis. This prospective study confirmed the good diagnostic value of Fibrotest as compared with the histological analysis of liver biopsy

[Auto immune hepatitis type 1 triggered by cytomegalovirus infection]

Autoimmune hepatitis is chronic and uncommon disease. The pathogenesis is a complex process. Several triggers for autoimmunity in predisposed individuals. Report a new case. We report a case of 17-year-woman presented with autoimmune triggered by cytomegalovirus infection. Cytomegalovirus induced autoimmune hepatitis has not been reported previously. Evolution was favourable under antiviral treatment, corticosteroid and azathioprine

Evaluation of nutritional status in patients with liver cirrhosis

Malnutrition is a frequently reported complication in patients with liver cirrhosis. It has a high clinical and economic impact reflected by an increased morbidity and prolonged hospital stay. This preliminary prospective study aimed to determine the prevalence of malnutrition in hospitalized cirrhotic patients and to investigate whether biological and anthropometric parameters are a valuable tool for identifying malnutrition in these patients. The nutritional status of 44 consecutive cirrhotic patients [21 men, 23 women] was assessed according to the anthropometric measurements and biochemical analysis. The diagnosis of malnutrition was based on diminished values of Mid arm muscle circumference [MAMC] and/or Triceps skinfold thikness [TST] below the 5th percentile or less than 60%. The aetiology of cirrhosis was viral hepatitis in 29 patients [66%]. Cirrhosis was classified Child Pugh A, B or C in respectively 9, 26 and 9 patients; 37 patients [84%] have mild or tense ascite. In this study, malnutrition was found in 35 patients [79.5%], whereas 9 patients has a good nutritional status. TST and MAMC less than 60%was found in respectively 72%and 25%of patients. No significant statistical difference in epidemiological characteristics was found between malnourished and well-nourished patients. TST and MAMC decreased significantly according to the Child score [p=0.014 and 0.032 respectively; a positive correlation was found between these two paramelers and the severity of cirrhosis. In this study, the high prevalence of denutrition was associated with the severity of cirrhosis. Anthropometric parameters are valuable tools for malnutrition diagnosis

[Nephrogenic ascites: an exceptional diagnosis. about one case]

Nephrogenic ascites is a clinical entity that manifests as refractory and exsudative ascites with unknown etiology in patients with end stage renal disease and often undergoing hemodialysis. This entity presents in practice many diagnostic and therapeutic difficulties. The aim of this study is to focus on these difficulties through a new observation. We report one case of nephrogenic ascites in chronic renal failure related to an idiopathic neurologic bladder. It's a 38 years old patient on hemodialysis for three years who consulted for exsudative ascites with a low rate of leucocytes. We conclude that nephrogenic ascites is rare. Its diagnosis is an exclusion diagnosis based on exclusion of other causes of ascites, particularly exsudative forms with low leucocytes rate. Its management is based essentially on renal transplantation and its prognosis is very poor

[Endoscopic ultrasonography versus helical CT in diagnosis and staging of pancreatic cancer]

Compare the performances of EUS to helical CT in the diagnosis and staging of pancreatic adenocarcinoma. Forty two consecutive patients [mean age 63 years; 25 men, 17 women] who had surgical exploration and histologically proved pancreatic cancer were retrospectively included. All our patients underwent with endoscopic ultrasonography [EUS] and helical computed tomography [helical CT]. Data analysis compared helical CT, EUS with the surgical data with or without histological study in diagnosis, staging and resectability of pancreatic cancer. Surgical findings were used as gold standard. For positive diagnosis EUS was more sensitive 100% [CI:93-100] than helical CT 88% [CI:77-95]. But helical CT was more specific 89% [CI:64-98] than EUS 83% [CI:58-96] for small tumors whose diameter is below 2,5 cm in which EUS was more sensitive in their detection [100% versus 83%]. In evaluating venous involvement EUS was more sensitive than helical CT [96% versus 50%; p<0.05], while CT was more specific [81% versus 75%; p<0.05]. Regarding lymph nodes invasion, the two imaging technique had the same sensibility [56%] with better specificity for helical CT [83% versus 75%; p<0.05]. The accuracy of EUS in identifying the T and N stages were 80% and 67% respectively, while helical CT have an accuracy of 50% and 71% respectively. EUS and helical CT correctly identified all resectable tumors while EUS was more accurate than helical CT in detecting non resectable tumors 94% versus 69%.EUS remains superior to helical CT in positive diagnosis of pancreatic adenocarcinoma especially for small tumors and also for the diagnosis of venous invasion and in identifying non resectable tumors. The two techniques have the same accuracy in the detection of lymph node involvement

[Prevalence of malnutrition in gastroenterology hospitalized patients: a 70 patients prospective study]

Malnutrition is a common problem in gastroenterology hospitalized patients. Its frequency varies considerably with the studied population and nutritional screening tools. The purpose of this study was to assess the prevalence of malnutrition in gastroenterology hospitalized patients. A prospective study was carried between January 2005 and March 2005 including 70 patients. The nutritional state of the patients was assessed according to the subjective global assessment scale [SGA]. anthropometric measurements and serum albumin level. Moderately and severely malnutrition was found for 54 patients [77 percent]. Statistical analysis found positive correlation between body mass index [BMI] and SGA C [p=0 .002] and between albumin level and SCA [p<0.005]. The median nutritional risk index [NRI] was 89.5 +/- 13 with significantly positive correlation with the other parameters [BMI, Albumin and SGA] respectively p=0.03, p=0.003 and p=0.004. Malnutrition is common in gastroenterology patients. The assessment of patient's nutritional state according to the subjective global assessment had a positive correlation with the others nutritional screening tools

[Usefulness of endoscopic ultrasonography for diagnosis between multivesicular hydatid cyst and serous cystadenoma of the pancreas. Case report]

Hydatid cyst of the pancreas is very rare. However, it should be suspected in every case of pancreatic cyst, especially in hydatid countries where hydatic cyst disease is endemic. In the paper we report the first case of a multivesicular hydatid cyst of the pancreas explored by endoscopic ultrasonography. Endoscopic ultrasonography is very reliable in the investigation of pancreatic cystic tumors. However it did not allow us to define semiological criteria capable of permitting a differential diagnosis between a hydatid cyst and serous cystadenoma. Per-echoendoscopic transduodenal puncture might improve the efficiency of this procedure with of hydatid cysts of the head of the pancreas

Place de la ligature elastique dans la prevention secondaire de l'hemorragie digestive par rupture de varices oesophagiennes. Etude prospective de 102 cas

The aim of this study was to assess the efficacy and morbidity of endoscopic variceal ligation for the prophylaxis of rebleeding from oesophageal varices. This work is a prospective study including 102 patients having had at] least one episode of variceal bleeding. The mean age is 52,5 years. Oesophageal varices were eradicated in 83,3% of cases after an average of 3,5 sessions. Recurrence of oesophageal varices after eradication was observed in 22% after an average follow-up of 7 months. 10 patients died before eradication of oesophageal varices from causes unrelated to the technique. The endoscopic variceal ligation is effective for eradication of oesophageal varices, with a low morbidity. This technique appears to be a method of choice in the prophylaxis of rebleeding from oesophageal varices

densite minerale osseuse au cours de la maladie de Crohn: Apport de l'osteodensitometrie chez 53 patients

Fifty-three patients with Crohn disease were included in A prospective study. Bone mineral density was measured at the Femoral neck and lumbar spine by dual-energy X-ray absorptiometry. Ten variables were analyzed in search of an association with bone demineralization; Age, sek, nutritional state, smoking, duration of the disease, hormonal status, inflammatory syndrome, site of disease ileal, colic or ileocolic, accumulated doses of corticoids and intestinal resection. A bone demineralization was observed in 58,5% of cases. The ileum location and the corticotherapie were predictives of bone demineralization. Crohn disease is a disease at high risk of bone demineralization. Predictors of the bone loss were smoking, long duration of the disease, ileal site and systematic corticotherapy

Atteinte he'patique au corus du coup de chaleur de'fort: a propos d'un cas

Liver injury is a well-known complication of exertional heat stroke. However severe acute irreversible liver dysfunction is rarely seen. Commonly, it manifest by only biochemically trouble as increased transaminases. We report a case of 58 years old man, who present a liver injury with a cholestasis syndrome occuring after a long walk in hot climate. This reported case illustrate the difficulties in diagnosis of such disease and suggest that exertional heat storke can cause a cholestasis liver injury