[Laparoscopic management of perforated duodenal ulcers results of a retrospective study]

Perforation of peptic duodenal ulcer is a frequent surgical emergency. The aim of this retrospective study is to evaluate the faisabiity and the results of laparoscopic management of perforated duodenal ulcers. Eighty-four patients had laparoscopic surgery for perforated duodenal ulcer. The duration of the study was seven years [2001 to 2007]. There were 81 men and 3 women aged from 16 to 64 years [mean: 28 years]. The mean duration between the onset of perforation and the time of operation was 20 hours [range: 6-72 hours]. The surgical procedure was suture and irrigation of the abdominal cavity. Conversion into laparotomy was performed in 14.2%of the patients. Mean operative time was 95 minutes. There was no post operative death. The morbidity rate was 15.4%. There was two surgical complications [post operative peritonitis and duodenal fistula] and ii medical complications. Mean hospital stay was 6 days. All patients were discharged with antibiotics for Helicobacter pylon eradication. Laparoscopic repair of perforated duodenal ulcer is a safe option providing low rates of morbidity, reoperation and mortality, and can be considered as the treatment of choice

[Pituitary deficiency of elderly subject: analysis of 14 cases]

The pituitary deficiency [PD] of the old subject is rare. To study the clinical biological etiologic and therapeutic characteristicsof PD in old subject. We report in this work a retrospective study of 14 patients older than 65 years presenting pituitary deficiency. This PD is characterized by a female preponderance [78, 5%of cases] and insidious initial symptomatology dominated by signs of thyreotrope deficiency and with a less degree of the signs of corticotrope sufficiency Anaemia [57, 5%] hypoglycaemia [28, 5%] and hyponatremia [21, 4%] are the most frequent biological signs. Hormonal exploration showed a dissociated pituitaiy deficiency in 11 cases [782 and global in 3 cases [21, 5%] The axis more touched is the gonadotrope axis [85, 7%] followed by the corticotrope [71, 4%] and thyreotrope axis [71, 4%]. The aetiologies are dominated by the Sheehan syndrome in 5 cases [35, 7%] followed by the hypophysis adenoma m 4 case [21, 4%]. The pituitary deficiency was idiopathic probably of vascular ongin in 2 cases [14, 28%] and secondary to primitive turcic saddle in 1 cases to a cyst of the pocket of Rathke in I case and to prolonged corticotherapy in 1 case. The hormonal substitutive treatment hare per-miffed a spectacular improvement in all the cases. It is necessary to think about the PD in the old subjects in front of minor signs and at the vascular ongin of this one witch remains the most frequent aetiology at the old subject especially those presenting atherogens factors