acute hyperlipemic pancreatitis [2 cases]

The aim of this work was to study the clinical and therapeutic features of this affection. Our retrospective study concerned two cases of hyperlipemic pancreatitis treated during 6 years from 1998 to 2003. The incidence of this affection was 1.42%. Our patients were respectively a man aged 32 years without any significant history and a pregnant woman aged 24 years with a positive history of dyslipidemia. Clinical, biologic and radiological data didn't differ from those of other causes of acute pancreatitis. The hyperlipemic origin was confirmed by a lactescent serum and a rate of triglycerides greater than 10 g/1. The course was characterized by the recurrence of pancreatitis related to the increased triglycerid serum level over 10 g/1. Plasmapheresis and administration of heparin and/or insulin seem to be efficient in reducing the serum level of triglyceride and in improving the course. Hygieno-dietary measures and hypolipemiant treatment were necessary for the level of triglyceirdes in serum below 10 g/1. We in the absence of comolicatons, surgery seemed umnecessry in the two cases. the clinical pattern of acute hyperlipemic pancreatitis doesn't include any specific elements, but its treatment and prevention must take into account the associated hyperlipidemia

results of Laparoscopic treatment of the gallbladder lithiasis about 500 cases

Laparoscopic cholecystectomy is at present the gold st and ard treatment of gallbladder lithiasis. Assesment of Laparoscopic cholecystectomy. Through a retrospective series of 500 laparoscopic cholecystectomies during a period going from January 1996 to March 2000, we tried to evaluate our experience by comparing our results to the literature data. There were 420 women and 80 men with a sex ratio of 0.19. Average age was 50 years. 16.2% of our patients were obese. 13 patients had a history of respiratory disease and 122 history of a cardiovascular pathology essentially arterial hypertension. All our patients benefited from at least one hepatobiliary ultrasound examination before the intervention. Antibioprophylaxy was administrated in 93.8% of cases. In 23 cases [4.6%], a conversion was necessary for different causes. We noted 11 surgical complications [2.2%] among which 2 required a surgical resumption, and 11 medical complications dominated by broncho-pulmonary infections. We had no death

[Fibrocystic mastopathy and Cancer of the breast. About 111 cases]

Objective: Our aim was to identify the predictive factors of degeneration of the fibrocystic mastopathy

Methods: This work is a retrospective survey of I 1 1 observations of isolated fibrocystic mastopathies or associated to a breast cancer among 542 women admitted for tumor of the breast during one period of 13 active years from 1991 to 2003. The diagnosis has been gotten by anatomo-pathologic exam in 95, 5% [106cas] on the operative piece and 4,5% [Scas] on a material of biopsy

Results: The fibrocystic mastopathy represented 30 % of the set of the benign tumors of the breast. They were associated to a breast cancer in 45 cases [40,5%]. The isolated benign fibrocystic mastopathy was observed in 66 cases with a middle age of 37 years. whereas the shapes associated to a breast carcinoma were noted in 45 cases. The middle age was 53 years. The non proliferative fibrocystic mastopathy is the most frequent histological type and repre-sent 54,6 % of the cases. The proliferative form with atypies was observed at 21 women [46,8%]. The carcinoma the more frequently associated to the fibrocystic mastopathy was the infiltrating canalled carcinoma in 91% of cases, with a pre-dominance of the 11 rank [SBR]

Conclusion: The discovery of a mastopathy must search a luteal failure and risk factors of breast cancer notably a proliferative shape of mastopathy with atypies

[pyogenic liver absecesses: a study of 25 cases]

Our aim was to study the anatomo-clinic particularities and the therapeutic modes of the infectious abscesses of the liver. Our retrospective study concerns 25 cases of the infectious abscesses of the liver collected on one period of 12 years from January 1992 to December 2003. They are 11 primitive abscesses and 14 secondary abscesses. We noted 14 women and 11 men, median age was 51,5 years. The Fontan triad was present in 7 cases. A liver mass with an abdominal sensitivity was found in 14 cases. Anomalies in the biologic exam of the liver were present in the 1/3 of the cases. We noted a double right and left localization in 3 cases and a multiple localization in 1 case. The hemoculture and the pyoculture permitted a bacteriological diagnosis in 52%. The percutaneous treatment achieved in 7 cases, permitted the recovery in 2 cases. One dead was noted following a severe cardiopathy. A surgical drainage has been achieved at 22 patients, 4 cases after the failure of the percutaneous treatment. Mortality rate was 20% [5 cases] related to the delay of diagnosis. The gravity of the septic shock, the advanced age and the flaws associated. The infectious abscess of the liver was a serious affection that affects the vital prognosis. The percutaneous treatment associated to the antibiotherapy, is the method of choice in the treatment of the abscesses of the liver. The surgical treatment must be reserved to the failure of the percutaneous treatment

[Tuberculous encapsulating peritonitis, about 18 cases]

Our goal is to study the circumstances of diagnosis and the therapeutic modes of encapsulating peritonitis of tubercular origin. We report in this retrospective study 18 cases of encapsulating peritonitis of tubercular origin collected from 1982 to 2000. Symptoms and signs are dominated by the general signs of tubercular nature, found isolated or in association with other, in 14 patients. Abdominal pain was found in all patients. Gastrointestinal disorders were found in 11 patients. A typically sound abdominal mass was found in 3 cases. The ultrasonographic data associated with the biologic data, helped in making the diagnosis. Confirmation of the tubercular origin was provided by histological examination of the biopsies. Treatment was based on the anti-tuberculosis chemotherapy associating four antitubercubus drugs taken daily during two months repeated by the association of two antituberculous drugs during a period of six to 13 months. The outcome was favourable in 16 patients but the two patients died. Histological diagnosis and more rarely bacteriological examination, would be essential in order to start an early treatment. This diagnosis is confirmed by open coelioscopy when the ascitis is septated or by exploratory laparotomy in the fibro-adhesive forms. Radical surgery is indicated in case of complications

[Anastomotic ulcer after vagotomy for duodenal ulcer]

Between January 1981 and December 2000, 2609 patient underwent surgery for duodenal ulcer. 2274 underwent isolated vagotomy; 1590 had vagotomy associated with GI anastomosis. Only relapses of anostomic ulcers after vagotomy associated with gastrojejunal anastomosis were included in this study. 22 patients [20 males, 2 females] aged between 26 and 79 years had anastomic ulcer relapses [1.38%] after vagotomy and GI anastomosis. Incomplete vagotomy was diagnosed in 14 cases [93%] associated with a defect in setting in 2 cases. Despite the ongoing controversy about the role of Helicobacter in the pathogenesis of anastomotic ulcers, medical treatment remains the primary therapy, and a partial gastrectomy alone or with vagotomy is necessary only in unresponsive cases