[Laparoscopic radical prostatectomy: initial experience: about two cases]

Laparoscopic radical prostatectomy was a major breakthrough in the treatment of localized prostate cancer. To report the first two laparoscopic radical prostatectomies performed in Tunisia. The two patients are aged 57 and 66 and were suffering from localized prostate cancer. We first tested the transperitoneal and under-peritoneal paths. We then used an anterogradic surgery technique with preservation of the bladder-neck, extra-facial dissection of neuro-vascular bandles and vesicourethral running anastomosis. The two procedures lasted 435 and 305 minutes. We did not have any conversion nor blood transfusion. Post-operatory situation was simple. The two patients were kept in clinic for 4 days and the trans-urethral catheter was removed 7 days following the surgery. The anatomo-pathologic study finds a negative surgical margins for both patients. 3 months later, both patients are continents. Only one of them showed an erection with phosphodieseterase type 5 inhibitors. The total PSA is indetectable. Laparoscopic radical prostatectomy for localized prostate cancer is a technique that has proven its effectiveness since 10 years at least

Primary lumbar hernia: analysis of three cases

Lumbar hernia is relatively rare; it is due to a defect of the posterior abdominal wall. To report three new cases of lumbar hernia and insist of the modalities of treatment. There are 2 women and one man. Mean age was 78 years. The mean symptom was lumbar mass. All patients had open surgery [by lumbar incision]. The post operative course was uneventful. Primary lumbar hernias are rare. Earlier diagnosis of non complicated hernia should be of primary importance to avoid some serious complication. The only curative treatment is surgery and must be done as soon as the diagnosis was made

Facteurs predictifs de morbidite et de mortalite de la chirurgie du vieillard

The aim of the study was to determine prognostic factors of post operative morbidity and mortality for patients aged 80 years and older. We compared two groups of patients aged 80 and over operated to determine predictive factors of morbidity and mortality group of patients who presented post operative complication within 30 days after surgery and group of patients without any complication. Comparison of the two groups for global morbidity using univariate analysis showed only one prognostic factor: surgery of diabetic foot [p = 0.034]. Predictive factors of mortality according to univariate analysis were: pre-operative shock [p = 0.001], abdominal wall pathology [p = 0.027], gastric or duodenal ulcer diseases [p= 0.011] and global morbidity [p = 0.006]. After logistic regression, only pre-operative shock was an independent predictive factor of mortality [p = 0.0023]. Risk for morbidity after surgery in the elderly 80 years and over is linked with type of surgery and not with soil. Likewise, risk for mortality is linked with advanced stage of disease that is presence of pre-operative shock and not with soil

Facterus pronostiques des splenectomies pour rate hematologique

The aim of this study was to identify the prognostic factors of intraoperative haemorrhage, perioperative blood transfusions and morbidity. We collected 120 splenectomies in Beau sejour department of surgery, charles' Nicolle Hospital, Tunis, Tunisia between 1979 and 1999. the descriptive analysis showed sex ratio 0.82 with mean age [ +/- standard deviation] 30.6 +/- 15 year. Idiopathic thrombopenic purpura was the principal disease indicating splenectomy. Morbidity was defined as occurrence of post operative peritoneal sepsis or bleeding. The mortality and morbidity rates were respectively 0.8% and 6.6%. the prognostic anlysis didn't identify predictive factors of intraoperative haemorrhage, however it identified two independent predictive actors of specific morbidity: intraoperative haemorrhage [p = 0.03] and preoperative rate of haemoglobin [p = 0.0049]

[Prenatal diagnosis of uropathies: a review of 10 cases]

Obstructive uropathies are a frequent cause of child renal failure. The prenatal diagnosis of such abnomalies should lead to appropriate management. to evaluate the interest of ultrosonographic prenatal diagnosis of urinary tract malformations retrospective study of 10 cases of urinary tract malformations diagnosed in utero. The mean age of the patients was 34,9 years and the mean gestationnal age at the prenatal diagnosis was 28,2 weeks of amenorrhea. The abnormalties diagnosed were: 2 cases of ureteropelvic junction obstruction, 3 cases of posterior urethral valves and 5 cases of mild hydronephrosis. The fetal karyotype, realised in 8 cases, was normal. In one case the urinary abnormalties was part of a multiple malformation syndrome and led to the termination of the pregnancy. 7 cases had a postnatal follow-up: 5 had a surgical management and two new borns had transient pyelectasies. The prediction of postnatal renal function is made by ultrasonographic appearence of the kidney and the amniotic fluid. Although the analysis of fetal urine for the assesment of renal function leads to conflicting results, it seems that sodium and beta-2 microglobulin urinary rates provide useful informations