[Comparative study of antibiotic resistance in bacteria isolated from the burned patients during two periods [2005-2008, 2008-2011] and in two hospitals [hospital Aziza Othmana, trauma and burn center]]

Continuous monitoring of the bacterial flora and antibiotic resistance of the main bacteria involved in nosocomial infections helps improve treatment and prevention strategies. To compare the bacteriological profile and antibiotic susceptibility of the main bacterial isolates within the burned patients over two periods of 3 years and in two hospitals. During two three-year periods: period 1 [P1]: 1/7/2005-30/6/2008 and period 2 [P2]: 1/7/2008-30/6/2011] and in two hospitals: Hospital Aziza Othmana [HAO] and the traumatology and burn center [CTGB], 2153 and 3719 non-repetitive strains were isolated from burn patients from different samples. The transfer of the intensive care unit was made on 01/07/2008 from the Hospital Aziza Othmana to CTGB. The study of antibiotic sensitivity was performed according to CA-SFM. During the period P1, Pseudomonas aeruginosa was the main bacteria isolated [18%] followed by Staphylococcus aureus [14%] and Acinetobacter baumannii [12%]. After the transfer of intensive care burn unit to the traumatology center, ecology bacterial varied with S. aureus [20%] in the first place followed by P. aeruginosa [15%] and Proteus mirabilis [11%]. The study of the evolution of antibiotic susceptibility showed an overall downward trend of resistance in the second half of 2008, immediately after the transfer of service in the new hospital structure. The rate of ceftazidim resistant Klebsilella pneumoniae decreased from 80.4% to 50%, Similary the resistance of P. aeruginosa to ceftazidime and imipenem decreased respectively from 61% to 39.4% and from 63.3% to 37.1%. Nevertheless, the reduction of resistance was followed by a rapid increasing during the year 2009 to reach overall rates of resistance previously observed in the hospital Aziza Othmana. Concerning S. aureus, the rate of MRSA [methicillin-resistant S. aureus] showed no significant variation throughout the study period: 60% versus 56.3% at HAO and CTGB. A. baumannii brings up the problem of mutir‚sistance: 92.7% of strains were resistant to ceftazidime and 63.9% to imipenem during P1 with an emphasis on resistance to imipenem during P2 increased to 89.3%.Resistance is a problem in the intensive care burn unit. Preventive measures have to be taken

[Epidemiological profile and antibiotic resistance of pseudomonas aeruginosa isolates in burn and traumatology center in Tunisia over a three-year period]

Pseudomonas aeruginosa is a known opportunistic pathogen frequently causing serious infections in burned patients. To analyze the epidemiological profile of Pseudomonas aeruginosa isolated in a Tunisian burn unit. During a 3-year period [from 01 July 2008 to 30 June 2011], 544 non repetitive strains of P. aeruginosa were isolated from burn patients. Susceptibility to antibiotics was assessed according to CA-SFM guidelines. Serotypes were identified by slide agglutination test using P.aeruginosa O antisera [Biorad]. Producing carbapenemase was analyzed for 202 imipenem resistant isolates by EDTA test. Susceptibility testing data were stored in a laboratory data base using whonet 5.3 software. The most frequent sites of isolation were cutaneous infections and blood cultures [83.4%]. The percentages of resistant isolates were as follows: ceftazidime: 34%; imipenem: 37.1%, ciprofloxacin: 27.1% and amikacin: 29.6%. The most prevalent serotypes were: 011[51%], 06[17%], 03 [8%], 04[12%], 012[5%]. Among the 202 imipenem resistant strains, 58% expressed a metallocarbapenemase. All theses strains were resistant to all tested antibiotics except colistin and belonged to the serotype O11. The dissemination of carbapenemases strains must be contained by implementation of timely identification, strict isolation methods and better hygienic procedures

[Parietal abscess revealing calculation forget eight years after laparoscopic cholecystectomy]

Laparoscopic cholecystectomy is the treatment of choice for symptomatic gall stone disease. The perforation of the gallbladder happens in 40% of cases. Stones spilled remain there in 20% of cases in view of their number and location. These lost stones can cause adhesions, abscess, peritonitis, digestive fistula or else cutaneous fistula. to report a new observation of a cutaneous fistula resulting from a gallstone lost during laparoscopic cholecystectomy, eight year later. A 57-year-old women, underwent 8 years ago laparoscopic cholecystectomy for acute cholecystitis. A cholecystectomy was performed without incidence and with uneventful post-operative course. She was admitted to hospital again for an inflammatory painful swelling of the right renal fossa which had been developing for one week without any fever or transit disorder. The abdominal C.T.scan performed revealed a subcutaneous collection of 8 CM. She underwent an excision of the collection with drainage of pus and numerous small stones. She was diagnosed with lost gallstone complicated with cutaneous fistula. The control C.T scan made 3 months later showed a small collection at the level of the right parieto-colic gutter. She was operated on again, laparoscopy excision of the fistulous tract was performed without showing stones. Healing was achieved two months later. She re-presented 3 months later for a swelling of the old scar which fistulized spontaneously with pus leaking. The abdominal C T scan was normal. She underwent an excision of a collection wish containing a large stone of two centimetres. The patient was regularly seen afterwards at the outpatients' department. She was feeling well 18 months later. A lost gallstone can cause serious complications. Spillage of gallstones should be avoided. When does occur, every effort should be made to withdraw spilled gallstones and especially to mention the event in the post-operative report

Adreno-cortical oncocytoma: a case report

Adrenal oncocytoma is a very rare lesion, non functioning and benign in most cases. Only 46 cases have been reported in the medical literature. This study aimed to report a new case of adrenal oncocytic tumor with uncertain malignant potential. A 72 year-old- man, consulted for renal fossa pain. Ultrasonography and omputed tomography scan revealed a large mass in the right adrenal gland with extension to the right kidney. A right adrenalectomy and nephrectomy was performed. The diagnosis of adrenal oncocytoma with malignant potential was confirmed by pathology. Patient had a well recovery and left hospital on the fifth day post operatively. He was followed up for 8 months, no tumor recurrence detected. Adreno cortical oncocytoma is a rare tumor. The majority of reported cases had good prognosis

Alimentary factors promonting colorectal cancer risk: a prospective epidemiology study

Some foods are incriminated in the genesis of colorectal cancers [CRC], on the other hand, other foods are considered as protectors. This study aimed to determine the alimentary factors influencing the risk of CRC. We conducted an epidemiologic prospective study. We performed firstly a descriptive analysis of the CRC group [32 patients] and we compared this group to a control group of 61 patients subdivided into two subgroups [Non tumoral digestive disease [31 patients] and a subgroup of trauma patients [30 patients]]. Factors, retained by the univariate analysis were introduced into a logistic regression model which identified the independent factors influencing the risk of CRC. Univariate analysis identified 12 factors influencing the risk of CRC with p

[Hydatid cysts of the pancreas, report of two cases]

Hydatid cyst of the pancreas is a rare affection with a frequency less than one percent of the various sites of hydatid disease. Rreport two cases of hydatid cyst of the pancreas. A 49 year old woman with a history of laparotomy for liver and peritoneal hydatid cyst was admitted with recurrent liver and peritoneal hydatid disease associated with a head pancreatic cyst of 3 cm in size. Surgical treatment consisted in a resection of the protruding dome with uneventful postoperative course. A 45 year old man who underwent laparotomy four years ago for hepatic hydatid cyst was admitted with recurrent liver and peritoneal hydatid disease associated with a head pancreatic cyst of 4 cm in size. At laparotomy it was a head pancreatic hydatid cyst without duct pancreatic lesion. The treatment consisted in the resection of the protruding dome. The postoperative evolution was simple. Hydatid cyst of the pancreas is rare. If associated with another hydatid localization, the diagnosis is generally easy. It can however be more difficult if the pancreatic localization is isolated. In most cases, resection of the protruding dome is sufficient

aggressive course of de novo ulcerative colitis after renal transplantation: colonic adenocarcinoma with choriocarcinomatous differentation

A rare case of colonic carcinoma arising in de novo ulcerative colitis after renal transplantation in a 42-year-old woman is reported. Clinically, the patient presented ulcerative colitis 8 years after renal transplantation, developed colonic cancer with liver metastasis 2 years later and died one month post operatively. Histologically, the removed tumor was composed of two distinctive elements consisting of adenocarcinoma and choriocarcinoma. The metastatic foci in the liver were composed exclusively of choriocarcinoma. Identification as choriocarcinoma was made on the basis, of typical histological appearance, immunohistochemical demonstration of human chorionic gonadotropin [hCG] in the tumor cells and the high serum hCG level, unrelated to trophoblastic disease. In this report, pathogenesis is briefly discussed and clinical conditions are reviewed. In conclusion, the issue of de novo UC after organ transplantation is still a matter of debate. Further investigations are necessary to understand the tumorogenesis of colorectal cancer in de novo UC after renal transplantation

[Myofibroblastic tumor of the great omuntum]

Myofibroblastic tumors are a spindle cell lesion at indeterminate malignant potential. Abdominal location was rare. We report a case of an unusual location at myofibroblstic tumors in the great omuntum. A 63-year-old women presented with a one year of isolated left hypochondrium pain. Physical examination was normal. CT scan of the abdomen showed a multicystic and a multilocular building-up of the great omentum suggestive of a peritoneal haemolymphangioma. Besides, at the MRI, this lesion showed up with threefold component: cystic, plump and fibrous, all leading towards a myofibroblastic tumor. At laparotomy, there was already a 10 cm diameter cystic tumor of the great omentum, composed of numerous cystic sockets, all filled with a thick brunish substance. A total resection of the great omentum was done, thus taking away the whole tumor. The histological examination confirms the diagnosis of myofibroblastic tumor of great omentum. Post operative evolution was uneventful. One year later there were no signs of recurrence. Myofibroblastic tumors of the great omentum are rare. The diagnosis is often confirmed by careful microscopic examination or immunohistochemical markers. Treatment consists on a complete surgical resection and life time follow-up is needed because the risk of recurrence

[Squamous cell carcinoma arising in Verneuil's disease]

Verneuil's disease or hidradenitis suppurativa is a chronic suppurative, and cicatricial inflammatory disease, mainly affecting apocrine-bearing area of the skin. Squamous cell carcinoma is an uncommon but a frightening complication of hidradenitis suppurativa. To report a new case of squamous cell carcinoma arising in Verneuil's disease. We reported a case of 60 year old man with a 30 years history of hidradenitis suppurativa in which squamous cell carcinoma arise. A wide surgical excision removing the tumour and leaving a large defect was performed. The patient had a well recovery, wounds healed well by primary intention. No recurrence observed at 18 months of follow up. Squamous cell carcinoma is an uncommon complication of hidradenitis suppurativa. Surgical excision represents also the treatment of choice

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

[Trauma of an ectopic kidney. A case report]

Ectopic kidney is a rare pathology. It is usually misknown and often revealed by a complication. We report a case of a 30- year-old male patient who presented in emergency with a right thoraco-abdominal trauma and a benign head trauma. Injury evaluation revealed a right ectopic pelvic kidney with a grade IV laceration. Furthermore, there was a hepatic contusion in the sixth segment and a fracture of the ninth, tenth and eleventh right ribs. Therapeutic attitude consisted on a successful conservative and nonoperative treatment for both lesions. CT scan is of utmost importance in diagnosis. Management is the same as for normally positioned kidney