Standardized approach to the conservative surgery of hepatic cystic echinococcosis: A prospective study.

OBJECTIVE: Surgery is the mainstay of hepatic cystic echinococcosis (HCE). The conservative surgery of HCE carries a non-negligible risk of recurrence and significant morbidity, dominated by Deep Surgical Site Infections (DSSI). To address these issues, we have improved and standardized this technique, which could reduce complications and achieve better postoperative outcomes. PATIENTS AND METHODS: We conducted a prospective study from June 2017 to June 2022 involving of patient operated using a standardized open technique for uncomplicated HCE at Habib Bourguiba University Hospital, Sfax, Tunisia. The aim was to obtain results at least similar to radical management in terms of DSSI. Patients with large cystobiliary fistulas or patients with complicated cysts were excluded. RESULTS: Fifty patients with 106 cysts were operated using the standardized technique comprising of liver mobilization, intraoperative ultrasound, systematic methylene blue injection to detect cystobiliary fistulas and omentoplasty. The median age of the patients was 44(semi-interquartile range: 16) years. The main symptom described by the patient was pain in 43 cases (86%). An abnormal liver test was found in 20 cases (40%). On imaging studies, the cyst had a median size of 7.4(3.0) cm. Cyst of the hepatic dome accounted for 38 cases (35.8%) with most cysts being situated in the right hemi-liver. Visual inspection of the cavity and Methylene blue testing allowed for the discovery of 57 cysts (53.7%) that had cystobiliary fistulas that were sutured. Omentoplasty was performed in 77 cysts (72.6%). Postoperatively, only 2 cases (1.9%) developed a DSSI in the form of an external bile leak with resolved with conservative management. No case of recurrence was found after a median follow-up of 24 months. CONCLUSION: The standardized conservative surgical technique, in selected patients, shows promise in reducing DSSI rates and overall morbidity, and achieve as equally good result as radical management.

Predicting Waist Circumference From a Single Computed Tomography Image Using a Mobile App (Measure It): Development and Evaluation Study.

Background: Despite the existing evidence that waist circumference (WC) provides independent and additive information to BMI when predicting morbidity and mortality, this measurement is not routinely obtained in clinical practice. Using computed tomography (CT) scan images, mobile health (mHealth) has the potential to make this abdominal obesity parameter easily available even in retrospective studies. Objective: This study aimed to develop a mobile app as a tool for facilitating the measurement of WC based on a cross-sectional CT image. Methods: The development process included three stages: determination of the principles of WC measurement from CT images, app prototype design, and validation. We performed a preliminary validity study in which we compared WC measurements obtained both by the conventional method using a tape measurement in a standing position and by the mobile app using the last abdominal CT slice not showing the iliac bone. Pearson correlation, student t tests, and Q-Q and Bland-Altman plots were used for statistical analysis. Moreover, to perform a diagnostic test evaluation, we also analyzed the accuracy of the app in detecting abdominal obesity. Results: We developed a prototype of the app Measure It, which is capable of estimating WC from a single cross-sectional CT image. We used an estimation based on an ellipse formula adjusted to the gender of the patient. The validity study included 20 patients (10 men and 10 women). There was a good correlation between both measurements (Pearson R=0.906). The student t test showed no significant differences between the two measurements (P=.98). Both the Q-Q dispersion plot and Bland-Altman analysis graphs showed good overlap with some dispersion of extreme values. The diagnostic test evaluation showed an accuracy of 83% when using the mobile app to detect abdominal obesity. Conclusions: This app is a simple and accessible mHealth tool to routinely measure WC as a valuable obesity indicator in clinical and research practice. A usability and validity evaluation among medical teams will be the next step before its use in clinical trials and multicentric studies.

Duplication cyst and diverticulum of the stomach: A case report of an unusual association.

Gastric duplication cysts are uncommon findings in adult patients. Accurate diagnosis of these cysts is difficult. Presenting symptoms are often non-specific, and complications are rare. We report an uncommon case of a non-communicating duplication cyst associated to a diverticula of the stomach in 38-year-old women.

Recommandations of the Tunisian Association of Surgery for the practice of visceral surgery during COVID-19 pandemic.

The World Health Organization declared on March 11, 2020 that the COVID-19 epidemic has become a pandemic. In Tunisia, the Ministry of Health has recommended enhanced preventive hygiene measures to contain and limit the spread of the virus. Following the entry of Tunisia into phase 4 of the COVID-19 epidemic, the Tunisian Association of Surgery proposed recommendations related to surgical activity. Surgical emergencies must be treated urgently and without delay. Non-tumor pathologies which require surgery in an elective situation and for which the risk of aggravation or complication is considered low shoud be postponed. For digestive tumor pathology, and apart from complicated forms, neoadjuvant treatment is highly recommended in the context of multidisciplinary concertation staff.

Primary squamous cell carcinoma of the pancreas: a report of two cases and review of the literature.

Primary squamous cell carcinoma (SCC) of the pancreas is extremely rare. We herein report two such cases. Aside from various morphological characteristics, the clinical presentation of pancreatic SCC is the same as that of adenocarcinoma. The treatment is controversial, and the prognosis is poor.

Hydatid cyst of the pancreas. About 12 cases.

INTRODUCTION: Pancreatic localization of hydatid disease is atypical and extremely rare; it accounts for less than 1% of cases. Preoperative diagnosis may be difficult regarding the absence of clinical or radiological signs. MATERIALS AND METHODS: We report a retrospective study of twelve cases of hydatid cyst of the pancreas over a period of 30 years (1980 to 2010). By means of our study we try to clarify clinical manifestation, radiological features and therapeutic modalities. RESULTS: The twelve patients consisted on eight men and four women with an average age of 25.8 years. Abdominal pain was the most frequent clinical signs. Jaundice was noted in 4 cases and abdominal mass in 2 cases. Hydatid serology, practiced in 7 cases was positive in 6 cases. Abdominal ultrasound, practiced in 11 cases, completed in 7 cases by abdominal computed tomography (CT), showed cystic lesions in 10 cases, in 7 cases the cystic lesion was dependent of the pancreas. All patients were operated by median laparotomy. Partial cystectomy was performed in six cases, cystic punture in one case, pancreaticoduodenectomy one case, distal spleno pancreatectomy in 2 cases, distal pancreatectomy in one case and trans-duodenal puncture of the cyst in 2 cases with pancreatico-duodenal anastomosis in one case. CONCLUSION: Hydatid cyst of the pancreas is extremely rare even in endemic countries, it should be considered in the differential diagnosis of cystic lesions of the pancreas. Ultrasound and CT coupled with hydatid serology could be helpful for the diagnosis. Surgery remains the treatment of choice in pancreatic hydatid cysts.

[Complications of Meckel's diverticulum. Report of 42 cases]. / Complications du diverticule de Meckel: a propos de 42 cas.

AIM: Our aim was to report the main complications of the Meckel's diverticulum. METHODS: Our retrospective study concerns 42 cases of complicated Meckel's diverticulum, collected during one period of 18 active years from January 1988 to December 2005. The yearly impact is 2,33 cases/year. We excluded the asymptomatic Meckel's diverticulum, of fortuitous discovery during intervention. RESULTS: The middle age of our patients is 25 years, with extremes going from 2 to 74 years. The sex-ratio is 3,2. The diagnosis before intervention of the complicated Meckel's diverticulum was not evoked in any time. The clinical features were an acute intestinal closure in 22 cases, an appendicitis in 13 cases, an appendicular peritonitis in 6 cases, and an acute intestinal intussusceptions in one case. In any case, it is the surgical exploration that permitted to confirm the diagnosis of a complicated Meckel's diverticulum. The approach way was median in 27 cases, MacBurney in 13 cases, and laparoscopic in 2 cases. The surgical exploration showed peritonitis in 16 cases, one diverticulitis in 23 cases, an acute intestinal intussusception in one case, a tumour in one case, and haemorrhagic diverticulum's ulcer in one case. The treatment consisted in a segmental resection of ileum with end to end anastomosis (37 cases) and a cuneiform resection (5 cases). The histological exam showed heterotopy of gastric tissue in 12 cases, of pancreatic tissue in two cases, and a Burkitt's lymphoma on a diverticulum in one case. We noted a precocious death following a septic shock. CONCLUSION: The Meckel's diverticulum constitutes a most common benign malformation of the digestive tube. The prognosis is related extensively to the gravity of its complications that can benefit, not only of the contribution of the laparoscopic diagnosis, but also therapeutic.

Effects of a back squat training program on leg power, jump, and sprint performances in junior soccer players.

The aim of the present study was to investigate the effects of voluntary maximal leg strength training on peak power output (Wpeak), vertical jump performance, and field performances in junior soccer players. Twenty-two male soccer players participated in this investigation and were divided into 2 groups: A resistance training group (RTG; age 17 +/- 0.3 years) and a control group (CG; age 17 +/- 0.5 years). Before and after the training sessions (twice a week for 2 months), Wpeak was determined by means of a cycling force-velocity test. Squat jump (SJ), countermovement jump (CMJ), and 5-jump test (5-JT) performances were assessed. Kinematics analyses were made using a video camera during a 40-m sprint running test and the following running velocities were calculated: The first step after the start (V(first step)), the first 5 m (V(first 5 meters)), and between the 35 m and 40 m (V(max)). Back half squat exercises were performed to determine 1-repetition maximum (1-RM). Leg and thigh muscle volume and mean thigh cross-sectional area (CSA) were assessed by anthropometry. The resistance training group showed improvement in Wpeak (p < 0.05), jump performances (SJ, p < 0.05 and 5-JT, p < 0.001), 1-RM (p < 0.001) and all sprint running calculated velocities (p < 0.05 for both V(first step) and V(first 5 meters), p < 0.01 for V(max)). Both typical force-velocity relationships and mechanical parabolic curves between power and velocity increased after the strength training program. Leg and thigh muscle volume and CSA of RTG remained unchanged after strength training. Back half squat exercises, including adapted heavy loads and only 2 training sessions per week, improved athletic performance in junior soccer players. These specific dynamic constant external resistance exercises are highly recommended as part of an annual training program for junior soccer players.

[Pancreas divisum]. / Pancréas divisum.

Pancreas divisum is the most frequent congenital disease of the pancreas. It results from the failure of the dorsal and ventral pancreatic ducts to fuse. It is responsible primarily for recurrent acute pancreatitis, chronic abdominal pain, and chronic pancreatitis. It is diagnosed today by MRI. Treatment is recommended only for symptomatic patients. Endoscopic sphincterotomy is the main treatment, and its results are good for most patients with recurrent acute pancreatitis. Surgical sphincteroplasty is indicated if endoscopic treatment fails.

[Gastric sarcoma]. / Sarcomes gastriques.

Sarcoma of the stomach is a rare histological entity. These differentiated mesenchymal tumors do not differ clinically from other gastric cancers. Endoscopic ultrasonography is the preferred means of exploration because it determines the existence of a submucosal lesion and provides guidance in determining its type. Certainty of diagnosis requires pathologic and immunohistochemical examinations of the surgical specimen. Malignant gastric stromal tumors are the first differential diagnosis of sarcoma of the stomach. They can be better characterized by testing their expression of the c-kit protein. Histological confirmation of malignancy sometimes remains difficult. Locoregional invasion and distant metastases confirm malignancy. Treatment is essentially surgical. Prognosis depends on tumor size, extension, rupture and histological grade.

[Acute hyperlipemic pancreatitis (2 cases)]. / Les pancréatites aiguës hyperlipidémiques (2 cas).

UNLABELLED: THE AIM of this work was to study the clinical and therapeutic features of this affection. CASE REPORT: 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/l. The course was characterized by the recurrence of pancreatitis related to the increased triglycerid serum level over 10 g/l. 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/l. We in the absence of comolicatons, surgery seemed umnecessry in the two cases. CONCLUSION: 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.

[Hydatid cysts of the spigelian lobe (segment I) of the liver: clinical and therapeutic particularities]. / Kystes hydatiques du lobe de Spiegel: particularités cliniques et thérapeutiques.

OBJECTIVE: Hydatid cysts of the spigelian lobe, that is, segment I of the liver, are rare. We analyzed their clinical and therapeutic particularities. METHODS: We conducted a retrospective search for the hydatid cysts of the liver treated surgically in our department from January 1, 1994, through December 31, 2005. Cases were identified and confirmed with the following investigatory techniques: routine abdominal ultrasonography, abdominal computed tomography recommended by the ultrasound operator when a cyst was discovered in segment I, routine intraoperative cholangiography, and three separate serological techniques: electrosyneresis, hemaglutination and ELISA (enzyme-linked-immunosorbent assay)(the latter two being quantitative). The cystic cavity was treated with hypertonic serum. Several surgeons performed different combinations of the following techniques: deroofing, sometimes with omentoplasty, simple drainage, and subtotal pericystectomy. RESULTS: We treated 44 hydatid cysts of segment I surgically in 10 men and 34 women, with a mean age of 40.6 years. Ten patients (22.7%) had a history of hydatid cysts. Symptoms or complications were noted at admission in 45% of cases. Only five cases (11.4%) required emergency surgery. Surgical examination confirmed vascular compression in 17 cases (38.6%) and a biliary fistula in 17 cases (38.6%). Surgical treatment consisted of deroofing in 37 cases (84,1%), with omentoplasty in 23 (54%), subtotal pericystectomy in 3 and simple drainage in 4. Large biliary fistulas (> 5 mm) were treated with bipolar drainage in 2 cases and internal transfistulary drainage in 3. Some hemorrhaging occurred during surgery in 5 cases, and one cyst ruptured in the peritoneal cavity. Albendazole was prescribed postoperatively for nine patients. There was one intraoperative death, secondary to hemorrhage resulting from erosion of the inferior vena cava. Morbidity was 25%. After a mean follow-up of 32 months, five patients had recurrences in the liver but outside segment I. CONCLUSION: Segment I of the liver is a rare site for hydatid disease, and a site where vascular and biliary complications are frequent. Its management requires a good knowledge of the vascular anatomy of the liver and wide experience of hydatid cyst surgery and especially of simple surgical procedures.

[Cystic lymphangioma of the abdominal cavity. Report of 11 cases]. / Les lymphangiomes kystiques des espaces abdominaux. A propos de 11 cas.

OBJECTIVE: Our aim was to assess the epidemiological particularities, the circumstances of the diagnosis and the therapeutic indications of the cystic lymphangioma of the abdominal spaces. METHODS: Our retrospective and analytic survey concerns 11 cases of cystic lymphangioma of the abdominal spaces: mesentere 6 cases, epiploon 1 case, retroperitoneum 3 cases and under peritoneum 1 case. The incidence was of 1/2476 hospitalizations (0.04%). RESULTS: The median age was 28 years. The sex-ratio was of 1.2. The main circumstance of discovery of the cystic lymphangioma was an abdominal mass in 7 cases. The other circumstances were: a pseudoappendicular syndrome, an ascitis, a disembowelment and a direct traumatism of the abdomen. Total resection of the cystic lymphangioma was performed in 7 cases. In 4 cases a simple enucleation and in 3 cases a resection of a segment of the organ that supports the lymphangioma. Only a partial resection of the lymphangioma has been achieved for the remnant patient. A cystic lymphangioma relapsed 13 years after a total resection in one case. Mortality rate was nul. CONCLUSION: The circumstances of diagnosis of the cystic lymphangioma were in relation with the volume of the tumor or a mechanical, infectious or hemorrhagic complications. The recidivism after a total resection let evoke the possibility of multiple and diffuse cystic lymphangioma.

Cannabis and psychosis: what is the link?

Growing evidence supports the hypothesis that cannabis consumption is a risk factor for the development of psychotic symptoms. Nonetheless, controversy remains about the causal nature of the association. This review takes the debate further through a critical appraisal of the evidence. An electronic search was performed, allowing to identify 622 studies published until June 1st 2005. Longitudinal studies and literature reviews were selected if they addressed specifically the issues of the cannabis/psychosis relationship or possible mechanisms involved. Ten epidemiological studies were relevant: three supported a causal relationship between cannabis use and diagnosed psychosis; five suggested that chronic cannabis intake increases the frequency of psychotic symptoms, but not of diagnosed psychosis; and two showed no causal relationship. Potential neurobiological mechanisms were also identified, involving dopamine, endocannabinoids, and brain growth factors. Although there is evidence that cannabis use increases the risk of developing psychotic symptoms, the causal nature of this association remains unclear. Contributing factors include heavy consumption, length and early age of exposure, and psychotic vulnerability. This conclusion should be mitigated by uncertainty arising from cannabis use assessment, psychosis measurement, reverse causality and control of residual confounding.