[Clinical and biological study of the 31 cases of gallstones]. / Étude clinique et biologique de 31 cas de lithiase biliaire.

This study reports the clinical and biological signs, as well as the morphological aspect and the chemical composition of the calculus during the biliary stones. The study population consisted of 31 patients with an average age of 49 years (30 women and one man) with biliary lithiasis and who had cholecystectomy. Hepatic colic and epigastralgia were the most evocative clinical signs. The calculus were pigmentary (n=6), cholesterolic and mostly single (n=18), and mixed (n=6) and one infectious multiple lithiasis. Cholesterol was found in 22 calculi (70.96%). We have found a significant increase in liver enzymes and total bilirubin, which is more pronounced in pigmentary lithiasis. Our results showed that most gallstones were composed of cholesterol. These results indicate the influence of diet and chronic hemolysis in calculus formation. More investigation should allow knowing the nutritional and environmental factors influencing gallstones formation in Tunisia, in order to prevent this disease.

What remains to surgeons in the management of abdominal tuberculosis? A 10 years experience in an endemic area.

BACKGROUND: Tuberculosis (TB) is a common endemic disease in Tunisia. Abdominal location is rare. Early diagnosis of abdominal TB remains difficult due to its non-specific clinical presentations. The aim of our study is to highlight the characteristics of the different presentations, to characterize tools contributing to a positive preoperative diagnosis, and finally to assess the role of surgery in the management of this entity. MATERIALS AND METHODS: A retrospective review from 2005 to 2015 identified 90 cases of confirmed abdominal TB managed in the Department of General Surgery of the Habib Thameur Hospital. The diagnosis was established by histopathology examination for all cases. This study was approved by the ethical committee. RESULTS: The mean age of the patient was 44.13 years with a sex ratio (M/F) of 0.34. We collected 56 cases of peritoneal TB, 12 cases of abdominal lymph node TB, 10 cases of intestinal TB, four cases of hepatic TB, and two cases of gallbladder's TB. For six patients, an association of many localizations was noted. The diagnosis was suspected on clinical, biological, and morphological arguments, but the confirmation was always made by surgical exploration and pathological examination of removed specimens. Surgical management was urgent in complicated cases (13.3%). Laparoscopy was performed in 71 cases (78.9%). Laparoscopic features of peritoneal TB were specific and always confirmed by histological examination. CONCLUSION: Despite the wide range of examination available for the preoperative exploration of abdominal TB, diagnosis is usually late and difficult. TB is a medical condition. However, surgical exploration is frequently needed in the management.

Detection of a new JCV strain of genotype A in a subpopulation of colorectal adenocarcinomas in Tunisia

The etiology of colorectal cancer (CRC) remains elusive in spite of major advances in knowledge of this disease and related risk factors. Several studies report the detection of human polyomavirus JC (JCV) in colorectal tumors and some suggest its association with CRC. Since many known human virus associations with cancer are linked to factors such as ethnic and geographical origin, it is interesting to search for the postulated association of JCV with CRC in different populations and regions. In this perspective, the present work was undertaken to assess the presence of JCV in CRC tumors in Tunisia. Fresh biopsies were obtained from both colorectal tumors and adjacent normal tissues of 47 CRC patients. Only tumors diagnosed as adenocarcinomas were included in the present study. Twenty patients with other gastroenterological disorders were taken as controls. DNA was extracted from fresh biopsies or formalin-fixed, paraffin-embedded tissue sections. A region of the viral T-Ag gene was amplified by PCR and the DNA amplicons were subjected to automated sequencing. JCV DNA was found in 22 (46%) of the adenocarcinomas but in none of the normal mucosa biopsies of either CRC or control patients. Sequence analysis indicated that the amplified DNA belonged to a new JCV variant of genotype A. The presence of JCV DNA was correlated with tumor location and grade. The data obtained suggest that JCV may be associated either with a subpopulation of colorectal tumors or with CRC in general, possibly through a hit and run mechanism.

[Spigelian hernias]. / Hernies de Spiegel.

Spigelian hernias represent 1-2% of all abdominal wall hernias. The pathogenesis often involves a dehiscence of the transverse and internal oblique muscle aponeurosis. The diagnosis is made by physical examination; but sometimes it is complicated by obesity. The risk of strangulation is important and can reach 30%. The abdominal CT scan is helpful in the description of hernia's topography and sometimes in diagnostic confirmation. The treatment is surgical. The rate of recurrence after direct closure is considerable. Synthetic mesh repair seems to be a more adequate alternative. The advent of laparoscopy has improved the management of these hernias.

Ectopic pancreas of the ileum: report of a double complication

The ectopic pancreas is defined by the presence of pancreatic tissue away from the pancreatic gland in the absence of any ductal or vascular connection. The authors report one exceptional case of aberrant pancreas located in the distal ileum with a double complication: Digestive hemorrhage and small bowel obstruction due to an entero-enteric Intussusception (AU)

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Primary hydatid cyst of the gallbladder: an unusual localization diagnosed by magnetic resonance imaging (MRI).

Hydatid disease is endemic in Tunisia and has been considered as one of the most common surgical pathology. Several localizations have been described, but hydatidosis of the liver is the most frequent clinical entity. Primary hydatid cyst of the gallbladder is very rare. We report in this observation a new case of primary hydatid cyst of the gallbladder diagnosed by Magnetic Resonance Imaging (MRI).

[Acute mesenteric ischemia: study of predictive factors of mortality]. / Ischémie mésentérique aigue : Etude des facteurs prédictifs de mortalité.

BACKGROUND: Acute mesenteric ischemia is a surgical emergency that requires a quick diagnosis and therapeutic care. Without treatment, the outcome is towards intestinal infarction whose prognosis remains grim. AIM: To look for predictive factors of mortality of this disease. METHODS: We retrospectively reviewed the clinical data of patients hospitalized between January 2000 and December 2008 for acute mesenteric ischemia. Univariate and multivariate analysis of factors that could influence mortality was conducted. RESULTS: 26 patients, predominantly male, were included. The mean age was 60 years. These patients were cared for on average 4 days after the onset of symptoms. The diagnosis was made pre-operatively in 9 patients, by CT scan in 8 patients and by Doppler ultrasound in 1 patient. The cause of AMI was arterial thrombosis in 19 cases, venous thrombosis in 4 cases and non occlusive mesenteric ischemia in 3 cases. 25 patients were operated on emergency 24 times by a laparotomy and one time by a laparoscopy. The surgery consisted in bowel resection in 15 patients; an abstention was decided in one case of venous mesenteric ischemia and in 9 cases where necrosis affected all small bowels. Revascularization of the superior mesenteric artery was associated in 4 cases. Outcome was simple in 8 patients. The mortality rate was 69%, death occurred in a period of J0 to J90 after surgery. This rate wasn't influenced by age or sex. It was higher in patients with preoperative collapse (p = 0.02) and having an expansive bowel necrosis (p=.0001). The prognosis is better in cases of venous infarction with a mortality rate of zero. CONCLUSION: Prognosis of acute mesenteric ischemia depends on the aetiology and the quickness of treatment. It is directly linked to the extension of intestinal infarction. An urgent and multidisciplinary care is necessary.

[Effectiveness of intravenous magnesium on postoperative pain after abdominal surgery versus placebo: double blind randomized controlled trial]. / Effet du magnésium intraveineux sur la douleur postopératoire en chirurgie abdominale versus placebo : Essai thérapeutique randomisé, en double aveugle.

PURPOSE: the purpose of our trial is to evaluate the impact of the intravenous perfusion of magnesium on the morphin consumption and on the controle of the stress neuro-endocrin and metabolic reaction in major digestive surgery. METHODS: prospective, randomized, double blinded study versus placebo.Including 42 ASA I patients, scheduled for major digestive surgery, randomized into two groups : Magnesium, receiving a bolus of magnesium sulfate; 50 mg/kg, followed by a continuous perfusion; 10 mg/kg/h for the 24 postoperative hours. The control group received the same volume of an isotonic saline solution.Postoperative analgesia was assured by morphin PCA. The patients were evaluated by the pain visual analogic scale (VAs), the total dose of morphine consumed and the evolution of the biological markers of stress (glycemia, cortisol, ATH, prolactine and IL6) during the first 24 postoperative hours. Hemodynamic and respiratory parameters, side effects and patient satisfaction were recorded. RESULTS: the total dose of morphine consumed during the first 24 postoperative hours,was equivalent in the two groups (44,49+/-6,4 vs 45,26+/-9,1 mg; p= 0,59).the initial pain VAS means were equivalent (68 mm +/- 15 vs 71 mm+/-14). Ulterior pain VAS means, after morphin titration then with PCA were also equivalent and less to 40 mm. the global amplitude and the evolution of the stress markers evaluated by the surface under curbs were comparable in the two groups, despite a magnesemia twice higher than the normal values in the magnesium group.the satisfaction and the incidence of side effects were similar. CONCLUSION: association of magnesium to morphin PCA does not help to reduce morphin consumption, and does not affect the control of the stress reaction in major digestive surgery.