Argon plasma coagulation in the management of symptomatic gastrointestinal angiodysplasia: experience in 69 consecutive patients.

BACKGROUND: Gastrointestinal angiodysplasias are associated with a high bleeding risk. AIM: to evaluate the efficiency of argon plasma electrocoagulation in the treatment of gastrointestinal angiodysplasia and to identify predictive factors of success of this technique. METHODS: Retrospective study of patients with bleeding gastrointestinal angiodysplasia treated with argon plasma electrocoagulation in the digestive endoscopy unit of the military hospital in Tunis between January 2000 and December 2011. RESULTS: 69 patients with a mean age of 68.7 years were included.The endoscopic treatment resulted in a rise in hemoglobin value from 7.3 to 9.3 g/ dl (p = 0.0001) and a decrease of transfusion requirements from 2.5 to 0.1 units of packed red cells (p <0.0001). It allowed to avoid surgery for 93.6% of patients with complex medicalhistory. Recurrence of bleeding was observed in 33.3% of patients after a mean time of 12.3 months. In a multivariate analysis, no factors were independently associated with the recurrence of bleeding. The overall survival without rebleeding at 1 and 2 years were 50% and 42% respectively. CONCLUSION: Argon plasma coagulation is an easy, effective and safe treatment of bleeding angiodysplasia. This technique is particularly interesting for patients with multiple medical problems, where surgical treatment could be burdened by significant morbidity and mortality risk.

Pre-emptive treatment of hepatitis B infection by lamivudine in two Tunisian renal transplant recipients.

Infection with hepatitis B virus has a major implication for transplant recipients due to the risk of reactivation under immunosuppression, progression to chronic liver disease, development of liver cirrhosis and hepatocellular carcinoma. We report two cases of renal transplantation patients who were hepatitis B surface antigen positive before transplantation and were treated by Lamivudine.

[Outcomes of endoscopic gluing with cyanoacrylate glue of bleeding gastric varices]. / Résultats de l'obturation endoscopique des varices gastriques hémorragiques par colle biologique.

BACKGROUND: Gastric variceal bleeding is associated with significant morbidity and mortality. Its optimal treatment is not yet standardized and glue injection is the most often proposed treatment. The longterm results of this technique are still controversial. AIM: To assess the safety and efficacy of gastric variceal glue injection. METHODS: Consecutive patients that underwent glue injection for gastric variceal bleeding in our endoscopy unit, from January 2000 to August 2011, were assessed. RESULTS: Sixteen patients (9 men, 7 women) underwent cyanoacrylate glue injections for gastric variceal bleeding. The median follow-up period of 13 patients was 33 months (three were lost to follow-up). The average age was 60 years (3 - 80 years). All patients had stigmata of recent bleeding at endoscopy. Patients underwent an average of 2 gluing sessions (1-3 sessions). N-butyl-2-cyanoacrylate (Histoacryl ®) was the most often product used. No significant complications from cyanoacrylate injection were observed. No patient had a recurrent variceal bleeding. During the median follow-up period, two patients died. CONCLUSION: Our data suggest that cyanoacrylate injection therapy is safe and effective for the prevention of short- and long-term bleeding from gastric varices.

[Long-term functional outcome of laparoscopic anti-reflux surgery]. / Résultats fonctionnels à long terme de la chirurgie anti-reflux sous coelioscopie.

BACKGROUND: Medical treatment of gastro esophageal reflux is associated with relapse in 30% of cases. In these patients, the best therapeutic option is surgical treatment, performed laparoscopically.However, there are few data on long-term functional outcome. AIM: To determine long-term results of laparoscopic antireflux surgery the mechanisms involved in patients with worse results. METHODS: We studied patients operated for reflux disease. They had either total or partial laparoscopic fundoplication. These patients were contacted to assess postoperative improvement, satisfaction and asked about the occurrence or not of a persistent postoperative dysphagia. RESULTS: Seventy one patients were included (Nissen in 61% of the cases and Toupet in 39%). After an average period of 52.4 months,80 % of patients were satisfied. 58% were completely improved,while 31% were partially improved after surgery. Persistent reflux symptoms reflux were observed in 8 patients and postoperative dysphagia was reported by 11 patients. Gastroesophageal reflux revealed by chronic cough was the only independent parameter associated with bad functional results in our patients. CONCLUSION: Laparoscopic anti reflux surgery is associated with a high frequency of satisfaction. However, patients with chronic cough respond less better to surgery. Strict selection of the patients before surgery must be done, to improve the functional results after anti reflux surgery.

Peritoneal amyloidosis: unusual localization of gastrointestinal amyloidosis.

Amyloidosis is a rare disease that results from the extracellular deposition of amorphous fibrillar protein. It is usually observed in a systemic form. Gastrointestinal involvement is frequent but peritoneal localization is unusual. A 43-year-old male was investigated for nephritic colic. Morphologic explorations revealed small intestine agglomerans in the periumbilical region, infiltration of peritoneal fat and multiple coelio-mesenteric lymph nodes. There were no clinical or biological abnormalities and endoscopic examinations were normal. The patient then underwent an exploratory laparoscopy. Macroscopically false membranes were seen throughout the peritoneum and small bowel without ascites. Anatomopathologic examination diagnosed peritoneal amyloidosis. After several investigations a diagnosis of a primary peritoneal amyloidosis was confirmed. The patient was treated with melphalan and prednisone with a favorable outcome. Our case illustrates a particular presentation of peritoneal amyloidosis. Despite improved imaging methods, peritoneal biopsy remains essential for diagnosis.

[Chronic heart failure: role of Doppler echocardiography in the evaluation of mortality risk]. / Insuffisance cardiaque chronique: place de l'échocardiographie-doppler dans l'évaluation du risque de mortalité.

BACKGROUND: Chronic heart failure (CHF) is a major cause of morbidity and mortality. Despite recent improvements in the management of this condition, the overall prognosis remains poor. Echocardiography is the most useful test in the evaluation of systolic and diastolic function and has also a prognostic value. AIM: The aim of this study is to determine echocardiographic predictors of mortality in patients with CHF. METHODS: We followed 100 patients with a diagnosis of CHF over an average period of 44+/-40.5 months. We compared echocardiographic parameters in survivors and non survivors. RESULTS: Four variables predicted death: LVEF <35% (p=0.001), TDE <150ms (p=0.001), E/A ratio >2 (p=0.05) and E/Ea ratio >10 (p=0.008). CONCLUSION: Doppler echocardiography has a central role in the evaluation of patients with CHF. It provides valuable prognostic information by combination of several parameters.

[Asymptomatic cor triatriatum sinister in adulthood]. / Le coeur triatrial gauche asymptomatique de l'adulte.

Cor triatrium sinister is a rare congenital disease (0,1% of cases of congenital heart disease). Cor triatrium is recognized by the finding of an abnormal fibromuscular membrane that subdivise the left atrium into posterosuperior and anteroinferor chambers. This anomaly creates an obstacle to the venous pulmonary flow. Depending on the severity of obstruction, cor triatrium may be symptomatic in childhood but it can be symtom free even in adulthood. Diagnosis of this abnormality has been easy supported by transthoracic and transoesophageal echocardiography.Treatment is easy to perform and consists in surgical defenitive correction in symptomatic patients. We report a case of a 31-year-old man in whom a non obstructive cor triatrium was discovered while evaluation for an atrial fibrillation secondary to a hyperthyroidism. According to this rare case we try to evaluate the severity and the outcome of this disease relating the literature data.

[Pregnancy in patients with prosthetic heart valves]. / Grossesse et prothese valvulaire cardiaque.

In women with prosthetic heart valves, pregnancy carry a risk for both mother and fetus, requiring an obstetrical and cardiological management at an optimal level. We performed a systematic review of the literature to estimate the maternal and fetal complications and in order to offer pregnant women carrying a prosthetic heart valve the most practical approach enabling reduction of these risks. As there are no available controlled clinical trials, larger prospective studies are needed to provide guidelines for effective antithrombotic therapy.