[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.

[Feasibility of laparoscopic treatment of duodenal ulcers: results of 160 cases]. / Traitement laparoscopique de l'ulcere duodenal faisabilite et resultats: a propos de 160 cas.

AIM: The objective of this study is to evaluate the feasibility, efficacy and safety of laparoscopic repair for perforated duodenal ulcer. METHODS: One hundred and sixty patients were treated by coelioscopic procedure for a perforated duodenal ulcer. The procedure consists on a suture of perforated ulcer associated with a peritoneal lavage. A medical treatment of Helicobacter pylori associated with an inhibitor of the protons pomp was conducted. RESULTS: The coelioscopic procedure permitted to confirm the diagnostic of perforated duodenal ulcer in all cases. A simple suture of the ulcer was done in 155 cases. The conversion was compulsory in 5 cases, because of difficulties of the peritoneal lavage in 2 cases, a bleeding associated with perforation of the ulcer in one case and associated stenosis in 2 cases. Mean duration was 90 min (extremes 50 - 120 min). Complications occur in 3,1%. They were post - operative peritonitis in 3 cases and duodenal fistulae in 2 cases. All patients were reviewed at 16 months. A recurrence, either clinical or endoscopic occurs in 4 cases because of no adhesion to medical treatment. CONCLUSION: Coelioscopic treatment of perforated duodenal ulcer is a safe and efficacy method. It permits to avoid potential septic and parietal complications of laparotomy. The actual efficacy of medical treatment mustn't allow place to the radical treatment of ulcerous illness.

[Common bile duct distomatosis managed by coelioscopic aproach. One case report]. / Distomatose de la voie Biliaire principale traitée par voie coelioscopique. A propos d'un cas.

Biliary distomatosis is caused by a parasitis of trematode family: the fascialo hepatica. It is a rare affection in Tunisia. The diagnostic is often done in the status phase. Adult parasite stay preferentially at biliary ducts, cause obstruction and cholangitis. The authors report a case of biliary treated successfully by laparoscopic procedure.

[Filiation hamartoma polyposis dysplasia and small bowel adenocarcinoma]. / La filiation polype hamartmateux-dysplasie-adenocarcinome.

Peutz-Jeghers syndrome is a hereditary affection with dominant autosomal transmission. The risk of cancerisation is largely higher than that in the general population. Dysplasia is rare. Transformation of the polyposis hamartoma into a site of dysplasia then into adenocarcinoma has been rarely reported. The authors report the case of a 14 year-old patient, having a severe dysplasia on ileal polyposis hamartoma related to the syndrome of Peutz-Jeghers.

[Multicentric extrahepatic bile ducts carcinoma. Clinical presentation, pathologic features and management]. / Carcinome excréto-biliaire multifocal: aspects anatomocliniques et prise en charge thérapeutique.

Extrahepatic bile ducts carcinoma (EHBC) arises usually in the upper third of the biliary tract. They are rarely multicentric associated or not to a gallbladder carcinoma. We report the case of a 53 years man operated for a head pancreas. Laparatomy revealed a tumour of the middle common bile duct extending to the cystic duct. Histologically it was a multicentric carcinoma of variable types occurring in several sites of the biliary tract. Patient had undergone a simple resection without any complications 9 months later. Although EHBC are morphologically similar to those of the gallbladder, their risk factors, epidemiology and treatment are different. Prognosis depends on proximal involvement of perihilar bile ducts which makes the treatment only palliative.

[Chronic pancreatitis in the ventral pancreas in pancreas divisum]. / Pancreatite chronique du pancreas ventral sur pancreas divisum.

Pancreas divisum, partial or non fusion of the dorsal and ventral pancreatic ductal system, affects up to 10 percent of the population. Approximately 25 percent of patients with pancreas divisum will develop complications such as recurrent pancreatitis. Surgical and endoscopic therapy usually include minor papilla sphincterotomy or sphincteroplasty to facilitate drainage of the dorsal ductal system. The following case represents an unusual complication of the pancreas divisum with primarily ventral duct disease and pancreaticolithiasis.