Removal of fluoride ions (F-) from aqueous solutions using modified Turkish zeolite with quaternary ammonium.

The natural Turkish zeolite has been modified with hexadecyltrimethylammonium bromide (CTAB) for the elimination of fluoride (F-) from aqueous solutions. The parent natural zeolite (NZ) and modified zeolite (MZ) have been characterized by Fourier transform infrared (FTIR) spectroscopy, thermogravimetric analysis (TGA), zeta potentials and Brunauer-Emmett-Teller (BET) method. The effect of pH, adsorbent dose, contact time, initial concentration and temperature on adsorption of fluoride ions onto modified zeolite (MZ) has been determined in batch experiments. Fluoride concentration can be reduced to 1.5 mg/L under the optimum condition (pH = 5, adsorbent dose = 20 mg/L, contact time = 60 min and T = 293 K) when initial fluoride concentration of 10 mg/L is employed. The fluoride adsorption on MZ has been described by the Langmuir isotherm and the maximum fluoride adsorption capacity was found as 2.994 mg/g. Kinetics data were best described by the pseudo-second-order model. The thermodynamic studies proved that the adsorption was exothermic and spontaneous.

Traditional versus three-dimensional teaching of peritoneal embryogenesis: a comparative prospective study.

INTRODUCTION: Anatomy teaching is newly boosted by the development of interactive three-dimensional (3D) teaching techniques. Nevertheless, their superiority as teaching aids has never been demonstrated. The aim of this study was to compare 3D and traditional chalk teaching efficiency in terms of student memorization concerning peritoneal embryogenesis. MATERIALS AND METHODS: 165 students from the Faculties of Medicine of Sfax (Tunisia) (n = 81) and of Paris-Descartes (France) (n = 84) were taught peritoneal embryogenesis either via a 3D technique (interactive DVD ROM) (3D group, n = 85) or via the traditional chalk technique (CL group, n = 80). Both groups were subjected to an evaluation test including 34 questions distributed in six chapters at the end of the course. RESULTS: The overall rate of correct answers was higher in the 3D group (65.12 +/- 14.88 vs. 49.33 +/- 16.17%, p < 0.001). It was the same for five of the six chapters of questions excluding the chapter concerning the clinical implications (p = 0.06). There was no significant difference between 3D and CL groups regarding the 20 questions focusing on static phenomena (64.52 +/- 27.10 vs. 58.87 +/- 23.67%, p = 0.24), but the rate of correct answers was higher in the 3D group for the 14 questions focusing on dynamic phenomena (65.96 +/- 20.97 vs. 28.17 +/- 24.40%, p < 0.001). CONCLUSION: The 3D technique is significantly more efficient than the traditional chalk technique for the teaching of peritoneal embryogenesis in terms of short-term memorization and particularly for the assimilation of dynamic phenomena. Medium-term and long-term studies are needed to demonstrate that this benefit has a long-lasting impact.

[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.

[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.

[Breast cancer in men]. / Cancer du sein chez l'homme.

Breast cancer in men is rare and most often occurs at or after the age of 60 years. Prognosis is poor when it is discovered at a late stage, as it often is in men, although it should be easier to detect because men have so little breast tissue. The causal mechanism appears to depend on hormone metabolism abnormalities related to elevated estrogen or prolactin levels. A family history of breast cancer is found in 5-10% of cases. Infiltrating ductal carcinoma accounts for most cases (70-90%) of male breast cancers. In situ but not invasive carcinoma is exclusively ductal and accounts for 7% of cases. Spread to lymph nodes is observed in 50-75% of cases. Immunohistochemical analysis shows that tumors are positive for progesterone and estrogen receptors more frequently in men than women. Diagnosis is based on clinical examination, ultrasonography, and mammography. Aspiration cytology often makes it possible to confirm the malignancy. Excisional biopsy with an immediate intraoperative pathology examination confirms malignancy and makes wider excision possible during the same procedure. A modified radical mastectomy with removal of some lymph nodes (Patey's mastectomy) is the standard basic treatment. Locoregional radiotherapy is very often indicated. Hormone therapy is also a first-line treatment. Chemotherapy is reserved for young men with substantial lymph node invasion and negative for hormonal receptors. The prognosis of breast cancer in men remains uncertain because of the frequently late diagnosis, unpredictable course, and high potential for metastasis.

[Retro-peritoneal liposarcoma. About 5 cases and revue of literature]. / Le liposarcome rétro-péritonéal. A propos de 5 cas et revue de littérature.

Liposarcomas are malignant mesenchymatous tumors developed from elements constituting the greasy tissue in various stages of differentiation. It is one of the most frequent mesenchymatous sarcomas. Retro-peritoneum is a privileged site of development in 12 to 15% of cases. During 9 years, from 1994 till 2002, we have colligated and operated 5 cases of retro-peritoneal liposarcomas. Average age was 50 years (extremes 34 to 79 years) with a sex-ratio of 1.5. Diagnosis was late beyond 6 months. Abdominal pain and the appearance of an enormous mass (20 cm) were the revealing signs. No imagery method allowed to evoke the diagnosis. The cyto-puncture realized once, was not able to determine with precision the histological type. Immunohistochimy occupies nowadays an important place to classify a sarcoma. Large surgical resection realized in 5 cases did not allowed the complete ablation of the tumour in 3 cases considering the advanced loco-regional extension, which was at the origin of 3 recurrences. Well differentiated histological type was noted in 3 cases, myxoid type in a case and not differentiated type in a case.

[Pyogenic liver abscesses: a study of 25 cases]. / Abcès du foie a pyogènes: etude de 25 cas.

OBJECTIVE: Our aim was to study the anatomo-clinic particularities and the therapeutic modes of the infectious abscesses of the liver. PATIENTS AND METHODS: Our retrospective study concerns 25 cases of the infectious abscesses of the liver collected on one period of 12 years from January 1992 to December 2003. They are 11 primitive abscesses and 14 secondary abscesses. RESULTS: We noted 14 women and 11 men, median age was 51.5 years. The Fontan triad was present in 7 cases. A liver mass with an abdominal sensitivity was found in 14 cases. Anomalies in the biologic exam of the liver were present in the 1/3 of the cases. We noted a double right and left localization in 3 cases and a multiple localization in 1 case. The hemoculture and the pyoculture permitted a bacteriological diagnosis in 52%. The percutaneous treatment achieved in 7 cases, permitted the recovery in 2 cases. One dead was noted following a severe cardiopathy. A surgical drainage has been achieved at 22 patients. 4 cases after the failure of the percutaneous treatment. Mortality rate was 20% (5 cases) related to the delay of diagnosis, the gravity of the septic shock. the advanced age and the flaws associated. CONCLUSION: The infectious abscess of the liver was a serious affection that affects the vital prognosis. The percutaneous treatment associated to the antibiotherapy. is the method of choice in the treatment of the abscesses of the liver. The surgical treatment must be reserved to the failure of the percutaneous treatment.

[Late post-operative adhesive small bowel occlusions. About 258 cases]. / Les occlusions du grele par brides post-operatoires tardives. A propos de 258 cas.

This retrospective study reports a series of 258 patients operated on for late developing post-operative adhesive occlusions. The impact of anterior interventions on these occlusions. The impact of anterior interventions on the occllusions as well as he clinical and paraclinical patterns are discussed before any approach to the different therapeutic aspects of this complication. Previous surgery had an impact not by number of the operations performed (80% of patient had undergone only one intervention on the pelvis or abdomen) but essentially by the nature of the opertions since most of the adhesions occured following surgery on the appendix. The diagnosis should be made urgently ont basis of findings yielded by physical examination and plain abdominal x-rays (ct-scan of the abdomen is hardly indicated for the absence of hydroaeric levels on the plain abdominal film does not defintely exclude the strangulation). Laparoscopic adhesiolys is an adegnate treatment in case of a single adhesion. This laparoscopic is an adegnate treatment in case of a single adhesion. This laparoscopic procedure practised on 11 patients had to be transformed in 3 cases in to an open laparoctomy. Resection rate was 11.6%. Mortality and morbidity rates were 2% and 17% respectively.

[Anastomotic ulcer after vagotomy for duodenal ulcer]. / Les ulcères anastomotiques après vagotomie pour ulcère duodénal.

Between January 1981 and December 2000, 2609 patient underwent surgery for duodenal ulcer. 2274 underwent isolated vagotomy; 1590 had vagotomy associated with GI anastomosis. Only relapses of anostomic ulcers after vagotomy associated with gastrojejunal anastomosis were included in this study. 22 patients (20 males, 2 females) aged between 26 and 79 years had anastomic ulcer relapses (1.38%) after vagotomy and GI anastomosis. Incomplete vagotomy was diagnosed in 14 cases (93%) associated with a defect in setting in 2 cases. Despite the ongoing controversy about the role of Helicobacter in the pathogenesis of anastomotic ulcers, medical treatment remains the primary therapy, and a partial gastrectomy alone or with vagotomy is necessary only in unresponsive cases.

[Duodeno-pancreatic trauma. About 14 cases]. / Les traumatismes duodéno-pancréatiques, à propos de 14 cas.

Through a series of 14 cases brought over a period of 12 years, we realized a retrospective, analytical and descriptive study of these traumatisms. We aimed to release recommendations to improve their management. It was 2 women and 12 men, whom mean age was 24.4 years (extremes: 50 and 60 years), divided into 10 pancreatic injuries, 2 duodenal injuries and 2 duodeno-pancreatic injuries. Etiology was dominated by traffic accidents 7 cases (50%). Trauma was closed in 13 cases (92%). Associated lesions were present among 13 patients (92%). The traumatism appeared by an urgent surgical abdomen among 9 patients, secondarily in 3 cases, tardily in 2 cases: a case of deep suppuration 3 months after a traumatism treated into ambulatory and a case of persistent ascites after a past unperceived traumatism. Abdominal ultrasonography was made among 4 patients. It allowed diagnosing only a case. Scanner was made among 4 patients. It allowed diagnosing all the cases. Only a patient was treated medically, it was a post-traumatic acute pancreatitis. Surgical treatment was made in 13 cases: conservative in 7 cases and radical in 6 cases. Follow-up was complicated in 11 cases (78%) and non-complicated in 3 cases. Mortality rate was 7.1%.

[Acute rupture of hydatid cysts in the peritoneum: 17 cases]. / Rupture aiguë du kyste hydatique dans le péritoine. A propos de 17 observations.

OBJECTIVE: Specify the clinical and progressive characteristics of acute rupture of hydatid cysts in the peritoneum. METHOD: We retrospectively studied patients who had undergone surgery for a hydatid cyst (HC) of the abdomen between January 1990 and December 2000 and in whom the exploration had confirmed the diagnosis of acute rupture of a hydatid cyst in the peritoneum. RESULTS: Over this period of 11 Years, 970 patients had undergone surgery for hydatid cysts of the liver and the spleen, 17 of whom had presented an acute rupture of the hydatid cyst in the peritoneum, that is to say 1.75% of the cases. The mean age was 30 Years and sex ratio was 0.41. Rupture was secondary to a trauma in 6 cases and to an intense physical effort in one case. The clinical table was acute peritonitis in 14 cases, acute intestinal occlusion in one case, suggested anaphylactic shock in one case, and a non-complicated hydatid cyst in one case. Ultra-sonographic diagnosis was made in all the cases, but that of rupture in 12 cases only. No scans were performed. Intervention was decided on within a delay of less than 72 hours in 16 cases. Surgical treatment consisted in the treatment of the peritonitis, the ruptured hydatid cyst, the associated hydatid cysts in the liver and the spleen, and the hydatid cyst of the right lung in two cases. Post-operative follow-up was complicated in 4 cases with two deaths through septic shock. Distant follow-up was marked by a secondary peritoneal hydatidosis in a patient whom has not benefited from medical treatment. The latter, based on albendazole, was prescribed in 6 patients with satisfying results and a mean follow-up of 32 months. CONCLUSION: The therapeutic progress has improved the prognosis of ruptured hydatid cysts in the peritoneum. Secondary peritoneal hydatidosis is fundamentally enhanced by the delay in diagnosis and treatment and the absence of medical treatment. The optimal strategy is to treat the patients at the non-complicated stage of the hydatid cyst and, above all, prevent the hydatid infestation.

[Intestinal Crohn disease: surgical aspects and predictive factors of risk of relapse. About 26 cases]. / Maladie de Crohn intestinale: aspects chirurgicaux et facteurs prédictifs de risque des récidives. A propos de 26 cas.

Crohn disease is an inflammatory bowel disease of which one cannot declare itself healed. It is a considerably invalidating disease, and surgery is necessary with more than 80% of patients during its long evolution. After a recent review of the literature, we wanted to contribute to the study of the predictive factors of risk of relapse among 26 patients operated for an intestinal Crohn disease during a period of 16 years, from 1986 till 2001. Sex ratio was 0.3 and average age was 33.9 years. Six patients only (23.1%) were known undergoing and treated for Crohn disease. Surgery was indicated urgently in 12 cases (46.2%). The gravity of urgently operated patients burdened the post-operative morbidity in 38.5% of cases of which 2 deaths. Six patients presented a post-operative relapse for an average delay of 40.8 months; among them 3 patients were operated. In our series, we noted that the relapse rate is more frequent with women that with men (42%/21%), and age does not intervene in the relapse contrary to smoking. The rate of relapses was so much more brought up that Crohn disease is former. The relapse was more frequent when the edge of section was sick (5/6). A post-operative medical treatment in the severe forms reduces the rate of relapses until 24%.