Predictive factors of difficult biliary cannulation: An experience of a tunisian tertiary center.

Introduction: Selective biliary cannulation is a prerequisite for a successful endoscopic retrograde cholangiopancreatography (ERCP). However, conventional biliary access can be difficult. The aims of our study were to determine the prevalence of difficult biliary cannulation (DBC) and its associated factors and to describe the efficiency and safety of used standard and advanced cannulation techniques. Methods: We conducted a single-center retrospective study including all patients with naïve papilla who had an ERCP procedure in Gastroenterology department of Mohamed Taher Maamouri Hospital from June 2019 to December 2021. Efficiency was defined as successful selective deep biliary cannulation. DBC was defined based on the presence of one or more of the European Society of Gastrointestinal Endoscopy (ESGE) criteria (5-5-1): more than five cannulation attempts, more than 5 min before cannulation and more than one accidental passage in the wirsung. Prevalence was measured using ESGE 5-5-1 cutoffs and chinese set cutoffs 15-10-2. Predictors of DBC were sought by univariate and multivariate analysis (SPSS software, p significant if < 0.05). Results: We included 664 patients (mean age 62 years and sex ratio M/W = 0.8). Main indication for ERCP was choledocholithiasis (67%, n = 442) followed by malignant biliary stenosis (21%, n = 138). Based on ESGE criteria, prevalence of DBC was 42.62% (n = 283). Prevalence was 21.15% when 15-10-2 cutoffs are applied in trainee-involved procedure. Cumulative biliary success rate was 96.46%. Standard cannulation method achieved access in 98.2% while advanced methods permitted success in 92.2% in fistulotomy, 94.1% in papillotomy and 77.3% in transpancreatic sphincterotomy. Independent predictive factors of DBC in multivariate analysis were: Trainee presence OR 1.80 [1.24-2.65], SOD OR 4.71 [1.11-19.88], biliary stenosis found on imaging examinations (OR 2.53 [1.63-3.92], small papilla OR 4.09 [1.82-9.17] and difficult orientation of the papilla OR 14.90 [3.28-67.62]. Conclusion: DBC is a frequent endoscopic situation. Predictors of DBC can be related to trainee involvement in the procedure, anatomical and clinical factors. A thorough understanding of these factors can actively contribute to ERCP management plans.

New Measurements of the Beam Normal Spin Asymmetries at Large Backward Angles with Hydrogen and Deuterium Targets.

New measurements of the beam normal single spin asymmetry in the electron elastic and quasielastic scattering on the proton and deuteron, respectively, at large backward angles and at ⟨Q^{2}⟩=0.22 (GeV/c)^{2} and ⟨Q^{2}⟩=0.35 ( GeV/c)^{2} are reported. The experimentally observed asymmetries are compared with the theoretical calculation of Pasquini and Vanderhaeghen [Phys. Rev. C 70, 045206 (2004).PRVCAN0556-281310.1103/PhysRevC.70.045206]. The agreement of the measurements with the theoretical calculations shows a dominance of the inelastic intermediate excited states of the nucleon, πN and the Δ resonance. The measurements explore a new, important parameter region of the exchanged virtual photon virtualities.

[Old pseudoarthrosis with large bone defect of the radius treated with the Watson-Jones technique: a case report]. / Pseudarthrose ancienne avec grande perte de substance osseuse du radius traitée par la technique de Watson-Jones. À propos d'une observation.

Large bone defects in the forearm pose a challenging reconstruction problem, especially when the condition has become chronic. The Watson-Jones technique is a relatively simple procedure that sacrifices pronation-supination, but allows the forearm to be used in everyday life. Here, we describe a unique case of one-bone forearm reconstruction for a patient who had been suffering from radius non-union for several years. This reconstruction technique provided the patient with acceptable function and appearance of the arm.

Measurement of strange quark contributions to the vector form factors of the proton at Q2 = 0.22 (GeV / c)2.

A new measurement of the parity violating asymmetry in elastic electron scattering on hydrogen at backward angles and at a four momentum transfer of Q;{2} = 0.22 (Ge V / c);{2} is reported here. The measured asymmetry is A_{LR} = (-17.23 +/- 0.82_{stat} +/- 0.89_{syst}) x 10;{-6}. The standard model prediction assuming no strangeness is A_{0} = (-15.87 +/- 1.22) x 10;{-6}. In combination with previous results from measurements at forward angles, it is possible to disentangle for the first time the strange form factors at this momentum transfer, G_{E};{s} = 0.050 +/- 0.038 +/- 0.019 and G_{M};{s} = -0.14 +/- 0.11 +/- 0.11.

[Pathological fracture of the carpal scaphoid (intra-osseous synovial cyst). Clinical and therapeutic aspect. Case report]. / Fracture pathologique du scaphoïde carpien (kyste synovial intraosseux). Aspect clinique et thérapeutique. A propos d'un cas.

The authors report a case of fracture of the carpal scaphoid through an intraosseous synovial cyst. Synovial cysts are not uncommon in the carpal region, and are usually discovered as an incidental radiological finding: they rarely present with wrist pain and only exceptionally as a fracture. In our knowledge, only one other case of intraosseous synovial cyst of the carpal scaphoid presenting as a fracture has been published. Surgical treatment of these benign tumors, in cases of fracture or painful symptoms, consists of curettage of the lesion followed by impaction grafting of cancellous bone combined with stabilization in the case of a fracture. The use of a vascularized bone graft pedicled on the volar carpal artery enables simultaneous treatment of both the cyst and the fracture. The prognosis is good and relapse is exceptional.

[Carpal dislocation combined with a lunate fracture. Report of a case ]. / Fracture luxation rétrolunaire du carpe avec fracture du lunatum. Une nouvelle forme clinique. A propos d'une observation.

A fracture of the semi-lunar in the frontal plan seems to be a rare and still exceptional hurt when it accompanies a retro-lunar dislocation of carp. Our case allows to see again the lesionnel mechanism of the dislocations of carp particularly in its retro-lunar variety and so to classify our case or rather to individualize it and to put it there "except series".

[Myoepithelial carcinoma ex-pleomorphic adenoma of the parotid gland]. / Carcinome myoépithélial ex-adénome pléomorphe de la parotide.

INTRODUCTION: Myoepithelial carcinoma accounts for less than 1% of salivary gland malignant tumors. It may develop de novo or, in approximately 50% of the cases, from a pleomorphic adenoma. OBSERVATION: A 57-year-old man with a history of a pleomorphic adenoma of the parotid treated surgically 6 years earlier, presented with a 2 cm tumor mass, palpable in the scar region. The histological examination and immunohistochemical study revealed a low-grade myoepithelial carcinoma. The patient had no complementary treatment. He presented 5 years later with a 2 cm parapharyngeal recurrence which was resected. There was no evidence of recurrent tumor or of distant metastasis at 4 year follow-up. DISCUSSION: Although myoepithelial cells are often predominant in pleomorphic adenomas, carcinomas developing in pleomorphic adenomas show in most cases a glandular differentiation and myoepithelial carcinomas are rare. Currently the diagnostic criteria, the prognosis, and the management of myoepithelial carcinomas are not well documented. Invasive carcinomas developing in pleomorphic adenoma are known to be highly aggressive neoplasms and myoepithelial carcinomas ex-pleomorphic adenoma seem to have a better prognosis. Our reported case was characterized by the weak aggressiveness of the lesion.

Evidence for strange-quark contributions to the nucleon's form factors at Q2=0.108 (GeV/c)2.

We report on a measurement of the parity violating asymmetry in the elastic scattering of polarized electrons off unpolarized protons with the A4 apparatus at MAMI in Mainz at a four momentum transfer value of Q(2)=0.108 (GeV/c)(2) and at a forward electron scattering angle of 30 degrees p)=[-1.36+/-0.29(stat)+/-0.13(syst)]x10(-6). The expectation from the standard model assuming no strangeness contribution to the vector current is A(0)=(-2.06+/-0.14)x10(-6). We have improved the statistical accuracy by a factor of 3 as compared to our previous measurements at a higher Q2. We have extracted the strangeness contribution to the electromagnetic form factors from our data to be G(s)(E)+0.106G(s)(M)=0.071+/-0.036 at Q(2)=0.108 (GeV/c)(2). We again find the value for G(s)(E)+0.106G(s)(M) to be positive, this time at an improved significance level of two sigma.

[Solitary eosinophilic granuloma of the orbit: a case report]. / Granulome éosinophile isolé de l'orbite. A propos d'un cas.

The authors report a case of eosinophilic granuloma involving the roof and the lateral wall of the left orbit in a 5-year-old boy. The clinical presentation and especially the imaging features (computed tomography and MRI) suggested a malignant tumor and the final diagnosis was obtained by fine needle aspiration biopsy with histopathologic examination. Despite its alarming radiologic appearance, there was spontaneous healing of the eosinophilic granuloma with restitution ad-integrum of the bone.