Postpartum ovarian vein thrombophlebitis: Report of a case and review of the literature.

CONTEXT: Postpartum ovarian vein thrombophlebitis is an uncommon life-threatening situation. It should be systematically evoked in case of persistent fever during the postpartum. Diagnosis is often not immediately apparent clinically and there are many that mimic this condition. CASE REPORT: A 26-year-old female presented with fever and acute right loin pain during four days after delivery. Right ovarian venous thrombosis was demonstrated on sonography and confirmed with computed tomography. The patient was given antibiotics and anticoagulation therapy with good response. CONCLUSION: Search for postpartum ovarian vein thrombophlebitis should be undertaken in patients with persistent fever. Treatment is more often medical.

[Gastric sarcoma]. / Sarcomes gastriques.

Sarcoma of the stomach is a rare histological entity. These differentiated mesenchymal tumors do not differ clinically from other gastric cancers. Endoscopic ultrasonography is the preferred means of exploration because it determines the existence of a submucosal lesion and provides guidance in determining its type. Certainty of diagnosis requires pathologic and immunohistochemical examinations of the surgical specimen. Malignant gastric stromal tumors are the first differential diagnosis of sarcoma of the stomach. They can be better characterized by testing their expression of the c-kit protein. Histological confirmation of malignancy sometimes remains difficult. Locoregional invasion and distant metastases confirm malignancy. Treatment is essentially surgical. Prognosis depends on tumor size, extension, rupture and histological grade.

[The results of laparoscopic treatment of the gallbladder lithiasis. About 500 cases]. / Les résultats du traitement laparoscopique de la lithiase vésiculaire. A propos de 500 cas.

BACKGROUND: Laparoscopic cholecystectomy is at present the gold standard treatment of gallbladder lithiasis. AIM: Assesment of Laparoscopic cholecystectomy METHODS: Through a retrospective series of 500 laparoscopic cholecystectomies during a period going from January 1996 to March 2000, we tried to evaluate our experience by comparing our results to the literature data. RESULTS: There were 420 women and 80 men with a sex ratio of 0.19. Average age was 50 years. 16.2% of our patients were obese. 13 patients had a history of respiratory disease and 122 history of a cardiovascular pathology essentially arterial hypertension. All our patients benefited from at least one hepato-biliary ultrasound examination before the intervention. Antibioprophylaxy was administrated in 93.8% of cases. In 23 cases (4.6%), a conversion was necessary for different causes. We noted 11 surgical complications (2.2%) among which 2 required a surgical resumption, and 11 medical complications dominated by broncho-pulmonary infections. We had no death.

[Fibrocystic mastopathy and cancer of the breast. About 111 cases]. / Mastopathies fibrokystiques et cancers du sein. A propos de 111 cas.

OBJECTIVE: Our aim was to identify the predictive factors of degeneration of the fibrocystic mastopathy. METHODS: This work is a retrospective survey of 111 observations of isolated fibrocystic mastopathies or associated to a breast cancer among 542 women admitted for tumor of the breast during one period of 13 active years from 1991 to 2003. The diagnosis has been gotten by anatomo-pathologic exam in 95.5% (106 cas) on the operative piece and 4.5% (5 cas) on a material of biopsy. RESULTS: The fibrocystic mastopathy represented 30% of the set of the benign tumors of the breast. They were associated to a breast cancer in 45 cases (40.5%). The isolated benign fibrocystic mastopathy was observed in 66 cases with a middle age of 37 years, whereas the shapes associated to a breast carcinoma were noted in 45 cases. The middle age was 53 years. The non proliferative fibrocystic mastopathy is the most frequent histological type and represent 54.6% of the cases. The proliferative form with atypies was observed at 21 women (46.8%). The carcinoma the more frequently associated to the fibrocystic mastopathy was the infiltrating canalled carcinoma in 91% of cases, with a predominance of the II rank (SBR). CONCLUSION: The discovery of a mastopathy must search a luteal failure and risk factors of breast cancer notably a proliferative shape of mastopathy with atypies.

[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%.

[Mucus secreting tumors of the appendix. Report of 22 cases]. / Les tumeurs mucosécrétantes de l'appendice. A propos de 22 cas.

The retrospective study presented in this article was realized on a series of 22 cases of mucus secreting tumor of the appendix compiled among 8373 appendicectomies. The clinical picture was dominated by an appendiceal syndrome (73%). The diagnosis was made pre or peroperatively in 10 cases and it was only with to the systematic anatomopathologic exam that 12 other cases were discovered. The histological study of the appendectomy piece showed a retention mucocele (12 cases), a mucosal hyperplasia (8 cases) and a cystadenoma (2 cases). For 5 patients, the diagnosis of peritoneal pseudomyxoma (4 cases) or extraperitoneal (1 case) was retained. All the patients underwent an appendicectomy, associated to an evacuation of the peritoneal gelatinous ascites for 5 patients among whom two underwent in more an omentectomie. Two cases of recurrence were recorded 5 months later.

[Male breast cancer]. / Le cancer du sein chez l'homme.

This study has been realized to determine epidemiological profile and clinico-pathologic aspects of male breast cancer in the south of Tunisia. We has counted and analysed all male breast cancers diagnosed in the general surgery department of the Sfax university teaching hospital with proof pathologic or to defect cytologic of malignancy, between 1989 and 2000. In the court of these years 23 new cases of mammary cancer has been diagnosed at the man. The average patient age was 68 years (extremes 40 and 95 years). According to TNM classification of 1988, 4.3% were classified T1, 26.1% T2, 8.6% T3 and 61% T4; 22% of tumors were M1. Histology found: 3 in-situ carcinomas (13%), 18 ductular infiltrating carcinomas (79%), 1 papillary cystadenocarcinoma, and 1 neuro-endocrin tumor. The clinic profile of male breast cancer in our country rest again relatively little frequent and its clinic profile resist alarming. To get better prognosis it is important to increase information and to promote early detection.

[Psoas abscess in Crohn's disease. Report of a new case]. / Abcès du psoas revelant une maladie de Crohn. A propos d'une nouvelle observation.

Psoas abscess complicating Crohn's disease is a rare condition. The clinical diagnosis is confirmed by ultrasonography and/or computerized axial tomography. Etiology of the abscess is confirmed by digestive opacifications. We present one case of recurrence psoas abscess, revealing Crohn's disease in young girl of 18 years. Therapy is consisting in a pathologic bowel resection after urgency drainage. After literature review we, try to propose diagnostic and therapeutic walk of this affection.

[Congenital diaphragmatic hernias in the adult: report of six cases]. / Les hernies diaphragmatiques congenitales de l'adulte: a propos de six cas.

The anterior hernia or the fissure of Larrey and Bochdalek hernia are exceptional in adult. We present 6 cases of congenital diaphragmatic hernia revealed in adult. Three hernia of the fissure of Larrey and three Bochdalek hernia. We discuss the different clinical, radiological, and therapeutic aspects of these hernia. We insist on the gravity of strangulated hernia and their surgical treatment.