[Management of isolated iliac aneurysms: A Tunisian center experience]. / Traitement des anévrismes iliaques isolés : expérience d'un centre tunisien.

Isolated aneurysms of the iliac arteries are rare. The diagnoses of these aneurysms become easier with non-invasive radiologic investigations. The development of endovascular treatment is a recent alternative to surgical treatment. We report our experience in the management of 8 cases of isolated iliac aneurysms in the department of cardiovascular and thoracic surgery of the Habib Bourguiba Hospital of Sfax.

[Post-traumatic carotido-jugular fistula: Case report and review of the literature]. / Fistule carotido-jugulaire post-traumatique : à propos d'un cas opéré.

The neck, being not protected by skeleton, is vulnerable to external trauma and injury which can involve blood vessels, muscles, nerves, and trachea. Carotid injuries can be potentially life-threatening by hemorrhage and stroke. We present a case of a 26-year-old manual worker who presented a neck injury caused by a metallic projectile. The injury involved the right common carotid artery with an internal jugular vein fistula, and tracheal damage. The patient was managed with surgical repair of the tracheal lesion, reconstruction of the carotid section using a PTFE graft bypass, and ligation of the internal jugular vein. In the immediate postoperative period, the patient presented with no neurological deficits, but he did develop a pulmonary infection that resolved with antibiotic therapy. The follow-up is now 3months. The patient is doing well without any neurological disorder.

[Myoplasty by reversal of the pectoris major muscle in the treatment of mediastinitis. A case report and review of the literature]. / Myoplastie par retournement du grand pectoral dans le traitement des médiastinites. À propos d'un cas et revue de la littérature.

Mediastinitis are among the most dreadful infectious complications following cardiac surgery. Their prognosis depends essentially on the precociousness of the diagnosis. In most of the cases, the medical treatment associated with an irrigation drainage is sufficient. But in case of severe sternal dehiscence, plastic surgery becomes necessary in order to fill up the loss with a well-vascularized tissue. We report the case of a 78-year-old patient, chronic bronchitic who presented, after a coronary artery bypass, an aseptic sternal dehiscence necessitating an osteosynthesis, then a Klebsiella pneumoniae mediastinitis with an enlarged sternal necrosis which was treated by bone resection and a myoplasty via reversal of the right pectoris major muscle. The postsurgery course was favourable. Now, after one-year remote, cicatrisation is complete and we have not noticed any infectious recurrence.

[Pelvic pseudotumoral actinomycosis: two cases]. / Actinomycose pelvienne pseudotumorale : à propos de deux cas.

INTRODUCTION: Pelvic actinomycosis is a rare suppurative disease that should be included in the differential diagnosis of gynecological cancers. CASE REPORTS: We report two women aged 40 and 41 years with pelvic tumor-like actinomycosis. Physical examination disclosed a pelvic mass in both cases. CT-scan showed annexial infiltrative tumor in both cases with liver metastasis and peritoneal carcinosis in one case each. Surgical procedure consisted in right annexectomy in one case and peritoneal biopsy in the other. Pathologic diagnosis was diagnostic of actinomycosis. Both patients were treated by penicillin G 20 million IU/day during two weeks and then by amoxicilline 3g/day per day during six months. Clinical outcome showed significant improvement in both cases with complete regression of hepatic and pelvic lesions on CT-scan in one case. CONCLUSION: Pelvic actinomycosis is a rare suppurative disorder, commonly associated with a long term wearing of intra-uterine device. Diagnosis is difficult, often delayed and pelvic actinomycosis could mimic gynaecologic neoplasia.

[Severe rectal bleeding in an Tunisian woman: colonic tuberculosis mimicking a tumor]. / Une rectorragie sévère sous les tropiques.

Since colonic tuberculosis is uncommon and its bifocal pseudo-tumor form is exceptional, differential diagnosis with the colonic cancer is exceedingly difficult. The purpose of this report is to describe a case of primary colonic tuberculosis in two separate locations discovered in a patient presenting with persistent massive hematochezia. A 69-year-old woman was examined for hematochezia, abdominal pain and recent weight loss. Colonoscopy revealed the presence of two ulcerated tumor-like lesions in right colon. One of these lesions caused significant stenosis. Histological examination of biopsy specimens was inconclusive. Colonic tumor with bleeding was considered as the most likely diagnosis. Surgical exploration demonstrated one tumor in the cecum and another in the ascending colon. Right hemicolectomy was performed. Histological examination of the surgical specimen demonstrated a granulomatous reaction pattern with caseous necrosis. Conventional antituberculosis treatment led to clinical improvement.

[The solid pseudopapillary tumor of pancreas: two cases and literature review]. / Tumeurs pseudopapillaires et solides du pancréas: deux observations et revue de la littérature.

Solid pseudopapillary tumor (SPT) of the pancreas is a rare exocrine pancreatic tumor behaving in a low-grade fashion, with limited local invasion risk and a rare metastatic evolution. We report SPT in two young females, revealed by abdominal pain and an epigastric mass. The diagnosis of a cystic tumor was based on abdominal ultrasound and CT data in the first case and on MRI in the second. A distal pancreatectomy and splenectomy were successfully performed in the first case and a central pancreatectomy in the second. Histological study confirmed the diagnosis of SPT of the pancreas.

[Laparoscopic treatment of perforated duodenal ulcer: 84 cases in Tunisia]. / Traitement laparoscopique des ulcères duodénaux perforés: 84 cas en Tunisie.

INTRODUCTION: The purpose of this study was to evaluate the feasibility, efficacy and safety of the laporascopic treatment of perforated duodenal ulcer. METHODS: This retrospective study included patients who underwent laparoscopic treatment of perforated duodenal ulcer during the seven-year period from 2001 to 2007. The procedure included direct suture of the perforated ulcer followed by peritoneal lavage. All patients received medical treatment including Helicobacter pylori eradication and proton pump inhibitor therapy. RESULTS: A total of 84 patients underwent laparoscopic surgery for perforated duodenal ulcer during the study period. There were 81 men and 3 women with a mean age of 28 years. Laparoscopic examination confirmed diagnosis of perforated duodenal ulcer in all cases. Direct suture of the ulcer was successful in 72 cases. In the remaining 12 cases conversion to open surgery was necessary due to difficulty in achieving peritoneal lavage in 6 cases, ulcer size and edge friability in 5, and septic shock in one. The mean duration of the procedure was 95 minutes (range, 60 to 180 minutes). The mean postoperative complication rate was 15.4%. Complications included peritonintis in one case and digestive fistula in one. There were no postoperative deaths. All patients were re-examined after 25 months. Two patients presented recurrences after the laparoscopic treatment and required tri-therapy. CONCLUSION: Laparoscopic suture of perforated duodenal ulcer is safe and effective. It avoids the need for laparotomy that is associated with a risk for septic and parietal complications. Since medical treatment is effective for ulcerous disease, there are currently no indications for radical treatment.

[Disseminated cutaneous leishmaniasis secondary to lymphoedema: two cases]. / Leishmaniose cutanée disséminée sur lymphoedème: deux cas.

BACKGROUND: Dissemination of cutaneous leishmaniasis may take various forms: satellite papules, sporotrichoid nodules and widespread papulonodular lesions (disseminated cutaneous leishmaniasis). We describe a particular clinical form of dissemination in two patients with erysipelas secondary to lymphoedema. PATIENTS AND METHODS: Case 1. A 75-year-old man with diabetes consulted for erysipelas of the leg secondary to lymphoedema. The site of entry was an infected cutaneous leishmaniasis lesion. The initial outcome was favourable under intravenous penicillin G treatment. Twelve days later, some fifty papulonodular lesions appeared and were strictly limited to the erythematous erysipelas plaque. PCR screening of papulonodular lesion smears for Leishman bodies was positive. Histological examination of skin biopsy samples showed lobular panniculitis. Case 2. A 64-year-old woman with diabetes presented erysipelas in the right upper limb secondary to lymphoedema scattered with multiple erythematous, infiltrated, papular lesions in a setting of cutaneous leishmaniasis lesions. PCR analysis of smears taken from the secondary nodular lesions demonstrated the presence of leishmaniasis, while histological analysis of biopsy samples revealed panniculitis. DISCUSSION: Disseminated cutaneous leishmaniasis is characterized by the appearance of multiple (>10) pleomorphic lesions on two or more noncontiguous areas of the body. Our two patients presented certain features of disseminated cutaneous leishmaniasis. However, they were unusual in terms of the strict localisation of nodular lesions to the erysipelas plaque. This particular aspect suggests haemolymphatic dissemination of the protozoan infection from the initial lesion as a result of local factors.

[Massive hemoptysis: experience of a surgical unit]. / Hémoptysies massives: expérience d'une unité chirurgicale.

Massive hemoptysis is a clinical entity characterized by its unpredictable and potential lethal course. We studied retrospectively the observations of 25 patients hospitalized in our surgical unit. We collected all the demographic, clinical and surgical data. A male predominance with a sex-ratio of 2,1 was noted. The average age was 45 years, with extremes of 17 and 75. The dominant cause was bronchiectasis. Twenty patients were operated on. The surgery consisted of a pulmonary resection in 9 cases (45%), an atypical lung resection in 4 cases (20%), a resection of an aspergilloma in 2 cases (10%), a kystectomy of hydatic cyst in 4 cases (20%) and one arterial ligature (5%). Five patients (25%) had emergent surgery, and 15 (75%) delayed surgery. Hospital mortality was 20% in the first group and 6.66% in the second. No recurrence of bleeding was observed after an average follow-up of 7 months. Surgery remains a therapy of choice for massive hemopysis. It must as far as possible be avoided during active bleeding.

[Malignant pheochromocytomas: about three cases]. / Les phéochromocytomes malins: à propos de trois observations.

The authors report three cases of malignant pheochromocytomas. Metastases occurred in the liver in two cases whereas malignancy was suspected in the third case because of recurrence and local invasion. One case was pregnant at diagnosis of pheochromocytoma. Pheochromocytoma was associated to papillary thyroïd carcinoma in another case. The treatment considered was surgery in all cases.

[Virilism during pregnancy]. / Virilisme au cours de la grossesse: à propos d'un cas.

We discuss the causes of virilism in pregnancy and the impact of hyperandrogeny on the female foetus. We report a case of virilism in a 28-year-old, gravida 1, para 1 patient with normal pregnancy and review the literature. After conception, the patient had been well until the 18th week of gestation, when she developed signs of virilization; her serum testosterone was markedly elevated. She delivered of a normal male infant at term. After delivery, signs of virilization regressed with normalization of testosterone level but a wide mass of the left ovary that persisted for 8 months. The histological study of the tumor showed luteinized thecoma. Luteomas and hyper-reactio luteinalis were the principal causes of virilism in pregnancy, thecomas are rare.