[Experimental teaching program on cooperation between "Sapienza" University of Rome and the University Hospital "Le Bon Samaritain" in N'Djamena, Chad]. / Progetto di sperimentazione didattica tra Sapienza - Università di Roma e l'Ospedale Universitario Le Bon Samaritain di N'Djamena, Ciad.

BACKGROUND: The shortage of essential surgical care in sub-Saharan Africa is a worldwide problem. Lack of healthcare workers, surgeons and very limited resources are the reason for this critical health crisis. Furthermore in Africa many physicians as soon as they get a degree emigrate in more attractive countries. METHODS: "Multidisciplinary teaching support to a new Faculty of Medicine in N'Djamena - Chad" is a teaching cooperation program between «Sapienza¼ University of Rome and the University Hospital "Le Bon Samaritain" in N'Djamena, Chad. The project started in 2010, with the aim of cooperating in teaching medical students of African origin and in training Italian residents in sub-Saharan surgical and internal pathologies. In Chad the greatest surgical burden (about 11% of the total global diseases) is created by injuries, cancers, congenital anomalies, appendicitis, bowel obstructions, hernias, abscesses (by amebiasis or others) and obstetric emergencies. CONCLUSIONS: Up till now healthcare in Africa especially in rural areas has been provided by international organisations,we believe that academic collaborations between high-income and low-income Nations is necessary to meet the real needs of the african surgical workforce; at the same time it is very useful for store of knowledge of our residents.

[Subtotal or total colectomy as surgical treatment of left-sided occlusive colon cancer]. / Place de la colectomie subtotale ou totale dans le traitement en urgence des cancers du côlon gauche et du sigmoïde en occlusion.

INTRODUCTION: The treatment of acutely obstructed carcinoma of the left colon and sigmoid still represents a matter of controversy. The aim of this study was to assess retrospectively the results of its management by emergency subtotal or total colectomy with primary anastomosis. MATERIALS AND RESULTS: Sixty-seven patients were reviewed. There were 42 males and 25 females. The mean age was 70.5 years (range: 26-87 years). Mean operative time was 210 minutes. There were five synchronous colon carcinomas (7.5%) and 23 (343%) synchronous tubulous and tubulo-villous adenomas. No death was noted in the series. Ten postoperative complications (15%) occurred in nine patients including one postoperative peritonitis without evidence of anastomotic leak, one alithiasic cholecystitis, one evisceration and two intra-abdominal abscesses. The mean hospital stay was 11.4 days. Fifty-eight patients were assessed at three and twelve months for functional results. No fecal incontinence was encountered. The mean number of bowel movements per 24 hours was 3.2 at three months and 2 at twelve months. All patients were satisfied with their quality of life. Twelve patients (20.7%) occasionally needed anti-diarrheic medications. CONCLUSION: Urgent subtotal or total colectomy with primary anastomosis is a safe and efficient procedure in the management of acutely obstructed neoplasm of the left colon. It allows to treat in one stage the cancer and the obstruction, bearing no mortality, acceptable morbidity and satisfactory postoperative functional results.

[Creation of the St Joseph University Faculty of Medicine in Beirut: 125 years of Franco-Lebanese healthcare cooperation]. / La faculté de médecine de l'Université Saint-Joseph: 125 ans de coopération franco-libanaise au service de la santé.

The Mediterranean--mare nostrum--has always been a cradle of exchanges for the different inhabitants of its shores, as highlighted by myths and legends dating back to antiquity. Cooperation between France and Lebanon expanded markedly in the 17th century and has continually expanded since, in fields such as education, through initiatives launched by the French government and by religious institutions. The Faculty of Medicine is an excellent example. The instigator was the Society of Jesus, which had created St Joseph University in 1875, eventually being supported by the French government. Following an agreement signed on 7 May 1883 between the Society of Jesus and the French authorities, the medical school opened on November 30th of the same year. The school soon became a faculty, and was managed until 1976 by a chancellor who answered to a French academic institution and delivered French state medical degrees. In 1976, however, following changes to the statutes of St Joseph University and the Faculty, the latter became a fully fledged Lebanese Faculty of Medicine delivering its diplomas through St Joseph University. The faculty soon needed a hospital complex to meet its students' medical needs. After some trials with local hospitals, it was decided to build the facility from scratch, and to name it Hotel Dieu de France. Construction was financed by the French government, and by a subscription launched by the French Press Syndicate, at the initiative of the newspaper Le Temps and at the request of the French Asia Committee (Comité de l'Asie Française). The Hospital was inaugurated on May 27, 1923. It soon encompassed a French maternity unit and cancer center, thus constituting the French Hospital Association (Association Hospitalière Française). In 1984, following an agreement between the French government and St Joseph University, Hotel Dieu became the property of the university, and the vice-chancellor became chairman of the board. The transfer of the faculty and Hotel Dieu to Lebanese authority did not spell an end to French support. Indeed, France continues to take an active part in the development of these two institutions through visiting professors and training for young doctors. Symbolically, the hospital is still called Hotel Dieu de France.

Use of fine-needle aspiration cytology and frozen section in the management of nodular goiters.

BACKGROUND: This study evaluates the role of frozen section (FS) in surgical decisions for nodular thyroid disease when a preoperative fine-needle aspiration cytology (FNAC) is available. MATERIAL AND METHOD: The charts of 113 patients who underwent thyroidectomy for nodular goiter were reviewed. Each patient underwent FNAC, FS, or both. Results were compared with the final pathologic examination to evaluate their effectiveness in predicting malignancy. RESULTS: The sensitivity and specificity of FNAC alone (49 patients) were 73% and 93.5%, respectively, and of FS (111 patients) 68% and 99%, respectively. The result of fine-needle aspiration cytology was: benign (n = 8), malignant (n = 13), indeterminate (n = 25), and nondiagnostic (n = 3). All cases diagnosed as benign on FNAC were benign on final pathology, but of the six FS performed in these cases, four were benign and two were suspect. Of the 13 FNAC that were interpreted as malignant, 11 and 10 proved to be malignant on final pathology and FS, respectively. The 25 indeterminate cases on FNAC were on final pathology benign (n = 21) and malignant (n = 4) and on frozen section were benign (n = 12), malignant (n = 2), and suspect (n = 11). CONCLUSION: When results of FNAC are interpreted as benign or malignant, FS is of little value, because it does not change the extension of thyroidectomy. FS proved useful in determining the extent of thyroidectomy only when results of the FNAC were suspect or atypical.

Perforation of the rectum and colon during barium enema examination. Report of four cases.

BACKGROUND: The barium enema examination (BEE) is an important diagnostic study and considered to be safe without adverse effects. Perforation of the bowel is rare but is the most frequent complication of BEE and can be life-threatening. STUDY DESIGN: We report four cases of barium extravasation due to BEE treated at our institution, three rectal perforations and one perforation in the descending colon. RESULTS: The four patients underwent surgery because signs of peritonitis developed. Two of them recovered and two died from multiple organ failure. CONCLUSION: Perforation of the colon and rectum during BEE constitutes a surgical emergency in most cases. Prompt recognition and management are vital in decreasing morbidity and mortality.