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Beji H, Bouassida M, Chtourou MF, Zribi S, Laamiri G, Kallel Y, Mroua B, Mighri MM, Touinsi H. Predictive factors of bowel necrosis in patients with incarcerated femoral hernia. Hernia 2023; 27:1491-1496. [PMID: 36943519 DOI: 10.1007/s10029-023-02776-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/12/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE Intestinal necrosis is a frequent complication in patients with incarcerated femoral hernias (IFH). Knowing the low incidence of IFH, few series with large samples studied predictive factors of intestinal necrosis. The main objectives of our study were to determine the predictive preoperative factors of intestinal necrosis in patients with IFH and to compare its morbidity with that related to incarcerate inguinal hernias (IIH). METHODS We conducted a retrospective observational cohort study in which we included patients with incarcerated groin hernias (IGH). This is a single-center study between January 2004 and December 2021. Patients were divided into two groups: group A (admitted for IFH) and group B (admitted for IIH). Intestinal necrosis was confirmed intraoperatively. RESULTS 383 patients with IGH were included in the study: 91 patients had IFH (23.76%) and 282 patients had IIH (76.24%). In patients with IFH, the median age was 67 years. We had 60 females (66%) and 31 males (34%). Bowel ischemia was present in 29 patients (32%). Bowel necrosis was present in 14 patients (16%). We identified three independent variables predicting bowel necrosis in patients with IFH: Duration from symptoms to surgery, NLR (Neutrophil to Lymphocyte ratio), and urea. Bowel ischemia and bowel necrosis were significantly higher in patients with IFH compared to those with IIH. CONCLUSIONS In summary, we found that duration from symptoms to surgery, NLR, and urea were significantly predictive of intestinal necrosis in patients with IFH.
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Affiliation(s)
- H Beji
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
| | - M Bouassida
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - M F Chtourou
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - S Zribi
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - G Laamiri
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Y Kallel
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - B Mroua
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - M M Mighri
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - H Touinsi
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
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Beji H, Kallel Y, Mroua B, Zribi S, Bouassida M, Touinsi H. Cystic mass with arteriovenous malformations of the lesser omentum. ANZ J Surg 2023; 93:722-723. [PMID: 35876717 DOI: 10.1111/ans.17926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Hazem Beji
- Department of general surgery Hospital Mohamed Taher Maamouri Nabeul, University of Tunis El Manar, Tunis, Tunisia
- Department of General Surgery, Hospital Mohamed Taher Maamouri Nabeul, Tunis, Tunisia
| | - Yassine Kallel
- Department of general surgery Hospital Mohamed Taher Maamouri Nabeul, University of Tunis El Manar, Tunis, Tunisia
- Department of General Surgery, Hospital Mohamed Taher Maamouri Nabeul, Tunis, Tunisia
| | - Bassem Mroua
- Department of general surgery Hospital Mohamed Taher Maamouri Nabeul, University of Tunis El Manar, Tunis, Tunisia
- Department of General Surgery, Hospital Mohamed Taher Maamouri Nabeul, Tunis, Tunisia
| | - Slim Zribi
- Department of general surgery Hospital Mohamed Taher Maamouri Nabeul, University of Tunis El Manar, Tunis, Tunisia
- Department of General Surgery, Hospital Mohamed Taher Maamouri Nabeul, Tunis, Tunisia
| | - Mahdi Bouassida
- Department of general surgery Hospital Mohamed Taher Maamouri Nabeul, University of Tunis El Manar, Tunis, Tunisia
- Department of General Surgery, Hospital Mohamed Taher Maamouri Nabeul, Tunis, Tunisia
| | - Hassen Touinsi
- Department of general surgery Hospital Mohamed Taher Maamouri Nabeul, University of Tunis El Manar, Tunis, Tunisia
- Department of General Surgery, Hospital Mohamed Taher Maamouri Nabeul, Tunis, Tunisia
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Beji H, Bouassida M, Mroua B, Belfkih H, M'farrej MK, Touinsi H. Extra-gastrointestinal stromal tumor of the pancreas: A case report. Int J Surg Case Rep 2022; 98:107581. [PMID: 36057252 PMCID: PMC9482973 DOI: 10.1016/j.ijscr.2022.107581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/28/2022] [Accepted: 08/28/2022] [Indexed: 02/07/2023] Open
Abstract
Introduction Presentation of case Clinical discussion Conclusion Pancreatic EGIST is extremely rare. There are no specific clinical and radiologic findings. Surgical resection is the cornerstone of the treatment. Whenever possible, enucleation is sufficient.
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Hadrich Z, Mroua B, Zribi S, Bouassida M, Touinssi H. Stump appendicitis, a rare but serious complication of appendectomy: A case report. Clin Case Rep 2021; 9:e04871. [PMID: 34584721 PMCID: PMC8457410 DOI: 10.1002/ccr3.4871] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/22/2021] [Accepted: 09/12/2021] [Indexed: 12/26/2022] Open
Abstract
Stump appendicitis is a rare delayed post-appendectomy complication. This diagnosis must be considered in case of right iliac fossa pain in a patient with a history of appendicectomy.
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Affiliation(s)
- Zied Hadrich
- Department of surgeryMohamed Taher Maamouri HospitalNabeulTunisia
- Faculty of Medicine of SfaxTunisia
| | - Bassem Mroua
- Department of surgeryMohamed Taher Maamouri HospitalNabeulTunisia
- Faculty of Medicine of TunisTunisia
| | - Slim Zribi
- Department of surgeryMohamed Taher Maamouri HospitalNabeulTunisia
- Faculty of Medicine of TunisTunisia
| | - Mehdi Bouassida
- Department of surgeryMohamed Taher Maamouri HospitalNabeulTunisia
- Faculty of Medicine of TunisTunisia
| | - Hassan Touinssi
- Department of surgeryMohamed Taher Maamouri HospitalNabeulTunisia
- Faculty of Medicine of TunisTunisia
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Bouassida M, Laamiri G, Zribi S, Slama H, Mroua B, Sassi S, Aboudi R, Mighri MM, Bouzeidi K, Touinsi H. Predicting Intestinal Ischaemia in Patients with Adhesive Small Bowel Obstruction: A Simple Score. World J Surg 2021; 44:1444-1449. [PMID: 31925521 DOI: 10.1007/s00268-020-05377-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIMS Intestinal ischaemia (II) is the most critical factor to determine in patients with adhesive small bowel obstruction (ASBO) because intestinal ischaemia could be reversible. The aim of this study was to create a clinicoradiological score to predict II in patients with ASBO. METHODS We conducted a retrospective study including 124 patients with ASBO. Logistic regression analysis was used to identify predictive factors of II. We assigned points for the score according to the regression coefficient. The area under the curve (AUC) was determined using receiver operating characteristic curves. RESULTS Six independent predictive factors of II were identified: age, pain duration, body temperature, WBC, reduced wall enhancement and segmental mesenteric fluid at CT scan. According to the regression, coefficient points were assigned to each of the variables associated with II. The estimated rates of II were calculated for the total scores ranging from 0 to 24. The AUC of this clinicoradiological score was 0.92. A cut-off score of 6 was used for the low-probability group (the risk of II was 1.13%). A score ranging from 7 to 15 defined intermediate-probability group (the risk of II was 44%). A score ≥16 defined high-probability group (100% of patients in this group had II). CONCLUSIONS We performed a score to predict the risk of intestinal II with a good accuracy (the AUC of our score exceeded 0.90). This score is reliable and reproducible, so it can help surgeon to prioritize patients with II for surgery because ischaemia could be reversible, avoiding thus intestinal necrosis.
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Affiliation(s)
- Mahdi Bouassida
- Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
| | - Ghazi Laamiri
- Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Slim Zribi
- Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Helmi Slama
- Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Bassem Mroua
- Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Selim Sassi
- Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Rania Aboudi
- Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Mohamed Mongi Mighri
- Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Khaled Bouzeidi
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
- Department of Radiology, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
| | - Hassen Touinsi
- Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
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Bouassida M, Zribi S, Krimi B, Laamiri G, Mroua B, Slama H, Mighri MM, M'saddak Azzouz M, Hamzaoui L, Touinsi H. C-reactive Protein Is the Best Biomarker to Predict Advanced Acute Cholecystitis and Conversion to Open Surgery. A Prospective Cohort Study of 556 Cases. J Gastrointest Surg 2020; 24:2766-2772. [PMID: 31768828 DOI: 10.1007/s11605-019-04459-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/29/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND White blood cell levels (WBC) is the only biologic determinant criterion of the severity assessment of acute cholecystitis (AC) in the revised Tokyo Guidelines 2018 (TG18). The aims of this study were to evaluate the discriminative powers of common inflammatory markers (neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP)) compared with WBC for the severity of AC, and the risk for conversion to open surgery and to determine their diagnostic cutoff levels. METHODS This was a prospective cohort study. Over 3 years, 556 patients underwent laparoscopic cholecystectomy for AC. Patients were classified into two groups: 139 cases of advanced acute cholecystitis (AAC) (gangrenous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis, emphysematous cholecystitis), and 417 cases of non-advanced acute cholecystitis (NAAC). Multiple logistic regression and receiver-operating characteristic curve analysis were employed to explore which variables (WBC, CRP, and neutrophil-to-lymphocyte ratio (NLR)) were statistically significant in predicting AAC and conversion to open surgery. RESULTS On multivariable logistic regression analysis, male gender (OR = 0.4; p = 0.05), diabetes mellitus (OR = 7.8; p = 0.005), 3-4 ASA score (OR = 5.34; p = 0.037), body temperature (OR = 2.65; p = 0.014), and CRP (OR = 1.01; p = 0.0001) were associated independently with AAC. The value of the area under the curve (AUC) of the CRP (0.75) was higher than that of WBC (0.67) and NLR (0.62) for diagnosing AAC. CRP was the only predictive factor of conversion in multivariate analysis (OR = 1.008 [1.003-1.013]. Comparing areas under the receiver operating characteristic curves, it was the CRP that had the highest discriminative power in terms of conversion. CONCLUSION CRP is the best inflammatory marker predictive of AAC and of conversion to open surgery. We think that our results would support a multicenter-international study to confirm the findings, and if supported, CRP should be considered as a severity criterion of acute cholecystitis in the next revised version of the Guidelines of Tokyo.
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Affiliation(s)
- Mahdi Bouassida
- Depatment of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia. .,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
| | - Slim Zribi
- Depatment of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Bassem Krimi
- Depatment of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Ghazi Laamiri
- Depatment of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Bassem Mroua
- Depatment of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Helmi Slama
- Depatment of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Mohamed Mongi Mighri
- Depatment of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Mohamed M'saddak Azzouz
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Depatment of Gastroenterology, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
| | - Lamine Hamzaoui
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Depatment of Gastroenterology, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
| | - Hassen Touinsi
- Depatment of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
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Bouassida M, Hamzaoui L, Mroua B, Belghith O, Mighri MM, Touinsi H, Azzouz MM. Retroperitoneal necrotizing fasciitis with gas gangrene, caused by perforated caecal diverticulitis. Int J Colorectal Dis 2015; 30:1739-40. [PMID: 25675887 DOI: 10.1007/s00384-015-2150-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Mahdi Bouassida
- Department of Surgery, Mohamed Tahar Maamouri Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, 8000, Mrazga, Nabeul, Tunisia.
| | - Lamine Hamzaoui
- Department of Gastroenterology, Mohamed Tahar Maamouri Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, 8000, Nabeul, Tunisia
| | - Bassem Mroua
- Department of Surgery, Mohamed Tahar Maamouri Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, 8000, Mrazga, Nabeul, Tunisia
| | - Obeid Belghith
- Department of Surgery, Mohamed Tahar Maamouri Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, 8000, Mrazga, Nabeul, Tunisia
| | - Mohamed Mongi Mighri
- Department of Surgery, Mohamed Tahar Maamouri Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, 8000, Mrazga, Nabeul, Tunisia
| | - Hassen Touinsi
- Department of Surgery, Mohamed Tahar Maamouri Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, 8000, Mrazga, Nabeul, Tunisia
| | - Mohamed M'saddak Azzouz
- Department of Gastroenterology, Mohamed Tahar Maamouri Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, 8000, Nabeul, Tunisia
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Bouassida M, Feidi B, Mroua B, Chtourou MF, Sassi S, Chebbi F, Bouchtili S, Mighri MM, Touinsi H, Azzouz MM, Sassi S. Histopathologic characteristics and short-term outcomes of colorectal cancer in young Tunisian patients: one center's experience. Pan Afr Med J 2012; 12:10. [PMID: 22826734 PMCID: PMC3396856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 04/03/2012] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Colorectal carcinoma (CRC) is generally a disease of persons older than 40 years. Concerning younger patients, controversies still exist regarding features and prognosis of CRC. We performed this study to characterise CRC in young patients (≤ 40 years) as well as to evaluate short-term outcome in comparison with older patients (>40 years) with CRC. METHODS Clinical and histopathological parameters of 40 patients aged 40 years or less were compared with 240 patients aged more than 40 years. RESULTS In young patients, the minority suffered from hereditary cancer syndromes (0.4%). Furthermore, up to 87% of young patients denied any cancers in their families. Compared with older patients, young patients had more mucinous adenocarcinomas (32.5% vs. 11.5%; p=0.02), more venous invasion (p=0.021), more perineural invasion (p=0.028). For grading (p=0.42), lymphatic invasion (p=0.17) and tumor sites (p=0.46), no significant differences between young and older patients were found. Young patients had less post operative morbidity (p=0.039), less post operative mortality (0.029). Young and older patients had the same overall 1-year survival rates (p=0.24), and the same cancer-related 1-year survival rates (p=0.1). CONCLUSION Tunisian patients present with colorectal cancer at a more advanced stage of the disease at younger ages compared to developed countries. The early detection of CRC followed by a sufficient oncologic treatment is crucial regardless of age. It is mandatory for all patients with suspicious symptoms to undergo early adequate diagnoses.
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Affiliation(s)
- Mahdi Bouassida
- Mohamed Thahar Maamouri Hospital, Nabeul, Tunisia,Corresponding author: Mahdi Bouassida, Department of Surgery, Mohamed Thahar Maamouri Hospital, 8000 Mrazga, Nabeul, Tunisia
| | - Bilel Feidi
- Mohamed Thahar Maamouri Hospital, Nabeul, Tunisia
| | - Bassem Mroua
- Mohamed Thahar Maamouri Hospital, Nabeul, Tunisia
| | | | - Selim Sassi
- Mohamed Thahar Maamouri Hospital, Nabeul, Tunisia
| | - Fathi Chebbi
- Mohamed Thahar Maamouri Hospital, Nabeul, Tunisia
| | | | | | | | | | - Sadok Sassi
- Mohamed Thahar Maamouri Hospital, Nabeul, Tunisia
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Bouassida M, Mroua B, Douggaz A, Mighri MM, Touinsi H, Sassi S. [Primary pure squamous cell carcinoma of the gallbladder revealed by an acute angiocholitis]. Presse Med 2012; 42:110-3. [PMID: 22386111 DOI: 10.1016/j.lpm.2012.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 01/05/2012] [Accepted: 01/09/2012] [Indexed: 10/28/2022] Open
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