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Tlili Y, Hadrich Z, Hafsi M, Bacha D, Mestiri H, Sahir O. Intrahepatic biliary cystadenoma, a challenging diagnosis and management: A case report. Int J Surg Case Rep 2024; 116:109454. [PMID: 38428050 PMCID: PMC10944128 DOI: 10.1016/j.ijscr.2024.109454] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Biliary cystadenoma (BC) is a benign hepatic cystic tumor with degenerative potential. Hepatic MRI can help guide the diagnosis. Surgical resection is recommended due to the malignant potential of biliary cystadenomas. Only anatomopathological examination of the surgical specimen can establish the definitive diagnosis of BC. The objective of this case report is to enhance our understanding of this disease and contribute to precise diagnosis for optimal management. CASE PRESENTATION A 55-year-old woman with a history of hypertension and atrial fibrillation presented to the surgery department with paroxysmal right hypochondrial pain. Ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) revealed a large septated cystic lesion occupying segments II, III, and IV of the liver. The patient underwent left hepatectomy without incident. The postoperative course was marked by a deep collection opposite the sectional area, which was successfully treated with antibiotics and radiological drainage. The pathological diagnosis confirmed BC without signs of malignancy, and no recurrence was detected post-surgery. CLINICAL DISCUSSION The rarity of BC, the absence of specific clinical signs and its potential for malignant transformation, underline the need for sophisticated imaging techniques. However, preoperative radiological diagnosis does not exceed 50 %. The operative decision requires a multidisciplinary discussion between radiologists and surgeons. This case highlights the unavailability of radical surgical treatment in cases of strong preoperative suspicion of BC. The cooperation of the pathologist in the histological diagnosis is crucial. CONCLUSION The diagnosis of BC should be considered in cases of multilocular cystic lesions in the liver, particularly in instances of recurrent cysts. Imaging aids in both positive and differential diagnoses. Complete resection is the recommended treatment for any suspected BC.
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Affiliation(s)
- Yassine Tlili
- Department of General Surgery, Mongi Slim University Hospital, Faculty of Medicine of Tunis, Tunisia
| | - Zied Hadrich
- Department of General Surgery, Mongi Slim University Hospital, Faculty of Medicine of Tunis, Tunisia
| | - Montacer Hafsi
- Department of General Surgery, Mongi Slim University Hospital, Faculty of Medicine of Tunis, Tunisia.
| | - Dhouha Bacha
- Department of General Surgery, Mongi Slim University Hospital, Faculty of Medicine of Tunis, Tunisia
| | - Hafedh Mestiri
- Department of General Surgery, Mongi Slim University Hospital, Faculty of Medicine of Tunis, Tunisia
| | - Omrani Sahir
- Department of General Surgery, Mongi Slim University Hospital, Faculty of Medicine of Tunis, Tunisia
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Tlili Y, Hadrich Z, Hafsi M, Sahir O, Rached B, Mestiri H. Refractory chylous ascites revealing follicular lymphoma: A case report. Int J Surg Case Rep 2024; 116:109414. [PMID: 38430893 PMCID: PMC10943983 DOI: 10.1016/j.ijscr.2024.109414] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Chylous ascites is an uncommon form of ascites characterized by milky fluid rich in triglycerides. It is associated with poor lymphatic drainage. We report a case of chylous ascites revealing a follicular lymphoma. CASE PRESENTATION A 73-year-old man presented with a 6-month history of abdominal distension attributed to a chylous ascitis. The thoraco-abdomino-pelvic CT scan revealed voluminous intra- and retroperitoneal mass inseparable from the duodeno-pancreatic block and encompassing the mesenteric vessels, inferior vena cava and renal vessels; abundant ascites and multiple mediastinal, coeliomesenteric, retroperitoneal, iliac and inguinal adenomegalia. The diagnosis of follicular lymphoma was retained through a radio-guided biopsy of the retroperitoneal mass. The patient had weekly paracentesis and immuno-chemotherapy. The course was unfavorable, marked by infection of the ascites fluid after two cycles of immuno-chemotherapy. Our patient developed severe sepsis and died. CLINICAL DISCUSSION Chylous ascites in conjunction with follicular lymphoma is an exceptional presentation. The pathophysiological mechanism is an impediment to subdiaphragmatic lymphatic drainage caused by external pressure, leading to leakage of dilated subserosal lymphatic ducts into the peritoneal cavity. Histological confirmation is fundamental to manage chylous ascites resulting from lymphomas. CONCLUSION Chylous ascites revealing lymphoma is a unique condition. The key to management is the treatment of the underlying etiology.
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Affiliation(s)
- Yassine Tlili
- Department of General Surgery, Mongi Slim University Hospital, Faculty of Medicine of Tunis, Tunisia
| | - Zied Hadrich
- Department of General Surgery, Mongi Slim University Hospital, Faculty of Medicine of Tunis, Tunisia
| | - Montacer Hafsi
- Department of General Surgery, Mongi Slim University Hospital, Faculty of Medicine of Tunis, Tunisia.
| | - Omrani Sahir
- Department of General Surgery, Mongi Slim University Hospital, Faculty of Medicine of Tunis, Tunisia
| | - Bayar Rached
- Department of General Surgery, Mongi Slim University Hospital, Faculty of Medicine of Tunis, Tunisia
| | - Hafedh Mestiri
- Department of General Surgery, Mongi Slim University Hospital, Faculty of Medicine of Tunis, Tunisia
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Hajri M, Talbi G, Ferjaoui W, Atallah A, Ben Slama S, Mestiri H, Bayar R. Huge mesenteric desmoid-type fibromatosis with unusual presentation: A case report. Ann Med Surg (Lond) 2022; 78:103741. [PMID: 35600202 PMCID: PMC9118479 DOI: 10.1016/j.amsu.2022.103741] [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: 03/19/2022] [Revised: 05/05/2022] [Accepted: 05/08/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Desmoid-type fibromatosis, also known as desmoid tumors, are rare fibroblastic neoplasms that account for less than 3% of all soft tissue tumors. Although they are benign neoplasms without metastatic potential, they are known to be locally aggressive and may invade adjacent structures leading to fatal complications. Case presentation We describe the case of a 26-year-old woman who presenting with the clinical picture of acute peritonitis. Emergency surgery was performed and a large poorly-circumscribed heterogeneous tumor was found, occupying the jejunum mesentery and infiltrating the jejunal wall causing its perforation into the abdominal cavity. En bloc resection of the tumor and the involved jejunum was performed. Histology and immunohistochemistry confirmed it to be mesenteric desmoid-type fibromatosis. The postoperative course was uneventful and the patient had no evidence of recurrence 18 months after tumor resection. Conclusions Mesenteric desmoid-type fibromatosis is a rare condition with insidious growth and locally aggressive behavior. Serious complications such as bowel perforation are rare but possible, as shown in our presentation. Complete surgical resection is the first-line treatment bur high recurrence rates remain problematic. Desmoid-typefibromatosis are rare fibroblastic neoplasms that account for less than 3% of all soft tissue tumors. We reported a rare case of diffuse peritonitis due to sporadic mesenteric desmoid-type fibromatosis with aggressive proliferation and consecutive intestinal perforation. Only a few similar cases have been reported in the literature. This case report an unusual presentation of mesenteric desmoid.
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Talbi G, Ferjaoui W, Omrani S, Hajri M, Baccouche S, Cherni N, Gharbi L, Arfaa N, Mestiri H, Bayar R. Hydatid cysts of the liver opening in the biliary tracts: about 120 cases comparative study between radical and conservative treatment. Ro J Infect Dis 2022. [DOI: 10.37897/rjid.2022.1.5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background. Hepatic hydatid disease is still common in Tunisia, is deemed benign disease but concerns its complications; the most frequent is the rupture in biliary ducts. The aim of the work was to study the results of surgical treatment of hydatid cysts of the open liver in the bile ducts and to deduce the predictive factors of postoperative complications. Methods. This was a retrospective study, done in the department of general surgery of Mongi Slim hospital, over a period of 11 years (from January 2000 to December 2013) and collecting 115 patients. Judging criteria were specific morbidity, length of postoperative stay and recurrence. Results. The median age was 43 years (62 women and 53 men). The clinic consisted of typical cholangitis episodes (6.95%), 6.95% of patients were asymptomatic. 50 radical interventions and 65 conservative interventions were performed, supplemented by treatment of the fistula as follows: Fistula blindness (43.47%), trans-fistulo-oddian drainage (3.4%), bipolar drainage (2.6%), PERDOMO (6.95%). The overall mortality was zero. The overall morbidity was 27.69% with an overall specific morality of 14.7% mainly represented by the suppuration of the CR and the external biliary fistulas. The median postoperative stay was 6 days; the recurrence rate was 1.7% with a delay of 30 months. The predictive factors of postoperative complications in bi variance were: The size of the cyst (p = 0.02), The location of a cyst in the hepatic dome (p = 0.002), Surgical treatment: radical or conservative (p = 0.02), The sex factor (p = 0.015). The multivariate study who found a significant association between sex only and postoperative complications. Conclusion. Advances in hepatobiliary surgery and anesthesia are changing the surgical attitude in favor of radical procedures with favorable consequences in terms of morbidity, length of stay and recurrence. It is believed that the surgeon’s experience is the most important factor in the success of surgical treatment. This helps to prevent complications.
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Hajri M, Omrani S, Ferjaoui W, Mestiri H, Bayar R. Actinomycosis mimicking a pancreatic head neoplasm: A case report. Int J Surg Case Rep 2022; 91:106794. [PMID: 35086048 PMCID: PMC8802006 DOI: 10.1016/j.ijscr.2022.106794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Actinomycosis is a chronic suppurative disease caused by a filamentous, Gram-positive, facultative anaerobic bacterium Actinomyces. Abdominal actinomycosis accounts for 10 to 20% of reported Actinomyces infections and pancreatic involvement is extremely rare. Presentation of case We report the case of a 64-year-old man who presented with a 3-week history of abdominal pain, nausea, weight loss, and icterus. Abdominal CT scan revealed a 3.5 cm heterogeneously enhanced mass of the pancreatic head, associated with mild dilation of the main bile duct and the Wirsung duct. The diagnosis of pancreatic head malignancy was highly suspected and surgical management was decided. Intraoperatively, a 3 cm indurated mass of the pancreatic head was found. Whipple's procedure was performed. Histopathological examination revealed pancreatic actinomycosis. Discussion Pancreatic actinomycosis is extremely rare. To our knowledge, only 18 cases have been reported in the English literature to date. It commonly presents as a slow-growing mass with bile and pancreatic ducts obstruction, which can mimic malignancy. Therefore, it has often been misdiagnosed and over-treated with futile surgery, when medical treatment based on antibiotherapy is the only required treatment. Conclusion We reported a rare observation of surgical management of actinomycosis mimicking a pancreatic head neoplasm. As clinical and radiological findings are nonspecific, the accurate diagnosis can only be made by histology. Through our case, we aim to highlight the importance of preoperative suspicion of pancreatic actinomycosis, given the still relevant morbidity of pancreatic resections. Actinomycosis is a chronic suppurative disease caused by a filamentous, Gram-positive bacterium Actinomyces Pancreatic actinomycosis is extremely rare It commonly presents as a slow-growing mass which can mimic malignancy Treatment is based on intravenous penicillin followed by oral penicillin for 6 to 12 months. Preoperative diagnosis of pancreatic actinomycosis is important, given the still relevant morbidity of pancreatic resections
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Affiliation(s)
- Mohamed Hajri
- Department of Visceral Surgery, Mongi Slim University Hospital, Tunis, Tunisia.
| | - Sahir Omrani
- Department of Visceral Surgery, Mongi Slim University Hospital, Tunis, Tunisia
| | - Wael Ferjaoui
- Department of Visceral Surgery, Mongi Slim University Hospital, Tunis, Tunisia
| | - Hafedh Mestiri
- Department of Visceral Surgery, Mongi Slim University Hospital, Tunis, Tunisia
| | - Rached Bayar
- Department of Visceral Surgery, Mongi Slim University Hospital, Tunis, Tunisia
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Bayar R, Baccouche S, Mzoughi Z, Chelbi A, Arfa N, Gharbi L, Mestiri H, Khalfallah MT. [Digestive stomas: which professional impact?]. Pan Afr Med J 2021; 38:118. [PMID: 33912288 PMCID: PMC8051210 DOI: 10.11604/pamj.2021.38.118.10700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/09/2016] [Accepted: 08/02/2017] [Indexed: 11/11/2022] Open
Abstract
Introduction les stomies digestives constituent l´aboutissement d´un certain nombre d´interventions chirurgicales. Elles peuvent être temporaires ou définitives. Le patient porteur de stomie se trouve confronté à des aléas d´ordre physique et psychologique. Il nécessite donc une adaptation aux changements et une acceptation de la situation qu´elle soit temporaire ou définitive. Le but de ce travail est d´évaluer l´impact des stomies digestives sur la qualité de vie des patients et leur retentissement professionnel. Méthodes il s´agit d´une étude rétrospective, menée de janvier 2010 à décembre 2014. Au cours de cette période 115 patients avaient eu des stomies digestives. Parmi ces patients, soixante étaient en âge d´activité professionnelle, avaient un emploi fixe et avaient repris leurs travail; ils constituent l´effectif de notre étude. Le recueil des données était réalisé par un questionnaire spécifique: le questionnaire généraliste SF-36 réalisé en post opératoire. Résultats le score moyen pour la qualité de vie globale pour les patients stomisés était 41. Quarante patients avaient une mauvaise qualité de vie avec un score SF-36 qui était inférieur à 50. Notre étude a démontré que les patients stomisés ont éprouvé des difficultés de fonctionnement dans des situations de travail. Quarante-huit patients décrivaient une gêne directement liée à la stomie lors de l´exercice de leurs activités professionnelles. Les causes évoquées étaient d´ordre physique dans 6 cas et d´ordre psychologique dans 3 cas. Six patients étaient mutés vers des postes plus adaptés à leur situation. Conclusion l´objectif de la prise en charge des patients porteurs de stomie digestive doit être la réintégration sociale et professionnelle adéquate. Ceci ne peut se concevoir qu´en impliquant le médecin de travail, le psychologue, le stomathérapeute et les associations dans cette prise en charge.
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Affiliation(s)
- Rached Bayar
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie.,Service de Chirurgie Viscérale, CHU Mongi Slim, Sidi Daoud, La Marsa, Tunisie
| | - Seifeddine Baccouche
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie.,Service de Chirurgie Viscérale, CHU Mongi Slim, Sidi Daoud, La Marsa, Tunisie
| | - Zeineb Mzoughi
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie.,Service de Chirurgie Viscérale, CHU Mongi Slim, Sidi Daoud, La Marsa, Tunisie
| | - Abdelkoddous Chelbi
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie.,Service de Chirurgie Viscérale, CHU Mongi Slim, Sidi Daoud, La Marsa, Tunisie
| | - Nafaa Arfa
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie.,Service de Chirurgie Viscérale, CHU Mongi Slim, Sidi Daoud, La Marsa, Tunisie
| | - Lassad Gharbi
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie.,Service de Chirurgie Viscérale, CHU Mongi Slim, Sidi Daoud, La Marsa, Tunisie
| | - Hafedh Mestiri
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie.,Service de Chirurgie Viscérale, CHU Mongi Slim, Sidi Daoud, La Marsa, Tunisie
| | - Mohamed Taher Khalfallah
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie.,Service de Chirurgie Viscérale, CHU Mongi Slim, Sidi Daoud, La Marsa, Tunisie
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Limaiem F, Mestiri H, Mejri S, Lahmar A, Mzabi S. Solid pseudopapillary neoplasm of the pancreas in two male patients: gender does not matter. Pan Afr Med J 2017; 27:283. [PMID: 29187952 PMCID: PMC5660899 DOI: 10.11604/pamj.2017.27.283.9800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 05/06/2016] [Accepted: 08/02/2017] [Indexed: 11/11/2022] Open
Abstract
Solid pseudopapillary tumour (SPT) is an unusual pancreatic neoplasm which predominantly affects young women. Less than 10% of patients with SPT in the reported literature were male. In this paper, the authors report two new cases of SPT that occurred in two male patients aged respectively 25 and 20 years old. Abdominal computed tomography scan showed a well-defined heterogeneous mass involving respectively the tail and the body of the pancreas with peripheral calcifications in the first case. The two patients underwent distal splenopancreatectomy. Histopathological examination of the surgical specimen coupled with immunohistochemical study was compatible with solid pseudopapillary tumour. On postoperative day 8, the first patient developed abdominal wall abscess and peritoneal collection. Postoperative course was uneventful for the second patient. In summary, a large, well-encapsulated cystic mass in the pancreas of a young man should raise suspicion of solid pseudopapillary tumour.
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Affiliation(s)
- Faten Limaiem
- University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisi
| | - Hafedh Mestiri
- University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisi
| | - Saloua Mejri
- University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisi
| | - Ahlem Lahmar
- University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisi
| | - Sabeh Mzabi
- University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisi
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Mzoughi Z, Djebbi A, Talbi G, Smati H, Bacha D, Ben Slama Mallouli S, Bouraoui S, Arfa N, Mestiri H, Gharbi L, Bayar R, Khalfallah MT. Resected colorectal cancer liver metastases : Prognostic study about 110 patients. Tunis Med 2017; 95:347-352. [PMID: 29509216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The prognosis of hepatic metastases in colorectal cancers is constantly being improved at the cost of multidisciplinary care, allowing each patient to have an adapted strategy. The prognostic factors make it possible to recognize patients needing further treatment after resection and closer monitoring. OBJECTIVE The aim of our study was to conduct a prognostic study to identify factors influencing survival at 5 years for patients operated of colorectal liver metastases. METHODS This is a retrospective study conducted over a period of 10 years (2005-2015). All patients operated for liver metastasis of colorectal cancers were included. The primary endpoint was overall survival. Secondary endpoints were recurrence-free survival and operative morbidity and mortality. The proportions were compared by the Chi 2 test. The survival curves were established according to the Kaplan-Meier method and the comparison of the curves according to the Logrank test. A univariate and then multivariate Cox model was used to determine prognostic factors. The significance level was set at 0.05. RESULTS Overall survival of our patients at 3 and 5 years was 49% and 32% respectively. Recurrence-free survival was 21% at 3 years and 15% at 5 years. In multivariate analysis, the hepatic resection margin <1 mm and the number of hepatic metastases ≥3 were independent factors correlated with survival. CONCLUSIONS colorectal liver metastases surgery improves patient survival. Some factors need to be sought to adapt care strategies.
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Bayar R, Djebbi A, Mzoughi Z, Talbi G, Gharbi L, Arfa N, Mestiri H, Khalfallah MT. [Strangled rectal prolapse in young adults: about a case and review of the literature]. Pan Afr Med J 2017; 25:60. [PMID: 28250884 PMCID: PMC5321152 DOI: 10.11604/pamj.2016.25.60.10721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 09/13/2016] [Accepted: 09/20/2016] [Indexed: 11/11/2022] Open
Abstract
Rectal prolapse is a rectal static disorder which involves rectal wall intussusception inducing its externalization through the anus. It usually affects children and the elderly. Its occurrence in young adults is rare. Strangulated rectal prolapse is also a rare complication. We report the case of a 30-year old patient who underwent emergency surgery for strangulated rectal prolapse. Emergency perineal rectosigmoidectomy (Altemeier repair) was performed with simple outcome.
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Affiliation(s)
- Rached Bayar
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie; Service de Chirurgie Viscérale CHU Mongi Slim, Sidi Daoued La Marsa, Tunisie
| | - Achref Djebbi
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie; Service de Chirurgie Viscérale CHU Mongi Slim, Sidi Daoued La Marsa, Tunisie
| | - Zeineb Mzoughi
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie; Service de Chirurgie Viscérale CHU Mongi Slim, Sidi Daoued La Marsa, Tunisie
| | - Ghofrane Talbi
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie; Service de Chirurgie Viscérale CHU Mongi Slim, Sidi Daoued La Marsa, Tunisie
| | - Lassaad Gharbi
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie; Service de Chirurgie Viscérale CHU Mongi Slim, Sidi Daoued La Marsa, Tunisie
| | - Nafaa Arfa
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie; Service de Chirurgie Viscérale CHU Mongi Slim, Sidi Daoued La Marsa, Tunisie
| | - Hafedh Mestiri
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie; Service de Chirurgie Viscérale CHU Mongi Slim, Sidi Daoued La Marsa, Tunisie
| | - Mohamed Taher Khalfallah
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie; Service de Chirurgie Viscérale CHU Mongi Slim, Sidi Daoued La Marsa, Tunisie
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Ennaifer R, Ayadi H, Romdhane H, Cheikh M, Mestiri H, Khalfallah T, Hadj NB. De novo autoimmune hepatitis following liver transplantation for primary biliary cirrhosis: an unusual cause of late grafts dysfunction. Pan Afr Med J 2015; 21:2. [PMID: 26401196 PMCID: PMC4561156 DOI: 10.11604/pamj.2015.21.2.6789] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 04/15/2015] [Indexed: 11/11/2022] Open
Abstract
De novo autoimmune hepatitis (AIH) is a rare disorder first described in 1998. It occurs in patients who underwent liver transplantation for a different etiology. We present the case of a 56-year-old woman who was diagnosed with primary biliary cirrhosis and had liver transplantation for refractory pruritis. Seven years after transplantation, she presented alterations in the hepatic profile with hypertransaminasemia, elevated alkaline phosphatase and gamma-glutamyl-transferase. Her liver functions test also showed elevated IgG levels. Serum autoantibodies were negative except for antimitochondrial antibodies. Histological findings indicated features of AIH without bile duct damage or loss. She had a pretreatment AIH score of 13 points and a post treatment score of 15 points according to the International AIH Group. The patient was treated effectively with prednisolone and her liver function and globulin levels rapidly returned to normal.
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Affiliation(s)
- Rym Ennaifer
- Department of Hepato-Gastro-Enterology, Mongi Slim Hospital, Tunis, Tunisia ; University of Tunis El Manar, Faculty of Medicine, Tunis, Tunisia
| | - Hend Ayadi
- Department of Hepato-Gastro-Enterology, Mongi Slim Hospital, Tunis, Tunisia ; University of Tunis El Manar, Faculty of Medicine, Tunis, Tunisia
| | - Haifa Romdhane
- Department of Hepato-Gastro-Enterology, Mongi Slim Hospital, Tunis, Tunisia ; University of Tunis El Manar, Faculty of Medicine, Tunis, Tunisia
| | - Meriem Cheikh
- Department of Hepato-Gastro-Enterology, Mongi Slim Hospital, Tunis, Tunisia ; University of Tunis El Manar, Faculty of Medicine, Tunis, Tunisia
| | - Hafedh Mestiri
- University of Tunis El Manar, Faculty of Medicine, Tunis, Tunisia ; Departement of Surgery, Mongi Slim Hospital, Tunis, Tunisia
| | - Taher Khalfallah
- University of Tunis El Manar, Faculty of Medicine, Tunis, Tunisia ; Departement of Surgery, Mongi Slim Hospital, Tunis, Tunisia
| | - Najet Bel Hadj
- Department of Hepato-Gastro-Enterology, Mongi Slim Hospital, Tunis, Tunisia ; University of Tunis El Manar, Faculty of Medicine, Tunis, Tunisia
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Ennaifer R, Ben Slama S, Romdhane H, Bayar R, Cheikh M, Ben Nejma H, Mestiri H, Bel Hadj N. Nodular hyperplasia of the gastrointestinal tract after liver transplantation: role of immunosuppressive therapy? A case report. Transplant Proc 2015; 47:820-2. [PMID: 25891739 DOI: 10.1016/j.transproceed.2015.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 02/11/2015] [Indexed: 11/25/2022]
Abstract
Nodular lymphoid hyperplasia (NLH) of the gastrointestinal tract is a rare disease usually reported in patients with congenital or acquired immunodeficiency and chronic gastrointestinal infections. However, no case of NLH in a patient receiving immunosuppressive therapy has been reported to date. We describe the case of a woman who developed chronic diarrhea related to NLH 9 years after liver transplantation. Other causes of diarrhea and NLH were excluded. Her immunosuppressive regimen consisted on mycophenolate mofetil (MMF) and tacrolimus. Reduction of MMF dose improved symptoms but led to a rising aminotransferase level. Given the risk of graft rejection, MMF at full dose was resumed and she was started on symptomatic treatment for diarrhea. The role of immunosuppressive drugs in the pathogenesis of NLH may be related to the reduction of T- and B-lymphocyte proliferation and decreasing antibody production. NLH will further develop to compensate functionally inadequate lymphoid tissue, as reported in congenital immunodeficiency states.
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Affiliation(s)
- R Ennaifer
- Department of Hepatogastroenterology, Mongi Slim Hospital, Tunis, Tunisia; Faculté de Médecine, Université de Tunis El Manar, Tunis, Tunisia.
| | - S Ben Slama
- Department of Pathology, Mongi Slim Hospital, Tunis, Tunisia; Faculté de Médecine, Université de Tunis El Manar, Tunis, Tunisia
| | - H Romdhane
- Department of Hepatogastroenterology, Mongi Slim Hospital, Tunis, Tunisia; Faculté de Médecine, Université de Tunis El Manar, Tunis, Tunisia
| | - R Bayar
- Department of Surgery, Mongi Slim Hospital, Tunis, Tunisia; Faculté de Médecine, Université de Tunis El Manar, Tunis, Tunisia
| | - M Cheikh
- Department of Hepatogastroenterology, Mongi Slim Hospital, Tunis, Tunisia; Faculté de Médecine, Université de Tunis El Manar, Tunis, Tunisia
| | - H Ben Nejma
- Department of Hepatogastroenterology, Mongi Slim Hospital, Tunis, Tunisia; Faculté de Médecine, Université de Tunis El Manar, Tunis, Tunisia
| | - H Mestiri
- Department of Surgery, Mongi Slim Hospital, Tunis, Tunisia; Faculté de Médecine, Université de Tunis El Manar, Tunis, Tunisia
| | - N Bel Hadj
- Department of Hepatogastroenterology, Mongi Slim Hospital, Tunis, Tunisia; Faculté de Médecine, Université de Tunis El Manar, Tunis, Tunisia
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Mzoughi Z, Hfaiedh R, Ben Abid S, Miloudi N, Marsaoui L, Arfa N, Mestiri H, Belhaj N, Gharbi L, Khalfallah MT. [A rare hepatic tumor: hepatic actinomycosis]. Tunis Med 2013; 91:219-220. [PMID: 23588642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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13
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Ben Abid S, Hfaiedh R, Mzoughi Z, Miloudi N, Marsaoui L, Arfa N, Mestiri H, Belhaj N, Lassaad G, Khalfallah MT. Tuberculosis of the transverse colon. Tunis Med 2013; 91:165. [PMID: 23526283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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14
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Mzoughi Z, Oueslati I, Attaoui MA, Marsaoui L, Askri A, Khadraoui E, Turki Z, Ben Slama C, Mestiri H, Hendaoui L, Gharbi L, Khalfallah MT. [Pancreatic insulinoma]. Tunis Med 2012; 90:666-667. [PMID: 22987387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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15
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Mzoughi Z, Attaoui MA, Marsaoui L, Askri A, Hendaoui L, Mestiri H, Gharbi L, Khalfallah MT. [Non operative management of pancreatic injury with a pancreatic duct rupture]. Tunis Med 2012; 90:584-586. [PMID: 22811237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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16
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Rekik W, Ben Fadhel C, Boufaroua A, Mestiri H, Khalfallah M, Bouraoui S, Mzabi-Rgaya S. Case report: Primary pure squamous cell carcinoma of the gallbladder. J Visc Surg 2011; 148:e149-51. [DOI: 10.1016/j.jviscsurg.2011.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Miloudi N, Hefaiedh R, Mzoughi Z, Ben Abid S, Mestiri H, Ghorbel A, Khalfallah T. Accidental insertion of biliary endoprosthesis in the portal vein: a case report. Clin Res Hepatol Gastroenterol 2011; 35:144-7. [PMID: 21809491 DOI: 10.1016/j.clinre.2010.10.008] [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] [Indexed: 02/04/2023]
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18
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Bahri O, Ezzikouri S, Alaya-Bouafif NB, Iguer F, Feydi AEE, Mestiri H, Benazzouz M, Khalfallah T, Afifi R, Elkihal L, Berkane S, Marchio A, Debzi N, Dejean A, Pineau P, Triki H, Benjelloun S. First multicenter study for risk factors for hepatocellular carcinoma development in North Africa. World J Hepatol 2011; 3:24-30. [PMID: 21307984 PMCID: PMC3035699 DOI: 10.4254/wjh.v3.i1.24] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 12/08/2010] [Accepted: 12/15/2010] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the role of the major risk factors for hepatocellular carcinoma (HCC) development in the western part of North Africa. METHODS A multicenter case control study was conducted in Tunisia, Morocco and Algeria in collaboration with Pasteur Institutes in these countries. A total of 164 patients with HCC and 250 control subjects without hepatic diseases were included. Prevalences of HBsAg, anti-hepatitis C virus (HCV) and diabetes were assessed. HCV and HBV genotyping were performed for anti-HCV and HBsAg positive patients. RESULTS The mean age of patients was 62 ± 10 years old for a 1.5 M:F sex ratio. Sixty percent of HCC patients were positive for anti-HCV and 17.9% for HBsAg. Diabetes was detected in 18% of cases. Odd ratio (OR) and 95% confidence intervals (CI) were 32.0 (15.8 - 65.0), 7.2 (3.2 - 16.1) and 8.0 (3.1 - 20.0) for anti-HCV, HBsAg and diabetes respectively. Multivariate analysis indicated that the three studied factors were independent. 1b HCV genotype and D HBV genotype were predominant in HCC patients. HCV was the only risk factor significantly associated with an excess of cirrhosis (90% vs 68% for all other risk factors collectively, P = 0.00168). Excessive alcohol consumption was reliably established for 19 (17.6%) cases among the 108 HCC patients for whom data is available. CONCLUSION HCV and HBV infections and diabetes are the main determinants of HCC development in North Africa. An active surveillance and secondary prevention programs for patients with chronic hepatitis and nutrition-associated metabolic liver diseases are the most important steps to reduce the risk of HCC in the region.
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Affiliation(s)
- Olfa Bahri
- Olfa Bahri, Hinda Triki, Laboratory of Clinical Virology, Institut Pasteur of Tunis, Tunis, BP 1002, Tunisia
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Miloudi N, Bayar R, Gharbi W, Manai S, Ben Abid S, Marsaoui L, Arfa N, Mestiri H, Gharbi L, Khalfallah MT. [Intestinal invagination after surgery]. Tunis Med 2010; 88:768-770. [PMID: 20890831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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20
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Mannai S, Frikha N, Maghrebi H, Arfa N, Mestiri H, Khalfallah MT, Ammar MSB. The model of end-stage liver disease (MELD) score in predicting postoperative liver failure after hepatic resection of hepatocellular carcinoma in cirrhotic patients: The Tunisian experience. Arab J Gastroenterol 2010. [DOI: 10.1016/j.ajg.2009.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Bahri O, Ezzikouri S, Ben Alaya-Bouafif N, Iguer F, Essaied El Feydi A, Mestiri H, Benazzouz M, Khalfallah T, Afifi R, Elkihal L, Tebbal S, Berkane S, Debzi N, Sadraoui A, Hogga N, Pineau P, Triki H, Ben Jelloun S. (015) Risk factors for hepatocellular carcinoma development in the North Africa. Arab J Gastroenterol 2009. [DOI: 10.1016/j.ajg.2009.07.023] [Citation(s) in RCA: 2] [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] [Indexed: 11/25/2022]
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22
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Sami Mebazaa M, Frikha N, Ben Hammouda N, Mestiri T, Mestiri H, Khalfallah T, Ben Ammar MS. [Postoperative analgesia after laparoscopic cholecystectomy: comparison of the preoperative administration of celecoxib with paracetamol?]. Tunis Med 2008; 86:869-873. [PMID: 19472804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The goal of this study was to evaluate the preventive analgesic effectiveness of paracetamol and celecoxib in laparoscopic cholecystectomy. METHODS Randomized prospective study was undertaken, 75 patients of class ASA I and II were included, divided into three groups: P (Paracetamol 1000 mg), C (Celecoxib 200 mg) given orally one hour before induction and group T (without preoperative analgesia). The VAS at rest and effort was noted on arrival in the recovery room then with regular intervals (T(30mn) to T(h24). A morphine titration was carried out during the first 12 postoperative hours. Hemodynamic parameters, Ramsay score and the adverse effects were noted. RESULTS The three groups were comparable for the demographic data, the duration of anesthesia and peroperative morphine consumption. The evolution of VAS scores shows a significant difference between the groups P and T with the effort of cough at t24h (p = 0.04), and between the groups C and T at postoperative T 4h (p = 0.016). In our study the group C consumed to a significant degree less morphine 5.44 +/- 3.00 Mg against 7.83 +/- 4.00 Mg for the group P (p < 0.03) and 8.04 +/- 3.00 Mg for the group T (p < 0.008). CONCLUSION The administration of 200 Mg of celecoxib in the preoperative period of a laparoscopic cholecystectomy allows a significant decrease in morphine consumption in the postoperative period and a reduction in the scores of the VAS at rest and at the effort of cough compared to the groups which received only one placebo or paracetamol.
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23
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Lahmar-Boufaroua A, Goutallier C, Yacoubi MT, Manai S, Mestiri H, Mzabi Regaya S. [Hepatic undifferentiated (embryonal) sarcoma arising in a mesenchymal hamartoma: association or malignant transformation]. Tunis Med 2008; 86:628-629. [PMID: 19216474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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24
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Pineau P, Ezzikouri S, Marchio A, Benazzouz M, Cordina E, Afifi R, Elkihal L, Khalfallah MT, Mestiri H, Tebbal S, Berkane S, Debzi N, Triki H, Dejean A, Iguer F, Bahri O, Essaid El Feydi AEE, Benjelloun S. Genomic stability prevails in North-African hepatocellular carcinomas. Dig Liver Dis 2007; 39:671-7. [PMID: 17531558 DOI: 10.1016/j.dld.2007.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Revised: 03/22/2007] [Accepted: 03/31/2007] [Indexed: 12/11/2022]
Abstract
The molecular pathogenesis of hepatocellular carcinoma, a tumour characterized by a vast clinical heterogeneity, remains unexplored outside Europe and Eastern Asia. We analysed by direct sequencing or loss of heterozygosity assay, the common targets of genomic alterations in 42 hepatocellular carcinomas collected in western North-Africa. Overall, genomic instability was uncommon, allelic losses affecting mostly chromosomes 1p, 4q, 8p and 17p (24-28% of cases). CTNNB1 and TP53 were infrequently mutated (9 and 17% of cases, respectively). Surprisingly, TP53 mutation R249S, diagnostic of aflatoxin B1 exposure, usually frequent in Africa, was exceptional (one case), indicating that in western North-Africa, hepatocellular carcinoma genetics differs markedly from that of the remainder of the continent.
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Affiliation(s)
- P Pineau
- Nuclear Organization and Oncogenesis Unit, INSERM U579, Pasteur Institute, Paris, France.
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25
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Charfi Darghouth L, Goutallier Ben Fadhel C, Lahmar A, Mestiri H, Khalfallah MT, M'Zabi Regaya S. [Sclerosing stromal tumor of the ovary: a case report and literature review]. Tunis Med 2007; 85:430-2. [PMID: 17657934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Sclerosing stromal tumor (SST) is an uncommon benign tumor of the ovary, representing 2-6% of all stromal ovarian tumors. Comparatively to other fibrothecals tumors, SST is distinct by particular clinical and histological features. A case of SST occurring in 15-year-old female and review of the literature are described in the present article.
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B'Chir Hamzaoui S, Abdallah M, Bouslama K, Mestiri H, Kallel L, Harmel A, Ennafaa M, M'Rad S, Ben Dridi M. [Chylous ascites revealing a systemic lupus erythematosus (L)]. ACTA ACUST UNITED AC 2007; 31:100-1. [PMID: 17273141 DOI: 10.1016/s0399-8320(07)89336-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Hentati H, Arfa N, Haouas N, Landolsi S, Gharbi W, Miloudi N, Mannaï S, Ghariani B, Gharbi L, Mestiri H, Khalfallah MT. Pancreaticoduodenectomy in the elderly over 80 years: a case report. Hepatobiliary Pancreat Dis Int 2007; 6:104-7. [PMID: 17287177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND An increasing number of elderly patients have been considered for major surgical procedures, such as pancreaticoduodenectomy. The decision to recommend this operation for localized pancreatic cancer or other periampullary process in a very elderly patient is complicated by the frailty of the patient and the poor prognosis of the disease. Moreover, increased surgical experience associated with better patient selection may reduce the mortality rate, even in very elderly patients (over 80 years of age), after pancreaticoduodenectomy. METHODS An 84-year-old woman underwent pancreaticoduodenectomy for ampullary adenocarcinoma. The tumor was classified pT3N0M0. RESULT A good postoperative outcome was obtained. The patient is still alive, 18 months after operation. CONCLUSIONS Radical resection of periampullary tumors is safe in selected patients of advanced age, with morbidity and mortality rates approaching those observed in younger patients. Age alone should not be a contraindication for pancreatic resection.
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Affiliation(s)
- Hassen Hentati
- Department of General Surgery, Mongi Slim Hospital, Sidi Daoued, 2046, La Marsa, Tunis, Tunisia
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Arfa MN, Ben Abid S, Gharbi L, Mannai S, Haoues N, Miloudi N, Guilani M, Ghariani B, Mestiri H, Khalfallah MT. [Results of laparoscopic treatement of common bile duct lithiasis. Report of 30 cases]. Tunis Med 2006; 84:786-9. [PMID: 17288281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
AIM The aim of this retrospective study was to report the results of the laparoscopic management of common bile duct stones in an unicentric series of 30 patients. METHODS From January 2001 to April 2004. 30 patients: 23 women, 7 men (mean age: 54 years). underwent a common bile duct exploration for lithiasis through a laparoscopic approach. The patients were hospitalized for angiocholitis (n = 12), cholecystitis (n= 4), jaundice (n = 4), pancreatitis (n = 3), abnormality of hepatic tests (n = 7). All the patients underwent an intra operative cholangiography. Removal of the stones was tried in 30 cases through a choledochotomy. never through the cystic duct, using Dormia and Fogarty catheters. External biliary drainage with T tube (kehr) and postoperative cholangiography was done systematically. RESULTS In 21 patients (70 %), removal of the stones was laparoscopically successful. The average diameter of the common bile duct was 10.5 mm (range 6-20 mm). The median number of stones was 5 (E: 1-12). The median operation time was 180mn (range 150-300mn). In 9 patients, a conversion into laparotomy was necessary for several reasons. In 2 patients with residual common bile duct, the stones were treated successfully by endoscopic sphincterotomy. There was no mortality and the morbidity rate was 10 %. The mean postoperative hospital stay was 14.7 days (range 7-18days) and 13.3 days in case of successful laparoscopic management. CONCLUSION In 70 % of the patients, the treatment of the common bile-duct lithiasis could be achieved laparoscopically, but conventional approach and endoscopic sphincterotomy are still useful in case of failure of the laparoscopic management.
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Affiliation(s)
- Mohamed N Arfa
- Service de Chirurgie Générale, Hôpital Mongi Slim La Marsa
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Gharbi L, Mannai S, Ghariani B, Mestiri H, Khalfallah MT. [Treatment of primary and secondary malignant tumor of the liver. Opinion of the surgeon]. Tunis Med 2006; 84:683-6. [PMID: 17294891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Hepatocellular carcinoma is the most frequent primitive cancer of the liver. This tumor mainly develops in cirrhotic liver that is a true precancerous state. Treatment can be surgical or not surgical. Orthotopic liver transplantation is the only treatment that definitively address both the metachronous occurrence risk of hepatocellular carcinoma and the underlying disease. Liver metastases from colorectal carcinomas are the most frequent secondary tumors. Only complete resection offers the potential for curative treatment of these metastases.
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Affiliation(s)
- Lassad Gharbi
- Service de chirurgie, Hôpital Mongi Slim, 2046 Sidi Daoud
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Gharbi L, Miloudi N, Ghariani B, Mannai S, Arfa N, Mestiri H, Khalfallah MT. [Is the presence of a gastric tumor a risk factor for multiple primary malignant tumors?]. J Chir (Paris) 2006; 143:271-3. [PMID: 17088734 DOI: 10.1016/s0021-7697(06)73689-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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31
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Abdallah M, B'Chir Hamzaoui S, Bouslama K, Mestiri H, Harmel A, Ennafaa M, M'Rad S, Ben Dridi M. [Acute pancreatitis associated with hemophagocytic syndrome in systemic lupus erythematous: a case report]. ACTA ACUST UNITED AC 2006; 29:1054-6. [PMID: 16435516 DOI: 10.1016/s0399-8320(05)88191-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 01/30/2023]
Abstract
Exceptionally, acute pancreatitis and reactive hemophagocytic syndrome (RHS) are observed in the course of systemic lupus erythematosus (SLE). However, the association of the two conditions has never been reported before. A 31-years-old woman with a 7-year history of SLE was admitted for abdominal pain and fever. Elevated serum amylase and pancreatic enlargement on computerized tomography confirmed the diagnosis of pancreatitis. Laboratory examinations revealed pancytopenia, abnormal hepatic tests, and elevation of serum LDH and triglyceride levels. Bone marrow aspiration showed hemophagocytosis. The patient responded well to high dose corticosteroids. About eighty cases of pancreatitis have been reported in patients with SLE. The mechanisms are still unclear: SLE as the primary etiologic factor, drug toxicity, especially steroids which play a controversial role, or infection. About 40 cases of RHS have been reported in patients with SLE, sometimes associated with active infection. Overall mortality is 38.5%. When RHS occurs as an initial manifestation of SLE, or in the course of active SLE, it responds well to immunosuppressive therapy.
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Affiliation(s)
- Meya Abdallah
- Service de Mèdecine Interne, CHU Mongi Slim, La Marsa Tunisie.
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Mannai S, Kraïem T, Gharbi L, Haoues N, Mestiri H, Khalfallah MT. [Congenital cystic dilatation of bile ducts]. ACTA ACUST UNITED AC 2006; 131:369-74. [PMID: 16630531 DOI: 10.1016/j.anchir.2006.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2005] [Accepted: 03/15/2006] [Indexed: 11/29/2022]
Abstract
Congenital cystic dilatation of bile ducts is a rare condition. We report a retrospective study about 18 patients having congenital bile duct cysts. According to Todani's classification, 11 cases were type I and 7 were type V. Six patients from the first group had a pancreatobiliary maljunction. A total resection of the cyst was conducted in the type I cysts. Anatomopathologic examination showed an adenocarcinoma of a common bile duct cyst. In one case, a cancer of the gall bladder associated to a common bile duct cyst in another case. Three patients with segmental dilatation of intrahepatic bile ducts (type V) underwent liver resection. Four patients had a diffuse form, one of them was treated by percutaneous drainage, and in the other cases a hepatojejunostomy was performed. Postoperative course was complicated with acute cholangitis in these four cases. Percutaneous drainage and antibiotics allowed a positive outcome in most of the cases. In one case, secondary biliary cirrhosis occurred as a long-term complication. Congenital cystic dilatation of bile ducts is considered to be a precancer state. Enterocystic anastomosis is proscribed and the resection has to be as complete as possible.
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Affiliation(s)
- S Mannai
- Service de Chirurgie Générale, Hôpital Mongi-Slim, 1004 Tunis, Tunisie.
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Arfa N, Gharbi L, Marsaoui L, Ben Rhouma S, Farhati S, Bougamra S, Mannai S, Ghariani B, Mestiri H, Khalfallah MT. Douleurs aiguës de la fosse iliaque droite: intérêt de la surveillance clinique hospitalière. Presse Med 2006; 35:393-8. [PMID: 16550128 DOI: 10.1016/s0755-4982(06)74602-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Because of the potential severity of acute appendicitis, many authors recommend the broad use of appendectomy. In this case, 15 to 20% of appendectomies are ultimately found to have been unnecessary. Hospital observation with repeated clinical and laboratory exams can be useful for patients with atypical clinical presentation. This paper assesses our approach, in which some patients with pain in the right iliac fossa (RIF) are admitted for observation before a decision about appendectomy. PATIENTS AND METHODS All patients (205 cases) admitted from March 2002 through February 2003 for acute abdominal pain of the RIF were included in this prospective study. The 120 women and 85 men (sex ratio=0.7) had a mean age of 27 years. We classified the patients into 3 groups: those who had an emergency appendectomy, those who had surgery after an observation period, and those discharged without appendectomy after observation. RESULTS The first group included 110 patients: 63% had a (rectal) temperature greater than 38 degrees C; 44% had guarding of the RIF and 87% elevated white blood cell counts (>10000/mm3). At surgery, appendicitis was diagnosed in 92%. After a mean delay of 36 hours of observation, 50 of the patients in the second group underwent surgery: 44% with (rectal) temperature > 38 degrees C, RIF guarding in 8%, and elevated white blood cell count (>10000/mm3) in 74%. In this group, 94% were diagnosed with appendicitis during surgery. Forty-five patients were discharged without surgery after 36 hours of observation. COMMENTARY In this study, pain and RIF guarding, associated with temperature greater than 38 degrees C and elevated white blood cell counts, were predictive of appendicitis in 96% of cases. Admission for observation of patients with atypical presentation avoided 45 unnecessary appendectomies (22%).
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Affiliation(s)
- Nafaa Arfa
- Service de Chirurgie Générale, Hôpital Mongi Slim, La Marsa, Tunisie.
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Arfa N, Hamdani I, Gharbi L, Ben Abid S, Ghariani B, Mannai S, Mestiri H, Khalfallah MT, Mzabi SR. [Survival and prognostic factors of colorectal adenocarcinoma: analytic multifactor review of 150 cases]. ACTA ACUST UNITED AC 2006; 131:104-11. [PMID: 16443189 DOI: 10.1016/j.anchir.2005.12.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2005] [Accepted: 12/15/2005] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Prognostic factors have a pivotal role in clinical oncology. They are helpful in the selection of treatment; provide insights into the disease process and the therapic response. The number of possibility useful prognosis factors in the colorectal cancer is large. This study attempts to observe the survival of colorectal adenocarcinoma and to find prognostic factors and other variables potentially associated with outcome of colorectal adenocarcinoma. MATERIAL AND METHODS It's a retrospective study based on 150 patients with colorectal adenocarcinoma from 1990 to 2002. There were 150 patients aged of 58 years (median 61 years) with 1.4 sex-ratio. 84 patients had colon adenocarcinoma and 66 patients had rectal adenocarcinoma. In histological exam the adenocarcinoma was well differenced in 69 cases (46%), and undifferentiated in 17 cases (18, 3%). RESULTS Locoregional extension was found in 18 cases and metastatic extension in 45 cases with hepatic metastasis in 37 cases and pulmonary metastasis in 8 cases. There were 6 cases of peritoneal localized carcinosis and 6 cases of ovary metastasis. There were 6 patients (4%) Dukes stage I TNM, 61 stage II (40, 7%), 51 stage III TNM (34%) and 32 patients stage IV TNM (34%). All patients had surgical curative resection associated with adjuvant chemotherapy in 60 cases of colon adenocarcinoma and preoperative radiotherapy in 33 cases of rectal adenocarcinoma. After a follow up of 46 months, 52 patients was died (10 operative mortality), 35 patients were lost of view and 63 patients were still alive at the point date. Median survival was 20 months with 95% confidence interval: (4, 2-7, 8). Overall one year and 5 years survival were respectively 92,8% and 26,3%. Various prognostic factors had been identified through univariate (Kaplan-Meier) then multivariate (Cox) analyze. In addition to the clinical factors, we found of significant prognostic value undifferentiated adenocarcinoma and an elevated value of serum carcinoembryonic antigen>5 ng/ml.
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Affiliation(s)
- N Arfa
- Service de Chirurgie Générale, Hôpital Mongi-Slim, Sidi-Daoued, La-Marsa 2045, Tunis, Tunisie.
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Ben Abid S, Gharbi L, Arfa MN, Mallouki I, Ghariani B, Mestiri H, Khalfallah MT. [Adrenal metastasis from a hepatocellular carcinoma with thrombosis of the inferior vena cava]. J Chir (Paris) 2005; 142:311-2. [PMID: 16292211 DOI: 10.1016/s0021-7697(05)80936-6] [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] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- S Ben Abid
- Service de Chirurgie Générale, Hôpital Mongi Slim - La Marsa, Tunisie.
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Arfa MN, Gharbi L, Zaafrani MR, Mbazaa M, Goutellier ben fadhel C, Mestiri H, Ben Ammar MS, Khalfallah MT. Cystic mesenchymal hamartoma of the liver report of a case and review of the literature. Hepatogastroenterology 2003; 50 Suppl 2:ccxlix-ccli. [PMID: 15244192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Mesenchymal Hamartoma (MH) of the liver constitutes the third or the fourth most common tumour of the liver in childhood and occurs most commonly in the first two years of life. It is often misdiagnosed clinically as a malignant tumour because of its rapid increase in size within a short period of time, or as a hepatic collections or abscess because of its cystic appearance. Although a benign lesion, MH may cause heart failure due to arteriovenous shunts, or death as a result of respiratory complications. A typical case of MH was recently encountered in a 6-years-old-boy. The patient presented with progres sive abdominal distension; surgery revealed a large mass arising from the right lobe of the liver. The mass was predominantly formed by fluid collections. Loose mesenchymal tissue and branched, tortuous bile ducts were the key diagnostic features. When predominantly cystic, MH may mimic lymphangioma both grossly and microscopically. Prudent examination of the cystic structures can establish a correct diagnosis.
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Affiliation(s)
- M N Arfa
- Department of surgery, Mongi Slim Hospital-La Marsa-Tunis, Tunisia
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Mlik K, Arfa MN, Zaafrani R, Gharbi L, Gouttelier Ben Fadhel C, Mestiri H, Mzabi Regaya S, Khalfallah MT. [Endometriosis: a rare cause of acute intestinal obstruction]. Tunis Med 2003; 81:972-5. [PMID: 14986536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
In the differential diagnosis of intestinal obstruction, the endometriosis is an uncommon disease, rarely reported preoperatively. Surgical objective is a total resection of endometriomas, to guarantee symptom relief and ovoid recurrence. In elective cases, preoperative GH-RH analogue hormonal treatment makes easier the surgical procedures. Conservative surgery of the ovaries is mandatory in premenopausal patients.
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Affiliation(s)
- Khaled Mlik
- Service de chirurgie générale, Hôpital Mongi Slim La Marsa
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Arfa MN, Bouzaiene H, Ben Farhat L, Gharbi L, Ghariani B, Mestiri H, Hendaoui L, Khalfallah MT. Intrahepatic Osler's disease: report of two cases and review of the literature. Hepatogastroenterology 2003; 50 Suppl 2:ccx-ccxiii. [PMID: 15244181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Osler-Weber-Rendu disease is a hereditary vascular disease with multiple manifestations. The liver is involved rarely. Vascular abnormalities include telangiectasis and arteriovenous fistulas, sometimes associated with fibrosis and cirrhosis. Hepatic arteriovenous shunting may include secondary portal hypertension, reduced liver function and high cardiac output. Two cases of Osler-Weber-Rendu disease with extensive hepatic arteriovenous fistulation were described in detail and we report on their clinical features. In the first patient, treatment was symptomatic since liver transplantation is not indicated because the patient was asymptomatic. Embolization treatment of hepatic arteries was indicated in the second patient because he had biliary disease and recurrent cholangitis secondary to vasculo-biliary shunts. Therapy with arterial embolization, banding, or ligature of hepatic arteries is still limited and provides unsatisfactory long-term results. Liver transplantation offers now another therapeutic option for patients with intrahepatic high shunting and secondary pulmonary hypertension.
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Affiliation(s)
- M N Arfa
- Department of Surgery and liver transplantation, Mongi Slim Hospital, La Marsa, Tunisia
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Bouraoui S, Letaief H, Mestiri H, Chadly-Debbiche A, Ben Zineb S, Haouet S, Mzabi-Regaya S. [Malignant granular cell tumors. Report of a case of anal localization]. Ann Pathol 1999; 19:151-2. [PMID: 10349486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Bouchoucha S, Ben Othman M, Ghariani B, Mestiri H, Khalfallah MT. [A rare cause of upper digestive hemorrhage: duodenal leiomyoma]. Tunis Med 1998; 76:212-4. [PMID: 9810853] [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] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- S Bouchoucha
- Service de chirurgie générale, Hôpital Mongi Slim, La Marsa
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Goutallier-Ben Fadhel C, Chadli-Debbiche A, Bellil S, Essamet W, Mestiri H, Larabi B, Mzabi-Regaya S. [Hodgkin's disease presenting as muscle lesions: an uncommon presentation]. Tunis Med 1997; 75:884-7. [PMID: 9507337] [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] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Chabot F, Mestiri H, Sabry S, Dall'Ava-Santucci J, Lockhart A, Dinh-Xuan AT. Role of NO in the pulmonary artery hyporeactivity to phenylephrine in experimental biliary cirrhosis. Eur Respir J 1996; 9:560-4. [PMID: 8730020 DOI: 10.1183/09031936.96.09030560] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [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: 02/01/2023]
Abstract
The aim of this study was to see whether increased activity of nitric oxide (NO) might account for decreased pulmonary vascular tone seen in the hyperdynamic circulation of cirrhosis. We compared the pulmonary vascular reactivity of isolated pulmonary arteries (PA) from control rats (n = 10), and rats with biliary cirrhosis (n = 10) induced by chronic bile duct ligation (4 weeks). The responses of PA rings to cumulative concentrations of phenylephrine, acetylcholine, and sodium nitroprusside were studied, and also the effects of inhibition of synthesis of NO by the L-arginine analogue, N omega-nitro-L-arginine (L-NOARG) in PA rings challenged with cumulative concentrations of phenylephrine and acetylcholine. The contractile response to phenylephrine was significantly reduced in cirrhotic PA rings as compared with controls. Pretreatment with L-NOARG (10(-4) M) significantly increased the contractile response to phenylephrine in PA rings from cirrhotic rats but not in control PA rings. Furthermore, L-NOARG restored the response to phenylephrine in cirrhotic PA rings back to normal. There was no difference in the relaxation of PA rings from both groups in response to acetylcholine and sodium nitroprusside. We conclude that in vitro pulmonary artery ring hyporeactivity to phenylephrine results from increased nitric oxide production in the pulmonary circulation of cirrhotic rats and might account for the hepatopulmonary syndrome.
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Affiliation(s)
- F Chabot
- Service de Physiologie-Explorations Fonctionnelles, C.H.U. Cochin Port-Royal, Université René Descartes, Paris, France
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Cardoso J, Gautreau C, Wroblewski T, Cherruau B, Neris J, Mestiri H, Crougneau S, Weill B, Houssin D. Lobular hemorrhage: an early parameter of rejection in isolated pig livers perfused with heparinized human blood. Transplant Proc 1994; 26:1308-9. [PMID: 8029917] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- J Cardoso
- Laboratoires de Recherche Chirurgicale, UER Cochin Port-Royal, Paris, France
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Belkhodja C, Mestiri H, Ben Ammar MS, Larabi B. [Conservative surgery of liver hydatid cysts draining into the biliary ducts]. Tunis Med 1993; 71:7-12. [PMID: 8328038] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- C Belkhodja
- Service de Chirurgie Pr. LARABI, Hôpital M. Slim, La Marsa, Tunisie
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Bahi S, Belkhodja C, Trabelsi O, Mestiri H, Larabi B, Ennabli E. [Internal pneumatic stabilization in the treatment of flail chest]. Tunis Med 1991; 69:83-8. [PMID: 2063489] [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] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- S Bahi
- Service de Chirurgie la Marsa
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Bahi S, Mestiri H, Belkhodja C, Trabelsi O, Landolsi H, Larabi B. [Cancer of the exocrine pancreas]. Tunis Med 1990; 68:715-8. [PMID: 1708542] [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] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- S Bahi
- Service de Chirurgie, Hôpital La Marsa
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Bahi S, Trabelsi O, Belkhodja C, Mestiri H, Landolsi H, Ghorbal A, Larabi B. [Endoscopic sphincterotomy]. Tunis Med 1990; 68:587-90. [PMID: 2288024] [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] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- S Bahi
- Service de Chirurgie, Hôpital Mongi SLIM, La Marsa
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Bahi S, Belkhodja C, Mestiri H, Trabelsi O, Larabi B. [Desmoid tumors in Gardner syndrome]. Tunis Med 1990; 68:313-7. [PMID: 2353373] [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] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- S Bahi
- Service de Chirurgie, Hôpital Mongi Slim, La Marsa
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