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Mrabet S, Falfoul Y, Bouassida M, Souissi A, El Matri K, Gharbi A, Chebil A, Kacem I, El Matri L, Gouider R. Retinal changes in multiple sclerosis: An optical coherence tomography and angiography study. Rev Neurol (Paris) 2024:S0035-3787(24)00421-1. [PMID: 38458836 DOI: 10.1016/j.neurol.2023.11.014] [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: 06/29/2023] [Revised: 10/28/2023] [Accepted: 11/07/2023] [Indexed: 03/10/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system with neuroaxonal damage. It is the principal driver of non-traumatic disability in young adults. Visual symptoms are common and optic neuritis (ON) may be the revealing feature in up to 30% of cases. Structural optical coherence tomography (OCT) represents a biomarker of central nervous system neurodegeneration in MS. OCT-angiography (OCT-A) is a noninvasive tool allowing the study of retinal vasculature and the detection of microvascular damage in neuro-retinal diseases. In this study, we aimed to assess structural and microvascular retinal changes in patients with MS with and without ON and to correlate the findings with visual function and MS disability. METHODS We conducted a cross-sectional study including patients diagnosed with MS according to the 2017 McDonald criteria. All patients underwent complete neurological examination with evaluation of the Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Severity Score (MSSS) and an ophthalmological examination including OCT and OCT-A. Patients were compared with age- and sex-matched healthy subjects. The primary endpoints were assessment of retinal nerve fiber layer (RNFL) thickness, ganglion cell layer (GCL+), and ganglion cell complex (GCL++) thicknesses on OCT. Vascular densities in the superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC) were assessed on OCT-A, as well as central avascular zone (CAZ) parameters, lacunarity and fractal dimension. RESULTS A total of 160 MS eyes with and without a previous history of ON and 64 age- and gender-matched healthy eyes were analyzed. Among 160 eyes with MS, 69 had a history of ON. We observed a decrease in RNFL and GCL++ thickness in all 12 quadrants in MS patients when compared to healthy controls. Multivariate analysis by linear regression noted a significant correlation for temporal GCL++ and inferonasal RNFL thickness that were decreased in the MS group. A greater decrease in retinal layers thickness was identified in MS patients with a history of ON. On OCT-A, vascular density in (SCP) was significantly reduced in the MS group (P<0.002). A significant correlation between RNFL thickness and retinal vascular density was found but only in less than half of the hourly quadrants. A significant correlation was noted between visual acuity and CC density (P<0.0001). We also noted an inverse correlation between EDSS scores and CC density (P=0.02 and r=-0.275) and between MSSS and RNFL/GCL++ thicknesses. CONCLUSIONS RNFL and GCL++ layers were thinner in MS patients with a history of ON and were reversely correlated with disease severity. Moreover, retinal vascular changes were observed in MS even in eyes without ON, and CC was reversely correlated with visual function and current disability. Thus, structural OCT coupled with OCT-A could represent a noninvasive and dynamic biomarker of MS severity and progression.
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Affiliation(s)
- S Mrabet
- Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - Y Falfoul
- Department B, Hedi Raies Institute of Ophthalmology, Oculogenetic Laboratory LR14SP01, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - M Bouassida
- Department B, Hedi Raies Institute of Ophthalmology, Oculogenetic Laboratory LR14SP01, Tunis, Tunisia
| | - A Souissi
- Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - K El Matri
- Department B, Hedi Raies Institute of Ophthalmology, Oculogenetic Laboratory LR14SP01, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - A Gharbi
- Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - A Chebil
- Department B, Hedi Raies Institute of Ophthalmology, Oculogenetic Laboratory LR14SP01, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - I Kacem
- Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - L El Matri
- Department B, Hedi Raies Institute of Ophthalmology, Oculogenetic Laboratory LR14SP01, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - R Gouider
- Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, 2010 Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, 1007 Tunis, Tunisia.
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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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Trabelsi B, Ghorbel S, Ben Rabeh R, Bouassida M, Ben Ali M. C-reactive protein in the early diagnosis of pneumonia complicating severe blunt chest trauma. Tunis Med 2023; 101:756-758. [PMID: 38465756] [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] [Received: 06/29/2023] [Accepted: 07/17/2023] [Indexed: 03/12/2024]
Abstract
INTRODUCTION The early diagnosis of pneumonia following severe blunt chest trauma (SBCT) allows the early prescription of antibiotics and initiation of adequate supportive care. AIM To assess the usefulness of C-reactive protein (CRP) in the early diagnosis of pneumonia complicating SBCT. METHODS We conducted a prospective study of patients admitted to trauma intensive care unit for SBCT between January 2020 and February 2023. Patients were divided into two groups according to whether or not they developed pneumonia. The CRP levels were monitored daily. RESULTS One hundred sixty-seven patients were included. Pneumonia occurred in 40.1% of patients within a median of 5 days. We found statistically significant difference in mean CRP levels between groups from day 3 to day 9 following trauma. The increase in CRP level on the 4th day from a value greater than or equal to 192 mg/L was a marker of early diagnosis of pneumonia (sensitivity 80.6%; specificity 80.8%). CONCLUSION Daily CRP measurement from the 3rd day following SBCT may be useful for early diagnosis of pneumonia complicating SBCT.
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Affiliation(s)
- Becem Trabelsi
- Department of Anesthesiology and Intensive Care, Taher Maamouri Teaching Hospital of Nabeul, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Sahar Ghorbel
- Department of Anesthesiology and Intensive Care, Taher Maamouri Teaching Hospital of Nabeul, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Rania Ben Rabeh
- Pediatric Department C, Bechir Hamza Children's Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Mahdi Bouassida
- Department of Surgery, Taher Maamouri Teaching Hospital of Nabeul, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Mechaal Ben Ali
- Department of Anesthesiology and Intensive Care, Taher Maamouri Teaching Hospital of Nabeul, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
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Beji H, Chtourou MF, Zribi S, Laamiri G, Bouassida M, Touinsi H. Gallstone ileus: A case report and review of the literature. Int J Surg Case Rep 2023; 106:108221. [PMID: 37075501 DOI: 10.1016/j.ijscr.2023.108221] [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: 02/21/2023] [Revised: 04/07/2023] [Accepted: 04/08/2023] [Indexed: 04/21/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Gallstone ileus (GI) is defined as the occlusion of the intestinal lumen due to the impaction of one or more gallstones. The optimal management of GI is not consensual. We report a rare case of GI with a successful surgical treatment for a 65 year-old-female. CASE PRESENTATION A 65 year-old-woman, presented with biliary colic pain and vomiting for three days. On examination, she had a distended tympanic abdomen. A computed tomography scan revealed signs of small bowel obstruction due to a jejunal gallstone. She had pneumobilia due to a cholecysto-duodenal fistula. We performed a midline laparotomy. We found a dilated and ischemic jejunum with false membranes regarding the migrated gallstone. We performed a jejunal resection with primary anastomosis. We performed cholecystectomy and closed the cholecysto-duodenal fistula at the same operative time. The postoperative course was uneventful. CLINICAL DISCUSSION We reported successful surgical treatment for GI. It was a one-step procedure. GI is a rare situation. Due to their restricted lumen, the terminal ileum and the ileocaecal valve are where GI occurs most commonly. GI appears usually in elderly patients with comorbidities. The clinical presentation is not specific. CT scan evokes the diagnosis with high specificity. The surgical management of GI is not consensual. In our case, we performed bowel resection due to the presence of an ischemic intestine. CONCLUSION GI is a rare situation. It appears usually in elderly patients with comorbidities. The clinical presentation is not specific. The surgical management of GI is not consensual.
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Affiliation(s)
- Hazem Beji
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia.
| | - Mohamed Fadhel Chtourou
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Slim Zribi
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Ghazi Laamiri
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Mahdi Bouassida
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Hassen Touinsi
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
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Beji H, Laamiri G, Chtourou MF, Zribi S, Sbaihi S, Nechi S, Bouassida M, Touinsi H. Gastrointestinal bleeding due to jejunal metastasis of pleomorphic lung carcinoma: a case report. Ann Med Surg (Lond) 2023; 85:1119-1122. [PMID: 37113964 PMCID: PMC10129109 DOI: 10.1097/ms9.0000000000000364] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/21/2023] [Indexed: 04/29/2023] Open
Abstract
Gastrointestinal metastasis of pleomorphic lung cancer presents with nonspecific manifestations, leading to delayed diagnosis. Herein, the authors report the case of a 56-year-old patient who presented with gastrointestinal bleeding due to pleomorphic lung carcinoma. Case presentation A 56-year-old patient presented to the emergency department with melena. On examination, he was hemodynamically stable. He had a sensitive and mobile mass in the periumbilical region. A thoracoabdominal computed tomography scan showed a mass of the right apical superior lobe measuring 4 cm and a lobulated jejunal mass measuring 10 cm. A percutaneous biopsy of the lung tumor revealed primary pleomorphic lung carcinoma. The authors performed a midline laparotomy and made a bowel resection with an end-to-end anastomosis. The postoperative course was marked by severe nosocomial pneumonia, leading to septic shock and death. The histopathologic examination concluded with a metastatic lesion of pleomorphic lung carcinoma. Clinical discussion The authors reported a rare case of jejunal metastasis of pleomorphic lung cancer. Pleomorphic carcinoma of the lung is a rare pathology that accounts for 0.1-0.4% of nonsmall-cell lung cancer. The prognosis is poor. In the presence of gastrointestinal bleeding caused by small bowel metastases of pleomorphic lung cancer, surgery is the treatment of choice. Conclusions Small bowel metastasis of pleomorphic lung cancer is rare. Surgical treatment is the treatment of choice. The authors highlight the importance of suspecting gastrointestinal metastases in patients with pleomorphic lung cancer in the presence of nonspecific digestive symptoms.
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Affiliation(s)
- Hazem Beji
- Departments of General Surgery
- University of Tunis El Manar, Tunis, Tunisia
- Corresponding authorHazem Beji. Address: Department of General Surgery, Faculty of Medicine of Tunis, University of Tunis El Manar, Nabeul 8000, Tunisia. Tel.: 0021626348312; fax: N/A. E-mail address: (H. Beji)
| | - Ghazi Laamiri
- Departments of General Surgery
- University of Tunis El Manar, Tunis, Tunisia
| | | | - Slim Zribi
- Departments of General Surgery
- University of Tunis El Manar, Tunis, Tunisia
| | | | - Salwa Nechi
- Departments of General Surgery
- Pathology, Hospital Mohamed Taher Maamouri, Nabeul
| | - Mahdi Bouassida
- Departments of General Surgery
- University of Tunis El Manar, Tunis, Tunisia
| | - Hassen Touinsi
- Departments of General Surgery
- University of Tunis El Manar, Tunis, Tunisia
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Beji H, Chtourou MF, Zribi S, Kallel Y, Bouassida M, Touinsi H. Are biopsies during endoscopic ultrasonography necessary for a suspected esophageal leiomyoma? Is laparoscopy always feasible? World J Clin Cases 2023; 11:2116-2118. [PMID: 36998946 PMCID: PMC10044951 DOI: 10.12998/wjcc.v11.i9.2116] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/18/2023] [Accepted: 03/03/2023] [Indexed: 03/16/2023] Open
Abstract
The present letter to the editor is related to the work entitled “Large leiomyoma of lower esophagus diagnosed by endoscopic ultrasonography-fine needle aspiration: A case report.” Although endoscopic ultrasonography seems necessary in a suspected leiomyoma of the esophagus, the performance of biopsies via fine needle aspiration is controversial as it increases the risk of complications such as bleeding, infection, and intraoperative perforations. Laparoscopy is the best treatment strategy for small tumors. Laparotomy with tumor enucleation or esophageal resection can be considered in large leiomyomas.
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Affiliation(s)
- Hazem Beji
- Department of General Surgery Hospital Mohamed Taher Maamouri Nabeul, University of Tunis El Manar-Faculty of Medicine of Tunis, Nabeul 8000, Tunisia
| | - Mohamed Fadhel Chtourou
- Department of General Surgery Hospital Mohamed Taher Maamouri Nabeul, University of Tunis El Manar-Faculty of Medicine of Tunis, Nabeul 8000, Tunisia
| | - Slim Zribi
- Department of General Surgery Hospital Mohamed Taher Maamouri Nabeul, University of Tunis El Manar-Faculty of Medicine of Tunis, Nabeul 8000, Tunisia
| | - Yassine Kallel
- Department of General Surgery Hospital Mohamed Taher Maamouri Nabeul, University of Tunis El Manar-Faculty of Medicine of Tunis, Nabeul 8000, Tunisia
| | - Mahdi Bouassida
- Department of General Surgery Hospital Mohamed Taher Maamouri Nabeul, University of Tunis El Manar-Faculty of Medicine of Tunis, Nabeul 8000, Tunisia
| | - Hassen Touinsi
- Department of General Surgery Hospital Mohamed Taher Maamouri Nabeul, University of Tunis El Manar-Faculty of Medicine of Tunis, Nabeul 8000, Tunisia
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Chtourou MF, Beji H, Zribi S, Kallel Y, Bouassida M, Touinsi H. Spontaneous rupture of an infected pseudocyst of the pancreas: A case report. Int J Surg Case Rep 2023; 105:107987. [PMID: 36934651 PMCID: PMC10033984 DOI: 10.1016/j.ijscr.2023.107987] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/01/2023] [Accepted: 03/16/2023] [Indexed: 03/19/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE A pancreatic pseudocyst is a known complication of acute and chronic pancreatitis. A pseudocyst rupture into the abdomen causes peritonitis, which can be fatal if surgical treatment is delayed. Here in we report the case of a 46-year-old woman presenting with a pancreatic pseudocyst doubly complicated with infection and rupture causing sepsis shock. CASE PRESENTATION A 46 year-old-woman, with a history of chronic pancreatitis four years prior complicated with a pancreatic pseudocyst of 3 cm, presented to our emergency department with clinical signs of generalized peritonitis. After a brief resuscitation, we performed a midline laparotomy. It showed purulent peritonitis due to a rupture of an infected pseudocyst of the pancreas. We performed an abundant peritoneal toilet with drainage. The patient was discharged after 25 days. In the one month follow-up, there were no unfavourable outcomes. CLINICAL DISCUSSION In presence of ruptured and infected pancreatic pseudocyst, surgical treatment should be performed as soon as possible after brief resuscitation. Laparotomy is the gold standard treatment. The main objective of surgical treatment is to perform abundant peritoneal toilet with large external drainage. In our case, the pancreatic pseudocyst didn't communicate with the Wirsung duct allowing us to withdraw the drainage. Otherwise, the drainage should be retained longer to treat the pancreatic leakage. CONCLUSION Rupture and infection of pancreatic pseudocysts is a rare situation. Diagnosis is assessed via computed tomography scan. Emergency laparotomy should be performed timely to make the peritoneal toilet and drain the pancreatic pseudocyst.
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Affiliation(s)
- Mohamed Fadhel Chtourou
- Department of general surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Hazem Beji
- Department of general surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia.
| | - Slim Zribi
- Department of general surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Yassine Kallel
- Department of general surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Mahdi Bouassida
- Department of general surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Hassen Touinsi
- Department of general surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of 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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Bouassida M, Beji H, Kallel Y, Chtourou MF, Belfkih H, Trabelsi B, Touinsi H. 5-mFI is more accurate than ASA score in predicting postoperative mortality in rectal cancer: A case series of 109 patients. Ann Med Surg (Lond) 2022; 81:104548. [PMID: 36147119 PMCID: PMC9486844 DOI: 10.1016/j.amsu.2022.104548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 11/17/2022] Open
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Bouassida M, Beji H, Chtourou MF, Ben Othmane N, Hamzaoui L, Touinsi H. Primary small bowel volvulus: A case report and literature review. Ann Med Surg (Lond) 2022; 80:104250. [PMID: 36045801 PMCID: PMC9422278 DOI: 10.1016/j.amsu.2022.104250] [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: 06/16/2022] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Small bowel volvulus (SBV) is an aberrant rotation of the small bowel segment along the axis of its mesentery. Secondary SBV is the most frequent situation. Postoperative adhesions represent the main cause. On the other hand, primary SBV is an extremely rare situation. There are no predisposing anatomical abnormalities. Herein, we present a case of a 73-year-old-patient, with no surgical history, presenting primary SBV. Case presentation A 73-year-old-patient presented to the emergency department with a one-day history of acute abdominal pain and vomiting. He had no medical comorbidities and no previous abdominal surgery. On examination, he was agitated and afebrile. Urgent computed tomography (CT) scan showed dilated small bowel loops with a “whirl sign”. A laparotomy was performed. It revealed a 320° SBV of the distal jejunum and the proximal ileum. The small bowel was ischemic. There were no congenital malformations, no adhesions, and no internal hernia. We performed a detorsion of the small bowel. It regained good vitality. To avoid recurrence, we performed enteropexy of the terminal ileum, and the caecum to widen the mesenteric base. We noted no recurrence of the pathology after three months of follow-up. Conclusion Primary SBV is an extremely rare situation. Physiopathology is still misunderstood. The clinical presentation is not specific. Diagnosis can be evoked by CT scan but can only be confirmed intraoperatively. The surgical treatment should be performed timely. Different techniques have been described to avoid recurrence. None of those techniques is consensual. Primary small bowel obstruction is an extremely rare situation. The physiopathology is still unclear. The diagnosis is difficult due to the non-specificity of the symptoms. The surgical treatment should be performed timely. Enteropexy is an option to avoid recurrence but it's not consensual.
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Bouassida M, Beji H, Chtourou MF, Nechi S, Chaabane A, Touinsi H. Leiomyosarcoma of the small bowel: A case report and literature review. Int J Surg Case Rep 2022; 97:107456. [PMID: 35907299 PMCID: PMC9403291 DOI: 10.1016/j.ijscr.2022.107456] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/19/2022] [Accepted: 07/24/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Malignant tumors of the small bowel are rare. The jejunum, ileum, and duodenum represent the most common sites of intestinal leiomyosarcoma (LMS). Herein, we present a case of a 65-year-old patient having ileal LMS successfully treated with surgical resection. PRESENTATION OF CASE A 65-year-old patient, with no comorbidities, presented with chronic and paroxysmal abdominal pain. Upper endoscopy and colonoscopy showed no abnormalities. Thoracoabdominal computed tomography (CT) revealed an ileal lobulated, heterogeneously enhancing solid mass measuring 6 cm. Laparotomy was performed. Findings showed a lobulated ileal mass. We made an enlarged ileal resection with end-to-end anastomosis. The postoperative course was uneventful. Histology and IHC stains concluded into ileal LMS. No relapse of the disease was noted during the 4-month follow-up. CLINICAL DISCUSSION Ileal LMS is a rare tumor originating from the smooth muscle cells within the muscularis mucosa or muscularis propria. CT colonography (CTC) and magnetic resonance enterography (MRE) represent good options to aid the diagnosis. Histologically, LMS often has a comparable morphological appearance to GISTs. IHC is essential to differentiate those tumors. Surgery is the only curative treatment. The prognosis is poor knowing that those tumors are discovered at advanced stages. CONCLUSION Ileal LMS is a rare tumor originating from the smooth muscle cells. It has a comparable morphological appearance to GISTs. Immunohistochemistry is essential to confirm the diagnosis. Surgery is the only curative treatment. The prognosis is poor.
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Affiliation(s)
- Mahdi Bouassida
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia,University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Hazem Beji
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia,University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia,Corresponding author at: 52, Street of roses, 8050 Hammamet, Tunisia.
| | - Mohamed Fadhel Chtourou
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia,University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Saloua Nechi
- University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia,Department of Pathology, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia
| | - Abir Chaabane
- University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia,Department of Pathology, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia
| | - Hassen Touinsi
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia,University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
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Beji H, Bouassida M, Laamiri G, Chelbi E, Nechi S, Touinsi H. Primary splenic lymphoma discovered on massive splenomegaly: A case report. Int J Surg Case Rep 2022; 94:107124. [PMID: 35658295 PMCID: PMC9079000 DOI: 10.1016/j.ijscr.2022.107124] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/24/2022] [Accepted: 04/24/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Malignant lymphoma occurs in all the systemic organs. Rarely, large B-cell lymphoma is located in the spleen, making the diagnosis difficult. Herein, we report a patient presenting with massive splenomegaly due to LBCL. Splenectomy was essential to assess the diagnosis and to guide postoperative therapeutics. PRESENTATION OF A CASE A 47-year-old woman, with no comorbidities, complained of weight loss and abdominal pain. She had a palpable spleen that extended below the navel. CT scan revealed massive splenomegaly and lymph nodes in the spleen hilum. Splenectomy was performed. Histopathological examination confirmed the diagnosis of large B-cell lymphoma. The postoperative course was uneventful. Three courses of chemotherapy were given. The patient was in remission after a follow-up of 8 months. DISCUSSION Massive splenomegaly can be one of the circumstances of the discovery of large B-cell lymphoma. Splenectomy was then essential to confirm the diagnosis and to guide postoperative therapeutics. It also permits reducing hypersplenism and preventing spleen rupture. In patients with high operative risk, splenic needle biopsy should be taken into consideration. Splenic artery embolization before surgery can also be performed in patients having massive splenomegaly to reduce the spleen volume. We highlight the importance of splenectomy to confirm the diagnosis and to relieve the symptoms. Postoperative chemotherapy is essential to prevent relapses. CONCLUSION Splenectomy is essential in spleen localized large B-cell lymphoma. It permits to confirm the diagnosis, relieve symptoms, and treatment of underlying hematologic malignancies. Postoperative chemotherapy is essential to prevent relapses.
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Affiliation(s)
- Hazem Beji
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia.
| | - Mahdi Bouassida
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Ghazi Laamiri
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Emna Chelbi
- University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia; Department of Pathology, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia
| | - Salwa Nechi
- University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia; Department of Pathology, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia
| | - Hassen Touinsi
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
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Beji H, Bouassida M, Chtourou MF, Zribi S, Moghri MM, Touinsi H. Myxofibrosarcoma of the abdominal wall : A case report and literature review. Int J Surg Case Rep 2022; 95:107275. [PMID: 36721186 PMCID: PMC9190001 DOI: 10.1016/j.ijscr.2022.107275] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Myxofibrosarcoma (MFS) is a subtype of soft tissue sarcoma characterized by diffuse infiltration patterns. Myxofibrosarcoma arises often in extremities. Its occurrence in the abdominal wall is extremely rare. Herein, we present here a case of high-grade MFS of the abdominal wall discovered in a 58-year-old woman complaining of an abdominal mass. PRESENTATION OF CASE This report illustrates the case of a female who presented a mass in the right lower quadrant of the abdomen. Abdominal computed tomography (CT) scan revealed a well-circumcised, heterogeneous soft tissue mass. We performed a wide margin excision of the mass. Histology concluded in myxofibrosarcoma of the abdominal wall. Adjuvant radiotherapy was performed. CLINICAL DISCUSSION We reported successful surgical treatment for myxofibrosarcoma of the abdominal wall. To our knowledge, this is the second report in English literature. MFS is a subtype of soft tissue sarcoma with a locally infiltrative behavior. To ensure the best curative treatment, It is important to excise the tumor with wide margins. Knowing that MFS has a propensity for local recurrence (16 to 57 %), adjuvant radiotherapy has emerged as an efficient treatment for improving local control. The role of chemotherapy is controversial and has not shown effects on survival. CONCLUSION Myxofibrosarcoma is a connective tissue neoplasm. Its occurrence in the abdominal wall is extremely rare. Surgical treatment with large negative margins is the cornerstone of the treatment. Adjuvant radiotherapy is essential in preventing local recurrences.
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Affiliation(s)
- Hazem Beji
- Corresponding author at: 52 - Street of roses - 8050 Hammamet – Tunisia, University of Tunis El Manar- Tunisia, Department of general surgery Hospital Mohamed Taher Maamouri, Nabeul, Tunisia.
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15
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Beji H, Bouassida M, Kallel Y, Tormane MA, Mighri MM, Touinsi H. Leiomyoma of the esophagus: A case report and review of the literature. Int J Surg Case Rep 2022; 94:107078. [PMID: 35439728 PMCID: PMC9027349 DOI: 10.1016/j.ijscr.2022.107078] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 02/20/2022] [Revised: 03/17/2022] [Accepted: 04/10/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Benign tumors represent less than 1% of esophageal neoplasms. Esophageal leiomyoma is a very rare tumor that arises from mesenchymal tissue. We present here a case of leiomyoma of the esophagus which was revealed by dysphagia and vomiting that was treated by surgical enucleation. PRESENTATION OF CASE This report illustrates the case of a female who presented with dysphagia and vomiting. Imageology demonstrated an esophageal mass which was treated with surgical enucleation. Histopathology confirmed the diagnosis of leiomyoma. CLINICAL DISCUSSION Benign esophageal tumors are rare. Leiomyoma commonly presents as a single lesion in the middle or lower third of the esophagus. Leiomyomas located in the proximal and middle third of the esophagus can be operated on by right thoracotomy. Surgical treatment varies from enucleation to esophageal resection depending on the size and location of the mass. In our case, the tumor was enucleated by a right posterolateral thoracotomy. CONCLUSION Esophageal leiomyoma is a benign and generally asymptomatic tumor. Surgery is the pillar of treatment. Enucleation should be performed whenever possible to avoid esophagectomy and thus decrease morbidity and mortality.
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Affiliation(s)
- Hazem Beji
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia.
| | - Mahdi Bouassida
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Yassine Kallel
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Mohamed Amine Tormane
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Mohamed Mongi Mighri
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Hassen Touinsi
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia; University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
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Beji H, Bouassida M, Zribi S, Touinsi H. Ileal gastrointestinal stromal tumor causing mesenteric gangrene. Clin Case Rep 2022; 10:e05772. [PMID: 35474987 PMCID: PMC9019869 DOI: 10.1002/ccr3.5772] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/09/2022] [Accepted: 03/28/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hazem Beji
- Department of General Surgery Hospital Mohamed Taher Maamouri Nabeul Tunisia
| | - Mahdi Bouassida
- Department of General Surgery Hospital Mohamed Taher Maamouri Nabeul Tunisia
| | - Slim Zribi
- Department of General Surgery Hospital Mohamed Taher Maamouri Nabeul Tunisia
| | - Hassen Touinsi
- Department of General Surgery Hospital Mohamed Taher Maamouri Nabeul Tunisia
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17
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Beji H, Zribi S, Bouassida M, Touinsi H. Snapshots Quiz. Br J Surg 2022; 109:390. [PMID: 35021197 DOI: 10.1093/bjs/znab440] [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: 11/02/2021] [Accepted: 11/28/2021] [Indexed: 11/14/2022]
Abstract
A 55-year-old man presented acutely with small bowel obstruction. What is shown in the intraoperative photograph?
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Affiliation(s)
| | - Slim Zribi
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia
| | | | - Hassen Touinsi
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia
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18
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Kammoun R, Bouassida M, Gharbi N, Lajmi Y, Boujelbene I, Ben Ayed I, Baklouti S, Belguith N, Ammar Keskes L, Masmoudi S, Kamoun H, Abdelhedi F. Troubles endocriniens associés au syndrome de Prader-Willi : intérêt du diagnostic génétique précoce. Annales d'Endocrinologie 2021. [DOI: 10.1016/j.ando.2021.08.875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bouassida M, Madhioub M, Kallel Y, Zribi S, Slama H, Mighri MM, Touinsi H. Acute Gangrenous Cholecystitis: Proposal of a Score and Comparison with Previous Published Scores. J Gastrointest Surg 2021; 25:1479-1486. [PMID: 32607855 DOI: 10.1007/s11605-020-04707-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/09/2020] [Accepted: 06/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gangrenous cholecystitis (GC) is a particularly severe form of acute cholecystitis (AC) and is associated with an increased risk of postoperative morbidity and mortality. Recent reports show that surgeons are remarkably unsuccessful in diagnosing GC. METHODS We conducted a retrospective study involving 587 patients with AC. Logistic regression analysis was used to identify independent predictive factors of GC. We assigned points for the score according to the regression coefficient. The area under the curve (AUC) was determined using receiver operating characteristic (ROC) curves. The scoring system was then prospectively validated on a second population. We validated 2 previously published scoring models. RESULTS Six independent predictive factors of GC were identified: [3-]4 ASA score, temperature, duration of symptoms, WBC, male gender, and pericholecystic fluid. A predictive score of GC was established based on these independent predictive factors. Sensitivity was 81.4%; specificity was 70%. The AUC of this clinicoradiological score was 0.83. The AUC of our score was higher than that of the first published score (the AUC was 0.75 in the original report and 0.78 in the validation model using our dataset) and that of the second published score (the AUC was 0.77 in the original report and 0.72 in the validation model using our dataset). CONCLUSIONS The AUC of our score exceeded 0.80, indicating that this score can help in diagnosing patients with GC, and thus in prioritizing these patients for surgery or choosing the adapted technique of drainage in critically ill patients.
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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.
| | - Mouna Madhioub
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Depatment of Gastroenterology, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
| | - Yessin Kallel
- Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.,Depatment of Gastroenterology, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
| | - Slim Zribi
- Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.,Depatment of Gastroenterology, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
| | - Helmi Slama
- Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.,Depatment of Gastroenterology, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
| | - Mohamed Mongi Mighri
- Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.,Depatment of Gastroenterology, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
| | - Hassen Touinsi
- Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.,Depatment of Gastroenterology, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
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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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Laamiri G, Ghalleb M, Ammar NB, Zribi S, Mighri M, Bouassida M, Touinsi H. Bowel obstruction due to the tightening of a loose bowel adhesion with uterus enlargement during pregnancy. J Clin Invest Surg 2020. [DOI: 10.25083/2559.5555/5.2/109.112] [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: 11/05/2022] Open
Abstract
Introduction. Acute intestinal obstruction during pregnancy is a rare digestive surgical emergency. Generally, it is associated with significant maternal and fetal mortality. The diagnosis is difficult, often delaying the therapeutic management. It is reported an exceptional association of acute intestinal obstruction due to a band adhesion that is put into tension as the uterus enlarges. Case Report. A 35 years old Caucasian pregnant woman with a past medical history of appendectomy was examined and found with abdominal pain, severe vomiting, and bowel obstruction. The patient underwent surgery. Per operatively, the obstruction was caused by an adhesion put into tension by the enlargement of the uterus. The postoperative course was uneventful and the patient was discharged on day 2. Conclusions. The etiological diagnosis of acute intestinal obstruction during pregnancy is difficult. Surgery is the cornerstone of the treatment and the management varies depending on the intraoperative findings and the condition of the patient.
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Khalfallah M, Makni A, Bouassida M, Bayar R, Abdelkafi S, Ben Amar M, Arfa N, Nouira R. Recommandations of the Tunisian Association of Surgery for the practice of visceral surgery during COVID-19 pandemic. Tunis Med 2020; 98:442-445. [PMID: 33479960] [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: 06/12/2023]
Abstract
The World Health Organization declared on March 11, 2020 that the COVID-19 epidemic has become a pandemic. In Tunisia, the Ministry of Health has recommended enhanced preventive hygiene measures to contain and limit the spread of the virus. Following the entry of Tunisia into phase 4 of the COVID-19 epidemic, the Tunisian Association of Surgery proposed recommendations related to surgical activity. Surgical emergencies must be treated urgently and without delay. Non-tumor pathologies which require surgery in an elective situation and for which the risk of aggravation or complication is considered low shoud be postponed. For digestive tumor pathology, and apart from complicated forms, neoadjuvant treatment is highly recommended in the context of multidisciplinary concertation staff.
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Zribi S, Bouassida M, Sassi S, Chtourou MF, Mighri MM, Touinsi H. [Giant retroperitoneal liposarcoma]. Presse Med 2018. [PMID: 29530297 DOI: 10.1016/j.lpm.2018.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Slim Zribi
- Mohamed-Tahar-Maamouri hospital, department of surgery, Nabeul, Tunisie; University-El-Manar, faculty of medicine of Tunis, Tunis, Tunisie
| | - Mahdi Bouassida
- Mohamed-Tahar-Maamouri hospital, department of surgery, Nabeul, Tunisie; University-El-Manar, faculty of medicine of Tunis, Tunis, Tunisie.
| | - Selim Sassi
- Mohamed-Tahar-Maamouri hospital, department of surgery, Nabeul, Tunisie; University-El-Manar, faculty of medicine of Tunis, Tunis, Tunisie
| | - Mohamed Fadhel Chtourou
- Mohamed-Tahar-Maamouri hospital, department of surgery, Nabeul, Tunisie; University-El-Manar, faculty of medicine of Tunis, Tunis, Tunisie
| | - Mohamed Mongi Mighri
- Mohamed-Tahar-Maamouri hospital, department of surgery, Nabeul, Tunisie; University-El-Manar, faculty of medicine of Tunis, Tunis, Tunisie
| | - Hassen Touinsi
- Mohamed-Tahar-Maamouri hospital, department of surgery, Nabeul, Tunisie; University-El-Manar, faculty of medicine of Tunis, Tunis, Tunisie
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Mseddi M, Masmoudi A, Bouassida M, Maayouf S, slimen MH, Rebai N, Mhiri M. La cure chirurgicale de la varicocèle chez l’adolescent, améliore-t-elle la croissance testiculaire et les paramètres du spermogramme ? Prog Urol 2017. [DOI: 10.1016/j.purol.2017.07.126] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bouassida M, Chtourou MF, Charrada H, Zribi S, Hamzaoui L, Mighri MM, Touinsi H. The severity grading of acute cholecystitis following the Tokyo Guidelines is the most powerful predictive factor for conversion from laparoscopic cholecystectomy to open cholecystectomy. J Visc Surg 2017; 154:239-243. [PMID: 28709978 DOI: 10.1016/j.jviscsurg.2016.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
BACKGROUND The relationship between the severity assessment of acute cholecystitis based on the Tokyo Guidelines and the risk for conversion from laparoscopic surgery to open surgery has been assessed in few previous reports, with conflicting results. METHODS A retrospective review of patients with acute cholecystitis within a single system from 2010 to 2013 was performed. The diagnosis and severity of acute cholecystitis were assigned by the Tokyo Guidelines 2013 (TG13). The primary outcome measure was conversion to open cholecystectomy. RESULTS During the period of study, 493 patients were operated by laparoscopy for acute cholecystitis. Laparoscopic cholecystectomy was intraoperatively converted to open surgery in 56 cases (11.4%). The multivariate analysis showed that the risk factors for conversion to open surgery included male gender (OR: 2.15; IC95% [1.18-3.9]), diabetes (OR: 2.22; IC95% [1.13-4.33]), total bilirubin levels (OR: 1.02; IC95% [1-1.05]), and the TG13 severity classification (OR: 4.44; IC95% [2.25-8.75]). CONCLUSIONS The independent risk factors for conversion to open surgery included male sex, diabetes mellitus, total bilirubin level, and TG13 grade. TG13 grade was found to be the most powerful predictive factor for conversion as it had the highest OR.
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Affiliation(s)
- M Bouassida
- Department of Surgery, Mohamed Tahar Maamouri Hospital, 8000 Nabeul, Tunisia.
| | - M F Chtourou
- Department of Surgery, Mohamed Tahar Maamouri Hospital, 8000 Nabeul, Tunisia
| | - H Charrada
- Department of Surgery, Mohamed Tahar Maamouri Hospital, 8000 Nabeul, Tunisia
| | - S Zribi
- Department of Surgery, Mohamed Tahar Maamouri Hospital, 8000 Nabeul, Tunisia
| | - L Hamzaoui
- Department of Gastroenterology, Mohamed Tahar Maamouri Hospital, 8000 Nabeul, Tunisia
| | - M M Mighri
- Department of Surgery, Mohamed Tahar Maamouri Hospital, 8000 Nabeul, Tunisia
| | - H Touinsi
- Department of Surgery, Mohamed Tahar Maamouri Hospital, 8000 Nabeul, Tunisia
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27
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Kefi A, Ben Abdelhafidh N, Zribi S, Bouassida M, Touinsi H. Cholangite à IgG4 simulant un cholangiocarcinome de la plaque hilaire : piège diagnostic redoutable. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.145] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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28
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Bouassida M, Smaoui W, Fourati M, Mseddi M, Chabchoub K, Chaabouni A, Rekik S, Rebai N, Masmoudi J, Hadjslimen M, Mhiri M. Étude de la sexualité masculine après dérivation urinaire externe continente de type Mitrofanoff. Prog Urol 2016; 26:115-20. [DOI: 10.1016/j.purol.2015.10.008] [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] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 10/15/2015] [Accepted: 10/16/2015] [Indexed: 10/22/2022]
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29
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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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30
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Mseddi M, Rebai N, Bouassida M, Rekik S, Hadjslimen M, Mhiri M. Amputation du gland après circoncision rituelle : expérience monocentrique devant ce drame familial. Prog Urol 2015; 25:746-7. [DOI: 10.1016/j.purol.2015.08.062] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Bouassida M, Fourati M, Majdoub B, Kammoun O, Rebai N, Slimen MH, Mhiri N. Impact de la promontofixation cœlioscopique sur la qualité de vie et la sexualité : résultats d’une étude prospective portant sur 26 patientes. Prog Urol 2015; 25:844. [DOI: 10.1016/j.purol.2015.08.257] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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32
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Hamzaoui L, Bouassida M, Kilani H, Medhioub M, Chelbi E. Metastatic Squamous Cell Carcinoma of the Stomach. J Clin Diagn Res 2015; 9:OD05-6. [PMID: 26673808 DOI: 10.7860/jcdr/2015/14527.6720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 04/17/2015] [Accepted: 08/05/2015] [Indexed: 12/23/2022]
Abstract
Primary squamous cell carcinoma of the stomach is very rare. Its pathogenesis is unclear and the treatment strategy is controversial. We report an agressive primary squamous cell carcinoma of the stomach with liver and lung metastases in a 55-year-old man. The patient presented with a 1-month history of abdominal pain, vomiting and weight loss. Abdominal ultrasound revealed multiple liver metastases. Endoscopic examination showed two tumour masses on the fundus of the stomach. Biopsy of the lesions revealed squamous cell carcinoma of the stomach. Chest x-ray showed multiple large pulmonary nodules highly suggestive of pulmonary metastases. The patient died ten days after he was admitted because of progression of the tumour and before any therapeutic decision.
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Affiliation(s)
- Lamine Hamzaoui
- Gastroenterologist, Department of Gastroenteroloy, Mohamed Tahar Maamouri Hospital , Nabeul, Tunisia
| | - Mahdi Bouassida
- Surgeon, Department of General Surgery, Mohamed Tahar Maamouri Hospital , Nabeul, Tunisia
| | - Houda Kilani
- Histopathologist, Department of Histopathology, Mohamed Tahar Maamouri Hospital , Nabeul, Tunisia
| | - Mouna Medhioub
- Gastroenterologist, Department of Gastroenteroloy, Mohamed Tahar Maamouri Hospital , Nabeul, Tunisia
| | - Emna Chelbi
- Histopathologist, Department of Histopathology, Mohamed Tahar Maamouri Hospital , Nabeul, Tunisia
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33
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Kefi A, Bouassida M, Ben Abdelhafidh N, Khawla B, Touinsi H. Nécrose colique due au Kayexalate® : à propos d’une lésion médicamenteuse fatale. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.03.197] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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34
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Bouassida M, Charrada H, Chtourou MF, Hamzaoui L, Mighri MM, Sassi S, Azzouz MM, Touinsi H. Surgery for Colorectal Cancer in Elderly Patients: How Could We Improve Early Outcomes ? J Clin Diagn Res 2015; 9:PC04-8. [PMID: 26155516 DOI: 10.7860/jcdr/2015/12213.5973] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 11/20/2014] [Accepted: 03/22/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Age is one of the causes behind the undertreatment of elderly colorectal cancer patients. The increase of mortality among elderly colorectal cancer (CRC) patients is due to competing causes of death occurring in the early post operative period. The purpose of this study was to evaluate the risk factors for post operative mortality and morbidity among elderly CRC patients. MATERIALS AND METHODS A retrospective descriptive chart review was performed on consecutive patients older than 70 y with CRC. We have collected data of 124 patients who were admitted from January 2001 to January 2010. Demographic characteristics, operative and postoperative informations were retrospectively analysed. RESULTS Early postoperative morbidity, operation related to morbidity and mortality were observed in 44 (35.5%), 9 (7.3%) and 20 (16.1%) cases, respectively. No other factors but ASA score (p = 0.002 and 0.005 in univariate and multivariate analyses, respectively) and emergency operations (p<0.001 and 10(-3) in univariate and multivariate analyses, respectively), were found to be risk factors of mortality. The results of multivariate analyses indicated that anaemia (p=0.021) and rectal cancer (p=0.015) had significant impact on the risk of anastomotic leakage. On the other hand, diabetes mellitus and rectal cancer were indicators that correlated with the width of hospitalization. CONCLUSION Elderly CRC patients should no longer be undertreated only because of their age. They should be exposed to more aggressive management than they are currently receiving. Careful preoperative evaluation, followed by medical optimization and planning of perioperative care could improve outcomes of colorectal surgery for elderly patients.
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Affiliation(s)
- Mahdi Bouassida
- Professor, Department of Surgery , Mohamed Tahar Maamouri, Hospital , Mrezga 8000, Nabeul, Tunisia
| | - Hédi Charrada
- Faculty, Department of Anaesthesiology, Mohamed Tahar Maamouri, Hospital , Mrezga 8000, Nabeul, Tunisia
| | - Mohamed Fadhel Chtourou
- Professor, Department of Surgery, Mohamed Tahar Maamouri, Hospital , Mrezga 8000, Nabeul, Tunisia
| | - Lamine Hamzaoui
- Professor, Department of Surgery, Mohamed Tahar Maamouri, Hospital , Mrezga 8000, Nabeul, Tunisia
| | - Mohamed Mongi Mighri
- Student, Department of Surgery, Mohamed Tahar Maamouri, Hospital , Mrezga 8000, Nabeul, Tunisia
| | - Selim Sassi
- Professor, Department of Surgery, Mohamed Tahar Maamouri, Hospital , Mrezga 8000, Nabeul, Tunisia
| | - Mohamed M'Saddak Azzouz
- Student, Department of Gastro Enterology, Mohamed Tahar Maamouri, Hospital , Mrezga 8000, Nabeul, Tunisia
| | - Hassen Touinsi
- Student, Department of Surgery, Mohamed Tahar Maamouri, Hospital , Mrezga 8000, Nabeul, Tunisia
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35
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Hamzaoui L, Kilani H, Bouassida M, Chelbi E, Medhioub M, Msadak Azouz M. [Endoscopic resection of a dermoid rectal cyst]. Presse Med 2015; 44:554-5. [PMID: 25908181 DOI: 10.1016/j.lpm.2015.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 01/19/2015] [Accepted: 01/29/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Lamine Hamzaoui
- Université Tunis-El Manar, faculté de médecine de Tunis, hôpital Mohamed Tahar Maamouri, service de gastroentérologie, 8000 Nabeul, Tunisie.
| | - Houda Kilani
- Université Tunis-El Manar, faculté de médecine de Tunis, hôpital Mohamed Tahar Maamouri, service d'anatomopathologie, 8000 Nabeul, Tunisie
| | - Mahdi Bouassida
- Université Tunis-El Manar, faculté de médecine de Tunis, hôpital Mohamed Tahar Maamouri, service de chirurgie générale, 8000 Nabeul, Tunisie
| | - Emna Chelbi
- Université Tunis-El Manar, faculté de médecine de Tunis, hôpital Mohamed Tahar Maamouri, service d'anatomopathologie, 8000 Nabeul, Tunisie
| | - Mouna Medhioub
- Université Tunis-El Manar, faculté de médecine de Tunis, hôpital Mohamed Tahar Maamouri, service de gastroentérologie, 8000 Nabeul, Tunisie
| | - Mohamed Msadak Azouz
- Université Tunis-El Manar, faculté de médecine de Tunis, hôpital Mohamed Tahar Maamouri, service de gastroentérologie, 8000 Nabeul, Tunisie
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36
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Bouassida M, Bouzaidi K, Nachi S, Chtourou MF, Mighri MM, Touinsi H. [Rare cause of ileo-colic intessusception in adults]. Presse Med 2015; 44:348-9. [PMID: 25578553 DOI: 10.1016/j.lpm.2014.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 09/23/2014] [Accepted: 10/09/2014] [Indexed: 11/28/2022] Open
Affiliation(s)
- Mahdi Bouassida
- Hôpital Mohamed Tahar Maamouri, service de chirurgie générale, Nabeul 8000, Tunisie.
| | - Khaled Bouzaidi
- Hôpital Mohamed Tahar Maamouri, service d'imagerie médicale, Nabeul 8000, Tunisie
| | - Salwa Nachi
- Hôpital Mohamed Tahar Maamouri, service d'anatomo-pathologie, Nabeul 8000, Tunisie
| | | | - Mohamed Mongi Mighri
- Hôpital Mohamed Tahar Maamouri, service de chirurgie générale, Nabeul 8000, Tunisie
| | - Hassen Touinsi
- Hôpital Mohamed Tahar Maamouri, service de chirurgie générale, Nabeul 8000, Tunisie
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37
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Affiliation(s)
- Mahdi Bouassida
- Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
| | - Selim Sassi
- Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
| | | | - Hassen Touinsi
- Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
| | - Sadok Sassi
- Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
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38
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Rebai N, Fourati M, Chaabouni A, Bouassida M, Rekik S, Smaoui W, Hadj Slimen M, Mhiri M. Corrélation entre fractures du bassin et complications urinaires : une étude à propos de 62 cas. Prog Urol 2014; 24:827-8. [DOI: 10.1016/j.purol.2014.08.101] [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] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bouzaïdi K, Daghfous A, Chahbani H, Bouassida M, Jabnoun F, Rezgui Marhoul L. An incidental rare lesion. Diagn Interv Imaging 2014. [DOI: 10.1016/j.diii.2014.04.012] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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40
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Mseddi M, Bouassida M, Chaabouni A, Rebai N, Chabchoub K, Bahloul A, Hadj Slimen M, Mhiri M. Métastase orbitaire d’un adénocarcinome prostatique: à propos d’un cas. African Journal of Urology 2014. [DOI: 10.1016/j.afju.2014.03.036] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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41
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Masmoudi J, Feki I, Trigui D, Bouassida M, Mnif L, Wali M, Hadj Slimen M, Mhiri M, Jaoua A. Perception de l’image du corps et sexualité féminine : enquête auprès de 100 femmes tunisiennes. Sexologies 2014. [DOI: 10.1016/j.sexol.2013.10.003] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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42
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Benali M, Bouassida M, Dhouib F, Bouzeidi K. [Pseudo-HELLP syndrome from folate and/or vitamin B12 deficiency: case report]. Pan Afr Med J 2014; 18:99. [PMID: 25404961 PMCID: PMC4232030 DOI: 10.11604/pamj.2014.18.99.2483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/20/2013] [Accepted: 03/11/2013] [Indexed: 11/11/2022] Open
Abstract
Plusieurs pathologies médicales peuvent interférer avec la grossesse et mimer le tableau biologique de HELLP syndrome. L’évolution naturelle de ce syndrome est d'une particulière gravité pour la mère et le fœtus, il convient d’éliminer rapidement les autres diagnostics afin d’éviter une extraction fœtale prématurée injustifiée. Nous rapportons le cas d'une parturiente qui s'est présentée avec un tableau évocateur d'un HELLP syndrome, rapporté finalement à une carence en folates et en vitamine B12.
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Affiliation(s)
- Mechaal Benali
- Service d'anesthésie réanimation, hôpital Taher Maamouri, Nabeul 8000, Tunisie
| | - Mahdi Bouassida
- Service de chirurgie générale, hôpital Taher Maamouri, Nabeul 8000, Tunisie
| | - Firas Dhouib
- Service d'anesthésie réanimation, hôpital Taher Maamouri, Nabeul 8000, Tunisie
| | - Kaled Bouzeidi
- Service d'imagerie médicale, hôpital Taher Maamouri, Nabeul 8000, Tunisie
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Affiliation(s)
- K Bouzaïdi
- Department of Radiology, MT Maamouri Hospital, 8000 Nabeul, Tunisia.
| | - A Daghfous
- Department of Radiology, Trauma Center, Tunis, Tunisia
| | - H Chahbani
- Department of Radiology, MT Maamouri Hospital, 8000 Nabeul, Tunisia
| | - M Bouassida
- Department of Surgery, MT Maamouri Hospital, Nabeul, Tunisia
| | - F Jabnoun
- Department of Radiology, MT Maamouri Hospital, 8000 Nabeul, Tunisia
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44
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Chaabouni A, Rebai N, Bouassida M, Fourati M, Chaabène W, Chabchoub K, Hadj Slimen M, Mhiri M. Une verge douloureuse révélant une thrombose veineuse profonde de la verge. À propos de sept cas et revue de la littérature. Sexologies 2014. [DOI: 10.1016/j.sexol.2013.12.011] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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45
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Bouassida M, Chtourou MF, Hamzaoui L, Sassi S, Mighri MM, Azzouz MM, Touinsi H, Sassi S. Clinico-Pathological Caracteristics, Therapeutic Features and Post-operative Course of Colorectal Cancer in Elderly Patients. J Clin Diagn Res 2014; 8:77-9. [PMID: 24596729 PMCID: PMC3939593 DOI: 10.7860/jcdr/2014/6294.3774] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 08/18/2013] [Indexed: 11/24/2022]
Abstract
STATEMENT OF PROBLEM Colorectal cancer is predominantly a disease of elderly people and is a major cause of morbidity and mortality in the elderly population. The geriatric colorectal population is a very heterogeneous group, including patients with excellent health status and others with comorbid conditions, functional dependency, and limited life expectancy. On the other hand, the effectiveness of surgery for colorectal cancer depends on it being carried out safely, which allows most patients to return to productive lives, with an improved post-operative life expectancy or at least one that is not diminished by the surgery. MATERIALS AND METHODS This work is a descriptive study of a retrospective cohort, based on administrative databases, of all patients with colorectal cancer diagnosed or treated in our institution. We extracted data on sociodemographic characteristics, comorbidity, type of cancer, stage of cancer, type of treatment received, post-operative complications and cause of post-operative death. We compared differences between an elderly group (Group A) (age >75 years) and a group of patients below 75 years (Group B). RESULTS We found that elderly patients with colorectal cancer were more likely to be operated in emergent conditions, had more non-specific complications and more post-operative mortality than patients below 75 years. On the other hand, tumours stages, tumours characteristics and post-operative specific morbidity have been proved to be similar, both in Group A and Group B patients. CONCLUSION These results suggest that surgery is feasible and can be safe for patients above 75 years, but it needs much more evaluation of comorbidities, pre- and post-operative intensive care to avoid post-operative non-specific complications.
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Affiliation(s)
- Mahdi Bouassida
- Professor, Department of Surgery, Mohamed Tahar Maamouri Hospital, Mrazga 8000 Nabeul, Tunisia
| | - Mohamed Fadhel Chtourou
- Professor, Department of Surgery, Mohamed Tahar Maamouri Hospital, Mrazga 8000 Nabeul, Tunisia
| | - Lamine Hamzaoui
- Professor, Department of Gastroenterology, Mohamed Tahar Maamouri Hospital, Mrazga 8000 Nabeul
| | - Selim Sassi
- Professor, Department of Surgery, Mohamed Tahar Maamouri Hospital, Mrazga 8000 Nabeul, Tunisia
| | - Mohamed Mongi Mighri
- Student, Department of Surgery, Mohamed Tahar Maamouri Hospital, Mrazga 8000 Nabeul, Tunisia
| | - Mohamed M’Saddak Azzouz
- Student, Department of Gastroenterology, Mohamed Tahar Maamouri Hospital, Mrazga 8000 Nabeul, Tunisia
| | - Hassen Touinsi
- Student, Department of Surgery, Mohamed Tahar Maamouri Hospital, Mrazga 8000 Nabeul, Tunisia
| | - Sadok Sassi
- Student, Department of Surgery, Mohamed Tahar Maamouri Hospital, Mrazga 8000 Nabeul, Tunisia
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Rebai N, Chaabouni A, Bouassida M, Fourati M, Chabchoub K, Slimen MH, Mhiri M. Le ganglioneurome rétropéritonéal: À propos de 5 cas et revue de la littérature. African Journal of Urology 2013. [DOI: 10.1016/j.afju.2013.08.002] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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47
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Bouassida M, Chtourou MF, Chalbi E, Chebbi F, Hamzaoui L, Sassi S, Charfi L, Mighri MM, Touinsi H, Sassi A. Appendiceal GIST: report of an exceptional case and review of the literature. Pan Afr Med J 2013; 15:85. [PMID: 24171067 PMCID: PMC3810228 DOI: 10.11604/pamj.2013.15.85.2430] [Citation(s) in RCA: 7] [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: 02/02/2013] [Accepted: 02/10/2013] [Indexed: 02/02/2023] Open
Abstract
Gastro-intestinal stromal tumors (GISTs) of the appendix are a rare entity. To date, only eight cases has been described in the literature, most of which have been of the benign type. We report a new case of an appendiceal GIST in a 75-year-old man. The tumor was discovered when the patient presented with acute appendiceacal peritonitis. Preoperative diagnosis of appendiceal GIST was rarely done as tumors were usually associated with appendicitis-like symptoms.
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Affiliation(s)
- Mahdi Bouassida
- Department of surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
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48
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Benali M, Charrada H, Bouassida M, Bahloul A, Jmal K, Dhouib F, Saied MR, Khaddar MK. [Splenic artery aneurysm rupture in late pregnancy: A case report]. ACTA ACUST UNITED AC 2013; 32:721-2. [PMID: 23993218 DOI: 10.1016/j.annfar.2013.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 06/28/2013] [Indexed: 11/15/2022]
Affiliation(s)
- M Benali
- Service d'anesthésie réanimation, hôpital Mohamed Tahr Maamouri, Nabeul, Tunisie.
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49
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Hamzaoui L, Kilani H, Bouassida M, Mahmoudi M, Chalbi E, Siai K, Ezzine H, Touinsi H, Azzouz MM, Sassi S. Iatrogenic colorectal Kaposi sarcoma complicating a refractory ulcerative colitis in a human immunodeficiency negative-virus patient. Pan Afr Med J 2013; 15:154. [PMID: 24396560 PMCID: PMC3880822 DOI: 10.11604/pamj.2013.15.154.2988] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [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: 06/18/2013] [Accepted: 08/23/2013] [Indexed: 11/11/2022] Open
Abstract
Kaposi sarcoma is a mesenchymal tumor associated to a human herpes virus-8. It often occurs in human immunodeficiency virus-positive subjects. Colorectal localization is rare. We report the case of a colorectal Kaposi sarcoma complicating a refractory ulcerative colitis treated with surgery after the failure of immunomodulator therapy in a human immunodeficiency virus-negative heterosexual man.
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Affiliation(s)
- Lamine Hamzaoui
- Gastroenterology department, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
| | - Houda Kilani
- Histopathology department, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
| | - Mahdi Bouassida
- General surgery department, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
| | - Moufida Mahmoudi
- Gastroenterology department, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
| | - Emna Chalbi
- Histopathology department, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
| | - Karima Siai
- Gastroenterology department, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
| | - Heykel Ezzine
- Gastroenterology department, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
| | - Hassen Touinsi
- General surgery department, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
| | | | - Sadok Sassi
- Gastroenterology department, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
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Bouassida M, Mighri MM, Chtourou MF, Sassi S, Touinsi H, Hajji H, Sassi S. Retroportal lamina or mesopancreas? Lessons learned by anatomical and histological study of thirty three cadaveric dissections. Int J Surg 2013; 11:834-6. [PMID: 23994001 DOI: 10.1016/j.ijsu.2013.08.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [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: 04/17/2013] [Revised: 06/13/2013] [Accepted: 08/20/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVE AND BACKGROUND Despite its importance in pancreatic head carcinoma, the retroportal lamina is still under studied, with only two anatomical cadaveric dissections in the English literature, with recent controversies about the concept of a mesopancreas. METHODS Resection of the mesopancreas was performed in 33 fresh cadavers. The pancreas and mesopancreas were separated from each other and the mesopancreas was immunohistochemically investigated. RESULTS The retroportal lamina is roughly rectangular in shape. Its dimensions are: height 6.2 cm (5-8), 2.5 cm wide (1.5-4). It contains a right hepatic artery arising from the superior mesenteric artery in 13.3% of cases. Microscopic examination revealed areolar tissue, adipose tissue, peripheral nerve, nerve plexus, lymphatics and capillaries. However, fibrous sheath and fascia were not found around these structures. CONCLUSION A right hepatic artery arising from the superior mesenteric artery is a frequent anatomic variation. Surgeons must be aware of this to ensure the integrity of the hepatic artery blood supply in patients treated by pancreaticoduodenectomy. Despite controversy about the reality of the mesopancreas (postulated in analogy to the mesorectum), because of the absence of fibrous sheath or fascia, its complete removal in pancreatic head carcinoma is feasible by a subadventitial dissection of the superior mesenteric artery which can be considered as the real limit of the mesopancreas.
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Affiliation(s)
- Mahdi Bouassida
- Department of Surgery, Mohamed Tahar Maamouri Hospital, Mrezga, 8000 Nabeul, Tunisia; Université Tunis-El Manar, Faculté de Médecine de Tunis, 15, rue Djebel Akhdhar, Tunis, Tunisia.
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