[Implementation of the safe surgery checklist of the World Health Organization at the University Hospital of Monastir (Tunisia)]. / Implémentation de la liste de contrôle chirurgical de l'Organisation Mondiale de la Santé au niveau de l'hôpital universitaire de Monastir (Tunisie).

OBJECTIVE: To evaluate the impact of introduction of the WHO safe surgery checklist in the university hospital of Monastir over a period of five months. METHODS: We conducted a longitudinal study (before - after) with evaluation of five result indicators which were: percentage of surgical site infections, not prescribed antibioprophylaxis, unplanned return to the operating room, postoperative length of stay and postoperatively death. RESULTS: We identified 185 patients during the period and 323 patients after the introduction of the WHO checklist. The proportion of surgical site infection decreased significantly from 13.5% in the reference period to 1.3% after the introduction of the checklist (p < 0.001). The proportion of unplanned return to the operative room was 10.3% before the introduction of the checklist and deceased significantly to 1.3% at the intervention period (p = 0.003). The proportion of not prescribed antibioprophylaxis and median post-operative length of stay deceased also significantly during the study period (p < 0.001). CONCLUSION: The surgical checklist control contributes to the development of a safety culture in the operating room. Maintaining its use should be supported by incentives such as certification and accreditation.

Autoimmune pancreatitis mimicking pancreatic cancer.

CONTEXT: Autoimmune pancreatitis is a particular type of pancreatitis of presumed autoimmune etiology, it is an entity distinct from all others forms of chronic pancreatitis, characterized by clinical, histopathological, radiographic, serologic and therapeutic features. This benign disease resembles pancreatic carcinoma both clinically and radiographically. CASE REPORT: A 27-year-old man presented with obstructive jaundice and evocative image of pancreatic tumor. A pancreaticoduodenectomy (Whipple operation) was performed and pathological examination of the specimen diagnosed AIP. Patient responded well to a course of corticosteroids with resolution of clinical and biological disorders. CONCLUSION: Accurate and timely diagnosis of autoimmune pancreatitis is particularly important because steroid therapy is effective and pancreatic resection is not necessary.

Liver cystic echinococcosis: which cysts are correlated with false negative indirect passive hemagglutination (IHA)?

BACKGROUND: It's generally agreed that calcified liver cystic Echinococcosis (CE) is associated with negative serology; the influence of other cystic features on serologic result remains unclear. The aim of this study is to determine predictive factors of negative indirect passive hemagglutination (IHA) in liver CE. METHODS: 119 patients operated on for liver CE, had preoperative IHA. Correlation was studied between serological result and sex, age of patient and number (single vs multiple), size, ultrasonic type (unilocular, multivesicular, degenerative) and intrabiliary rupture of cyst. RESULTS: IHA sensitivity was 74.8%. Univaried analysis showed that false negative serology was correlated with age <10 or >20 years (p < 0.01), single cyst (p < 0.006), cystic size <9 cm (p < 0.03) and unilocular or degenerative cyst in comparison with multivesicular type (p < 0.01 and p < 0.03 respectively). IN CONCLUSION: in liver CE, cystic predictive factors of false negative IHA are single cyst, unilocular or degenerative type and size inferior to 9 cm.

[Intussusception in adults. Thirteen case reports]. / Invaginations intestinales de l'adulte. A propos de 13 cas.

This study was retrospective. The authors analyse the clinical, etiological and therapeutic aspects of the intestinal intussusception based on 13 adults observed over 14 years in the surgical department of the university hospital in Monastir. This disease was rare because accounted for 2.6% of all cases of intestinal obstruction. The diagnosis was made in the majority of cases during the operation (8/13). Abdominal pain was noted in all cases. The underlying pathologic processes were identified in 69%. Operation was required in every case. During the surgery, the lead point was identified in the small bowel in 12 cases and in the colon in one case. An intestinal tumor was found in four patients (39%), only one of which was malignant. Adult intussusception is an unusual cause of abdominal pain and bowel obstruction. It requires preoperative diagnosis. Operative management is always necessary because this condition is almost always secondary to definable lesion.

[Peutz-Jeghers syndrome. Two case reports]. / Le syndrome de Peutz Jeghers. A propos de deux cas.

The Peutz jeghers syndrome is a familial affection with dominant autosomic transmission characterized by a hamartoma digestive polyposis and a cutaneous mucous lentiginosis with periorifice predominance. This affection represented 3 into 10% for the familial polyps. The digestive polyps constitute the must important part of the pentz jeghers syndrome because they determined to only the clinic manifestation and the disease prognostic with there complications: intestinal invaginations, haemorrhage. In this work, we report two observations of patients presented a Peurtz Jeghers syndrome, and we determine, after literature review the epidemiologic, pathogenic, clinic, anatomy pathologic, prognosis and therapeutics of this effection.

[Congenital diaphragmatic hernias in the adult: report of six cases]. / Les hernies diaphragmatiques congenitales de l'adulte: a propos de six cas.

The anterior hernia or the fissure of Larrey and Bochdalek hernia are exceptional in adult. We present 6 cases of congenital diaphragmatic hernia revealed in adult. Three hernia of the fissure of Larrey and three Bochdalek hernia. We discuss the different clinical, radiological, and therapeutic aspects of these hernia. We insist on the gravity of strangulated hernia and their surgical treatment.