Gastric lipoma: An unusual cause of the upper gastrointestinal bleeding.

INTRODUCTION: Gastric lipomas, though rare, are noteworthy for their potential to cause upper gastrointestinal bleeding. This case report highlights the diagnostic and management challenges associated with this uncommon entity. CASE PRESENTATION: We present a case of a 39-year-old male with epigastric pain and hematemesis, ultimately diagnosed with a gastric lipoma in the antrum. Endoscopy revealed a submucosal lesion with mucosal ulceration, confirmed by imaging studies. Surgical resection was performed, leading to a favorable outcome. CLINICAL DISCUSSION: Gastric lipomas are benign tumors that can present with gastrointestinal bleeding, abdominal pain, or obstruction. Diagnosis relies on imaging and endoscopic findings, with biopsy often inconclusive due to the submucosal location. Surgical resection is the preferred treatment for symptomatic or large lipomas, while observation may suffice for asymptomatic lesions. CONCLUSION: Gastric lipomas, although infrequent, pose a challenge for diagnosis, especially when associated with bleeding. Surgical resection remains the cornerstone of management for symptomatic or large lipomas, with observation being an option for asymptomatic lesions.

Financial fallout from the COVID-19 pandemic:Report from a high-volume academic neurosurgery.

BACKGROUND: The global healthcare system has been overwhelmed by the Coronavirus disease-2019 (COVID-19). In order to mitigate the risk of spread of the virus, most elective surgical procedures have been cancelled especially during the lockdown periods. The purpose of this study was to assess the financial impact of the COVID outbreak due to the supposed reduced workload from our neurosurgery department in 2020. METHODS: Number of neurosurgical procedures (NSP) within the Department of Neurosurgery and their associated estimated income were retrospectively reviewed globally and month wise from administrative records of billing in 2020 and 2019 based on the Diagnosis related group (DRG) and severity of illness (4 levels). RESULTS: Overall, 824 and 818 inpatient surgical procedures were performed in 2019 and 2020 respectively. The total estimate revenue generated from inpatient surgeries was moderately decreased (3%): 9 498 226.41 euros in 2020 versus 9 817 361.65 euros in 2019 without significant difference across DRG (P=0.96) and severity of illness. CONCLUSIONS: Our data suggests a moderate negative impact of the COVID-19 pandemic had on neurosurgical and financial activity. However, a more in-depth medico-economic analysis need to be performed to assess the real financial impact.

Scimitar syndrome with bicuspid aortic valve. A case report of cross-sectional non- invasive imaging allowing a complete anatomical and functional assessment.

Scimitar syndrome is a variant of partial anomalous pulmonary venous return with an aberrant vein, the Scimitar vein, draining the right lung to the inferior vena cava instead of the left atrium, resulting in a left-to-right shunt. The classic frontal radiographic finding, designated as "the scimitar sign", is of a scimitar (a Turkish sword) shaped density along the right cardiac border. The diagnosis can be made by echocardiography, and cardiac catheterisation remains the gold standard to assess the left-to-right shunt. However, the place of multimodal cardiac imaging by computed tomography and magnetic resonance imaging is increasing. We report the case of a 26 year-old man presenting with chest pain during a brief panic attack, in whom scimitar syndrome was associated with a bicuspid aortic valve, a clinical association rarely reported in the literature. CT and MRI cardiac imaging was as accurate as echocardiography and hemodynamics, particularly for shunt quantification.

[Adjuvant and neoadjuvant radiotherapy in breast cancer: A literaure review and update on the state of the evidence in 2020]. / Radiothérapie adjuvante et néoadjuvante des cancers du sein : mise au point sur les données de la littérature disponibles en 2020.

Radiation therapy has benefited from many developments over the past 20 years. These developments are mainly linked to the technology, imaging and informatics evolutions which allow better targets definitions, ensure better organs-at-risk sparing and excellent reproducibility of treatments, with a perfect control of patient positioning. In breast cancer radiotherapy, the evolution was marked by the possibility of reducing the duration of treatments from 6-7 to 3-4 weeks by using hypofractionated regimens, or by further reducing the irradiation to one week when treatment is solely focalised to the tumour bed. This concept of accelerated partial breast irradiation has challenged the paradigm of the obligation to irradiate the whole breast after conservative surgery in all patients. In addition, the technical mastery of accelerated partial breast irradiation and the development of stereotactic radiotherapy techniques are currently contributing to the development of research projects in neoadjuvant settings. Thus, numerous ongoing studies are evaluating the impact of high-dose preoperative tumour irradiation, alone or in combination with systemic treatments, on biological tumor changes, on anti-tumour immunity, and on the pathologic complete response, which is considered as predictive of better long-term survival in some molecular breast cancer subtypes. In this review, we discuss all these developments which allow breast radiation therapy to enter the era of personalisation of treatments in oncology.

[Inherited kidney stones: A nephrology center experience]. / Lithiase urinaire héréditaire : expérience d'un service de néphrologie.

INTRODUCTION: Genetic factors must be considered in etiological diagnosis of urinary lithiasis. The aim of this study was to determine clinical, metabolic characteristics and the progression of hereditary urinary lithiasis in our patients. METHODS: A retrospective study was conducted between 2008 and 2018 and 60 patients were included. Patients were referred to our department from pediatrics departments to be followed-up in adulthood in 9 cases, for etiological investigation in 42 cases and for chronic renal failure in 9 cases. RESULTS: Thirty-five men and twenty-five women were enrolled in this study with a M/F sex ratio equal to 1.4. The mean age at the time of diagnosis of the hereditary character of the urinary lithiasis was 28.6years (3months-63years). The average delay between the onset of the lithiasis disease and the etiological diagnosis was 8years (0-42years). We noted 31 cases of cystinuria, 18 cases of primary hyperoxaluria type 1 with two mutations (I244T in 14 cases, 33-34 Insc in 23 cases) and 11 cases of renal tubulopathy. Fourteen patients were affected with chronic renal failure, of which five were in the end-stage renal disease. Crystalluria was positive in 62% of cases. The morpho-constitutional analysis of stones was performed in 37 cases and it contributed to the diagnosis in 29 cases. After an average follow-up of 16years, we noted normal renal function in 42 cases, chronic renal failure in 7 cases, hemodialysis in 10 cases all with primary hyperoxaluria and transplantation in 1 case. CONCLUSION: The etiological diagnosis of hereditary urinary lithiasis in our study was made with considerable delay. Cystinuria was the most frequent etiology and primary hyperoxaluria was the most serious affection. LEVEL OF EVIDENCE: 4.

Intercostal, ilioinguinal, and iliohypogastric nerve transfers for lower limb reinnervation after spinal cord injury: an anatomical feasibility and experimental study.

OBJECTIVESpinal cord injury (SCI) has been investigated in various animal studies. One promising therapeutic approach involves the transfer of peripheral nerves originating above the level of injury into those originating below the level of injury. The purpose of the present study was to evaluate the feasibility of nerve transfers for reinnervation of lower limbs in patients suffering SCI to restore some hip and knee functions, enabling them to independently stand or even step forward with assistive devices and thus improve their quality of life.METHODSThe feasibility of transferring intercostal to gluteal nerves and the ilioinguinal and iliohypogastric nerves to femoral nerves was assessed in 5 cadavers. Then, lumbar cord hemitransection was performed below L1 in 20 dogs, followed by transfer of the 10th, 11th, and 12th intercostal and subcostal nerves to gluteal nerves and the ilioinguinal and iliohypogastric nerves to the femoral nerve in only 10 dogs (NT group). At 6 months, clinical and electrophysiological evaluations of the recipient nerves and their motor targets were performed.RESULTSThe donor nerves had sufficient length to reach the recipient nerves in a tension-free manner. At 6 months postoperatively, the mean conduction velocity of gluteal and femoral nerves, respectively, increased to 96.1% and 92.8% of the velocity in controls, and there was significant motor recovery of the quadriceps femoris and glutei.CONCLUSIONSIntercostal, ilioinguinal, and iliohypogastric nerves are suitable donors to transfer to the gluteal and femoral nerves after SCI to restore some hip and knee motor functions.

Retro-peritoneal paraganglioma, diagnosis and management.

INTRODUCTION: Paragangliomas, defined as extra-adrenal chromaffin-cells tumors, are rarely located in the retro-peritoneum. Clinical presentation is similar to pheochromocytoma, and mainly depends on the producing character of the tumor. Positive diagnosis requires plasmatic and urinary hormonal assays. Radiological and isotopic explorations are essential before surgery. The only curative therapeutic strategy is surgical, associated to peri-operative prevention and monitoring of the frequently reported hemodynamic and cardiovascular disorders. Outcome depends of the metastatic character of the tumor, the presence of tumor remnant after surgical resection. Genetic study is recommended; the risk of recurrence and association to other neoplasm is more described in genetic forms. MATERIAL AND METHODS: Authors report 5cases of retro-peritoneal paraganglioma, operated in the department of urology of Hospital, between 2013 and 2017. Observations are about 2men and 3women. Clinical presentation is not always specific and paraganglioma may be discovered fortuitously. Two patients have been operated by coelioscopic approach, midline incision was performed in two other cases, and dorsal lumbotomy associated to a Rutherford-Morrison incision in a patient. RESULTS: Two patients presented resistant hypertension and palpitation associated to suspect retro-peritoneal masses in imagery and elevated urinary methoxylated derivates before surgery. One patient was asymptomatic and the tumor was discovered in imagery. Per-operative hypertensive crisis and sinus tachycardia occurred in a case. The average follow-up period is 22.8months. Hypertension and palpitation disappeared after surgery. There was no recurrence for all the operated patients. CONCLUSION: Retro-peritoneal paraganglioma is a rare condition. Symptoms are not specific and clinical presentation may be similar to pheochromocytoma. Abdominal CT-scan and MRI, in association with MIBG scintigraphy are strongly evocative. Histological examination ensures diagnosis. Per-operative cardio-vascular disorders are to consider and must prevented and managed by anesthesiologists. Complete surgical resection is the only curative treatment and avoids recurrences.

Splenogonadal fusion - a rare cause of scrotal swelling: a case report.

BACKGROUND: Splenogonadal fusion is a rare and benign condition. Diagnosis is challenging for clinicians. Despite its indolence, diagnosis is often confirmed after orchidectomy. Surgery is mandatory, particularly to rule out the extremely rare association with malignancy. CASE PRESENTATION: We report a case of splenogonadal fusion in a 38-year-old North African man presenting a palpable scrotal mass. We describe clinical aspects, pathogenic hypothesis, radiological features, as well as surgical management principles. CONCLUSIONS: Splenogonadal fusion is rarely suspected and diagnosed preoperatively. A diagnosis is made once an ectopic testicular mass is associated with cryptorchidism and suggestive radiological signs. A better knowledge of the clinical and radiological features of splenogonadal fusion provides an opportunity for conservative surgery.

Supplementation of Nigella sativa seeds to Barbarine lambs raised on low- or high-concentrate diets: Effects on meat fatty acid composition and oxidative stability.

Twenty-eight Barbarine male lambs were used to investigate the effect of dietary Nigella sativa seeds (NSS) on meat fatty acids and oxidative stability in two different feeding systems (high- or low-concentrate). Dietary treatments were planned to offer: 70% barley hay and 30% concentrate (LC); LC+12g/day of NSS (LCN); 30% barley hay and 70% concentrate (HC); HC+12g/day of NSS (HCN). NSS increased intramuscular fat only in the low-concentrate system (P=0.039); accordingly, the content of 14:0, c-9 14:1, t-9 18:1, t-11 18:1 and both individual and sum of odd and branched chain fatty acids were greater in LCN than LC meat. TBARS in raw meat increased from 0 to 3days of refrigerated storage regardless NSS supplementation. From 3 to 6days, TBARS further increased only in the meat from lambs not receiving NSS. At 6-days storage, TBARS were lower (P<0.05) in the meat of lambs receiving NSS compared to the meat of lambs not receiving NSS.

Transitional Bladder Cell Carcinoma Spreading to the Skin.

Cutaneous metastases from bladder malignancies are rare. We report the case of a 74 year old man who underwent cysto-prostatectomy and adjuvant chemotherapy for a pT3b N+ bladder transitional cell carcinoma. Four months later, he presented with skin disseminated pigmented lesions. Skin biopsy confirmed cutaneous metastasis from urothelial carcinoma.

The predictor of mortality outcome in adult patients with Ebola virus disease during the 2014-2015 outbreak in Guinea.

The purpose of this study was to examine the association of any demographic and clinical factors with mortality outcome among adult patients with Ebola virus disease (EVD) in Guinea. This retrospective observational study analyzed medical records of laboratory confirmed EVD adult patients during the 2014-2015 EVD outbreak in Guinea. The associations between any demographic or clinical variables and mortality outcome of EVD were assessed using univariate and multivariate logistic regression analyses. Of 2,310 EVD adult patients included for analysis, the overall case fatality rate was 68.1%. Univariate analyses identified factors possibly associated with mortality outcome, including patient age (p < 0.001), history of visiting or close contact with a suspected or confirmed EVD patient (p = 0.035), and seven clinical symptoms on admission, i.e., fever (p = 0.003), hiccups (p < 0.001), vomiting (p = 0.003), diarrhea (p < 0.001), cough (p = 0.001), sore throat (p = 0.016), and unexplained bleeding (p = 0.021). The multivariate analysis showed that patient age was independently associated with mortality outcome of EVD (OR = 1.06; 95%CI = 1.03-1.09; p < 0.001), while none the of clinical symptoms on admission were significantly associated with the mortality outcome. Our analysis indicates that older age was the only independent factor associated with death among EVD adult patients in Guinea. This suggests that older EVD patients should receive intensive medical care and be carefully monitored.

Maximal power training induced different improvement in throwing velocity and muscle strength according to playing positions in elite male handball players.

This study was designed to assess the effect of strength and power training on throwing velocity and muscle strength in handball players according to their playing positions. Twenty-two male handball players were assigned to either an experimental group (n=11) or a control group (n=11) (age: 22.1 ± 3.0 years). They were asked to complete (i) the ball throwing velocity test and (ii) the one-repetition maximum (1-RM) tests for the half-back squat, the pull-over, the bench press, the developed neck, and the print exercises before and after 12 weeks of maximal power training. The training was designed to improve strength and power with an intensity of 85-95% of the 1RM. In addition to their usual routine handball training sessions, participants performed two sessions per week. During each session, they performed 3-5 sets of 3-8 repetitions with 3 min of rest in between. Then, they performed specific shots (i.e., 12 to 40). Ball-throwing velocity (p<0.001) was higher after the training period in rear line players (RL). The training programme resulted in an improvement of 1RM bench press (p<0.001), 1RM developed neck (p<0.001) and 1RM print (p<0.001) in both front line (FL) and RL. The control group showed a significant improvement only in ball-throwing velocity (p<0.01) and 1RM bench press (p<0.01) in RL. A significantly greater improvement was found in ball-throwing velocity (p<0.001), 1RM bench press (p<0.001), and 1RM half-back squat exercises in players of the central axis (CA) compared to the lateral axis (LA) (p<0.01). The power training programme induced significantly greater increases in ball-throwing velocity and muscle strength in FL than RL and in CA than LA axis players.

Biological control of the grapevine diseases 'grey mold' and 'powdery mildew' by Bacillus B27 and B29 strains.

Uncinula necator and Botrytis cinerea are the most destructive pathogens of the grapevine in Tunisia and elsewhere. We used two strains of Bacillus subtilis group, B27 and B29 to control powdery mildew and the grey mold disease of the grapevine. Green house experiments showed that B29 and B27 strains of the bacteria efficiently reduced the severity of powdery mildew up to 50% and 60%, respectively. Further, they decreased Botrytis cinerea development on grape leaf by 77% and 99%, respectively. The mode of action has been shown to be chitinolytic. These two bacteria showed significant production of total proteins discharged into the culture medium. Determination of some chitinolytic enzymes revealed the involvement of N-acetyl glucosaminidase (Nagase), the chitin-1,4-chitobiosidase (Biase) and endochitinase in degrading the mycelium of B. cinerea.

First Report of Mature Citrus Trees Being Affected by Fusarium Wilt in Tunisia.

Citrus is an important crop in Tunisia and over 98% of trees of all varieties are grafted on sour orange rootstock. Since September 2010, unusual wilt symptoms have been observed in Takilsa, Bni-Khaled, and Manzel Bouzalfa fields that eventually caused tree death. The disease was observed on 10- to 25-year-old trees of sweet orange (Citrus sinensis) 'Washington Navel' and on 'Clementine' tangerines (C. tangerina) 'Cassar,' 'Hernandina,' and 'MA3,' all grafted on sour orange (C. aurantum) 'Bigarade Gou Tou.' The most conspicuous symptoms were wilting of sections of the canopy, chlorosis and epinasty of young leaves, and discoloration of vascular tissue. No root rot was observed. The problem was widespread with a disease incidence of 45 to 67%. Similar symptoms were described by Timmer et al. (2) on Mexican lime (C. aurantiifolia) nursery plants and some other species of citrus. Three representative isolates of Fusarium oxysporum Schlechtend.:Fr. from crown were single-spored and identified by the production of characteristic, three- to five-celled, sickle-shaped macroconidia with foot-shaped basal cells, ellipsoid microconidia borne in false heads on short monophialides, and chlamydospores in culture (1). The internal transcribed spacer (ITS) region of rDNA and the elongation factor (TEF 1-α) were amplified with primers ITS1/ITS4 and (TEF1/TEF2), respectively. GenBank accessions of ITS region are KC282838, KC282839, and KC282840, for TEF 1-α region are KF531633, KF537336, and KF537337, showed 99% homology with isolates of F. oxysporum in Fusarium-ID data. Pathogenicity tests were conducted on 7-month-old seedlings of sour orange using 10 plants for each of the three isolates. Prior to inoculation, roots were scraping with a sterile scalpel and plants were dipped in a conidial suspension of F. oxysporum (106 conidia ml-1) for 10 min. Each seedling was planted in a separate pot containing 0.7 liter of sterile soil. Non-inoculated plants with scraped roots dipped in sterile distilled water served as controls. Plants were irrigated and placed in a greenhouse at 24 ± 2°C and 12-h photoperiod. One month after inoculation, leaf chlorosis was observed and 2 months later, 90% of inoculated plants presented a severe wilt. Symptoms on infected plants were similar to those observed in the field. F. oxysporum was successfully re-isolated from the stems, thereby completing Koch's postulates. Genomic DNA was isolated from the re-isolations and PCR amplification of the ITS region was performed with the same primers. There was 100% nucleotide identity with sequences of the original isolates. To our knowledge, this is the first report of fusarium wilt of citrus trees in Tunisia. The pathogen may represent a new form species because previously, the disease was only reported from lime and lemon. References: (1) J. F. Leslie and B. A. Summerell. Page 256 in: The Fusarium Laboratory Manual. Blackwell Publishing Professional, Hoboken, NJ, 2006. (2) L. W. Timmer et al. Phytopathology 72:698, 1982.

[Ileocolic intussusception from metastatic renal cell carcinoma]. / Localisation iléale d'un carcinome à cellules rénales révélée par une invagination iléo-cæcale.

The lung, the liver, the bone tissue and the brain are the most frequent sites for renal cell carcinoma metastasis. Small bowel metastasis from renal cell carcinoma is rare, with only few cases published. We report the case of ileal metastasis from operated kidney cancer revealed by ileocolic intussusception and causing intestinal obstruction in a 32-year-old woman.