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BACKGROUND: Nucleotide-binding oligomerization domain 1 (NOD1) and NOD2 are involved in carcinogenic processes by recognizing bacterial cell wall components and triggering inflammation. This study explored the association between genetic variations in NOD1 and NOD2 and susceptibility to hepatocellular carcinoma (HCC) and its progression in a Moroccan population. METHODS: Genotyping of NOD1 rs2075820 (C>T) and NOD2 rs718226 (A>G) was performed using the TaqMan allelic discrimination assay in 467 Moroccan individuals. The cohort included 156 patients with hepatocellular carcinoma (HCC), 155 patients with liver cirrhosis (LC) diagnosed with HBV, HCV, or MASLD, and 156 controls. RESULTS: The NOD1 rs2075820 variant showed no association with HCC susceptibility or progression, which is consistent with in silico predictions. However, the NOD2 rs718226 G allele and GG genotype were more common in the HCC group compared to the cirrhosis and control groups. Individuals with the homozygous G variant had a 2-fold higher risk for HCC (ORadâ¯=â¯2.12; CI=1.01-4.44; Padâ¯=â¯0.04). Those with the GG genotype also had an increased risk of HCC (GG vs. AG+AA ORadâ¯=â¯2.28; CI=1.15-4.54; Padâ¯=â¯0.016). Furthermore, GG genotype carriers had a significantly higher risk of HCC progression (ORadâ¯=â¯2.58; CI=1.26-5.31; Padâ = 0.031). Individuals with the rs718226 minor allele had a significantly elevated risk of progressing from LC to HCC (ORadâ¯=â¯1.50; CI=1.07-2.09; Padâ¯=â¯0.016). Stratification analysis indicated that men had a higher risk of HCC progression compared to women (ORadâ¯=â¯4.63; CI=1.53-14.00 vs. ORadâ¯=â¯2.73; CI=1.05-7.09). CONCLUSION: The NOD1 rs2075820 polymorphism does not appear to be a genetic risk factor for susceptibility to HCC. In contrast, the non-coding NOD2 rs718226 variant significantly increases HCC susceptibility and promotes liver cancer progression in the Moroccan population. Further studies involving larger cohorts are warranted to definitively confirm or refute the effects of NOD1 and NOD2 genetic variants on liver cancer susceptibility and progression.
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BACKGROUND: Hepatocellular carcinoma (HCC) is the most common primary malignancy. Peroxisome proliferator-activated receptor gamma coactivator 1 alpha (PPARGC1A) plays a crucial role in regulating the biogenesis of mitochondria. We aimed to assess the association between PPARGC1A polymorphisms and HCC risk in a Moroccan population. METHODS: In this case-control study, 147 patients with HCC and 147 controls without pre-existing liver disease were matched for ethnicity. TaqMan SNP allelic discrimination assays were used for genotyping of PPARGC1A rs8192678 and rs12640088 polymorphisms. RESULTS: The result revealed that individuals with the GA/AA genotypes for rs8192678 had a significantly higher risk of HCC compared to those with the GG genotype (OR=6.68; P<0.0001, and OR=9.78; P<0.0001, respectively). In particular, the A allele of rs8192678 was over-represented in HCC patients compared to controls (40% versus 12%, P<0.0001, respectively). With respect to PPARGC1A rs12640088 variant, two genetic models (codominant and dominant) were tested to explore any potential variations in the distribution of SNP A>C among HCC cases and control subjects group. Overall, no significant association between rs12640088 and HCC was found (P>0.05). Interestingly, a significantly higher level of aspartate aminotransferase was observed in HCC patients with GG-GA genotypes (280 IU/L) compared to those with GG genotype (164 IU/L) at rs8192678 (P=0.0019). CONCLUSION: Our results suggest that the PPARGC1A rs8192678 polymorphism is associated with an increased risk of HCC in Moroccan population and may serve as a prognostic marker for liver cancer.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Coativador 1-alfa do Receptor gama Ativado por Proliferador de Peroxissomo , Humanos , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/genética , Estudos de Casos e Controles , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/genética , Coativador 1-alfa do Receptor gama Ativado por Proliferador de Peroxissomo/genéticaRESUMO
Hepatocellular carcinoma (HCC) is the fifth most common human malignancy and the fourth most frequent cause of cancer-related deaths worldwide. Toll-like receptors (TLRs), are known to play a key role in hepatocarcinogenesis through induction of inflammation. We aimed to investigate the association between TLR2 rs3804099, TLR4 rs4986790, rs4986791, and rs11536889 and TLR5 rs5744174 and HCC risk in a total of 306 Moroccan subjects, including 152 HCC patient and 154 controls using a TaqMan allelic discrimination assay. Our result showed that the frequency of TLR4 rs11536889 C allele was higher in control group than in HCC patients (OR = 0.52, 95% CI = 0.30-0.88, p = 0.01). Moreover, under the dominant model, we observed that CG/CC genotypes were protective factors against HCC risk (OR = 0.51, 95% CI = 0.28-0.91, p = 0.02). However, no significant differences were found in the allele and genotype frequencies of TLR4 rs4986790 and rs4986791, between HCC patients and controls. Similarly, genotypic frequencies of TLR2 and TLR5 polymorphisms did not differ significantly between HCC patients and controls. However, TLR4 haplotype analysis revealed that ACC haplotype may be protective of HCC risk in patients with HCC (OR = 0.53, 95% CI = 0.31-0.92, p = 0.02). In conclusion, our result suggest that TLR4 rs11536889 polymorphism and ACC haplotype may decrease risk of hepatocellular carcinoma in Moroccan population.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/genética , Estudos de Casos e Controles , Predisposição Genética para Doença , Genótipo , Neoplasias Hepáticas/genética , Polimorfismo de Nucleotídeo Único , Receptor 2 Toll-Like/genética , Receptor 4 Toll-Like/genética , Receptor 5 Toll-Like/genéticaRESUMO
Background: Little data is available about colon laparoscopic surgery in low mid-income countries. The aim of this study was to audit the status and results of laparoscopic colon cancer surgery in Morocco. Patients and methods: This was a prospective study performed at 4 academic departments in Morocco between January 1, 2018, and March 31, 2020. All adult patients who underwent elective right or left colonic resection for colon adenocarcinoma were included. The main outcomes were the rate of laparoscopic surgery (LS) and the comparison of its short-term outcomes with open surgery (OS). Results: Among 121 patients included, 52 (43%) underwent laparoscopic resection (0-49.3%). Five surgeons (29%) performed at least one laparoscopic resection. There were more left colectomies in the laparoscopic group (71.2% vs. 39.1%. p = 0.0004), and more extended resections (23.1% vs. 40.6%. p = 0.043) and T4 stage (19% vs. 37.5%. p = 0.037) in the open group. There were no differences in 90-days overall and serious complications. OS patients had significantly more harvested lymph nodes (14 vs. 18. P = 0.007) and higher median surgical margins (6 cm vs. 9 cm. P = 0.003) than LS patients. Conclusions: LS for colon cancer in Morocco is performed by few surgeons, who apply strict patient selection for laparoscopic cases. It was associated with lower quality resections compared to open surgery. There are still many challenges requiring more focus on training, certification, centralization and standardisation of care across the nation.
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BACKGROUND: Many data suggest that patients with low rectal adenocarcinoma who achieved ypT0N0 status have improved survival and disease-free survival (DFS) compared to all other stages however only few data are available regarding the specific prognosis factors of this subgroup. This study aimed to evaluate predictive factors for disease free survival after complete pathological response (CPR) in cases of low rectal adenocarcinoma. MATERIALS AND METHODS: From January 2005 to December 2013, all patients with low rectal adenocarcinoma who underwent neoadjuvant chemoradiotherapy followed by total mesorectal excision and achieved CPR were included at 7 Moroccan and 1 Algerian centres. Predictive factors for disease-free survival were analysed by uni and multivariate analysis. RESULTS: Eigthy-four (12.1%) patients achieved a CPR (ypT0N0). Multivariate analysis revealed that both poorly differentiated tumors (OR, 9.23; 95 CI 1.35-62.82; P = 0.023) and the occurrence of perineal sepsis (OR, 13.51; 95 CI 1.96-93.12; P = 0.008) were independently associated with impaired DFS. CONCLUSIONS: Patients with low rectal cancer who exhibited a CPR after neoadjuvant therapy have good prognoses; however, the occurrence of perineal sepsis and/or poor initial differentiation may be associated with impaired DFS in these patients. TRIAL REGISTRATION: The study was retrospectively registered the 28th July 2018 in ClinicalTrials.gov register with the reference NCT03601689.
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Adenocarcinoma/mortalidade , Adenocarcinoma/terapia , Quimiorradioterapia/mortalidade , Terapia Neoadjuvante/mortalidade , Neoplasias Retais/mortalidade , Neoplasias Retais/terapia , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adulto , Idoso , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Períneo/microbiologia , Prognóstico , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , SepseRESUMO
INTRODUCTION: Resident participation in laparoscopic cholecystectomy (LC) is one of the first steps of laparoscopic training. The impact of this training is not well-defined, especially in developing countries. However, this training is of critical importance to monitor surgical teaching programmes. OBJECTIVE: The aim of this study was to determine the impact of seniority on operative time and short-term outcome of LC. DESIGNS AND SETTINGS: We performed a retrospective study of all consecutive laparoscopic cholecystectomies for gallbladder lithiasis performed over 2 academic years in an academic Surgical Department in Morocco. PARTICIPANTS: These operations were performed by junior residents (post-graduate year [PGY] 4-5) or senior residents (PGY 6), or attending surgeons assisted by junior residents, none of whom had any advanced training in laparoscopy. All data concerning demographics (American Society of Anesthesiologists, body mass index and indications), surgeons, operative time (from skin incision to closure), conversion rate and operative complications (Clavien-Dindo classification) were recorded and analysed. One-way analysis of variance, Student's t-test and Chi-square tests were used as appropriate with statistical significance attributed to P < 0.05. RESULTS: One hundred thirty-eight LC were performed. No differences were found on univariate analysis between groups in demographics or diagnosis category. The overall rate of operative complications or conversions and hospital stay were not significantly different between the three groups. However, mean operative time was significantly longer for junior residents (n = 27; 115 ± 24 min) compared to senior residents (n = 37; 77 ± 35 min) and attending surgeons (n = 66; 55 ± 17 min) (P < 0.001). CONCLUSION: LC performed by residents appears to be safe without a significant difference in complication rate; however, seniority influences operative time. This information supports early resident involvement in laparoscopic procedures and also the need to develop cost-effective laboratory training programmes.
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OBJECTIVE: To verify the feasibility and safety of laparoscopic adrenalectomy for large tumours, as since it was described, the laparoscopic approach for adrenalectomy has become the 'gold standard' for small tumours and for large and non-malignant adrenal tumours many studies have reported acceptable results. PATIENTS AND METHODS: This is a retrospective study from a general surgery department from January 2006 to December 2013 including 45 patients (56 laparoscopic adrenalectomies). We divided patients into two groups according to tumour size: <5 or ⩾5 cm, we compared demographic data and peri- and postoperative outcomes. RESULTS: There was no statistical difference between the two groups for conversion rate (3.7% vs 11.7% P = 0.32), postoperative complications (14% vs 12%, P = 0.4), postoperative length of hospital stay (5 vs 6 days P = 0.43) or mortality (3.5% vs 0% P = 0.99). The only statistical difference was the operating time, at a mean (SD) 155 (60) vs 247 (71) min (P < 0.001). CONCLUSION: Laparoscopic adrenalectomy for large tumours needs more time but appears to be safe and feasible when performed by experienced surgeons.
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AIM OF THE STUDY: Our aim was to propose and examine the outcomes of a comprehensive strategy for the management of cystic liver hydatidosis (CLH) based on extensive intraoperative assessments and optimal management of cystobiliary communications. BACKGROUND DATA: Although operative intervention remains the preferred treatment for CLH, and the presence of a cystobiliary communication remains a well-established predictive factor for postoperative complications, no internationally accepted management strategy integrates the specific management of cystobiliary communication into the choice of surgical approach. METHODS: Early postoperative outcomes were compared before (1990-2004; P1 group; n = 664) and after (2005-2013; P2 group; n = 156) the implementation of a CLH surgical management strategy for CLH in our overall group of patients in subgroups selected by risk factors (as determined by multivariate analysis), and in 2 propensity score-matched groups. RESULTS: Specific complications related to the hepatic procedure (intraabdominal complications) were independently associated with the presence of ≥ 3 cysts (P = .013), a fibrotic pericyst (P = .005), a cystobiliary communication (P < .001), and the P1 treatment period (P = .002). Between P1 and P2 groups, the rate of specific complications decreased in the overall group of patients with CLH (18.3% vs 4.5%; P < .001). The rate also decreased in risk factor-based subgroups: patients with ≥ 3 cysts (31.0% vs 4.0%; P = .005), a fibrotic pericyst (23.1% vs 9.2%; P = .011), and a cystobiliary communication (33.0% vs 13.2%; P = .006). After propensity score matching among 123 well-balanced matched pairs of patients, the overall complication rate, specific hepatic surgery-related complication rate, and median duration of hospital stay decreased between the P1 and P2 groups: 23.6% vs 12.2% (P = .02), 21.1% vs 4.9% (P < .001), and 7 vs 5 days (P < .001), respectively. CONCLUSION: Implementation of a CLH surgical management strategy based on specific intraoperative assessment and optimal management of cystobiliary communications improved early postoperative outcomes.
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Equinococose Hepática/cirurgia , Hepatectomia/métodos , Complicações Pós-Operatórias/prevenção & controle , Adulto , Protocolos Clínicos , Feminino , Hepatectomia/normas , Humanos , Cuidados Intraoperatórios , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
The partial substitution of the ureter using a pediculated double short segments of the ileum is a technique used to re-establish ureteral transit and preserve the renal unit, following the resection of extensive ureteral lesions. Standard surgical procedure for an ileoureteroplasty consists of isolating an ileal duct of equal or greater length than the ureteral defect and interposing it in the urinary tract in an isoperistaltic direction. Monti described a surgical technique that allows for the creation of catheterizable stomas in continent urinary diversions, using the Mitrofanoff principle. These passageways were created from one or several 2.5 cm long ileal sections by means of their detubulization and transverse retubulization.
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Íleo/transplante , Complicações Pós-Operatórias/cirurgia , Transplante Heterotópico , Ureter/cirurgia , Fibromatose Agressiva/cirurgia , Humanos , Hidronefrose/etiologia , Hidronefrose/cirurgia , Laparotomia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/patologia , Esclerose , Stents , Transplante Autólogo , Ureter/lesões , Ureter/patologiaRESUMO
BACKGROUND: Over past decades laparoscopic liver resection (LLR) has gained wide acceptance among hepatobiliary surgeons community. To date, few data are available concerning LLR programs in developing countries. This study aimed to assess feasibility and safety of LLR in a Moroccan surgical unit. METHODS: From June 2010 to February 2013, patients that received LLR were identified from a prospective "liver resection" database and included in this study. Parenchymal transection was performed using Harmonic scalpel and bipolar clamp with no Intraoperative ultrasound use or systematic pedicle clamping. LLR difficulty was categorized into 3 categories according to Louisville-statement (I-III). Demographic informations, liver lesion informations, operative details, pathological tumor-margin and 1-months postoperative morbidity according to Clavien-Dindo(C-D) classification were analyzed. RESULTS: Among 104 patients who underwent liver resection 13(12,5%) had LLR. There were 7 females and 6 males with mean age of 57,5 ± 17 years. LLR was performed for benign lesions in 3 cases and malignant ones in 10 (77%) patients: hepatocarcinoma in 7 patients and synchronous rectal-liver metastasis in 3 patients. Lesions were solitary in 12 (92%) patients with median size of 50mm (15 mm-150 mm). Patients with liver metastasis received combined laparoscopic rectal and liver resection. We used pure laparoscopic approach in 12 (92%) patients and hybrid one in 1 patient. LLR difficulty was category I, II and II in respectively 3(23%), 6(46%) and 4(31%)patients. Conversion rate to open liver resection was 15%. Mean blood loss was 395 min ± 270 min with no hepatic pedicle clamping or peroperative blood transfusion. All resections were tumor free margin. Mortality rate was nil and morbidity occurred in 4(30%) patients: ascites (C-D 2) and pelvic sepsis in combined resections (CD 3b). Median hospital stay was 6 days. CONCLUSION: Laparoscopic liver resection in our context is safe in selected patients, since no operative mortality, blood transfusion requirement or palliative resection was recorded and liver related morbidity rate was low. Intraoperative ultrasound liver examination capacities are mandatory to improve laparoscopic liver resection program's quality and extend indications.
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Hepatectomia/métodos , Laparoscopia , Neoplasias Hepáticas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Conversão para Cirurgia Aberta , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Marrocos , Complicações Pós-OperatóriasAssuntos
Doenças das Glândulas Suprarrenais/complicações , Hipersecreção Hipofisária de ACTH/complicações , Tuberculose Endócrina/complicações , Adenoma Hipofisário Secretor de ACT/complicações , Adenoma Hipofisário Secretor de ACT/diagnóstico , Adenoma/complicações , Adenoma/diagnóstico , Adolescente , Doenças das Glândulas Suprarrenais/diagnóstico , Feminino , Humanos , Hipersecreção Hipofisária de ACTH/diagnóstico , Tuberculose Endócrina/diagnósticoRESUMO
INTRODUCTION: A perforation occurring during colonoscopy is an extremely rare complication that may be difficult to diagnose. It can be responsible for acute abdominal compartment syndrome, a potentially lethal complex pathological state in which an acute increase in intra-abdominal pressure may provoke the failure of several organ systems. CASE PRESENTATION: We report a case of acute abdominal compartment syndrome after perforation of the bowel during a colonoscopy in a 60-year-old North African man with rectal cancer, resulting in respiratory distress, cyanosis and cardiac arrest. Our patient was treated by needle decompression after the failure of cardiopulmonary resuscitation. An emergency laparotomy with anterior resection, including the perforated sigmoid colon, was then performed followed by immediate anastomosis. Our patient remains alive and free of disease three years later. CONCLUSION: Acute abdominal compartment syndrome is a rare disease that may occasionally occur after a colonoscopic perforation. It should be kept in mind during colonoscopy, especially considering its simple salvage treatment.
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Adenocarcinoma/cirurgia , Neoplasias Esofágicas/cirurgia , Junção Esofagogástrica/cirurgia , Neoplasias Gástricas/cirurgia , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Esofágicas/patologia , Esofagectomia/métodos , Junção Esofagogástrica/patologia , Feminino , Gastrectomia/métodos , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Marrocos , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND AND AIMS: Hydatid disease is still a major health problem in sheep-raising areas. Surgery remains the basic treatment for liver hydatid cyst (LHC). However, recurrences can occur after all therapies. Surgery for recurrence of LHC becomes technically more difficult with higher rate of morbidity and mortality. The aim of this study was to determine perfective factors associated to hepatic recurrence after LHC surgery and to propose and discuss postoperative follow-up schedules. METHODS: It is a retrospective cohort study of 672 patients with LHC treated at the surgery department "A" at Ibn Sina University Hospital, Rabat, Morocco, from January 1990 to December 2004. Recurrence rates have been analyzed by the Kaplan-Meier method for patients undergoing surgery. RESULTS: Fifty-six patients (8.5%) had LHC recurrence after surgery. There were 34 females (60.7%) and 22 males (39.3%). Median duration of recurrence's diagnosis was 24 months (interquartile range: 10-48 months). Recurrence's risk was 2.3% +/- 0.6% at 1 year and 9.1% +/- 1.3% at the 10th year. The history of LHC (hazard ratio, 2; 95% confidential interval, 1.13-3.59) and three cysts or more (hazard ratio, 3.8; 95% confidential interval, 2.07-6.98) was an independent risk factor for recurrence. CONCLUSION: We think that the surgeon's practice and experience are the most important to success the surgical treatment. It prevents complications and recurrences.
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Equinococose Hepática/cirurgia , Adulto , Competência Clínica , Estudos de Coortes , Equinococose Hepática/patologia , Feminino , Humanos , Masculino , Recidiva , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: Incidence of liver hydatid cyst (LHC) rupture ranged 15%-40% of all cases and most of them concern the bile duct tree. Patients with biliocystic communication (BCC) had specific clinic and therapeutic aspect. The purpose of this study was to determine witch patients with LHC may develop BCC using classification and regression tree (CART) analysis METHODS: A retrospective study of 672 patients with liver hydatid cyst treated at the surgery department "A" at Ibn Sina University Hospital, Rabat Morocco. Four-teen risk factors for BCC occurrence were entered into CART analysis to build an algorithm that can predict at the best way the occurrence of BCC. RESULTS: Incidence of BCC was 24.5%. Subgroups with high risk were patients with jaundice and thick pericyst risk at 73.2% and patients with thick pericyst, with no jaundice 36.5 years and younger with no past history of LHC risk at 40.5%. Our developed CART model has sensitivity at 39.6%, specificity at 93.3%, positive predictive value at 65.6%, a negative predictive value at 82.6% and accuracy of good classification at 80.1%. Discriminating ability of the model was good 82%. CONCLUSION: we developed a simple classification tool to identify LHC patients with high risk BCC during a routine clinic visit (only on clinical history and examination followed by an ultrasonography). Predictive factors were based on pericyst aspect, jaundice, age, past history of liver hydatidosis and morphological Gharbi cyst aspect. We think that this classification can be useful with efficacy to direct patients at appropriated medical struct's.
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Doenças Biliares/epidemiologia , Equinococose Hepática/classificação , Equinococose Hepática/epidemiologia , Adulto , Distribuição por Idade , Análise de Variância , Doenças Biliares/diagnóstico por imagem , Doenças Biliares/etiologia , Estudos de Coortes , Equinococose Hepática/diagnóstico por imagem , Equinococose Hepática/cirurgia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Marrocos/epidemiologia , Valor Preditivo dos Testes , Probabilidade , Análise de Regressão , Estudos Retrospectivos , Ruptura Espontânea/epidemiologia , Ruptura Espontânea/etiologia , Índice de Gravidade de Doença , Distribuição por Sexo , Ultrassonografia , Adulto JovemRESUMO
AIM: the aim of this retrospective study was to assess our experience in surgical management of bilateral pheochromocytoma (BP) and to report diagnosis methods and therapeutic results of a series of 10 patients treated in "surgical clinique A" department. METHODS: from 1986 to 2005, we studied all cases of histological confirmed BP in their clinical, biochemical and radiological aspects. We analyzed all of therapeutic attitudes suggested and their results. RESULTS: Ten patients underwent adrenalectomy for BP: 6 men and 4 women with age average of 37.1 (13-60). Eight of them were synchronous BP versus two metachronous ones. Eight patients were symptomatic. One of them had a Von Hippel Lindeau syndrome and 2 others had a familial form of BP. For the two asymptomatic cases: the first one was an incidentaloma and the second one was discovered in a MEN IIb screening. As a primary biochemical diagnostic measure, the determination of the excretion rate of cathecholamine in the 24h urine was high among 6 patients. The ultrasonic imaging and CT scanning were done to localize the tumor site. The surgical treatment consisted in a bilateral adrenalectomy in one phase for 5 patients and in two phases for the 5 others (one double laparoscopy). An enucleating of a pancreatic nodule was an associated act practiced on a patient. Perioperative incidents were related in heart rythme dysfunctions, crises of hypertension among 6 patients and a cardiac arrest rehabilitated. In postoperative phase we assess a death case of sepsis chock, an acute adrenal insufficiency, an acute pancreatitis and a liver metastasis one year after the adrenalectomy. All patients were under hydrocortisone (30 mg) for life. CONCLUSION: Bilateral adrenalectomy is the basic treatment of a BP. A familial screening must be systematically carried out. Laparoscopic adrenalectomy has good results.
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Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia , Feocromocitoma/cirurgia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: Isolated tuberculosis of pancreas and peripancreatic lymph nodes is very rare and difficult to recognise. It may mimic pseudocyst, cystic tumor or carcinoma of pancreas and lead to unuseful and potentially morbid surgery. AIM: We report 3 cases diagnosed in peropeative and postoperative situations. CASES: Thirty four-year-old and 50-year-old women presented with obstructive jaundice. Abdominal CT scan showed resectable head of pancreas tumour. In first patient, peroperative biopsies suggested tuberculosis and resection was avoided. The second patient underwent Whipple procedure. Third case was a 48-year-old alcoholic man who presented with recent history of painful mass of left hypochondre. Cystic tumor of pancreas tail and pseudocyst were suggested in CT scan. En bloc resection of tumor, pancreas tail and spleen was performed. The three patients had antitubercular therapy after histological confirmation of pancreatic tuberculosis. Follow-up is respectively 3 years, 5 months and 2 years free of recurrence. CONCLUSION: Radio or echoendoscopical fine needle punction can contribute to the diagnosis. Surgery remains the main treatment of complications (fistulas, bleedings, obstructions) and the last diagnosis option. Tuberculous origin of an isolated pancreatic mass may be suspected in young people and immunocompromised especially in endemic areas.