[Tumoral form of abdominal actinomycosis: a retrospective case series of seven patients]. / Actinomycoses abdominales à forme tumorale : une série rétrospective de sept observations.

PURPOSE: Abdominal actinomycosis is an uncommon chronic infectious disease due to Actinomyces, a Gram-positive bacteria. This saprophytic bacteria of digestive tract and genital mucosa can occasionally become pathogenic mimicking a digestive neoplasia. The aim of this study was to underline diagnostic features of abdominal actinomycosis and to summarize data about clinical, diagnostic and therapeutic approach of this type of infection. PATIENTS: From January 1995 to December 2007, retrospective data concerning patients with abdominal actinomycosis who were followed-up in the University Hospital Sahloul (Sousse, Tunisia) were analysed. RESULTS: Seven patients with abdominal actinomycosis were identified during the study period. All presented with an abdominal mass. The diagnosis of actinomycosis was obtained after surgical resection in all cases. The histological study permitted the diagnosis in six cases, and the surgical samples grew up Actinomyces in two patients. For the five patients who received prolonged and adapted antibiotic therapy, a favourable outcome was observed. CONCLUSION: Actinomycosis must be included in the differential diagnosis of invasive abdominal lesions with "malignant appearance".

[Perineal recurrence of an aggressive angiomyxoma: Is an incomplete resection useful?]. / Récidive d'un angiomyxome périnéal agressif : une chirurgie d'exérèse incomplète est-elle utile?

Angiomyxoma is a rare but aggressive mesenchymal tumor. It commonly develops in the pelvis, perineum and groin and is more common in females. Angiomyxoma characteristically has a high incidence of local recurrence. The only treatment of recurrence is surgical re-excision. We report a case of recurrent aggressive angiomyxoma, which was only incompletely resected.

[Detection of nasal colonization methicillin-resistant Staphylococcus aureus: a prospective study comparing real-time genic amplification assay vs selective chromogenic media]. / Détection de la colonisation nasale de Staphylococcus aureus résistant à la méthicilline : étude prospective comparant l'amplification génique temps réel vs les milieux chromogènes sélectifs.

UNLABELLED: In contrast to "classical" genic amplification, real-time genic amplification can be performed in every laboratory without the need of sophisticated isolation procedures. Moreover, real-time genic amplification allows an early detection of meticillin resistant Staphylococcus aureus colonization, 2 hours compared to 1 or 2 days for culture. OBJECTIVE: In order to assess the feasibility on Smartcycler of the IDI-MRSA real-time genic amplification assay in comparison with chromogenic media. METHODS: A prospective study has been initiated in July 2004: nasal swabs were taken from patients entering the ICU, vascular surgery, diabetology and geriatry wards. During a 4 months period, 682 specimens have been obtained from 508 patients. RESULTS: Sixty-four (9.3%) patients were positive by genic amplification and selective agar culture (CHROMagar MRSA, MRSASelect and/or ORSAB), 19 (2.9%) were positive by genic amplification only (3 of these patients were under antibiotic treatment); 572 specimens remained negative by both methods. The sensitivity and specificity of this assay were 100% and 96% respectively with a positive predictive value of 70% and negative predictive value of 100%. Initially 82 nasal specimens were unresolved (12%). 38 were resolved following a freeze-thaw cycle. Thus, 44 (6.4%) were unresolved specimens. Comparison between CHROMagar MRSA and MRSASelect showed a good correlation for the detection at 24 hours (5.5% and 5.6% respectively). These two chromogenic media allowed a much better detection of MRSA than ORSAB medium within 24H. CONCLUSION: The results obtained by the early real-time genic amplification for the detection of meticillin resistant Staphylococcus aureus are promising. Despite 6.4% amplification failure, we consider that IDI-MRSA real-time genic amplification assay represents a significant breakthrough in the detection of colonization.

Predictive factors of glucocorticosteroid treatment failure in severe acute idiopathic colitis.

INTRODUCTION: The purpose of our study was to determine clinical, biological or endoscopic factors that could predict glucocorticosteroid treatment failure in acute colitis. PATIENTS AND METHODS: Fifty-four Tunisian Caucasian patients with acute idiopathic colitis (ulcerative colitis in 53 patients, Crohn's colitis in 1 patient) have been evaluated. Non-therapeutic response was defined as over 6 bowel movements per day, blood visible to the naked eye in stools on the fifth day after admission or the development of a complication inducing a resort to surgery. Predictive factors were assessed using bivariate and multivariate analysis. RESULTS: Thirty-nine patients (72.2%) had no medical response. In univariate analysis, predictive factors of therapeutic failure were: male sex, tobacco, previous history of colitis attacks, bowel movements per day over seven at admission and on day three, and pulse rate over 90/mn, temperature over 38 degrees C, systolic blood pressure below 11 on day 3 and on day 5 after admission. In multivariate analysis, bowel movements over seven per day on day 3 of hospitalization and male sex independently predicted a failure of glucorticosteroid treatment. CONCLUSION: Bowel movements per day over seven on day 3 of hospitalization and male sex were the independently predictive factors of failure of glucocorticosteroid treatment.

[Hydatid cyst of the liver]. / Le kyste hydatique du foie.

Hydatid cyst of the liver is a parasitic disease caused by Echinococcus granulosus. The principal complications are infection, biliary duct fistula, and rupture into the peritoneum or chest. Diagnosis has become easier with advances in ultrasonic imaging and CT scanning. Surgery remains the most effective treatment but postoperative complications arise in 30% of cases, particularly when the surgical approach is conservative. Radical surgical approaches give better results and should be used in most cases. Biliocutaneous fistula and infection of the residual cavity are the most common postoperative complications and result in prolonged hospitalization and excess costs. New therapeutic strategies incorporate endoscopic, percutaneous, and medical therapies with surgery and have allowed an improvement in morbidity and mortality due to hydatid cysts of the liver. Until immunization becomes a possibility, preventive measures are necessary to avoid disease recurrence.

[Anal metastasis of colonic adenocarcinoma?]. / Métastase anale d'un adénocarcinome du côlon?

Two cases of sigmoid and anal adenocarcinoma are reported. The two patients were treated by abdominoperineal resection of the rectum and resection of the sigmoid colon. The relationship between colonic adenocarcinoma and anal adenocarcinoma is not obvious but possible. The various mechanisms of tumoral spread are discussed and the most frequent mechanism seems to be cellular exfoliation.

[Tuberculous mesenteric lymphadenitis: a case report]. / La lymphadénite mésentérique d'origine tuberculeuse: à propos d'un cas.

The authors report a case of mesenteric tuberculous lymphadenitis which mimic a pancreatic cystadenoma. They emphasize ultrasound and CT scan features which lead to the recognition of tuberculosis and permit a percutaneous fine needle biopsy. Laparotomy seems the most reliable method for a positive diagnosis. The place of different imaging methods is discussed.

[Postero-lateral surgical approach to soft cervical herniated discs. Technical note]. / Abord postéro-latéral des hernies discales cervicales molles. Note technique.

Most ruptured cervical discs are operated on by an anterolateral approach. The posterior approach is an older procedure, nowadays underused because it was associated with a high morbidity, especially in terms of medullary complications. However, posterior approach has evolved in posterolateral route, which is not so devastating and has a very low morbidity rate. It gives excellent functional results when surgery is dedicated to monoradiculopathy from soft posterolateral cervical hernias. It seems appropriate to consider this surgical route as an alternative to anterolateral surgery in these very selected cases. The authors describe and comment the technique.

[Hydatic cysts of the liver ruptured into the thorax. Diagnostic and therapeutic aspects]. / Les kystes hydatiques du foie rompus dans le thorax. Aspects diagnostiques et thérapeutiques.

Hydatic cysts of the liver can rupture into the thorax. The aim of this work was to demonstrate how abdominal access can be used in most cases. We report 44 cases of hydatic cysts which ruptured into the thorax among a series of 1411 hydatic cysts of the liver operated between 1974 and 1995. Abdominal ultrasound and chest x-ray provided the diagnosis preoperatively in 35/42 operated cases (one case of spontaneous elimination of a hydatic membrane via a cutaneous orifice and one case of preoperative death). Thoracophrenolaparotomy was used in 12 cases, thoracotomy with laparotomy in 6, thoracotomy alone in 5 and laparotomy alone in 19. Pulmonary resections were performed in 18 cases. No procedure could be performed in one patient who died at the beginning of surgery. A breach in the diaphragm was repaired in 41 cases. The dome of the cyst was resected in 29 cases and complete pericystectomy was performed in 12. There were 7 post-operative deaths. There were no deaths in the abdominal access patients. All emergency problems were controlled with abdominal access. Thoracic access was reserved for specific cases.