Primary lumbar hernia : analysis of three cases.

BACKGROUND: Lumbar hernia is relatively rare; it is due to a defect of the posterior abdominal wall. AIM: To report three new cases of lumbar hernia and insist of the modalities of treatment. CASES REPORT: There are 2 women and one man. Mean age was 78 years. The mean symptom was lumbar mass. All patients had open surgery (by lumbar incision). The post operative course was uneventful. CONCLUSION: Primary lumbar hernias are rare. Earlier diagnosis of non complicated hernia should be of primary importance to avoid some serious complication. The only curative treatment is surgery and must be done as soon as the diagnosis was made.

[Laparoscopic radical prostatectomy: initial experience: about two cases]. / Prostatectomie radicale coelioscopique: début d'expérience: a propos de deux cas.

BACKGROUND: Laparoscopic radical prostatectomy was a major breakthrough in the treatment of localized prostate cancer. AIM: To report the first two laparoscopic radical prostatectomies performed in Tunisia. CASES REPORT: The two patients are aged 57 and 66 and were suffering from localized prostate cancer. We first tested the transperitoneal and under-peritoneal paths. We then used an anterogradic surgery technique with preservation of the bladder-neck, extra-facial dissection of neuro-vascular bandles and vesicourethral running anastomosis. The two procedures lasted 435 and 305 minutes. We did not have any conversion nor blood transfusion. Post-operatory situation was simple. The two patients were kept in clinic for 4 days and the trans-urethral catheter was removed 7 days following the surgery. The anatomo-pathologic study finds a negative surgical margins for both patients. 3 months later, both patients are continents. Only one of them showed an erection with phosphodieseterase type 5 inhibitors. The total PSA is indetectable. CONCLUSION: Laparoscopic radical prostatectomy for localized prostate cancer is a technique that has proven its effectiveness since 10 years at least.

[Predictive factors of morbidity and mortality after surgery in the elderly]. / Facteurs prédictifs de morbidité et de mortalité de la chirurgie du vieillard.

UNLABELLED: The aim of the study was to determine prognostic factors of post operative morbidity and mortality for patients aged 80 years and older. We compared two groups of patients aged 80 and over operated to determine predictive factors of morbidity and mortality: group of patients who presented post operative complication within 30 days after surgery and group of patients without any complication. Comparison of the two groups for global morbidity using univariate analysis showed only one prognostic factor: surgery of diabetic foot (p = 0.034). Predictive factors of mortality according to univariate analysis were: pre-operative shock (p = 0.001), abdominal wall pathology (p = 0.027), gastric or duodenal ulcer diseases (p = 0.011) and global morbidity (p = 0.006). After logistic regression, only pre-operative shock was an independent predictive factor of mortality (p = 0.0023). CONCLUSION: Risk for morbidity after surgery in the elderly 80 years and over is linked with type of surgery and not with soil. Likewise, risk for mortality is linked with advanced stage of disease that is presence of pre-operative shock and not with soil.

[Acute pancreatitis due to lupus]. / La pancréatite aiguë lupique.

Among digestive clinical presentations of systemic lupus erythematosus, acute pancreatitis remains a serious affection with very poor prognosis. To date, pathogenesis is still unclear. We report two cases of fatal acute pancreatitis related to systemic lupus erythematosus.

Neuroendocrine tumours of the digestive tract report of two cases and literature review.

Neuroendocrine tumors (NET) of the digestive system are rare. They comprise only 1% of all the tumors of the gastrointestinal tract. The aim of this study is to report two cases of exceptional localization of non secretary neuroendocrine tumors. Their difficulty in diagnosis, treatment and controversy in chemotherapy merit their study in depth. These are two patients that were treated in the department of general surgery (Beau Séjour) in Charles Nicolle Hospital for non secretary (NET) of the pancreas and stomach. The first was presented as a painless epigastria mass with frequent diarrhea. The second was presented as a painful mass in the left hypochondriac area without any other symptoms. Biochemical evaluation confirmed their non secretary properties. Surgery remains the first line of treatment. It was possible for the gastric, but not for the pancreatic tumor. Both were very advanced and had metastasis. Histopathological evaluation and immunohistochemical study using the method of peroxydase antiperoxydase (PAP) complexes for some special monoclonal antibodies confirmed the diagnosis. Chemotherapy of both cases was mal tolerated and was discussed in details.

[Testicular epidermoid cyst. A case report]. / Kyste epidermoïde intratesticulaire: a propos d'un cas.

Epidermoid cyst of the testis is a rare, begnin intratesticular tumor. Through a case report of a patient who underwent an orchidectomy, we study clinical, radiological and therapeutic aspects and particularities of this pathology.

[Abdomino-pelvic actinomycosis: a case report]. / Actinomycose abdomino-pelvienne: à propos d'un cas.

The actinomycosis is a chronic suppurative granulomatosis disease. It is owed to a bacillus gram positive; actinomycès israelli. The cervical and thoracic localizations are most frequent. The digestive localization represents 20% of cases. It interest very rarely the pelvis and the genital tracts. We bring back the observation of a patient old of 30 years admitted for mass abdominal. To the exam, the patient had a sensibility of the left hypochondriac area and we found a mass of 6 cm of diameter. To the rectal touch, we found a mass in the bag of Douglas. The echography and the computed tomography revealed a collection under the spleen and a pelvic collection. A rectotomy is performed. The bacteriological study isolates actinomycès israelli. The collection under the spleen is drained under radiological control. Actinomycès israelli is also recovered in the pus brought back by the puncture. The patient is treated by Penicillin. The patient had a favourable evolution. No etiology is found at this patient. For this observation, the collection was accessible to a drainage permitting the diagnosis and the treatment of the actinomycosis while avoiding a mutilated surgery.

[Prognostic factors for splenectomy for hematologic diseases]. / Facteurs pronostiques des splenectomies pour rate hematologique.

The aim of this study was to identify the prognostic factors of intraoperative haemorrhage, perioperative blood transfusions and morbidity. We collected 120 splenectomies in Beau Séjour department of surgery, Charles' Nicolle Hospital, Tunis, Tunisia between 1979 and 1999. The descriptive analysis showed sex-ratio 0.82 with mean age (+/- standard deviation) 30.6 +/- 15 year. Idiopathic thrombopenic purpura was the principal disease indicating splenectomy. Morbidity was defined as occurrence of post operative peritoneal sepsis or bleeding. The mortality and morbidity rates were respectively 0.8% and 6.6%. The prognostic analysis didn't identify predictive factors of intraoperative haemorrhage, however it identified two independent predictive actors of specific morbidity: intraoperative haemorrhage (p = 0.03) and preoperative rate of haemoglobin (p = 0.0049).