Endoscope disinfectant-induced colonic pseudolipomatosis: case series of a rare condition.

Aim: Colonic mucosal pseudolipomatosis is a rare and benign endoscopic finding with distinct macroscopic and histological characteristics. Case series: We observed a form of unprecedented colitis in eight patients in a 3-month period. Operators have found, during colonoscopy, flat or slightly raised whitish-yellow plaques, in the colonic mucosa of all patients. Histological examination concluded to pseudolipomatosis. After investigation, the disinfectant machine was found to have technical malfunctioning of the rinse cycle of the endoscope during this period. No other cases were observed after the machine was fixed. Conclusion: Pseudolipomatosis is more an endoscopically induced lesion than a true pathological condition. A careful check of the disinfection process should be carried out when such lesions are detected.

Pseudolipomatosis is a rare and harmless condition that can occur in various parts of the digestive system. It looks like flat or slightly raised whitish or yellow patches mixed with normal gut tissue. Under a microscope, it appears as empty spaces in the tissue layer. We found several cases during colonoscopy over a 3-month period, likely caused by the disinfectant used on the endoscope. Finding these lesions should prompt careful inspection of the disinfection procedure.

Pernicious anemia presenting with dysphagia and melanoderma: a confusing manifestation.

Vitamin B12 deficiency is widely recognized as a common cause of anemia. However, symptoms such as dysphagia, melanoderma, and pancytopenia, although less frequent, can also be associated with this deficiency. We report the case of a 47-year-old Caucasian man presented with dysphagia to solids associated to high heart rate, dyspnea and melanoderma. He was diagnosed with severe anemia (hemoglobin 4 g/dl) in association with pancytopenia. Further investigation confirmed that the underlying cause was severe vitamin B12 deficiency secondary to pernicious anemia. Subsequent treatment with vitamin B12 supplements led to a significant improvement in all symptoms. A review of the existing literature corroborated the rarity of severe anemia occurring in conjunction with dysphagia and melanoderma due to B12 deficiency.

Anemia is a condition where your body does not have enough healthy red blood cells. We report the case of a 47-year-old man who presented with difficulty swallowing solid food (dysphagia), a fast heart rate, difficulty breathing (dyspnea), and changes in skin color (melanoderma). After some tests, we diagnosed the patient with severe anemia and low counts of different types of blood cells (pancytopenia). The underlying cause was a severe lack of Vitamin B12, and the specific type of anemia was called pernicious anemia. Subsequent treatment with Vitamin B12 supplements led to significant improvement. Physicians should be aware of uncommon presentations of pernicious anemia to diagnose it early, avoid unnecessary investigations and to initiate rapidly simple and efficient treatment.

Iatrogenic orbital hematoma: an exceptional complication of upper gastrointestinal endoscopy.

Iatrogenic orbital hematoma is a rare event, most often manifested by a painful exophthalmos that could compromise the patient's visual prognosis. We report the case of a 51-year-old female patient with a history of non-ischemic dilated cardiomyopathy and high blood pressure, who developed a painful exophthalmos following an upper gastrointestinal sedation-free endoscopy. The diagnosis of an intra-orbital hematoma was made by computed tomographic scan and a conservative attitude was adopted after a thorough ophthalmological examination. Upper endoscopy may trigger this condition in the presence of pre-existing predisposing factors such as blood clotting disorders, high blood pressure or vascular malformation. This case highlights an uncommon complication of a commonly performed endoscopy that endoscopists should be aware of to provide safe and optimal examination.

A complication called iatrogenic orbital hematoma is a rare occurrence that can potentially harm a patient's vision. We report a 51-year-old patient who experienced a painful bulging of her eye after undergoing an upper endoscopy (a common procedure to look inside the upper digestive tract) without sedation. A CT scan helped doctors diagnose the problem and after a thorough examination, the condition resolved by itself. This case shows that upper endoscopy can lead to complications and endoscopists should be aware of this possibility to make sure the procedure is safe and successful.

Tunisian consensus on the management of Helicobacter Pylori infection.

Helicobacter pylori infection is the most common infectious disease worldwide. It is associated with duodenal and gastric ulcer disease and the risk of gastric neoplasia. The management of helicobacter pylori infection currently represents a real challenge for clinicians, given the ever-increasing rate of resistance of Helicobacter pyolori to various antibiotics. In this consensus document, we present recommendations adapted to the Tunisian context, including indications for the detection of helicobacter pylori infection, indications for the use of different diagnostic methods, and a therapeutic strategy for the management of Helicobacter pylori infection.

EncephalApp Stroop Test for covert hepatic encephalopathy screening in Tunisian cirrhotic patients.

Background: Covert hepatic encephalopathy (CHE) is underdiagnosed and is difficult to detect. The EncephalApp Stroop test is validated for its screening. The aim of the study was to define Tunisian norms for the test based on healthy controls norms and to estimate the prevalence of CHE in cirrhotic Tunisian patients. Methods: A prospective, multicenter, cross-sectional study was conducted. Ambulatory or hospitalized cirrhotic patients aged 40 years and over were recruited at 11 centers. Healthy subjects aged 40 years and over were recruited at 8 centers. We used a translated Arabic version of the streamlined EncephalApp Stroop test. The task has two components: "Off" and "On" state depending on the discordance or concordance of the stimuli. Results: 142 patients were included. The mean age was 57.26 years [40-86]. 40 (28.17%) of cirrhotic patients who were included were diagnosed as having a minimal hepatic encephalopathy or CHE. Among the ineligible patients, 22 had overt hepatic encephalopathy. If we consider these patients, the overall prevalence rate of CHE was around 24.39% in cirrhotic patients. It was more frequent in women (34.21% vs 25.96%), and in patients whose level of school education is between 6 and 13 years. Its prevalence does not appear to be affected by gender, MELD score, etiology of cirrhosis and age group of patients, as these variables were independent with respective p according to the chi-square test 0.413; 0.736; 0.663 and 0.1. The stroop times (On / Off and On + Off) correlated significantly with each other, are associated significantly and positively with age (respective Pearson coefficients: 0.578; 0.567 and 0.6). The more the age increases, the more the stroop response times increases (p > 10 -3). Conclusions: EncephalApp Stroop test was an efficient screening tool for CHE in Tunisian cirrhotic patients.

Intestinal pseudo-obstruction: Unusual presentation of systemic lupus erythematous.

Systemic diseases should be always considered when managing unexplained intestinal pseudo-obstruction. Intestinal pseudo-obstruction related to systemic lupus erythematosus is often responsive to corticosteroid therapy when promptly treated.

Sleep-Related Painful Erections in a Patient With Obstructive Sleep Apnea Syndrome.

Sleep-related painful erection (SRPE) is a rare sleep disorder characterized by recurrent, painful penile erections occurring when awakening from rapid eye movement sleep, while erections are painless during wakefulness. Almost 35 cases have been reported worldwide, and only two of them had an associated obstructive sleep apnea syndrome (OSAS). We report a new case of a 61-year-old man suffering from SRPE associated with OSAS. The adequate treatment of respiratory events with continuous positive airway pressure did not alleviate the SRPE symptoms and excessive daytime sleepiness. The SRPE diagnosis was made by polysomnography coupled with video surveillance when the patient was referred to the sleep laboratory for residual excessive daytime sleepiness. The patient had 2-4 episodes of SRPE/night. Beta-blocker did not alleviate the SRPE, but a transient improvement was noted when the patient was treated with paroxetine. In contrast with the two previously published cases of SRPE plus OSAS, continuous positive airway treatment did not improve SRPE symptoms in our patient.

[Frequency and predictive factors of colectomy and restorative colo-proctectomy in ulcerative colitis]. / Frequence et facteurs predictifs de colectomie et de coloproctectomie au cours de la rectocolite hemorragique.

AIMS: To determine the frequency and the predictive factors of colectomy and restorative colo-proctectomy in patients with ulcerative colitis. METHODS: We conducted an 11-year retrospective study based on hospitalized ulcerative colitis patients followed up for more than 6 months. RESULTS: From 1995 to 2005, 115 patients were included (50 men, 65 women, mean age: 38.4 years). Mean duration of follow-up was 39.2 months (6 - 145). Colectomy was performed in 20 patients (17%), with an actuarial risk of 16% at 5 years and 35% at 10 years. Proctocolectomy with ileoanal anastomosis was performed in 16 cases and total colectomy with ileorectal anastomosis in 4 cases. In univariate analysis, factors associated with an increased risk of colectomy were pancolitic location (p = 02), acute severe colitis (p < 0.0001), treatment by intravenous corticosteroids (p < 0.0001) and intravenous cyclosporine (p = 0.001). In multivariate analysis, acute severe colitis was the only independent factor associated with colectomy (p = 0.04 OR [CI 95%] :6.66 [1.04 - 50]). In patients with distal location, the independent factor associated with colectomy was colonic extension during follow up (p = 0.04 OR [CI 95%] :7.69 [1.07 - 50]). In patients with pancolitic location, risk of colectomy was associated with acute severe colitis (p = 0.01 OR [CI 95%] :9.09 [1.58 - 50]) and years of hospitalization from 1995 to 1999 (p = 0.02 OR [CI 95%] :7.14 [1.35 - 44]). CONCLUSION: Although the diffusion of treatment by intravenous cyclosporin, surgery is frequently performed in our ulcerative colitis patients, specially in case of acute severe colitis. Evaluation of colonic extension during the follow-up is associated with an important prognostic impact.