RESUMO
BACKGROUND: Esophageal hypomotility is frequent in patients with gastroesophageal reflux disease (GERD). AIMS: To precise the frequency and the patterns of esophageal manometric abnormalities in GERD patients referred before antireflux surgery, to determine the frequency of post-operative dysphagia and to look for associated factors with high risk of dysphagia, with special interest on pre-operative esophageal manometric study. METHODS: We conducted a retrospective study based on patients having anti-reflux surgery and pre-operative esophageal manometry. Post-operative dysphagia was prospectively assessed during the follow-up. RESULTS: We studied 33 patients (mean age: 46 years; sex-ratio: 0.4). Pre-operative esophageal manometry was abnormal in 1/3 of cases, with a high prevalence of non specific motor disorders and hypomotility. Nor epidemiological, clinical or pHmetric factor was associated with the risk of motor esophageal abnormalities. Postoperative dysphagia was noted in 21% of the cases, with any correlation with results of pre-operative manometry. CONCLUSION: Esophageal hypomotility is frequent in patients with GERD; and not associated with a higher risk of post-operative dysphagia after anti-reflux surgery.
Assuntos
Esôfago/fisiopatologia , Refluxo Gastroesofágico/fisiopatologia , Refluxo Gastroesofágico/cirurgia , Cuidados Pré-Operatórios , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos RetrospectivosRESUMO
Familial Adenomatous Polyposis (FAP) and Attenuated FAP (AFAP) are caused by a germline mutation in the Adenomatous polyposis coli (APC) gene. Recently, a new pathway characterized by a biallelic mutation in the MYH gene, with a recessive model of inheritance was discovered for this inherited syndrome. This report describes a Tunisian patient with an attenuated FAP phenotype, presenting seven colon polyps and an adenocarcinoma but no detectable germline mutations in the FAP target genes. A well known somatic mutation was found in the APC mutation cluster region (MCR). This case shows that further studies are needed to fully understand all the pathways of the FAP syndrome.
Assuntos
Polipose Adenomatosa do Colo/genética , Adenina , Sequência de Bases/genética , Códon/genética , Códon de Terminação/genética , Genes APC , Heterozigoto , Humanos , Masculino , Pessoa de Meia-Idade , Família Multigênica/genética , Mutação/genética , Penetrância , Fenótipo , Deleção de Sequência/genéticaRESUMO
Splenic abscess are a rare and severe pathology causing difficulty in diagnosis and treatment. The Clinical presentation usually associated with abdominal pain in the left upper quadrant, fever and splenomegaly. Diagnosis will be confirmed by morphologic examination such as ultra sonography and computed tomography. Percutaneous drainage procedure made in first intention can be used either for curative purpose or to prepare patient for surgery. We report four cases of splenic abscess collected in our departement between 1997 and 2000 in which percutaneous drainage procedure was trial first. Two of them were successful and the others were completed by splenectomy.
