Prognostic factors in metastatic gastric carcinoma.

Although its incidence has declined over last half-century, gastric cancer remains the second most frequent cause of cancer death in the world. The ⅔ of the patients are metastatic at diagnosis. The current study aimed to identify some determinants of survival in patients with metastatic gastric carcinoma. MATERIALS AND METHODS: It was a retrospective study that involved 49 patients treated with palliative chemotherapy between January 2000 and December 2010. Factors included: age, gender, performance status, metastatic diagnosis onset (at diagnosis or later); specific metastatic sites, number of metastatic localizations, response to chemotherapy, and hemoglobin rate. RESULTS: In univariate analysis, factors associated to a better survival were: metastasis at diagnosis, good performance status, response to chemotherapy and single metastatic site. Independent factors in multivariate analysis were: metastasis at diagnosis and single metastatic site. CONCLUSION: Our study confirmed many determinants on survival described in the literature.

Buschke - Lowenstein anal tumor: an ambiguous entity.

The Buschke - Lowenstein tumor is a rare sexually transmitted disease. Its location at the anal margin is also very rare. The most incriminated risk factor is human papillomavirus infection. Its clinical form may be confusing with other tumor and infectious lesions. Histologically, it is characterized by a well-differentiated malpighian proliferation. It represents local aggressive behavior. The treatment of reference remains the surgery with healthy margins of excision. Other treatments have been tested, but their effectiveness remains uncertain. We report here a new case of anal margin Buschke - Lowenstein tumor with a review of the literature.

Iatrogenic colorectal Kaposi's sarcoma complicating a refractory ulcerative colitis in a human immunodeficiency negative-virus patient.

Kaposi sarcoma is an unusual tumor associated to a human herpes virus-8 infection involving the skin or internal organs. Iatrogenic Kaposi's sarcoma often occurs in patients receiving immunosuppressive therapy. So far, a few Kaposi's sarcoma cases have been reported in the literature associated with inflammatory bowel diseases. We report a 53-year-old male diagnosed with a severe refractory ulcerative colitis who was treated with corticosteroids and azathioprine. The patient underwent a colectomy after the failure of medical treatment. Histological examination of the colon showed findings suggestive of Kaposi's sarcoma. Immunohistochemistry for human herpes virus-8 was positive in the colonic lesions. Correspondence.

An unusual case of gallbladder cancer.

Pure squamous cell carcinoma (SCC) of gallbladder is a very rare tumour and is responsible for only 3% of the malignant neoplasm of this organ. We report a case of SCC of gallbladder in a 58-year-old woman. Through this new observation, we propose to study the clinicopathologic features, pathogeny and treatment of this rare entity.

[Role of laparoscopy in the diagnosis of peritoneal tuberculosis in endemic areas]. / Intérêt de la laparoscopie dans le diagnostic de la tuberculose péritonéale en zones endémiques.

The aim of our study is to demonstrate the difficulties of diagnosis of peritoneal tuberculosis in endemic areas and the value of laparoscopy for diagnostic confirmation. We report a retrospective study of 60 cases of peritoneal tuberculosis, collected from January 2004 to December 2009. The patients' median age was 41 years, and the sex ratio 0.4. The dominant reasons for consultation were pain and abdominal distension. Abdominal ultrasound found ascites in all patients. Computed tomography (CT) was performed in 30 patients and confirmed the ultrasound data. Paracentesis of the ascites took place in all patients, collecting exudative fluid in all cases; lymphocytes predominance in 83%. Screening for Mycobacterium tuberculosis in the ascites on direct examination and after culture was performed in 43 cases and negative in all of them. Surgical biopsy was performed laparoscopically in 29 patients and by laparotomy in 31 patients. Histological examination of the peritoneal biopsies confirmed the diagnosis of peritoneal tuberculosis in all cases.

Altemeier operation for gangrenous rectal prolapse.

A stranguled rectal prolapse is a rare cause of intestinal occlusion. It requires emergency surgery. A patient who underwent emergency perineal proctectomy, the Altemeier operation, combined with diverting loop sigmoid colostomy is described. The postoperative course was uneventful, with an excellent final result after colostomy closure. The successful treatment of this patient illustrates the value of the Altemeier procedure in the difficult and unusual scenario of bowel incarceration.

Ileal pouch-anal anastomosis: Points of controversy.

Restorative proctocolectomy with ileal pouch-anal anastomosis has become the most commonly used procedure for elective treatment of patients with ulcerative colitis and familial adenomatous polyposis. Since its original description, the procedure has been modified in order to obtain optimal functional results with low morbidity and mortality, and yet provide a cure for the disease. In this review of the literature of restorative proctocolectomy with ileal pouch-anal anastomosis, we discuss these technical modifications, limiting our discussion to the current points of controversy. The current "hot topics" for debate are: indications for ileal pouch-anal or ileo-rectal anastomosis, indications for pouch surgery in the elderly, indeterminate colitis and Crohn's disease, the place of the laparoscopic approach, transanal mucosectomy with hand-sewn anastomosis vs. the double-stapled technique, the use of diverting ileostomy and the issue of the best route for delivery of pregnant women. Longer follow-up of patients and increased knowledge and experience with pouch surgery, coupled with ongoing prospective evaluation of the procedure are required to settle these issues.

[Acute occlusion with fever in a Tunisian woman]. / Syndrome occlusif fébrite aigu chez une tunisienne.

The purpose of this report is to describe a case of idiopathic segmental infarction of the great omentum, in a Tunisian woman, who presented with acute right hypchondrial pain simulating cholecystitis. Abdominal CT scan is the modality of choice. If symptoms resist medical treatment or complications occur, laparoscopic excision is the best therapeutic technique.

Peritoneal tuberculosis.

The peritoneum is one of the locations outside the most common pulmonary tuberculosis. Peritoneal tuberculosis poses a public health problem in endemic regions of the world. The phenomenon of migration, the increased use of immunosuppressive therapy and the epidemic of AIDS have contributed to a resurgence of this disease in regions where it was previously controlled. The aim of this review is to expose the clinical, biologic end radiologic futures of the peritoneal tuberculosis and to present the methods of diagnosis and treatment. The diagnosis of this disease is difficult and still remains a challenge because of its insidious nature, the variability of presentation and limitations of available diagnostic tests. The disease usually presents a picture of lymphocytic exudative ascites. There are many complementary tests with variable sensitivities and specificities to confirm the diagnosis of peritoneal tuberculosis. Isolation of mycobacteria by culture of ascitic fluid or histological examination of peritoneal biopsy ideally performed by laparoscopy remains the investigation of choice. The role of PCR, ascitic adenosine deaminase, interferon gamma and the radiometric BACTEC system can improve the diagnostic yield. An antituberculous treatment with group 1 of the WHO for 6 months is sufficient in most cases.

[Cystic lymphangioma of the pancreas: an exceptional location]. / Lymphangiome kystique du pancréas : une localisation exceptionnelle.

Cystic lymphangioma of the pancreas is a rare benign vascular tumor. Its histogenesis is still hypothetical and preoperative diagnosis is difficult. We report a new case in a 14-year-old girl hospitalized for pain in the epigastrium and vomiting. Radiologic findings concluded in a cystic tumor of the head of the pancreas. The mass was completely excised. The pathological examination of the surgical specimen revealed cystic formations whose wall consisted of a squamous endothelial epithelium on a fibrous tissue and a few scattered lymphoid clusters, arguing in favor of a cystic lymphangioma.

[Intrauterine device and pelvic tumor: two case reports of pelvic actinomycosis with pseudotumor from tropical zones]. / Dispositif intra-utérin et tumeur pelvienne: 2 observations sous les tropiques d'actinomycose pelvienne pseudotumorale.

Pelvic actinomycosis is a rare chronic disease caused by actinomycete species. The pseudotumorous form is the most common and often leads to misdiagnosis. The purpose of this report is to describe two cases of pelvic actinomycosis involving women with a history of intrauterine contraceptive device (IUD) use. Diagnosis was based on pelvic mass and the findings of surgery undertaken for suspicion of an advanced ovarian tumor with hepatic metastasis in one case and for a tumor of the right ovary in the other case. Diagnosis was confirmed by histological examination of a biopsy specimen in the first case and of the surgical specimen (right ovariectomy) in the second case. Long-term antibiotic therapy was effective in both patients. Based on these two cases and review of the literature, discussion focuses on diagnostic pitfalls, natural course, and therapeutic options for this particular infection.

[Pancreatic hydatid cyst: an exceptional localization]. / Kyste hydatique du pancréas: une localisation exceptionnelle.

Pancreatic hydatid cysts are rare. They account for 1% of all hydatid cysts and are extremely rare in children. This may explain the problems diagnosing this condition. We report on a new case of pancreatic hydatic cyst in an 11-year-old girl who was admitted with a previous history of abdominal pain and jaundice. We discuss the diagnostic features of pancreatic hydatid cyst and therapeutic modalities.

[Gallbladder diaphragm: an unusual cause of acute alithiasic cholecystitis complicated of biliary peritonitis]. / Diaphragme vésiculaire : une cause inhabituelle de cholécystite aiguë alithiasique compliquée de péritonite biliaire.

The gallbladder diaphragm is a very rare abnormality of the embryogenesis. It is an exceptional cause of biliary peritonitis. We report a 54-year-old man who presented with hepatic colic for the past 2 years. Imaging disclosed evidence of alithiasic cholecystitis on gallbladder diaphragm. The coelioscopic exploration confirmed the diagnosis and an associated presence of a biliary peritonitis. A cholecystectomy and a peritoneal washing were performed. The histological examination ruled in the diagnosis of cholecystitis on gallbladder diaphragm. The embryogenesis, the histological and morphological features as well as the treatment are discussed.

[Intestinal perforation in a Tunisian woman: peritonitis due to a fishbone]. / Un coup de poignard abdominal chez un tunisien: péritonite par arête de poisson.

Diagnosis of foreign body perforation of the gastrointestinal tract can be difficult. The purpose of this report is to describe a case of acute peritonitis after perforation of the ileum by a fish bone that was detected by computed tomography.

[Isolated abscess of the thoracic and abdominal wall: an exceptional form of tuberculosis]. / Abcès de la paroi thoracique et abdominale isolé : une forme exceptionnelle de tuberculose.

Isolated thoracic parietal involvement is a very rare form of tuberculosis and multifocal localization is exceptional. It often poses a diagnostic problem with parietal tumours requiring recourse to surgical biopsy. We report a case of tuberculous abscess localized to the anterior and superior part of the chest wall with a second abdominal localization but without any pulmonary involvement. The patient was a woman of 56 years presenting with a one-year history of a swelling to the right of the sternum accompanied after several months by a second swelling to the right side of the abdomen. The radiological and biological investigations revealed a parietal tumour in two separate areas. The diagnosis was confirmed by histological examination of a surgical biopsy and bacteriological examination of a percutaneous aspirate of the collection. Standard anti-tuberculosis treatment was given for nine months with good clinical and radiological resolution. In this case report, we study the anatomical and clinical features of this condition and discuss the diagnostic difficulties.

[Pelvic pseudotumoral actinomycosis: two cases]. / Actinomycose pelvienne pseudotumorale : à propos de deux cas.

INTRODUCTION: Pelvic actinomycosis is a rare suppurative disease that should be included in the differential diagnosis of gynecological cancers. CASE REPORTS: We report two women aged 40 and 41 years with pelvic tumor-like actinomycosis. Physical examination disclosed a pelvic mass in both cases. CT-scan showed annexial infiltrative tumor in both cases with liver metastasis and peritoneal carcinosis in one case each. Surgical procedure consisted in right annexectomy in one case and peritoneal biopsy in the other. Pathologic diagnosis was diagnostic of actinomycosis. Both patients were treated by penicillin G 20 million IU/day during two weeks and then by amoxicilline 3g/day per day during six months. Clinical outcome showed significant improvement in both cases with complete regression of hepatic and pelvic lesions on CT-scan in one case. CONCLUSION: Pelvic actinomycosis is a rare suppurative disorder, commonly associated with a long term wearing of intra-uterine device. Diagnosis is difficult, often delayed and pelvic actinomycosis could mimic gynaecologic neoplasia.

[Two pelvic tumors which should not be operated, lymphoma of Burkitt and actinomycosis]. / Le lymphome de Burkitt et l'actinomycose, deux tumeurs pelviennes qu'il ne faut pas opérer.

The treatment of the pelvic tumors depends of their histological nature. Some of them require only one medical treatment without recourse to surgery. We report two rare cases of pelvic tumors occurring in young adults. For the first case, actinomycosic nature was related to the histological study of the surgical biopsies. Concerning the second case, the lymphatic nature of a tumor of the low rectum was retained on the immunohistochimic study of the endoscopic biopsies. The evolution was uneventful in the two cases after a medical treatment containing penicillin G or a chemotherapy. We discuss at the time of these two observations the diagnostic difficulties and the therapeutic methods of these rare affections.

[Severe rectal bleeding in an Tunisian woman: colonic tuberculosis mimicking a tumor]. / Une rectorragie sévère sous les tropiques.

Since colonic tuberculosis is uncommon and its bifocal pseudo-tumor form is exceptional, differential diagnosis with the colonic cancer is exceedingly difficult. The purpose of this report is to describe a case of primary colonic tuberculosis in two separate locations discovered in a patient presenting with persistent massive hematochezia. A 69-year-old woman was examined for hematochezia, abdominal pain and recent weight loss. Colonoscopy revealed the presence of two ulcerated tumor-like lesions in right colon. One of these lesions caused significant stenosis. Histological examination of biopsy specimens was inconclusive. Colonic tumor with bleeding was considered as the most likely diagnosis. Surgical exploration demonstrated one tumor in the cecum and another in the ascending colon. Right hemicolectomy was performed. Histological examination of the surgical specimen demonstrated a granulomatous reaction pattern with caseous necrosis. Conventional antituberculosis treatment led to clinical improvement.

[The solid pseudopapillary tumor of pancreas: two cases and literature review]. / Tumeurs pseudopapillaires et solides du pancréas: deux observations et revue de la littérature.

Solid pseudopapillary tumor (SPT) of the pancreas is a rare exocrine pancreatic tumor behaving in a low-grade fashion, with limited local invasion risk and a rare metastatic evolution. We report SPT in two young females, revealed by abdominal pain and an epigastric mass. The diagnosis of a cystic tumor was based on abdominal ultrasound and CT data in the first case and on MRI in the second. A distal pancreatectomy and splenectomy were successfully performed in the first case and a central pancreatectomy in the second. Histological study confirmed the diagnosis of SPT of the pancreas.

[Laparoscopic treatment of perforated duodenal ulcer: 84 cases in Tunisia]. / Traitement laparoscopique des ulcères duodénaux perforés: 84 cas en Tunisie.

INTRODUCTION: The purpose of this study was to evaluate the feasibility, efficacy and safety of the laporascopic treatment of perforated duodenal ulcer. METHODS: This retrospective study included patients who underwent laparoscopic treatment of perforated duodenal ulcer during the seven-year period from 2001 to 2007. The procedure included direct suture of the perforated ulcer followed by peritoneal lavage. All patients received medical treatment including Helicobacter pylori eradication and proton pump inhibitor therapy. RESULTS: A total of 84 patients underwent laparoscopic surgery for perforated duodenal ulcer during the study period. There were 81 men and 3 women with a mean age of 28 years. Laparoscopic examination confirmed diagnosis of perforated duodenal ulcer in all cases. Direct suture of the ulcer was successful in 72 cases. In the remaining 12 cases conversion to open surgery was necessary due to difficulty in achieving peritoneal lavage in 6 cases, ulcer size and edge friability in 5, and septic shock in one. The mean duration of the procedure was 95 minutes (range, 60 to 180 minutes). The mean postoperative complication rate was 15.4%. Complications included peritonintis in one case and digestive fistula in one. There were no postoperative deaths. All patients were re-examined after 25 months. Two patients presented recurrences after the laparoscopic treatment and required tri-therapy. CONCLUSION: Laparoscopic suture of perforated duodenal ulcer is safe and effective. It avoids the need for laparotomy that is associated with a risk for septic and parietal complications. Since medical treatment is effective for ulcerous disease, there are currently no indications for radical treatment.