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ABSTRACT: Malignant epithelioid hemangioendothelioma (EH) is a rare tumor of vascular origin. We report a case of a woman who was found to have multiple hepatic masses in the right lobe of the liver on radiologic investigations, initially misdiagnosed as a metastatic carcinoma. The diagnosis of EH was made on histopathological study and confirmed by immunohistochemistry, which showed diffuse response for CD34 marker and no response to tissue CEA, HMB-45 or S-100 protein. Partial hepatectomy was made with good results.
Oman medical journal. 03/2013; 28(2):135-137.
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ABSTRACT: Background: Hepatitis C virus (HCV) infection is one of the main causes of chronic liver disease worldwide. Aim: To describe epidemiological patterns of hepatitis C in Tunisia. Methods: Literature review. Results: In Tunisia, the prevalence of HCV infection is about 0, 7 % in the general population with an increased transmission in the north of the country. Genotype 1b is the most frequent (76 % - 88 %).
La Tunisie médicale 02/2013; 91(2):86-91.
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La Tunisie médicale 12/2012; 90(12):894.
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ABSTRACT: Background: Infections are frequent in cirrhotic patients. They are potentially severe, modifying pejoratively the natural history of the cirrhosis and are suppliers of a heavy mortality. Aim: To determine the predictive factors of hospital mortality in cirrhotic infected patients. Methods: We conducted a retrospective study including 97 cirrhotic patients hospitalized in the department of gastroenterology of Charles Nicolle's hospital, for a first infectious episode and not having received antibiotics in the previous 15 days. Clinico-biological, bacteriological, therapeutic and evolutionary data were collected. Scores were adopted and calculated such as the score of Child-Pugh, the score MELD (The Model for End-Stage Liver Disease) and the score SOFA (Sequential Organ Failure Assessment). These data allowed a descriptive study and an uni and multi-varied analysis. Results: The median age of the studied population was of 59 ± 12 years with a sex ratio of 0.83. The diabetes was the comorbidity most frequently associated with the cirrhosis (26.8 % of the cases) Viral aetiology of the cirrhosis was dominant (3/4 of the cases) especially the virus C (62.5 % of the cases). The clinical presentation of the infection was polymorphic with presence of symptoms connected to the infection and the other connected to the progression of the liver disease. The fever was absent in 3/4 of the cases. The identified infections were, in order of frequency, urinary, infection of ascite, bronchopulmonary, cutaneous and gynecological. The responsible germs were especially bacilli gram negative of intestinal origin. The estimated scores of gravity were: a score of Child-Pugh C in 60 % of the cases, an average score MELD in 18±8 points and a score average SOFA in 8 ± 4 points. Multivariate study found that only encephalopathy, bilirubin level more than 40 μmol/l and creatinin level more than 120 μmol/l was independent factors predicting mortality. Conclusion: Infection in cirrhotic patients was a severe and mortal complication. The hepatic encephalopathy, the hyper bilirubinemia and the renal failure are predictive of the hospital mortality. The use of the scores of gravity: Child-Pugh, MELD and SOFA would an important help for the decision to admit in intensive care unit any infected cirrhotic patient.
La Tunisie médicale 11/2012; 90(11):807-11.
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La Tunisie médicale 08/2012; 90(8):667-8.
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ABSTRACT: Hepatocellular carcinoma (HCC) is the most frequent primitive hepatic tumor, the fifth most common cancer in the world,and the third highest cause of cancer-related mortality. The presence of cirrhosis is the main risk factor.Aim: To describe the epidemiological, clinical and therapeutic features of HCC.
Retrospective study including all the patients with HCC occurring in cirrhotic liver followed in the gastroenterological department of Charles Nicolle hospital between 1997 and 2009.
A hundred and one patient were enrolled; 64 men and 37 women with a median age of 65.4 years (31-88 years). Cirrhosis was due to viral hepatitis B or C in 25.7% and 62.2% of cases respectively and was classified Child Pugh A, B and C in 30.7%,50.5% and 18.8% of patients respectively. HCC was inaugural in most cases (68.3 %) and it was revealed by a tumoral syndrome in 38.6% of cases, by decompensation in 22.7% and was discovered during systematic screening when cirrhosis was already known in 19.8% of cases. Diagnosis of HCC was non invasive, relying on imaging and alphafetoprotein in most cases (95%). 84 patients(83.2%) had an advanced HCC, with vascular or extra hepatic spread in 58 (57.5%) of them. Treatment was curative in 14 cases, based on surgical resection in one case and percutaneous ablation in 13 cases.Six patients received transarterial chemoembolization as a palliative treatment. In 71 patients, only symptomatic treatment was given. The median survival time was 11 months.
In the majority of the cases, HCC was diagnosed at an advanced stage and treatment was only symptomatic.
La Tunisie médicale 06/2012; 90(6):468-72.
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ABSTRACT: Congenital megacaecum is a rare entity and difficult to diagnose. The pathogenesis of this malformation is not well known since there are very few cases reported in the literature. The purpose of this observation is to describe the functional signs that may suggest this rare diagnosis and the means to confirm it. We report the case of a 22-year-old young man, who complained of constipation associated with pelvic pain in the form of gravitational pull exacerbated by standing, sitting and going down the stairs. However, symptoms seemed to be relieved by supine positions. The radiological investigations concluded that the megacaecum dipped into the pelvis, but there was no evidence of mechanical or functional obstruction distally. The treatment consisted of a laparoscopic right colectomy. The postoperative course was uneventful. The megacaecum is rare and poorly understood. The abdominal pain is directly related to fecal stasis, which increases the pressure on cecal colonic segment and this in turn causes a pull on the mesentery. The entero-MRI is valuable in the diagnosis so as to eliminate other causes of chronic abdominal pain.
Gastroentérologie Clinique et Biologique 05/2012; · 0.80 Impact Factor
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La Tunisie médicale 03/2012; 90(3):271-3.
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ABSTRACT: Patients with inflammatory bowel disease (IBD) are at increased risk of thromboembolic complications (TEC), which represent an important cause of morbidity and mortality.
To assess the prevalence and risk factors of TEC in patients with IBD. Methods: We conducted a retrospective study including all the IBD patients in the gastroenterological department of Charles Nicolle hospital between 2000 and 2010. Only thromboembolic events that had been diagnosed by an imaging procedure were counted.
A total of 266 patients with IBD were consecutively included. TE events occurred in nine patients (3.4%); six men and three women. Their mean age was 31 years [15-64 years]. Five patients had Crohn's disease and four had ulcerative colitis. The types of TEC were deep venous thrombosis of the leg in five cases with pulmonary embolism in one of them, cerebral venous thrombosis in two cases, portal thrombosis in one case and jugular vein thrombosis in one case. Active disease was present in all cases at the time TEC occurred.
In our study, the prevalence of TEC is 3.4% in patients with IBD. Deep venous thromboses of the leg are the most common TEC and all our cases occurs during the active phase of IBD.
La Tunisie médicale 12/2011; 89(12):924-8.
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ABSTRACT: Colonoscopy is the standard investigation for colonic disease, but clinicians often are reluctant to refer elderly patients for colonoscopy because of a perception of higher risk and a high rate of incomplete examinations.
To evaluate feasibility and tolerance of this investigation in elderly and to review the most frequent indications of colonoscopy in these patients.
A pilot retrospective study including 901 patients from January 2005 to December 2009; divided into two groups. Group (I) included patients 75 years old and more, group (II) included patients 45 years old or less. All those patients underwent colonoscopy at the gastroenterology department of Charles Nicole hospital.
The 1st group included 231 patients, and the 2nd group included 670 one. A past history of colorectal cancer was more frequent in the group I (33.3% versus 9.90%; p<0.05) however history of chronic inflammatory bowel disease was more frequent in group II (0 versus 40.6%; p<0.05). The main indication of colonoscopy was constipation in group II (6.1% versus 27%; p<0.05) and chronic diarrhoea in group I (42.9% versus 16.4%; p<0.05). Bowel preparation was poor in 30.4% cases of the group I and 12.9% of group II (p<0.05). The tolerance was similar in the two groups. The incomplete colonoscopy rate was higher in the group I (38.3% versus 23.4%; p<0.05). The most frequent cause of colonoscopy interruption was the poor preparation in group I and the bad tolerance in group II. Diverticular disease, polyps and colorectal cancers prevailed in group I, whereas inflammatory bowel disease was current in group II.
In elderly patients, colonoscopy is safe, well tolerated and offers a good diagnostic yield. Its non completion was essentially due to the poor preparation. Sedation did not seem essential. The optimisation of results of colonoscopy requires an improvement of quality preparation.
La Tunisie médicale 11/2011; 89(11):848-52.
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Leila Mouelhi,
Leila Abbes,
Insaf Belhadj Ali,
Fatma Houissa,
Haifa Mekki,
Majd Ben Rjeb,
Slim Bouzaidi,
Mohamed Salem,
Radhouane Debbeche,
Adel Khedher, Taoufik Najjar
La Tunisie médicale 11/2011; 89(11):875.
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Joint, bone, spine: revue du rhumatisme 09/2011; 79(2):202-3. · 2.25 Impact Factor
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La Tunisie médicale 07/2011; 89(7):654-6.
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ABSTRACT: The risk of thromboembolism is increased in inflammatory bowel disease and its symptoms may be overlooked. The commonest are deep vein thrombosis and pulmonary emboli. Cerebral thrombosis, in a particular stroke, is rare. Furthermore, its treatment can be complex. We present the cases of 4 patients with cerebral vascular involvement.
Journal of Crohn s and Colitis 06/2011; 5(3):249-52. · 2.57 Impact Factor
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Journal of Crohn s and Colitis 04/2011; 5(2):171-2. · 2.57 Impact Factor
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ABSTRACT: Intestinal intussusception occur when a portion of the gastrointestinal tract invaginates into the part of the tract that precedes into the peristaltic direction.
To determine clinical presentation, diagnostic methods and outcome of the intestinal intussusception and to compare our results to previous data.
A retrospective study of 20 patients with mean age of 40 years admitted between 1982 and 1999 and underwent surgery for intestinal intussusceptions.
Our patients were 10 males and 10 females. The clinical findings were essentially abdominal pain (90%). Preoperative diagnosis of intestinal intussusceptions was established in 30% of cases. Intussusceptions were ileo-ileal (n=10), ileo-colic (n=7) and colo-colic (n=3). 12 patients had tumors. For all intussusceptions involving the colon, all patients underwent resection while intussusceptions located on the small bowel were treated by reduction then resection or simple reduction then fixation. The mortality rate was 5%.
Intestinal intussusception in adults is uncommon in comparison with children. Correct diagnosis is often established during surgery. Resection is recommended because of the frequent malignancy.
La Tunisie médicale 03/2011; 89(3):243-7.
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Sana Aissi-Ben Moussa,
Amel Moussa,
Nadia Kourda,
Amel Mezlini,
Nabil Abdelli,
Farid Zerimech, Taoufik Najjar,
Sarah Ben Jilani,
Nicole Porchet,
Farhat Ben Ayed,
Mohamed Manai,
Marie-Pierre Buisine
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ABSTRACT: High rates of early colorectal cancers (CRC) are observed in Tunisia suggesting genetic susceptibility. Nevertheless, up to now, no molecular study has been performed in the Tunisian population. In our research, we evaluated the clinical characteristics of Tunisian families suspected of Lynch syndrome and the contribution of DNA mismatch repair (MMR) genes.
Thirty-one unrelated families suspected of Lynch syndrome were studied. Probands were tested for the presence of germline mutations in the MMR genes MLH1, MSH2, MSH6 and in MUTYH. Available tumours were analysed for microsatellite instability and expression of MMR proteins. Detailed family and medical histories were collected.
A total of 134 cancers were noted in the 31 families, the most frequent type of cancer corresponding to CRC (69%), followed by uterine cancer (7.5%). Germline mutations were identified in 11 (35.5%) families (six MSH2, five MLH1, including seven novel mutations), seven of which fulfilled the Amsterdam criteria (sensitivity, 63.6%; positive predictive value, 58.3%). Noteworthy, germline mutations were detected in 52.6% of male patients tested, but in only 8.3% of females (p = 0.02). Moreover, CRC were essentially left sided in families without detected mutation (p = 0.017). Ages of onset of cancers and tumour spectrum were very similar in families with or without MMR germline mutation, contrasting with previous studies performed in other populations.
MMR genes contribute significantly to CRC susceptibility in the Tunisian population. However, the cause of early CRC susceptibility remains unknown in most cases, especially in women and in patients with early left colon or rectal cancer.
International Journal of Colorectal Disease 02/2011; 26(4):455-67. · 2.38 Impact Factor
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La Tunisie médicale 01/2011; 89(1):83-4.
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Walid Ben Aleya,
Imen Sfar,
Imen Habibi,
Leila Mouelhi,
Houda Aouadi,
Mouna Makhlouf,
Salwa Ayed-Jendoubi, Taoufik Najjar,
Taeib Ben Abdallah,
Khaled Ayed,
Yousr Gorgi
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ABSTRACT: Interleukin (IL)-18 can regulate the Th2-mediated immune response and it may be involved in the pathogenesis of Th1 and Th2 chronic inflammatory diseases. This study sought to detect a possible association between two single nucleotide polymorphisms (SNPs) (-137G/C and -607C/A) in the IL-18 gene promoter region and susceptibility to inflammatory bowel disease (IBD) including Crohn's disease (CD) and ulcerative colitis (UC) in the Tunisian population.
The (-137G/C and -607C/A) IL-18 polymorphism was analyzed in 105 patients with CD, 59 patients with UC, and 100 controls using the sequence-specific polymerase chain reaction method.
The distribution of allele and genotype frequencies illustrate that the -137G/G genotype frequency was significantly higher in UC than in controls (p value corrected (pc) = 0.038). On the other hand, we found a statistically significant association (pc = 0.033) between genotype AA of the IL-18 gene promoter (-607C/A) polymorphism in UC patients and the distal localization of the lesions. In CD, no significant differences were observed at positions -607 and -137. The analysis of IBD patients according to clinical behavior revealed no difference.
The two SNPs at position -607 (C/A) and -137 (G/C) in the promoter region of the IL-18 gene was associated with the development of UC but not CD, providing a strong support for an IBD susceptibility gene in the region surrounding IL-18. It remains to be determined precisely how the IL-18 alleles influence the pathogenesis of IBD.
Digestion 01/2011; 83(4):269-74. · 2.05 Impact Factor
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ABSTRACT: Hepatocellular carcinoma (HCC) with sarcomatous change is an uncommon neoplasm with a poor prognosis.
To report a new case.
A 72-year-old man presented with abdominal right upper quadrant pain. The diagnosis of cirrhosis was suspected on clinical and biochemical data. On abdominal computed tomography, the mass was not enhanced in the arterial phase and exhibited peripheral enhancement during portal phase which persisted in the delayed phase. The serum alpha-fetoprotein was 500 ng/ml but since the imaging features were not typical of ordinary HCC, percutaneous liver biopsy was performed and confirmed the diagnosis of HCC with sarcomatous change.
Except for liver biopsy, no diagnostic method could distinguish between sarcomatous and ordinary HCC.
La Tunisie médicale 12/2010; 88(12):957-60.
