Formation of Pancreatoduodenal Fistula in Intraductal Papillary Mucinous Neoplasm of the Pancreas Decreased the Frequency of Recurrent Pancreatitis

Intraductal papillary mucinous neoplasms (IPMN) of the pancreas are characterized by proliferation of mucin-secreting cells in the main pancreatic duct (PD) or its branches. The secreted thick mucin usually leads to PD obstruction and dilation. A common complication of IPMN is recurrent acute pancreatitis secondary to poor pancreatic fluid drainage, and rarely, pancreatobiliary and pancreatointestinal fistulae. We describe a unique case of IPMN in a 57-year-old male who was referred to our institution for evaluation of recurrent acute pancreatitis. After extensive evaluation, he was diagnosed with main duct IPMN. Intraductal PD biopsy revealed intestinal type IPMN with intermediate grade dysplasia. Patient was managed clinically by large caliber (10 French) PD stenting which eliminated his recurrent acute pancreatitis. The patient was initially referred for pancreatic resection; however, surgery was aborted and evaluated to be high risk with high morbidity secondary to the extensive adhesions between the pancreas and surrounding structures. Patient remained clinically stable for a few years except for an episode of acute pancreatitis that happened after a trial of stent removal. Subsequently, the patient did well after the PD stent was replaced. Recently, repeat abdominal imaging revealed a large pancreatoduodenal fistula which was confirmed on repeat endoscopic retrograde cholangiopancreatography. We were able to perform pancreatoscopy by advancing a regular upper scope through the fistula and into the PD. Interestingly, the fistula relieved the symptoms of obstruction and subsequently decreased the frequency of recurrent pancreatitis episodes with no further episodes at 6 months follow-up. This case highlights the importance of providing adequate PD drainage to reduce the frequency of recurrent acute pancreatitis in the setting of main duct IPMN, especially if the patient is not a surgical candidate. Also, physicians need to monitor for complications such as fistula formation between the pancreas and surrounding structures in the setting of chronic inflammation due to recurrent episodes of pancreatitis. Early identification of a fistula is important for surgical planning. Furthermore, since recent studies suggested a higher incidence of additional primary malignancies in patients with IPMN of the pancreas compared to the general population, patients may be considered for screening for other primary malignancies

Quantitative analysis of cell organization in the external region of the olive fruit

Definitions of the cells that constitute the exocarp or exterior tissue of fleshy fruits are often vague, sometimes providing contradictory descriptions of the epidermis plus none or varying numbers of underlying cell layers for the same species. This study uses a morphometric approach to investigate how cell dimensions, cell number, and their relation with genetically based fruit size differences can contribute to a characterization of tissue organization in the external fruit region, using the olive drupe as an example.We determined cell area, radial and tangential widths, and cell number in the epidermis and 20 subepidermal cell layers of mature fruits of four olive cultivars that range in fruit size. Variation of these measurements among cell layers and the implied cellular contributions to fruit expansion revealed two different subepidermal regions, but with constant widths and layer numbers for all cultivars: (1) the first four cell layers (1-4), which have similar behavior to the epidermis; and (2) the following five cell layers (5-9), which are more similar to the mesocarp. The results provide new insights about cell patterns in the external region of the olive fruit and suggest that layers 1-4 together with the epidermis may act as a multiseriate exocarp and layers 5-9 may act as an outer mesocarp. © 2012 by The University of Chicago. All rights reserved.The study was funded by the Ministry of Science and Innovation of Spain and European Research and Development Funds (grant AGL2009-07248).Peer Reviewe

Denutrition et cancers des voies aero-digestives superieures

Head and neck cancer and its treatment are responsible in more than 30% of cases of malnutrition witch can be severe and interfere with the management of these tumors. The aim of this paper is to provide a protocol for nutritional management practices of these cancers. The malnutrition diagnosis requires an examination that must define essentially a recent weight loss and try to quantify it. Clinical examination is a crucial time in the diagnosis and classification of malnutrition severity. Biology also provides a severity evaluation but also to follow up. The management of malnutrition in head and neck cancer must be early before the cancer treatment. The oral nutrition support should always be preferred. Enteral nutritional support by nasogastric, gastrostomy or jejunostomy must be used if the oral support has failed. Parenteral nutrition retains a limited and short duration

Laryngectomie totale résultats de l’expérience du service d’orl de sfax

Introduction : La laryngectomie totale (LT) reste l’intervention la plus réalisée dans notre pays pour les cancers laryngés. Le but de ce travail est d’évaluer les résultats postopératoires et évolutifs des malades ayant eu une LT. Matériel et méthodes : Il s’agit d’une étude rétrospective à propos de 187 cas de patients ayant eu une laryngectomie totale, sur une période de 19 ans (1987-2005). La tumeur a été classée T3T4 dans 87,8 % des cas. L’atteinte des 3étages était trouvée dans 56% des cas et l’extension extra laryngée dans 59 % des cas. Une trachéotomie première pour dyspnée laryngée a été réalisée dans 44 % des cas. La laryngectomie était étendue au pharynx ou à la base de la langue dans 43 % des cas. Résultats : Les suites opératoires ont été marquées par l’apparition d'un  pharyngostome chez 19% des patients et par une infection dans 11% des cas. Les limites de résection ont été tumorales dans 14% des cas. Une radiothérapie postopératoire a été réalisée dans 92,5% des cas.Une rééducation orthophonique a pu être réalisée chez 36% des patients. Sur un recul moyen de 40 mois (2 à 132 mois), une récidive tumorale ou ganglionnaire a été retrouvée dans 8 % et 5 % des cas respectivement. Le taux de métastase à distance était de 11 % des cas. Une deuxième localisation a été objectivée dans 4 % des cas. La survie moyenne à 5 ans était de 75 %. Discussion : La laryngectomie totale est une intervention mutilante, par le handicap vocal qu’elle engendre mais la survie à 5 ans est de 75%. La perte définitive de la fonction phonatoire du larynx en constitue l’handicap majeur. Le diagnostic plus précoce de ces cancers dans notre pays peut permettre d’autres alternatives thérapeutiques.Mots-clés : Laryngectomie totale, pharyngostome, cancers laryngés

Prise en charge des complications orbitaires et endocrâniennes des sinusites bacteriennes aiguës

Les complications orbitaires et endocrâniennes des sinusites aiguës infectieuses posent un problème diagnostique et thérapeutique Le but de notre travail est de proposer un algorithme de prise en charge de ces complications à travers une revue de littérature Les sinusites de la base du crâne (frontal, sphénoïdal et éthmoïdal) sont les plus fréquents en cause de complications endocrâniennes. Les atteintes orbitaires sont le plus souvent consécutives à des sinusites éthmoïdales chez l’enfant et fronto-maxillaires chez l’adulte. L’imagerie joue un rôle important dans le diagnostic précoce et précis de ces affections et pour guider le traitement. Le traitement du foyer sinusien est systématique aussi bien pour les complications orbitaires ou endocrâniennes si l’indication chirurgicale est retenue. Les complications orbitaires sont traitées par des antibiotiques visant les bactéries en cause avec des indications chirurgicales selon la classification scannographique de Chandler. Le traitement est désormais plus conservateur notamment pour l’abcès sous périosté. Pour les complications endocrâniennes le traitement est basé sur un traitement médical antibiotique. Le geste chirurgical serait fait en fonction du résultat de l’imagerie. Le pronostic est amélioré actuellement grâce à la précocité du diagnostic, ainsi qu’aux progrès rapportés dans le domaine de la chirurgie endonasaleMots clés : sinusite, complications orbitaires, complications endocrâniennes, imagerie, antibiotique, chirurgieOrbital and intracranial complications of acute infectious sinusitis (SIA) pose a diagnostic and therapeutic problem. The aim of our work is to provide an algorithm support these complications through literature review. Sinusitis the base of the skull (frontal, ethmoid and sphenoid) are more involved in intracranial complications. Orbital sufferers are most often secondary to ethmoidal sinusitis in children and fronto -maxillary adults. The imaging plays an important role in the early and accurate diagnosis of these diseases and to guide treatment. The treatment of sinus home is also good for the systematic orbital or intracranial complications if surgical indication is retained. Orbital complications are treated with antibiotics for the bacteria involved with some surgical indications according to CT scan classification Chandler. The treatment is now more conservative including subperiosteal abscess. Intracranial complications for treatment are based on medical treatment and between other antibiotic. The surgical procedure was done according to the result of imaging The prognosis is currently improved with early diagnosis, and the progress reported in the field of endonasal surgeryKeywords: sinusitis, orbital complications, intracranial complications, imagery, Antibiotic, surger

Traitement Chirurgical De L\'hyperparathyroidie Primaire : Techniques Et Resultats

L\'hyperparathyroïdie est secondaire à une sécrétion élevée de parathormone. Le diagnostic positif est biologique et le diagnostic de localisation est radiologique et isotopique. Le traitement chirurgical est la règle. Le but : de ce travail est d\'étudier notre stratégie thérapeutique en cas d\'hyperparathyroïdie primitive et ses résultats. Patients et méthodes : Nous avons mené une étude rétrospective à propos de 34 patients traités pour hyperparathyroïdie primitive durant la période entre 1992 et 2004. Résultats : L\'âge moyen de nos patients était de 51 ans avec une nette prédominance féminine. Notre stratégie chirurgicale était l\'exploration sous anesthésie générale des 4 glandes parathyroïdes. Les glandes pathologiques ont siégé au niveau des compartiments inférieurs dans la majorité des cas. Histologiquement l\'aspect adénomateux a été observé chez 26 patients. L\'examen extemporané était systématique. Son résultat était concordant avec l\'examen anatomopathologique final lui conférant une fiabilité de 100 %. L\'hypocalcémie post-opératoire immédiate a été rencontrée chez 11 patients. Elle était transitoire dans 8 cas. Un seul patient avait une hypercalcémie persistante conférant à notre stratégie chirurgicale un taux de succès de 97,15 %. Discussion : le risque d\'hypocalcémie immédiate varie dans la littérature de 3 à 50%. Dans notre série il était de 32,35%. Ceci est surtout expliqué par notre technique opératoire exposant les parathyroïdes à la dévascularisation. D\'autres techniques chirurgicales moins invasives ont été essayées visant à diminuer le risque d\'hypoparathroidie transitoire ou définitive. Elles sont basées sur un bilan localisateur performant actuellement surplombé par la scintigraphie au sestamibi.Primary hyperparathyroidism is secondary to an elevated secretion of parathormone. The positive diagnosis is biologic. The diagnosis of localization is radiological and isotopic. The surgical treatment is the rule. The aim : of this work is to study our therapeutic strategy in cases of primary hyperparathyroidism and its results. Patients and methods: We proceed to a retrospective study about 34 patients treated for primary hyperparathyroidism during the period between 1992 and 2004. Results: The middle age of our patients was of 51 years with a female predominance. Our surgical strategy was the exploration under general anaesthesia of the 4 parathyroid glands. The pathological glands were in the lower compartments in the majority of cases. Histologically, adenoma has been observed at 26 patients. Extemporary exam was systematic. Its result was in agreement to the final anatomopathological result conferring him a reliability of 100%. The immediate post-operative hypocalcaemia has been observed at 11 patients. It was transient in 8 cases. One alone patient had an obstinate hypercalcaemia conferring to our surgical strategy a rate of success of 97,15%. Discussion: the risk of immediate hypocalcaemia varies in the literature from 3 to 50%. In our study it was 32,35%. It is especially explained by our operative technique exhibitor parathyroïd to the devascularisation. Other operative techniques less invasiveness have been tried aiming to decrease the risk of transient or definitive hypoparathroidy. They are based currently on a effective exam of localization overhung by the scintigraphy to the sestamibi. Journal Tunisien d\'ORL et de chirurgie cervico-faciale Vol. 16 2006: pp. 8-1

West Nile virus meningoencephalitis during pregnancy: Case report with MR imaging findings

AbstractMR imaging findings of West Nile virus meningoencephalitis during pregnancy are unknown. We report the first case of serologically proved West Nile virus meningoencephalitis complicating pregnancy with MRI findings. MR imaging of the brain revealed abnormal hyperintensity in the periventricular white matter near the left frontal horn and insular left lobe on fluid-attenuated inversion recovery and T2-weighted images. Evolution was favorable, and no obvious fetal consequences of infection were noted after birth. Recognition of the MR imaging appearance of this entity is important because of the expanding epidemic

Changes in volatiles of olive tree Olea europaea according to season and foliar fertilization

In the present study, four foliar fertilizers (FF1, FF2, FF3 and FF4) were separately sprayed on Chemlali olive trees at different moments of the vegetative cycle. FF1 (rich in nitrogen) was applied during the vegetation stage (Last January-February) at a dose of 5 L/ha per spray (three sprays per season). FF2 (rich in boron, magnesium and sulphur), FF3 (rich in phosphorus and potassium) and FF4 (rich in phosphorus and calcium) were applied respectively during the stages of flowering (Last March-April), fruit growth (July-August) and ripening (October-November), at a dose of 3 L/ha per spray (three sprays per season for each fertilizer).The volatile fraction was analysed by GC-MS, 46 volatile compounds were identified and their amount were expressed as relative abundance (%). In a general view, the most abundant volatiles in Chemlali olive leaves across the vegetative cycle were (E)-2-hexenal, nonanal, (E)-β-damascenone, 3-ethenyl pyridine and β-caryophyllene. The levels of these main compounds and the general composition of the volatile fraction varied significantly through season.The volatile levels were mainly affected by the two foliar fertilizers enriched with nitrogen and Boron respectively. The most affected volatiles were (E)-2-hexenal, nonanal, 3-ethenyl pyridine, (E,E)-α-farnesene, and (E)-nerolidol. Less impact was noticed after the use of the other foliar fertilizers.Our study is the first investigation bringing data about the variation of leaf volatile profile of Chemlali cultivar across a vegetative cycle and showing the impact of nutrient foliar sprays on olive leaf volatile

Les tumeurs myofibroblastiques inflammatoires cervico-faciales

Objectifs : Confronter les signes cliniques et paracliniques de cette entité à celle des cancers et étudier ses modalités thérapeutiques.Matériel et méthodes : Etude rétrospective portant sur huit cas de tumeurs myofibroblastiques inflammatoires cervico-faciales.Résultats : L’âge moyen était de 37 ans sans prédominance de sexe. Le siège de la pseudotumeur était thyroïdien dans un cas, ganglionnaire dans deux cas, les parties molles cervicales dans un cas, laryngé dans un cas, nasosinusien dans un cas, orbito-sinusienne dans 1 cas et du cavum dans un cas. Le traitement était chirurgical dans 6 cas. Une corticothérapie a été instaurée dans 4 cas dont 2 en post opératoire. L’évolution, après un recul moyen de 21 mois, était marquée par la survenue de récidive dans 2 cas, une poursuite évolutive dans 1 cas et l’apparition d’autres localisations rénales et rétro péritonéale chez une patiente.Discussion : Les tumeurs myofibroblastiques inflammatoires sont rares. De caractère bénin, ces tumeurs présentent généralement des caractéristiques cliniques d’agressivité avec un pouvoir lytique mimant une tumeur maligne. L’atteinte des voies aérodigestives supérieures se voit dans 11 % des tumeurs extrapulmonaires. Le diagnostic préopératoire est difficile. L’exérèse aussi large que possible de la tumeur est généralement préconisée. L’association d’une corticothérapie est indiquée chez des patients demeurant symptomatiques.Mots clés : tumeur myofibroblastique inflammatoire, cervico-facial, chirurgie, corticoïdesObjectives: Compare clinical, radiological and histological features of inflammatory myofibroblastic tumours with cancers and describe this entity therapeutic management.Material and methods: Retrospective study on eight cases of head and neck inflammatory myofibroblastic tumours.Results: The median age was 37 years without sex predominance. The tumor location was the thyroid (1 case), cervical lymph nodes (2 cases), neck (1 case), larynx (1 case), sinonasal tract (1case), orbit and sinosal tract (1 case) and nasopharynx (1 case). Surgical procedure was performed in 7 case. Corticosteroid therapy was established in 4 cases. The median follow-up was 21 months. Local recurrence was noted in 2 cases. A disease evolution was noted in 1 case. Occurrence of renal and retroperitoneal locations was noted in 1 case.Discussion : Inflammatory myofibroblastic tumours are uncommon. Although they are histological benign, they often show aggressive clinical behavior, with locally destructive features that mimic a neoplastic process. Head and neck involvement is seen in 11% of extrapulmonary locations. Preoperative diagnosis is difficult. A wide surgical excision of the tumor is recommended. The combination of a corticosteroid is indicated in patients who remain symptomatic.Key words: Inflammatory myofibroblastic tumour, Head and neck, surgery, corticosteroid

L'atteinte du sinus caverneux dans le carcinome adenoïde systique

Introduction: Head and neck adenoid cystic carcinoma (ACC) is a malignant epithelial neoplasm, developing from salivary gland tissue. Cavernous sinus and skull base invasion by perinervous spread is a particular behavior of this tumor entity. We report two cases of cavernous sinus invasion.Cases report: The first one was originated in the parotid gland, invaded infratemporal fossa and extended to cavernous sinus through perineural infiltration along trigeminal nerve. Second case of ACC was developed in submandibular gland. An invasion of cavernous sinus was observed two years later despite a surgical resection with post operative  chemoradiotherapy.Discussion: ACC is characterized by locally aggressive invasion and a strong tendency to recur. Perineural spread extension is common in ACC, as a precursor of skull base invasion and cavernous sinus involvment along the mandibular, maxillary and facial nerves. Magnetic resonance imaging (MRI) has a higher sensitivity and specificity in detecting perineural spread. Surgical therapy is the choice treatment although complete resection is not possible in all cases due to the infiltration andperineural spread. So, radiation therapy is considered effective, and has been used successfully in ACC invading cavernous sinus. The place of chemotherapy has yet to be determinate. The prognosis of these extensive tumors is bad because high frequency of local recurrence and distant metastases.Key-words: adenoid cystic carcinoma, cavernous sinus, skull base, perineural invasion