Sleep Habits and Disturbances Among Tunisian Adults: A Cross-Sectional Online Survey [Response to Letter]

Sameh Msaad,1 Nouha Ketata,2 Nesrine Kammoun,3 Rahma Gargouri,1 Rim Khemekhem,1 Sourour Abid,1 Saeb Bader,1 Sabrine Efidha,4 Narjes Abid,5 Jamel EL Ghoul,6 Imen Sahnoun,4 Hazem Altalaa,1 Jihene Jdidi,2 Mohamed Jlidi,7 Nadia Keskes Boudaouara,8 Imen Gargouri,9 Najla Bahloul,1 Samy Kammoun1 1Department of Respiratory and Sleep Medicine, Hedi Chaker University Hospital of Sfax, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia; 2Department of Preventive Medicine, Hedi Chaker University Hospital of Sfax, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia; 3Tunisian Occupational Health and Safety Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia; 4Department of Pneumology, Abderrahman Mami University Hospital of Ariana, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia; 5Department of Pneumology, Mohamed Taher Maamouri University Hospital of Nabeul, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia; 6Department of Pneumology, Habib Bourguiba University Hospital of Mednine, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia; 7Orthopedics and Traumatology Department, Mohamed Taher Maâmouri University Hospital of Nabeul, Faculty of Medicine of Tunis, University of Tunis EL Manar, Tunis, Tunisia; 8Department of Pneumology, Taher Sfar University Hospital of Mahdia, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia; 9Department of Pneumology, Farhat Hached University Hospital of Sousse, Faculty of Medicine of Sousse, University of Sousse, Sousse, TunisiaCorrespondence: Sameh Msaad, Email [email protected]

Small bowel obstruction caused by congenital transmesenteric defect

Transmesenteric hernias are extremely rare. A strangulated hernia through a mesenteric opening is a rare operative finding. Preoperative diagnosis still is difficult in spite of the imaging techniques currently available. The authors describe two cases of paediatric patients presenting with bowel obstruction resulting from a congenital mesenteric hernia. The first patient had a 3-cm wide congenital defect in the ileal mesentery through which the sigmoid colon had herniated. The second patient is a newborn infant who presented with symptoms and radiographic evidence of neonatal occlusion. At surgical exploration, a long segment of the small bowel had herniated in a defect in the ileal mesentery. A brief review of epidemiology and anatomy of transmesenteric hernias is included, along with a discussion of the difficulties in diagnosis and treatment of this condition

Small bowel obstruction caused by congenital transmesenteric defect

Transmesenteric hernias are extremely rare. A strangulated hernia through a mesenteric opening is a rare operative finding. Preoperative diagnosisstill is difficult in spite of the imaging techniques currently available. The authors describe two cases of paediatric patients presenting with bowel obstruction resulting from a congenital mesenteric hernia. The first patient had a 3-cm wide congenital defect in the ileal mesentery through which the sigmoid colon had herniated. The second patient is a newborn infant whopresented with symptoms and radiographic evidence of neonatal occlusion. At surgical exploration, a long segment of the small bowel had herniated in a defect in the ileal mesentery. A brief review of epidemiology and anatomy of transmesenteric hernias is included, along with a discussion of the difficulties in diagnosis and treatment of this condition

Testicular tumours in prepubertal children: About eight cases

Background: To analyze the spectrum of testicular tumors in prepubertal children and the therapeutic resultants in an unselected population. Materials and Methods: Our hospital database was analyzed for testicular tumors from January 1995 to December 2010 concerning clinical presentation, treatment and therapeutic results. Results: Eight patients were operated on because of testicular tumors.In six cases (75%) the tumor was benign: benign teratoma (four cases), epidermoid cyst (one case) and immature teratoma (one case). Two  patients (25%) had a malignant tumour: yolk-sac tumour (two cases). All this children underwent surgery. Radical inguinal orchidectomy was  performed in six cases and conservative surgery was performed in two cases. One patient has received adjuvant chemotherapy. Followup was uneventfully three years after primary surgery.Conclusion: In prepubertal children, most testicular tumours are benign. If tumour markers were negative testis-preserving surgery can be proposed,  complete excision of the tumour should be ascertained. In the case of testicular teratoma, the possibility of contralateral tumour should be    considered in the follow-up.Key words: Children, Testis, Tumour, Teratoma,yolk-sac tumou

Intra-articular osteolipoma of the elbow: A case report and a review of the literature

Introduction: Lipomas are the most common benign mesenchymal tumors. The intra-articular localization is exceptional.We report the first case of an intra-articular osteolipoma at the elbow. Case report: A 36-year-old patient with no pathological history, presented to the emergency room with a two weeks history of a painless, progressively left elbow swelling in a context of apyrexia.Physical examination revealed a hot, edematous left elbow. The gentle mobilization of the joint was painless. Biologie was normal. Initial radiograph showed a well-defined lobular image. Ultrasound revealed an anechoic intra-articular collection associated to a synovium hyperaemia and the MRI shows an aspect of synovitis. An arthrotomy was done via an internal approach of the elbow. Joint fluid was red. A free ossified intraarticular mass was discovered. Bacteriological samples were sterile. Histological examination concluded to an osteolipoma with no histological signs of malignancy. At the last 3-year follow-up, the patient didn't report any pain or functional discomfort. Elbow mobility was complete, with the absence of recurrences. Discussion: Osteolipoma is defined as a histological variant of lipoma having undergone bone metaplasia. Allen found 06 cases in a series of 635 lipomas over five years. Pain has not been reported in the literature. In our case the pain was explained by the interposition of the tumoral mass between the articular surfaces. Histological examination confirms the diagnosis and recurrences are rare. Conclusion: Osteolipoma is an extremely rare entity of mesenchymal tumors whose intra-articular location, although exceptional, does not worsen the prognosis

Management of congenital bladder diverticulum in children: A report of seven cases

Background: The purpose of the study is to present theauthor’s experience with congenital bladder diverticulain seven pediatric patients at a developing world tertiarycare center.Materials and Methods: Records of seven patients diagnosed and treated as congenital bladder diverticulum, from January 1998 to December 2009were retrospectively reviewed for age, sex, clinical symptoms, investigative work-up, operative notes, and postoperative follow-up. Results: All patients were males. Age at presentation ranged from six months to six years (mean three years and six months). All were manifested postnatally by urinary tract infection in four cases, bladder retention in three cases and abdominal pain in two cases. Diagnosis was suggested by ultrasound and confi rmed by voiding cystourethrography(VCUG) in all cases and urethrocystoscopy in three cases. Open surgical excision of diverticulum was done in all the patients associated with ureteral reimplantation in four patients with VCUG-documented high-gradevesicoureteral refl ux (VUR). Average follow-up was four years; there is a resolution of symptoms and no diverticulum recurrence at the defi ned mean followup.Conclusion: Recurrent urinary tract infections and voiding dysfunction in pediatric population should always be evaluated for congenital bladder diverticulum. Investigations such as abdominal ultrasound, VCUG and nuclear renal scanning, form an important part of preoperative diagnostic work-up and postoperative follow up. Diverticulectomy with ureteral reimplantation in case of high-grade refl ux, provides good resultswithout recurrence.Key words: Children, congenital bladder diverticulum, diverticulectomy, voiding cystourethrogram, voiding dysfunctio

Congenital diaphragmatic hernia in neonate: A retrospective study about 28 observations

Objective:Our purpose was to review our experience with congenital diaphragmatic hernia emphasizing diagnosis, management, and outcome. StudyDesign: We conducted a retrospective review of all cases of babies with congenital diaphragmatic hernia diagnosed and treated in our centre from1998 to 2010. Results: There were 28 congenital diaphragmatic hernia cases, 13 girls and 15 boys with a mean weight birth of 3 kg. Three  patients (10,6% of cases) died within a few hours after admission. In the remaining cases, surgery was performed after a stabilization period of 2 days. The diaphragmatic defect was sitting in the posterolateral left in 23 cases and right in 2 cases. Its dimensions were on average 4,5 cm, tow cases of agenesis of the cupola were seen and required the placement of  gortex prosthesis. The remaining cases are treated by direct closure ofdefect. Postoperative course was marked by an early death in context of respiratory distress in six cases and later with sepsis in tow cases. The  outcome was favourable in 17 cases (60, 7%), despite the occurrence of sepsis in four cases and evisceration in two cases.Conclusions: Congenital diaphragmatic hernia remains a serious disease with high mortality and morbidity despite advances in prenatal diagnosis and neonatal  resuscitation.Key words: Congenital diaphragmatic hernia, pulmonary hypoplasia,  tracheal occlusion, paediatric surger