235 research outputs found

    Left pancreatectomy for primary hydatid cyst of the body of pancreas

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    Hydatid disease is a considerable health problem Worldwide. Primary hydatid disease of the pancreas is very rare. We report the case of a 30-year-old woman who presented with abdominal pain and an epigastric mass. A  diagnosis of hydatid cyst of the pancreas was established by ultrasonographybefore surgery. The treatment consisted of a distal pancreatectomy. The postoperative evolution was uneventful. Hydatid disease should be consideredin the differential diagnosis of all cystic masses in the pancreas, especially in the geographical regions where the disease is endemic. Surgical removal remains the main form of defi nitive treatment

    Leiomyosarcome du Rein: A Propos D’un Cas

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    Le lĂ©iomyosarcome du rein est une tumeur rare. Les auteurs ont rapportĂ© l’observation d’un homme ĂągĂ© de 45 ans, chez lequel le diagnostic d’une tumeur rĂ©tropĂ©ritoĂ©nale gauche a Ă©tĂ© posĂ© lors de l’exploration de douleurs du flanc gauche associĂ©es Ă  une altĂ©ration de l’état gĂ©nĂ©ral et ce par l’imagerie (Echographie et scanner abdominal). La laparotomie exploratrice avait conclu Ă  une tumeur rĂ©nale gauche localement Ă©voluĂ©e, une nĂ©phrectomie Ă©largie a Ă©tĂ© rĂ©alisĂ©e et l’histologie Ă©tait en faveur d’un lĂ©iomyosarcome rĂ©nal. Une rĂ©cidive locale a Ă©tĂ© diagnostiquĂ©e aprĂšs un recul de 6 mois. AprĂšs une nouvelle laparotomie, l’abstention Ă©tait de mise devant le caractĂšre Ă©voluĂ© de la rĂ©cidive. Le but de cette observation est double. Le premier, est la nĂ©cessitĂ© de faire un diagnostic prĂ©coce, afin d’intervenir sur une tumeur de petite taille, plus accessible Ă  la chirurgie. Le second, est de discuter la place du traitement adjuvant, qui pourrait rĂ©duire le risque de rĂ©cidive prĂ©coce.Mots clĂ©s : LĂ©iomyosarcome, rei

    Le carcinome oncocytaire de la parotide : A propos d’un cas

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    Introduction : Le carcinome oncocytaireest une tumeur salivaire rare. Sa prise en charge est non codifiĂ©e et son pronostic semble ĂȘtre mauvais. Le but est d’étudier les caractĂ©ristiques Ă©pidĂ©miocliniques et thĂ©rapeutiques des carcinomes oncocytaires de la parotide.Observation: Homme de 79 ans a consultĂ© pour une tumĂ©faction parotidienne gauche Ă©voluant depuis 2 mois. L'examena montrĂ© une masse dure mal limitĂ©e de la rĂ©gion parotidienne gauche associĂ©e Ă  des nodules cutanĂ©scervicaux, des adĂ©nopathies cervicales et axillaires homolatĂ©rales. L’examen du cavuma montrĂ© une asymĂ©trie de la paroi latĂ©rale gauche dont la biopsie a conclu Ă  carcinome oncocytaire. La biopsie ganglionnaire axillaire a confirmĂ© la mĂ©tastase d’un carcinome oncocytaire.L’échographie abdominale rĂ©vĂ©lait des mĂ©tastases hĂ©patiques. Le malade Ă©tait en dehors de toute ressource thĂ©rapeutique et il est dĂ©cĂ©dĂ© aprĂšs un recul de 3 mois.Conclusion : Le carcinome oncocytairesalivaire est caractĂ©risĂ© par un potentiel Ă©levĂ© d’extension locale, rĂ©gionale et de mĂ©tastases Ă  distance.Son diagnostic est basĂ© sur une combinaison des Ă©lĂ©ments cliniques et immuno-histo-chimiques. L’exĂ©rĂšse chirurgicale large est le traitement de choix. AprĂšs chirurgie, les rĂ©cidives sont frĂ©quentes. Le rĂŽle de la radiothĂ©rapie et de chimiothĂ©rapie est toujours controversĂ©.Le pronostic est mauvais.Mots clĂ©s : Carcinome oncocytaire, parotide, chirurgie, radiothĂ©rapieIntroduction : Oncocyticcarcinomais a rare salivary gland tumor. its management is not codified and its prognosis is worse. Objective: study of epidemio-clinical and therapeutic characteristic.Case report : 79 year old man presented with a left parotid swelling lasting for 2 months. The examination revealed a hard mass of left parotid region associated with cutaneous nodules, ipsilateral cervical and axillary adenopathy. An examination of the nasopharynx showed an asymmetry of the left side wall whose biopsy concluded oncocyticcarcinoma.Axillary lymph node biopsy confirmed metastasis of carcinoma oncocytic. Abdominal ultrasound revealed multiple liver metastases. The patient was without any therapeutic resource and he died after falling three months. Salivary oncocytic carcinoma is a rare tumor characterized by a high potential for local extension, regional and distant metastases. its diagnosis is based on a combination of clinical and immuno-histo-chemical.Wide surgical excision is the treatment of choice. After surgery, recurrences are common. The role of radiotherapy and chemotherapy is still controversial. The prognosis is bad.Keyswords : oncocytic carcinoma, parotid, surger

    Primary Plasmacytoma of The Testis with no Evidence of Multiple Myeloma: a New Case Report and Literature Review

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    Plasmacytomas of the testis are extremely rare tumours, especially when occurring in the absence of a previous or concurrent diagnosis of multiple myeloma. We report a new case of solitary testicular plasmacytoma, with immunohistochemical studies showing monoclonal cytoplasmic production of IgG lambda light chains, in a 51-year-old man who had no evidence of multiple myeloma 3 years after the orchiectomy.Key Words: Testis, plasmacytoma, multiple myelom

    Paratesticular Liposarcoma: What is the Best Therapeutic Strategy?

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    Introduction: Liposarcomas are neoplasms of mesodermal origin derived from adipose tissue and correspond to 10–14% of all soft tissue sarcomas. Paratesticular liposarcoma is very rare.Case report: We report a 60-year old man who presented with a left testicular tumor 20 cm in diameter. Initial incisional biopsy was reported as fibromatosis. Chest and abdominal CT scan did not show distant metastases. Through an inguinal incision orchidectomy with homolateral inguinal node dissection was performed. Histopathological examination showed a paratesticular myxoid liposarcoma. Adjuvant radiotherapy without chemotherapy was administered. The patient remains well at 11 months followup, with no evidence of recurrence.Conclusion: Complete surgical extirpation reduces the risk of local recurrence. Neoadjuvant chemotherapy or radiotherapy may reduce the tumor size, thus facilitating complete excision

    Case report: Acute peritonitis from non-traumatic rupture of the bladder

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    Spontaneous bladder rupture (SBR) is rare. This entity occurs outside of any traumatic context. A 70 years-old man was admitted for acute peritonitis, acute urinary retention and hematuria. Laparotomy and exploration showed acute generalized peritonitis related to a centimeter hole in the bladder dome. Peritoneal lavage was done with biopsy of the perforation edges, a cystostomy and suturing of the bladder. The immediate postoperative course was uneventful. The etiological investigation revealed a locally advanced and metastatic prostate cancer. The evolution was rapidly fatal and the patient’s death occurred two months later due to metastatic disease. The causes, diagnosis and treatment of SBR are reviewed by the authors

    Complications after intestinal resection in Crohn's disease: laparoscopic versus conventional approach

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    AbstractBackgroundsignificant advances in medical therapy for Crohn's disease (CD) occurred in the last 12 years, mainly due to the introduction of anti-TNF therapy. Laparoscopic colorectal surgery represented the most important advance on surgical treatment in the management of CD, as it also had developed in the treatment of other conditions. There is a tendency for lower complication rates after laparoscopic bowel resections as compared to open surgery. The aim of this study was to analyze and compare the complication rates after bowel resections for CD between the two approaches in a Brazilian case series.Methodsthis was a retrospective longitudinal study, including CD patients submitted to bowel resections from a single Brazilian Inflammatory Bowel Diseases (IBD) referral center, treated between January 2008 and June 2012 with laparoscopic approach (LA) or conventional approach (CA).Variables analyzedage at surgery, gender, Montreal classification, smoking, concomitant medication, type of surgery, surgical approach, presence and type of complication up to 30 days after the procedures. Readmission and reoperation rates, as well as mortality, were also analyzed. Patients were allocated in two groups regarding the type of procedure (LA or CA), and complication rates and characteristics were compared. Statistical analysis was performed with Mann-Whitney test (quantitative variables) and chi-square test (qualitative variables), with p < 0.05 considered significant.Resultsa total of 46 patients (25 men) were included (16 submitted to LA), with mean age of 38.1 (± 12.7) years. The groups were considered homogeneous according to age, gender, CD location, perianal disease and concomitant medications. There were more patients with fistulizing CD on the CA group (p = 0.029). The most common procedure performed was ileocolic resection on both groups (56.7% of the CA and 75% of the LA patients – p = 0.566). Overall, total complications (surgical and medical, including minor and major issues) oc- curred in 60% (18/30) of the CA group and 12.5% (2/16) of the LA group (p = 0.002). Wound in- fection was the most frequent complication (10/30 on CA and 1/16 on the LA groups). There were 3 deaths in the CA group. Specific analysis of each complication did not demonstrate any difference between the groups regarding abdominal sepsis, urinary tract infections, pneumonia, readmission, reoperations and deaths (p = 0.074).Conclusionsthere was a higher complication rate in patients operated with CA as compared to LA. This was probably due to patient selection for the laparoscopic approach, with severe cases, mostly due to fistulizing abdominal CD, being operated mainly by open surgery. LA tends to be the recommended approach in most cases of non-complicated CD

    Tumeur maligne des gaines nerveuses périphériques révélant une neurofibromatose type 1

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    La Neurofibromatose type 1 (NF1) ou maladie de Von Recklinghausen est une affection Ă  expression clinique variable. La transformation maligne est rare et redoutable. Le but de ce travail est d’étudier les critĂšres diagnostiques ainsi que la prise en charge thĂ©rapeutique de cette transformation maligne. Observation : A.B, ĂągĂ© de 16 ans, a consultĂ© pour une tumĂ©faction basicervicale antĂ©rieure d’apparition rĂ©cente, ayant augmentĂ© progressivement de taille sans signes de compression ni de dysthyroĂŻdie. L’examen clinique a trouvĂ© une masse dure, bien limitĂ©e, indolore, de 4 cm de grand axe siĂ©geant en regard du manubrium sternal, adhĂ©rente au plan profond et dĂ©bordant sur le creux sus sternal. A cette masse s’associaient des taches cutanĂ©es cafĂ© au lait dissĂ©minĂ©es sur tout le corps, des nodules de Lish iriens et des neurofibromes occipitaux et parotidiens. AprĂšs une exĂ©rĂšse de la masse par voie cervicale, l’examen histologique a conclu Ă  une tumeur maligne de la gaine nerveuse. Le malade a eu dans un 2Ăšme temps, une exĂ©rĂšse plus large emportant le manubrium sternal et les tissus adjacents  avec une reconstruction par des fragments de cĂŽtes mais avec des limites chirurgicales envahies. L’évolution a Ă©tĂ© marquĂ©e par une poursuite Ă©volutive prĂ©coce imposant une exĂ©rĂšse chirurgicale plus large suivie d’une chimiothĂ©rapie et d’une radiothĂ©rapie externe (RT). Le malade Ă©tait cependant toujours en poursuite Ă©volutive et le dĂ©cĂšs est survenu dans un contexte d'envahissement mĂ©diastinal.Mots-clĂ©s : Neurofibromatose type 1, Sarcome, tissus mous, gaines nerveuses pĂ©riphĂ©riques, Chirurgie

    Appendagite Ă©piploĂŻque primitive: Ă  propos de cinq cas

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    La torsion de frange Ă©piploĂŻque (ou appendagite) est une pathologie rare qui survient principalement chez les adultes entre 20 et 50 ans.L'incidence de cette pathologie n'est pas rĂ©ellement connue et elle varie de 2 Ă  7% chez les patients hospitalisĂ©s pour suspicion d'appendicite oude sigmoĂŻdite. Nous rapportons cinq cas d'appendagites dont nous prĂ©cisons les particularitĂ©s cliniques, radiologiques et thĂ©rapeutiques. Il s'agit de 5 patients dont l'Ăąge moyen est de 34.6 ans (24-55). Le sexe ratio est de 1.5. Le principal motif de consultation Ă©tait un syndrome douloureux de l'abdomen principalement au niveau de la fosse iliaque droite. L'examen abdominal montrait toujours une sensibilitĂ© localisĂ©e. La fiĂšvre Ă©tait prĂ©sente chez 3 patients. Le bilan biologique rĂ©vĂšle un syndrome inflammatoire biologique chez trois patients. Les examens complĂ©mentaires radiologiques en particulier Ă©chographie abdominale et TDM abdominale ont Ă©liminĂ© formellement une urgence chirurgicale et ont Ă©voquĂ© le diagnostic d'appendagite dans trois cas. Trois patients ont bĂ©nĂ©ficiĂ© d'une coelioscopie diagnostique confirmant le diagnostic  d'appendagite. L'Ă©volution Ă©tait favorable chez tous les patients. Les appendagites Ă©piploĂŻques primitives sont des Ă©tiologies rares et  sous-estimĂ©es de syndrome abdominal aigu. Le diagnostic peut ĂȘtre affirmĂ© par imagerie notamment avec le scanner hĂ©licoĂŻdal injectĂ©,  permettant d'instaurer ainsi un traitement mĂ©dical premier et d'Ă©viter un traitement chirurgical et des hospitalisations excessives

    Current Opinion and Practice on Peritoneal Carcinomatosis Management: The North African Perspective.

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    The status of peritoneal surface malignancy (PSM) management in North Africa is undetermined. The aim of this study was to assess and compare current practice and knowledge regarding PSM and examine satisfaction with available treatment options and need for alternative therapies in North Africa. This is a qualitative study involving specialists participating in PSM management in North Africa. The survey analyzed demographic characteristics and current knowledge and opinions regarding PSM management in different institutions. We also looked at goals and priorities, satisfaction with treatment modalities and heated intraperitoneal chemotherapy (HIPEC) usefulness according to specialty, country, years of experience, and activity sector. One-hundred and three participants responded to the survey (response rate of 57%), including oncologists and surgeons. 59.2% of respondents had more than 10 years experience and 45.6% treated 20-50 PSM cases annually. Participants satisfaction with PSM treatment modalities was mild for gastric cancer (3/10 [IQR 2-3]) and moderate for colorectal (5/10 [IQR 3-5]), ovarian (5/10 [IQR 3-5]), and pseudomyxoma peritonei (5/10 [IQR 3-5]) type of malignancies. Good quality of life and symptom relief were rated as main priorities for treatment and the need for new treatment modalities was rated 9/10 [IQR 8-9]. The perceived usefulness of systemic chemotherapy in first intention was described as high by 42.7 and 39.8% of respondents for PSM of colorectal and gastric origins, while HIPEC was described as highly useful for ovarian (49.5%) and PMP (73.8) malignancies. The management of PSM in the North African region has distinct differences in knowledge, treatments availability and priorities. Disparities are also noted according to specialty, country, years of expertise, and activity sector. The creation of referral structures and PSM networks could be a step forward to standardized PSM management in the region
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