LE TRAITEMENT CHIRURGICAL DE L’ ANGIODYSPLASIE DUODENALE SURGICAL TREATEMENT OF DUODENAL ANGIODYSPLASIA

Management of angiodysplasia is usually based on endoscopic therapies. Surgical treatement is required in massive bleeding and when the others procedures failed. However the duodenal seat and diffuse lesions remains a challenging problem. We present two patients with duodenal angiodysplasia who underwent cephalic duodenopancreatectomy. Both patients had good follow-up. We justify our choice which is unusual by the duodenal seat, diffuse and symptomatic lesions and recurrent hemorrhage.Le traitement de l’angiodysplasie fait   habituellement appel aux méthodes endoscopiques. Le recours à la chirurgie s’impose devant une hémorragie massive ou en cas d’échec des autres thérapeutiques .Toutefois le siège duodénal et le caractère diffus des lésions angiodysplasiques rendent difficile la décision thérapeutique. Nous présentons deux cas d’angiodysplasie duodénale traités chirurgicalement. Le geste a consisté en une duodénopancréatectomie céphalique .Les suites immédiates et à distance étaient simples. Nous justifions notre choix thérapeutique qui reste exceptionnel par le siège duodénal des lésions, leur caractère symptomatique et durable ainsi que leur nombre élevé

Predictive model of biliocystic communication in liver hydatid cysts using classification and regression tree analysis

<p>Abstract</p> <p>Background</p> <p>Incidence of liver hydatid cyst (LHC) rupture ranged 15%-40% of all cases and most of them concern the bile duct tree. Patients with biliocystic communication (BCC) had specific clinic and therapeutic aspect. The purpose of this study was to determine witch patients with LHC may develop BCC using classification and regression tree (CART) analysis</p> <p>Methods</p> <p>A retrospective study of 672 patients with liver hydatid cyst treated at the surgery department "A" at Ibn Sina University Hospital, Rabat Morocco. Four-teen risk factors for BCC occurrence were entered into CART analysis to build an algorithm that can predict at the best way the occurrence of BCC.</p> <p>Results</p> <p><b>I</b>ncidence of BCC was 24.5%. Subgroups with high risk were patients with jaundice and thick pericyst risk at 73.2% and patients with thick pericyst, with no jaundice 36.5 years and younger with no past history of LHC risk at 40.5%. Our developed CART model has sensitivity at 39.6%, specificity at 93.3%, positive predictive value at 65.6%, a negative predictive value at 82.6% and accuracy of good classification at 80.1%. Discriminating ability of the model was good 82%.</p> <p>Conclusion</p> <p>we developed a simple classification tool to identify LHC patients with high risk BCC during a routine clinic visit (only on clinical history and examination followed by an ultrasonography). Predictive factors were based on pericyst aspect, jaundice, age, past history of liver hydatidosis and morphological Gharbi cyst aspect. We think that this classification can be useful with efficacy to direct patients at appropriated medical struct's.</p

Retaining Participants in Community-Based Health Research: A Case Example on Standardized Planning and Reporting

Background Effective strategies for participant retention are critical in health research to ensure validity, generalizability and efficient use of resources. Yet standardized guidelines for planning and reporting on retention efforts have been lacking. As with randomized controlled trial (RCT) and systematic review (SR) protocols, retention protocols are an opportunity to improve transparency and rigor. An RCT being conducted in British Columbia (BC), Canada provides a case example for developing a priori retention frameworks for use in protocol planning and reporting. Methods The BC Healthy Connections Project RCT is examining the effectiveness of a nurse home-visiting program in improving child and maternal outcomes compared with existing services. Participants (N&thinsp;=&thinsp;739) were girls and young women preparing to parent for the first time and experiencing socioeconomic disadvantage. Quantitative data were collected upon trial entry during pregnancy and during five follow-up interviews until participants’ children reached age 2 years. A framework was developed to guide retention of this study population throughout the RCT. We reviewed relevant literature and mapped essential retention activities across the study planning, recruitment and maintenance phases. Interview completion rates were tracked. Results Results from 3302 follow-up interviews (in-person/telephone) conducted over 4 years indicate high completion rates: 90% (n&thinsp;=&thinsp;667) at 34&thinsp;weeks gestation; and 91% (n&thinsp;=&thinsp;676), 85% (n&thinsp;=&thinsp;626), 80% (n&thinsp;=&thinsp;594) and 83% (n&thinsp;=&thinsp;613) at 2, 10, 18 and 24 months postpartum, respectively. Almost all participants (99%, n&thinsp;=&thinsp;732) provided ongoing consent to access administrative health data. These results provide preliminary data on the success of the framework. Conclusions Our retention results are encouraging given that participants were experiencing considerable socioeconomic disadvantage. Standardized retention planning and reporting may therefore be feasible for health research in general, using the framework we have developed. Use of standardized retention protocols should be encouraged in research to promote consistency across diverse studies, as now happens with RCT and SR protocols. Beyond this, successful retention approaches may help inform health policy-makers and practitioners who also need to better reach, engage and retain underserved populations

Intracranial hypotension in a girl with Marfan syndrome: case report and review of the literature.

A 14-year-old girl, followed in our department for Marfan syndrome, presented with postural headache for a month. Neurological examination was normal. The diagnosis of intracranial hypotension syndrome was suspected. Bilateral subdural hematomas were found on brain magnetic resonance imaging (MRI), and spinal MRI showed large lumbosacral arachnoid diverticula; no cerebrospinal fluid leaks could be found. Despite bed rest and hydration for 2 weeks, postural headache remained. Epidural blood patching was also performed. Subsequently, the patient became asymptomatic and could stand up after 1 day. Brain MRI did not find recurrent subdural hematoma after 1 month. Dural ectasia is one of the major criteria of Marfan syndrome, and it is often poorly symptomatic. Intracranial hypotension is a rare complication especially in children, and management is not standardized. In this case report, blood patching was sufficient. Further research into the diagnosis and management of spontaneous intracranial hypotension is required

Treatment of neuromyelitis optica with rituximab: a 2-year prospective multicenter study

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