Résection laparoscopique d’une duplication gastrique chez l’adulte: traitement avec succès pour une pathologie rare

Les duplications de l'appareil digestif sont les malformations congénitales rares qui peuvent toucher tout  l'appareil digestive depuis la bouche jusqu' à l'anus. Certaines duplications sont asymptomatiques et sont diagnostiqués dans la plupart des cas pendant l'enfance. La prise en charge de la duplication gastrique est essentiellement chirurgicale. Le traitement de choix est l'exérèse complète de la duplication gastrique. Les auteurs rapportent un cas inhabituel de duplication gastrique complètement reséquée par laparoscopie. A notre connaissance, ceci est le premier cas d'une duplication gastrique traitée avec succès par laparoscopie dans la littérature Tunisienne. La Résection laparoscopique peut être ajoutée à l'arsenal thérapeutique dans le traitement chirurgical de duplications du tube digestif.Key words: Duplication, estomac, diagnostic, endoscopi

Extra-anatomic “Rendezvous” Technique in Management of Biliary Complications Following Liver Surgery: A Technical Note

We describe extra-anatomic “rendezvous” technique for the management of bile leak associated with biliary stricture following hepatic surgery in two patients. In the procedure, the endoscopic guidewire was snared from the biloma cavity and pulled through the percutaneous access allowing for a drain to be placed. Both procedures were technically successful

Risk factors associated with bone loss and occurrence of fragility fractures in rheumatoid arthritis patients

Aim of the work: To investigate the bone mineral density (BMD) in rheumatoid arthritis (RA) Tunisian patients, to identify the risk factors associated with its decrease and to assess the fracture risk. Patients and methods: The study included 173 patients and 173 matched healthy controls. BMD was assessed by the dual-energy X-ray absorptiometry. The risk of hip fracture (HF) and major osteoporotic fracture (MOF) were assessed using the fracture risk assessment tool (FRAX). The disease activity, radiological severity and functional status were investigated. Results: The mean age of patients was 54.1 ± 11.04 years and 141 were females; 71.6% menopausal. Disease duration was 8.2 ± 8 years and disease activity score was 5.54 ± 1.26. Sharp van-der-Heijde (SvdH) score was 113.9 ± 106.8, health assessment questionairre (HAQ) score 1.03 ± 0.9. The BMD was significantly reduced in 138 (79.8%) patients and FRAX was higher compared to control (p < .001). The frequency of osteoporosis (48% vs. 18.5%), the risk of MOF (1.8 ± 2.6 vs. 0.6 ± 0.3) and HF (0.7 ± 1.7 vs. 0.08 ± 0.1) were significantly higher in RA patients than in controls. Bone loss in RA was significantly associated with age, low body mass index (BMI), longer disease duration, rheumatoid factor, SvdH, atlantoaxial subluxation and corticosteroids use. Menopause, low calcium intake, erythrocyte sedimentation rate and HAQ were risk factors for reduced BMD. The risk of MOF and HF was associated with age, menopause, calcium intake, BMI, disease duration, HAQ, SvdH, cumulative dose and duration of corticosteroids. Conclusion: bone loss and fragility fracture are frequent in RA and related to disease severity, function impairment and corticosteroids use. Keywords: Rheumatoid arthritis, Osteoporosis, Fracture, FRAX, Bone mineral densit