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In 1965, Seze et al described a first case associating spondylodiscitis and endocarditis...

Colorectal cancer represents 8% of metastatic cancers. For decades, the gold standard therapy has been infusional chemotherapy with 5-Fluorouracil (5-FU) associated to folinic acid. The discovery of irinotecan, oxaliplatin and oral forms of 5-FU in the nineties is considered a milestone in the treatment of this disease. Since 2004, targeted therapy with monoclonal antibodies including anti-EGFR and angiogenesis inhibitors showed superiority in terms of mortality compared to conventional therapy. Metastatic colorectal cancer, however, remains an incurable disease. We present the current treatments of metastatic colorectal cancer, the clinical development of these emerging treatments, and their position in the Lebanese health care system.

OBJECTIVES: To evaluate the fingertip reconstruction with occlusive dressing and explore the mechanisms and the mediators of this "fingertip regeneration". PATIENT AND METHODS: Nineteen patients who sustained a fingertip injury were treated with occlusive dressing. Two prospective studies: a clinical analysis of the aesthetics and the functional results, a biologic analysis of the dressings in order to search microorganisms, cytokines, and growth factors. RESULTS: Among 15 patients reviewed, the healing was acquired in 2.7 weeks (2.5). The thickness of the fingertip was excellent in 30% and good in 70%. The Weber test was 3.8mm for the fingertip reconstruction against 3mm for the opposite side. The analysis of the dressing exudates brings to light a pullulement of saprophyte bacterium of the skin but also pathologic species, and presence of angiogenic factors (PDGF, VEGF, EGF). CONCLUSIONS: The occlusive dressings remain a reliable and reproducible alternative for treatment of fingertip injuries in zone 1 and 2. This reconstruction seems to depend on bacterium pullulement and cellular growth factors liberation.

Panniculitis is an uncommon and rare complication of systemic fat necrosis in patients with pancreatic diseases. The skin manifestations are independent of the severity of the pancreatic pathology and can occur at any time. The lesions can preceed, be concomitant with or rarely follows the pancreatic illness. We report a case of acute pancreatitis post Endoscopic Retrograde Cholangio Pancreatography (ERCP) for common bile duct stone, with subcutaneous panniculitis. We noted a complete resolution within two weeks after the treatment of the pancreatic pathology.

We compare our results of a prospective study, on 120 totally implantable venous access ports (TIVAP) inserted at angiographic unit, under ultrasound and fluoroscopic guidance, with those of the literature.The 120 AP data, placed under ultrasound and fluoroscopic control for chemotherapy treatment, were prospectively analyzed. The detailed technique of insertion is noted. Data related to the technical success rate and to complications were classified into major, minor, early or late, according to the recommendations of the interventional radiology society.The technical success rate is 100% with no major complication noted. Eight (6.6%) TIVAP were withdrawn because of infection in 4 cases (33%), and end of treatment in the other four. The withdrawals took place in chemotherapy clinics. Three (25%) are classified as early infections, within two months of the procedure, two of which were associated to wound non-healing. Four patients (33%) presented early minor complications (hematoma surrounding TIVAP insertion site).Our results correspond to previously published data. The insertion of AP at the angiographic unit under ultrasound and fluoroscopic control has lower risk of complications and a success rate higher than that being inserted following anatomical location. Collaboration with a specialized care nurses team is of paramount importance.

The antihelminthic Levamisole (LVM) is actually used as an immunomodulator in colon cancer. Its neurological toxicity is well known when used concomitantly with 5-Fluorouracil (5 FU) and, rarely when used solely at high doses. Antihelminthic imidazoles induced encephalopathy (AIIE), has been reported only in China.We report two Lebanese patients with AIIE, with literature review concerning the pathophysiology, clinical presentation, laboratory, imaging and prognosis of this entity.AIIE supervenes after sensitization and re-exposure to the drug. It resembles the acute disseminated encephalomyelitis (ADEM) and the differentiation from multiple sclerosis is primarily based on the monophasic clinical and radiological (MRI) pattern of the disease. The treatment consists of steroids, and it has a good prognosis. The immunomodulatory role of Levamisole is evident but the pharmacokinetics remain unknown.This disease entity has to be considered anytime a patient, in an endemic area for helminthiasis, develops an encephalopathy, especially after a documented exposure to imidazoles, even at low doses and particularly after re-exposure to the drug that has to be prudent.

Introduction L’implant de tete radiale a cupule flottante de Judet permet de remplacer une tete radiale non reconstructible. L’evaluation clinique et radiographique de cette prothese montre de bons resultats, mais les travaux qui montrent la prothese « en mouvement » sont rares. Nous rapportons une etude radio cinetique de l’implant. Materiel et Methode Treize patients, (7 femmes, 6 hommes, d’âge moyen 55 ans), ont ete operes d’une fracture Mason III par mise en place en urgence d’une prothese a cupule flottante (Tornier®) entre 1999 et 2004. Un operateur independant a evalue les parametres fonctionnels permettant de calculer les scores de la Mayo clinic de la SOO et du DASH. Une etude radiographique et une etude radio cinetique de l’implant ont ete realisees chez 12 patients. Resultats Treize patients ont ete revus a 43,8 mois (2069). La reprise de travail s’est faite a 4,2 mois de moyenne (7 actifs). Trois patients (23 %) etaient asymptomatiques, les autres gardaient des douleurs barometriques ou a l’effort. Le deficit d’extension etait de 14,6° (-35-0), et la flexion de 133,8 (100-145). La pronation etait de 69,2° (0-80), la supination de 70° (0-80). La force de la poigne/cote sain atteignait 82,25 %, et le DASH atteignait 17,8 (0-58,3). Onze patients (84,6 %) avaient un score de la SOO tres bon et bon, 12 patients (92,3 %) avaient un score de la Mayo Clinic excellent et bon. Le bilan radiographique retrouvait une arthrose chez 3 patients (23 %), une ossification chez 8 patients (61,5 %), et 1 descellement de la tige non symptomatique. Aucune osteoporose du capitulum, ni modification de l’index radio ulnaire distal n’etaient observees. L’etude radio cinetique a permis de retrouver une mobilite de la cupule en pronation (flexion moyenne de 17° par rapport a la tige) chez 9 patients (75 %). Une mobilite en flexion n’a ete observee que pour 3 patients (18,3° en moyenne) en fin de mouvement, lorsque la cupule butte sur l’humerus. Conclusion L’implant a cupule flottante de Judet permet d’obtenir de bons resultats cliniques et fonctionnels qui perdurent dans le temps avec un faible taux de complications. L’etude radio cinetique de l’implant permet de confirmer la bonne tolerance de l’implant, et la faible mobilite de la cupule. Cette etude montre que le dessin de l’implant permet de « rattraper » les erreurs de positionnement, l’implant n’etant mobile qu’en amplitude extreme. Un implant bien pose « ne bougera pas » ou peu.