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Introduction. The prognosis of dermatomyositis (DM)/ polymyositis (PM) in adults is partly related to their association with neoplasia. The aim of our study was to report the epidemiologic, clinical, paraclinical, therapeutic and evolutionary aspects of DM associated with malignancy in patients from Sfax, south eastern of Tunisia. Methods. A retrospective cohort study of patients with DM or PM admitted in Dermatology and Internal Medicine Departments of Hedi Chaker University Hospital of Sfax between 1996 and 2015. Cases of DM or PM associated with malignancy were retained. Results. Seventeen cases (13.5%) of DM or PM associated with malignancy were noted. Fourteen patients had DM and 3 patients had PM. The Sex ratio M / F was 0.3 and the mean age at diagnosis was 56.5 years. In DM patients, malignancy preceded the myositis in 64.2% of cases. In PM patients, only one patient was known to have breast cancer and the myositis revealed the cancer for 2 others. Treatment consisted of corticosteroids associated with methotrexate in 4 cases. Outcome was fatal in 5 cases (29.4%), due to the underlying cancer in 3 cases. Swallowing disorders related to DM/PM were responsible for death in 2 cases. Conclusion. There are no specific clinical or biological features in paraneoplastic DM. In our series, breast neoplasm represented the first cancer associated with DM. Cancers of nasopharynx, colon and urinary tract had the second position.

Abstract Background We investigated the oxidative modifications of lipids, proteins and DNA, potential molecular targets of oxidative stress, in two lymphoblastoid cell lines: B95-8 and Raji, after EBV lytic cycle induction. Conjugated dienes level was measured as biomarker of lipid peroxidation. Malondialdehyde adduct and protein carbonyl levels, as well as protein thiol levels were measured as biomarkers of protein oxidation. DNA fragmentation was evaluated as biomarker of DNA oxidation. Results After 48 h (peak of lytic cycle), a significant increase in conjugated dienes level was observed in B95-8 and Raji cell lines (p = 0.0001 and p = 0.019 respectively). Malondialdehyde adduct, protein carbonyl levels were increased in B95-8 and Raji cell lines after EBV lytic cycle induction as compared to controls (MDA-adduct: p = 0.008 and p = 0.006 respectively; Carbonyl: p = 0.003 and p = 0.0039 respectively). Proteins thiol levels were decreased by induction in B95-8 and Raji cell lines (p = 0.046; p = 0.002 respectively). DNA fragmentation was also detected in B95-8 and Raji cell lines after EBV lytic cycle induction as compared to controls. Conclusion The results of this study demonstrate the presence of increased combined oxidative modifications in lipids, proteins in B95-8 and Raji cells lines after EBV lytic cycle induction. These results suggest that lipid peroxidation, protein oxidation and DNA fragmentation are generally induced during EBV lytic cycle induction and probably contribute to the cytopathic effect of EBV.

Introduction: Ovarian cancer is the leading cause of death from gynecological cancer. Ovarian carcinosarcomas represent a rare, aggressive entity with a poor prognosis. Spontaneous fistulization of ovarian cancer into the digestive tract is a rare phenomenon., Presentation of Case: A 67-year-old woman with a significant history of cardiac rhythm disorders was consulted for abdominal pain. Examination revealed tachycardia and abdominal guarding. Biology pictured elevated inflammatory markers and low prothrombin time. The abdominal computed tomography scan suggested a perforated sigmoid tumor with a peri-colonic abscess and pneumoperitoneum. She was rushed to the operating theater. Upon exploration, it was an ovarian tumor fistulized to sigmoid with peritonitis. She had an en-bloc resection with a terminal stoma. Control radiological study revealed diffuse lymph node metastasis. She was scheduled for chemotherapy., Discussion: This complication worsens the prognosis. The fistulous communication in the digestive lumen leads to the overflow of its microbial deposit. The tumor, therefore, becomes superinfected and may result in pelvic peritonitis in case of secondary rupture. On the other hand, the patient is deprived of the benefit of undergoing neoadjuvant chemotherapy, which will decrease the chances of complete macroscopic cytoreduction. Through a literature review, we aim to shed light on this rare entity in order to clarify its pathophysiological consequences and make adequate therapeutic measures., Conclusion: Fistulization to the large intestine worsens the prognosis of ovarian carcinosarcomas. Surgery is mandatory and should comply with oncological requirements. Adjuvant therapy is mostly needed, although more studies should be conducted to delineate the regimen accurately., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Gastrointestinal tract perforation is the most harmful complication of Foreign Body (FB) ingestion, besides diagnostic delay adversely affects the outcome. This paper aims to present our preoperative diagnostic flowchart and describe the surgical management in a Tunisian center., Methods: A retrospective review of 48 patients with gastrointestinal perforation by ingested FB treated in the surgery department of Jendouba Hospital. January 2010-December 2020., Results: 48 patients were treated for gastrointestinal tract perforation induced by FB ingestion. The mean age was 56.6 years. The sex ratio was 2/1. Acute abdominal pain was reported in all the patients. 35 patients had abdominal X-ray that showed a FB in 12 cases. CT scan was performed in 38 patients and identified the FB in 28 cases. Postoperative proofreading has identified a preoperative missed diagnosis of FB perforation in 5 cases, all before applying the diagnostic flowchart. All patients underwent open surgery after a median time of 7.12 h. This duration decreased after applying the flowchart (8.21 h versus 5.6 h). 33 patients had a terminal ileum perforation. Enterectomy was performed in 33 patients. Postoperatively, there was one abdominal abscess, one pulmonary embolism, one refractory septic choc, and one wound abscess. The median hospital stay was 6.35 days. The mortality rate was 6.25%. All patients managed with enterostomy had their stoma closed after 3-5 months., Conclusions: The challenge of gastrointestinal perforation due to FB ingestion is accurate diagnosis and early management. A standardized initial assessment based on a diagnostic flowchart is helpful to achieve this goal and improve outcomes., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: This study aims to describe the epidemiological, clinical, and radiological features of appendicular abscesses, compare the different approaches, and assess the safety and utility of laparoscopy in its management., Methods: This descriptive retrospective study was carried out over 3 years extending from January 2017 to December 2019, reporting 150 appendicular abscesses cases. Data were collected from the register of the general surgery department B of the Rabta hospital. Cases with appendicular abscess were included. Files concerning patients with early appendicitis, non-appendicular abscesses or generalized appendicular peritonitis were excluded. Data were analysed with Statistical Package for the Social Sciences (SPSS) software. In univariate analysis, we used the chi 2 test, the Fischer test, the Student t test. The factors retained by the univariate analysis were introduced into a logistic regression model. The significance level was set to 0.05., Results: The mean age was 40.51 years. The gender ratio in patients with appendicular abscesses was M:F 1.94:1. Pain in the right iliac fossa associated with fever was the most common symptom (78% of cases). Clinical examination showed tenderness in the right iliac fossa in 38% of cases, rebound and guarding were found in 77 patients (51.3%), and a palpable mass was noted in 4 cases (4.2%). Imaging was done to confirm diagnosis; 46 patients underwent ultrasonogram and this confirmed the diagnosis in 26 patients (56%), while among the 71 patients who underwent CT abdomen confirmatory diagnosis was made in 65 patients (91.55%). An appendectomy was performed in 148 patients (98.6%) via laparoscopic approach in 94 patients, open Mac burney procedure in 32 cases (21.3%) and midline incision in 24 cases (16%). Two patients had an ileocecal resection. The appendix was most commonly located retrocecally (55.3%) in our cohort. The laparoscopic approach was performed in 94 patients (62.6%), and we had to convert in 44 patients due to dissection difficulties (46.8%). Among patients who underwent laparascopic approach 7 had developed peritonitis.. There were only 2 deaths. The mortality rate was 0,013%. The median duration of outpatient followup was 6 months (4-24 weeks) and was uneventful., Conclusion: Appendicular abscess is a disease of young adults more common in men. Location of the appendix in our case series was mostly retroceacal. Laparoscopy was associated with good outcomes; peritonitis was uncommon and mortality was rare. The laparoscopic approach is a safe surgical technique for treating appendicular abscess and it can be considered as the routine approach for this condition In developing countries with limited technical resources, laparoscopy guarantees the absence of recurrence, reduces healthcare costs and decreases the risk of treating a severe disease conservatively., (© 2021. The Author(s).)

Abstract: Hydatid cyst is a parasitic infection caused mainly by Echinococcus granulosus, which is generally considered benign. However, the hepatic hydatid cyst rupture in the abdominal cavity is a life-threatening incident that requires urgent and multidisciplinary management (emergency physicians, radiologists, anesthetists, and surgeons). This study describes clinical and paraclinical liver hydatid cyst rupture in the peritoneal cavity and details the appropriate treatment.A retrospective review of clinical records of patients hospitalized in Jendouba Hospital for liver hydatid cyst was performed over 8 years, from January 1, 2012 to December 31, 2019. Fifteen cases of liver hydatid cyst complicated with acute rupture into the abdominal cavity were collected out of 625 hydatid liver cysts. All patients underwent emergency laparotomy allowing conservative unroofing procedure associated with peritoneal lavage and external drainage combined with necessary intensive care measures. Clinical features, therapeutic procedures' details as well as postoperative outcomes are reported. Statistical analysis was performed using the Statistical Package for the Social Sciences for Windows version 20.There were 9 men and 6 women. Patients' age ranged from 14 to 59 years, with an average of 38 years. Two patients were admitted with abdominal trauma. Acute abdominal pain was the most common complaint. Only 1 patient had an anaphylactic shock. Abdominal ultrasonography and computed tomography scan showed discontinuous cyst wall associated to intraperitoneal fluid in all cases. Intraoperatively, the intraperitoneal effusion was clear in 13 cases and purulent in 2. All patients underwent unroofing procedures associated with intra-operative peritoneal lavage and external drainage. The mean hospital stay was 6.11 days, and the mean follow-up was 19 months. No case of recurrence was reported among the patients.In endemic areas, rupture of a hepatic hydatid cyst in the abdominal cavity should be considered in every case of acute abdominal pain, especially if associated with anaphylaxis signs. Early management starting in the emergency room is needed to ensure good outcome., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Gallbladder adenomyomatosis is a benign acquired gallbladder disease. It can mimic cancer on radiological findings, leading to a diagnostic dilemma. The management and prognosis of these two gallbladder anomalies are entirely different. Therefore, it is essential to recognize the pathognomonic features of gallbladder adenomyomatosis is in order to accurately diagnose this pathology. This paper presents two encountered cases of gallbladder adenomyomatosis is, their diagnostic modalities as well as the algorithmic approach of their management. These two-case reports have been reported in line with the SCARE Criteria 2020 [1]., Presentation of Case: Patient-1 was symptomatic. He was explored by an abdominal ultrasound picturing gallbladder wall thickening while the biopsy showed pleomorphic proliferation of inflammatory cells. An examination of the liver with MRI was indicated, showing diffuse parietal thickening with multiple cystic pockets. He underwent laparoscopic cholecystectomy with simple operative follow-up. Patient 2 was asymptomatic, a staging CT scan of acute pancreatitis revealed focal mural thinking of the gallbladder wall. A liver MRI showed an intramural cystic formation in the vesicular fundus. Given the inconclusive imaging results, laparoscopic cholecystectomy was performed. Histological examination confirmed the diagnosis of GA., Discussion: Adenomyomatosis is usually asymptomatic. Imaging can confirm the diagnosis of gallbladder adenomyomatosis without the need for invasive procedures such as vesicular biopsy. Histologic examination can also confirm the diagnosis when cholecystectomy is done. High resolution ultra-sound is the most efficient radiological examination. Laparoscopic cholecystectomy is the gold standard for symptomatic GA or radiological suspicion of a gallbladder cancer., Conclusion: The practitioner should always consider gallbladder carcinoma before confirming the GA, as they share the same features but with a far worse prognosis. The likelihood of malignancy depends on radiological characteristics. In the case of inconclusive findings, cholecystectomy is justified., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction and Importance: The gallbladder volvulus is a rare but life-threatening condition characterized by an axial torsion of the gallbladder along the cystic pedicle, causing gallbladder ischemia and necrosis. This paper aims to present and discuss a rare case of gallbladder volvulus. This case report has been reported in line with the SCARE criteria 2020 [1]., Case Presentation: We report the case of a 90-year-old female patient who presented to the emergency room with sharp right upper abdominal quadrant pain of acute onset associated with vomiting, evolving for the last 12 h. She had no fever nor jaundice. Her body mass index (BMI) was 22. She had kyphosis, and scoliosis. Physical examination found tenderness with a palpable mass in the right upper abdominal quadrant. Laboratory test results showed leukocytosis at 11600 /mL and a high C-reactive protein rate at 40 mg/L revealed acute calculous cholecystitis features. However, emergency laparotomy was performed and discovered a gallbladder volvulus. A detorsion and cholecystectomy were performed with a good outcome., Clinical Discussion: The preoperative diagnosis of gallbladder volvulus is difficult due to its misleading clinical presentation mimicking acute cholecystitis. The presence of the three highly suggestive triad clinical signs should encourage the radiologist to search for a gallbladder with a horizontal orientation and located outside its anatomical fossa connected to the liver by a conical structure corresponding to the twisted pedicle in ultrasonography. Unlike ordinary acute cholecystitis, which may sometimes tolerate an initial conservative medical treatment, gallbladder volvulus management is always an emergency cholecystectomy., Conclusion: Despite the clinical similarities with the classical acute calculous cholecystitis, gallbladder volvulus is more likely to result in fatal outcome. Therefore, a high level of clinical suspicion is necessary to save lives., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Urolithiasis in a kidney transplanted patient is an uncommon but complex urological complication. Its potential severity comes from its occurrence on a solitary kidney and on a field of immunosuppression. The aim of our study is to assess the incidence, characteristics and course of urolithiasis in our series., Methods: A retrospective study was performed. We included kidney transplanted patients between November 2002 and November 2019 and presenting lithiasis during their follow-up. Clinical, biological and radiological data were collected as well as lithiasis disease related data. The management of and patient's evolution were also specified., Results: Seven of 416 kidney transplanted patients developed lithiasis during their follow-up with an incidence of 1.6 %. The mean age at lithiasis diagnosis was 36.5 years [24-55 years], the sex ratio was 1.3. They developed stones after mean follow-up of 67 months [4-168 months]. The stones' size varied from 2 to 18mm. Treatment was alkalisation in 3 cases, extracorporeal lithotripsy in 2 cases, a double J stent in 3 cases and pyelolithotomy in 2 cases. Four patients had multiple treatments. Three patients had 1 residual stone during evolution (7mm average diameter), 1 microlithiasis, 1 lost to follow-up after treatment and only 2 (out of 7) were "stone free". Furthermore, lithiasis didn't damage the graft survival after a median follow-up of 62 months post-treatment., Conclusion: Urolithiasis in the kidney transplanted patient requires an adapted multidisciplinary management. Its skill is a challenge for both the nephrologist and urologist., (Copyright © 2020 Société francophone de néphrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.)

Background: Pheochromocytoma brain metastasis is extremely rare. Few cases have been reported in the literature. Therefore, diagnosis and effective treatment of these lesions are difficult., Case Description: Here, we report the case of 29-year-old woman, who was operated on for a right adrenal pheochromocytoma. Fourteen months later, a posterior fossa tumor was diagnosed. Radiologic findings mimicked an extra-axial lesion. The radiologic differential diagnosis was difficult even using magnetic resonance imaging spectroscopy. The patient was operated on through a retrosigmoid approach. Local recurrence occurred 6 months after first surgery. The patient died 1 month later, despite a second operation., Conclusions: Although the occurrence of brain metastases in pheochromocytoma is not prevalent, patients presenting with suggestive features need to be carefully considered. Magnetic resonance imaging can help in differential diagnosis with a primary brain tumor. There are no established guidelines for the treatment of pheochromocytoma brain metastasis, for which the prognosis remains dismal, despite effective surgery., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: To evaluate the influence of continent external urinary diversion type Mitrofanoff on male sexuality., Material and Methods: Between 1992 and 2011, 140 patients underwent continent urinary diversion type Mitrofanoff at an academic hospital. Among 76 men, 46 were interviewed about their sexuality after this operation. This study was performed using a set of validated questionnaires (IIEF, DAN PSS and Urolife), grouped by the model of the CTMH. Patients were divided according to their marital status: group 1: patients married before surgery (15 cases), group 2: patients married after surgery (7 cases) and group 3: singles (24 cases)., Results: In the first group, the functional dimension of sexuality was positive with an overall score of 81%, the sexual discomfort score was assessed at 26 % and the sexual satisfaction score was 77%. In the second group, sexual function was considered conserved in all cases with a satisfaction score estimated at 98%. These patients reported a feeling of well-being following the disappearance of urinary incontinence with integrity of their body images. In contrast, in the last group, relatively impaired sexual function was noted (65%) with a satisfaction score estimated at 59%. These disorders were multifactorial, mainly related to neurological causal pathology., Conclusion: To our knowledge, this is the first study about male sexuality in patients with a continent urinary diversion type Mitrofanoff. Marital status has a major role in the sexuality of these patients. A prospective study with pre- and postoperative evaluation will better clarify the factors affecting sexuality in these patients., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Background: Sexual disturbances after colostomy are various. However, they probably remain underestimated in societies where sexuality is still a taboo issue. THE AIM of this prospective study was to evaluate the possible sexual behaviour and the post operative sexual disturbances in patients whome underwent colostomy., Methods: The group was devided in 10 male and 11 female patients. Seventeen patients (81%) were married, 3 widowed and 1 unmaried., Results: Sexual disturbances were found in 47% of patients. There was a lack of interest in sexual relations in 2 women, a resolved premature ejaculation in one case, post operative dysparenia in 2 female patients, a retrograde ejaculation in a 60-year-old man, impotence in a 46 years old patient, and a premature ejaculation in a 36-year-old man. The frequency of sexual disturbances (47%) in our series was close to that reported in the literature (50%)., Conclusion: The sexual disorders are more common in male patients, the most frequent being ejaculatory dysfunction. In women, dyspareunia is the most common disorder. The particular case of colostomy in homosexuals remains a current issue.

The acute porphyria is an autosomal dominant disorder of the héme biosynthesis enzyme. The aim of this work is to determin a diagnostic step in order to anticipate porphyric crises. We report the observation of a child which was hospitalized in the pédiatric service three years ago for peripheric arthralgies and myalgies where the diagnosis of an acute porphyria was not posed. He wase admitted in our service for appendicitis, he was operated, the anesthesie was carried out by the thiopenthal and the succinylcholine. At the first post-operative day, a respiratory insufficiency was the cause of death. The rate of coproporphyrines and of uroporphyrines in the urine had confirmed the diagnosis of acute porphyria. The positive diagnostic of acute porphyria is difficult, the association of abdominal, psychological and neurologic signs must suggest the diagnostic, all the more, if the urines have a dark colour. The presence of uroporphyrines and coproporphyrines and certain precursors in the urines or in the high-rated stools confirm the diagnostic. The family survey and dosage of porphyric compounds in the sickness-bearing patient's family members allow to reveal certain asymptomatic forms of the heriditary acute porphyria, it is caused by certain products used in neuropsychiatry, in aneasthesic or in certain circunstances, such as, the infection or the trauma. The treatment of the acute porphyria is an emergency wich requires the transfert of the patient to a unit of intensive care.

The Peutz jeghers syndrome is a familial affection with dominant autosomic transmission characterized by a hamartoma digestive polyposis and a cutaneous mucous lentiginosis with periorifice predominance. This affection represented 3 into 10% for the familial polyps. The digestive polyps constitute the must important part of the pentz jeghers syndrome because they determined to only the clinic manifestation and the disease prognostic with there complications: intestinal invaginations, haemorrhage. In this work, we report two observations of patients presented a Peurtz Jeghers syndrome, and we determine, after literature review the epidemiologic, pathogenic, clinic, anatomy pathologic, prognosis and therapeutics of this effection.

Psoas abscess complicating Crohn's disease is a rare condition. The clinical diagnosis is confirmed by ultrasonography and/or computerized axial tomography. Etiology of the abscess is confirmed by digestive opacifications. We present one case of recurrence psoas abscess, revealing Crohn's disease in young girl of 18 years. Therapy is consisting in a pathologic bowel resection after urgency drainage. After literature review we, try to propose diagnostic and therapeutic walk of this affection.

The anterior hernia or the fissure of Larrey and Bochdalek hernia are exceptional in adult. We present 6 cases of congenital diaphragmatic hernia revealed in adult. Three hernia of the fissure of Larrey and three Bochdalek hernia. We discuss the different clinical, radiological, and therapeutic aspects of these hernia. We insist on the gravity of strangulated hernia and their surgical treatment.