Abdel Ilah Mehdi

Nissen versus Toupet fundoplication: Results of a randomized and multicenter trial

BackgroundLaparoscopic Toupet fundoplication (TF) is reported to be as effective as Nissen (NF), but to be associated with fewer unfavorable postoperative side-effects. This study evaluates the one- and three-year clinical outcome of 140 randomized patients after a laparoscopic NF or TF.Patients and methodsInclusion criteria included patients over 16 years old with complications of gastro-oesophageal reflux disease (GORD) and persistence or recurrence of symptoms after three months of treatment. Subjects with a previous history of gastric surgery or repeated fundoplication, brachy-oesophagus or severe abnormal manometry results were excluded. Seventy-seven NF and 63 TF were performed. The severity of symptoms was assessed before and after the procedure.ResultsOne hundred and twenty-one of the 140 patients after one year, and 118 after three years, were evaluated and no statistically significant clinical difference was observed. The level of satisfaction concerning the outcome of the operation remained high after one or three years regardless of the type of fundoplication performed.ConclusionsFunctional complications after NF are not avoided with TF.

Results of Silastic Ring Vertical Gastroplasty More Than 6 Years after Surgery: Analysis of a Cohort of 214 Patients

Background: Among the different techniques of surgical treatment for morbid obesity, silastic ring vertical gastroplasty (SRVG) is an alternative, effective and easily reproducible technique. The aim of this study is to evaluate a cohort of patients >6 years after SRVG for morbid obesity. Methods: From 1991 to 1996, 273 consecutive patients were eligible for SRVG. The evaluation criteria included weight loss, evolution of co-morbidities, long-term morbidities, satisfaction of patients and quality of life. Results: Among these 273 patients, 1 patient died in the postoperative period (0.4%). Postoperative morbidities occured in 27 patients (10%). The long-term follow-up involved 213 patients (78%). Late postoperative complications consisted of outlet stoma stenosis (14%), staple-line dehiscence (5.6%) and incisional hernia (8.5%). 23 patients (10%) needed a re-do operation. Co-morbidities drastically improved. BMI fell from 45.3 to 30.7. Failure of SRVG was statistically associated with male gender and super-obese patients. 69% of the patients were satisfied, and 73% would recommend this operation. Conclusion: SRVG is very effective in a selected group of morbidly obese patients.

Laparoscopic treatment of a sigmoid perforation after colonoscopy

The authors report a case of sigmoid colon perforation post colonoscopic polypectomy. Such perforation is rare and has been estimated to occur between 0.1 and 3% of the time. Surgical treatment is necessary when there is deterioration of the clinical state. In this reported case, surgical closure of the perforation was achieved by laparoscopy. We believe that this approach is effective for colonic suture, peritoneal lavage, and drainage.

Haemoperitoneum Associated with Cocaine Abuse : A Case Report

Abstract Cocaine use is now relatively common in the occidental societies and is responsible for a long list of medical complications involving almost every organ system in the body. The digestive complications are less known. We report a case of a young man who presented to the emergency department with violent abdominal pain and several episodes of vomiting after using intranasal cocaine. The abdominal pain was caused by a massive haemoperitoneum with no evidence of any underlying pathology. This case shows that we have to consider the possibility of a lethal abdominal haemorrhage in the differential diagnosis of acute abdominal pain in cocaine abusers.

Strangulation of giant rectal prolapse

Introduction Rectal prolapse is the complete protrusion of the rectum through the anal canal, incarceration rarely complicates rectal prolapse. Even more rarely, it becomes strangulated and gangrenous, necessitating emergency surgery. Case presentation We present the first reported case of strangulated acute rectal prolapse as the first manifestation of rectal prolapse. The patient was a 26-year-old man who presented with a 20×6 cm semi-spherical mass extra-anally. Rectosigmoidectomy with sacral rectopexy was performed, resecting 20 cm of the incarcerated rectum and sigmoid colon. The postoperative course was uneventful with a good final result after colostomy closure and continuity restoration. Conclusion The successful treatment of this patient illustrates the value of surgery in this difficult and unusual case scenario of rectal incarceration.

Acute Appendicitis due to Metastasis of Prostatic Adenocarcinoma: A Case Report

G acid (GABA) agonists are used as exogenous neuromodulators for patients with chronic pain and refractory mental illness. Phenibut is a controlled GABA-B agonist with an extensive use in Russia for psychiatric and perioperative patients. In recent times, its anxiolytic and nootropic properties are commercially marketed with an increased risk for recreational abuse. We present a case of a complicated admission of phenibut overdose in a 44 year old Caucasian man and subsequent management in an intensive care unit (ICU). The drug was accessed over the Internet. The patient previously had multiple ICU admissions due to overdosing on this particular substance with a fluctuating conscious state and a threatened airway that required intubation, ventilation, haemodynamic monitoring and vasoactive supports. His ongoing agitation over a course of several days mandated sedatives and hypnotics and his admission was complicated by hypertensive crises and aspiration pneumonia. The clinical dilemma is yet to be addressed including the implications of this toxidrome and multi-organ dysfunction. The laboratory diagnosis (i.e., plasma phenibut level) are still investigational and needs more research. This report highlights the role of phenibut as an emerging psychotropic substance with a significant disease burden on the public health system. There is neither a consensus-based approach nor an antidote for this toxidrome and its diagnosis often relies on accurate history alone. Long-term neurological sequelae and outcomes remain uncertain and more clinical surveillance and governance is needed in this particular area of toxicology and the nexus between e-commerce and substance abuse.Melanomas are malignants neoplasms arising from melanocytes, originating from the neural crest cells, it ́s account for 1-3% of all malignants tumors and the incidence is increasing in Western Countries up to 6-7% yearly [1]. Most of the IntraOral Melanomas had radial growth phases similar to Acral Lentiginous Melanoma (ALM) of the Skin [2]. The frequency of intraoral melanoma among Japanese is higher than that among Caucasians [3]. The most common site for mucosal melanoma is the head and neck region (55%), followed by the anal/rectal region (24%), female genital tract (18%), and urinary tract (3%). Oral melanomas comprise 50% of head and neck melanomas, and the most frequent site of intraoral melanoma is the palate, followed by maxillary gingiva. In a previous study, mandibular gingival melanomas comprised 7% of 703 another unusual place of the body that Melanomas shows are the upper aerodigestivetract [4].Acute appendicitis due to metastasis of prostatic carcinoma is very rare, and only five cases of metastasis of prostatic carcinoma are described in the literature. We report the case of a 73-year-old man with a history of an adenocarcinoma of the prostate with multiple bone metastases. The patient was admitted to the emergency department with symptoms and signs of an acute appendicitis which was confirmed by computed tomography (CT). Laparoscopic surgical exploration was performed, affirming an acute appendicitis with a suspicious lesion in the appendix base. Due to the location of the lesion, an ileocecectomy was performed. Histopathological and immunohistochemical examinations of the specimen showed an extrinsic infiltration of the appendix by adenocarcinoma metastasis expressing the prostate-specific antigen (PSA). These results confirmed an acute appendicitis caused by metastasis of prostatic adenocarcinoma. J Curr Surg. 2015;5(4):204-206 doi: http://dx.doi.org/10.14740/jcs284wMetastatic tumors to the oral cavity are extremely rare lesion that represent 1% of all oral and maxillofacial malignancies. It is invariably associated with a widespread disease and a poor prognosis. Such metastasis occur mostly in the jaw bones than the soft tissues of the mouth. Metastasis to the oral soft tissues most prevalently affects the gingiva and alveolar mucosa. Gingival metastasis may have an unremarkable clinical appearance and they can be difficult to distinguish from more common hyperplasic or reactive lesions that appear to be benign entities, such as peripheral giant-cell granuloma, pyogenic granuloma. We present an unusual case of a testicular choriocarcinoma metastasized to the buccal mucosa mimicking a reactive lesion. An 18 year old male patient presented with a right sided intraoral buccal mass for one month in the department of oral and maxillofacial surgery department of NICRH. Clinically it was diagnosed as pyogenic granuloma. In addition there was right sided non-tender testicular swelling which he noticed eight months earlier. His beta HCG level was 22,5000 mIU/ml and alfa Fetoprotein level was 2.23 ng/ml. Ultrasonography shows right testicular mass, para-aortic lymphadenopathy and multiple hepatic SOL. CT scan shows soft tissue mass in the right hemimandible area. Excision of the right sided intraoral buccal mass and right sided hemimandibulectomy was done. Histopathological examination reveals clear cytotrophoblastic cells with central nuclei and syncytiotrophoblastic cells with multiple dark nuclei embedded in eosinophilic cytoplasm in a hemorrhagic and necrotic stroma and diagnosed as testicular choriocarcinoma. The primary lesion must be removed by orchiectomy. In patients with metastatic illness, the disease must be controlled with cytotoxic chemotherapy, which results in complete regression of the metastasis in 60% to 90% of patients.Introduction: Takotsubo cardiomyopathy (TTC) is an entity firstly described in 1991, characterized by acute but reversible left ventricular systolic dysfunction in the absence of atherosclerotic coronary artery disease. Acute physical or psychological stresses seem to be the most common causes of takotsubo. We reported a case of atypical TTC, during a dental procedure, including 2% xylocaine injection into gum. Case Report: A 51-year-old Caucasian female with a past medical history of depression underwent dental procedure. The dentist injected a solution of 2% xylocaine into the gum and three minutes following the procedure, the patient complained for chest pain, during one hour. Electrocardiogram revealed T waves inversions into inferolateral leads. Troponin level performed at admission was 23 ng/mL (N ≤ 0,05). Clinical examination, echocardiography and coronary angiography were normal. Cardiac magnetic resonance imaging (MRI) found a global left ventricular hypokinesis, with ejection fraction of 40%, without late Gadolinium enhancement.

Acute Appendicitis Due to Metastasis of Prostatic Adenocarcinoma: A Case Report

Acute appendicitis due to metastasis of prostatic carcinoma is very rare, and only five cases of metastasis of prostatic carcinoma are described in the literature. We report the case of a 73-year-old man with a history of an adenocarcinoma of the prostate with multiple bone metastases. The patient was admitted to the emergency department with symptoms and signs of an acute appendicitis which was confirmed by computed tomography (CT). Laparoscopic surgical exploration was performed, affirming an acute appendicitis with a suspicious lesion in the appendix base. Due to the location of the lesion, an ileocecectomy was performed. Histopathological and immunohistochemical examinations of the specimen showed an extrinsic infiltration of the appendix by adenocarcinoma metastasis expressing the prostate-specific antigen (PSA). These results confirmed an acute appendicitis caused by metastasis of prostatic