Amine Rahili

Small bowel involvement is a prognostic factor in colorectal carcinomatosis treated with complete cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy

BackgroundCytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising treatment for patients with peritoneal carcinomatosis (PC). Our objective was to identify new prognostic factors in patients with PC from colorectal cancer treated with this procedure.MethodsAll patients with PC from colorectal cancer treated by HIPEC from January 2000 to December 2007 were prospectively included. The tumor extension was assessed by the Peritoneal Cancer Index (PCI) and the residual disease was recorded using the completeness cytoreductive score (CCs). All clinical and treatment data were computed in univariate and multivariable analyses using survival as primary end point.ResultsWe carried out 51 complete procedures in 49 consecutive patients. The mean PCI was 10. The allocation of CCs was: CC-0 = 37, CC-1 = 14. The five-year overall and progression-free survival rate were 40% and 20%, respectively. Several prognostic factors for survival were identified by univariate analysis: PCI < 9 (P < 0.001), CC-0 vs. CC-1 (P < 0.01) and involvement of area 4 (P = 0.06), area 5 (P = 0.031), area 7 (P = 0.014), area 8 (P = 0.022), area 10 (P < 0.0001), and area 11 (P = 0.02). Only the involvement of the distal jejunum (area 10) was significant in the multivariable analysis (P = 0.027).ConclusionsWe demonstrated that the involvement of area 10 (distal jejunum of the PCI score) was an independent factor associated with poor prognosis.

Ascites and malnutrition are predictive factors for incomplete cytoreductive surgery for peritoneal carcinomatosis from gastric cancer

BACKGROUND Prognosis in peritoneal carcinomatosis from gastric cancer has improved with cytoreductive surgery (CS) and hyperthermic intraperitoneal chemotherapy. The aim of this study was to identify predictive factors for incomplete CS. METHODS Forty-five patients undergoing laparotomy for gastric cancer with peritoneal carcinomatosis were prospectively included from January 2000 to December 2010. In case of optimal CS, patients (n = 14) received hyperthermic intraperitoneal chemotherapy. Otherwise, the laparotomy was closed or a palliative procedure was performed if necessary. All preoperative data were compared between the 2 groups. RESULTS Ascites (hazard ratio, .09; 95% confidence interval, .010-.48; P = .0103) and nutritional status evaluated by the prognostic nutrition index (hazard ratio, .11; 95% confidence interval, .0019-.54; P = .027) were independent predictive factors for incomplete CS. CONCLUSIONS The selection of patients for CS plus hyperthermic intraperitoneal chemotherapy should include the assessment of nutritional status and the detection of an ascites.

Post-traumatic transdiaphragmatic intercostal hernia: report of two cases

Transdiaphragmatic intercostal hernias (TIH) are rare. Less than 40 cases of TIH have so far been reported, with only 8 cases involving herniation of the liver. This report presents the case of 2 patients with a right-sided abdominal lump following a fall. Thoracoabdominal CT-scan showed a TIH between the 9th and 10th ribs with liver and right colonic herniation in both patients. Both patients were successfully treated with mesh repair. The presentation, physiopathology and management of this rare occurrence are discussed.

Swallowing a safety pin: Report of a case

Ingestion of a foreign body is a frequent and well-known medical problem with several diagnostic and therapeutic approaches. Usually, ingested foreign bodies pass through the alimentary tract without incident. In some cases, they can be lodged in the appendix and may cause appendicitis. We report a case of a 29-year old woman, suffering from mental illness, with a safety pin lodged in the appendix. Initially, the patient consulted for abdominal pain. After a period of waiting, during which time the foreign body did not move, a colonoscopy was performed but failed to see the safety pin. Then, the patient underwent a laparoscopic appendectomy. Pathological examination showed an ulcerative appendicitis.

Cancer sur pancréas ectopique de la paroi duodénale.

Resume Le pancreas ectopique est defini comme la presence de tissu pancreatique en dehors de la localisation normale du pancreas. Il peut etre le siege des memes affections que le pancreas orthotopique, en particulier l’adenocarcinome. Ce dernier a ete tres rarement rapporte (14 cas publies) ; il parait etre de meilleur pronostic que celui survenant sur pancreas orthotopique. L’echoendoscopie parait etre un examen utile dans le diagnostic de cette affection. Nous rapportons ici l’observation d’un adenocarcinome sur pancreas ectopique de la paroi duodenale, avec revue de la litterature.

Thrombose de la veine ovarienne droite

Resume Introduction La thrombose de la veine ovarienne (TVO) survient classiquement dans le post-partum . Ses principaux signes sont la douleur du flanc ou de la fosse iliaque associee a de la fievre et a une hyperleucocytose. Sa predominance a droite en fait un diagnostic differentiel de l’appendicite aigue. Observation Une femme de 26 ans, primigeste, a consulte a 38 semaines d’amenorrhee pour douleur de la fosse iliaque et du flanc droit et temperature a 38,6°C. Trois jours apres l’accouchement, en raison de la majoration de la douleur, une cœlioscopie est decidee permettant le diagnostic de thrombose de la veine ovarienne droite. Commentaires L’amelioration des moyens diagnostiques, notamment l’echographie Doppler et la tomodensitometrie spiralee, doit permettre de ne plus faire de diagnostic operatoire de la TVO. Classiquement complication du post-partum , la TVO peut survenir avant l’accouchement, periode ou il est d’autant plus important de ne pas meconnaitre ce diagnostic, notamment en cas d’extension de la thrombose a la veine cave inferieure avec existence d’un thrombus cave flottant. Le traitement de la TVO est essentiellement medical. En cas d’extension cave, la pose d’un filtre cave ou une thrombectomie cave chirurgicale peuvent s’averer necessaires.

Rupture spontanée de rate sur pancréatite chronique calcifiante: À propos de 3 observations

Resume La rupture spontanee de rate (RSR) est une complication rare de la pancreatite chronique calcifiante (PCC). L’anemie et l’etat de choc hemorragique ne font pas toujours partie du tableau clinique initial et peuvent retarder le diagnostic. Malgre un traitement conservateur efficace, le traitement doit etre chirurgical car la rupture de rate est liee aux effets locaux de la pancreatite chronique calcifiante. Nous rapportons trois observations de cette complication peu frequente. La rupture spontanee de rate inaugurale a permis de faire le diagnostic de pancreatite chronique calcifiante chez deux malades. Le traitement a consiste en une splenectomie en urgence. Le diagnostic de pancreatite chronique calcifiante etait connu chez le troisieme malade mais l’absence de saignement actif a justifie un traitement conservateur qui s’est solde par un echec. Nous discutons l’interet d’une pancreatectomie caudale dans le meme temps que la splenectomie afin de reduire les taux de complications post-operatoires et de reinterventions. Nous discutons aussi de la place de la radiologie interventionnelle et de la laparoscopie.Spontaneous rupture of the spleen is a rare complication of chronic calcifying pancreatitis. Anemia and hemorrhagic shock may not occur, making diagnosis more difficult. Favourable response to conservative treatment does not prevent the need for splenectomy, as calcifiying chronic pancreatitis may progress locally. We report three cases of spontaneous rupture of the spleen. In two cases, splenic rupture revealed calcifying chronic pancreatitis and both patients underwent urgent splenectomy. In the third case, the patient was known to have calcifying chronic pancreatitis, and splenectomy was performed because of unsuccessful conservative treatment. We discuss the role of distal pancreatectomy during splenectomy to reduce the rate of postoperative complications and additional surgery. We also discuss the role of arterial embolisation and laparoscopy in the management of this rare condition.

Outcome of exfoliative rejection after isolated intestinal transplantation in an adult: case report.

A 34-year-old-man with short-bowel syndrome received an isolated small bowel graft. On postoperative day (POD) 11, ileal biopsy specimen demonstrated mild to moderate rejection that did not respond to corticosteroid bolus therapy. On POD 14, endoscopy and histologic examination revealed exfoliative rejection that was not controlled after 14 days of therapy with thymoglobulin. On POD 95, the patient underwent surgery again because of intestinal obstruction. The graft was removed 6 months after transplantation because of continuous severe abdominal pain with weight loss. After enterectomy, the patient developed multiple-organ failure and died on POD day 8. This case underlines the severity of exfoliative rejection and suggests that early enterectomy be performed when the diagnosis is made, before deterioration of clinical status and development of infectious and nutritional complications.

Gemcitabine combined with oxaliplatin is safe and effective in patients with previously untreated advanced pancreatic adenocarcinoma

AIM The aim of this study was to determine the safety and the efficacy of a gemcitabine/oxaliplatin combination (GEMOX) as first line therapy in patients with metastatic or unresectable locally-advanced pancreatic cancer. PATIENTS AND METHODS Patients received gemcitabine 1000 mg/m2 as a 10-mg/m2/min infusion on day 1 followed on day 2 by oxaliplatin 100 mg/m2 as a 2-hour infusion, each cycle being given every 2 weeks. All patients had measurable disease and histological diagnosis before inclusion. Patients were treated until progression or for 12 cycles in the absence of progression. Tumor lesions were assessed by computed tomography scan every 4 cycles. RESULTS Between January 2001 and January 2003, 32 patients were eligible for the study. The objective response rate (OR) was 28.1% with a 12.5% complete response rate (CR). Median progression-free survival and median overall survival were 7 and 9 months, respectively. Median overall survival for patients with metastatic disease and locally-advanced disease were 7 and 25 months, respectively (P < 0.0007). Eleven patients were alive at 1 year (34.4%), six at 2 years (18.8%) and two at 3 years (6%). Fourteen (43.8%) of 32 patients experienced a clinical benefit response. CONCLUSION These results support the safety, the antitumor activity and the possibility of durable responses of the GEMOX regimen in patients with locally-advanced disease.

Intestinal Transplantation in a Patient with Superior Vena Cava Thrombosis

In patients undergoing small bowel transplantation, the current consensus is to avoid transplanting patients with insufficient vascular patency to guarantee easy central venous access for up to 6 months following transplantation. Here we present the case of a patient who received an intestinal transplant despite obstruction of the superior vena cava (SVC). The complicated post-operative outcome supports the view that these patients should be transplanted when easy central venous access is available.