S. Charfi

Histopathological findings in appendectomy specimens: a study of 24,697 cases

PurposeAppendicitis is by far the commonest major emergency general surgical operation. Histopathological examination of the appendix is routinely performed.MethodsThis study is a retrospective analysis of 24,697 appendectomies performed from January 2003 to December 2011. Pathological reports were analyzed for the following parameters: age, gender, and pathological diagnosis.ResultsAppendectomy specimens represent 17xa0% of all pathological reports. Acute appendicitis was present in 19,637 (79.5xa0%) patients. The perforation rate was 6.3xa0% and was significantly higher in adult patients. The negative appendectomy rate was 15xa0% and was significantly higher in female and adult patients. The incidence of negative appendectomies had clearly decreased over the 9-year period distribution. Incidental unexpected pathological diagnoses were noted in 226 (0.9xa0%) appendectomy specimens. Neoplastic lesions were present in 171 cases (0.7xa0%); they include carcinoid, adenocarcinoma, and mucinous neoplasms.ConclusionsRoutine pathological examination of appendectomy specimens is expensive. With advances in technology and imaging modalities, the diagnosis of acute appendicitis has improved, with a subsequent significant reduction in negative appendectomy. There are still a number of unusual diagnoses found in appendicectomy specimens supporting the continued use of routine histology.

Protective effects of Cynara scolymus leaves extract on metabolic disorders and oxidative stress in alloxan-diabetic rats

BackgroundDiabetes mellitus (DM) is associated with hyperglycemia, inflammatory disorders and abnormal lipid profiles, currently the extracts from leaves of cynara scolymus has been discovered to treat metabolic disorders and has been stated by multitudinous scientists according to a good source of polyphenols compounds. The present study aimed to evaluate the protective effect of the ethanol leaves extract of C. scolymus in alloxan induced stress oxidant, hepatic-kidney dysfunction and histological changes in liver, kidney and pancreas of different experimental groups of rats.MethodsWe determinate the antioxidant activity by ABTS.+ and antioxidant total capacity (TAC) of all extracts of C. scolymus leaves, the inhibition of α-amylase activity in vitro was also investigated. Forty male Wistar rats were induced to diabetes with a single dose intraperitoneal injection (i.p.) of alloxan (150 mg/kg body weight (b.w.)). Diabetic rats were orally and daily administrated of ethanol extract from C. scolymus at two doses (200-400 mg/kg, b.w) or (12 mg/kg, b.w) with anti-diabetic reference drug, Acarbose for one month. Ethanol extract of C. scolymus effect was confirmed by biochemical analysis, antioxidant activity and histological study.ResultsThe results indicated that the ethanol extract from leaves of C. scolymus showed the highest antioxidant activity by ABTS.+ (499.43g± 39.72 Trolox/g dry extract) and (128.75 ± 8.45 mg VC /g dry extract) for TAC and endowed the powerful inhibition in vitro of α-amylase activity with IC50=72,22 ug/uL. In vivo, the results showed that ethanol extract from the leaves of C. scolymus (200-400 mg/kg) decreased significantly (p < 0.001) the α-amylase levels in serum of diabetic rats, respectively associated with significant reduction (p < 0.001) in blood glucose rate of 42,84% and 37,91% compared to diabetic groups after 28 days of treatment, a significant lowered of plasma total cholesterol (T-Ch) by 18,11% and triglyceride (TG) by 60,47%, significantly and low-density lipoproteins (LDL-C) by 37,77%, compared to diabetic rats, moreover, the administration of ethanol extract appears to exert anti-oxidative activity demonstrated by the increase of CAT, SOD and GSH activities in liver, kidney and pancreas of diabetic rats. This positive effect of the ethanol extract from C. scolymus was confirmed by histological study.ConclusionThese observed strongly suggest that ethanol extract from the leaves of C. scolymus has anti-hyperglycemic properties, at least partly mediated by antioxidant and hypolipidemic effects.

Métastases hépatiques révélatrices : étude épidémiologique et stratégie diagnostique

Introduction Un foie metastatique revelateur represente une situation frequente dans notre pratique. Le but de notre etude etait d’evaluer, d’une part, les caracteristiques epidemiologiques et cliniques des patients ayant une metastase hepatique revelatrice et, d’autre part, notre demarche diagnostique dans la recherche d’une tumeur primitive. Patients et methodes Il s’agit d’une etude retrospective incluant les malades hospitalises, sur une periode de 12xa0ans, apres diagnostic echographique de metastases hepatiques sans tumeur primitive connue. Resultats Il s’agit de 87xa0patients (47xa0H/40xa0F), d’âge moyen de 62,7xa0ans. Les circonstances de decouvertes etaient dominees par l’association de douleurs de l’hypochondre droit et d’alteration de l’etat general (42,5xa0%). Un gros foie tumoral etait palpe dans 52,9xa0% des cas. La biologie a revele une insuffisance hepatocellulaire dans 10xa0% des cas, une cholestase dans 64xa0% des cas et une cytolyse dans 42xa0% des cas. Une ponction biopsie du foie (PBF), pratiquee dans 19xa0cas, etait contributive pour le diagnostic de la tumeur primitive dans 78xa0% des cas. La gastroscopie et la colonoscopie avaient revele une lesion dans 12,5xa0% et 27,5xa0% des cas respectivement. Une tumeur primitive bronchopulmonaire etait suspectee a la radiographie du thorax chez 9xa0patients. La tomodensitometrie (TDM) thoraco-abdomino-pelvienne avait evoque un primitif chez 20xa0parmi 28xa0patients. Un cancer primitif n’a pu etre determine dans 32xa0% des cas. Dans les cas ou le primitif etait localise, il s’agissait d’un cancer digestif chez 36xa0patients, extradigestif chez 18xa0patients et hepatobiliaire chez 6xa0patients. Le traitement etait palliatif ou symptomatique dans tous les cas. Conclusion Les resultats de notre serie sont en faveur de l’utilite de la PBF apres une TDM thoraco-abdomino-pelvienne normale pour orienter le diagnostic et la prise en charge des metastases hepatiques en l’absence de signes d’orientation clinique.

Pemphigus herpetiformis in South Tunisia: a clinical expression of pemphigus foliaceus?

Pemphigus herpetiformis (PH) is a rare subtype of pemphigus combining clinical features of dermatitis herpetiformis and the immunopathologic characteristics of pemphigus. We aimed to analyze the epidemiological, clinical, and immunological presentation and management of the disease in a cohort of south Tunisian patients with a long‐term follow‐up.

Histopathological findings in cholecystectomies specimens: A single institution study of 20 584 cases

BACKGROUNDnThe histopathological examination of cholecystectomy specimens has not been standardized with a debate concerning the routine and the selective approach. The aim of this study was to assess the information obtained from routine histopathological examination of cholecystectomy specimens.nnnMETHODSnAll histopathological reports of cholecystectomy specimens between January 2003 and December 2016 were analyzed, including a clinical diagnosis of benign gallstone disease or cholecystitis.nnnRESULTSnA total of 20,584 reports were examined. The mean age of patients was 54.2 years. Patients aged more than 60 years represent 37.6% of the study population. Of all patients, 15,973 (77.6%) were females. Incidental gallbladder cancers (GBC) were present in 155 cholecystectomies specimens (0.8%). 67.1% of GBC are at T2 and T3 stage. Granulomatous cholecystitis was diagnosed in only 19 cases (0.1%). GBC were more prevalent in older patients (Pxa0<xa010-6) and cholesterolosis was more prevalent in young patients (Pxa0<xa010-6). There was no gender predilection for GBC (Pxa0=xa00.739).nnnCONCLUSIONSnThe rate of incidental gallbladder carcinoma in our study is low, yet, we found a higher proportion of T2 and T3 carcinomas stage. Granulomatous cholecystitis may need further investigations and treatments. When a selective approch of histopathological examination of cholecystectomy specimens is used, it is important to take into account that clinical parameters are significantly associated with gallbladder cancer.

Parapharyngeal space pleomorphic adenoma: a case report

Parapharyngeal space masses account for 0.5% of all head and neck neoplasms. Pleomorphic adenoma arising from the epithelial rests of the salivary tissue in the parapharyngeal space is rare. Computed tomography (CT) and Magnetic Resonance Imaging (MRI) allows a precise topographical localization of the mass and the diagnosis of its nature in the majority of cases. Treatment of parapharyngeal pleomorphic adenoma is primarily surgical excision. Tumor recurrence occur in less than 10% of patients. We report a case of a 37-year-old man presented with dysphagia and disturbed sleep during night since last 6 months. The intraoral examination found a bulging submucosal mass underneath the right oropharynx crossing the midline and pushing the uvula to left side. CT and MRI scan revealed a heterogeneously enhancing tumor in the right parapharyngeal space measuring 4.5×5×6.4 cm and causing luminal narrowing of oropharynx. The patient was operated through a transcervical approach to gain entry into parapharyngeal space without osteotomy of the mandible. The tumor was completely resected without rupture. The postoperative course was uneventful. Histopathological examination confirmed the diagnosis of a pleomorphic adenoma. At the 3 years follow-up the patient was free from disease.