Publications by authors named "Lamine Hamzaoui"

35 Publications

Esophageal hirudiniasis: an unusual cause of upper gastrointestinal bleeding.

Future Sci OA 2022 Jul 27;8(6):FSO802. Epub 2022 Jun 27.

Department of Gastroenterology, Mohamed Tahar Maamouri University Hospital, Faculty of Medicine of Tunis, Nabeul, Tunisia.

Leeches are carnivorous, hermaphroditic, segmented worms mainly found in fresh water. The majority of leech attachments are external and short-lasting. Internal surfaces can be involved. Yet, esophageal attachment is very rare. We report a case of a 59-year-old female who presented with hematemesis, melena and chest pain. Upper gastrointestinal endoscopy revealed a round black foreign body in the mid-third of the esophagus identified as a leech. We carefully extracted the worm with a forceps applied to the middle of its body. The diagnosis of leech infestation should be kept in mind when exploring gastrointestinal bleeding in patients living in rural areas and those with poor living conditions.
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http://dx.doi.org/10.2144/fsoa-2022-0023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9327638PMC
July 2022

Post-chemotherapy Gastric Obstruction in Diffuse Large B-Cell Lymphoma: Endoscopic Dilation Can Fix It!

Case Rep Gastroenterol 2022 May-Aug;16(2):301-307. Epub 2022 May 17.

Gastroenterology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia.

Treatment of diffuse large B-cell lymphoma (DLBCL) is based on immunochemotherapy with overall good outcomes. Complications related to the treatment or the disease itself can occur during follow-up. We herein report a case of a 37-year-old male who was diagnosed with stage IV gastric DLBCL. Subsequently, he underwent R-CHOP (rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisone) chemotherapy. After six cycles of treatment, complete remission has been achieved. But afterwards, the patient presented with a symptomatic gastric obstruction related to a tight stenosis in the antro-fundic junction. Endoscopic dilation was performed and multiple macrobiopsies within the stenosis were taken. Pathological examination concluded to the fibrous character of the stricture. In cases of post-chemotherapy obstruction in gastric DLBCL, endoscopic treatment should be attempted carefully in patients with no evidence of active lymphoma. Diagnosis of fibrosis can avoid surgery and its morbidity.
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http://dx.doi.org/10.1159/000524497DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9209960PMC
May 2022

Jejunal diverticulitis as a rare cause of abdominal pain: a case report.

Pan Afr Med J 2022 17;41:222. Epub 2022 Mar 17.

Gastroenterology Department, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.

Jejunal diverticulitis is an uncommon and underdiagnosed condition. Due to the rarity of This disease, diagnosis is often difficult and delayed. Medical treatment is usually sufficient for jejunal diverticulitis without peritonitis. Surgery is required in case of generalized peritonitis or voluminous abscess complicating diverticulitis. We report the case of a 76-year-old woman who suffered from recent abdominal pain. Diagnosis of uncomplicated jejunal diverticulitis was based on computed tomography (CT) scan. The evolution was favorable after antibiotic treatment. Jejunal diverticulitis have to be evoked among the differential diagnosis of patients with abdominal pain especially in the elderly and it is important for clinicians and radiologists to have awareness about this disease.
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http://dx.doi.org/10.11604/pamj.2022.41.222.29095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9167478PMC
June 2022

Esophageal tuberculosis as an unusual cause of dysphagia: a case report.

Pan Afr Med J 2022 18;41:225. Epub 2022 Mar 18.

Gastroenterology Department, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.

Esophageal tuberculosis is a rare cause of infectious esophagitis, even in countries with endemic tuberculosis. This impairment is often secondary. We report a case of secondary esophageal tuberculosis in an immunocompetent patient, clinically revealed by dysphagia. Esophagogastroduodenoscopy showed a large ulcer in the middle third of the esophagus with a fistula opening in the center of the ulcer. Histopathological examination of multiple esophageal tissue biopsies revealed epithelioid cell granulomas without caseous necrosis. We completed with Computed Tomography (CT) scan of the chest which revealed a fistula of the middle third of the esophagus, multiple mediastinal necrotic adenopathies and diffuse pulmonary micronodules suggesting miliary tuberculosis. Sputum examination for acid-fast-bacilli was positive. Anti-tuberculosis treatment resulted in a good response with complete remission. It is therefore important to recognize and include this entity in the differential diagnosis of patients with dysphagia particularly in countries with a high incidence of tuberculosis.
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http://dx.doi.org/10.11604/pamj.2022.41.225.29790DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9167476PMC
June 2022

Solitary gastric Peutz-Jeghers polyp: a case report.

Pan Afr Med J 2022 24;41:65. Epub 2022 Jan 24.

Department of Gastroenterology, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.

Peutz-Jeghers syndrome is an inherited condition that is characterized by mucocutaneous pigmentation and hamartomatous polyposis in the gastrointestinal tract. It increases significantly the risk for developing of several cancers such as breast, colon, rectum, pancreas and stomach. Solitary Peutz-Jeghers polyp is defined as a unique hamartomatous polyp having the same histological features as Peutz-Jeghers syndrome polyps without associated intestinal polyposis, mucocutaneous pigmentation and family history of Peutz-Jeghers syndrome. Gastric solitary Peutz-Jeghers polyp is extremely rare. We found only 13 cases in the literature. We report a new case of solitary gastric Peutz-Jeghers polyp associated with a branch duct intraductal papillary mucinous neoplasm revealed by an acute pancreatitis. Computed tomography of the abdomen found a branch duct intraductal papillary mucinous neoplasm with a pedicled polypoid formation in the greater gastric curvature. Endoscopic resection was performed without complications. Histologic examination showed Peutz-Jeghers hamartomatous polyp. The risk of cancer remains unclear in this entity. Therefore, the follow-up of these patients is necessary because of the possible risk of malignancy.
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http://dx.doi.org/10.11604/pamj.2022.41.65.29526DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8933450PMC
April 2022

Acquired double pylorus presenting as a gastrointestinal bleeding.

Clin Case Rep 2022 Mar 20;10(3):e05634. Epub 2022 Mar 20.

Gastroenterology Department Hospital Mohamed Taher Maamouri Nabeul Tunisia.

We present the case of a 65-year-old man without a past medical history who was admitted for gastrointestinal bleeding. The case shows an acquired double pylorus due to probable pre pyloric ulcer.
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http://dx.doi.org/10.1002/ccr3.5634DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8935129PMC
March 2022

Traumatic neuroma of the bile duct: A case report.

Clin Case Rep 2021 Aug 21;9(8):e04619. Epub 2021 Aug 21.

General surgery Department Mohamed Tahar Maamouri Hospital Nabeul Tunisia.

We report the case of a bile duct traumatic neuroma in a 76-year-old man who presented with obstructive jaundice one year after cholecystectomy. Despite the radiological examinations, the preoperative diagnosis was difficult. The patient underwent a biliary resection with choledoco-duodenal anastomosis.
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http://dx.doi.org/10.1002/ccr3.4619DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8380124PMC
August 2021

Abdominal unicentric Castleman's disease: a case report.

Pan Afr Med J 2021 8;38:339. Epub 2021 Apr 8.

Gastroenterology Department, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.

Castleman's disease is a rare disease characterized by benign lymphoepithelial proliferation. There are two forms: unicentric and multicentric Castleman's disease. Mediastinal location is the most frequent. Intra-abdominal Castleman's disease is a rare presentation. We report a case of 65-year-old female who presented with epigastric pain. Investigations revealed a retroperitoneal mass which was surgically resected. Histopathological examination showed hyaline-vascular type Castleman's disease. In conclusion, Castelman´s disease is a diagnostic challenge and it must be included in the differential diagnosis of retroperitoneal tumors.
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http://dx.doi.org/10.11604/pamj.2021.38.339.28859DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8265241PMC
August 2021

Preoperative endoscopic treatment for the management of concomitant gallstones and common bile duct stones.

Tunis Med 2021 Feb;99(2):233-237

Background: The combination of gallbladder stone and main biliary stone is seen in 10-25% of cases. Its management with the combination of endoscopic and surgical treatment is increasingly adopted.

Aim: To evaluate the efficacy and safety of preoperative retrograde endoscopic retrograde cholangiopancreatography in the treatment of concomitant gallstones and common bile duct stones.

Methods: Retrospective study including patients with concomitant gallstones and common bile duct stones and who had preoperative endoscopic retrograde cholangiopancreatography. The rate of clearance from the main bile duct and the rate of complications were evaluated.

Results: One hundred and twenty patients aged 57.4±2.7 years were included on average. The rate of catheterization of the main bile duct was 90%. Endoscopic retrograde cholangiopancreatography was unnecessary in 34.1%. Main bile duct clearance was obtained in 95.5% of patients who presented lithiasis during the procedure. The endoscopic treatment was efficient in 53,3% of cases Post endoscopic retrograde post cholangio-pancreatography acute panreatitis occurred in 1.6% of cases with an overall complication rate of 6.6%.

Conclusion: Preoperative endoscopic treatment of concomitant gallstones and common bile duct stones is effective with good safety.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8636957PMC
February 2021

Performance of FIB4 and APRI scores for the prediction of fibrosis in patients with chronic hepatitis B virus infection.

Tunis Med 2020 Dec;98(12):998-1004

Background: The evaluation of hepatic fibrosis is essential in the therapeutic management of chronic hepatitis B virus infection. The development of non-invasive tests for liver fibrosis assessement has allowed to avoid liver biops in some cases.

Aim: To assess the performance of the scores APRI and FIB-4 in the assessment of significant fibrosis in chronic hepatitis B virus infection.

Methods: Evaluation study, including patients with chronic hepatitis B virus infection who had a liver biopsy. The accuracy of APRI and FIB4  for the detection of significant fibrosis was compared with  the liver biopsy data.

Results: One hundred and one patients were included. Significant fibrosis was found in 10.9% of patients. For a cut-off value of 0.49, the APRI score predicted significant fibrosis with a sensitivity of 54%, a specificity of 93% and a negative predictive value of 94%. For a cut-off value of 1.01, the FIB-4 score predicted significant fibrosis with a sensitivity of 64%, a specificity of 84% and a negative predictive value of 95%. Performance of both scores was influenced by age, the body mass index, and cytolysis.

Conclusion: The APRI and FIB-4 scores had a good accuracy to exclude significant fibrosis in chronic hepatitis B virus infection.
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December 2020

The risk of subclinical carotid atherosclerosis in patients with chronic hepatitis C.

Tunis Med 2021 Avril;99(4):449-455

Introduction: The role of hepatitis C virus in the pathogenesis of atherosclerotic disease has been suggested by several studies.

Aim: To assess the association between subclinical carotid atherosclerosis and chronic hepatitis C.

Methods: 40 patients infected with chronic hepatitis C and 40 control cases were evaluated by anthropometric and metabolic measurements. The risk of subclinical atherosclerosis was assessed by ultrasound measurement of carotid intima-media thickness. A high cardiovascular risk atherosclerosis was defined by carotid intima-media thickness > 75th percentile.

Results: The carotid intima-media thickness and the prevalence of high cardiovascular risk atherosclerosis were significantly higher in the group infected with hepatitis C compared to the control group (0.68 VS 0.60, p=0.02) and (82.5% vs. 40%; 0.001) respectively. In multivariate studies, activity ≥ A2 and age> 40 years were the independent factors associated with the carotid intima-media thickness and hepatitis C was the only independent factor associated with high cardiovascular risk atherosclerosis (OR=4.81 CI at 95%: 1.6-14.42).

Conclusions: In our study, chronic hepatitis C was associated with a high risk of carotid atherosclerosis.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8734473PMC
March 2022

Selective expression of KCNA5 and KCNB1 genes in gastric and colorectal carcinoma.

BMC Cancer 2020 Dec 2;20(1):1179. Epub 2020 Dec 2.

Laboratory of Venoms and Therapeutic Biomolecules, LR16IPT08 Institute Pasteur Tunis, Tunis Belvédère- University of Tunis El Manar, 13 Place Pasteur, BP74, Tunis, Tunisia.

Background: Gastric and colorectal cancers are the most common malignant tumours, leading to a significant number of cancer-related deaths worldwide. Recently, increasing evidence has demonstrated that cancer cells exhibit a differential expression of potassium channels and this can contribute to cancer progression. However, their expression and localisation at the somatic level remains uncertain. In this study, we have investigated the expression levels of KCNB1 and KCNA5 genes encoding ubiquitous Kv2.1 and Kv1.5 potassium channels in gastric and colorectal tumours.

Methods: Gastric and colorectal tumoral and peritumoral tissues were collected to evaluate the expression of KCNB1 and KCNA5 mRNA by quantitative PCR. Moreover, the immunohistochemical staining profile of Kv2.1 and Kv1.5 was assessed on 40 Formalin-Fixed and Paraffin-Embedded (FFPE) gastric carcinoma tissues. Differences in gene expression between tumoral and peritumoral tissues were compared statistically with the Mann-Whitney U test. The association between the clinicopathological features of the GC patients and the expression of both Kv proteins was investigated with χ2 and Fisher's exact tests.

Results: The mRNA fold expression of KCNB1 and KCNA5 genes showed a lower mean in the tumoral tissues (0.06 ± 0.17, 0.006 ± 0.009) compared to peritumoral tissues (0.08 ± 0.16, 0.16 ± 0.48, respectively) without reaching the significance rate (p = 0.861, p = 0.152, respectively). Interestingly, Kv2.1 and Kv1.5 immunostaining was detectable and characterised by a large distribution in peritumoral and tumoral epithelial cells. More interestingly, inflammatory cells were also stained. Surprisingly, Kv2.1 and Kv1.5 staining was undoubtedly and predominantly detected in the cytoplasm compartment of tumour cells. Indeed, the expression of Kv2.1 in tumour cells revealed a significant association with the early gastric cancer clinical stage (p = 0.026).

Conclusion: The data highlight, for the first time, the potential role of Kv1.5 and Kv2.1 in gastrointestinal-related cancers and suggests they may be promising prognostic markers for these tumours.
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http://dx.doi.org/10.1186/s12885-020-07647-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7709444PMC
December 2020

C-reactive Protein Is the Best Biomarker to Predict Advanced Acute Cholecystitis and Conversion to Open Surgery. A Prospective Cohort Study of 556 Cases.

J Gastrointest Surg 2020 12 25;24(12):2766-2772. Epub 2019 Nov 25.

Depatment of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.

Background: White blood cell levels (WBC) is the only biologic determinant criterion of the severity assessment of acute cholecystitis (AC) in the revised Tokyo Guidelines 2018 (TG18). The aims of this study were to evaluate the discriminative powers of common inflammatory markers (neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP)) compared with WBC for the severity of AC, and the risk for conversion to open surgery and to determine their diagnostic cutoff levels.

Methods: This was a prospective cohort study. Over 3 years, 556 patients underwent laparoscopic cholecystectomy for AC. Patients were classified into two groups: 139 cases of advanced acute cholecystitis (AAC) (gangrenous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis, emphysematous cholecystitis), and 417 cases of non-advanced acute cholecystitis (NAAC). Multiple logistic regression and receiver-operating characteristic curve analysis were employed to explore which variables (WBC, CRP, and neutrophil-to-lymphocyte ratio (NLR)) were statistically significant in predicting AAC and conversion to open surgery.

Results: On multivariable logistic regression analysis, male gender (OR = 0.4; p = 0.05), diabetes mellitus (OR = 7.8; p = 0.005), 3-4 ASA score (OR = 5.34; p = 0.037), body temperature (OR = 2.65; p = 0.014), and CRP (OR = 1.01; p = 0.0001) were associated independently with AAC. The value of the area under the curve (AUC) of the CRP (0.75) was higher than that of WBC (0.67) and NLR (0.62) for diagnosing AAC. CRP was the only predictive factor of conversion in multivariate analysis (OR = 1.008 [1.003-1.013]. Comparing areas under the receiver operating characteristic curves, it was the CRP that had the highest discriminative power in terms of conversion.

Conclusion: CRP is the best inflammatory marker predictive of AAC and of conversion to open surgery. We think that our results would support a multicenter-international study to confirm the findings, and if supported, CRP should be considered as a severity criterion of acute cholecystitis in the next revised version of the Guidelines of Tokyo.
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http://dx.doi.org/10.1007/s11605-019-04459-8DOI Listing
December 2020

Identification of novel pathogenic MSH2 mutation and new DNA repair genes variants: investigation of a Tunisian Lynch syndrome family with discordant twins.

J Transl Med 2019 06 27;17(1):212. Epub 2019 Jun 27.

Laboratory of Human and Experimental Pathology, Institut Pasteur de Tunis, Tunis, Tunisia.

Background: Lynch syndrome (LS) is a highly penetrant inherited cancer predisposition syndrome, characterized by autosomal dominant inheritance and germline mutations in DNA mismatch repair genes. Despite several genetic variations that have been identified in various populations, the penetrance is highly variable and the reasons for this have not been fully elucidated. This study investigates whether, besides pathogenic mutations, environment and low penetrance genetic risk factors may result in phenotype modification in a Tunisian LS family.

Patients And Methods: A Tunisian family with strong colorectal cancer (CRC) history that fulfill the Amsterdam I criteria for the diagnosis of Lynch syndrome was proposed for oncogenetic counseling. The index case was a man, diagnosed at the age of 33 years with CRC. He has a monozygotic twin diagnosed at the age of 35 years with crohn disease. Forty-seven years-old was the onset age of his paternal uncle withCRC. An immunohistochemical (IHC) labeling for the four proteins (MLH1, MSH2, MSH6 and PMS2) of the MisMatchRepair (MMR) system was performed for the index case. A targeted sequencing of MSH2, MLH1 and a panel of 85 DNA repair genes was performed for the index case and for his unaffected father.

Results: The IHC results showed a loss of MSH2 but not MLH1, MSH6 and PMS2 proteins expression. Genomic DNA screening, by targeted DNA repair genes sequencing, revealed an MSH2 pathogenic mutation (c.1552C>T; p.Q518X), confirmed by Sanger sequencing. This mutation was suspected to be a causal mutation associated to the loss of MSH2 expression and it was found in first and second degree relatives. The index case has smoking and alcohol consumption habits. Moreover, he harbors extensive genetic variations in other DNA-repair genes not shared with his unaffected father.

Conclusion: In our investigated Tunisian family, we confirmed the LS by IHC, molecular and in silico investigations. We identified a novel pathogenic mutation described for the first time in Tunisia. These results come enriching the previously reported pathogenic mutations in LS families. Our study brings new arguments to the interpretation of MMR expression pattern and highlights new risk modifiers genes eventually implicated in CRC. Twins discordance reported in this work underscore that disease penetrance could be influenced by both genetic background and environmental factors.
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http://dx.doi.org/10.1186/s12967-019-1961-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598283PMC
June 2019

Mauriac syndrome: An unusual presentation with portal fibrosis.

Presse Med 2019 Jun 25;48(6):718-720. Epub 2019 May 25.

Mohamed Taher Maamouri Hospital, gastro-enterology department, 8000 Nabeul, Tunisia.

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http://dx.doi.org/10.1016/j.lpm.2019.05.013DOI Listing
June 2019

Esophagitis dissecans superficialis due to severe nonsteroidal anti-inflammatory drugs toxicity.

Presse Med 2018 Jul - Aug;47(7-8 Pt 1):695-697. Epub 2018 Jun 12.

Mohamed Taher Maamouri Hospital, Gastroenterology department, route d'Hammamet, Mrezga, 8000 Nabeul, Tunisia; Faculty of Medicine of Tunis, Tunisia.

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http://dx.doi.org/10.1016/j.lpm.2018.05.004DOI Listing
November 2018

Cutaneous Large B Cell Lymphoma Involving the Duodenum and the Bile Duct: a Case Report.

J Gastrointest Cancer 2019 09;50(3):681-683

Gastroenterology Department, Mohamed Tahar Maamouri Hospital, Route d'Hammamet, Mrezga, 8000, Nabeul, Tunisia.

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http://dx.doi.org/10.1007/s12029-018-0112-5DOI Listing
September 2019

[Choledocoduodenal fistula complicating a Crohn's disease].

Presse Med 2017 Jul - Aug;46(7-8 Pt 1):782-784. Epub 2017 May 25.

Hôpital Mohamed Tahar Maamouri, service de gastroentérologie, Nabeul, Tunisie; Université Tunis-El Manar, faculté de médecine de Tunis, Nabeul, Tunisie.

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http://dx.doi.org/10.1016/j.lpm.2017.05.010DOI Listing
March 2018

Gastrointestinal stromal tumours (GISTs): A descriptive study on 29 cases.

Arab J Gastroenterol 2016 Dec 7;17(4):185-187. Epub 2016 Dec 7.

Gastroenterology Department, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.

Background And Study Aim: Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the gastrointestinal tract, originating from Cajal cells in different sites of the digestive tract. The aim of the study is to report on epidemiological, clinical, histological, and therapeutic characteristics of GISTs.

Patients And Methods: A retrospective descriptive study of 29 cases of GIST in gastroenterology and general surgery departments of Mohamed Tahar Maamouri Hospital (Nabeul, Tunisia) was conducted from January 2005 to March 2012.

Results: Among the 29 patients, there were 18 males (62%) and 11 females (38%) with a median age of 63 years (range, 30-96years). The main symptoms were abdominal pain (40%) and weight loss (28%). The tumour was revealed by a complication in 5 cases (17%). Six patients (20.7%) had metastatic lesions. The most common sites were the stomach (41.4%) and the small intestine (17.3%). The median tumour size was 9.5cm (range, 1-30cm). Spindle cell tumours were the main histological type (62%). KIT was positive in the majority of cases (75%). Twenty-one patients with primary disease (72%) underwent a surgical resection. Imatinib was prescribed in 7 patients (24%). Sunitinib malate was indicated in 3 patients who had tumour progression under imatinib. Median survival was 17 months (range, 1-69months). Ten patients died.

Conclusion: The management of GISTs has considerably evolved during the last years. Surgical resection, which remains the mainstay of treatment, was indicated in the majority of patients. Imatinib treatment has not improved overall survival in metastatic and/or inoperable cases.
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http://dx.doi.org/10.1016/j.ajg.2016.11.001DOI Listing
December 2016

Inflammatory pseudotumor of the liver.

Presse Med 2016 Sep 27;45(9):804-7. Epub 2016 Jul 27.

Hôpital Mohamed Tahar Maamouri, service de gastroentérologie, Nabeul, Tunisia; Université Tunis-El Manar, faculté de médecine de Tunis, Tunis, Tunisia.

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http://dx.doi.org/10.1016/j.lpm.2016.06.011DOI Listing
September 2016

Metastatic Squamous Cell Carcinoma of the Stomach.

J Clin Diagn Res 2015 Nov 1;9(11):OD05-6. Epub 2015 Nov 1.

Histopathologist, Department of Histopathology, Mohamed Tahar Maamouri Hospital , Nabeul, Tunisia .

Primary squamous cell carcinoma of the stomach is very rare. Its pathogenesis is unclear and the treatment strategy is controversial. We report an agressive primary squamous cell carcinoma of the stomach with liver and lung metastases in a 55-year-old man. The patient presented with a 1-month history of abdominal pain, vomiting and weight loss. Abdominal ultrasound revealed multiple liver metastases. Endoscopic examination showed two tumour masses on the fundus of the stomach. Biopsy of the lesions revealed squamous cell carcinoma of the stomach. Chest x-ray showed multiple large pulmonary nodules highly suggestive of pulmonary metastases. The patient died ten days after he was admitted because of progression of the tumour and before any therapeutic decision.
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http://dx.doi.org/10.7860/JCDR/2015/14527.6720DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4668455PMC
November 2015

Should acute cholecystitis be operated in the 24 h following symptom onset? A retrospective cohort study.

Int J Surg 2016 Jan 30;25:88-90. Epub 2015 Nov 30.

Department of Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.

Background: Early laparoscopic cholecystectomy is the gold standard for management of acute cholecystitis (AC). Nevertheless, the definition used for early phase remained unclear. We aimed to compare the clinical outcome and cost of immediate (patients undergoing laparoscopic cholecystectomy within 24 h following symptom onset) versus early laparoscopic cholecystectomy (patients managed 25-72 h following symptom onset) for acute cholecystitis.

Methods: A retrospective analysis was performed. The outcomes of 143 patients undergoing laparoscopic cholecystectomy within 24 h (ICG) were compared to 350 patients managed 25-72 h following symptom onset (ECG) for acute cholecystitis.

Results: There were significantly more diabetic patients in the early laparoscopic group (ECG). All other characteristics were comparable (demographic, clinical, biologic and ultrasonographic characteristics) between the two groups. The rate of conversion to open surgery was significantly higher in the ECG. Overall postoperative morbidity and specific morbidity did not differ significantly between the groups. Total hospital stay was longer in the ECG. Direct medical costs were higher in the ECG.

Conclusions: Laparoscopic cholecystectomy, for acute cholecystitis, during the first 24 h of onset of symptoms, significantly reduced conversion to open surgery and total hospital stay without increasing postoperative complications.
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http://dx.doi.org/10.1016/j.ijsu.2015.11.049DOI Listing
January 2016

Balloon dilatation in patients with gastric outlet obstruction related to peptic ulcer disease.

Arab J Gastroenterol 2015 Sep-Dec;16(3-4):121-4. Epub 2015 Oct 3.

Gastroenterology Department, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.

Background And Study Aims: Gastric outlet obstruction (GOO) is a rare complication of peptic ulcer disease (PUD). The endoscopic balloon dilatation (EBD) associated with medical treatment of Helicobacter pylori is a successful method in the management of pyloric stenosis. The aim of this study was to describe epidemiological, clinical, and endoscopic characteristics of GOO related to PUD and to evaluate the effectiveness, safety, and outcome of EBD.

Patients And Methods: In a retrospective study of patients seen between 1999 and 2009 with symptoms of GOO secondary to PUD, pyloro-bulbar stenosis was confirmed by endoscopic examination. Balloon dilatation was performed when obstruction persisted after treatment with double-dose proton-pump inhibitor (PPI) intravenously for 7-10days. The H. pylori status was assessed with histology, and eradication therapy was prescribed for infection.

Results: A total of 45 consecutive patients (38 males, 7 females median age, 51.9years; range, 20-58years) with symptoms of GOO secondary to PUD underwent EBD. Median follow-up time of the 45 patients was 32months (range, 4-126months). The immediate success rate of the procedure was 95.5%. Clinical remission was noted in 84.4% of the patients. Remission without relapse was observed in 55.8%, 30months after the dilatation. Pyloric stenosis relapsed in 15 patients (39.5%) after a median period of 22.9months. The dilatation was complicated in three patients (6.7%, two perforations and one bleeding). A total of 13 patients (29%) underwent surgery. H. pylori was found to be positive in 97.7% of the patients, and was eradicated in 78.4% of them. Smoking and failure of H. pylori eradication were associated with the relapse of the stenosis.

Conclusion: EBD is a simple, effective, and safe therapy for the GOO related to PUD, producing short- and long-term remission.
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http://dx.doi.org/10.1016/j.ajg.2015.07.004DOI Listing
September 2016

Surgery for Colorectal Cancer in Elderly Patients: How Could We Improve Early Outcomes ?

J Clin Diagn Res 2015 May 1;9(5):PC04-8. Epub 2015 May 1.

Student, Department of Surgery, Mohamed Tahar Maamouri, Hospital , Mrezga 8000, Nabeul, Tunisia .

Background: Age is one of the causes behind the undertreatment of elderly colorectal cancer patients. The increase of mortality among elderly colorectal cancer (CRC) patients is due to competing causes of death occurring in the early post operative period. The purpose of this study was to evaluate the risk factors for post operative mortality and morbidity among elderly CRC patients.

Materials And Methods: A retrospective descriptive chart review was performed on consecutive patients older than 70 y with CRC. We have collected data of 124 patients who were admitted from January 2001 to January 2010. Demographic characteristics, operative and postoperative informations were retrospectively analysed.

Results: Early postoperative morbidity, operation related to morbidity and mortality were observed in 44 (35.5%), 9 (7.3%) and 20 (16.1%) cases, respectively. No other factors but ASA score (p = 0.002 and 0.005 in univariate and multivariate analyses, respectively) and emergency operations (p<0.001 and 10(-3) in univariate and multivariate analyses, respectively), were found to be risk factors of mortality. The results of multivariate analyses indicated that anaemia (p=0.021) and rectal cancer (p=0.015) had significant impact on the risk of anastomotic leakage. On the other hand, diabetes mellitus and rectal cancer were indicators that correlated with the width of hospitalization.

Conclusion: Elderly CRC patients should no longer be undertreated only because of their age. They should be exposed to more aggressive management than they are currently receiving. Careful preoperative evaluation, followed by medical optimization and planning of perioperative care could improve outcomes of colorectal surgery for elderly patients.
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http://dx.doi.org/10.7860/JCDR/2015/12213.5973DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4484108PMC
May 2015

[Endoscopic resection of a dermoid rectal cyst].

Presse Med 2015 May 20;44(5):554-5. Epub 2015 Apr 20.

Université Tunis-El Manar, faculté de médecine de Tunis, hôpital Mohamed Tahar Maamouri, service de gastroentérologie, 8000 Nabeul, Tunisie.

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http://dx.doi.org/10.1016/j.lpm.2015.01.011DOI Listing
May 2015

Retroperitoneal necrotizing fasciitis with gas gangrene, caused by perforated caecal diverticulitis.

Int J Colorectal Dis 2015 Dec 13;30(12):1739-40. Epub 2015 Feb 13.

Department of Gastroenterology, Mohamed Tahar Maamouri Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, 8000, Nabeul, Tunisia.

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http://dx.doi.org/10.1007/s00384-015-2150-9DOI Listing
December 2015

Clinico-Pathological Caracteristics, Therapeutic Features and Post-operative Course of Colorectal Cancer in Elderly Patients.

J Clin Diagn Res 2014 Jan 12;8(1):77-9. Epub 2014 Jan 12.

Student, Department of Surgery, Mohamed Tahar Maamouri Hospital , Mrazga 8000 Nabeul, Tunisia .

Statement Of Problem: Colorectal cancer is predominantly a disease of elderly people and is a major cause of morbidity and mortality in the elderly population. The geriatric colorectal population is a very heterogeneous group, including patients with excellent health status and others with comorbid conditions, functional dependency, and limited life expectancy. On the other hand, the effectiveness of surgery for colorectal cancer depends on it being carried out safely, which allows most patients to return to productive lives, with an improved post-operative life expectancy or at least one that is not diminished by the surgery.

Materials And Methods: This work is a descriptive study of a retrospective cohort, based on administrative databases, of all patients with colorectal cancer diagnosed or treated in our institution. We extracted data on sociodemographic characteristics, comorbidity, type of cancer, stage of cancer, type of treatment received, post-operative complications and cause of post-operative death. We compared differences between an elderly group (Group A) (age >75 years) and a group of patients below 75 years (Group B).

Results: We found that elderly patients with colorectal cancer were more likely to be operated in emergent conditions, had more non-specific complications and more post-operative mortality than patients below 75 years. On the other hand, tumours stages, tumours characteristics and post-operative specific morbidity have been proved to be similar, both in Group A and Group B patients.

Conclusion: These results suggest that surgery is feasible and can be safe for patients above 75 years, but it needs much more evaluation of comorbidities, pre- and post-operative intensive care to avoid post-operative non-specific complications.
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http://dx.doi.org/10.7860/JCDR/2014/6294.3774DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3939593PMC
January 2014

Iatrogenic colorectal Kaposi sarcoma complicating a refractory ulcerative colitis in a human immunodeficiency negative-virus patient.

Pan Afr Med J 2013 29;15:154. Epub 2013 Aug 29.

Gastroenterology department, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.

Kaposi sarcoma is a mesenchymal tumor associated to a human herpes virus-8. It often occurs in human immunodeficiency virus-positive subjects. Colorectal localization is rare. We report the case of a colorectal Kaposi sarcoma complicating a refractory ulcerative colitis treated with surgery after the failure of immunomodulator therapy in a human immunodeficiency virus-negative heterosexual man.
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http://dx.doi.org/10.11604/pamj.2013.15.154.2988DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3880822PMC
July 2014

Appendiceal GIST: report of an exceptional case and review of the literature.

Pan Afr Med J 2013 3;15:85. Epub 2013 Jul 3.

Department of surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.

Gastro-intestinal stromal tumors (GISTs) of the appendix are a rare entity. To date, only eight cases has been described in the literature, most of which have been of the benign type. We report a new case of an appendiceal GIST in a 75-year-old man. The tumor was discovered when the patient presented with acute appendiceacal peritonitis. Preoperative diagnosis of appendiceal GIST was rarely done as tumors were usually associated with appendicitis-like symptoms.
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http://dx.doi.org/10.11604/pamj.2013.15.85.2430DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3810228PMC
December 2014
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