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Purpose: To study the epidemiological and clinical features of noninfectious retinal vasculitis (NIRV)., Methods: We analyzed 128 consecutive patients with NIRV, collected over 15 years (1993-2007) in an ophthalmological reference university hospital in Tunis, Tunisia. Data were analyzed regarding associated systemic disease, ocular syndromes, anatomic features (type and topography of vessel and type of capillaropathy), age and sex. The results of the etiologic work-up were based on the Levy-Clarke and Perez classification., Results: A total of 240 cases of NIRV (128 patients) were collected (mean age: 32; sex ratio: 2.6). It was bilateral in 93.7% of cases. The mean visual acuity (VA) was 20/50 (range: 20/800-20/20). NIRV was mainly venous (84.1%), diffuse (57%), with a mixed capillaropathy (40.2%). There were complications in 56.25% of the cases, mainly macular edema (48.1%), vascular occlusion (25.9%), optic atrophy (22.2%) and cataract (19.2%). NIRV was idiopathic in 15.6% of the cases, characterized by a predominance of young subjects (mean: 38 years old), males (sex ratio: 4), VA at 20/25, and edematous periphlebitis in 100% of cases. There were ocular disorders in 12.5% of the cases and systemic disease in 72% of the cases, with a predominance of Behçet disease (BD): 53.9% of all patients and 81% of systemic disease with predominant venous features. In 48.3% of cases, VA was less than 20/200, due to BD in 48% of the cases., Conclusion: In NIRV, the etiologic work-up is oriented on anatomic presentation, based on fluorescein retinal angiography, and requires an interdisciplinary approach. In young adults with retinal phlebitis, BD is suggested first., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Fibrolamellar carcinoma (FLC) of the liver is a rare variant of hepatocellular carcinoma (HCC) occurring on non cirrhotic liver. Since its first description by Hugh Edmondson in 1956, 200 cases of FLC have been reported in the literature, but only some cases describe the association of the ordinary HCC with the FLC within the same lesion. We report in this study the case of a 14-year-old female patient with a hepatic mass whose radiological aspect evoked a nodular and focal hyperplasia. Histologically, this tumor was composed of area of FLC mixed with ordinary HCC. Staining for cytokeratine 7 was positive in the FL component and negative in the ordinary HCC component.

The duodenal varix rupture is a rare and serious complication of portal hypertension. The authors report one case of duodenal varix rupture in a 38 year old woman, revealing portal hypertension, which caused a massive gastro-intestinal bleeding. The endoscopy didn't allow to conclude to a diagnosis. An emergent laparotomy was necessary regarding the massive bleeding. A duodenal varix suture ligation was performed after pyloroduodenotomy. She had a well recovery. After a review of literature, the authors conclude that this abnormal situation is rare, its diagnostic is difficult and it has several therapeutic strategies.

The aim of the study was to asseses the operative, functional results of total proctectomy with coloanal anastomosis (CAA). Between 1990 and 2002, 24 patients (14 males and 10 females ) with a mean age of 50,6 years were operated on for cancer of the rectum and they underwent a total proctectomy with CAA. There was one operative death. 3 patients developed non specific complications. 4 patients experienced a supra anastomosis stenosis and underwent a new straight CAA Functional outcome were evaluated by a scoring system fonction and were considered good in 87 and 84% at 1 and 2 years respectively. Low anterior resection combined with CAA provides good treatment for mid-rectal cancers and for some distal rectal cancers. It had a good functional outcome. However Both procedures and selection of patients who underwent radiotherapy must be carefully performed.

We realized a retrospective study concerning 1570 cases of celioscopic cholecystectomy screened during 6 years: from September 1995 to August 2001. There were 1328 females and 242 males with a wean age of 50 years. 256 patients underwent laparoscopic cholecystectomy for acute cholecystitis. There were one operative death. The morbidity is weak 2.1%. The rate of conversion is 12.4%. We performed 999 operative cholangiography, we found 82 common bile duct stones. Cholangiography should be systematic.

Objective: Remind the clinical and radiological features of the internal left para duodenal hernia., Materials and Method: We report the case of a left para duodenal hernia in a 30 years old woman who suffers of an acute abdominal pain explored by ultra sonography, barium upper gastro intestinal radiography, computed tomography and MRI., Results: CT shows a well limited intra abdominal mass composed of small bowel wrapped in a bag of peritoneum, and moving to the left the mesenteric axis, Conclusion: Left internal para duodenal hernia is a rare phenomenon and is frequently non diagnosed. Spiral computed tomography allows us now, to make the diagnostic with a good sensitivity in the majority of cases.

The authors study the epidemiological, diagnostic and therapeutic features of 153 consecutive cases of colon cancers collected between 1985 and 1998. They compare the results with those of a previous study performed in the same hospital service (140 cases between 1966 and 1984). It is a series of 79 men and 74 women (sex ratio = 1.07). The mean age was 56.6 +/- 14 years old with 13.7% of the patients who were less than 40 years old. The operability and the resectability were respectively 98.7% and 83.7% with a global operative mortality of 7.9%. According to the Dukes classification, they were 2 A stages, 73 B stages, 32 C stages and 45 D stages. Starting from 1993, 53% of the C stages an 48% of the B stages had an adjuvant chemotherapy. The comparison between our present results and those of our previous series does not show any modification in what regards the mean age, the cancer frequency in young people, the complicated forms proportion and time needed for the diagnosis by comparison to the beginning of symptomatology. The colic cancer prognostic improvement is attained through an earlier diagnosis, making it possible to reduce the developed forms and the complicated forms proportion, the consequence of which is the operative mortality decrease and the log-range survival increase.

The neuroendocrine tumours of the oesophagus are exceptional. They are a spectrum of heterogeneous tumours often not clearly defined in the literature. We report a case of moderately differentiated neuroendocrine tumour of the oesophagus arising from Barrett's mucosa in 51-year-old man treated surgically and who was free of disease 28 months after excision. We discuss about this case, the classification, the histogenesis and therapeutic approaches of these tumours.