Plateforme Télé-Enseignement de l'Université Oran 1 Ahmed Ben Bella

TROUBLES DE LA CONDUCTION

il s'agit d'un TD: ECG des troubles de la conduction:

au niveau sino-atrial

au niveau atrio-vatriculaire

et intra-ventriculaire

Pure large cell neuroendocrine carcinoma of the gallbladder is a rare disease. However, the prognosis of this aggressive tumor is poor with short survival after diagnosis. We are describing in this manuscript a case of pure large cell neuroendocrine carcinoma in which survival exceeded 26 months, after performing two curative surgeries. We are reporting the case of a 68-year-old woman with a history of recovered right breast carcinoma and operated 6 years later for a completely asymptomatic gallbladder tumor of 31 mm. In this case, curative surgery was performed allowing monobloc resection of the gallbladder and the hepatic segments IVb and V, a lymph node dissection was performed to. The histological examination of the specimen and immunohistochemistry confirms that the tumor was a grade 3 pure large cell neuroendocrine carcinoma of the gallbladder with lymph node invasion, the hepatic and biliary surgical margins were free. Postoperative adjuvant chemotherapy was administered and the evolution was eventless until the discovery at 20 months of a lymph node considered being a metastatic recurrence. A second surgery was performed allowing the removal of three lymph nodes. This time, a different protocol of chemotherapy was administered to our patient who remains alive and without recurrence at 26 months from her first surgery. Surgical relentlessness with free margins resections associated with appropriate chemotherapy probably improves the survival of patients suffering from this rare and aggressive tumor.

Hemorrhagic manifestations during COVID-19 infections are increasingly described in the literature. We report the first case of spontaneous subcapsular hematoma of the liver revealing a COVID-19 infection in a 44-year-old woman with no underlying health condition history, a computerized tomography evaluation showed an aspect of lung ground-glass opacities, with moderate impairment estimated at about 20%. Reverse transcription-polymerase chain reaction confirmed the diagnosis of COVID-19 infection. During the COVID-19 pandemic, non-traumatic bleeding such as spontaneous hematomas in patients with no coagulation disorder could be a manifestation of COVID-19 infection.

Background bile duct injury is a complication that occurs mainly after cholecystectomy. Outcomes of biliary repair surgery are worse when the stricture level is above the biliary confluence. Method A single-centered retrospective study was carried out on patients operated in our department for biliary stricture after a major bile duct injury over the period from January 2010 to May 2018. Only patients operated for biliary stricture were included. This study aimed to determine the independent factors influencing the occurrence of a stricture above the biliary confluence. Univariate and multivariate binary regression was used for data analysis. Results Fifty-three patients were included, they were 43 women and 10 men, sex ratio was 0.23. Thirty-one patients had Grade E3–E4-E5 stricture (58,5%), and patients who had a failure of a previous repair surgery accounted for 36% (n = 19) of our patients. After univariate and multivariate analysis, only laparoscopic cholecystectomy (OR = 7.58, CI = [1.47–38, 91], P = 0.015) and failure of anterior biliary repair surgery (OR = 7, 12, CI = [1.29–39.42], P = 0.025) were independent factors associated with more frequent occurrence of biliary strictures above the confluence. Conclusion Failure of biliary repair surgery makes the pre-existing biliary stricture progress and compromises subsequent surgery's outcomes. It is important to refer all cases of bile duct injury to specialized centers to increase the chances of success of the first biliary repair surgery.

Résumé: Avec la généralisation de la cholécystectomie laparoscopique, l’incidence des traumatismes opératoires des voies biliaires a augmentée de façon significative. La perte de la sensation haptique, la vision bidimensionnelle, et l’éclairage centré favorisent l’illusion aboutissant à des erreurs d’identifications, où le chirurgien confond voie biliaire principale et canal cystique. Ce phénomène explique l’augmentation des traumatismes biliaires à l’ère de la laparoscopie.Récemment, et grâce aux recommandations des sociétés savantes comme la SAGES sur les bonnes pratiques chirurgicales, l’incidence de ces traumatismes est en régression et tend a rejoindre celle décrite à l’ère de la chirurgie ouverte. Parmi ses recommandations, la SAGES met l’accent sur l’adoption par tous les chirurgiens de la « Critical View of Safety » durant la réalisation de la cholécystectomie par voie laparoscopique. L’objectif de cette mise au point est de décrire cette attitude, mais surtout analyser son efficacité et ses limites dans la prévention des traumatismes opératoires des voies biliaires.Abstract:With the generalization of laparoscopic cholecystectomy, the incidence of operative bile ducts injury has increased significantly, the loss of haptic sensation, the two-dimensional vision, and the centered lighting favor the illusion leading to misidentifications, as consequences the surgeon confuses the main bile duct and the cystic duct. This phenomenon explains this increase in the incidence of bile duct injuries in the era of laparoscopy.Recently, and thanks to the recommendations of some learned societies such as SAGES on good surgical practices, the incidence of these complications is declining and tends to join that described in the era of open surgery. Among its many recommendations, SAGES recommends the adoption by all surgeons of the “Critical View of Safety” during the performance of laparoscopic cholecystectomy, an attitude that we will describe, and analyze its effectiveness and its limits in prevention of operative bile ducts injury.

Background: Cholecystectomy is one of the most practiced surgeries; the learned societies published guidelines to improve surgical practices. Guidelines are sometimes not followed, either by negligence, by lack of means, or an adequate professional environment. So, to know the real practices of surgeons, a survey was conducted. Methods: An anonymous national survey involving all practicing Algerian surgeons was conducted. At the end of the survey, all data were captured and processed using the SPSS v20 software; χ2 tests were used to compare different groups of surgeons. Results: Only 122 responses were retained, twenty-two percent of surgeons perform open cholecystectomy. No surgeon performed routinely cholangiography, 43% extracted the gallbladder using extraction disposal, 18% performed systematic abdominal cavity drainage, all surgeons send the gallbladder to histology for examination and postoperative antibiotic prophylaxis was routinely prescribed by 69% of surgeons. The average postoperative hospitalization recommended by surgeons was 1.65 days (0-5) days. The experience of the surgeon or his position was associated with lower rates of systematic prescription of antibiotic prophylaxis, and with a lower duration of postoperative hospitalization. Conclusions: We recommend the publication of guidelines of good practices adapted to the socio-professional and economic context of countries. 

Transomental hernia is the rarest form of internal hernias. Clinical expression of this pathology is ambiguous and diagnosis is often made at the complication phase, after irreversible strangulation of the herniated loop. Radiological diagnosis is still difficult and intraoperative exploration usually allows discovering this pathology when the patient is operated for acute intestinal obstruction. Treatment is surgical and aims to treat intestinal obstruction and prevent a recurrence. We describe the case of a 65 years old male operated on for a preoperatively suspected internal hernia; surgical exploration found a transomental hernia through the greater omentum.