Fournier's gangrene (FG) is a rapidly progressive necrotizing bacterial dermo-hypodermitis of the perineum and external genitalia. It represents a real medical and surgical emergency requiring multidisciplinary care. Our study was based on the retrospective analysis of 18 cases of FG, collected in the Department of General and Visceral Surgery of Fattouma Bourguiba University Hospital in Monastir over an 18-year period extending from January 2000 to December 2018. Our series included 18 cases of FG collected over an 18-year period, an annual incidence of one case per year. The average age of our patients was 58 years (36 to 77). The male prevalence was clear. Diabetes and old age were found to be the major risk factors. The treatment was based on an aggressive surgical debridement remains to be the cornerstone of therapy and is commonly preceded by patient preparation for the surgical act by perioperative resuscitation and broad-spectrum antibiotic therapy, possibly accompanied by hyperbaric oxygen therapy (HBOT). The vaccum assisted closure (VAC) therapy is also used, which is a non-invasive system that promotes open wound healing. Healing techniques can be once the septic risk is controlled. Dressings topical treatments, such as fatty substances or calcium alginate, in addition to skin grafts, musculo-neurotic or musculo-cutaneous cover flaps can be used. During the follow-up period, no reccurrence occurred in 14 out of the 18 cases (2 patients were lost to follow-up and 2 patients died). A colostomy was closed in 10 out of 11 cases with simple follow-ups. Restorative surgery (partial thickness skin graft) at the perineal level was performed in only one case. Despite the better understanding of its etiopathogenesis, the advent of targeted antibiotic therapy, the establishment of a better codification of surgical procedures, the contribution of hyperbaric oxygenation and reconstruction techniques, mortality rates are still high and FG remains a real health threat, thus constituting a real medical and surgical emergency.
Hydatidosis is a widespread anthropozoonosis. It can affect almost any part of the body, but it occurs most commonly in the liver (75%) and the lungs (15%). Its occurrence in female genital tract, especially the uterus, is very rare. Diagnosing hydatid disease at these unusual locations can be difficult. Hereby, we report two cases of primary hydatid cyst of the uterus. The first case is that of a 62-year-old woman, G7P5A2, who presented with an eight-month history of chronic pelvic pain. Clinical examination and radiological explorations revealed the presence of a uterine fibroid and a serous cystadenoma of the left ovary. She underwent a hysterectomy and a bilateral adnexectomy. Anatomopathological examination concluded that a serous cystadenoma of the left ovary was a calcified subserous hydatid cyst of the uterine fundus. The second case is that of a 69-year-old woman, G6P4A2, who consulted for chronic pelvic pain that had been evolving for 3 months. The clinical examination and radiological explorations doubted a hydatid cyst of the uterus, with a positive hydatid serology. She underwent a resection of the salient dome. The anatomopathological examination was in favor of a hydatid cyst of the uterus. Hydatid disease is endemic in Tunisia. The pelvic region is rarely affected with an incidence ranging from 0.3 to 0.9%, 80% of which involves the genitals. The uterus is more rarely affected than the ovaries. Most often, it is a contamination secondary to the intra-abdominal rupture of a hydatid cyst of the liver. However, primary uterine hydatid cysts have been reported. Surgery is the Gold Standard for the treatment of uterine hydatid cysts. Exploration of the abdominal cavity is essential in the search for other localizations, particularly hepatic. Postoperative medical treatment with Albendazole can be discussed. The ideal approach to deal with this public health concern is to emphasize the need for improved preventive measures. Modern imaging techniques have significantly improved the detection rates of hydatid cysts in atypical localizations. Indeed, the preoperative diagnosis of uterine hydatidosis requires a meticulous approach which is necessary to initiate an adequate treatment and thus guarantee a better management of the patient.
Neurofibromatosis type I (NF1) is also known as von Recklinghausen disease. It is a genetic disorder that affects the growth and development of nerve cell tissue, which is characterized by a multisystem disorder and an increased risk for cancer. The incidence of gastroduodenal stromal tumor during Recklinghausen disease can reach 35% in autopsies and 5% in clinical cases. In our case, the diagnosis of neurofibromatosis type I was made in a middle-aged women initially diagnosed with a pancreaticoduodenal tumor.
Introduction: Mucinous carcinoma of the breast constitutes 1% to 4% of all breast cancers. Two different forms of presentation are distinguished: pure mucinous carcinoma and mixed mucinous carcinoma. The purpose of our work was to clarify the anatomo-clinical and radiological particularities of this rare form of breast cancer. Materials and methods: This was a retrospective study of a series of 14 cases of mucinous carcinoma of the breast, including 8 pure mucinous carcinomas and 6 mixed mucinous carcinomas treated at the Maternity and Neonatal Center of Monastir between January 2009 and December 2017. Results: The frequency of mucinous carcinoma of the breast in our study period was 1.9%. The average of the patients was 55 years old. The average tumor size was 40 mm. Mucinous carcinoma of the breast was pure in 8 cases, mixed in 6 cases. The clinical size of pure CM was smaller than that of mixed CM (41 mm vs 45 mm) [p = 0.12]. Axillary adenopathies were found in 28.5% of patients. Mammography detected a total of 19 masses with three cases of multifocality. The average size was 27 mm, there was no significant difference between subtype sizes. Pure CMs had an oval shape in 83% of the cases with microlobulated contours in half of the cases, mixed CM rather had an irregular shape (71%) with indistinct contours (85%) (p = 0.01/p = 0.04). On ultrasound, pure CMs had a homogeneous hypoechogenic oval mass appearance with microlobulated contours enhancing ultrasound. The mixed CMs had an irregular shape of non-geometric contours and heterogeneous hypoechogenic appearance with posterior ultrasound attenuation (p = 0.06). Microcalcifications were present in 37% of pure CM and 60% of mixed CM (p = 0.13). Ganglionic invasion was noted in 28% of cases. The extension assessment was negative in all cases.
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