Wandering spleen is a rare condition defined as a mobile spleen only attached with its pedicle. It can be complicated by a volvulus, which is a surgical abdominal emergency. Preventing infarction is the aim of a prompt surgery that can preserve the spleen and then proceed to splenopexy. We report a rare case of torsion of a wandering spleen associated with a dolichosigmoïd.

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These results (a) support the view that chronic iron overload decreases serum antibacterial effect against Salmonella enterica Typhimurium LT2, (b) favor the interest of including, besides serum ferritinemia, serum transferrin saturation levels as a further criterion for iron-depletive treatment efficacy, and (c) provide an argument for not discouraging the use of blood from iron-depleted hemochromatosis patients for transfusion.

The liver biopsy has long been the "gold standard" for assessing liver fibrosis in patients with hepatitis C. It's an invasive procedure which is associated with an elevated bleeding, especially in chronic hemodialysis patients. Main goal is to assess liver fibrosis in chronic hemodialysis with HCV by Fibroscan and by biological scores (APRI, Forns and Fib-4), and to measure the correlation between these tests. Cross-sectional study including all chronic hemodialysis patients with hepatitis C virus, in two public hemodialysis centers of Fez. All patients were evaluated for liver fibrosis using noninvasive methods (FibroScan and laboratory tests). Subsequently, the correlation between different tests has been measured. 95 chronic hemodialysis were studied, twenty nine patients (30.5%) with chronic hepatitis C. The average age was 52.38 ± 16.8 years. Nine liver fibrosis cases have been concluded by forns score. Fibroscan has objectified significant fibrosis in 6 cases. On the other side APRI has objectified sgnifivant fibrosis only in 3 cases. The Fib-4 showed severe fibrosis in five cases. The results have been most consistent between APRI and Fib-4, followed by Fibroscan and Forns, then APRI and FibroScan.

ABSTRACT

Intra-hospital mortality in cirrhotic patients is variable depending on the studies reported in literature. Several studies have demonstrated independent predictors of mortality. The aim of this work is indeed to identify these predictors. Patients and Methods: We conducted a retrospective study of 1080 cirrhotic patients hospitalized in our department of gastroenterology and hepatology between January 2001 and August 2010. A descriptive study of the study population was performed, and a univariate analysis looking for an association between intra-hospital mortality, and clinical, biological, etiological and socio-demographic characteristics of our patients. Results: The average age of our patients was 54 years, with an equal number of men and women. 41.1% of patients had cirrhosis secondary to hepatitis C and 18.5% had cirrhosis secondary to hepatitis B. 26.1% of our patients were CHILD C. Intra-hospital mortality was 8.7% (97 deaths) with a mean of 23.4 ± 35.8 months. Univariate analysis showed that the intra-hospital mortality was significantly associated with higher age (p = 0.049) as well as the reasons for admissions like hepatic encephalopathy, and hematemesis (p < 0.0001), melena, jaundice and ascites (p = 0.001). Among the biological parameters analyzed in univariate analysis, significant associations with mortality were objectified for high white blood cell count (p = 0.035), and high serum bilirubin and creatinine (p < 0.0001); low rate of prothrombin time (PT) (p < 0.0001), of albumin (p = 0.0001) and of serum sodium (p < 0.0001). Among the complications analyzed, significant associations with mortality were objectified for jaundice, ascites (p = 0.001), hemorrhagic decompensation, hepatic encephalopathy, and spontaneous bacterial peritonitis (p < 0.001). Univariate analysis of the etiology of cirrhosis objectified significant associations for cirrhosis secondary to hepatitis B (p = 0.001) and hepatitis C (p = 0.022). Multivariate analysis objectified four independent predictors of mortality: hepatic encephalopathy, infection (hyper leukocytosis ≥ 10,000/mm 3 ), renal failure (serum creatinine ≥ 15 mg/l) and hyponatremia. Conclusion: In our series, we identified four independent predictors of intra-hospital mortality in cirrhotic patients: hepatic encephalopathy, infection, renal failure and hyponatremia.

Objectif : L'hémorragie digestive haute (HDH) est une urgence fréquente en hépatogastroentérologie. Le profil épidémiologique des HDH reste mal connu dans notre pays. Le but de notre travail est de décrire le profil épidémio-logique, étiologique et évolutif des HDH et d'analyser les différents facteurs liés à la mortalité. Matériels et méthodes : Il s'agit d'une étude initialement rétrospective [2001][2002][2003][2004] puis prospective [2005][2006][2007][2008], ayant inclus tous les patients adultes qui se sont présentés pour une HDH et ayant bénéficié d'une endoscopie haute au centre hospitalier universitaire Hassan-II de Fès. Résultats : Mille trois cent trois cas ont été inclus. Huit cent vingt-sept étaient des hommes représentant 63,5 % des patients. L'âge moyen des patients était de 47,6 ± 17,7 ans. Les étiologies les plus fréquentes étaient l'hémorragie ulcéreuse (46 %) et l'hémorragie liée à l'HTP (23,3 %). La prévalence des oesophagites était de 10,9 % et celle des gastrites aiguës de 7,3 %. Les taux de récidive précoce et de mortalité intrahospitalière étaient de 8,3 et 6,5 % respectivement. Les hémorragies liées à l'HTP ou à la pathologie tumorale, l'âge avancé, l'état de choc initial et la récidive hémorragique sont les principaux facteurs de risque de mortalité retrouvés dans notre étude.Conclusion : Les patients de notre série avaient un âge jeune. La première étiologie des HDH dans notre contexte était la pathologie ulcéreuse reflétant la prévalence de celle-ci dans notre population. Les hémorragies liées à l'hypertension portale, l'âge avancé et la récidive hémorragique étaient les principaux facteurs liés à la mortalité. Pour citer cette revue : Acta Endosc. 41 (2011). Mots clésHémorragie digestive haute · Épidémiologie · Mortalité · Endoscopie · Ulcère gastroduodénal · Hypertension portale Abstract Background: Acute upper gastrointestinal bleeding (AUGIB) is a common emergency in hepatogastroenterology. Epidemiology of AUGIB in our country remains unknown. The aim of this study is to evaluate the clinical and etiological characteristics and outcomes of patients with upper gastrointestinal bleeding and to define risk factors of poor prognosis. Materials and methods: This is a retrospective (2001)(2002)(2003)(2004) and prospective (2005)(2006)(2007)(2008) study, including patients with AUGIB who had upper digestive endoscopy in Hassan II University Hospital of Fez. Results: Thousand three hundred and three cases were included. Eight hundred and twenty-seven were men (63.5%). The mean age was 47.6 ± 17.7 years. The most common causes of AUGIB were ulcer bleeding (46%) and bleeding related to portal hypertension (PH) (23.3%). Prevalence of esophagitis and acute gastritis were 10.9% and 7.3% respectively. The recurrence rate and in-hospital mortality were 8.3% and 6.5% respectively. Portal hypertension-related bleeding, malignancy, advanced age, shock and recurrent bleeding were the main risk factors of mortality in our study. bleeding, which reflects the prevalence of peptic ulcer in our population. ...