Prerequis : Les tumeurs stromales du tube digestif sont des tumeurs conjonctives indifferenciees,... more Prerequis : Les tumeurs stromales du tube digestif sont des tumeurs conjonctives indifferenciees, identifiees comme issus des cellules «pacemaker» de Cajal grâce a la caracterisation immunohistochimique de leur phenotype. But: Rapporter trois nouvelles observations. Observation: Nous rapportons trois observations de tumeurs stromales du grele revelees par une anemie dans un cas et une masse abdominale dans les deux autres cas. A travers ces observations nous discuterons, le profil anatomo-clinique et pronostique ainsi que les implications therapeutiques de ces tumeurs.
R E S U M E La steatohepatite non alcoolique est une hepatopathie acquise le plus souvent metabol... more R E S U M E La steatohepatite non alcoolique est une hepatopathie acquise le plus souvent metabolique caraderisee par des lesions histologiques a type de steatose et de lesions necroticoinflammatoires intralobulaires identiques a celles induites par la consommation excessive d'alcool. Sa prevalence est en augmentation dans les pays industrialises notamment a cause de l'augmentation de la prevalence de l'obesite et du diabete qui sont les principaux fadeurs de risque de cette maladie. Le diagnostic de steatohepatite non alcoolique repose sur une confrontation des donnees cliniques et anatomiques et implique l'elimination de toute consommation excessive d'alcool et de toute autre cause d'hepatopathie. La biopsie hepatique a un interet diagnostique et pronostique, notamment lorsqu'il existe des facteurs de risque de fibrose. Cette pathologie est potentiellement grave presentant un risque d'evolution vers la cirrhose non negligeable. Des progres dans les connaissances des mecanismes physiopathologiques ont ete observes mais les implications therapeutiques restent encore a evaluer. Le but de cette mise au point est d'indiquer les connaissances actuelles sur la gravite de la steatohepatite et de ses consequences et de comprendre sa pathogenie pour prevenir la cirrhose.
Les tumeurs stromales digestives (TSD) constituent une entite anatomopathologique et immunohistoc... more Les tumeurs stromales digestives (TSD) constituent une entite anatomopathologique et immunohistochimique d'identification recente. Elles sont caracterisees par l'expression du protooncogene C-Kit (CD117). Leur diagnostic est relativement facile, leur evolution pronostique, par contre, n'est pas toujours aisee. Le traitement de base des TSD est chirurgical. Ces tumeurs sont particulierement d'actualite depuis la decouverte d'un traitement non chimiotherapique des formes malignes par un inhibiteur de tyrosine kinase en particulier de C-Kit : STI571 ou Glivec*.
But : Ce travail a pour but de rechercher des parametres cliniques, biologiques ou endoscopiques ... more But : Ce travail a pour but de rechercher des parametres cliniques, biologiques ou endoscopiques predictifs du recours a la chirurgie apres l'echec d'un traitement par les glucocorticoides en cas de rectocolite ulcero-hemorragique en poussee grave. Methodes: Soixante et un patients ont ete inclus. Une reponse therapeutique aux corticoides etait definie par le non recours a la chirurgie dans un delai inferieur a 30 jours. Les donnees ont ete collectees retrospectivement et analysees sur le logiciel SPSS version 10 puis incluses dans un modele de regression logistique. Resultats : Une reponse therapeutique aux corticoides a ete notee chez 15 patients (24,6%). En etude uni-variee, les facteurs predictifs du recours a la chirurgie etaient le sexe masculin, le tabac, le nombre de poussees dans les antecedents, une temperature depassant 38°C, une vitesse de sedimentation depassant 30 mm, une tension arterielle systolique inferieure a 11, des ulcerations en puits et des ulcerations etendues occupant plus du tiers de la superficie du colon. Au cours du suivi, un nombre de selles depassant 7, un pouls depassant 90, une temperature depassant 38°C au troisieme jour d'hospitalisation et la presence de sang dans les selles au cinquieme jour etaient predicteurs de recours a la chirurgie. En etude multi variee, un nombre de selles depassant 7 au troisieme jour d'hospitalisation etait le seul facteur predictif du recours a la chirurgie. Conclusion : Un nombre de selles eleve au troisieme jour d'hospitalisation est apparu comme un facteur predictif du recours a la chirurgie.
Nephrogenic ascites is a clinical diagnosis defined as a refractory ascites in patients with end-... more Nephrogenic ascites is a clinical diagnosis defined as a refractory ascites in patients with end-stage renal disease. The exact cause of ascites formation is unknown. Patients frequently present with moderate to massive ascites and cachexia. The ascitic fluid is an exudate. The diagnosis is one established only by exclusion of the others causes of exudative ascites. Only continuous ambulatory peritoneal dialysis and renal transplantation appear to be effective in controlling ascites formation. The prognosis is dismal. We described here one patient case with nephrogenic ascites and review of the literature.
Recurrence is found in 24 to 50% in patients undergoing surgery for colorectal cancer. The main p... more Recurrence is found in 24 to 50% in patients undergoing surgery for colorectal cancer. The main purpose of follow-up is the screening of local or metastatic recurrence. Actually, the follow-up can not be justified only if there is a real advantage for the patient. Optimal modalities of surveillance of colorectal cancers resected have not been determined. The search of liver or lung metastases is actually preferred. The same pattern is used for searching colorectal lesions after a resection of colorectal cancer and after a polypectomy. The cost/effectiveness deontological value must be considered in the choice of further exams. However, the contribution of a cancerology follow-up is always controversial. Only prospective and randomized trials with a sufficient number of patients would prove the usefulness of a follow-up. In order to minimize the cost's problem, it is interesting to propose follow-up for a target population with a greater individual risk for recurrence.
Hepatocellular carcinoma is a rapidly fatal tumor. The only hope for a cure lies in early diagnos... more Hepatocellular carcinoma is a rapidly fatal tumor. The only hope for a cure lies in early diagnosis. It follows that an effective screening strategy should be used in high-risk populations. Screening currently relies on tumor markers such as alfa fetoprotein (AFP) and imaging modalities. Because the AFP assay lacks sensitivity and specificity in patient with small tumors, other serum markers are being evaluated.
The non alcoholic steatohepatitis is a more and more frequent disease. Great progress in the phys... more The non alcoholic steatohepatitis is a more and more frequent disease. Great progress in the physiopathologic mechanisms has been recently observed. The mitochondrial dysfunction seems to be the main mechanism implied in the necroticoinflammatory genesis of the non alcoholic steatohepatitis lesions. When this one is of metabolic origin, this dysfunction occurs on a vulnerable to aggressions steatosis liver. Several implied factors leads to the increased liberation of free radicals that will activate the lipidic peroxydation. This one is considered as the main generator of necroticoinflammatory lesions and fibrosis. The future therapeutic alternatives depends on a better comprehension of mitochondrial dysfunction.
L'ascite est une complication frequente chez les malades atteints de cirrhose. Le traitement ... more L'ascite est une complication frequente chez les malades atteints de cirrhose. Le traitement de l'ascite depend de son abondance: En cas d'ascite moderee: on associe un traitement diuretique par voie orale et un regime pauvre en sodium. La surveillance porte sur l'efficacite jugee sur l'evolution ponderale et sur la tolerance. En cas d'ascite volumineuse: l'evacuation se fait en une seule seance par paracentese, associe a un remplissage vasculaire pour prevenir l'hypovolemie. Immediatement apres, un traitement diuretique oral est institue pour prevenir la recidive. En cas d'ascite refractaire: les differents options therapeutiques sont les paracenteses evacuatrices iteratives, le shunt peritoneo-jugulaire et le shunt intra-hepatique porto-systemique.
The aim of our study was to determine demographic, clinical, biological or endoscopic factors tha... more The aim of our study was to determine demographic, clinical, biological or endoscopic factors that predict intestinal stenosis in Crohn's disease. One hundred and twenty one patients were retrospectively analyzed during 10 years. The diagnosis of stenosis were determined by morphologic and endoscopic exams independently of appearance of symptoms. The studied characteristics were age at appearance of symptoms, sex, geographical origin, tobacco addiction, symptoms revealing Crohn's disease, extra-digest and auto-immune signs associate and seat of disease. Biological values studied were: haemoglobin, white cells, platelet, erythrocyte sedimentation rate, C- reactive protein and albumin. Predictive factors were assessed using univariate and multivariate analysis. Forty-seven patients (38,8%) had a stenosis. In univariate analysis, predictive factors of stenosis were a young age and ileum site of Crohn's disease. In multivariate analysis, none of these variables was independe...
Stromal tumors of the digestive tract are undifferenciated connective tissue tumors, identified a... more Stromal tumors of the digestive tract are undifferenciated connective tissue tumors, identified as stemming of "pace-maker" cells of Cajal related to the immunohistochimical characterization of the phenotype. Report three new cases We report three observations of the small bowel stromal tumors reveal by anemia in one case and mass formation in two cases. The aim of this study was to discuss the anatomo-clinical, prognosis and management of these tumors.
Autoimmune hepatitis (AIH) is a chronic inflammatory condition of the liver of unknown etiology. ... more Autoimmune hepatitis (AIH) is a chronic inflammatory condition of the liver of unknown etiology. Its epidemiological and anatomoclinical characteristics and its outcome were unknown in Tunisia. To analyse epidemiological, anatomoclinical, immunological and histological aspects of AIH and to determine factors predicting relapse after treatment and death of this disease in Tunisia. Patients presenting with AIH between January 1996 and December 2004 were evaluated in retrospective multicentric study. The diagnosis of AIH was established according to the criteria of the revised score of the international autoimmune hepatitis group (1999) Eighty three patients were identified (70 female; mean age=49+17.9 years). 63% presented probable AIH and 37% presented definite AIH. Thirty two percent presented with the acute pattern. Eighty three per cent of cases were type I AIH and 5 % of cases were type II HAI. Fifty seven percent of the patients were cirrhotic at presentation. Associated autoimm...
Prerequis : Les tumeurs stromales du tube digestif sont des tumeurs conjonctives indifferenciees,... more Prerequis : Les tumeurs stromales du tube digestif sont des tumeurs conjonctives indifferenciees, identifiees comme issus des cellules «pacemaker» de Cajal grâce a la caracterisation immunohistochimique de leur phenotype. But: Rapporter trois nouvelles observations. Observation: Nous rapportons trois observations de tumeurs stromales du grele revelees par une anemie dans un cas et une masse abdominale dans les deux autres cas. A travers ces observations nous discuterons, le profil anatomo-clinique et pronostique ainsi que les implications therapeutiques de ces tumeurs.
R E S U M E La steatohepatite non alcoolique est une hepatopathie acquise le plus souvent metabol... more R E S U M E La steatohepatite non alcoolique est une hepatopathie acquise le plus souvent metabolique caraderisee par des lesions histologiques a type de steatose et de lesions necroticoinflammatoires intralobulaires identiques a celles induites par la consommation excessive d'alcool. Sa prevalence est en augmentation dans les pays industrialises notamment a cause de l'augmentation de la prevalence de l'obesite et du diabete qui sont les principaux fadeurs de risque de cette maladie. Le diagnostic de steatohepatite non alcoolique repose sur une confrontation des donnees cliniques et anatomiques et implique l'elimination de toute consommation excessive d'alcool et de toute autre cause d'hepatopathie. La biopsie hepatique a un interet diagnostique et pronostique, notamment lorsqu'il existe des facteurs de risque de fibrose. Cette pathologie est potentiellement grave presentant un risque d'evolution vers la cirrhose non negligeable. Des progres dans les connaissances des mecanismes physiopathologiques ont ete observes mais les implications therapeutiques restent encore a evaluer. Le but de cette mise au point est d'indiquer les connaissances actuelles sur la gravite de la steatohepatite et de ses consequences et de comprendre sa pathogenie pour prevenir la cirrhose.
Les tumeurs stromales digestives (TSD) constituent une entite anatomopathologique et immunohistoc... more Les tumeurs stromales digestives (TSD) constituent une entite anatomopathologique et immunohistochimique d'identification recente. Elles sont caracterisees par l'expression du protooncogene C-Kit (CD117). Leur diagnostic est relativement facile, leur evolution pronostique, par contre, n'est pas toujours aisee. Le traitement de base des TSD est chirurgical. Ces tumeurs sont particulierement d'actualite depuis la decouverte d'un traitement non chimiotherapique des formes malignes par un inhibiteur de tyrosine kinase en particulier de C-Kit : STI571 ou Glivec*.
But : Ce travail a pour but de rechercher des parametres cliniques, biologiques ou endoscopiques ... more But : Ce travail a pour but de rechercher des parametres cliniques, biologiques ou endoscopiques predictifs du recours a la chirurgie apres l'echec d'un traitement par les glucocorticoides en cas de rectocolite ulcero-hemorragique en poussee grave. Methodes: Soixante et un patients ont ete inclus. Une reponse therapeutique aux corticoides etait definie par le non recours a la chirurgie dans un delai inferieur a 30 jours. Les donnees ont ete collectees retrospectivement et analysees sur le logiciel SPSS version 10 puis incluses dans un modele de regression logistique. Resultats : Une reponse therapeutique aux corticoides a ete notee chez 15 patients (24,6%). En etude uni-variee, les facteurs predictifs du recours a la chirurgie etaient le sexe masculin, le tabac, le nombre de poussees dans les antecedents, une temperature depassant 38°C, une vitesse de sedimentation depassant 30 mm, une tension arterielle systolique inferieure a 11, des ulcerations en puits et des ulcerations etendues occupant plus du tiers de la superficie du colon. Au cours du suivi, un nombre de selles depassant 7, un pouls depassant 90, une temperature depassant 38°C au troisieme jour d'hospitalisation et la presence de sang dans les selles au cinquieme jour etaient predicteurs de recours a la chirurgie. En etude multi variee, un nombre de selles depassant 7 au troisieme jour d'hospitalisation etait le seul facteur predictif du recours a la chirurgie. Conclusion : Un nombre de selles eleve au troisieme jour d'hospitalisation est apparu comme un facteur predictif du recours a la chirurgie.
Nephrogenic ascites is a clinical diagnosis defined as a refractory ascites in patients with end-... more Nephrogenic ascites is a clinical diagnosis defined as a refractory ascites in patients with end-stage renal disease. The exact cause of ascites formation is unknown. Patients frequently present with moderate to massive ascites and cachexia. The ascitic fluid is an exudate. The diagnosis is one established only by exclusion of the others causes of exudative ascites. Only continuous ambulatory peritoneal dialysis and renal transplantation appear to be effective in controlling ascites formation. The prognosis is dismal. We described here one patient case with nephrogenic ascites and review of the literature.
Recurrence is found in 24 to 50% in patients undergoing surgery for colorectal cancer. The main p... more Recurrence is found in 24 to 50% in patients undergoing surgery for colorectal cancer. The main purpose of follow-up is the screening of local or metastatic recurrence. Actually, the follow-up can not be justified only if there is a real advantage for the patient. Optimal modalities of surveillance of colorectal cancers resected have not been determined. The search of liver or lung metastases is actually preferred. The same pattern is used for searching colorectal lesions after a resection of colorectal cancer and after a polypectomy. The cost/effectiveness deontological value must be considered in the choice of further exams. However, the contribution of a cancerology follow-up is always controversial. Only prospective and randomized trials with a sufficient number of patients would prove the usefulness of a follow-up. In order to minimize the cost's problem, it is interesting to propose follow-up for a target population with a greater individual risk for recurrence.
Hepatocellular carcinoma is a rapidly fatal tumor. The only hope for a cure lies in early diagnos... more Hepatocellular carcinoma is a rapidly fatal tumor. The only hope for a cure lies in early diagnosis. It follows that an effective screening strategy should be used in high-risk populations. Screening currently relies on tumor markers such as alfa fetoprotein (AFP) and imaging modalities. Because the AFP assay lacks sensitivity and specificity in patient with small tumors, other serum markers are being evaluated.
The non alcoholic steatohepatitis is a more and more frequent disease. Great progress in the phys... more The non alcoholic steatohepatitis is a more and more frequent disease. Great progress in the physiopathologic mechanisms has been recently observed. The mitochondrial dysfunction seems to be the main mechanism implied in the necroticoinflammatory genesis of the non alcoholic steatohepatitis lesions. When this one is of metabolic origin, this dysfunction occurs on a vulnerable to aggressions steatosis liver. Several implied factors leads to the increased liberation of free radicals that will activate the lipidic peroxydation. This one is considered as the main generator of necroticoinflammatory lesions and fibrosis. The future therapeutic alternatives depends on a better comprehension of mitochondrial dysfunction.
L'ascite est une complication frequente chez les malades atteints de cirrhose. Le traitement ... more L'ascite est une complication frequente chez les malades atteints de cirrhose. Le traitement de l'ascite depend de son abondance: En cas d'ascite moderee: on associe un traitement diuretique par voie orale et un regime pauvre en sodium. La surveillance porte sur l'efficacite jugee sur l'evolution ponderale et sur la tolerance. En cas d'ascite volumineuse: l'evacuation se fait en une seule seance par paracentese, associe a un remplissage vasculaire pour prevenir l'hypovolemie. Immediatement apres, un traitement diuretique oral est institue pour prevenir la recidive. En cas d'ascite refractaire: les differents options therapeutiques sont les paracenteses evacuatrices iteratives, le shunt peritoneo-jugulaire et le shunt intra-hepatique porto-systemique.
The aim of our study was to determine demographic, clinical, biological or endoscopic factors tha... more The aim of our study was to determine demographic, clinical, biological or endoscopic factors that predict intestinal stenosis in Crohn's disease. One hundred and twenty one patients were retrospectively analyzed during 10 years. The diagnosis of stenosis were determined by morphologic and endoscopic exams independently of appearance of symptoms. The studied characteristics were age at appearance of symptoms, sex, geographical origin, tobacco addiction, symptoms revealing Crohn's disease, extra-digest and auto-immune signs associate and seat of disease. Biological values studied were: haemoglobin, white cells, platelet, erythrocyte sedimentation rate, C- reactive protein and albumin. Predictive factors were assessed using univariate and multivariate analysis. Forty-seven patients (38,8%) had a stenosis. In univariate analysis, predictive factors of stenosis were a young age and ileum site of Crohn's disease. In multivariate analysis, none of these variables was independe...
Stromal tumors of the digestive tract are undifferenciated connective tissue tumors, identified a... more Stromal tumors of the digestive tract are undifferenciated connective tissue tumors, identified as stemming of "pace-maker" cells of Cajal related to the immunohistochimical characterization of the phenotype. Report three new cases We report three observations of the small bowel stromal tumors reveal by anemia in one case and mass formation in two cases. The aim of this study was to discuss the anatomo-clinical, prognosis and management of these tumors.
Autoimmune hepatitis (AIH) is a chronic inflammatory condition of the liver of unknown etiology. ... more Autoimmune hepatitis (AIH) is a chronic inflammatory condition of the liver of unknown etiology. Its epidemiological and anatomoclinical characteristics and its outcome were unknown in Tunisia. To analyse epidemiological, anatomoclinical, immunological and histological aspects of AIH and to determine factors predicting relapse after treatment and death of this disease in Tunisia. Patients presenting with AIH between January 1996 and December 2004 were evaluated in retrospective multicentric study. The diagnosis of AIH was established according to the criteria of the revised score of the international autoimmune hepatitis group (1999) Eighty three patients were identified (70 female; mean age=49+17.9 years). 63% presented probable AIH and 37% presented definite AIH. Thirty two percent presented with the acute pattern. Eighty three per cent of cases were type I AIH and 5 % of cases were type II HAI. Fifty seven percent of the patients were cirrhotic at presentation. Associated autoimm...
Uploads
Papers by Salem Ajmi