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Introduction en chirurgie du cancer colique, la fistule anastomotique (FA) est la complication la plus redoutée. Le but de cette étude était de déterminer les facteurs prédictifs de fistule anastomotique après résection pour cancer colique ainsi de décrire l´impact de cette complication sur la mortalité et la durée du séjour postopératoire. Méthodes nous avons mené une étude retrospective, descriptive et analytique, allant du 1 er janvier 2013 au 31 d écembre 2020, dans le service de chirurgie générale de l´Hôpital Habib Bourguiba de Sfax, Tunisie. Résultats nous avons colligé 163 malades opérés pour cancer colique. L´âge moyen était de 62,7 ans avec un sexe ratio de 1,36. Les suites opératoires étaient simples dans 64,4% des cas et compliquées dans 35,6%. La morbidité chirurgicale était essentiellement représentée par les fistules anastomotiques, identifiées chez 22 malades. Au terme de notre travail, il ressort que les facteurs prédictifs de la survenue de cette complication sont: le diabète avec un p = 0,04, le tabagisme avec un p = 0,01, l´hypoalbuminémie avec un p = 0,01, l´hémoglobine préopératoire inférieure à 10g/dl avec un p < 0,01, la localisation au niveau de l´angle colique gauche avec un p = 0,02, la transfusion peropératoire avec un p <0,01 et une durée opératoire supérieure à 180 min avec un p = 0,04. Par ailleurs, la survenue de FA était accompagnée d´un taux de mortalité spécifique de 9% et avait prolongé de façon significative la durée de séjour postopératoire. Conclusion la prévention de la FA doit s´inscrire dans le cadre d´une prise en charge multimodale du patient avec essentiellement un apport nutritionnel et une correction d´une éventuelle anémie en préopératoire.

IntroductionThe postpartum depressions (PPD), rank first postpartum complications and therefore pose a public health problem by their frequencies and their adverse consequences.ObjectivesTo detect the depression among a Tunisian parturient, to evaluate their perceived stress and to study the link between these entitiesMethodsA cross-sectional, analytical study of 40 first week postpartum women hospitalized in the gynecology department in Hedi Cheker hospital in Sfax-Tunisia, during the month of September 2019. We used the Arab version of Edinburgh Postnatal Depression Scale (EPDS) and the Cohen perceived stress scale (PSS).Results The average age of the participants was 31.07 years old. The Parturient have a rural origin in 62.5% of cases, they have a secondary school level in 52.5% of cases. There were exaggerated sympathetic signs in 52.5% of the cases. An organic pathologies were present during pregnancy in 47.5%. The postpartum period was simple in 77.5% of cases. For the post-natal period, 90% of parturient were going to receive help of a family member. EPDS: the average score was5.35 and the risk of developing a PPD was 20%. PSS we found that life represents a perpetual threat in 27% of cases. The factors correlated with the PPD were: a high level of perceived stress (p < 0.00) and organic pathology during pregnancy (p=0.02).Conclusions Our study shows that the risk of postpartum depression is high among Tunisian parturient and it is associated with high level of stress, because of this a precocious screening is necessary.DisclosureNo significant relationships.

Collision tumor is a rare entity composed of two different tumors that occur in close to one another and maintain distinct borders. Only few cases have been reported in the breast. We report the first case of concomitant and adjacent primary angiosarcoma (PBAS) and invasive carcinoma of the breast (IBC), in a 45-year-old patient which presented with a lump in her right breast. Biopsy revealed PBAS. She underwent mastectomy. Gross examination showed a hemorrhagic and spongy tumor in contact with a second small grayish-white mass. Histologically, the hemorrhagic tumor was consistent with a high grade (HG) PBAS; the second mass was consistent with an IBC with no images of histological admixture. The diagnosis of a collision tumor composed of HG PBAS and IBC was established. During follow-up, the patient developed ovarian angiosarcomatous metastasis. The diagnosis of breast collision tumor is very uncommon and hence is challenging for pathologist. Careful gross and microscopic examinations help in establishing the appropriate diagnosis.

Objective:Polycystic ovary syndrome (PCOS) causes many problems ranging from reproductive to cardiovascular pathology. High sensitive C-reactive protein (CRP-hs) has been proved to be one of the strongest predictors of cardiovascular risk events.Objective:to assess cardiovascular risk (CVR) in women with PCOS based on CRP-hs values.Design and method:women diagnosed with PCOS and age-matched controls were recruited in one year period. PCOS was diagnosed according to the Rotterdam 2003 criteria. Hormonal assessment was performed by electrochemiluminescence and CRP-hs by turbidimetry on cobas-Roche.CVR was defined as “low” when CRP-hs <1 mg/L, “intermediate” when CRPhs 1–3 mg/L, “high” when CRPhs 3–8.5 mg/L, and “unspecific elevation” CRP-hs > 8.5 mg/L.Results:A total of 96 PCOS patients and 108 controls were enrolled. The mean age of patients was 25.67 ± 5.12 years and 28.89 ± 6.57 years for controls. CRP-hs was higher in PCOS compared with controls. In PCOS, 44% were at a low CVR, 31% at an intermediate CVR, and 25% at a high CVR. However, in controls, 58% of had low CVR, 26% intermediate CVR, and 16% high CVR.Conclusions:Cardiovascular risk seems to be higher in PCOS patients compared to controls. We suggest an early detection based on CRP-hs levels. Specific guidelines would be established for management of CVR in this young population.