05). Kaplan-Meier estimate showed that OS of PALN(+) and PN (+) was significantly lower than the negative group, respectively (p<0.05). No statistical difference in OS was seen between LN(-) and LN(+) PALN(-); and between LN(+) PALN(-) and PALN(+) (p=0.107). Patients with PN (-) PALN(+) had similar OS compared to PN (+) PALN(-) (p>0.05).
 
  PDAC had a poor outcome despite treatment with radical resection. Further follow-up should be conducted to determine the role of surgery in PALN(+)and PN invasion.
 PDAC had a poor outcome despite treatment with radical resection. Further follow-up should be conducted to determine the role of surgery in PALN(+)and PN invasion.
  and importance Caecal volvulus represents 30% of colonic volvulus. It happens due to torsion or hyperflexion of a hypermobile caecum. Usually it is secondary to an axial rotation of the caecum and the ileum around the mesentery. On the other hand Intestinal malrotation occurs due to incomplete or faulty rotation and fixation of the gut during fetal life. The occurrence of these two anomalies together is scarse which makes this case report interesting.
 
  A 75 year old man with medical history of terminal kidney failure, presented to the emergency room with an intestinal obstruction syndrome. On examination the patient had a distended abdomen with tenderness in the left upper quadrant. Biology found an important biological inflammatory syndrome with hyperleukocytosis and elevated CRP. Plain X-ray of the abdomen in erect posture showed an air fluid colonic level in the left hypochondrium. CT scan showed signs of caecal volvulus with intestinal malrotation. A brief reanimation and nasogastric aspiration couldn'urgical emergency in order to provide an efficient treatement.
 This case reports a rare association of a caecum volvulus with intestinal malrotation that emphasis the place of modern technologies such as CT scan in order to achieve correct preoperative diagnosis. We also describe our approach to this uncommon surgical emergency in order to provide an efficient treatement.
  Evisceration of the small bowel through the vagina is an extremely rare condition and a life-threatening surgical emergency. Complications associated with this condition include bowel ischemia, abdominal sepsis, and deep vein thrombosis. Therefore, prompt surgical consultation and treatment are crucial as delay in treatment can lead to a grim outcome.
 
  We report the case of a 50-year-old female obese patient with a past medical history of uterine surgery. During a cough episode, she experienced sudden transvaginal evisceration that required emergent surgery. Thankfully she fully recovered and is doing well.
 
  Transvaginal evisceration is a life-threatening and extremely rare pathology; it requires urgent diagnosis and surgical intervention since bowel viability can be compromised. During these rare events, interdisciplinary surgical cooperation is vital to obtain the best possible outcome for patients.
 Transvaginal evisceration is a life-threatening and extremely rare pathology; it requires urgent diagnosis and surgical intervention since bowel viability can be compromised. During these rare events, interdisciplinary surgical cooperation is vital to obtain the best possible outcome for patients.
  Lumbar discectomy is one of the most common surgical procedures performed to manage pain caused by the protrusion of an intervertebral disc. Postoperative pain management can be challenging and might lead to increased intake of opioids. 
  The aim of this study was to determine the effect of preoperative sublingual buprenorphine on severity of pain after lumbar disc surgery and postoperative intake of morphine.
 
  This Randomized clinical trial study was performed on 78 patients who were selected for lumbar discectomy surgery. Patients were randomly divided into two groups of 39 patients, each. Patients in the buprenorphine and placebo group received 2mg buprenorphine sublingual, and placebo 1h before surgery. Severity of pain, nausea, vomiting and pruritus and intake of opioids in the two groups were evaluated and recorded 1, 6, 12 and 24h after surgery. Data were analyzed using SPSSv21.
 
  There was a significant difference in pain score in buprenorphine group at 1, 6, 12, and compared with placebo (P<0.005).  https://www.selleckchem.com/products/5-ethynyluridine.html  In the control group, the use of analgesics was more than the buprenorphine group. In the first hours after surgery (1-6h), the incidence of nausea in the buprenorphine group was significantly lower than of the control group (P<0.05). However, at 12 and 24h, this difference was not observed, p>0.05. There was no significant difference in incidence of side effects (nausea, vomiting, pruritus) in the two groups (P>0.05).
 
  Sublingual buprenorphine in postoperative pain management is an effective and low dose drug. Due to its simpler administration, it is recommended to relief postoperative pain after lumbar disc surgery.
 Sublingual buprenorphine in postoperative pain management is an effective and low dose drug. Due to its simpler administration, it is recommended to relief postoperative pain after lumbar disc surgery.
  Spontaneous rupture of the spleen (SPR) is a rare and severe affection, difficult to diagnose, with multiple causes such as Infectious and hematologic affections which represent more than half of the cases. Among this subset of patients, acute myeloid leukemia is one of the causes.
 
  A 48-year-old man undergoing chemotherapy for acute myeloid leukemia presented with acute intense abdominal pain. Computed tomography showed Abdominal CT scan showed a splenic rupture with abundant hemoperitoneum and bilateral pleural effusion. The patient presented hemodynamic instability and was immediately operated, splenectomy were performed.
 
  Spontaneous rupture of the spleen usually presents as a severe abdominal syndrome, which may accompany non-specific symptoms.Two signs are suggestive of splenic rupture Kehr's sign (left diaphragmatic irritation resulting in referred pain to the left shoulder) and Balance's sign (palpable tender mass in the left upper quadrant. Diagnostic methods of choice are computed tomography andultrasound.