[Solid-pseudopapillary tumor of the pancreas]

It is a rare tumor characterized by a good prognosis even in metastatic cases. Its etiopathogenesis is still controversial and the anatomopathological progress permits for the best comprehension of these tumors. It's a case revealed by an abdominal pain witch the diagnosis was done by a histological study aided by an immunohistochemistry analysis of the excised tumnor. This pathology represents 0.7 to 2.7% of all cases of the exocrine tumors of the pancreas, with a female predominance and the average age is 22 years old. The clinical picture is not specific and may be discovered by chance. The diagnosis is based on histological study. It shows a tumoral proliferation of a pseudopapillary shape composed of small sized cells adherent to the fibrovascular axes. The differential diagnosis between these tumors and essentially the neuroendocirne tumors is based on the immunohistochemistry analysis. The treatment is essentially surgical with a good prognosis even with metastatic cases. The diagnosis of solid pseudo-papillary tumor of the pancreas bases on histological study aided by an immunohistochemistry analysis. Its good prognosis justifies a surgical radical treatment. The visible increase of its incidence is the likely consequence of a better knowledge of this pathology

[Percutaneous drainagae of the secondary psoas abscess]

We report a series of 15 cases of secondary psoas abscess, showing its diagnostic and therapeutic difficulties aiming at evaluating the interest of precutaneous drainage role in its treatment. It is a monosentric retrospective study lasts for 5 years [January 2003- December 2007]. The study based on the clinical and operative reports, radiological and bacteriological findings. The study includes 15 cases aged 14 to 72 years old, the average was 31,4 years with slight male predominance 9 males to 6 females. Diagnosis has been done by the ultrasound and scanner examinations. 6 cases have [Crohm's disease, 3 retroc ecal apprendicitis, 2 tuberculous spondylitis 2 on top on colon tumors, 1 with diverticulitis and 1 post traumatic case. The most causative germes were gram-negative of digestive origin. In addition to the antibiotic treatment, 8 patients were operated from the start, 3 cases operated after a percutaneous drainage and 4 cases had a percutaneous drainage only which was effective. The secondary psoas abscesses are rare. As the clinical picture is less specific and hides the original pathology, which must be searched for and treated, diagnosis delayed. The most efficient treatment is the combined surgical and antibiotic one. The percutaneous drainage has its role in treating secondary psoas abscesses. At least it defers the surgical treatment to be done in better conditions latter on during the second step

occlusive colo-rectal cancer

It is the most common progressive and revealing complication of colon cancer. This urgent situation becomes grave by combination of both cancer and occlusion. The surgean must deal with the blockage as well as the cancer. This action takes into account several parameters, not only the patient's clinical state but also the site and stage of the tumor. It is concerning 18 patients who had a colonic occlusive cancer, throught a period of 5 years. The parameters include the clinical state of the patient, and site and stage of the tumor. Of 123 colo-rectal cancer patients operated during this period, 18 cases were suffering from occlusion, represting 15%. Average age was 54 years, ranging from 31 to 78 years, divioed to 10 men and 8 women with sex ratio of 1, 2. The location was predommataly in the left colon with 13 cases, 4 cases in the right colon and 1 case in medium rectum. The right colon 1 cases in medium rectum. The right localisations were operated in a one stage operation while the left and rectal cases were carried out in 2 stage: 1 with primary colostomy and 13 with surgical colostomy the morbidity rate was at 19%. Early diagnosis, an adapted resuscitation procedure and a rapide surgical interferance with colostomy, can reduce the morbidity and mortality rate. Tumoral resection witn continous restauration is the most pratical urgent surgical interference. An appropriate care, manily the patient's rehydration and rapide surgical interferance will reduce mortality and morbidity rates. While the treatment or right colon cancer can be done by an one stage surgery, the left occlusive colon cancer as it is more urgent is managed case by case and we recomond a colostomy with or without the first resection

[Hydatic cyst of the pancreas - a case report]

We report a new case of hydatid cyst of the pancreas. The diagnosis has been suspected on the radiological aspect then confirmed by serology. The treatment consisted in a resection of the prominent dome associated to drainage of the residual cavity. The post operative sequences were simple. To the light of this observation and data of the literature, the different clinical aspects, para clinical and therapeutic modalities of this very rare localization of hydatidosis are discussed

[Complications of the hepatectomies]

It is a retrospective study valuing the hepatectomies for all disconcerted indication. The interest is carried on the death rates, of morbidity and the middle length of hospitalization. On 5 years period [2001-2005], 81 patients have been have been included in our study. The indications of the hepatectomies were very disparate: 26 cases of hepatocellular carcinoma, 13 cases of benign tumors, [7 cases of hydatid cysts, 5 cases of gallbladder's carcinoma, 19 cases of hepatic metastases and one case of hepatic abscess. We analyzed the factors of mortality and morbidity. We noted a masculine predominance of 61%. The middle age was 50 years. The achieved interventions were: right or left hepatectomy in 32%des cases, sectorectomy or lobectomy in 39%of the cases and no typical resection in 29%of the cases. The rate of morbidity is of 28,3%, with 8 cases of ascitis, 5 cases of hemorrhages of the section slice, 3 cases of hepatocellular insufficiency, 2 cases of hematoma, 2 cases of parietal infection, one case of biliary wound, a case of hepatic encephalopathy and a case of reversible acute renal insufficiency on tubulo-interstitial necrosis. We deplore in our study a death rate of 3, 7%. The death rate and morbidity are influenced by the extent of the hepatic resection. This rate is in greatimprovement thanks to a better selection of the patients and indications. The use of the vascular clampage became widespread, and the resections parenchymateuses has been standardized, what decreased in a considerable way the complications in per and postoperative

Diabetic neuropathy and peri operative period in general surgery: about 164 cases

The objective of our study is to evaluate the morbidity of diabetic neuropathy, during peri operative time in a general surgery unit. This retrospective study was conducted between January 2002 and December 2004 in the Military Hospital Mohamed V in Rabat. All diabetic patients with a diabetic neuropathy and who had surgery were included [164 upon 516 diabetic patients]; mean age is 54.6 +/- 10.2 years and type 1 diabetes was present in 56% of the cases. The diagnosis of diabetic neuropathy was based on a careful clinical examination. A distal and symmetrical neuropathy was found in 91% of the cases; a proximal and symmetrical neuropathy in 10% and a diabetic foot in 68%. In these patients, neuropathy was associated to hypertension [29%], to renal insufficiency [9%] and to cardiac disease 4%. Diabetic neuropathy was significantly associated to a higher hospitalization duration [p<0.05] and to a higher postoperative incidence of infection