[Surgical treatment of secondary hyperparathyroidism in chronic renal failure. Report of 57 cases]

The aim of this study was to report the experience of the department of general surgery [Aile III] Ibn Rochd Hospital in surgical management of hyperparathyroidism in patients with end-stage renal disease [ESRD]. Fifty seven patients [24 M, 33F] with hyperparathyroidism underwent surgical parathyroidectomy from 1998 to 2004. Surgical indication was established according to clinical or biological assessment. Fifty nine operations were performed [57 first-hand cervicotomies and resumptions in two cases]. Histological examination of parathyroid gland specimens disclosed adenoma in 33 patients and hyperplasia in 14 patients. The follow-up was normal in 52 patients, marqued by cervical hematoma in 2 cases and death was deplored in 4 patients. The post-operative calcium level was in the normal range in 43 cases, low comparatively to the baseline in 12 cases and high in 2 cases. The PTH level was normal in 55 patients and high in two patients. Long-term outcome was evaluated in 36 patients mean follow-up [18 months]. A good evolution was noted in all patients referring to clinical, biological and radiological investigations. That, in our context, surgical parathyroidectomy still an appropriate approach for the treatment of hyperparathyroidism in patients with end-stage renal disease

[Rare causes of low digestive hemorrhage]

The lesions responsible for low digestive hemorrhage [LDH] are located at the lower part of the angle of Treitz. They are of origin colic in 90% of the cases. The lesions of hail are less frequent, with more difficult diagnosis and management. We report 2 observations of rare causes of LDH 47 and 44 years old respectively admitted both because of an anaemia with low digestive hemorrhage related to a stromal jejunal tumor in the first case and on a cavernous hemangioma of hail in the other case. The diagnosis is confirmed by the histologic study of the exeresis product