Management of bone painful metastases

Bone is the thirdmost common site of metastatic cancer after lung and liver. It becomes painful in 70% and may significantly impair the cancer patient's quality of life. The pathophysiology of pain due to bone metastasis in now better understood. The character of painful bone includes both inflammatory and neuropathic features.Different and many therapeutic options are available. It is important to know the different options of treatment in order to select the appropriate treatment for the individual patient. However multimodal approach is often necessary and includes medical treatment [analgesics, bisphosphonates anddenosumab] and non-medicalsuch us radiotherapy and cementoplasty Analgesics include three levels of WHO and will be indicated depending on the pain intensity. Bisphosphonates and denosumab decrease bone resorption by acting on osteoclasts and have demonstrated analgesic effect particularly in prostate cancer with bone metastases. Radiotherapy provides an analgesic effect resulting from the radiotoxic effect directly on tumor cells and inflammatory reaction of the boneenvironment. While external beam radiotherapy is the treatment of choice to treat pain from localized bone metastases, Radiopharmaceuticals by their systemic action is better suited in case of extensive metastases. Cementoplasty consist in injecting cement into the injured vertebral body injured but its analgesic role remains unproven. Anti-cancer therapy should be reviewed when the tumor is responsive. The therapeutic approach should be individualized for each patient and requires an understanding of the mechanisms of cancer pain. At present, there is no algorithm of choice between the different therapeutic modalities. The treatment must be discussed within a multidisciplinary working team with specialists of cancer, a nuclear physician, an intensivist, a surgeon and a palliative care physician

[Longo's technique in the treatment of hemorrhoids grade III and IV]

The purpose of this study is to show the interest of the Longo technique in the treatment of hemorrhoidal prolapse stage III and IV as to report as results too. Twenty-one patients were operated by the Longo technique. Hemorrhoids were classified as stage III and IV respectively in 13 and 8 patients. They have been followed in consultation at two months, six months and one year, allowing data collection. The mean duration of intervention was 38 minutes. The mean duration hospital stay was 2.2 days. There were no incidents during surgery. The mortality rate was zero. The complication rate is estimated at short, medium and long term, it was 23.80% [n=5]: two hemorrhages [9.52%] at the staple line, two acute urinary retention [9.52%] and external hemorrhoidal thrombosis [4.76%]. All patients didn't need any local treatment. The postoperative follow-up detected a bleeding at defecation in one patient; another one had a recurrence of the prolapse associated with rectal bleeding, the third had a completely asymptomatic moderate stenosis stapling site easily dilatable. Eighteen patients [85.71%] had no symptoms and were completely satisfied, two patients were moderately satisfied, and one was dissatisfied. The circular anopexy is an effective technique with 85.71% of patients satisfied in one year. The complication rate is low and the quality of results depends on the technical gesture

[Preoperative portal vein embolization]

The liver failure is a severe complication of major hepatectmies. Preoperative portal vein embolization allows a prior interruption of the portal flow in the liver territories that are to be resected, inducing their atrophy and the compensatory hypertrophy of the futur liver that persists after this removal. It is interesting to discuss the feasibility of this technique in our contexte starling from accessibles means for obtaining satisfactory results. Patient aged 55 years old, who presented for two months a cholestatic jaundice cutaneous mucosal. The Magnetic Resonnance Imaging abdominal showed an appearance very evocative of a cholangiocarcinoma of the biliary confluence reaching the right hepatic duct type IIIA of bisthmuth and cornette. Three weeks after portal vein embolization, an hypertrophy of the futur remaining liver is obtained. Finally, we perfomed a right hepatectomy extended to segments IV anterior and I. The postoperative course was uneventful. The major hepatectomy carries the risk of postoperative liver failure. Portal vein embolization of the liver to resect aims to redistribute the portal flow to induce a hypertrophy of the futur liver remnant. Portal obstruction can be used by an embolization with biological glue, acrylic adhesives, alcohol, or by a ligation. It can be done by ultrasound guided percutaneous transhepatic or by catheterization of an ileocolic vein. However, given the specific equipment required for the percutaneous and human skills still not widespread, it is best in our context the ileal way that is accessible to all surgeons and also effective. Major liver surgery is developing in our country, thus preoperative portal vein embolization can now make extensive liver resections with less risk and complications

[Retrorectal tumors in adults about 3 cases]

Retrorectal tumors [RRT] constitute a topographic entity grouping benign andmalignant tumors that are congenital for the majority, and developing in presacral retrorectal space. The multiplicity of the embryologic theories, the difficulty of their histological classification, as well as the diagnostic and therapeutic delays, will be illustrated by three new cases in the visceral surgery service of the Military Hospital of Instruction Mohammed V of Rabat. Their topographic diagnosis and extension rests on the abdomino-pelvic tomodensitometry and the imagery by magnetic resonance in order to determine the nature and especially the reports of the tumor. Their treatment rests on the surgical excision systematically. The forecast of these tumors depends of their histological nature and the quality of the surgical excision

[Primary linit plastica of the rectum in child]

The plastic linit is defined-as the infiltration of the wall of a hollow body by a diffuse anaplastic cancer . Its most frequent seat is gastric. The rectal primitive linit is very exceptional. All diagnosis, therapeutics and prognosis aspects this affection were discuss. A 12 year ad girl is hospitalized for primitive rectal linit. She was treated by abdominoperineale amputation after radiochemotherapy. The patient have received adjunct chematherapy. The out come was simple without recurrence after 4 months. The plastic linit of the rectum is a little differentiated shape of adenocarcinoma. The diagnosis is provided on a major biopsy and the absence of gastric attack. The farecast is very bad in spite of intencive treatment, associating surgery, radiotherapiy and chemotherapy

inflammatory pseudotumors of the colon

The inflammatory pseudotumors of the colon are very rare benign lesions, of unknown etiology and whose differential diagnosis is difficult with the adenocarcinoma. Young girl patient of 12 years old, presented with mass in the right iliac fossa, the preoperative assement was in favour of right colon malignancy with retro peritoneal extension. Right colectomy was done, histological examination confirmed the diagnosis of inflammatory pseudotumors of the colon. The inflammatory pseudotumors of the colon are benign tumor they can be the origin of local and general signs colonic localization is exceptional and etiology remains unknown. Surgery is necessary to obtain an histological diagnosis of the lesion and to eliminate malignant tumor

[Gastric stomal tumor revelated by post traumatic rupture]

The rupture of stromal gastric tumour is an exceptional cause of hemoperitoneum. We report a case of ruptured stromal gastric tumor in the peritoneal cavity after a contusion of the left hypochondrial region in a 58 years old male patient operated in emergency for an acute anemia thought to be caused by a pathological rupture of the spleen. The emergency laparotomy revealed an exo-gastric tumor located in a fundus intimately linked with the spleen. Therefore, we realized a partial gastrectomy and the patient was treated by chemotherapy with Glivec [R] [imatinib]. The evolution was favorable for two years without recurrence. The traumatic rupture of a stromal gastric tumour is an exceptional event. The diagnosis is rarely evocated before intervention. It constitutes an predicative sign of malignancy. The circumstances of finding a stromal gastric tumour are not specific. However, their rupture indicates an urgent laparotomy in order to perform a hemostatic gastrectomy

Cancer colon and pregnancy

We are reporting a case of colonic adenocarcinoma in a 18 weeks pregnant woman aged 42 years. We realised a left segmental colectomy completed by an adjuvant chemotherapy after a normal delivery. For months later, bilateral ovarian metastases were diagnosed. Therfore, hysterectomy and a bilateral ablation of annexes with an omentectomy was done. The ovulation was good without recurrence for four months later. Discussion: The advised therapeutical attitde is to stop pregnancy before intervention during the first trimester, in the scond trimester surgical treatment is indicated regardless pregnancy, in the third trimester, it is necessary to wait until full pulmonary maturity of the foetus is reached, then intervene by a caesarian section and a curative surgical treatment at the same time. The diagnosis of cancer colon associated with pregnancy is difficult and needs a strong multidisciplinary collaboration. The prognosis of cancer colon is aggravated in pregnant women. It can not be improved except with an early diagnosis