prescription evaluation of the preoperative investigations within the University Hospital lbn Rochd of Casablanca

Several publications challenge the usefulness about the prescription, known as routine, of the preoperative paraclinic examinations, and insist on the necessity to abandon this practice with a view to a selective proposal according the recommendations of acceptal protocoles. To rate the current state about the prescription of the preoperative investigations within the universitary hospital center lbn Rochd, we report a prospective study about 1000 cases operated on within the central unit in UHC lbn Rochd during four months. The mean age of collected patients is 43.3 +/- 20.5 years old with slight male predominance, 86.4% of the ASA I and 10.9% are classified ASA II. The preanesthesic consultation has been realised first in 56% of the cases, the preoperative visit concernced 81.5% of the cases. We conclude from this study that, in spite of the establishment of prenasthesic concultation and the preoperative visit, excessive prescription of preoperative paraclinic investigation is still used, this excess is due to several hindrances analysed with details in our study that must be defined in order to escape the superfluous investigations and to adapt the latters to "case by case" according the allowed recommendations

Serious acute pancreatitis made complicate by hepatic necrosis and extended digestive peforation

Severe acute pancreatitis [SAP] is a serious frequent pathology in the Intensive Care Unit. The authors report a case of SAP complicated by extended digestive perforations with hepatic necrosis in a 24 year-old patient. The clinic and paraclinic data concluded to a baltazar stage E severe acute pancreatitis. A first intervention was decided on the 14th day of admittance to hospital due to the absence of clinic improvement despite the ressucitation. On the fifth day after surgery, the clinic condition is made serious on the infections level with hemodynamic instability. The surgical reintervention showed a brownish liquid with extended necrosis to all over the abdomen and mainly the sus mesocolic level. The surgery team opted for a therapeutic withrawal. Through this observation, the authors insist on the rarety of the mechanic complications of the severe acute pancreatitis whose diagnosis remains difficult and often late. When they exist, the evolution is often lethal

[Evaluation of the systematic per-operative complete physical examination]

The authors report on a retrospective study about 1000 cases of patients hospitalized in a department of adult visceral surgery in order to evaluate the importance of the systematic preoperative complete physical examination and laboratory testing. The blood grouping has been realized for all the patients where as only 37 patients have been transfused. The rate of prothrombine [TP] is abnormal in 2 cases [0,2%]. The creatinine and the blood urea have been abnormal, respectively in 9,25% and 8,9% of the cases, but without any influence on the decision of the intervention. The fasting blood glucose showed 0,2% of asymptomatic diabetus. The thoracic radiography has been abnormal in 17,3% of the cases, but it has differed the intervention only in 0,7% of the cases. The electrocardiogram influenced the decision to operate only in 1,16% of the cases. We conclude from this study that we must abandon the pre-operative systematic complete physical examination. The interogatory and the clinic examination realized during a per-anesthesic consultation permit a judicious joice of complementary examinations

Illegal abortion: from gravity of complications to judicial consideration

We live at a time in wich abortion is legalized in a great number of western countries. In our country, the laws forbid abortion have not prevented its clandestine practice leading not only to medical problems but to social and ethical ones too. We present here the histories of 4 patients each of whom have presented grave complications of clandestine abortion [3 deaths and one with favorable evolution after a stay of 62 days in intensive care unit]; at the light of this, we have tried to analyse incriminated factors and remind the evolution Morrocan legislation in that field

Brachial plexus block and upper limb regional anesthesia

The authors report their experience about 50 cases of supra clavicular plexus block realised by Kulen-Kampff method. The anesthesia obtained has been complete in 84% of cases and in the 16% remaining general anaesthesia was necessery to permit surgery. A case of moderate pleural detachment lately and a case of post anaesthesia paresthesia both spontaneously resolvent were registered. Actualy the adoption of perivascular techniques of brachial plexus anaesthesia [interscalenic, supraclavicular, axillary] have greatly improved the performance of this variety of upper limb locoregional anaesthesia, thus reducing the percentage of failure and eliminating or reducing the risk of pneumo-thorax. Locoregional anaesthesia of the upper limb should constitute a daily method in the surgery of upper limb and not a technic subordinated to the contra-indications of general anaesthesia