[Femoral nerve block for fractured or the femur in children [15 cas]]

The orthopedic treatment of the fractured femoral shaft child is based either on the reduction with plaster immobilization, usually practiced under general anesthesia, or on pulling during 10 days followed of plaster immobilization without any analgesia. The block of the femoral nerve is a simple technic that permits a good quality analgesia after fracture of the femur and can be practiced out operative room. We tried to value the possibility of realization of orthopedic treatment of femoral fractures under block of femoral nerve alone. These are the preliminary it is an open prospective study about 15 children aged from 2 to 9 years, they suffer from fractured femoral shaft. The fracture was insulate, there was no alteration of consciousness and any antalgesis medication has been is realized by an anesthesist doctor or sergeon with admiscture of Xylocaine 1% and marcain 1,5%. The pain, the muscular relaxation and the hemodynamic variation are noticed before during 5,10 and 15 minutes after the achievenement of the block. Finally, we noticed also the quality of recution. The spontaneous pain or this caused by papation of the fractured member disappeared 10 minutes after the achievenement of the femoral block, on average, and the muscular relaxation of the thigh has been obtained 11 minutes later. The pulling of the member with manipulation of the fracture focus permitted to get in all the cases an acceptable, or else anatomic reduction of the fracture. The block of the insulate femoral nerve has been for us an effective method and easy to realize even ambulatory

[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

[Acute post-operative evisceration in visceral emergency unit]

The evisceration is rather a well-known complication to surgeons of the abdomen. 38 post-operating eviscerations were observed at the visceral emergency service C.H.U. Ibn Rochd Casablanca, for the last four years for 2385 laparotomies, with 5 deceases, be it frequency of 1,32% and a mortality of 13,16%. The analysis of these. observations, noting that the emergency conditions played probably a role in the unexpected happening of this complication, since the majority of our operated patients are peritonitis affected [63,2%], so lften mal nutruted, with the antecedents of chronic bronchitis [24,10%] which amputale the possibilities of the pre-operating reanimation. Our death rate, relatively lessened, reflets the interest of the prophylactic and preventive measures taben in respect to this affection. This were able to treat in time [55,26%] of P.O.E. covered before their affirmation in free forms [31,58%], the fixed forms [13,16%] were symptomatic of occlusion on deep seated bride in two patients. Our therapeutic means and our indications are well precise and well codified, however the pronostic of the evisceration remains defited with the post-operating peritonitis and the conditions of collision complicated by renal insufficiency and lung collision; and almost by their combination

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

Management of differentiated thyroid carcinoma. About 43 cases

This study is about 43 differentiated thyroid carcinoma. This form of cancer affects principaly women and young people between 20 and 40 years. Diagnosis is essentially based on the histological findings. Main treatment is surgery associated with hormonotherapy. We have practiced 43 operations: 9 unilateral thyroidectomies, 18 total thyroidectomies on one time, 8 total thyroidectomies on two times, 6 subtotal thyroidectomies, 2 tumors reductions, 6 neck dissections. The protocol that should be followed is the one that will give the best chances of survival with the lowest sequelae. Surveillance should last during all life

Intentional normovolemic hemodilution with autotransfusion. Report of 20 cases

Issuing from this work, it is proved that the intentional normovolemic hemodilution is a technique with numerous adventages and containing no risks. Effectively, blood economy and the possibility to compensate the per-operatory bleeding by means of auto-transfusion, make clear that the application of this technique aught to bring about a changer of the transfusional therapeutics policy, and incite doctors to modify their attitude facing any hemorrage surgery. If the intentional normovolemic hemodilution constitutes a certain place in the field of blood transfusion, there is nothing left except the intentional decrease of the hematocrit and the determining increase in the diminution of the globular loss in the course of the per-operatory haemorrhage