[Epidemiological profile and management of rectal cancer: what changed in 20 years?]

The incidence of rectal cancer is increasing in Western countries. What is it for us, do we have more rectal cancer? The change of our way of life, the aging population could be risk factors. Furthermore the management of rectal cancer has considerably progressed. The purpose of this study is to compare the epidemiological profil and the management of rectal cancer between two series collected to 20 years of interval. It is about two retrospective cases, the first one, collected from 1981 to 1985 [série A], includes 80 patients. The second one, recent, collected from 2005 to 2011 [série R], includes 94 patients. We analyzed for the epidemiological profile, the middle number of case per year, age, sex, seat of the tumor, histological type, metastatique stage. We analyzed for the management: operability rate, resection rate, type of intervention. The middle number of cancer of the rectum hospitalized per year in our formation is respectively 16 +/- 4.06 and 18 +/- 4.14 in serie A and the serie R [p = 0.91]. The mean age of patients was 49.5 +/- 14.7 for serie A and 48.6 +/- 13.3 for serie R [p = 0.674]. There is a masculine predominance in the two series [p = 0.7]. The three segments of the rectum are reached in the same proportions in the two series [p = 0.8]. The low rectum represented half of the cases [54.5% serie A, 56.9% série R]. The metastatique stage is more frequent in série R [32 [22.7%] vs 18 [34%] [p = 0.14]. Resection rate represents respectively in série A and série R, 68.9% and 84% [p = 0.428]. Abdomino-perineal amputation has been achieved in 45% of the cases in serie A and 30.3% of the cases serie R [p = 0.003]. The study found that the incidence of rectal cancer has not increased in our training in the space of 20 years, however, in two series, 25% of patients are aged less than 25. The management of this cancer was marked by systematic preoperative radiotherapy in the serie R for low rectal cancers, by reducing the safety margin to 2 cm and by reducing the number of abdominoperineal resection. Eidemiological profile did not change. However, the management of rectal cancer been influenced by the new data of the rectal surgery. This study showed that rectal cancer in Morocco had different characteristics than that in West country. Environmental and genetic studies may explain this difference

[Gastric metastasis of choroidal melanoma]

Gastric metastasis of melanoma are rare, and usually secondary to a cutaneous location. Gastric metastasis of choroidal melanoma are exceptional. Clinical symptoms are absent or atypical causing delay diagnosis. Only earlier diagnosis and complete surgical removal can improve survival of metastatic melanoma. 60 years old patient, treated for choroidal melanoma in 2007, admitted to the emergency for hematemesis. The patient also reported epigastric pain for three months and a weight loss of 10 kg. Upper gastrointestinal endoscopy revealed multiple ulcers with bleeding. Histology revealed a metastasis of melanoma. CT showed no other secondary locations. A total gastrectomy was contemplated. However a fatal gastrointestinal bleeding leads to death of the patient. Clinical symptoms of these metastases are atypical, and complications are rarely revealing. In oesgastroduodénale endoscopy, the presence of one or more nodules sometimes topped by ulcer can suggest the diagnosis. The himmunohistochimie confirm the diagnosis and mainly to amelanotic lesions. Staging must search for other secondary sites: lung, liver, peritoneal. Treatment is surgical and should be considered if complete resection is possible or in case of complications. Survival of gastric metastases of melanoma related to the completeness of resection The occurrence of digestive disorders in patients treated for melanoma must invite practicians to propose a gastrointestinal endoscopy with multiple biopsies to make an early diagnosis of gastric metastasis because only a surgical resection will allow a chance for these patients

[Bladder inguinoscrotal hernia]

The incarceration of the bladder in the ininguinal hernia is rare. Often asymptomatic, the diagnosis is made during surgery or postoperatively due to complications. We report the case of a patient with a right inguino-scrotal hernia associated with urinary symptoms and whose retrograde urethrocystography [UCR] showed an bladder totally intra scrotal. Incarceration of the bladder in the hernial sac is found only in 1-4% of inguinal hernias, the total extra abdominal bladder migration is even more exceptional. The association of inguinal hernia and urinary irritative and obstructive signs should suggest the diagnosis, however it is most often done during surgery. Confirming diagnosis is provided by the opacification of the lower urinary tract [cystourethrography or retrograde intravenous urography] or by CT. The treatment includes the cure of the hernia with bladder reintegration. Resection of the herniated bladder portion is needed only in case of large hernia or narrow neck. The preoperative diagnosis avoids postoperative complications

[Landau-kleffner syndrome]

Landau-Kleffner syndrome is a rare disorder caraterised by acquired aphasia of children, paroxysmal electroencephalographic disturbance and in 75% of cases epileptic seizures and cognitives disturbances. We report a 6 year old daughter who presented epileptic seizures and six months later regression langage and a behaviour of deaf. This patient had a global aphasia. The understanding was affected because of the cortical deafness. The electroencephalogramme showed discharges in the temporal bilateral regions. The cerebral scan and the potential evoked auditory were normal. The Landau-Kleffner syndrome's diagnosis was confirmed. The patient was treated by valproic acid and corticosteroids with good evolution. The stoopage of treatment has brought more seizure and the worsening aphasia. The authors discussed the pathogenic hypothesis, the semiology and the treatment of the Landau-Kleffner syndrome

[Gastric epidermoid carcinoma]

The gastric localization of the epidermoid tumors is rare. Only 90 cases have been published since 30 years. The observation returned here is, according to us, the second of the french literature. The objective of our work is to raise the etiopathogenic particularities and diagnostic of this pathological entity. It is about a lady of 60 years, without pathological history, admitted for stimulating epigastric pain to 6 months, without hemorrhages. The physical exam was without particularity. The fibroscopic exam of oeso-gastric tractus had objectified a tumor of the stomach. The histological exam of the biopsies revealed a epidermoid carcinoma. The scanning had not shown locoregional extension. The surgical exploration found a tumor of the stomach without invasion of the neighborhood structures. A subtotal gastrectomy was achieved. The histological exam of the operative piece confirned the diagnosis of epidermoid carcinoma well differentiated. The follow up was simple

[Post hemorroidal anal stenosis]

Anal stenosis represents a rare post hemorroidectomy complication which is difficult to manage. We report a series of eight cases, five male and three female, aged 29 to 67 years old, through a period of 12 years, in whom anal stenosis occurred 2 to 16 months after hemorroidectomy, which was of pedicular type in 5 cases, circular in one case and of a non precise type in 2 cases. We performed three sphincterotomy with anoplasty, two dilatations associated with lateral sphincterotomy, one Bellan's anoplasty and an Y-V flap's anoplasty. All our patients regained their proper anal diameter, with amelioration of the discriminatory sensibility, the medium recurrence time was three years and half [maximum 9 month and 7 years]. The anoplasties provide good results. The best treatment is prophylaxis done by choosing the safety technic and respecting the rules of hemorroidectomy

La technique de shouldice dans le traitement des hernies inguinalesa propos de 130 cas

The authors report a study of 130 patients, 114 men and 16 women operated on for inguinal hernias according to shouldice procedure over the period 1991-1993. The age of patients ranges from 17 to 82 years with mean age of 43 years. Indirect hernias were the most frequent with 84,6%. Surgery was conducted under locoregional anesthesia [96,2%]. No resorbable thread was the most used material. The follow up was marked by two parietal sepsis, two cases of scrotal oedema and four parietal hematomas. No death was registered. Hospital stay has varied between 3 and 12 days with an average of 4,5 days. Our patients were seen regularily during a period ranging from 6 months to 3 years. Two relapses were noted before the end of the first post operative year

[ gastric stump cancer]

Among a series of 266 cases of gastric cancer operated on between 1981 and 1991, 8 cases were developed on gastric stump after gastro-duodenal surgery. A post operative delay of 10 years has been insisted upon. We noticed an exclusive masculine serie. The main age was 61 years. Clinical aspects were univoque and treatment was always surgical with a resecability rate of 37%. Pathological analysis of operatory specimen and biopsies has shown everywhere an adenocarcinoma. The only way to improve prognosis is based on early histoendoscopic supervision since the tenth year after initial intervention of these operated patients of the stomach with high neoplasic risk

Postoperative subphrenic abcess. A study of 20 cases

20 post operative subphrenic abcess are repported, 11 secondary to hepatic hydatic cyst procedures [55%], 7 secondary to biliary surgery, one after splenectomy and one after digestive fistula after gastrectomy. The value of clinical signs, radiology and echotomography is emphasized. The mortality rate [10%] is the consequence of a septic state. The prevention should include a better surgical technique and an efficient drainage after various abdominal interventions

Les formes neuro-psychiatriques des meningoencephalites tuberculeuses

The study of 47 patients with neuropsychiatric form of tuberculous meningitis effectuated in the service of neurology that: - The age of the onset is between 15 and 40 years in 80% of the cases. - The diagnosis is often late because the psychiatric forms are very unknown, and so, mortality stays very important [36%]. - The study of cerebrospinal fluid can be normal in the encephalitic forms and the Koch's bacillus is rarely found [only in 50% of the cases]. - We have found: * 11 meningitis forms * 8 neurologic forms. and 28 forms where the main manifestations were psychiatric. - The electroencephalographic study appears very important in these forms and we have found EEG abnormalities in 100% of the cases. - The prognosis of these meningoencephalitis is severe and it is necessary to begin the treatment in the doubtful forms, while the etiologic research is begun

[Arterial complication of thoracic outlet syndrom. report of a case]

The authors report a case of cervical rib with post stenotic sub clavian aneurism and acute ischemia of right upper limb with digital necrosis. Etiologic, anatomic, physiologic, clinic, radiologic, and therapeutic aspect of thoracic outlet syndrome are reviewed