[ video-thoracic surgery: indications and limits]

The thoracic video-surgery [TVS] represents an interesting therapeutic alternative at the hour of the thoracic surgery mini-invasive or video-attended. This survey intends to make a retrospective meta-analysis of the first 55 cases of TVS: 14 cases of pneumothorax, 17 cases of hydatic-cyst of the lung, 12 cases of mediastinal lymph node biopsies, 5 cases of pulmonary biopsies, 4 cases of recurrent pleurisies and 3 other cases of diaphragm rupture. For all these patients, the VTS permitted us to reduce the diagnostic stage, the rate of spoil thoracotomy and especially to replace advantageously and efficiently the conventional surgery by a complete therapeutic mini-invasive act. For a lot of authors, indications of the TVS are more and more precise, with pain profits, functional ad aesthetic obvious. It is also a reliable and sure diagnostic and therapeutic means

[ thoraco-Abdominal injury: about 78 cases]

The authors report a series of 78 cases of the thoraco-abdominal wounds collected between 1992 and 2002.The mean age of the patients is 27 years old [16- 60 years old] with male predominance [90%].The aggressions with a blade [stab] are the exclusive etiology [100%]. The left hemi thorax represents the Site of penetration in 80% of cases. The clinical symptoms at the admission were dominated by the respiratory detress. The chest radiography that has been achieved systematically. In all our patient, showed a hemothorax [39 cases] hemopneumothorax [20 cases], the radiography was normal in 27 cases. The abdominal ultrasound was done in 36 cases when the thoraco-abdominal injury was suspect, however the clinical examination and radiography were normal. It's showed a double peritoneal and pleural effusion in 36% of the cases. About the therapeutics, the treatment has been always surgical, so, the laparotomy has been necessary in 66 patients, the thoracotomy in 2 cases, the thoraco-laparoscopy in 4 cases, and the thoracoscopy in 2 cases. No death was noticed in this series The immediate following have been simple in the majority of the cases, in 6 patients, pleuro-pulmonary complications have been occurred. The thoraco-abdominal injuries have sometimes a problem of diagnostic, specially if only the diaphragm was injured. We believe that the thoracoscopy is the best exam to confirm the diaphragm injuries. The thoraco-laparoscopy can be the best surgical approach

surgical treatment of the dilatations of the bronchi [about 48 cases]

In spite of the progress of the medical treatment of the bronchiectasies or dilations of the bronchi, a certain number of patients can benefit from a surgical treatment. The aim of our work is to value the results of the surgical treatment and to specify the moment of the surgical intervention. Our work is about 48 cases of bronchectasies operated in the service of the emergencies visceral Ibn Rochd of Casablanca between January 1994 and February 2001. It was about 30 women for 18 men, the middle age of our patients was 27 years. It was a sequelae of respiratory infections of the childhood in 22.9%, of tuberculosis in 35.42% of the cases, and 10.41% of the patients had presented a pulmonary abscess. The dilations of the bronchi were apparently primitive in 31.45% of the cases. The sits of the bronchiectasies has been specified the most often by a thoracic computed tomography in 80%, in 20% of the cases the lesion was bilateral. The type of intervention practiced was 33 cases of lobectomies, 6 cases of bilobectomies and 9 case of trisegmentectomies. The operative continuations were simple in the majority of the cases, except in 9 cases: 4 cases of pyopneumothorax, 2 case of emphysema under cutaneous and 3 case of parietal suppuration. The long-term follow-up interested 34 patients, 30 became asymptomatic, 1 patient presented a parietal pain, an obstinate cough has been noted in one patient and two patients presented occasional respiratory infections

Inflammatory pseudo-tumour of the liver in child: a case report

The inflammatory pseudo-tumour is a very rare benign tumour in the child. Its hepatic localization leads to diagnosis difficulties particularly with malignant tumours. We report the case of a 17 month-old boy who had an enormous abdominal mass which was 18 cm diameter. The hepatic origin has been visualized by echography and magnetic resonance imaging. The diagnosis of liver inflammatory pseudo-tumour has been realized after surgical biopsy. The treatment consisted in total resection of the tumour, taking the liver left lobe, with good clinical evolution and good recession of 34 months. The diagnosis of the liver inflammatory pseudo-tumour is histologic. It may be based on the needle biopsy of the tumour assisted by the imaging, which allows to have a conservative attitude for these benign tumours

Surgical resection of klmatskin tumor. About 6 cases

Hilar bile duct carcinomas or klatskin's tumors are rare that represent 1.5% of the digestive cancers and their prognosis is poor with a survival until 5 years less than 3%. From 1996 to 2001, 6 patients had beneficied from a surgical resection because of a tumor of the hepatic helium. It is about 2 men and 4 women aged from 34 to 51 year-old. Three patients had suffered from biliary lithiasis and all the patients presented a retential jaundice. Surgical procedure had consisted in a resection of the extrahepatic bile ducts [6 cases], pedicular ganglial curettage [6 cases] associated to a left hepatectomy in one case. The recovery of the continuity has been based in the patients on anastomosis between a well made bile mouth and a jejunal ansa in Y shape of 70 cm. The anatomopathologic study confirmed the diagnosis of a tubulosecreting adenocarcinoma in all patients. The operative mortality has been nil and the morbidity consisted in anastomatic fistula [1 case], pleuropulmonary infection [1 case], one patient died 9 months after a tumoral relapse. The radical surgical resection is the only therapeutic that permits to hope a prolonged survival and sometimes recovery

[Liver abcesses: clinicals aspects and actual treatment]

A serie of 32 liver abcesses during a trial of 7 years is reported by the authors. The male sex is predominant [90%] The symptoms of the illness are typicaly those of the classic liver abcess. The treatment has improved with the progress of the imagery and especially the echography. The punction under echography had been tried in 7 cases, of which 6 were cured. When the seize of the liver abcess is small the medical treatment permits recovery in 68% of the cases. Only new cases that do not answer to medical treatment and punction are candidate to surgery

Hepatitis B vaccination. Evaluation of efficacy in a high risk hospital personnel population

B. Viral hepatitis endemo-epidemiological potencial in hospital practice remains a preoccupyng problem. The study of serological status in an order of an active protection has been realised in a group of 100 of the medical staff in university hospital of Casablanca. 49 of the subjects had at least one of the markers of B. hepatitis among them one is chronical carrier of H.B.S. antigen. 51 seronegative and volonteers subjects [51%] have received 3 injections of the vaccine Hevac B [R] of Pasteur Institute, at one month interval. The evolution controls of Anti H.B.S. antibodies have been realised a month later after each injection. At the end of this vaccination 86.2% of the subjects have acquired a protection with rates of anti H.B.S. superior to the minimal protective rate. 5 bad responders have received a forth injection of the vaccine. The control of the antibodies H.B.S. was realised one year after, in 30 subjects [58.8%], 29 have kept Anti H.B.S. antibodies, among them 25 at protective rates

Treatment of urinary tract infection with a daily and unique dose of gentamycin

Twenty nine patients with Gram negative urinary tract infection have received gentamicin in a single daily dose of 2,5 mg per kilogram of body weight for 10 days. Follow up is based on bacteriologic and biologic data and on dosage of gentamicin. The mean values of gentamicin levels obtained in blood and urine are efficient and non toxic. In 14% of cases, failure of treatment is due to a local cause of urinary tract infection. A single daily dose of gentamicin is efficient and non toxic if adapted to the patient's weight