[Myofibroblastic tumor of the great omuntum]

Myofibroblastic tumors are a spindle cell lesion at indeterminate malignant potential. Abdominal location was rare. We report a case of an unusual location at myofibroblstic tumors in the great omuntum. A 63-year-old women presented with a one year of isolated left hypochondrium pain. Physical examination was normal. CT scan of the abdomen showed a multicystic and a multilocular building-up of the great omentum suggestive of a peritoneal haemolymphangioma. Besides, at the MRI, this lesion showed up with threefold component: cystic, plump and fibrous, all leading towards a myofibroblastic tumor. At laparotomy, there was already a 10 cm diameter cystic tumor of the great omentum, composed of numerous cystic sockets, all filled with a thick brunish substance. A total resection of the great omentum was done, thus taking away the whole tumor. The histological examination confirms the diagnosis of myofibroblastic tumor of great omentum. Post operative evolution was uneventful. One year later there were no signs of recurrence. Myofibroblastic tumors of the great omentum are rare. The diagnosis is often confirmed by careful microscopic examination or immunohistochemical markers. Treatment consists on a complete surgical resection and life time follow-up is needed because the risk of recurrence

[Squamous cell carcinoma arising in Verneuil's disease]

Verneuil's disease or hidradenitis suppurativa is a chronic suppurative, and cicatricial inflammatory disease, mainly affecting apocrine-bearing area of the skin. Squamous cell carcinoma is an uncommon but a frightening complication of hidradenitis suppurativa. To report a new case of squamous cell carcinoma arising in Verneuil's disease. We reported a case of 60 year old man with a 30 years history of hidradenitis suppurativa in which squamous cell carcinoma arise. A wide surgical excision removing the tumour and leaving a large defect was performed. The patient had a well recovery, wounds healed well by primary intention. No recurrence observed at 18 months of follow up. Squamous cell carcinoma is an uncommon complication of hidradenitis suppurativa. Surgical excision represents also the treatment of choice

[Idiopathic renal vein thrombosis. About two cases]

Renal vein thrombosis is a rare pathology diffcult to diagnose. It has quite various clinical expression and biological consequences. The diagnosis is based upon radiologic explorations. This entity may have various causes. Detecting this condition may lead to restoration of renal function compromised by renal vein thrombosis. The treatment of renal vein thrombosis is mainly medical and based on anticoagulants. The role of fibrinolytic treatment is controversial. Surgical is exceptional. We report two cases of idiopathic thrombosis of the renal vein in adult patient. Also, we have done a review of the literature on this clinical syndrome and its diagnostic and therapeutic aspects

Surgical and anesthetic considerations for patients undergoing minimally invasive coronary artery bypass surgery mini- sternotomy and mini -thoracotomy approaches

Minimally invasive surgical techniques for coronary bypass grafting [CABG] have not been advanced until recently. Successful grafting of the internal mammary artery [IMA] to the coronary arteries has been a surgical practice since 1987[1]. To retain the benefits of IMA grafting and to offset the invasiveness of the conventional CABG , Robison et al. have recently described a minimally invasive approach to CABG using a mini-anterior mediasternotomy approach [2]. Arom et a1. have also described a partial sernotomy approach ,Whereas Subramanian et al. have described a minimally invasive access using a mini lateral thoracotomy [3]. All these approaches can be performed under direct vision. MIDCAB [minimally invasive direct vision coronary artery bypass]. This study discuss these individual surgical techniques and examines the anesthetic concerns for patients undergoing minimally invasive CABG with both the ministernotomy and minithoracotomy approaches

Radial artery infection as a complication following radial cannulation in cardiac surgery

Radial artery infections secondary to catheterization for blood pressure monitoring are rare but potentially serious complications. The objective of the study was to evaluate the incidence, the risk factors and the evolution of radial artery infections following cardiac surgery. A retrospective review of 830 patients undergoing cardiac surgery between 2001 and 2003 at the National Heart Institute was undertaken. All patients with superficial radial artery infections, infected radial artery pseudoaneurysms, and arterial catheter-related bacteremia, were considered using prospective global surveillance of all nosocomial infections over the study period. Thirteen patients with radial infections were encountered [1.5%] with bacteremia occurring in 9 patients [1%] Five patients developed infected radial artery pseudoaneurysms [0.6%] and 5 patients developed subsequent sternal wound infections. Two patients died in their early postoperative evolution. Mean patient age was 67 years old and mean duration of cannulation was 5.8 days. Only 1 patient had diabetes. Seven of the 13 patients were positive for Staphylococcus aureus [54%]. All patients had undergone cardiopulmonary bypass for various procedures. All superficial infections responded well to antibiotic therapy. Early surgical intervention is essential in cases of infected radial artery pseudoaneurysms. Conclusions: The postoperative state and cardiopulmonary bypass put patients at risk for infectious complications. Strict systematic changing of arterial lines on a timely basis is unwarranted in our opinion. A high suspicion index, aggressive surgical treatment of bacterial arteritis and appropriate intravenous antibiotics are essential to improve the prognosis

Facteurs predictifs de morbidite et de mortalite de la chirurgie du vieillard

The aim of the study was to determine prognostic factors of post operative morbidity and mortality for patients aged 80 years and older. We compared two groups of patients aged 80 and over operated to determine predictive factors of morbidity and mortality group of patients who presented post operative complication within 30 days after surgery and group of patients without any complication. Comparison of the two groups for global morbidity using univariate analysis showed only one prognostic factor: surgery of diabetic foot [p = 0.034]. Predictive factors of mortality according to univariate analysis were: pre-operative shock [p = 0.001], abdominal wall pathology [p = 0.027], gastric or duodenal ulcer diseases [p= 0.011] and global morbidity [p = 0.006]. After logistic regression, only pre-operative shock was an independent predictive factor of mortality [p = 0.0023]. Risk for morbidity after surgery in the elderly 80 years and over is linked with type of surgery and not with soil. Likewise, risk for mortality is linked with advanced stage of disease that is presence of pre-operative shock and not with soil

Coronary artery bypass grafting using arterial conduits

The use of arterial conduits in CABG showed better results and higher patency in long term follow-up. Complete myocardial revascularization using only arterial conduits can be accomplished by using multiple arterial conduits with one directed to each distal site, or 3 arterial conduits with the use of sequential anastomoses. Finally, the advent of T- graft or Y- graft has allowed complete revascularization with only 2 conduits. In the last few years, off-pump CABG has progressed and showed more and more popularity. This technique allowed surgeons to operate on high risk groups with better patient outcome. The aim of this study is to assess our results with these new techniques. In addition, different techniques of myocardial protection have been used for comparison. The patient population consisted of 50 patients. Patients' profiles are explained in the text and in table 1. Inclusion criteria include the use of two or more arterial conduits and isolated coronary surgery. On the other hand, exclusion criteria include less than two arterial conduits or associated valvular surgery. We used different techniques of myocardial protection; warm intermittent blood cardioplegia in 14 patients [28 percent], crystalloid cardioplegia in 22 patients [44 percent], fibrillating heart with or without intermittent cross clamping in seven patients [14 percent] and OPCAB in seven patients. These patients were studied immediately after operation by hemodynamic monitoring, complete laboratory investigation, myocardial serum enzymes and daily ECG for 3 days. Three months later, these patients were studied by a complete clinical work-up, Echo and stress ECG. All the patients were stable hemodynamically. They were put on minimal vasopressor support and liberal use of nitroglycerine. Intraaortic balloon pumping was not used. We had few complications; two patients developed preoperative myocardial infarction [4 percent], and two others [4 percent] developed neurological problems, one of them died and this was the only mortality in this series [2 percent]. All techniques of myocardial protection used could be the same in some patients, but there are certainly some subsets of patients need special precautions. Chronic renal disease, elderly patients and redo CABG are better operated upon by off-pump CABG. Patients having bad left ventricular function may need warm blood cardioplegia for better myocardial protection. Therefore, every surgeon should be able to handle different techniques

Effect of age on the vestibular evoked myogenic response potentials [VEMP]

To evaluate the effect of aging on the vestibular evoked potentials. Fifty males free from auditory and vestibular symptoms participated in this study. They were divided into 5 groups according to age; 15-25, 26-40, 41-55, 56-65 and 66 years and above. One channel recordings were obtained using three electrodes; active electrode placed on the upper half of sternocleidomastoid muscle ipsilateral to the stimulated ear, reference electrode placed on the lateral end of the upper sternum and a ground electrode placed on the fore head. Rarefaction clicks of 0.1 milliseconds duration were generated by D.C. pulse and delivered via a TDH-49 P. Telephonics ear phone. Monaural stimulation was employed with a stimulus presentation level of 95 dB nHL and stimulus repetition rate of 5 Hz. EMG signals were amplified and band pass filtered between 10 and 500 Hz. Each averaged response was based upon 100 stimulus sweeps and was replicated once. The results of this study showed that VEMP is a reproducible response the distinct morphology of which decreases by age. VEMP is a reproducible response that can be incorporated intoclinical use but results should be cautiously interpreted when dealing with older age groups as distinct morphology decreases with age

Facterus pronostiques des splenectomies pour rate hematologique

The aim of this study was to identify the prognostic factors of intraoperative haemorrhage, perioperative blood transfusions and morbidity. We collected 120 splenectomies in Beau sejour department of surgery, charles' Nicolle Hospital, Tunis, Tunisia between 1979 and 1999. the descriptive analysis showed sex ratio 0.82 with mean age [ +/- standard deviation] 30.6 +/- 15 year. Idiopathic thrombopenic purpura was the principal disease indicating splenectomy. Morbidity was defined as occurrence of post operative peritoneal sepsis or bleeding. The mortality and morbidity rates were respectively 0.8% and 6.6%. the prognostic anlysis didn't identify predictive factors of intraoperative haemorrhage, however it identified two independent predictive actors of specific morbidity: intraoperative haemorrhage [p = 0.03] and preoperative rate of haemoglobin [p = 0.0049]

Gadolinium-DTPA: a contrastagent for conventional x-ray and CT examinations; when? why and how?

It was noticed that Gadolinium-based contrast agents produced vascular and tissue enhancement on computed tomographic [CT] scans obtained in patients after magnetic resonance [MR] imaging examinations. It also have been used as an alternative to iodinated contrast agents in angiography. This study was performed to assess more systematically the potential utility of gadolinium based contrast agent at both CT and conventional X-ray procedures .Fifteen patients were examined with Gd-DTPA as a contrast medium for CT of Brain [5 patients], CT abdomen [5 patients] and another five patients underwent routine intravenous urography [IVU] examination. Single cut level dynamic scan for CT examinations performed after intravenous injection of the Gd-DTPA as a bolus technique and time enhancement curves for different tissues of interest were drown. Gd-DTPA showed satisfactory diagnostic visualization of the urinary system, good contrast visualization of the veins, and Good enhancement of the brain vascularity, but milder degrees of tissue enhancement for parenchymatous organs occurred however the aorta showed good diagnostic enhancement. We concluded that gadolinium may be an alternative CT contrast agents for patients who cannot receive iodinated contrast agents and in whom contrast-enhanced CT is the examination of choice. While the current high cost of gadolinium-based contrast agents might prohibit their routine use, the cost might be justifiable in various infrequent clinical situations, particularly for vascular studies

Left atrial spontaneous echo contrast before and after percutaneous mitral balloon valvuloplasty: an echocardiographic study

Left atrial spontaneous echo contrast [SEC] is a marker of blood stagnation in the left atrium in mitral valve disease and a forerunner of cardiogenic thromboembolism. To assess the effect of mitral balloon valvuloplasty on SEC visualization in the left atrium [LA] in rheumatic mitral valve disease, 30 patients with rheumatic mitral stenosis [MS] [7 males and 23 females, mean age 30 +/- 10.5 years] were studied by transthoracic echocardiography [TTE] including M-mode, two-dimensional, continuous and pulsed wave Doppler with colour flow mapping for the detection of associated or consequent mitral regurgitation [MR]; as well as transoesophageal echocardiography [TEE] prior to and within one week after balloon valvuloplasty [BV] of the mitral valve. Measurements of LA dimensions, mitral valve area [MVA], mitral valve score [MVS], mean transvalvular pressure gradient [MPG] and fractional shortening [FS] were carried out. TEE was utilized to detect SEC in the LA and determine its grade, as well as to rule out the likelihood of thrombus formation in the LA or left atrial appendage [LAA] and to measure the thickness of the interatrial septum [IAS]. TTE failed to detect SEC in all patients and proved insensitive in this respect. The impact of BV was manifested by a significant reduction of the LA diameter, a significant increase in FS, a significant increase in the 2-D estimated MVA and in the Doppler-estimated MVA and a reduction of MPG. Before BV, only 9 patients [30%] depicted an evidence of associated grade I MR, whereas after BV 21 patients depicted MR of grade 1[80.9%] and grade 11[19.1%], while the remaining 9 patients [30%] revealed no trace of MR. Before BV, a SEC was displayed in all patients [100%], 13 [43.3%] having +1 SEC. 8 patients [26.7%] having +2 SEC and 9 patients [30%] having +3 SEC; whereas after BV, only 9 patients [30%] had SEC. 6 among them [66.7%] depicting +1 SEC and 3 [33.3%] depicting +2 SEC. Thus, 21 patients [70%] were free of SEC post-BV. Before BV, the grade of SEC was a function of cardiac rhythm [the majority of patients with atrial fibrillation "AF" displayed +3 SEC vs. +1 and +2 SEC in those with sinus rhythm], mean transmitral pressure gradient [the higher the MPG the higher the grade of SEC] and fractional shortening [the lower the FS the higher the grade of SEC. p=0.03]. The rate of resolution of SEC post-BV was a function of age, fractional shortening, MPG across the mitral valve, cardiac rhythm [SEC was more common in association with AF than with sinus rhythm] and mitral regurgitation [SEC was more common in patients with MR]; whereas gender and LA diameter exhibited no striking influence on the rate of resolution of SEC post-BV. It was concluded that TEE is greatly superior to TTE in detecting SEC in patients with rheumatic MS pre- and post-BV, that the frequency of SEC detection is related to cardiac dysrhythmia, particularly chronic AF, MPG across the mitral valve, FS and age of the patient. Successful BV is associated with a significant resolution in SEC or reduction in its grade due to the establishment of a wider MVA, hence a lower MPG, better ventricular filling and higher FS. The visualization of SEC should be considered as a prothrombotic state warranting anticoagulation