[Reccurrent desmoid tumor of the gluteal area]

Desmoids tumors are fibrous infiltrates recurrent proliferations but not metastasizing. It is about a 40-year-old patient who presented a tumor of the right gluteal area, operated twice for a tumor at the right gluteal area and its histopathologic examination confirmed the diagnosis of a desmoid tumor. A standard X-ray as well as a scanner of the pond objectivized a third recurrence of the desmoid tumor. Given that the clinical signs are not alarming, a surgical abstention was recommended with a regular follow-up of the patient. Desmoids tumors are a port of deep fibromatosis. These kinds of tumors rarely attack young adults with a net feminine predominance. Clinically, the tumor appears in the form of a mass badly limited, of a slow growth, little or not sensitive. The scanner and especially the resonance nuclear magnetic represent radiological examinations of choice. The confirmation diagnosis remains based on the histopathologic study of surgical specimen. The surgery treatment stays the base treatment, the indication of adjuvant treatment based on radiotherapy and medical treatment is limited and the results are uncertain. These tumor rare gluteral; their diagnosis is mostly histological, the treatment is especially based on surgery

[Shoulder dislocation associated with polyfractures of the same member [Report of 2 cases]]

We return two rare cases of lesion's associations treated in our service. It was about a dislocation of the shoulder associated to lesions stacked of the same superior member revealing the violence of the initial traumatism. The mechanism of lesions and the therapeutic strategy were discussed. In the first observation the dislocation was associated to a fracture of the humeral shaft and a supra and intercondylienne comminuted fracture of the humeral pillar, the patient had benefitted from a surgical treatment with in first an access of the shaft home that allowed us to manipulate the proximal fragment and to feel humeral head for the reduction, so the shaft has been fixed by a screwed plate and the epiphyseal fracture by a plate of Lecestre. In the second observation the dislocation was associated to fracture of the humeral shaft, a simple fracture of the internal condyle of the humeral pillar and a comminuted fracture of all the third inferior of the radius. The patient had benefitted from an access of the shaft home permitting the reduction of the humeral head; the shaft has been fixed by a screwed plate and the internal condyle of the pillar by a simple srew. For the fracture of the third inferior of the radius we opted for the association of a plate screwed to a fixer for the epiphyseal distraction. The present receding is of more than 1 year. The functional results of our patients are correct

[Bony tuberculosis of the thumb revealed by a trauma]

Tuberculous dactylis is uncommun which is difficult to differentiate from tumorous and metabolic affections. The histological studie constitutes a reliable and easy element to achieve for the positive diagnosis especially as the biologic studie can be negative. We report the case of a 43 year old woman who consulted for a post traumatic painful inch of the right hand. The x-ray of the hand visualized a fracture of the first phalanx of the inch with a lyse bony. Pathology examination of a biopsy specimen reveled granulomatous with caseous necrosis specific of tuberculous. The clinical signs and radiographs resolved after anti tuberculosis treatment for 12 months

[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

Surgical treatment of the metastatic fracture and of the long bones metastsis

Analysis of surgical modalities and techniques used in treatment of fractures of long bones. Material and methods: The authors reported 72 metastatic fractures and perfracture bony metastatics in 68 patients collected from traumato-orthopedic departement in the university hospital center Ibn Sina of Rabat, through a period of 10 years between 1989 and 1999. Average age was 59 year [27-78 year]. Females was more affected [36 women equ 53% of cases]. The classical localisations were femoral and humeral respectively 47 cases [63%] and 24 cases [32,5%]. Sixty four patients were treated surgically, abstinence for four patients. Fracture femur was treated according to its localisation, either by prosthetic replacement for fracture neck, or by symmetrical or non internal osteosynthesis for other localisations. The humeral fructures were treated by centromedulary cement nailing. The association of adjuvant treatment [chemotherapy, radiotherapy and horomotherapy] was needed according to the histological type of the primitive tumour. Evoluation was marked by the functional replacement of limbs and relief of pains in 21 patients [31%] with average follow up of 9,5 months with extremes of 1 month to 5 years. Long bones metastases must be dealt with the prefracture state in order to help the practitioner to do precosious diagnosis

Pathological cyst of adrenal gland

The cyst of the adrenal gland is a relatively rare pathology. It is defined as being an excrescence to content liquidien to adrenal tissues that is partially or completely destroyed. Through 3 cases collected in the service of general surgery, we report the preoperatory diagnosis difficulties in spite of the means of recent investigation. It is about three women whose middle age is of 33 years. The motive of consultation is an abdominal pain in the 3 patients. The exam is normal in 2 cases and watch an enormous abdominal mass in the third case. The diagnosis of the cyst of the adrenal is evoked in the ultrasonography and the CT scan in a case. In the two other cases, one is oriented toward a hydatid cyst of the liver and a pseudocyst of the pancreas. The hydatid serology is negative among the three patients. The surgical access is a lapartomy under left costal in two cases, and under right costal in a case. The surgical procedure consists in a left surrenalectomy in two cases and an excision of the cyst in a case. The operative follow up are simple. The pathological examination shows a pseudo-cyst in a case, and a cyst endothelial in the two other cases. The cyst of the adrenal is most often asymptomatic. Its symptomatology is bound to the compression of the neighborhood organs. The diagnosis is not always easy its treatment is essentially surgical

Reparations prothetiques des eventrations post-operatoires

The treatment of recurent post-operative eventrations or with major loss of parietal substance often justifies the use of prosthetic materiel. From 1987 to 1994; 119 from a serie of 252 post operative eventration were treated by such procedure using a prothesis type "Mersilene". The age intervall ranges from 28 to 72 years old with majority female [80%]. Benefited from this prosthetic treatment the patients who had undergone multiple surgery [65%] with large volume or complex post-operative eventration [35%]. All of them had at least one risk factor. This complication is seen predominatly after gynecology [45%] or bilairy tract surgery [34%]. Wound sepsis is present in 30% of the cases as complication of the first laparotomy which was mediane in 86%. In 60% of cases the apparition delay was less than a year. The prothesis was implanted preperitoneally. Antibioprophylaxy was systematically given. In the post-operative course, 7 wound abcess accured, 5 hematomas and 5 recurrent eventration. The others patients had a good outcome 8 months to 7 years after surgery. The authors stress the fundamental importance of peri operative carre during such intervention. The quality of results depends on it

Les luxations sous astragaliennes [a propos de 12 Cas]

We present in this work the clinical and therapeutical fearures of suastragalor dislocation based on serie of 12 cases reported in the service of TraumatoOrthopedic of the U.H.C. of RABAT. Our patients are betwen 15 and 55 years aged.They have been followed-up for a period oscillating between 4 and 16 months. Thy are especialy male with slight prevalence of the internal form. The diagnosis was immediate in 7 cases, delayed in 5 cases with a dislocation age ranging from 2 months to 3 years.The orthopedic treatment is basic management in the isolated dislocation. The surgical management is imperious in the case of opening or no reductibility, and it is discussed, more particulaty in case of associated fractures. Arthrodesis can be carried out right away, and it is absolutely necessary in cases of ancient dislocation. The study of the results allowed to point on some factors that have influence on the prognosis of these desions. As for evolution, arthrosis is certainely the main risk. It's appearance seems to be favoured by existence of associated lesions

Place de la derivation bilio-Digestive dans le traitement du cancer de la tete du pancreas

The study of 46 cases of pancreas cancer gathered betwen 1976 - 1990, showed the importance of the palliative surgery in the treatment of this affection, particularly the bilio-digestive derivation. The choledocoduodenal derivation had been praticed in 78,3% with digestive derivation. The operatory death rate was 8,7% the morbidity 26% with a duodenal stenosis in 4 cases the survive was 4,7 months. These resultats showed the importance of the palliative treatment