[Surgical treatment of secondary hyperparathyroidism in chronic renal failure. Report of 57 cases]

The aim of this study was to report the experience of the department of general surgery [Aile III] Ibn Rochd Hospital in surgical management of hyperparathyroidism in patients with end-stage renal disease [ESRD]. Fifty seven patients [24 M, 33F] with hyperparathyroidism underwent surgical parathyroidectomy from 1998 to 2004. Surgical indication was established according to clinical or biological assessment. Fifty nine operations were performed [57 first-hand cervicotomies and resumptions in two cases]. Histological examination of parathyroid gland specimens disclosed adenoma in 33 patients and hyperplasia in 14 patients. The follow-up was normal in 52 patients, marqued by cervical hematoma in 2 cases and death was deplored in 4 patients. The post-operative calcium level was in the normal range in 43 cases, low comparatively to the baseline in 12 cases and high in 2 cases. The PTH level was normal in 55 patients and high in two patients. Long-term outcome was evaluated in 36 patients mean follow-up [18 months]. A good evolution was noted in all patients referring to clinical, biological and radiological investigations. That, in our context, surgical parathyroidectomy still an appropriate approach for the treatment of hyperparathyroidism in patients with end-stage renal disease

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