[Management of recurrent pneumothorax]

Recurrent pneumothorax represent medical and surgical emergency that expose to dead risk. Multidisciplinar coordination and codified procedures are necessary in care of this entity.To improve this care, We must evaluate the degree of severity, emergency procedures, theuse of CT scan and prevention of recurrences. Authors propuse, inside this work, guidelines to care and to prevent recurrences. Infact, the surgical treatment is recommended in recurrent pneumothorax: second ipsilateral recurrence, first controlateral recurrence, first episode of pneumothorax in case of alone lung and in case of dangerous jobs [pilot, marine]. Surgery consist in bullae resection and pleural adhesion by performing chemical and/or mechanical irritation of pleura, or pleurectomy. This treatment could be performed by medical thoracoscpy, thoracotomy, or surgical videothoracoscopy which was the usually performed procedure now in care and prevention of recurrent pneumothorax

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

Education for tuberculous patients: a quest about the knowledges and impact upon the therapeutic results

At the begining of 1990, and on the occasion of the adoption of the new programme of fight against tuberculosis, the Moroccan Association of Prevention and Health Education decided to arrange sessions of health education. These sessions concerned persons with tuberculosis in the Great Wilaya of Casablanca. In order to evaluate this act, we compared the therapeutic results of two groups of 100 patients, the first group received a health education, the other, reference sample, was treated under usual conditions. We noticed that the educated patients "knowledge about tuberculosis notably improved; these patients had better adhesion to treatment against 18% in the reference group. [p=0.03]. Whereas, relapse and death. The relative success of our intervention may be explained by the persistance of supervisory problems, thereby diminishing the effectiveness of the health education and causing bad patient/health agent relationship

[Diaphragm pathology seen by specialist in lungs disease]

38 cases of diaphragmatic pathology has been observed in the CHU Pneumology unit -Ibn Rochd hospital- between 1976 and 1989, and from 1987 to 1989 [in 20 Aout hospital]. The serie is dominated by diaphragmatic hernia and eventration divided into 22 cases of diaphragmatic eventration 11 cases of post traumatic diaphragmatic hernia and 3 cases of retro rib xyphoid hernia. The circumstances of discovery are variable: respiratory symptoms [chest aches and dyspnea] associated with abdominal pain and dyspepsia. After the analysis of the cases the authors stress the importance of following elements: Variability of radiologic anomaly is very suggestive of the hernia or eventration, so as pneumoperitoneum and gastroduodenal transit with chest photos delayed. It's useful to precise the nature of the organs intrachest. Concerning therapy repercussions only the eventration with functional re are to be proposed to a surgical, intervention. For the post traumatic hernia or retro-ribxyphoidhernia, the indication of surgical operation is formal because of the risk of a stranglement which is very important

[Etiologic profile of hemoptysis in pneumology unit: [291 cases]]

To determine the profile of hemoptysis their main etiologies, we reviewed 291 cases hospitalized in 5 years [from 1980 to 1984] in a service of pneumology. Patients with hemoptysis represente 8,8% of all hospitalized patients. They have a mean age of 46 years and 47% of them have less than 50 years; 69,4% are men. The hemoptysis is a telltale sign of a thoracic pathology in 35,4%. It is trivial in 71,1% medium in 26,8%, important in 2,1%. In all the cases the chest radiograph is abnormal, the abnormalities evokating the etiologies in 70,8%. The prevailing etiologies are lung cancer [34,4%] and both active and sequelary tuberculosis [18,9%]. Among other causes bronchectasies hold an important place [15,1%] as well as broken hydatic cysts [9,3%]. The other causes are as follows: bacterial pneumopathies with or without abcess [7,2%], pulmonary aspergillosis [6,9%], chronic bronchitis with or without emphysema [3,5%]. Exceptional causes gather only 4 cases. In 3,1% no cause for the hemoptysis is demonstrated. This study emphasizes the leading role of lung cancer as an etiology of hemoptysis, even in country with a great tuberculosis prevalence. Nevertheless this outward reality is also due in part to the fact that most of patients with tuberculosis are hospitalized in specific yards

Haemorrhagic pleural effusion. A report of 123 cases

1.132 pleural effusion admitted to the hospital in 113 months, 123 haemorrhagic pleural effusions are confirmed by puncture. The most reliable means the pleural biopsy with the Abrams needle which is systematically used. It has often led to adjust the diagnosis suggested by the clinical context. The pleural metastasis is the dominating aetiology, 53 cases are confirmed on the biopsy or cytodiagnosis and 28 cases are suspected which makes a total of 81 cases [65.9%] then pleural tuberculosis are confirmed in 11 cases, suspected in 8 cases [15.4%]. The cardiovascular etiology represents 3 cases [2.4%], different other causes 2 cases [1.6%], no etiology 18 cases [14.6%]

Clinical profile and follow-up study of 277 children consulting in pneumo-allergology from 1980 to 1982

The authors report the results of a retrospective follow-up study of 277 children under 15 years of age, confirming the close correlation already noted between skin tests on one hand [household dust+acariens], and both total and specific IgE on the other. Indeed, a positive correlation was found between skin tests household dust+acariens and total IgE essays in 77.3% of the children in the groups, as compared with 55% in adults [p 0.01]. Household dust and acariens constitute the antigenic mixture most often incriminated, with a positive correlation of skin tests to specific IgE results of 97%. Specific immunotherapy using essentially extracts from household dust and/or acariens concerned 234 children, of which 96 [41%] dropped out of the program months to 3 years after the beginning of treatment. Thus, among the 138 children who carried through their desentization treatment for at least 3 years, the authors note a global subjective improvement in 75% of the cases