[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

[ gastric trichobezoard: a case report]

Trichobezoar is defined as the presence of a foreign body in the stomach. This body is formed by a hair mass or fibres. The typical patient presenting with a trichobezoar is an adolescent experencing mental disturbance or retardation. A voluminous trichobezoar was discovered in a young woman aged of 23 years old. The diagnosis was easily made by computerized tomography and endoscopy. The surgery was performed without complications. Psychiatric follow-up is needed to prevent the recurrence

Plummer-Vinson syndrome [report of two cases]

Plummer-Vinson syndrome is rare. It associates upper dysphagia, cervical oesophageal webs and iron deficiency. We report two cases of this syndrome collected at our department. The first case is a woman, 43 years old, and the second a man of 81 years old, both admitted for upper dysphagia. Biological investigation found iron deficiency anemia. Oesophageal transit disclosed annular stenosis of the cervical segment. Oesogastroduodenal endoscopy performed in the second patient showed regular stenosis. Our two patients beniffited from a pneumatic dilatation under radiological control in one session, iron supplementation was associated. The evolution was common after 2 years. Plummer-Vinson syndrome is rare and affected mainly young women. Its pathophysiology is still unclear. Its diagnosis is based on oesophagel transit and endoscopy. The treatment consist on iron supplementation during 3 months associated to iterative endoscopic dilatations. Pneumatic dilatation under radiological control seem to have good results. The risk of malignant transformation is estimated 10% after 30 to 40 years of evolution, requires rigourous surveillance

Pheochromocytoma [a report of 8 cases]

We reviewed a serie of 8 patients, 6 females and 2 men operated for a pheochromocytoma. Sex patients had a high blood pressure; permanent in 4 cases and paroxystic in two. Three patients had a left ventricular hypertrophy. The vanyl-mandalic-acid was elevated in 5 cases and dopamin in one case. This study confirmed the remarkable sensitivity of computed tomography [100%] for the detection of the pheochromocytoma. The ultrasonography was objectived the surrenalien tumor in 5 cases. The surgical procedure consisted on a total resection of the tumor by an anterior intraperitoneal approach. There was no mortality in our serie. Only one patient kept a high blood pressure after the resection neverthless negativity of the check-up. The pre-operative treatment is systematic and the only treatment of pheochromocytoma remains ablation of the tumor

Peritoneal puncture lavage in closed abdominal injury. About 230 cases

In this work, the authors have studied especially the reliability and the limits of the perironeal puncture lavage. About 230 cases of abdominal trauma collected in the services of surgical emergencies and surgical intensive care of the Ibn Rochd Teaching Hospital of Casablanca from 1980 to 1984. In this series, the child and the young adult of masculin sex are the most concerned, the road accidents constitute the most frequent etiology. The reliability of the method in our experience is 93%. The caution of use are reminded; 11% of wrongly positive results concern particularly the retro-peritoneal hematoma; the problem of the tiny intra-peritoneal lesion is discussed, the risk of the wrongly negative results is of 3%. The indications, sensibility and specificity of the peritoneal puncture lavage are discussed. That is a practice and useful examination, which diminishes the delay of diagnosis and the mortality in the case of abdominal trauma without evident clinic sign, and in the polytraumatised

Hydatid cyst of the pancreas. About 2 cases

The authors report two cases of pancreatic hydatid cyst and the rarety of this localisation and the poly-morphison of the clinic symptomatology. Attention is drawn to the place of the ultrasonography and the therapeutic problems

foreign bodies after abdominal surgery

The authors report a review of literature about the foreign bodies missed after abdominal surgery. The anatomical aspect are discussed. Diagnosis is helped by the history of disease and a plain X ray of the abdomen. Prophylaxis is based on a better organisation of the abdomen operation room and the introduction of a radio-opaque marker in the linen

Surgical treatment of idiopathic megaoesophagus

About an analysis of 15 cas of mecaoesophagus, the authors underline it's clinical latency. The clinical features become clear when the megaoesophagus is already constitued after a certain delay. Heller's myotomy is the operation of choice that gives fonctionnals and anatomical results

Surgical treatment of hemorrhagic complications of duodenal ulcer

Haemorrhage complicating duodenal ulcer is relatively rare compared with other complications of duodenal ulcer. Inspite of this fact, haemorrhage of duodenal ulcer is responsible for high rate mortality of complicated duodenal ulcer. The mortality rate is related to: severity of bleeding, recurrency, and also advanced age great help in the identification of the chracteristics and types of the ulceratives lesions showing the tendency of recurrent bleeding, hence, a more active attitude will be adopted rapidly as the risk of mortality is higher in these cases when recurrent massive bleeding arrives. In this study carride on 85 cases of haemorrhage complicating duodenal ulcer: 48 patients are operated upon, 45 with trunkal vagotomy with or without local hemostatic mesures, 3 cases of supraselective vagotomy were than. Mortality rate in this group was 10% [8 patients out of 85] 5 deaths happend before any intervention, other 2 deaths during surgical operation and related to massive or recurrency haemorrhage. The recurrent haemorrhage arrived for 2 patients after trunkal vagotomy was responsible of death for these two cases. According to this study, and also to other recent publications, we found that the Weinberg operation is the operation of choice, but the good results published recently by certain groups using supraselective vagotomy, obtained also in our group [3 cases] are encouragely to substitued trunkal vagotomy by this technic

Choledocal cyst in adult. Report of 2 cases

The congenital choledocal cyst is a rare but not exceptional affection. The diagnosis is rather easy, thanks of the clinical symptoms, the echography and the intravenous cholangiogram. The evolution with complication compulse a surgical treatment just after the diagnosis. The most complete removal of the cyst with choledocojejunostomy is the favorite technic for most authors

Thyphic acute cholecystis

The acute typhoid cholecystis is a rare complication of typhoid fever in childhood. The authors report the observation of a 7 year old child operated of a perforation of a mortified gall bladder. The authors review the pathological aspects, the clinical features and the treatment of this affection

injury severity score: a prognosis index in multiple injuries patients. 400 cases report

For the early, objective and quantitative evaluation of prognostic in multiple injuries patients, the authors would like to introduce in their current practice the injury severity score [ISS]. This clinical score is based on the abbreviated injury scale [AIS] witch divide the human body into four parts: head, face, trunk and limbs. Mean ISS equal 35.8 while mortality rate reach 52%. The matter of fact is that mortality is proportional to ISS rise: when the ISS is between 30 and 40, mortality reach 50%; when ISS is lower, prognostic improve, but when it exceed 50, prognosis is awfull. For a best evaluation of prognossis of polytraumatised, the authors propose to group head and face injuries in a same column of cotation and to divide trunkular injuries into chest and abdominal injuries

Analytic study of 1481 appendicular syndrome

Our work consists of a retrospective study of 1.481 appendicular syndromes collected in the service of surgical emergencies from June 1980 to December 1984. Summarizing the date count, it emphasizes from our study: The acute appendicitis is the most frequent of abdominal surgical emergencies, it attacks both sexes with a light male predominance, the clinical is very polymorphic, and the confrontation anatomo-clinical, trial shows the absence of paralylism between the clinic, the operatory explorations and the histology

Huge neurofibroma of intrathoracic vagus

A case of neurofibroma of the left vagus nerve associated with a Recklinghausen's disease is reported. The review of the literature shows how rare is this type of localisation, only 62 cases are reported since 1926. The authors remind us the absence of specific signs of vagal involvement and mildness of postoperative course of surgical excision

Hydatid cyst of adrenal gland. A case report

The authors report a case of hydatic cyst of the adrenal left gland in a 35 year-old woman. They give a clinical and paraclinical description. Such lesions are uncommon and only detected fortuitously or in case of hardly definable pains. Their diagnosis has largely profited by the contribution of echotomo-graphy and tomodensitometry. The removal of a cyst with conservation of the adrenal gland is the best approach of such lesions

[Benign pancoast and tobias syndrome. report of a case]

The authors report on a case of Pancoast and Tobias syndrome due to a mediastinal and right apical hydatic cyst. This parasitosis, so frequent in North Africa, is with tuberculosis the least rare benign etiology of Pancoast and Tobias syndrome. A conservative treatment has lead to a satisfactory result

Galeazzi's fracture. About 28 cases

In a study of 28 cases involving a GALEAZZI Fracture or equivalent, the authors point out the relative importance of the arthrography of the wrist amongst the various radiologic explorations possible, and the necessity, in adult cases, of complete surgical treatemeat: that is, repair of all lesions of the triangular ligament of the wrist, the negligence of which can seriously affect the functional prognosis