prescription evaluation of the preoperative investigations within the University Hospital lbn Rochd of Casablanca

Several publications challenge the usefulness about the prescription, known as routine, of the preoperative paraclinic examinations, and insist on the necessity to abandon this practice with a view to a selective proposal according the recommendations of acceptal protocoles. To rate the current state about the prescription of the preoperative investigations within the universitary hospital center lbn Rochd, we report a prospective study about 1000 cases operated on within the central unit in UHC lbn Rochd during four months. The mean age of collected patients is 43.3 +/- 20.5 years old with slight male predominance, 86.4% of the ASA I and 10.9% are classified ASA II. The preanesthesic consultation has been realised first in 56% of the cases, the preoperative visit concernced 81.5% of the cases. We conclude from this study that, in spite of the establishment of prenasthesic concultation and the preoperative visit, excessive prescription of preoperative paraclinic investigation is still used, this excess is due to several hindrances analysed with details in our study that must be defined in order to escape the superfluous investigations and to adapt the latters to "case by case" according the allowed recommendations

Serious acute pancreatitis made complicate by hepatic necrosis and extended digestive peforation

Severe acute pancreatitis [SAP] is a serious frequent pathology in the Intensive Care Unit. The authors report a case of SAP complicated by extended digestive perforations with hepatic necrosis in a 24 year-old patient. The clinic and paraclinic data concluded to a baltazar stage E severe acute pancreatitis. A first intervention was decided on the 14th day of admittance to hospital due to the absence of clinic improvement despite the ressucitation. On the fifth day after surgery, the clinic condition is made serious on the infections level with hemodynamic instability. The surgical reintervention showed a brownish liquid with extended necrosis to all over the abdomen and mainly the sus mesocolic level. The surgery team opted for a therapeutic withrawal. Through this observation, the authors insist on the rarety of the mechanic complications of the severe acute pancreatitis whose diagnosis remains difficult and often late. When they exist, the evolution is often lethal