[ thoraco-Abdominal injury: about 78 cases]

The authors report a series of 78 cases of the thoraco-abdominal wounds collected between 1992 and 2002.The mean age of the patients is 27 years old [16- 60 years old] with male predominance [90%].The aggressions with a blade [stab] are the exclusive etiology [100%]. The left hemi thorax represents the Site of penetration in 80% of cases. The clinical symptoms at the admission were dominated by the respiratory detress. The chest radiography that has been achieved systematically. In all our patient, showed a hemothorax [39 cases] hemopneumothorax [20 cases], the radiography was normal in 27 cases. The abdominal ultrasound was done in 36 cases when the thoraco-abdominal injury was suspect, however the clinical examination and radiography were normal. It's showed a double peritoneal and pleural effusion in 36% of the cases. About the therapeutics, the treatment has been always surgical, so, the laparotomy has been necessary in 66 patients, the thoracotomy in 2 cases, the thoraco-laparoscopy in 4 cases, and the thoracoscopy in 2 cases. No death was noticed in this series The immediate following have been simple in the majority of the cases, in 6 patients, pleuro-pulmonary complications have been occurred. The thoraco-abdominal injuries have sometimes a problem of diagnostic, specially if only the diaphragm was injured. We believe that the thoracoscopy is the best exam to confirm the diaphragm injuries. The thoraco-laparoscopy can be the best surgical approach

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

Ingestion of foreign body

Ingestion of foreign body. The ingestion of foreign body can be accidental or voluntary. It is frequent at old person having a defective set of teeth or with mental deficiency, but also at the child. Mortality of ingestion of a foreign body is at present lower than 1%, thanks to the improvement of taking in charge, and especially techniques of origin endoscopiques. The urgency of taking in charge the foreign body of the digestive tract rests essentially on the location especially oesophagal and character vulnerant of the foreign body. The foreign body can present an immediate danger, delayed during the elimination or still during its extraction. In the case, a fast extraction is necessary. If endoscopice extractionis difficult, with important risk of perforation, an urgent surgical operation is then indicated. In the case of the foreign body gastric, the spontaneous evacuation is usual and appeal to the surgery is exceptional. Besides, once the stomach exceeds, the risk of performing of small bowel is important, especially with sharp, stiff and long foreign body

[ gastric stump cancer]

Among a series of 266 cases of gastric cancer operated on between 1981 and 1991, 8 cases were developed on gastric stump after gastro-duodenal surgery. A post operative delay of 10 years has been insisted upon. We noticed an exclusive masculine serie. The main age was 61 years. Clinical aspects were univoque and treatment was always surgical with a resecability rate of 37%. Pathological analysis of operatory specimen and biopsies has shown everywhere an adenocarcinoma. The only way to improve prognosis is based on early histoendoscopic supervision since the tenth year after initial intervention of these operated patients of the stomach with high neoplasic risk

[Mortality and morbidity in bilary surgery]

Mortality and morbidity of surgical treatment of gallstones are analyzed through a series of 3314 operations collected between 1976 and 1988. The cases were shared followed: 84,1% for chronic cholecystitis, 5,8% for acute cholecystitis, 9,9% for choledocolithiasis and 1.6%for biliary fistula. The overall mortality rate is 0.96%. The operatory sequela minor or major, are like abdominal surgery's sequela