[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

[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