[ video-thoracic surgery: indications and limits]

The thoracic video-surgery [TVS] represents an interesting therapeutic alternative at the hour of the thoracic surgery mini-invasive or video-attended. This survey intends to make a retrospective meta-analysis of the first 55 cases of TVS: 14 cases of pneumothorax, 17 cases of hydatic-cyst of the lung, 12 cases of mediastinal lymph node biopsies, 5 cases of pulmonary biopsies, 4 cases of recurrent pleurisies and 3 other cases of diaphragm rupture. For all these patients, the VTS permitted us to reduce the diagnostic stage, the rate of spoil thoracotomy and especially to replace advantageously and efficiently the conventional surgery by a complete therapeutic mini-invasive act. For a lot of authors, indications of the TVS are more and more precise, with pain profits, functional ad aesthetic obvious. It is also a reliable and sure diagnostic and therapeutic means

[ 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

[Liver abcesses: clinicals aspects and actual treatment]

A serie of 32 liver abcesses during a trial of 7 years is reported by the authors. The male sex is predominant [90%] The symptoms of the illness are typicaly those of the classic liver abcess. The treatment has improved with the progress of the imagery and especially the echography. The punction under echography had been tried in 7 cases, of which 6 were cured. When the seize of the liver abcess is small the medical treatment permits recovery in 68% of the cases. Only new cases that do not answer to medical treatment and punction are candidate to surgery

[Acute post-operative evisceration in visceral emergency unit]

The evisceration is rather a well-known complication to surgeons of the abdomen. 38 post-operating eviscerations were observed at the visceral emergency service C.H.U. Ibn Rochd Casablanca, for the last four years for 2385 laparotomies, with 5 deceases, be it frequency of 1,32% and a mortality of 13,16%. The analysis of these. observations, noting that the emergency conditions played probably a role in the unexpected happening of this complication, since the majority of our operated patients are peritonitis affected [63,2%], so lften mal nutruted, with the antecedents of chronic bronchitis [24,10%] which amputale the possibilities of the pre-operating reanimation. Our death rate, relatively lessened, reflets the interest of the prophylactic and preventive measures taben in respect to this affection. This were able to treat in time [55,26%] of P.O.E. covered before their affirmation in free forms [31,58%], the fixed forms [13,16%] were symptomatic of occlusion on deep seated bride in two patients. Our therapeutic means and our indications are well precise and well codified, however the pronostic of the evisceration remains defited with the post-operating peritonitis and the conditions of collision complicated by renal insufficiency and lung collision; and almost by their combination

Postoperative peritonitis after digestive surgery. About 92 cases

92 cases of post-operative peritonitis in digestive surgery are recorded: - Diagnosis is difficult inspite of the multiplicity of symptoms which are variable and non specific. - Clinical presentation is dominated by the frequency of infectious symptoms essentially fever, neuro -psychic, hemodynamic and respiratory disorders. Abdominal signs though advocatory are late. - Early reoperation represents the only possibility of survival for the patients. It must contain a way large, a complete peritoneal washing, an eradication of the source of peritonitis and an effective drainage. - A correct ressucitation effective before, during, and after operation is fundamental. - The prognosis of this fearful complication improves clearly in case of operation and the mortality rate declines from 100% [in absence of operation] to 47.4% [in case of operation]. Because of the high mortality rate, [44.4%], this post-operative complication has to be prevented

Volvulus of the sigmoid colon. Therapeutic strategy. About 38 cases

A retrospective study of 38 cases of sigmoid volvulus is reported. The relative frequency of this pathology among young people in Morocco is noted. In 82% of cases diagnosis was without difficulty; and in two cases an associated small bowel volvulus was found. When deciding on the therapeutic approach it is essential to differentiate between cases in which the sigmoid colon is necrotic and those in which the changes are reversible. In the latter, the authors recommend a non surgical reduction [using flatus tube or better: colonoscopy] with elective surgery performed at later date. If initial reduction proves impossible, colonic resection whith colostomy appears to give the best results

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

Surgical treatment of cervical and facial epithelioma of the skin. About 72 cases

The authors report a sery of 72 cases of cervico-facial skin carcinomas all managed surgically. The aim of this study is to make an analysis of the different surgical procedures to manage these carcinomas. Whatever the surgical procedure used, 2 principles were respected: complete resection of carcinomatous process [controlled by pathological study] and immediate reparation. All the patients have a follow-up between 2 to5 years. During this period 7% of recurrence have been observed. The functional results are satisfactory because the recurrence ratio is low and is the same than the litterature data. Further more, all the cases of recurrence are of high risk. The functional and esthetic results are also satisfactory since the majority of patients are satisfied of the quality of their social reinsertion after a shocking surgery of the face

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

[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

kyste chyleux du mesentere chez l'adulte

Our study brings clarification of the problem of mesenteric cystic lymphangioma in adult. The extreme rarity of this disease makes its pre-operatory diagnosis very difficult. Essay to precise clinical features, pathogenical hypothesis and the role of echotomography which permits a cheap diagnostic approach. This study insists also on the therapeutical aspect in reason of the benignity of the affection and the operatory risk which is sometimes unmeasured

Radial head fracture: surgical treatement

Treatement of cephalic fractures of the radius, type I and type II, remains controversial. In a series of 8 cases treated by osteosynthesis, the authors point out the advantages of this technique while insisting on active, early physical therapy

Surgical treatment of oesophageal stenosis secondary to reflux oesophagitis. About 18 cases

Eighteen peptic oesophagitis have been treated in the University Hospital of Casablanca mainly by conservative surgery. The results obtained show that the surgical procedure should discharge always the oesophagus, distend the stenosis by candling and end by an anti-surging back method