bronchectasies: place de la chirurgie

Surgery of bronchectasies has evaluated with the progress of both surgical techniques pre and post surgical care. Surgical indications are now better defined on physical laboratory and imaging findings, mainly the dispersion of the lesions in the lungs and there stability with time. Prognosis of surgery is good in localized bronche ctasin. Wide lesions, mainly in children, should be discussed among a multidisciplinary team and should throuroughly investigated

L'autocontrole glycemique chez le diabetique insulinotraite

Many epidemiologic, clinic and experimental arguments suggest that chronic hyperglycemia is the main factor of diabetic microangiopathy. The advent of blood glucose control in the course of the last years represents indisputably an important therapeutic progress. That's the only reliable monitoring method if we want to approach normoglycemia. The method gives security and motivation to the patient and improves his comfort. The balance of blood glucose is better later because of reinforced education and a privileged relation between doctor and patient. It necessitates also an optimal diagram of insulinotherapy. To avoid failure, the treatment must be adapted to each patient's needs and become a wide part of their education and motivation

Bronchogenic cysts: report of 15 cases

The 15 cases of bronchogenic cysts operated during 15 years in the University Hospital of Rabat represent only 0.28% from 5.000 thoracics operated during the same period. These dysembryomas present a malformation of the tracheobronchic tree and they can be diagnosed at any age. They remain asymptomatic before fissuration or bronchial fistulisation. Their diagnosis is then essentially radiological [9 cases on 15]. Recently C.T. scan has given more informations delincate the connections of the cyst with mediastinal structures. Their surgery must always search their complete resection without harming the digestive, aerials or vascular structures. A colerette abrased or electrocoagulated, let in contact with these axis constitue an attitude of wisdom [6 times on 15]. The post operatory's evolution is excellent for short and long term

Mortality in a thoracic surgery department of a University Hospital of Rabat

This study was mainly done from the wards' registers, the hospital's registers, the death certificates and the medical charts. We noted 343 deaths among the 10.140 patients admitted during the ten years [3.4%]. Deaths were more frequent in males [3.7%] than in females [2.6%]. Deaths were more frequent in patients admitted from the emergency unit of the hospital [8%]. They occured a little more during autumn and winter [55.4%]. Forty two percent occured during the first ten days of hospitalisation and 15% during the first day. Cancer was the most frequent cause of death [36.7% with 20.4% were primitive lung cancer]. The principal other causes were: tuberculosis and its sequelae [15.6%], bronchial, pulmonary and pleural non specific infections [12.5%], hydatic cyst [9%], chronic broncho-pulmonary diseases [6.1%]. No cause was determined in 10% of cases. Among the 3.248 surgical patients we noted 63 deaths [1.9%]: 10.6% for primitive lung cancer, 5% for aspergilloma, 2.1% for tuberculosis and its sequelae and 0.9% for hydatic cysts. The importance of hospital mortality studies is stressed

dysembryomes du mediastin [a propos de 30 cas operes]

From 1965 still 1980 thirty dysembryoma out of 100 surgical tumors of mediastinum operated by the members of the thoracic surgery Service [Hospital Avicenne] are analysed and compared to the donnees of literature. The bronchogenic cysts prevail with 12 cases out of 22 homoplastic dysembryoma. They are followed by the coelomic cysts. Out of 8 heteroplastic dysembryoma there are six dermoid cysts and 2 non malignant teratoma. In this series in which there is neither new borns non infants, the seven children who are aged less than 15 years old had specially bronchogenic cysts [5/7]. The coelom cysts are seen in adults only. The 30 dysembryoma are benign, the prognosis good. However, if the tumor resection had been complete in 23 cases, it was associated to 7 cases of partiel lung resection

[Spontaneous pneumothorax in the adult]

Two hundred and seventy six cases of spontaneous pneumothorax seen in 11 years [1967-1977] were studied. The frequency of the disease has rised sharply but seems to have stabilised for the last 3 years. Males are more frequently involved [84.8%]. 53.2% of the patients were less than 30 years old. Clinically typical symptoms were found in 70% of cases. On the X-Rays, fluid reactions were frequently seen [34%]. Radiology is very important for determining the etiology. 51,8% of cases were primitive [idiopathic], 24% were tuberculous, 8,7% were of hydatic etiology and 4,7% were infectious. 263 patients were cured [95%]. 25 presented with recurrence. Therapeutic result and recurrences were analysed depending on the etiology and the therapeutics used

Abcesses in previously unaffected adult's lungs. 100 cases

The authors recall the main clinical radiological, bacteriological and therapeutic characteristics of a 100 cases of abcesses in previously unaffected adults lungs observed over a period of 10 years [1968-1977]. They note the young age of a great number of patients, the long evolution preceeding the first consultation illustrated by the frequency of the vomica and the dyspnea. The radiological aspect is typical in 89% of the cases. The bacteriological study, not quite conclusive is in fact not necessary to conduct the treatment. Recovery is achieved in 94% of the cases