[Vaccination for hepatitis A and B practical informations]

If vaccination for the viral hepatitis B keeps a major importance in term of public health to warn occurred of new cases of viral hepatitis B and especially the evolution towards the cirrhosis and hepatocellulaire carcinoma, the generalization of the use of vaccination against hepatitis A runs up against the high cost of the vaccine and the secondary position of hepatitis A among the priorities of public health of many countries including Morocco. We propose through a review of the literature to put the point on practical concepts for vaccination against the two types of vaccine

[Rare causes of low digestive hemorrhage]

The lesions responsible for low digestive hemorrhage [LDH] are located at the lower part of the angle of Treitz. They are of origin colic in 90% of the cases. The lesions of hail are less frequent, with more difficult diagnosis and management. We report 2 observations of rare causes of LDH 47 and 44 years old respectively admitted both because of an anaemia with low digestive hemorrhage related to a stromal jejunal tumor in the first case and on a cavernous hemangioma of hail in the other case. The diagnosis is confirmed by the histologic study of the exeresis product

[Pilonidal sinus: about 105 cases]

The pilonidal sinus is a little frequent benign affection with often sacrococcygeal localization and that the etiopathologenesis is still debated. It affects mainly the young male adult. The diagnosis is generally easy in the typical forms: purulent discharge by an orifice located in the inter gluteal furrow and containing hairs. The authors suggest the analysis of the clinic and therapeutic aspects of the pilonidal sinus through a study spread over 9 years [January 1996-December 2004] and concerns 105 cases of pilonidal sinus with sacrococcygeal localization. The study is based on cases and operative reports in the register of proctology in the department. In our series, the chronic form of the pilonidal fistula represents 53, 7% whereas the acute form of abscess represents only 46,25% of all consultations. The pilonidal sinus may be associated to other protolo-gical affections. The open exeresis procedure was the only method used in our series, it is easy and effective method. Generally, the results were satisfying, the rate of recurrence was about 2,5% with minimal recession about 4 months. The only disadvantage is the long period of cicatrisation [6 weeks on average in our series]

[Aspergillosis of the paranasal sinuses]

Aspergillosis of the paranasal sinuses is rare. It's responsible of chronic sinusitis resistant to the antibiotic treatment, especially in a patient with antecedents of dental cares. Two cases of aspergillosis have been collected in our service during a period of 2 years, between January 2002 and December 2003. It is about a man and a woman of age respective 49 and 32 years hospitalized for a chronic rhinorrhea The CT scan discovered micro-calcifications within a complete opacity of the sinus The treatment consisted in a surgical excision by Caldwell Luc way The evolution is good with a middle receding of 15 months Discussion The diagnosis of the aspergillosis of sinus is easy in front of a chronic sinusitis poorly symptomatic with total or subtotal opacity of a maxillary sinusis [TDM] However only the endoscopy and/or the surgery with histological or mycological exam confirm the diagnosis The treatment is essentially surgical

Cryoglobulinemia in hepatitis C virus infection

Various extrahepatic manifestations are described during infection by hepatitis C virus [HCV]. They are essentially represented by cryoglobulinemia. We report a case of cryoglobulinemia associated with chronic hepatitis C. A 62 years old woman was hospitalised due to members purpura, associated with peripheral neuropathy localised in lower members. A biologic check-up showed a moderate hepatic cytolysis. A mixed cryoglobulin of type II has been found. Test for antibodies to HCV in serum was positive. HCV RNA was detectable in serum with a low content. The genotype was 2a/2c. Liver biopsy showed active hepatitis. The check-up before the treatment was normal, as well as the renal function. The treatment consisted of the combination of interferon plus ribavirin for 6 months

Surgical treatment of anoperineal lesions in Crohn's disease

The treatment of anoperineal crohn disease [APCD] is difficult and still a controversy subject. We reviewed 31 cases, which were 19 men. The middle age was 37 years. The lesions were represented by ulcerations in 14 cases, the fistulas in 28 cases and 2 cases of stenosis of the rectum. An hemorroidary disease was associated at nine patients with 1 case of malignant degeneration. The intestinal location was present at 63% of the cases and mostly in a distal part of the bowel. The biopsy of the APCD had objectives a granuloma in 15 cases and a malpighien carcinoma in one case. The treatment consisted, in addition to the treatment of the intestinal disease, on the hygienic and dietary prescription, metronidazol in 100% of the cases, ciprofloxacin in 7 cases. A treatment by immunosuppressor has been instituted for 2 patients. The surgical treatment done for 14 patients consisted in a drainage of the fistulas through fistulotomy [6 cases], incision of abscess [4 cases], progressive fistulotomy with elastic drainage [2 cases], resection of a fibrous diaphragm [1 case] and abdomino-perineal amputation in one case. The APCD is often invalidating with a real therapeutic problem: how can we treat the infectious process without compromising the sphincterian function

Tuberculosis of the colon. About one case

This illustrating case of primitive colic tuberculosis has permited us to underline its scarcity and its lack of specifity in its clinical and radiological presentation, making the diagnosis difficult especially with cancer. Endoscopy is fundamental because even when caseum or M.B.T. are not found, the endoscopy permits nevertheless to indicate trial treatment showing tuberculoid granuloma. Surgical treatment is necessary essentialy in cases of occlusion or perforation

Diverticular disease of the colon. About 15 cases

The study of 5 cases of colic diverticulosis observed during 12 years and a review of the literature permit the authors to show that this pathology is rare in Morocco, to insist on these different clinical aspects and to show the rarely and especially the gravity of its complications which make colectomy necessary. Finally, the authors notice the importance of the pathogenical and therapeutical part of dietary fibers on matter of colic diverticulosis

tuberculosis of oesophagus. Report of two cases

Tow abservations about the oesophageal tuberculosis have been collected. In the two observation no oesophageal symptomatology has been indicated. The diagnosis of oesophageal tuberculosis has been done on anamnestic, clino, radiologic, enodoscopic and histologic bases. The different anatomic, clinio, radiologic and therapeutic aspects of the oesophageal tuberculosis based on review of literature have been investigated. It is necessary to notice the importance of fibroscopy with biojosies in order to do the diagnosis of the oesophageal tuberculosis