Biliary digestive fistulas. About 31 cases

We report a serie of 31 bilio-digestive fistulae of lithiasis origin. Symptomatologia is often quite atypic. This discovery was fotuitous in 93.6%. Hence, plain X ray examination of the abdomen, and upper gastroduodenal series are of importtance. All our patients have been treated surgically with satisfactory results except one death

Brachial plexus block and upper limb regional anesthesia

The authors report their experience about 50 cases of supra clavicular plexus block realised by Kulen-Kampff method. The anesthesia obtained has been complete in 84% of cases and in the 16% remaining general anaesthesia was necessery to permit surgery. A case of moderate pleural detachment lately and a case of post anaesthesia paresthesia both spontaneously resolvent were registered. Actualy the adoption of perivascular techniques of brachial plexus anaesthesia [interscalenic, supraclavicular, axillary] have greatly improved the performance of this variety of upper limb locoregional anaesthesia, thus reducing the percentage of failure and eliminating or reducing the risk of pneumo-thorax. Locoregional anaesthesia of the upper limb should constitute a daily method in the surgery of upper limb and not a technic subordinated to the contra-indications of general anaesthesia

Postoperative subphrenic abcess. A study of 20 cases

20 post operative subphrenic abcess are repported, 11 secondary to hepatic hydatic cyst procedures [55%], 7 secondary to biliary surgery, one after splenectomy and one after digestive fistula after gastrectomy. The value of clinical signs, radiology and echotomography is emphasized. The mortality rate [10%] is the consequence of a septic state. The prevention should include a better surgical technique and an efficient drainage after various abdominal interventions

Papillary carcinoma: a rare cancer of the biliary duct

Papillary carcinoma is rare as it represents only 5% of carcinomas of the common bile duct. The long prodromal phase is dominated by attacks of cholangitis and incomplete appearance of the jaundice when fully constituted. Its papillary structure consists of coalescent fringes producing a typical glandular appearance. Finaly, it evolves very little, therefore is of good hope of survival even after palliative treatment

injury severity score: a prognosis index in multiple injuries patients. 400 cases report

For the early, objective and quantitative evaluation of prognostic in multiple injuries patients, the authors would like to introduce in their current practice the injury severity score [ISS]. This clinical score is based on the abbreviated injury scale [AIS] witch divide the human body into four parts: head, face, trunk and limbs. Mean ISS equal 35.8 while mortality rate reach 52%. The matter of fact is that mortality is proportional to ISS rise: when the ISS is between 30 and 40, mortality reach 50%; when ISS is lower, prognostic improve, but when it exceed 50, prognosis is awfull. For a best evaluation of prognossis of polytraumatised, the authors propose to group head and face injuries in a same column of cotation and to divide trunkular injuries into chest and abdominal injuries

Intentional normovolemic hemodilution with autotransfusion. Report of 20 cases

Issuing from this work, it is proved that the intentional normovolemic hemodilution is a technique with numerous adventages and containing no risks. Effectively, blood economy and the possibility to compensate the per-operatory bleeding by means of auto-transfusion, make clear that the application of this technique aught to bring about a changer of the transfusional therapeutics policy, and incite doctors to modify their attitude facing any hemorrage surgery. If the intentional normovolemic hemodilution constitutes a certain place in the field of blood transfusion, there is nothing left except the intentional decrease of the hematocrit and the determining increase in the diminution of the globular loss in the course of the per-operatory haemorrhage

Anesthesia in gastroenterologic and proctologic medecine

Different anaesthetic modalitis are actualy used in gastro-enterologic medecine. These anaesthesias allow to undertake with security and confort surgical gestures [cure of fistula and anal fissure, cure of hemorroidal thrombosis and hemorroidectomy] and endoscopic procedures [perendoscopic resection of a polyp, to put an endobiliary prothesis, retrograd cholangiography and pancreatography]. The doctor anaesthesist whose presence is indispensable has the choice between general anaesthesia [intraveinous or inhalation] and loco regional anaesthesia [rachianaesthesia, epidural anaesthesia, peridural anaesthesia]. Minimum means of ventilatory and circulatory reanimation are however necessery to undertake theses anaesthesias

effect of dopamine on the renal function of shocked patients. About two observations

Two patients, representing a shock and an oligo-anuric renal insufficiency have been treated with 2.5 to 7.5 mcg/kg of dopamine. The result was a resuming of diuresis, a normalization of the hemodynamic situation with a normal heart beat rate and without any anomaly of the auriculo-ventricular conduction. This study emphasizes the effect of dopamine on the renal function during hemodynamic failures complicated with oligo-anuria

Hypomagnesemia. A danger present everyday. About 2 observations

Two cases of major hypomagnesemia were diagnosed following prolonged parenteral nutrition. The parenteral nutrients had not included this trace element because it is not locally available. The authors stress its importance and the necessity to include it in the Moroccoan therapeutic arsenal

[Enteric nutrition in children with denutrition]

Since it was first described by E. Levy, enteric nutritional assistance has been used successfully in surgical and medical denutritions. The authors have applied this method on 34 children whose ages range from 8 months to 16 years, suffering from denutrition among which 10 protein caloric malnutritions. This first Moroccan experience is based on the use of a cheap mixture of a hyperprotidic flour basis of local production. Enteric reanimation in cases of protein caloric malnutritions improves the prognosis, contributes to the recovery and improves the psychomotor development as well. As for surgical denutritions, enteric reanimation with a low and continuous flow has unabled better defense against infection, quick reconstitution of the losses of substance and a better cicatrization of the walls