[Epidemiological profile and management of rectal cancer: what changed in 20 years?]

The incidence of rectal cancer is increasing in Western countries. What is it for us, do we have more rectal cancer? The change of our way of life, the aging population could be risk factors. Furthermore the management of rectal cancer has considerably progressed. The purpose of this study is to compare the epidemiological profil and the management of rectal cancer between two series collected to 20 years of interval. It is about two retrospective cases, the first one, collected from 1981 to 1985 [série A], includes 80 patients. The second one, recent, collected from 2005 to 2011 [série R], includes 94 patients. We analyzed for the epidemiological profile, the middle number of case per year, age, sex, seat of the tumor, histological type, metastatique stage. We analyzed for the management: operability rate, resection rate, type of intervention. The middle number of cancer of the rectum hospitalized per year in our formation is respectively 16 +/- 4.06 and 18 +/- 4.14 in serie A and the serie R [p = 0.91]. The mean age of patients was 49.5 +/- 14.7 for serie A and 48.6 +/- 13.3 for serie R [p = 0.674]. There is a masculine predominance in the two series [p = 0.7]. The three segments of the rectum are reached in the same proportions in the two series [p = 0.8]. The low rectum represented half of the cases [54.5% serie A, 56.9% série R]. The metastatique stage is more frequent in série R [32 [22.7%] vs 18 [34%] [p = 0.14]. Resection rate represents respectively in série A and série R, 68.9% and 84% [p = 0.428]. Abdomino-perineal amputation has been achieved in 45% of the cases in serie A and 30.3% of the cases serie R [p = 0.003]. The study found that the incidence of rectal cancer has not increased in our training in the space of 20 years, however, in two series, 25% of patients are aged less than 25. The management of this cancer was marked by systematic preoperative radiotherapy in the serie R for low rectal cancers, by reducing the safety margin to 2 cm and by reducing the number of abdominoperineal resection. Eidemiological profile did not change. However, the management of rectal cancer been influenced by the new data of the rectal surgery. This study showed that rectal cancer in Morocco had different characteristics than that in West country. Environmental and genetic studies may explain this difference

[Longo's technique in the treatment of hemorrhoids grade III and IV]

The purpose of this study is to show the interest of the Longo technique in the treatment of hemorrhoidal prolapse stage III and IV as to report as results too. Twenty-one patients were operated by the Longo technique. Hemorrhoids were classified as stage III and IV respectively in 13 and 8 patients. They have been followed in consultation at two months, six months and one year, allowing data collection. The mean duration of intervention was 38 minutes. The mean duration hospital stay was 2.2 days. There were no incidents during surgery. The mortality rate was zero. The complication rate is estimated at short, medium and long term, it was 23.80% [n=5]: two hemorrhages [9.52%] at the staple line, two acute urinary retention [9.52%] and external hemorrhoidal thrombosis [4.76%]. All patients didn't need any local treatment. The postoperative follow-up detected a bleeding at defecation in one patient; another one had a recurrence of the prolapse associated with rectal bleeding, the third had a completely asymptomatic moderate stenosis stapling site easily dilatable. Eighteen patients [85.71%] had no symptoms and were completely satisfied, two patients were moderately satisfied, and one was dissatisfied. The circular anopexy is an effective technique with 85.71% of patients satisfied in one year. The complication rate is low and the quality of results depends on the technical gesture

[Gastric metastasis of choroidal melanoma]

Gastric metastasis of melanoma are rare, and usually secondary to a cutaneous location. Gastric metastasis of choroidal melanoma are exceptional. Clinical symptoms are absent or atypical causing delay diagnosis. Only earlier diagnosis and complete surgical removal can improve survival of metastatic melanoma. 60 years old patient, treated for choroidal melanoma in 2007, admitted to the emergency for hematemesis. The patient also reported epigastric pain for three months and a weight loss of 10 kg. Upper gastrointestinal endoscopy revealed multiple ulcers with bleeding. Histology revealed a metastasis of melanoma. CT showed no other secondary locations. A total gastrectomy was contemplated. However a fatal gastrointestinal bleeding leads to death of the patient. Clinical symptoms of these metastases are atypical, and complications are rarely revealing. In oesgastroduodénale endoscopy, the presence of one or more nodules sometimes topped by ulcer can suggest the diagnosis. The himmunohistochimie confirm the diagnosis and mainly to amelanotic lesions. Staging must search for other secondary sites: lung, liver, peritoneal. Treatment is surgical and should be considered if complete resection is possible or in case of complications. Survival of gastric metastases of melanoma related to the completeness of resection The occurrence of digestive disorders in patients treated for melanoma must invite practicians to propose a gastrointestinal endoscopy with multiple biopsies to make an early diagnosis of gastric metastasis because only a surgical resection will allow a chance for these patients

[Hydatid cust of the spigelian lobe of the liver: diagnosis and treatment]

Surgery of the hepatic of hygdated cysts is a current practical procedure in Marocco due to the endemic context it is generally simple, and the surgical technique is viell cadified. Nevertheless certain hepatic localization like segment I may engeder difficulties and operatory complications that the surgeon must know for a better management. This is a retrospective study over ten years, it concerns ten patients with hydatid cyst affecting the Spigelian lobe with or without other localization. There is a female predominance the mean age is 43 years. Four patients were already operated on for liver hydatid cyct: two had involvement of caudal lobe. The clinical symptoms were not specific. Diagnostic imaging is mainly based on ultrasound and CT. All the patients were operated by laparotomy. Five patients had an hydatid cyst in caudal lobe only, four other associated hepatic lesions, and one case had a peritoneal hydatid disease. Type I was found in 2cases, type III in 5, type IV in one case and infected cyst in 2 cases. At surgical exploration it was found that caudael lobe cyst was intimatel anterioly with the hilum and the hepatic pedicle and with the inferior vena cava retrohepatic posterioly and at the right sue. We performed resection of the prominent dome ; the residual cavity was treated with hydrogen peroxide and systematically drained. The immediate postoperative were simple, the postoperative hospital stay was between 8 and 18 days. The surgical treatment of segment I hepatic hydatid cyst obyes the principals of hydated surgery and involues an important large vascular or buliarg wound risk. The resection of the prominent dome is an intervention simple, rapid and hemorrhagic with low mortality, but fails to eluminate a residual cavity may be ne seat of callection. Conservative treatment remains the gold standard, provided that there is a good postoperative monitoring and adequate management of biliary complications or infection