Demons-meigs syndrome

Demons Meigs is a rare, anatomo-clinical syndrome associated, with a benign ovarian tumor, ascitis and hydrothorax. The interest assigned to this triad reside in its similarity to the malignant ovarian tumor in its advanced stage and in its perfect and definitive surgical curability. The authors report here a case of 65 years old female patient, who were consulted for hypogastric pains and signs of vesical compression. Clinical examination showed a well defined hypogastic mass, rounded in shape measured 15cm diameter in a moderately abundant ascitis. The abdomino-pelvic echographic examination, showed a left heterogenic ovarian mass associated with intra peritoneal effusion. Chest X-Ray showed right hydrothorax. As the general condition was conserved, diagnosis of Demons-Meigs syndrome was evoked. This diagnostic was confirmed in the preaperative period by the presence of an ovarian mass without macroscopic malignants signs of malignancy, also histological examination showed benign fibroma. A simple excision was sufficient to have a definite recovery without recurrence six years after the operation. The association of pleural effusion and an ovarian tumour is not synonymous of metastasic invasion. Demon Meigs syndrome must be evoked because the surgical excision of the ovarian tumour permits the definitive recovery without complementary treatment

[Breast carcinoma associated to cancer of the vulva]

The synchronous association of breast infiltrating ductal carcinoma and moderately-differentiated squamous cell carcinoma of the vulva is extremely rare. The interest assigned to this association is not only resides in its rarity, but also in the therapeutic problems that it can raise. A 50 year woman, presented with a lesion of the left labia major of the vulva, its diameter measured 2cm, The tumour was mobile, painful, and bleeds at the least contact. The biopsy concluded to a moderately-differentiated squamous cell-carcinoma. Systematic genital examination revealed the presence of a nodule the right upper quadrant of breast. It was hard, painless and without axillary's nodes. The surgical intervention consisted at a radical mastectomy, with axillary's lymphonodectomy; in followed by a radical vulvectomy and bilateral inguinal lymphatic nodes dissection. The pathological examination concluded to a breast infiltrating ductal carcinoma II rank of SBR, confirmed the histological type of the vulvar tumour, and showed an inguinal involvement node. A postoperative radiotherapy and chemotherapy has been done. The patient was well with a postoperative follow up period of 18 months. The coexistence of a breast infiltrating ductal carcinoma and squamous cell carcinoma of the vulva is an extremely rare occurrence. Two cases have been previously reported in the literature. A congenital origin is possible; adenocarcinoma can be developed from ectopic, mammary gland tissue in the vulva. The acquired origin is also possible; the vulvar localization can be secondary to a metastatic breast cancer. Nevertheless, these two etiological approaches suppose that in the two localizations, the cancers are of the same histological type. The association of distinct types is uncommon. The double localization poses a problem of operative time chronology, and of the necessity of adjustment of doses of radiotherapy or chemotherapy. It must be discussed case by case; indeed the reduced number published case doesn't permit to establish a standard protocol. The logical therapeutic attitude seems to be, the surgical excision in the same time; every localization being considered as isolated. Otherwise all complementary pen-operative treatment [radiotherapy, chemotherapy] should include an adjustment of doses

Ectasies des voies biliaires intra-hepatiques: [a propos de deux cas]

Two cases of bile duct ectasia are here described: a first one localized to the left lobe and the segment I and a second one being diffuse: Both cases are mixed. We discuss etiology, anatomopathology and more Particularly: - The difficulties to diagnose the localization at the segment I level seeing that the latter was confirmed only ten months after a first surgical management. - The therapeutical problems related to the diffuse form if we consider that our patient has undergone surgery for five times during a 25 year period

Tumeur benigne langerhansienne non fonctionnelle [a propos d'un cas] Revue de la litterature

A case of non functional langerhansian tumor is reported here. A literature review was done and 14 cases were recorded. These pancreatic tumors whose course is quiet are uncommonly diagnosed in case of acompressive picture. The paraclinical examinations are not always able to give of the pancreatic origin, the therapeuticaL management is mainly surgical and consists of tumor excision. The histological examination allows to diagnose non secretory langerhansian tumor and suspects a benignity that only the course of disease can confirm

leiomyosarcome gastrique [LMSG]: a propos de 2 cas dont un revele par un hemoperitoine

The authors describe two cases of gastric leiomyosarcoma, reported in the department of surgery [Unite B] in the period between Jan. 1974-1 990. One of these cases presented by heamoperitoneom which is an uncommon complication. [Only 6 case presented in medical literatur]. The authors discuss, etiology, diagnostic of this rare tumor which shows difficulty in diagnostic preoperativly, Managment which is mainly surgical, prognosis which is better than that relating to adenocarcinoma

Lesreinterventions tardives apres thyroidectomie pour lesion benigne

From january 1974 to decembre 1988, 1252 thyroidectomies were caried out including 33 cases who are twice surgically managed for recurrence, 2,6% Of the 33 patients, 18 [544% did not undergo primitive surgery in the service. Recurrence results from two main diseases multiheteronodular goiter [4,85%] and Basedow's disease [4,30%] Among the methods that were used, enucleation is the most implicated [33%]; subtotal lobectomy ranks second with 7,62%. Recurrence is often Contralateral reproducing the primary disease in most cases; however it is neoplasic in one case [3%]. This latter eventuality justifies the surgical remanagement whose main preoccupations must be, as far as possible, preservation of thyroidal function and respect of reccurrents and parathyroids The treatment must be essentially preventive since that the rate of complications and sequelae is higher than in the usual surgery. Prevention is more particularly based on surgery during the first management. As for opotherapy, its braking is still a controversial question

Lestraumatismes de la VBP au cours des contusions de l'abdomen

The bile duct ruptures during abdominal contusions are uncommon and require often a violent trauma, Their mechanism is stilt unknown, but the theory of wrench of choledochus, firmly fixed to duodenum, by liver pressed back at the time of trauma in the diaphragmatic concavity, seems to be the very likely. Indeed, the seat of the lesion is most often at the junction between pedicular choledochus and retropancreatic choledochus, and it can be either partial or total. In general, it is diagnosed in peroperative stage and its diffIculty depends on the lesion type. The effective therapeutical management lies in the direct or canal suture associated or not to the kehr's drainage. The bilio-digestive anastomosis can be used when repair end to end is impossible. Secondary bile duct stenosis can occur in the operative sequelae

Resultats de l'examen clinique du cancer du sein: [a propos de 310 cas]

Breast cancer is an affection which occurs frequently in woman and in our country, it ranks second after cervix neoplasm. In spite of accessibility of mammary glands at the clinical examination, the diagosis is done lately in most caes. From the analysis of data of the clinical examination it results that: the consultation delay is over 6 months in more than 50% of cases, the tumor is the main reason of consultation in 76% of cases, its diameter is over 2 cm in 90% of cases. The regional adenopathies are found to be present in 82% of patients; metastases were noted in 10% of cases, cancer in developing eruption represents 10,88% and affection was diagnosed at very advanced stages [III or IV] in most cases. Prognosis in bad and the improvement can result from the early detection in which affected by the socio-economic level, the management conditions and apprenticeship of breast self-examination which remains an important element that one should take into consideration