[Surgical treatment of secondary hyperparathyroidism in chronic renal failure. Report of 57 cases]

The aim of this study was to report the experience of the department of general surgery [Aile III] Ibn Rochd Hospital in surgical management of hyperparathyroidism in patients with end-stage renal disease [ESRD]. Fifty seven patients [24 M, 33F] with hyperparathyroidism underwent surgical parathyroidectomy from 1998 to 2004. Surgical indication was established according to clinical or biological assessment. Fifty nine operations were performed [57 first-hand cervicotomies and resumptions in two cases]. Histological examination of parathyroid gland specimens disclosed adenoma in 33 patients and hyperplasia in 14 patients. The follow-up was normal in 52 patients, marqued by cervical hematoma in 2 cases and death was deplored in 4 patients. The post-operative calcium level was in the normal range in 43 cases, low comparatively to the baseline in 12 cases and high in 2 cases. The PTH level was normal in 55 patients and high in two patients. Long-term outcome was evaluated in 36 patients mean follow-up [18 months]. A good evolution was noted in all patients referring to clinical, biological and radiological investigations. That, in our context, surgical parathyroidectomy still an appropriate approach for the treatment of hyperparathyroidism in patients with end-stage renal disease

Acute renal failure in children: a 111 cases report

Acute renal failure [ARE] is not exceptional in child. The aim of this study was to analyze the epidemiology, etiologies and the prognosis of ARE in children in Casablanca. We report 111 children with ARE, treated from 1991 to 2001 in the department of nephrology and pediatric unit of Ibn Rochd Universitary Hospital of Casablanca. The children were separated into 3 groups: newborn [6 cases], infants [28 cases] and child [77 cases]. Oligoanuria was observed in 71 cases [63%]. Causes of ARE were: functional ARF in 16 cases [14.4%], organic ARF in 86 cases [77.4%] due to glomerulonephritis in 39 cases [45.3%], hemolytic-uremic syndrome in 21 cases and acute tubular necrosis in 19 cases [18.2%]. Obstructive ARF was observed in 9 cases. The treatment depended on the cause of ARF. Renal replacement therapy was necessary in 37 cases [33%]. Eighty three children [90.2%] recovered a normal renal function, 9 children [9.7%] involved to chronic renal failure. Death occurred in 14 cases [12.6%]. We conclude that ARE prognosis depends on the cause and the early treatment

[Kidney disease in high hypertension]

The relation between hypertension and kidney disease is difficult to distinguish if the kidney disease is the cause or the consequence of hypertension or there is an other factor responsible. The aim of this study is to analyse the different kidneys damage in a group of hypertensive outpatients. It's a prospective study including 185 patients. The OMS criteria were necessary to have a confirmation of hypertension. The check up contained "azotaemia, creatininaemia, kaliaemia, natriaemea, alburninuria ". All the patients had a kidney ultrasonography. This study included l46females and 39 males. The average age was 48 years. Most of the patients [43%] were aged from 50 to 60 years. Kidney damage was found in 56 cases. There are 2 types of kidney disease in hypertension. The malignant nephroangiosclerosis found in accelerated hypertension and glomerulo-sclerosis with slow evolution noted in moderated hyper-tension and diabetes. Even though a benign kidney disease may be found in a hypertension and patient, it may be a sign of more important vascular and kidney risk and justifies vigilant surveillance

[Renal papillary necrosis retrospective study of 7 cases]

In this retrospective study, the authors precise the different aspects of 7 cases of renal papillary necrosis, hospitalized in the department of Nephrology-Hemodialysis of UHC Ibn Rochd of Casablanca between 1st January 1984 to December 1990. During these 7 years, the renal papillary necrosis constituted 5% of the annual hospitalizations. The study of age and sex-ratio showed a male predominance [7]%], with an average age equal to 31,7 +/- 12,9 years. Clinically, the most frequent signs were hematuria [100%]. The etiology has been dominated by diabetes associated with acute pyelonephritis in 71% of cases. One patient had sickle-cell hemoglobinopathy and the other had renal papillary necrosis due to the abuse of analgesics. Antibiotics has been given in cases of urinary infection. Blood transfusion has been necessary in the patient having sickle-cell hemolgobinopathy. There was an improvement in the outcome of all patients

[ surgery in hemodialysis patients]

The experience of the hemodialysis unit in the university hospital lbn Rochd Casablanca since its beginning in 1983 rest on 20 patients who underwent at least one surgical operation, that is 16 percent, of the population undergoin hemodialysis in our unit. The study of age and sex-ratio showed; 13 men [65%] and 7 women [35%] with an average age equal to 42 years. The frequency of untercurrent surgical pathology unrelated to renal failure is 4 percent. The analysis of the nature of operation in terms of kind of kidney disease shows a high frequency of urological surgery in chronic pyelonephritis. Regarding glomerulonephretis it is rather question of general surgery. Consequences of operation were simple in 90 percent of cases. We didn't deplore any decease after surgery

Nephrotic syndrome with minimal charge

On 230 cases of nephrotic syndrome treated between 1982 and 1988, 40 nephrotic syndromes were with minimal charge. The average of age was 22 years with a light male predominance [56%]. Oedema was the first motive of consultation, no case of arterial hypertension was seen. While hematuria was noted in 16% of the cases, proteinuria was between 3 g/24h and 22g/24h, protidemia average was 42.5 g/l, albuminemia was 17g/l. Corticosensibility was observed in 95.5% of cases. Relapse were frequent, the infection was the principal reason

Hepatitis B vaccination. Evaluation of efficacy in a high risk hospital personnel population

B. Viral hepatitis endemo-epidemiological potencial in hospital practice remains a preoccupyng problem. The study of serological status in an order of an active protection has been realised in a group of 100 of the medical staff in university hospital of Casablanca. 49 of the subjects had at least one of the markers of B. hepatitis among them one is chronical carrier of H.B.S. antigen. 51 seronegative and volonteers subjects [51%] have received 3 injections of the vaccine Hevac B [R] of Pasteur Institute, at one month interval. The evolution controls of Anti H.B.S. antibodies have been realised a month later after each injection. At the end of this vaccination 86.2% of the subjects have acquired a protection with rates of anti H.B.S. superior to the minimal protective rate. 5 bad responders have received a forth injection of the vaccine. The control of the antibodies H.B.S. was realised one year after, in 30 subjects [58.8%], 29 have kept Anti H.B.S. antibodies, among them 25 at protective rates

[Diagnostic value of antibody coated bacteria in the site diagnosis of urinary tract injection]

The clinical and radiologic data cannot always differentiate between upper urinary tract and lower tract infections. The antibody coated bacteria test has been performed in 12 cases and has proved to be a sensitive and specific indicator of renal infection

Value of determination of the aminoglycoside serum levels in severe infectious diseases

The authors have used a simple and cheap microbiological method for the determination of the aminoglycoside serum levels of four patients. The clinical situation where these monitoring may be useful are emphasized

[ treatment of acido-ketosis by small intramuscular doses of insulin]

The authors have examined 90 cases of acido-ketosis treated either by a discontinous insulin treatment with high indirect intravenous doses or small intramuscular doses, or by continuous perfusion of small doses of ordinary insulin. It is a fact that the best results on the duration of the ketosis as well as on the glycemia decrease, or on the full dose of insulin have been obtained by the continuous perfusion of insulin which was considered as a major disadvantage in the University hospitals of Morocco for many reasons: affected equipment, high cost, qualification of the medical personnel, intensive supervision. On the other hand, the intramuscular way is the way of the future in our country, first for its very good results barely inferior to the continuous perfusion, its harmlessness, its simplicity of execution and small cost. Furthermore it requires neither specialized services to the utmost, nor very qualified personnel

Acute barbiturate poisoning. About the biology

The acute barbiturate poisonings represent 20% of the whole medicinal poisonings, diagnosed in the university hospital of Casablanca during a year. Concerning 23 cases, the authors stress the different clinical, toxicological and therapeutic problems that the I.B.A. arise. They settle a relation between the rate of the barbiturics and the importance of the clinical symptoms. Being a result of a narrow collaboration of the university hospital and the school of Medicine, this study is a first approach to the organisation of a toxicological center likely to respond to the needs of Casablanca

[Acute poisonings by phosphorated insecticides. Measures of cholinesterase activity]

Acute poisonings caused by phosphorated insecticides, represent 8% of all cases of poisoning observed in the medical intensive care department of the Casablanca University Hospital during 1978. The authors report their clinical observations and their therapeutic results. After a review of the main techniques of evaluation of the cholinesterase activity and the choice of a method, they analyse the results of the dosage carried out in eight patients and discuss the evolution of the cholinesterase level according to the applied treatment

[Charbon meningitis: about one case]

The authors report a case of a primary charbon meningitis, with a review of the literature. The physiopathology of this affection is reviewed. The diagnosis is based only on bacteriology, especially when it is not known wether the patient has been exposed. The understanding of the toxin's action enables to consider the treatment which includes: antibiotics and serotherapy. The importance of prevention is emphasized