[Liver abcesses: clinicals aspects and actual treatment]

A serie of 32 liver abcesses during a trial of 7 years is reported by the authors. The male sex is predominant [90%] The symptoms of the illness are typicaly those of the classic liver abcess. The treatment has improved with the progress of the imagery and especially the echography. The punction under echography had been tried in 7 cases, of which 6 were cured. When the seize of the liver abcess is small the medical treatment permits recovery in 68% of the cases. Only new cases that do not answer to medical treatment and punction are candidate to surgery

[Acute post-operative evisceration in visceral emergency unit]

The evisceration is rather a well-known complication to surgeons of the abdomen. 38 post-operating eviscerations were observed at the visceral emergency service C.H.U. Ibn Rochd Casablanca, for the last four years for 2385 laparotomies, with 5 deceases, be it frequency of 1,32% and a mortality of 13,16%. The analysis of these. observations, noting that the emergency conditions played probably a role in the unexpected happening of this complication, since the majority of our operated patients are peritonitis affected [63,2%], so lften mal nutruted, with the antecedents of chronic bronchitis [24,10%] which amputale the possibilities of the pre-operating reanimation. Our death rate, relatively lessened, reflets the interest of the prophylactic and preventive measures taben in respect to this affection. This were able to treat in time [55,26%] of P.O.E. covered before their affirmation in free forms [31,58%], the fixed forms [13,16%] were symptomatic of occlusion on deep seated bride in two patients. Our therapeutic means and our indications are well precise and well codified, however the pronostic of the evisceration remains defited with the post-operating peritonitis and the conditions of collision complicated by renal insufficiency and lung collision; and almost by their combination

Volvulus of the sigmoid colon. Therapeutic strategy. About 38 cases

A retrospective study of 38 cases of sigmoid volvulus is reported. The relative frequency of this pathology among young people in Morocco is noted. In 82% of cases diagnosis was without difficulty; and in two cases an associated small bowel volvulus was found. When deciding on the therapeutic approach it is essential to differentiate between cases in which the sigmoid colon is necrotic and those in which the changes are reversible. In the latter, the authors recommend a non surgical reduction [using flatus tube or better: colonoscopy] with elective surgery performed at later date. If initial reduction proves impossible, colonic resection whith colostomy appears to give the best results

Peritoneal puncture lavage in closed abdominal injury. About 230 cases

In this work, the authors have studied especially the reliability and the limits of the perironeal puncture lavage. About 230 cases of abdominal trauma collected in the services of surgical emergencies and surgical intensive care of the Ibn Rochd Teaching Hospital of Casablanca from 1980 to 1984. In this series, the child and the young adult of masculin sex are the most concerned, the road accidents constitute the most frequent etiology. The reliability of the method in our experience is 93%. The caution of use are reminded; 11% of wrongly positive results concern particularly the retro-peritoneal hematoma; the problem of the tiny intra-peritoneal lesion is discussed, the risk of the wrongly negative results is of 3%. The indications, sensibility and specificity of the peritoneal puncture lavage are discussed. That is a practice and useful examination, which diminishes the delay of diagnosis and the mortality in the case of abdominal trauma without evident clinic sign, and in the polytraumatised

Management of differentiated thyroid carcinoma. About 43 cases

This study is about 43 differentiated thyroid carcinoma. This form of cancer affects principaly women and young people between 20 and 40 years. Diagnosis is essentially based on the histological findings. Main treatment is surgery associated with hormonotherapy. We have practiced 43 operations: 9 unilateral thyroidectomies, 18 total thyroidectomies on one time, 8 total thyroidectomies on two times, 6 subtotal thyroidectomies, 2 tumors reductions, 6 neck dissections. The protocol that should be followed is the one that will give the best chances of survival with the lowest sequelae. Surveillance should last during all life

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

Surgical treatment of oesophageal stenosis secondary to reflux oesophagitis. About 18 cases

Eighteen peptic oesophagitis have been treated in the University Hospital of Casablanca mainly by conservative surgery. The results obtained show that the surgical procedure should discharge always the oesophagus, distend the stenosis by candling and end by an anti-surging back method