[Rare causes of low digestive hemorrhage]

The lesions responsible for low digestive hemorrhage [LDH] are located at the lower part of the angle of Treitz. They are of origin colic in 90% of the cases. The lesions of hail are less frequent, with more difficult diagnosis and management. We report 2 observations of rare causes of LDH 47 and 44 years old respectively admitted both because of an anaemia with low digestive hemorrhage related to a stromal jejunal tumor in the first case and on a cavernous hemangioma of hail in the other case. The diagnosis is confirmed by the histologic study of the exeresis product

[Pilonidal sinus: about 105 cases]

The pilonidal sinus is a little frequent benign affection with often sacrococcygeal localization and that the etiopathologenesis is still debated. It affects mainly the young male adult. The diagnosis is generally easy in the typical forms: purulent discharge by an orifice located in the inter gluteal furrow and containing hairs. The authors suggest the analysis of the clinic and therapeutic aspects of the pilonidal sinus through a study spread over 9 years [January 1996-December 2004] and concerns 105 cases of pilonidal sinus with sacrococcygeal localization. The study is based on cases and operative reports in the register of proctology in the department. In our series, the chronic form of the pilonidal fistula represents 53, 7% whereas the acute form of abscess represents only 46,25% of all consultations. The pilonidal sinus may be associated to other protolo-gical affections. The open exeresis procedure was the only method used in our series, it is easy and effective method. Generally, the results were satisfying, the rate of recurrence was about 2,5% with minimal recession about 4 months. The only disadvantage is the long period of cicatrisation [6 weeks on average in our series]

Surgical treatment of anoperineal lesions in Crohn's disease

The treatment of anoperineal crohn disease [APCD] is difficult and still a controversy subject. We reviewed 31 cases, which were 19 men. The middle age was 37 years. The lesions were represented by ulcerations in 14 cases, the fistulas in 28 cases and 2 cases of stenosis of the rectum. An hemorroidary disease was associated at nine patients with 1 case of malignant degeneration. The intestinal location was present at 63% of the cases and mostly in a distal part of the bowel. The biopsy of the APCD had objectives a granuloma in 15 cases and a malpighien carcinoma in one case. The treatment consisted, in addition to the treatment of the intestinal disease, on the hygienic and dietary prescription, metronidazol in 100% of the cases, ciprofloxacin in 7 cases. A treatment by immunosuppressor has been instituted for 2 patients. The surgical treatment done for 14 patients consisted in a drainage of the fistulas through fistulotomy [6 cases], incision of abscess [4 cases], progressive fistulotomy with elastic drainage [2 cases], resection of a fibrous diaphragm [1 case] and abdomino-perineal amputation in one case. The APCD is often invalidating with a real therapeutic problem: how can we treat the infectious process without compromising the sphincterian function

Les dysphonies de l'enfant

Dysphonia is a modification of the timbre of the voice which becomes deep. It is more frequent in the child than in the adult. When it is acute, its etiological diagnosis is easy; but when it is chronic, it requires a complete otolaryngologic check-up to set up a diagnosis, and institute the appropriate treatment. There are many etiologies, and they are either organic or functional. The vocal unconfortableness is always present. The congenital malformations must be looked for, because they can entail organic lesions such as nodules. The treatment requires the cooperation of the child, and orthophonic therapy is essential to complete the treatment

pport des explorations otologiques dans le diagnostic des tumeurs de l'angle ponto-cerebelleux [A.P.C.]

The otologic explorations in pontocerebellar angle tumors are non invasive, not very expensive and constitute a means of patients detection and selection for neuroradiological examinations [CT scan and Magnetic Resonance Imaging]. When the affection is diagnosed, they are useful to discuss the surgical management according the audition level and the controlateral ear state

Tuberculosis of the colon. About one case

This illustrating case of primitive colic tuberculosis has permited us to underline its scarcity and its lack of specifity in its clinical and radiological presentation, making the diagnosis difficult especially with cancer. Endoscopy is fundamental because even when caseum or M.B.T. are not found, the endoscopy permits nevertheless to indicate trial treatment showing tuberculoid granuloma. Surgical treatment is necessary essentialy in cases of occlusion or perforation

tuberculosis of oesophagus. Report of two cases

Tow abservations about the oesophageal tuberculosis have been collected. In the two observation no oesophageal symptomatology has been indicated. The diagnosis of oesophageal tuberculosis has been done on anamnestic, clino, radiologic, enodoscopic and histologic bases. The different anatomic, clinio, radiologic and therapeutic aspects of the oesophageal tuberculosis based on review of literature have been investigated. It is necessary to notice the importance of fibroscopy with biojosies in order to do the diagnosis of the oesophageal tuberculosis

Gastric Polyps. About one case

The authors report on a case of gastric polyposis diffuse and isolated. The affection is rare and not well known. We have tried to emphasize certain aspect of this affection, such as its positive diagnosis which has become easy by the current practice of high fibroscopy. The second problem relates to the evolving risk dominated mainly by the degeneration of adenomatous polyps, but the association of gastric polyposis with stomach cancer is not rare. The gastric polyposis is considered as a precancerous lesion; thus total gastrectomy constitutes the means of therapeutic safety

Kystes hydatiques multiples du foie: a propos de 18 cas

Through 18 cases of hydatid kystis of the liver, we have tried to emphasize not easthe positive-diagnosis; which became easy due to ecnography tests, but on the majority of complications [biliary, fistulas, rupture, and high infectious]. Which add the difficulty of the technical details of an operation. The authors insist on the usefulness of presenting to a surgeon a patient with a very precise topographic diagnosis, to be able to decrease the morbidity of this social scourge

Primary appendiceal adenocarcinoma. A case report with pseudomyxoma peritonei

A case of primary adenocarcinoma of the vermiform appendix is reported with infiltrating mucus-secreting adenocarcinoma of the peritionium and a pseudomyxoma peritonei

Primary anorectal melanoma. About one case

The authors report one observation of a primary anorecral melanoma, in a woman of 60 years, diagnosed by biopsy of a pigmented tumour, situated 4 cm above the anal margin. The evolution was fatal by a metastatic diffusion and an abundant rectum haemorrhage within the period of 5 months. Through our case and review of literature we try to bring out the characteristics, particularly the problem of diagnosis and therapeutics of this rare location and a very bad forecast of a primary melanoma

Syndrome de Peutz Jeghers touraine: probleme pose par les polypes [a propos d'un cas]

The P-J syndrome is a dominant autosomic affection which exposes to many complications such as digestive bleeding, repeated small intestine invagination but mainly the proved exceptional possibilitey of digestive polyp degeneration. We may conclude sayreg that he P-J syndrome has a malignant potential