Surgical treatment of hydatidothorax. Series of 79 cases.

OBJECTIVE: A retrospective review of 79 cases of ruptured intrapleural pulmonary hydatid cysts. We analyse and evaluate our experience in the surgical treatment of this complication. MATERIALS AND METHODS: In a ten-year period, from 1990 to 1999, 79 patients were operated on in our service for intrapleural rupture of a pulmonary hydatid cyst. There were 51 males and 28 females with a mean age of 35.4 years. The diagnosis was established on the basis of different clinical signs and imaging studies. Surgical approach consisted of a posterolateral thoracotomy in all cases. After decortication, different procedures were performed on the pulmonary lesions according to the importance of lung destruction. RESULTS: Radical resections were done in 48 cases, including lobectomies (15), segmentectomies (33) and conservative treatment: simple capitonnage and bronchial fistula closure (31). Postoperative complications occurred in 8 cases (10.1%), including one pyothorax, one haemothorax, one prolonged air leak, two pneumonias and two wound infections. There was one postoperative death, by respiratory failure. Ninety-five percent (95%) of patients were free of recurrence of thoracic hydatid disease in a follow-up ranging from 1 to 10 years (mean: 5.4 years). CONCLUSION: Hydatid cysts of the lung should be treated before complications occur, particularly intrapleural rupture because it considerably increases morbidity.

Desmoid tumors of the chest wall.

OBJECTIVE: Desmoid tumors of the chest wall are uncommon fibromatous tumors characterized by their local invasion and frequent recurrences. They are considered low-grade malignant sarcomas. We analyze our results and evaluate our experience in their surgical treatment. PATIENTS AND METHODS: From 1980 and 1999, eight patients were operated in our service for desmoid tumors of the chest wall. There were five males and three females with a mean age of 32 years old (17-52 years). The diagnosis was established on the basis of clinical signs and imaging studies (Chest X-ray and computed tomography). Surgery was done by direct approach of the tumors. RESULTS: None of the patients had Gardner's syndrome. Complete resection was done in seven of the eight cases. Histology confirmed all cases. The follow-up ranged from 24 and 180 months, for a mean of 82 months. There was one death from cardiac and renal failure 3 months after a fifth resection associated with adjuvant radiation therapy. No other post-operative complications were observed. Recurrences occurred in 50% of cases, all treated by surgery, associated to radiotherapy in one case. CONCLUSION: Surgical treatment of primary desmoid tumors of the chest wall requires wide local resection. In cases of recurrences, multimodality therapies should be considered.

[Diaphragmatic hydatidosis: Report of a series of 27 cases]. / L'hydatidose diaphragmatique: A propos d'une série de 27 cas.

OBJECTIVES: To analyze the clinical, radiological and treatment of this rare disease and assess the results of surgical treatment by thoracotomy. PATIENTS AND METHODS: In the period of 10 years (1990-1999), 27 patients (15 males and 12 females, mean age: 32,4) underwent surgical treatment for hydatid cyst of the diaphragm with or without other location. Clinical signs were chest pain and dyspnea. Diagnosis was by abdominal echography and thoracic CT in 82% of cases. Surgical treatment was given alone in 25 cases, completed by medical care in 2. RESULTS: Diaphragmatic cyst was simple in 17 cases and complicated in 10: intrapleural rupture (4 cases), pulmonary hydatid cyst association (3 cases), hepatic cyst (2 cases) and disseminated form (1 case). Resection of the dome and pericystectomy were the used surgical procedures. Pneumothorax was the only post-operative complication (3.7%). The mortality was nil. CONCLUSION: Diaphragmatic hydatidosis requires a careful topographic diagnosis between the lung, diaphragm, liver or abdominal localizations. Ultrasound and computed tomography are highly contributive. Surgery is the best treatment, thoracotomy being an excellent approach.

Hydatid cyst: an unusual disease of the mediastinum.

BACKGROUND: Hydatid cystic disease is still a significant clinical problem in endemic countries, particularly in Morocco. Mediastinal localization is very rare. We report our surgical experience with this particular lesion. PATIENTS AND METHODS: In a retrospective review of the last ten years (1990-1999), we had seven cases of mediastinal localization out of total of 2332 (0.3%) intrathoracic hydatid cysts treated in our service. Imaging investigation consisted of chest x-ray and computed tomography. All diagnoses were confirmed peroperatively macroscopically and for some lesions, histologically. RESULTS: Complete resection of the cyst was performed in six cases. In one case, a small part of the wall intimately adherent to the superior vena cava was left in place. There were no complications, mortality or recurrence. CONCLUSION: Hydatid cysts can be found in many different sites in the body. Whenever possible, surgical management is the best treatment but extensive resection should be avoided. Medical treatment as an adjunct to surgery is indicated when there is a risk of dissemination.

[Treatment of hydatid bilio-bronchial and bilio-pleuro-bronchial fistulas by thoracotomy]. / Traitement des fistules biliobronchiques et bilio-pleuro-bronchiques d'origine hydatique par thoracotomie.

STUDY AIM: The aim of this study was to report the results of surgical treatment of hydatid bilio-bronchial et bilio-pleuro-bronchial fistulas via thoracotomy. MATERIAL AND METHODS: From 1990 to 1998, 63 cases were observed in the same center. Biliptysis was the main symptom in 72% of cases. The diagnosis was based on chest radiography and abdominal ultrasonography; both examinations visualised the cyst, intrathoracic collections, a diaphragmatic breach and biliary lesions. All patients were treated by one-stage thoracotomy. The procedures consisted of lung resection (lobectomy and/or segmentectomy) (n = 47) and decortication (n = 16) in the chest, cyst dome resection (n = 61) or partial pericystectomy (n = 12) in the abdomen and suture of the diaphragmatic defect in all cases after hepato-diaphragmatic disconnection. An additional laparotomy was necessary in 4 cases. RESULTS: There were 8 deaths (12.7%): one intraoperative death due to haemorrhage and seven postoperative deaths, mostly related to pulmonary complications. Postoperative complications (14.3%) were mainly respiratory. Clinical and radiological results were good with a one-year follow-up. CONCLUSION: Bilio-bronchial and bilio-pleurobronchial fistulas due to hydatid cyst are rare, but severe diseases. They are responsible for lesions at three levels: abdominal, diaphragmatic and thoracic. A high perioperative mortality rate was observed. Thoracotomy is the best approach for surgical treatment at all three levels.

[Descending necrotizing mediastinitis. A case report]. / La médiastinite descendante nécrosante. A propos d'une observation.

Descending necrotizing mediastinitis which may occur as a complication of neglected oropharynx infection is an uncommon disease, although it is lethal in most cases. Trismus and dyspnea are usual with palpable crepitation located in the cervico-thoracic area. Early diagnosis can be confirmed with accuracy by CT scan. Treatment is based on early mediastinal drainage by cervical approach, intravenous antibiotics and reanimation. The reported case had a favorable outcome.

[Hydatid thymic cyst. A case report]. / Kyste hydatique du thymus. A propos d'une observation.

Hydatid thymic cyst is exceptional. The diagnosis is suspected by radiology and epidemiology. Serology tests provide variable results and surgery is the only treatment. We report a case of thymic hydatid cyst in a 20-year-old man who had no other localizations. Diagnosis was confirmed at surgery and by histology.

[Pulmonary aspergilloma: results of surgical treatment. Report of a series of 206 cases]. / Les aspergillomes pulmonaires: résultats du traitement chirurgical. A propos d'une série de 206 cas.

STUDY AIM: The aim of this retrospective study was to report the results of the surgical treatment in 188 patients operated on for pulmonary aspergilloma in a series of 206 patients observed in Morocco. PATIENTS AND METHOD: From 1982 to 1998, 206 patients were treated for pulmonary aspergilloma in the same hospital; 188 were operated on and surgery was contraindicated in the other patients with general or respiratory failure. Hemoptysis was the main symptom, present in 190 patients (92%). Surgery was performed on principle with 108 lobectomies, 38 segmentectomies, 18 lobectomies and segmentectomies, 21 pleuropneumonectomies and 3 thoracoplasties. RESULTS: Postoperative complications occurred in 36% of the patients including: pyothorax (n = 15), hemothorax (n = 10), rehabitation defects (n = 17) and respiratory failure (n = 10). Reoperation was necessary in 6 patients. Postoperative mortality rate was 6.4% (12 patients including 5 treated by pleuro-pneumonectomy). CONCLUSION: The surgical treatment, in spite of its high morbidity, has to be proposed to all patients with pulmonary aspergilloma, even in asymptomatic patients when there is no surgical contraindication. Pleuropneumonectomy is a very high risk procedure and its indications must be restricted. Thoracoscopy was rarely performed in this series.