Thyroid tuberculosis: diagnosis and treatment.

OBJECTIVE: It was the aim of this study to report clinical characteristics and treatment of thyroid tuberculosis (TT). METHODS: During 16 years, 2,426 patients have been operated on the thyroid in the surgical department 'A' in Ibn Sina Hospital, Rabat, Morocco. Anatomopathological results of the removed thyroid were analyzed for evidence of tuberculosis. RESULTS: Eight cases of TT were diagnosed. Five patients had a goiter and 3 patients had an isolated nodule of the thyroid. In one case, fine-needle aspiration cytology gave the diagnosis of TT. This patient had a complete drainage of the abscess. In all other patients, the diagnosis was given after surgery. All patients received additional antituberculous drugs for 6 months, and follow-up was satisfactory. CONCLUSION: TT does not have any consistent symptoms. Fine-needle aspiration is the best method for diagnosis and can result in the avoidance of surgery.

[Recurred hydatid cyst of the thyroid: a case report]. / Kyste hydatique récidivant de la thyroïde: à propos d'un cas.

A 21-year-old patient underwent surgery in 1987 for hydatid cyst of segment VIII of the liver. Six years later, the patient developed a cold thyroid nodule. During the thyroid operation, needle aspiration and cytology study confirmed the diagnosis of hydatid cyst. Resection of the prominent dome was performed. In 1996, the patient developed cervical recurrence. Pericytectomy was attempted and during the procedure a wound of the subclavian artery required sternoclavicular disarticulation. Hydatid cyst of the thyroid gland is rare, but should be considered in patients living in endemic zones who develop an anterior neck tumor. Cystectomy, isthmolobectomy or sub-total thyroidectomy may be indicated. Resection of the prominent dome may be required in the event of recurrence.

[Iterative surgery for goiter]. / Les réinterventions après thyroïdectomie pour goitre.

AIM: Identify and resolve problems related to iterative surgery for goiter. PATIENTS AND METHOD: Fifty-nine patients who underwent surgery for recurrent benign goiter between 1990 and 1999 were included in the study. RESULTS: Forty-two patients had lobectomy and isthmusectomy (71.2 and 17 patients had subtotal thyroidectomy (28.8%). The delay from initial surgery to recurrence was less than 5 years for 44% of the patients and was more than 10 years for 17.8%. There was no post-operative mortality and no recurrent laryngeal nerve injury. Early post-operative hypocalcemia occurred in 2 patients (3.3%). CONCLUSION: The goal of revision surgery for recurrent goiter is total thyroidectomy. Prevention is a rational management scheme for thyroid nodules.

[Tuberculosis of the thyroid. Diagnosis and treatment]. / La tuberculose de la thyroïde. Diagnostic et traitement.

Thyroid tuberculosis is rare. We present the case of a 25 year-old woman with tuberculosis of the thyroid. Although seldom observed, tuberculosis should be considered in the differential diagnosis of nodular lesions of the thyroid. Diagnosis is made by histological examination and demonstration of the tubercle bacilli from biopsy or aspiration specimen. The efficacy of fine-needle aspiration cytology in diagnosis of tuberculosis of the thyroid is proved. Administration of antituberculous drugs is considered as the treatment of choice. Abscess drainage is sufficient. In rare cases surgery is necessary. The prognosis is good.

[Massive rectorrhagia and acute intestinal occlusion revealing Peutz-Jeghers syndrome: apropos of 3 cases]. / Rectorragie massive et occlusion intestinale aigueë révélant un syndrome de Peutz-Jeghers: à propos de trois cas.

Peutz-Jeghers syndrome is a rare hereditary disorder involving digestive polyposis with hamartomatous gastrointestinal polyps and mucocutaneous lentiginosis. We report three cases in which this syndrome was detected by complications: a massive rectal hemorrhage requiring a blood transfusion in one case and acute impaction of the bowel requiring emergency surgery in the other two. This work demonstrates the importance of the complications that may indicate that the patient has this syndrome. We also discuss the cancers of the digestive system and other organs that may be associated with PJS and recent progress in genetic research into this disease.

Primary psoas abscess. A review of 16 cases.

OBJECTIVE: Most psoas abscesses are secondary. The objective of this study was to report on the clinical features, diagnosis and treatment of primary psoas abscess. METHODS: We retrospectively studied 16 cases seen over a ten-year period (1987-1997) and compared our findings to published data. RESULTS: There were 14 men and two women, with a mean age of 6 years (range, 17-57 years). The right side was affected in nine cases, the left side in six, and both sides in one. Fever, pain and psoas spasm were the presenting symptoms. Laboratory tests for inflammation were positive; four patients had a high neutrophil count. Ultrasonography demonstrated a fluid collection in the psoas in 13 patients. A computed tomography scan was done in 14 patients and showed either a fluid collection (n = 11) or a presuppurative abscess (n = 3). Magnetic resonance imaging was not used. The organism was recovered in nine patients and was a Staphylococcus aureus in seven, an Escherichia coli in one and a Pseudomonas aeruginosa in one. The Brucella agglutination test was strongly positive in two patients. Findings were negative from investigations done to look for a cause (discitis, urinary tract infection, Crohn's disease, ulcerative colitis, malignancy or infection in the vicinity of the psoas muscle). All patients received antimicrobial therapy. Drainage was percutaneous in six patients and surgical in ten. The outcome was favorable in every case.

[Duodenopancreatic injuries. Apropos of 30 cases]. / Les traumatismes duodéno-pancréatiques. A propos de 30 observations.

We present a retrospective study of 30 cases of duodenopancreatic injuries seen between 1985 and 1995. All injuries were due to blunt trauma mostly in traffic accidents. They include 16 duodenal injuries, 7 pancreatic injuries and 7 combined duodenopancreatic trauma. All patient were operated for peritonitis or state of shock. Preoperative diagnosis was evoked in two cases (6%). Isolated duodenal trauma (30%) were treated by primary repair and drainage, while pyloric exclusion was performed for five patients (17%), distal pancreatectomy in one case (3%), duodenojejunostomy with pancreatic jejunostomy in one patient (3%). In three patients (10%) isolated pancreatic trauma were treated by drainage, cystogastrocotomy in two cases (6.6%). There were nine deaths (30%) due to the severity of associated injuries, a false diagnosis, or incomplete initial treatment. Poor outcome was mostly due to delay in the diagnosis and associated intra-abdominal injuries. A precise diagnosis of the duodenopancreatic trauma allows an appropriate therapeutic strategy avoiding subsequent complications.

[Treatment of bleeding duodenal ulcer. A study of mortality and indication of surgical treatment. Apropos of 557 cases]. / L'ulcère duodénal hémorragique. Etude de la mortalité et des critères d'opérabilité. A propos de 557 cas.

From 1986 to 1996, 557 patients are treated for acute ulcer bleeding. The sex ratio is five to one for men, the average age is 40 years old. The duodenal ulcer is revelated by haemorrhage in 25.8%. 181 patients underwent a surgical operation (32%). This percentage is higher that those encountered in the literature, due probably to our specific context (patients from low socioeconomic level, can not afford medical treatment, medical surveillance or control, lack of blood products in emergency. The most practiced surgical treatment is weinberg operation: "Troncular Vagotomy" with "pyroloplasty" and "ulcer sean" practiced in 86.1% of the cases; "Troncular Vagotomy" with "Gastro-intestinal anastomosis" is operated in 7.7% of the cases; "Superselective Vagotomy" and "Seromyotomy" is practiced in 3.8%, with the "Antroduodenectomy" is practiced in 1.1% of the cases. The overall death rate observed is about 4% this value increase to 11% after surgical treatment. This death rate is lower than the literature, that's probably anociated the fact that most of our patients are young and do not hold severe weaknesses. This study indicates that mortality was related to the patient's age, the patient's condition and recurrent haemorrhages.

[Immediate esophagojejunal anastomosis after total gastrectomy for caustic necrosis. Apropos of 5 cases]. / Anastomose oeso-jéjunale immédiate après gastrectomie totale pour nécrose caustique. A propos de 5 cas.

Five patients have had an immediate recovery of the continuity after total gastrectomy for caustic necrosis by an oesophago-jejunostomy. One patient died of post operative peritonitis no linked with the oesophago-jejunostomy. Two cases had a respiratory infection and one patient had presented a jejuno-jejunostomy fistula. Three healed without sequela. The immediate recovery of the continuity after total gastrectomy for caustic necrosis with moderate lesions of the oesophagus steals the ideal therapeutic attitude.

[Left internal paraduodenal hernia. Apropos of a new case]. / Hernie interne para-duodénale gauche. A propos d'une nouvelle observation.

Internal herniae are responsible for 2% of intestinal obstructions. Various types of such herniae have been described. Diagnosis is difficult but must be thought of in a patient with small bowel obstruction without previous laparotomy or apparent hernia of the abdominal wall. Treatment is always surgical.

[A rare cause of massive upper digestive hemorrhage. Duodenal tuberculosis, apropos of two cases]. / Une cause rare d'hémorragie digestive haute massive. La tuberculose duodénale à propos de deux observations.

Tuberculosis of the duodenum was revealed in two patients by severe upper digestive tract bleeding. These cases illustrate the difficulties in diagnosing tuberculosis of the duodenum which can present as a simple bleeding ulceration. This "infectious" ulcer is an exceptional finding but certain diagnosis can be made at laparotomy with extemporaneous pathology of the lymph nodes. For non-complicated cases, the diagnosis may be suspected on the bases of routine laboratory tests. Surgery should be limited as much as possible since specific antibiotics are usually successful in cases of digestive tract tuberculosis.

[An unusual cause of colonic perforation: sinus haemophagocyte histiocytosis]. / Une cause exceptionnelle de perforation colique: l'histiocytose sinusale hémophagocytaire.

The authors report about one case of colic perforation due to sinus histiocytosis with massive lymphadenopathy. This observation has permitted us to give a point of view about this uncommon affection with unknown cause.

[Biliary surgery using the ligamentum teres. Technique for repairing loss of substance in the common bile duct]. / Plastie biliarie utilisant le ligament rond. Technique de réparation des pertes de substance de la voie biliaire principale.

Ligamentum teres was used to repair a total or partial common duct defect in seven cases: 4 cases of biliobiliary stone fistula, 2 cases of hydatid cysto-biliary fistula and one case of iatrogenic common bile duct trauma. Biliary duct reconstruction is possible in the above cases of biliary damage. The short-term and long-term results were satisfactory.

[Spontaneous rupture of a mucinous cystadenoma of the pancreas and suppuration in the abdomen]. / Rupture spontanée et suppuration dans l'abdomen d'un cystadénome mucineux du pancréas.

The spontaneous rupture and the suppuration of a mucinous cystadenoma of the pancreas remain exceptional. The authors report about one case. The help provided by ultrasound and computed tomography for the diagnosis is indisputable. The condition is most often mistaken with a pseudocyst of the pancreas. This case is used as a basis to study the mechanism of suppuration and discuss the merits of an emergent histological diagnosis to choose an appropriate therapy.

[Pseudotumor form of hepatic tuberculosis. Apropos of a case]. / La forme pseudo-tumorale de la tuberculose hépatique. A propos d'une observation.

The authors report about one new case of hepatic tuberculosis in a pseudotumoral form, and emphasize the diagnostic difficulties even in a country where tuberculosis is endemic. Hepatic puncture, either with sonographic monitoring or during laparotomy, is the paraclinical examination of choice. The histological study supports the diagnosis. The medical treatment is that of any form of tuberculosis. The surgical treatment is most often indicated when a diagnosis of liver tumor is assumed.

[Encapsulating peritonitis. Report of 2 cases]. / Les péritonites encapsulantes. A propos de deux observations.

Walled-off peritonitis which is a frequent occurrence in patients treated by continuous ambulatory peritoneal dialysis may also occur in cases where there is no obvious pathological factor. This was the case in the two patients reported. Both were male patients aged 28 and 32 years hospitalised and operated on for acute intestinal obstruction. Positive diagnosis was made at the time of operation. Decortication with total enterolysis was performed in the two cases. However, a jejunal fistula with a favorable outcome occurred in one case, investigation for acid fast bacilli was negative and histological examination was non specific.