Hydatid disease of the ribs: An exceptional location.

Background: Hydatid disease is a zoonosis caused by larval stages of cestodes belonging to the genus Echinococcus. The rib location is exceptional. It presents a real diagnostic and therapeutic challenge. Objectives: To describe the clinical, serological and radiological features and surgical management of rib hydatidosis. Methods: This is a retrospective study conducted over 4 years, on five cases of rib hydatidosis. We analysed the clinical and radiological presentations and the adopted therapeutic procedure. Results: The average age of our patients was 44 years, without gender predominance. The clinical signs were dominated by the presence of an immobile swelling of fluid consistency without inflammatory sign, accompanied by moderate and intermittent localised pain. The laboratory assessment was nonspecific. The radiological assessment, including chest X-ray and thoracic computed tomography, with and without contrast, was essential in order to assess the extent of the lesion. Thoracic magnetic resonance imaging was requested in one case because of suspicions of a spinal extension. All of our patients underwent a rib excision accompanied by medical treatment of albendazole 24 hours after the surgery. The follow-up ranged from 1 year to 4 years and did not show any recurrence. Conclusion: Hydatidosis of the ribs is an exceptional location of hydatid disease. The diagnosis was based on radiology and intraoperative exploration. The treatment remained essentially surgical by rib excision with anthelmintic drugs to prevent recurrence.

[Amelanotic pulmonary melanoma]. / Mélanome pulmonaire achromique.

We report a case of amelanotic pulmonary melanoma in a 52-year-old man. Histological diagnosis was established after right lower lobectomy. The primary source was not found. We describe the diagnosis, treatment and surgical follow-up of this type of pulmonary tumour.

[Role of pulmonary resections in management of multidrug-resistant tuberculosis. A monocentric series of 29 patients]. / Le rôle des résections pulmonaires dans le traitement de la tuberculose multirésistante. Une série monocentrique de 29 patients.

INTRODUCTION: Multidrug-resistant tuberculosis (MDR-TB) is a worldwide health problem. Surgery is often used as an adjuvent therapy with anti-tuberculosis agents. The aim of this study is to present our results of pulmonary resections in the treatment of MDR-TB. MATERIAL AND METHODS: [corrected] This is a retrospective monocentric study of 29 patients operated on between 1995 and 2010 for MDR-TB. RESULTS: Tuberculosis was evolving from 9 to 108 months with a median of 34.77±19.88 months. The average number of tuberculosis relapses was 2.73 per patient. All patients had a destroyed and/or cavitary parenchyma and 17 had bacilli in sputum at the time of surgery. Lobectomy (51.17%) and pneumonectomy (41.37%) were the main interventions carried out. The operative mortality was 3.44%. Complications such prolonged air leaking and empyema had occurred in 9 patients. The rate of postoperative microbiological conversion was 88.23%. One patient had a relapse 5 months after surgery. CONCLUSION: Surgery associated with medical treatment provides a high cure rate to the detriment of an acceptable morbidity and mortality.

[Outcomes after thoracotomy for intra-abdominal hydatid cysts ruptured into the thorax (a 160 case series)]. / La place de la thoracotomie dans le traitement des kystes hydatiques abdominaux rompus dans le thorax.

INTRODUCTION: The purpose of this study was to assess the results of the surgical treatment of abdominal hydatid cysts ruptured in the thorax. PATIENTS AND METHODS: We collected data from 160 patients who experienced the intra-thoracic rupture of an abdominal hydatid cyst during the period 1997 - 2008: 158 located in the liver, one in the spleen and one in the kidney, which had been treated surgically in a single centre. Diagnosis was based on a history of surgery for abdominal hydatid cysts, specific symptoms including biliptysis (40% of the cases) and expectoration of hydatid cysts, as well as radiological findings (chest x-ray; abdominal ultrasound and CT-scan). All patients were operated on through a thoracotomy. RESULTS: In-hospital mortality was 7.5%. Postoperative complications occurred in 16% and mainly consisted of pleural and pulmonary disorders. CONCLUSION: Thoracotomy offers simultaneous and adequate access to address thoracic and abdominal injuries with a reasonable mortality and morbidity in patients with this condition.

[Paraoesophageal cyst revealed by repeated infections]. / Kyste para-oesophagien révélé par des broncho-pneumopathies récidivantes.

Paraoesophagial cyst is an extremely rare congenital malformation of the oesophagus often discovered incidentally in adults. We report the case of a paraoesophageal cyst in a 45 year old man revealed by recurrent chest infections and confirmed by examination at surgery.

[Thymolipoma revelated by myasthenia]. / Thymolipome révélé par une myasthénie.

Thymolipomas are rare, often asymptomatic benign tumors; their revelation by myasthenia is exceptional. A 49-year-old patient with a one-year history of fluctuant muscular fatigability developed ptosis. Electromyography revealed a myasthenic neuromuscular block. The CT scan disclosed a thymic mass especially important on the left side. Thoracotomy under left mammary was performed for thymectomy. Pathology examination of the surgical specimen provided the diagnosis of benign thymolipoma. At 37 months follow-up, the myasthenia has remained unchanged.

[Multiple extrapulmonary thoracic hydatidosis]. / L'hydatidose thoracique extrapulmonaire multiple.

INTRODUCTION: Extrapulmonary intrathoracic hydatid cysts are unusual but they may be multiple, particularly during a secondary dissemination. With the aim to clarify the origins of this dissemination, we report our experience in the treatment of multiple thoracic extrapulmonary hydatidosis (MTEH). MATERIAL AND METHODS: Between January 1995 and December 2004, 41 patients were operated on for MTEH in our department. Chest roentgenogram and computed tomography were the main means of diagnosis. The treatment consisted of total surgical removal of the intact cysts. The approach was a postero-lateral thoracotomy (right in 29 cases, left in 8 cases, bilateral in 3 cases) and a median sternotomy in one case. All patients received complementary medical treatment with Albendazol. RESULTS: The MTEH was secondary to haematogenous dissemination in 6 patients (15%), to a hydatid cyst of the lung in 7 patients (17%) and to a hydatid cyst of the liver in 28 patients (68%). 75% of these patients had had a previous surgical intervention for hepatic cyst and 88% of them had diaphragm involvement. There were no deaths among our patients but the recurrence rate was 12%. CONCLUSION: Secondary intrathoracic extrapulmonary hydatidosis is generally seen among patients operated on for hydatid cyst of the liver. Necessary precautions must be taken at the time of surgery to avoid any intrathoracic dissemination.

[Endobronchial schwannoma in a child. A case report]. / Schwannome endobronchique chez l'enfant. A propos d'un cas.

Intrathoracic neurogenic tumors are rare and interest primarily the mediastinum. Their endobronchial localization is exceptional, a fortiori in the child. The authors report a case of endobronchial benign schwannoma in a 11 year-old-child treated by pneumonectomy.

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.

[Cystic lymphangioma of the mediastinum. Seven cases]. / Les lymphangiomes kystiques du médiastin. A propos de 7 cas.

Cystic lymphangioma of the mediastinum is an uncommon vascular tumor frequently discovered incidentally on chest x-ray exams. Radiology (CT and MRI) may suggest the diagnosis and allow an assessment of the operatives difficulties, but histology of the surgical specimen is required for precise diagnosis. Complete resection is the only treatment; in some patients resection was incomplete because of the infiltrating character of these tumors, leading to recurrence. We report seven cases of mediastinal localization with a review of literature.

[Surgery for intra-bronchial foreign bodies]. / Chirurgie des corps étrangers intrabronchiques.

OBJECTIVE: The aim of this study was to evaluate the results of surgical treatment of intra-bronchic foreign bodies after unsuccessful endoscopic extraction. MATERIALS AND METHODS: Fifteen patients underwent surgical treatment of intra-bronchic foreign bodies in our department during a period of 10 years. There was 9 males and 6 females, the mean age was 20.27 years (range between 5 and 39 years), there were 8 right localizations and 7 left. The recurrent pulmonary infections were most frequent complaint of patients. RESULTS: Twelve pulmonary resections (including one pneumonectomy) were necessary because of the importance of pulmonary parenchyma destruction. There was one post-operative complication (one empyema) and the peri-operative mortality was nul. CONCLUSION: Surgical treatment of intra-bronchic foreign bodies must be used only after unsuccessful endoscopic extraction. The preventive measures are the best treatment.

[Intrathoracic textiloma caused by transdiaphragmatic migration after biliary surgery. Report of a case]. / Textilome intrathoracique par migration transdiaphragmatique après chirurgie biliaire. A propos d'un cas.

Intrathoracic textiloma is very rare and the transdiaphragmatic migration after abdominal surgery is exceptional. The diagnosis was suspected by history of surgery and radiology (CT), the treatment is only surgical. We report a case of intrathoracic textiloma after biliary surgery 30 years before and we describe the clinical, radiological features and treatment of this severe complication including clinical and medico-legal consequences.