A rare case of super-refractory epileptic status in pregnant woman: Schizencephaly.

Schizencephaly is an anomaly of the subtotal brain development, which occurs as the presence of a cleft lined with grey matter extending from subarachnoid space to the ventricles. It may be manifested by psychomotor retardation, paresis or partial seizures and drug-resistant convulsions. The clinical expression of schizencephaly depends on the bilaterality of the slit, its size and its seat. The diagnostic strategy of schizencephaly in the ante- and postnatal period has been revolutionised by MRI imaging, the only technique able to provide an accurate and complete lesional assessment, particularly in type I. We report the case of a 34-year-old pregnant woman at the 25th weeks of amenorrhea, who presented a super-refractory epileptic-status due to a right schizencephaly. The diagnosis of eclampsia was excluded. This case report is very particular cause of the late appearance of epileptic seizures in this pregnant woman who has never done so.

[Prioperative adverse events: critical reading of the data registry used in the surgery department of military hospital Moulay Ismail, Meknes]. / Evénements indésirables peropératoire: lecture critique du registre du bloc opératoire de l'hôpital militaire Moulay Ismail Meknès.

INTRODUCTION: Despite significant progress made in the field of safety in anesthesia, morbidity (serious or not, completely or partially related to anesthesia) remains common and no health practitioner is immune from accidents. In the current context where priority is given to training programmes, to quality and safety improvement in health care, the occurrence of an anesthesia-related accident in the surgery department is an extremely traumatic event. The fear of prosecution, the emotional context make it difficult to manage. For this reason, it must be codified according to Department protocols, based on three main axes of management: patient victim, medical and paramedical staff involved and accident analysis to prevent its recurrence. METHOD: In order to improve health care quality in surgery department we have implemented a continuously updated data registry containing the incidents and accidents occurred either in the operating room or in the post-interventional surveillance room A first reading was made on the occasion of Post Doctoral Training (JEPU) in Fez (Morocco) organized in partnership with the JEPU of the Pitié Salpêtrière in Paris at the School of Medicine and Pharmacy of Fez under the theme: «Critical Situations In Surgery Department¼ 17,18 April 2015. RESULTS: 1761 patients were admitted to different operating rooms, 96 in the endoscopy room and 17 under sedation in diagnostic radiology. 29 patients (1.64%) reported a perioperative incident and/or a perioperative accident. Most of the adverse events occurred during surgery (58.6%). 28.6% of cases in the immediate post-operative period or in the post-interventional surveillance room. The most frequent complications were respiratory (34%) or cardiovascular (31%). We recorded 5 perioperative deaths (mortality rate of 28%) Determining the cause is not always obvious. The human factor is responsible for 24% of incidents. CONCLUSION: This observation highlights the different adverse events which have been recorded since the establishment of the data registry 6 months before. We offer a critical reading of this data registry for the sole purpose of improving our practices with a view to strengthening safety during anaesthesia.

Dural tear of unusual cause.

Epidural analgesia is highly recommended in cancer anorectal surgery. In addition to the fight against pain it provides some benefit in allowing early rehabilitation of patients. One of the risks of this practice is the dural tear creating a cerebrospinal fluid leak (CSF) in the epidural space (EPD). Clinical features the typical positional headache, a procession of various more or less severe symptoms: nausea, vomiting, dizziness, visual or hearing impairment or radicular pain. We report a dural of unusual cause secondary of the obstruction of tuohy catheter by vertebral cartilage.

Intrathoracic extrapulmonary hydatid cysts.

Hydatid disease caused by echinococcus granulosus is still a serious problem in both underdeveloped and developing countries. Clinical signs of the disease are not specific. Most patients have a few symptoms when a hydatid cyst is discovered. Symptoms depend on its location, size and complications. Parasite can settle in every organ and tissue in the human body. We report two cases with intrathoracic extrapulmonary hydatid cyst with multiple cysts. Pathophysiology of the mode of dissemination, and surgery are discussed.

Diffuse large B-cell lymphoma presenting as large anterior chest wall mass involving pleura and lung: A possible result of post-traumatic chronic inflammation.

A 67 year-old-man was hospitalized due to chronic pain and a large mass on the anterior chest wall. His medical history showed chest trauma in 1970, the reconstitution of the scenario revealed there was blunt trauma with swelling and rib fracture on the same side. Physical examination revealed an isolated large anterior chest wall mass. Chest radiography showed two bilateral irregular masses, chest computed tomography showed a large right chest wall tumor with pleural effusion, nodules of the right upper lobe and tumor of the left lower lobe without mediastinal lymphadenopathy. Whole body exploration showed only the chest disease. Transthoracic biopsy showed inflammatory reaction. Surgical biopsy by anterior thoracotomy of the right mass was performed under general anesthesia. Histological and immunohistological analysis revealed lymphoid diffuse large cell proliferation with positive staining of CD 20, BCL-6 and MUM1, confirming the diagnosis of diffuse large B-cell malignant lymphoma. Chemotherapy based on CHOP-21 (cyclophosphamide, doxorubicin, vincristine, and prednisolone) was administered with good response after three cycles. The patient was discharged under surveillance in good condition after the end of chemotherapy. We report an infrequent neoplasm with an unusual and subtle clinical presentation.

[Bilateral pleurisy revealing a myelome with free light chains complicated with an osseous amylose]. / Pleurésie bilatérale révélant un myélome à chaînes légères compliqué d'une amylose osseuse.

The osseous amyloidosis associated with a pleural effusion in a myeloma is a rare situation. We report a case of an association of these three disease entities for discussion. A 75-year-old man was admitted for chest pain and dyspnea with left sacred bone pain. The radiological assessment reported pleurisy and bilateral lytic images of the sacrum with soft tissue invasion, the biochemical tests showed a lambda free light chain myeloma and bone biopsy reported amyloidosis. The occurrence of systemic amyloidosis in myeloma is well documented, but the osseous location is rare and rarely revealed. Pleural effusion is a known complication of myeloma but is exceptionally revealing; it is usually seen in the myeloma IgG and IgA but very rarely in free light chain myeloma. We reported here a case that represents an exceptional situation of complications of light chains myeloma to remember their possible occurrence and to insist for the clinician sensitizing to carry out investigations on time and avoid complications or at minimum to retard them.

A well-differentiated fetal adenocarcinoma of the lung with early local recurrence after limited resection.

A 42-year-old man was found to have an abnormal shadow during a systematic physical examination. Computed tomography of the chest revealed a mass in the lateral segment of the left lower lobe with parietal contact without pleural effusion or mediastinal lymphadenopathy. Bronchoscopy showed inflammation at the pyramid basal bronchus without visualization of hydatid materials or bud tumor. The hydatid serology, testing for myobacterium tuberculosis in sputum and the histological finding of bronchial biopsy, were negative. Initial surgery of a posterolateral thoracotomy showed a mass with soft consistency adherent to the parietal pleura on the seventh and eighth intercostal space. Because of the technical difficulties of extemporaneous examination, a limited resection was performed. The histopathological exam showed a well-differentiated fetal adenocarcinoma. The patient was re-operated on for complete resection 1 month and 20 days later, she was staged cT2N0M0. At exploration we discovered local recurrence with a 1.5 cm nodule in the same segment. An extended lower lobectomy to the seventh and the eighth rib was performed with lymphadenectomy. The patient was staged as Ib (pT2N0M0) with clear resected margins (R0). She was discharged in good condition from hospital 11 days postoperatively. Review at 2, 6 and 11 weeks showed no complications and chest radiograph revealed no anomaly. No adjuvant therapy was conducted and the patient is under surveillance.