[Thyroid tuberculosis]. / La tuberculose thyroïdienne.

Thyroid is a rare localization of tuberculosis, and should be considered in the diagnosis of nodular lesion of the thyroid gland except for the complicated forms with collection in which the fine needle aspiration showed the acid fast bacilli on Ziehl-Neelson stain (Koch bacilli) and/or granulomatous inflammation with caseation necrosis. We report the case of a 70 year-old woman referred to the hospital with a diagnosis of endothoracic goiter without clinical signs of tuberculosis. The diagnosis was established after total thyroidectomy and histological exam. Six-month treatment with three antituberculous drugs was administered with a good outcome.

[Thoracic gossypibomas]. / Textilomes thoraciques.

OBJECTIVES: Intrathoracic gossypiboma are exceptional, but diagnosis and treatment are difficult. The purpose of this study was to recall the clinical and radiological aspects of intrathoracic gosssyibomas and discuss the medicolegal consequences. MATERIAL AND METHODS: From January 1990 to June 2003, eight cases of gossypiboma were treated in our unit. The patients were aged 31 to 60 years (mean 40.5). Six had a history of thoracic surgery and two a history of biliary surgery. Clinically, the main symptom was hemoptysia (7 patients, 87.5%). Four patients (50%) presented thoracic pain and one a pleurocutaneous fistula. The chest x-ray revealed a poorly delimited opacity in six patients, a liquid effusion in one and a raised left diaphragm in one. The thoracic scan performed in two patients demonstrated an air image in one and a liquid image in the other. RESULTS: Surgical removal was difficult in all eight patients. Pulmonary parenchyma had to be sacrificed in certain patients. Two patients developed postoperative complications (one pneumothora and one thoracic wall infection). CONCLUSION: The diagnosis of intrathoracic gossypiboma should be suggested in all patients with a pulmonary mass and a history of thoracic surgery, more rarely laparotomy. Prevention remains the best treatment.

[Chronic alveolar syndrome]. / Syndrome de condensation alvéolaire chronique.

We report a case of primary pulmonary Hodgkin's disease in a 20 year-old woman. The chest x-ray showed a chronic alveolar syndrome. The diagnosis was established from a pulmonary biopsy. The radiological features and the options for diagnosis of primary pulmonary Hodgkin's disease are discussed.

[A rare cause of posterior mediastinal tumors: extramedullary hematopoiesis]. / Une cause rare des tumeurs du médiastin postérieur: l'hématopoïèse extra-médullaire.

We report a case of a patient with intrathoracic extramedullary hematopoiesis presenting as a posterior mediastinal tumor, without associated myelofibrosis. Pathophysiology and the options for diagnosis and treatment in this condition are discussed.

[Pyothorax in pneumonectomy cavity. Apropos of 24 cases]. / Les pyothorax sur cavité de pneumonectomie. A propos de 24 cas.

AIM OF THE STUDY: Describe as series of post-pneumonectomy empyema episodes, with or without bronchial fistula treated at the department of Thoracic Surgery, University of Ibn Sina, Rabat, Morocco. PATIENTS, METHOD AND RESULTS: Twenty-four patients with post-pneumonectomy pyothorax cared for between 1991 and 2000 were reviewed retrospectively. There were 15 men and 9 women, mean age 34 years. Pneumonectomy was indicated for tuberculous pyothorax and destroyed lung (n = 8), 8 destroyed lung (n = 8), pulmonary aspergilloma (n = 2), pulmonary hydatidosis (n = 2), bronchial dilatation (n = 2), lung cancer (n = 1), and bullet wound (n = 1). The patients were divided into two groups according to presence or absence of bronchial fistula: group 1, 19 patients with without bronchial fistula, and group 2 5 with bronchial fistula. Fourteen patients in group 1 (73.7%) achieved definitive cure, 12 after drainage and washout (63%) at mean delay of 45 days and 2 after drainage and washout with thoracoplasty. Five patients did not respond to hospital drainage and washout and remained under definitive ambulatory drainage as they declined further surgical treatment. One death occurred in this group. Two patients in group 2 (40%) achieved definitive cure, one after daily aspiration, and the other after thoracoplasty. Two fistulae in one patient were treated with nitratage. For this patient, we also attempted revision of the bronchial stube via posterior throacotomy, the closure of the bronchial fistula using an intercostal muscle flap associated with thoracoplasty. All these methods failed. There were two deaths in this group. CONCLUSION: Sixteen patients were definitively cured (66.6%). Eight patients (33.3%) remain in a chronic condition. Patients with pyothorax on a pneumonectomy cavity should be managed in specialized centers before reaching the chronic stage. Thoracomyoplasty with preparation of the cavity by thoracostomy should be proposed.

[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.

[Malignant primary fibrous histiocytoma of the pleura]. / Histiocytofibrome malin primitif de la plèvre.

UNLABELLED: Malignant fibrous histiocytoma (MFH) is a uncommon primary sarcoma, occurring exceptionally in the thoracic site. We report a case of malignant fibrous histiocytoma of the pleura in a 23-year-old man. The tumour was revealed by chest pain and alteration of the general state. A complete resection of the tumour histologically diagnosed as a malignant fibrous histiocytoma, with a right upper lobectomy was performed. No adjuvant treatment was proposed. The patient died 4 months after operation with cerebral metastasis. CONCLUSION: MFH should be treated by wide surgical resection if technically feasible, the role of adjuvant treatment is not defined.

[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.

Early complications of thoracic endoscopic sympathectomy: a prospective study of 940 procedures.

BACKGROUND: Thoracic endoscopic sympathectomy (TES) has become the surgical technique of choice for treating intractable palmar hyperhidrosis and is usually considered as a simple and safe procedure. To evaluate the complication rate of TES, we conducted a prospective study of peri- and postoperative complications. METHODS: From 1995 to 1999, 467 consecutive patients were operated on for upper limb hyperhidrosis. There were 164 men and 303 women, ranging in age from 15 to 59 years (mean 31 years). In all but 5 cases, the procedure was bilateral. Eleven patients underwent a reoperation for failure; thus the total number of sympathectomies was 940. The procedure was performed in two stages in 182 patients and in one stage in 267 patients. All patients were seen 1 month after the operation. RESULTS: There was no mortality. The mean postoperative hospital stay was 2.3 days in the group of patients who were operated on in two stages and 1.1 day in patients who were operated on in one stage. There were three major complications: one tear of the right subclavian artery and two chylothoraces. There were 25 cases (5.3%) of bleeding (300 to 600 mL) during dissection of the sympathetic trunk due to injury to an intercostal vein; in all cases it was controlled thoracoscopically. There were 12 pneumothoraces (1.3%) after removal of chest tubes. All of these were unilateral. Four required chest drainage for a period of less than 24 hours. One patient had a mild pleural effusion. Four patients had a unilateral partial Horner Syndrome (0.4%) that disappeared within 3 months in 2 patients. The other 2 patients were lost to follow-up. One patient complained of rhinitis. CONCLUSIONS: Although morbidity was low, significant complications of TES occurred. Patients should be clearly warned that TES is not as minor a procedure as usually asserted. Complications as well as adverse effects should be considered when discussing this surgical indication.

[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.

[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.

[Nephrobronchial fistula: a case report]. / Fistule néphrobronchique. A propos d'un cas.

Nephrobronchial fistulas following pyonephrosis associated with urolithiasis are a rare occurrence. The possibility of severe problems arising during surgery should be taken into considerations; both the surgeon and the anesthetist should be fully informed of the specific risk factors involved. A favorable outcome mainly depends on the appropriate treatment and timely management of any thoracic complications. Although this rare pathology has been described in detail in the literature, the problems encountered during anesthesia and surgery have not been fully reported. This study therefore provides new data, as a case has been reported of a 38-year old female who underwent surgery for pyonephrosis; disease management and prognosis problems have been discussed.

[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.

[Malignant small-cell thoracic pulmonary tumor (Askin tumor)]. / Tumeur maligne thoraco-pulmonaire à petites cellules (tumeur d'Askin).

We report 4 cases of malignant thoraco-pulmonary small-cell tumors (Askin tumor). Only two cases were operated. We emphasize the difficult histological diagnosis and demonstrate the importance of complete removal for survival. Prognosis remains poor.

[Inflammatory pseudotumor of the lung. An anatomoclinical study of a case report]. / Pseudotumeur inflammatoire du poumon. Etude anatomoclinique d'une observation.

One solitary pulmonary nodule was observed in a 47-year-old woman with history of right thigh liposarcoma 1 year before. Histological examination of the pulmonary specimen excluded liposarcoma metastasis and revealed an inflammatory pseudotumor. These unusual lesions with an excellent prognosis may exhibit, as in our case, atypical radiologic features and nuclear atypia, making the diagnosis difficult with malignancy.

[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.

[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.