Ruptured abdominal aortic aneurysm in psoriasis: A case report and review of literature.

INTRODUCTION: Psoriasis, a chronic inflammatory skin condition, affects 4 % of the population and is associated with various comorbidities, making it a public health concern. CASE REPORT: We discuss the case of a 50-year-old man with severe erythrodermic psoriasis who presented with a ruptured saccular abdominal aortic aneurysm (AAA), requiring emergency surgery with good postoperative follow-up. shedding light on the link between psoriasis and cardiovascular complications. DISCUSSION: Psoriasis severity correlates with cardiovascular risk and shares common development pathways with aortic aneurysms such as systemic and aortic inflammation, and arterial stiffness, emphasizing the importance of managing both skin symptoms and systemic inflammation to reduce vascular comorbidities. Psoriasis patients have a higher risk of AAA, warranting consideration for AAA screening. Controversies exist regarding corticosteroid therapy and choice of surgical intervention for AAA in psoriatic patients. CONCLUSION: Psoriasis patients face an increased risk of AAA, highlighting the need for vigilant screening and comprehensive management. Further research is essential to understanding the pathophysiological connections between psoriasis and arterial diseases, guiding preventive strategies and optimal medical treatments for these high-risk patients.

Endovascular wall-grafting for mycotic common iliac pseudo-aneurysm: Systemic mycoses.

Mycotic pseudoaneurysms of the iliac arteries are extremely rare and are caused by infection of the artery wall. It is difficult to diagnose early due to its silent manifestation. We present a case of a 64-year-old man with an isolated left common iliac artery pseudoaneurysm caused by Candida albicans who presented with thrombophlebitis, abdominal pain, nausea and vomiting associated with fever, which was successfully treated with interposition grafting and antibiotic therapy. We present this case to highlight that aneurysms and other vascular lesions can affect different arteries in the body and may therefore only be discovered during routine investigations of non-specific symptoms.

The New Reform of the National Health System in Morocco: An Opportunity to Meet the Challenges and Improve the Practice of Anesthesiology.

The health sector in Morocco has undergone major changes in recent years, thanks to the reform of the national health system. This reform aims to improve accessibility and the equitable distribution of care throughout the country and enhance the quality and safety of health services. Anesthesia plays an important role in improving patients' quality of life and reducing the risks associated with surgical procedures. However, anesthetic practice in Morocco faces several challenges, including territorial disparities, unequal access to anesthetic services, financial constraints, a shortage of qualified staff, insufficient continuing education, and the need for appropriate administrative and legal frameworks regarding current anesthesiology practice. The reform of the Moroccan national health system has the potential to significantly advance the practice of anesthesia in Morocco. Indeed, this reform includes a number of measures that could help to improve access to anesthesia services, enhance the quality of care, ensure patient safety, and promote research in this field. Its success will depend on the effective implementation of planned measures and the ability to overcome potential obstacles.

Successful coiling embolization of an intraparenchymal renal pseudoaneurysm: Case reports.

INTRODUCTION AND IMPORTANCE: Intraparenchymal renal artery aneurysms are a really rare condition that represents <10 % of all renal artery aneurysms. They are more often caused by trauma or iatrogenic injury and their rupture can lead to life-threatening hemorrhage. CASE PRESENTATION: We report the case of a 25-year-old male with history of back stab wound three months before being admitted to our unity. The patient presented a macroscopic hematuria three days after the injury. An abdominal CT angiography revealed an intraparenchymal renal artery aneurysm, and it was successfully treated with super selective endovascular coil embolization, achieving both pseudoaneurysm exclusion and renal preservation. CLINICAL DISCUSSION: Intraparenchymal renal artery aneurysms are rare. They are more often caused by trauma or iatrogenic injury. Renal artery pseudoaneurysms are mainly asymptomatic. Renal pseudoaneurysms can be diagnosed through contrast enhanced CT, renal Doppler ultrasound, or MRI. Super selective embolization of the feeding artery of the pseudoaneurysm using endovascular techniques is the treatment of choice. CONCLUSION: The management of patients with renal pseudo aneurysms should allow to achieve two main goals: Preserving Renal function, and excluding the pseudoaneurysm.

[Brachial artery aneurysm in kidney transplant patient after distal fistula closure]. / Anévrisme de l'artère brachiale chez un patient transplanté rénal après fermeture de fistule distale.

Brachial artery aneurysmal degeneration is an exceptional complication of distal native fistulas. Chronic mechanical stresses due to high flow, as well as immunosuppressants drugs following renal transplantation, are the mains factors implicated in the pathophysiological mechanism. We report a case of a transplant patient with a true, symptomatic, brachial artery aneurysm, 8 years after transplantation and 5 years after radiocephalic wrist fistula ligation. The patient underwent open surgical repair, with aneurysm resection and end-to-end anastomosis. We present a literature review of the different therapeutic strategies of this unusual entity.

[Compressive false aneurysm of the brachial artery in a hemodialysis patient: Always superficialize the basilic vein of the arm!] / Faux anévrisme compressif de l'artère brachiale chez un hémodialysé : toujours superficialiser la veine basilique du bras !

The creation and preservation of vascular accesses, in patients with end-stage renal failure, remains a challenge for nephrologists and vascular surgeons. Native fistula is the best vascular access, humeral-basilic fistula is a precious access in patients who have exhausted their venous capital in the forearm and in whom the cephalic vein of the arm is small or damaged. Given its deep location, any puncture of this vein is prohibited before its superficialization, even if it is of good caliber, because it can have dramatic consequences, in particular the loss of the limb or even death. We report the case of a patient undergoing hemodialysis for seven years with a non-superficialized humeral-basilic fistula, admitted for an iatrogenic false aneurysm of the brachial artery following a puncture for dialysis, with compression of the median nerve, treated surgically.

Symptomatic subclavian steal syndrome: Report of four Moroccan cases and literature review.

INTRODUCTION: Subclavian steal syndrome (SSS) is the hemodynamic phenomenon of blood flow reversal in the vertebral artery due to significant stenosis or occlusion of the proximal ipsilateral subclavian artery. MATERIALS AND METHODS: Four patients with subclavian steal syndrome were treated in our center. Percutaneous radial approach was used for angioplasty, primary stenting of subclavian artery was performed, surgical techniques in particular carotid-subclavian bypass and carotid-subclavian transposition were used. RESULTS: We report the cases of four patients, three of which are male, with an average age of 60 years. All of them were symptomatic. Diagnosis was made by duplex ultrasound, supplemented by CT-angiography and arteriography. Endovascular treatment was attempted in all four patients, which was successful in two patients, who underwent primary stenting, and failed for the two others, for whom surgical treatment was considered. One had a subclavio-carotid bypass graft with a polytetrafluorethylene (PTFE) prosthesis and the other had a subclavio-carotid transposition. The technical results were satisfactory in all patients with symptoms resolution. The postoperative evolution was without notable complications and the postoperative checkups were satisfactory. DISCUSSION: There are excellent screening tools and effective medical therapies which can be instituted if the SSS is diagnosed early. When the need for revascularization arises, percutaneous modalities are favored given their proven long-term efficacy, decreased morbidity and mortality, and cost-effectiveness. Nevertheless, large, prospective, randomized and controlled trials are needed to compare the long-term patency rates between the endovascular and surgical techniques.

TEVAR for thoracic mycotic aneurysm: Case report.

INTRODUCTION: Mycobacterium tuberculosis is a cause of mycotic aortic pseudoaneurysms, wich are a rare case with high mortality rates. Three types of dissemination hematogenous by contiguity and direct to the aortic wall are possibles. PRESENTATION OF CASE: We report a rare case of tuberculous thoracic aortic pseudo aneurysm, successfully treated endovascularly associated to antituberculosis drugs. DISCUSSION: Classically TB pseudoaneurisms have been treated with open surgical therapy.however, they are associated to high morbidity and mortaity with increased lenghts of hospital stay. Due to advancements of endovascular technology, it be cames a good and successful alternative as a treatment, with a background of medical treatment. CONCLUSION: Thoracic endovascular aneurysm repair (TEVAR) associated to anti-tuberculosis medication have revolutionized the management and improved the prognosis of this pathology.

[Juxta-anastomotic venous aneurysm of a fistula in the anatomical snuffbox: An atypical location]. / Anévrisme veineux juxta-anastomotique d'une fistule au niveau de la tabatière anatomique : une localisation atypique.

Native arteriovenous fistula is the best available vascular access for hemodialysis in end-stage renal failure. It is characterized by higher patency rates and lower rates of morbidity, mortality and complication compared to prosthetic bypass grafts and central venous catheters. Aneurysmal complications remain the main complications of these access with a high risk of rupture and fatal hemorrhage. Their management varies from case to another and several methods are reported in the literature. We describe a case of an atypical localization of a juxta-anastomotic venous aneurysm in the anatomical snuffbox, treated by resection with proximal reimplantation of the cephalic vein at the wrist.

Predictive Factors for Impaired Mental Health among Medical Students during the Early Stage of the COVID-19 Pandemic in Morocco.

The COVID-19 pandemic has great consequences on mental health. We aimed to assess medical students' psychological condition and influencing factors as a baseline evidence for interventions promoting their mental wellbeing. We conducted an online survey from April 8 to April 18, 2020 to examine the mental health of medical students by the nine-item Patient Health Questionnaire, seven-item Generalized Anxiety Disorder Scale, seven-item Insomnia Severity Index, and six-item Kessler psychological distress scale. Factors associated with mental health outcomes were identified by multivariable logistic regression analysis. Five hundred forty-nine students completed the survey; 341 (62.3%), 410 (74.6%), 344 (62.6%), and 379 (69%) reported anxiety, depression, insomnia, and distress, respectively. Female students, living in high COVID-19 prevalence locations, more than 25 days confinement, psychiatric consult history, and being in a preclinical level of studies had higher median scores and severe symptom levels. Multivariable logistic regression showed female gender as a risk factor for severe symptoms of anxiety (odds ratio [OR]: 1.653; 95% CI: 1.020-2.679; P = 0.042), depression (OR: 2.167; 95% CI: 1.435-3.271; P < 0.001), insomnia (OR: 1.830; 95% CI: 1.176-2.847; P = 0.007), and distress (OR: 1.994; 95% CI: 1.338-2.972; P = 0.001); preclinical level of enrollment as a risk factor for depression (OR: 0.679; 95% CI: 0.521-0.885; P = 0.004), insomnia (OR: 0.720; 95% CI: 0.545-0.949; P = 0.02), and distress (OR: 0.650; 95% CI: 0.499-0.847; P = 0.001), whereas living in high COVID-19 prevalence locations was a risk factor for severe anxiety (OR: 1.628; 95% CI: 1.090-2.432; P = 0.017) and depression (OR: 1.438; 95% CI: 1.002-2.097; P = 0.05). Currently, medical students experience high levels of mental health symptoms, especially female students, those at a preclinical level and living in regions with a high prevalence of COVID-19 cases. Screening for mental health issues, psychological support, and long-term follow-up could alleviate the burden and protect future physicians.

Technical management of traumatic arteriovenous fistula: Tips and tricks.

INTRODUCTION: Traumatic Arteriovenous Fistulas (AVFs) are a rare complication of vascular injuries and pose a problem of topographic diagnosis and therapeutic management. Delayed treatment may cause cardiac and trophic complications. PRESENTATION OF CASES: We describe 4 cases of AVFs complicating stab wounds of the lower limb, associated in 2 cases with pseudoaneurysms. DISCUSSION: In two cases we performed a surgical repair, whereas in the other 2 patients we choose an endovascular treatment with wall graft stent placement. CONCLUSION: All traumatic AVFs must be treated to avoid vascular, local and general complications. Using both techniques, we had great results with no complications.

Best strategy in managing the association of Horse-shoe-Kidney and Abdominal Aortic Aneurysm: Case report.

INTRODUCTION: Horseshoe Kidney (HSK) is probably the most common of all renal fusion abnormalities. However the association of Abdominal aortic aneurism (AAA) and HSK is rare, and occurred in 0,12% of patient affected by AAA. PRESENTATION OF CASE: We present a patient with the concomitant presence of AAA and HSK treated by open surgical repair with a transperitoneal approach without section of the isthmus with great outcomes after surgery. DISCUSSION: The management of AAA associated with HSK presents a special challenge during vascular surgery, given the close spatial relationship and the frequent renal arterial variations that accompanies HSK. CONCLUSION: Diagnosis and a well designed surgical strategy are required to avoid surgical post operative complications.

Synchronous sigmoid cancer and abdominal aortic aneurysm treated by laparoscopic colectomy followed by endovascular aneurysm repair.

INTRODUCTION: The occurrence of synchronous abdominal aorta aneurysms and colorectal cancer represents a real management challenge. Up till now, there is no evidence-based consensus recommendation in the surgical management of such patients. Herein we reported the clinical management challenge of synchronous abdominal aorta aneurysms (AAA) and colorectal cancer (CRC). PRESENTATION OF CASE: 78-year-old man was admitted in our structure for acute abdominal pain, vomiting and constipation. His past medical history included type 2 diabetes, arterial hypertension and a stable infra-renal aortic aneurysm documented 2 years ago. Physical examination found a stable patient with blood pressure and heart rate within normal range, pulsatile mass along with abdominal distension with vital signs within normal limits. Abdominal CT scan and subsequent CT angiogram confirmed an 88 × 75 mm infra-renal aortic aneurysm concomitant with considerable lumen reduction due to asymmetric wall thickening of the sigmoid. Colonoscopy combined with biopsy examination confirmed structuring irregular sigmoid adenocarcinoma Therefore we report a case of a large AAA and concomitant sigmoid adenocarcinoma tumor causing stricture. DISCUSSION: In such situation, the main controversy is the necessity of treating the diseases simultaneouslor in two stages favoring the AAA management first. To our best knowledge, we report the first case published in literature in which the patient was treated for colorectal cancer first by laparoscopic surgery followed by AAA management with EVAR. CONCLUSION: In this case report, we highlight some tricks required in performing laparoscopic sigmoid colectomy for patient with large AAA to prevent per-operative pitfalls. Evidence-based consensus is required to determine the optimal surgical treatment.

[Iatrogenic carotid-jugular arterio-venous fistula: a rare complication associated with jugular venous catheterization (a case report)]. / Fistule artério-veineuse iatrogène carotido-jugulaire: une complication rare du cathétérisme de la veine jugulaire (à propos d'un cas).

Catheterization of the internal jugular vein is widely performed by both nephrologists and surgeons. It has become a routine procedure, but can be associated with serious complications. Carotid-jugular arterio-venous fistula (CJAVF) is a rare but potentially fatal complication. Very few cases have been reported in the literature. This study involved a patient with iatrogenic CJAVF following hemodialysis catheter placement performed three weeks earlier. The diagnosis was clinically suspected based on the discovery of laterocervical thrill and confirmed by echo-Doppler and angiography. The patient underwent successful open surgery. Operator experience and trainees support, in addition to the use of ultrasound guidance, can significantly reduce the occurrence of complications during jugular venous catheterization.

Infectious aneurysm of the two primary iliac arteries: rare localization of Salmonella typhimurium infection.

Infectious aneurysm is a severe entity of the aneurysmal pathology, due essentially to a bacterial agent. The most frequently implicated organisms are salmonella and staphylococci. We report the case of an infectious aneurysm of the two primitive iliac arteries with Salmonella typhimurium in a 70-year-old man.

Double localization of a non-anastomotic pseudoaneurysm after an axillofemoral bypass: a case report and review of the literature.

BACKGROUND: A traumatic non-anastomotic pseudoaneurysm is a rare complication of an axillofemoral bypass graft. Fewer than 20 cases have been reported in the literature. Our case is unusual in that we report a double localization of this complication. CASE PRESENTATION: We report the case of a 60-year-old Arabic male patient who was diagnosed with two hematomas in the trajectory of his axillofemoral bypass secondary to a traumatism. The diagnosis of a non-anastomotic pseudoaneurysm was retained considering the results of a computed tomography angiography scan, which showed the double localization of the pseudoaneurysm. Surgical management consisted of flattening the pseudoaneurysm along with the interposition of a prosthetic segment. There were no postoperative complications and our patient was well 3 years after discharge. CONCLUSIONS: Non-anastomotic pseudoaneurysm is a rarely described complication of a axillofemoral bypass graft. To the best of our knowledge, a double localization has not been described in the literature before. Minimally invasive techniques as a treatment option are being widely used as an alternative to open repair.

True Aneurysm of the Left Internal Thoracic Artery.

Aneurysms of the internal thoracic artery (ITA) are rare and can have many etiologies. Hyperflow is an exceptional etiology. We report the case of a 56-year-old woman who presented with a stress-induced ischemia of the left arm. Computed tomography angiography showed occlusion of the subclavian artery and a true aneurysm of the ITA. The ITA aneurysm was resected without restoration of the ITA continuity and a carotid-subclavian bypass was performed. Pathological examination of the aneurysm sac was not specific.

A Rare Case of a Massive Carotid Body Tumor in a 3-Year-Old Infant: Case Presentation and a Literature Review.

BACKGROUND: Paragangliomas are neuroendocrine tumors derived from the extra-adrenal paraganglia of the autonomic nervous system. Only 3% of all paragangliomas are reported to occur in the head and neck region. The most common paraganglioma of the head and neck is the carotid body tumor. Only few cases have been described in the literature regarding the pediatric age group less than aged 14 years, mostly as case reports. CASE REPORT: Our case describes a massive paraganglioma in the head and neck region occurring in a 3-year-old Arabic boy, for which surgical excision was not possible and radiotherapy resulted in a good clinical and radiologic response. CONCLUSIONS: Paragangliomas a rare in children and mostly diagnosed in a locally advanced stage. Surgery in most cases is difficult especially because of the proximity of the vessels; radiotherapy is still a good alternative for those cases.