Biomedical subjects

A Soumana

Publications and source records attributed to A Soumana.

At least 19 recordsLinked to original sources

PubMed1999

[Adrenal gland pheochromocytoma. Report of 26 cases].

The authors analyse of a series of 26 patients (17 females and 9 males) with a mean age of 32 years (range: 18 to 55 years) operated for adrenal phaeochromocytoma. All patients were hypertensive. The laboratory assessment (assay of blood catecholamines and urinary catecholamine metabolites) performed in more than 2/3 of cases confirmed the diagnosis in more than 80% of cases. The topographic diagnosis was facilitated by computed tomography. Fifteen patients received preoperative treatment with alpha-blockers or calcium channel blockers. Various incisions were used, but a lumbar incision was the most frequent. Blood pressure was controlled postoperatively in 24 patients. Two patients died 1 and 2 postoperatively. New diagnostic modalities (CT, MRI) have facilitated the diagnosis and the site of localization of phaeochromocytomas, thereby improving the choice of incision. Patient-specific preoperative preparation and appropriate anaesthesia facilitate successful adrenal gland surgery.

Adolescent↗

PubMed1999

[Hydatid cyst of the kidney. Report of 45 cases].

The kidney is a rare site of hydatid disease. It remains clinically silent for a long time and only presents at the stage of complications. The diagnosis is essentially radiological. Renal hydatid cyst (RHC) raises therapeutic problems due to its complications, which sometimes make kidney-preserving cyst resection surgery difficult. The authors report a series of 45 cases of RHC treated in their department during a 20-year period. This series consisted of 27 men and 18 women with a mean age of 47 years (26-80 years). The clinical features were dominated by pain (80%), flank mass (42%), hydaturia (22%), haematuria (13%), urinary tract infection (6%), hypertension (3%). IVU, performed in all patients, showed calcifications in 35% of cases, renal tumour syndrome in 71% of cases and silent kidney in 22% of cases. Surgery was usually performed via a lumbar incision (75%) or a BARAYA incision (15%). Treatment consisted of 18 cyst roof resections (40%), 6 pericystectomies (13%), partial nephrectomy in 2 cases (4%) and total nephrectomy in 18 cases (40%). The postoperative course was marked by urinary fistula in two patients and one death at the 2nd postoperative month related to associated renal sarcoma. The objective of this study is to analyse the epidemiological, pathological and therapeutic features of this disease, which still constitutes a public health problem in Morocco.

Adult↗

PubMed1999

[Thyroid cancer metastasizing to the kidney. Report of a case].

The authors report a case of renal metastasis from a thyroid adenocarcinoma in a 56-year-old man, occurring 3 years after isthmolobectomy for papillary thyroid carcinoma. He predominant clinical symptoms were low back pain, haematuria and deterioration of the general state. Ultrasonography showed a hypoechoic left renal mass, 56 mm in diameter, with a thickened wall. Renal CT showed a homogeneous low-density formation with a thickened wall in the left kidney. Iodine 131 whole body scan showed increased uptake in the left kidney. The patient wes treated surgically via a subcostal incision. The surgical procedure consisted of radical nephrectomy. Macroscopic examination of the lesion showed a cystic mass. Histological examination of the mass revealed a renal metastasis from moderately differentiated thyroid adenocarcinoma.

Adenocarcinoma↗

PubMed1999

[Inguinal hernia of the bladder. Report of 6 cases].

The authors report 6 cases of inguinal hernia of the bladder seen between 1976 and 1996. All patients were males with a mean age of 67 years (range: 53 to 80 years). The hernia was situated in the right groin in all patients. No patients presented any suggestive clinical features. In 5 patients, the diagnosis was established by IVU, indicated for another disease associated with the hernia and, in one patient, the hernia was discovered after an operative wound to the bladder. Treatment consisted of elimination of bladder neck obstruction in 3 patients and reintegration of the bladder and abdominal wall repair in 4 patients. The postoperative course was uneventful.

Aged↗

PubMed1999

[Traumatic rupture of the bladder. Report of 12 cases].

Over the previous 8 years, the authors have treated 12 patients (11 males and 1 female with a mean age of 32 years (26 to 54 years)) with traumatic rupture of the bladder. Rupture was secondary to direct trauma to the full bladder in one case and pelvic trauma in 11 cases. Associated lesions were pelvic trauma (11 cases), head injury (4 cases), chest trauma (2 cases), rupture of the spleen (1 case) and small bowel perforation (1 case). The clinical features were dominated by suprapubic pain (11 cases), haematuria (10 cases), haemorrhagic shock (4 cases) and peritoneal syndrome (3 cases). IVU confirmed the diagnosis in 6 out of 8 cases. Retrograde cystourethrography was conclusive whenever it was performed. The retroperitoneal rupture was treated by indwelling catheter for 15 days. Intraperitoneal ruptures were treated surgically. The breach was situated in the dôme in 10 cases and on the posterior surface in 1 case. The size of the wound ranged from 2 to 8 cm. Treatment consisted of suture of the rupture and indwelling catheter for an average of 12 days. Cure was always obtained without sequelae.

Adult↗

PubMed1999

[Vesico-uterine fistulas. Report of 30 cases].

The authors report a series of 30 vesico-uterine fistulas (VUF) observed over a 25-year period. The mean age of the patients was 28 years (range: 18 to 40 years). VUF were secondary to caesarean section (23 cases), abnormal delivery (5 cases) and rupture of the bladder and uterus (2 cases). The presenting complaint was a permanent total and isolated urinary incontinence (22 cases), partial urinary incontinence associated with menstrual haematuria (4 cases), vesical menstrual bleeding associated with a oligomenorrhoea (3 cases) and menouria (1 case). The diagnosis was established on clinical findings in 14 patients. IVU, performed in 30 patients, visualized the uterine cavity in only 12 patients. Retrograde cystography, performed in 4 cases, demonstrated opacification of the uterine cavity. Hysterosalpingography, performed in 6 cases, confirmed the diagnosis of VUF in all 6 patients. Treatment was surgical, via a transperitoneovesical incision (22 cases) or a transvesical incision (8 cases) and consisted of isolation of the bladder and uterus and uterine and vesical suture. Urine drainage was performed by urethral catheter (28 cases) or cystostomy (2 cases). Urinary continence was perfectly restored in 24 patients, 6 patients presented residual fistulas another patient had a reduction of her bladder capacity. The objective of this study is to analyse the aetiological, diagnostic and therapeutic aspects of this disease.

Adolescent↗

PubMed1999

[The Martius flap in the treatment of vesicovaginal fistulas. Report of 20 cases].

The authors report a series of 20 cases of vesicovaginal fistula (VVF) treated according to the Martius procedure. The mean age of the patients was 30 years (range: 20 to 37 years). All fistulas were secondary to obstetric trauma. The mean diameter of the fistula orifice was 4 cm. Fourteen fistulas were cervico-trigonal and 6 were urethro-cervico-trigonal. A rectovaginal fistula was associated with VVF in 2 patients. Five of the 20 patients had never been previously operated, while 15 patients had already been operated without success. Fifteen patients were cured immediately, while a second Martius procedure was necessary in 3 cases. Failure was considered to be definitive in 2 cases.

Adult↗

PubMed1999

[Urethrorectal fistula. Report of 11 cases].

The authors report a series of 11 urethrorectal fistulas observed over a 25-year period. The mean age of the patients was 37 years (range: 15 to 70 years). The aetiologies were surgical trauma (5 cases), fracture of the pelvis (2 cases), inflammatory lesions (3 cases), and one fistula was congenital. The clinical features were dominated by urine discharge from the anus (11 cases), urinary tract infection (8 cases), spurious diarrhoea (6 cases), faecaluria (4 cases), pneumaturia (2 cases). Digital rectal examination was normal in 7 patients. IVU demonstrated opacification of the rectum in 5 out of 8 cases. Cystourethrography, performed in 9 patients, demonstrated the communication in each case. Urethrocystoscopy visualized the fistula in each case in which it was performed. Treatment consisted of bladder drainage by urethral catheter in all patients, allowing closure of the fistula in 2 patients. Colostomy was performed in 2 patients, internal urethrotomy and urethral catheter was performed in 2 cases. Surgical closure of the fistula was performed in 7 patients, via an abdominoperineal (3 cases), perineal (2 cases), transperitoneal (1 case) or transanosphincteric incision (1 case).

Adolescent↗

PubMed1999

[Carcinosarcoma of the prostate. Case report].

We report one case of carcinosarcoma of the prostate in a patient of 43 years old. The clinical symptomatology was dominated by pollakiurie, dysuria digestive disorders, oedema of the lower limbs and the alteration of the general status. Digital rectal examination showed a big prostate, hard and irregular. The rate of PSA increased. Echography revealed a pelvic echogenic mass corresponding to a bulky prostate. CT scan of the abdomen and the pelvis showed a tissular, heterogeneous mass of 11 cm occupying the vesicoprostatic space and invading the basis of the bladder and the adjacent muscles (muscles obturateurs internes). Histology of a biopsy fragment of the mass revealed an adenocarcinoma and a mesenchymatous component calling up a prostatic carcinosarcoma. The treatment consisted in chemotherapy VAC. The evolution was deadly after 2 months.

Adult↗

PubMed1998

[Urogenital tuberculosis. 80 cases].

Urogenital tuberculosis raises major diagnostic problems due to the frequently atypical and misleading clinical features. It is a serious disease as the lesions are often multifocal and extensive, requiring major surgical resection and urinary tract reconstruction. Prevention of this disease is based on generalization of BCG immunization and adequate treatment of pulmonary tuberculosis. Between 1985 and 1995, 80 patients with urogenital tuberculosis were treated in our department. These patients consisted of 50 males (62.5%) and 30 females (37.5%) with a mean age of 38 years (range: 20 to 50 years). IVU revealed silent kidney in 26% of cases, ureterohydronephrosis in 36% of cases, small bladder in 17% of cases, and was normal in only 5% of cases. Renal function was impaired in 32% of patients. The diagnosis was confirmed by a positive test for AFB in the urine in 64% of cases, bladder biopsy in 20% of cases and pathological examination of the operative specimen in 20% of cases. Treatment consisted of temporary urinary diversion (32%), antituberculous chemotherapy in all patients, and corticosteroid therapy in 8.7% of patients. Surgical treatment was required in 95% of patients: partial nephrectomy (2.5%), nephrectomy (50%), enterocystoplasty (18%), ileoureteroplasty (5%), ureteric reimplantation (12.5%), ureterocaliceal anastomosis (1.2%).

Adult↗

PubMed1998

[Ureterosigmoidostomies. 35 cases].

35 patients underwent ureterosigmoidostomy between 1986 and 1996, corresponding to 25 males (71%) and 10 females (29%) with a mean age of 48 years (range: 21 to 81 years). 25 (71%) of these patients had invasive bladder cancer, 4 (12%) had a vesicovaginal fistula, 3 (9%) had bladder exstrophy and 3 (9%) had urethral trauma. All patients had normal renal function. In 2 patients, the ureter was dilated and in 3 other patients, one kidney was silent. The postoperative course are marked by death in 2 cases (6%) due to myocardial infarction, mechanical obstruction in 2 cases (6%), anastomotic dehiscence in 2 cases (6%). The mean follow-up was 4 years (range: 2 to 10 years). Eight patients (22%) developed impaired renal function, isolated hyperchloraemic acidosis was observed in 10 cases (28%), hypokalaemia was observed in 2 cases (6%), and episodes of acute pyelonephritis were reported in 4 cases (11%). Radiological signs of upper urinary tract deterioration were observed in 6 cases (17%). A tumour of the sigmoid colon was observed in one case after a follow-up of 10 years. 25 patients (72%) remain dry throughout the night, while 8 (22%) need to empty their rectum during the night. The poorly tolerated Coffey diversion was replaced in 6 patients (17%). The objective of this study is to analyse the results of ureterosigmoidostomy and to emphasize the advantages and disadvantages of this urinary diversion technique.

Adult↗

PubMed1998

[Internal urethrotomy in the treatment of urethral stenoses (longterm results)].

The authors report their experience of a series of 100 patients undergoing internal urethrotomy for urethral stricture, with a follow-up ranging from 12 months to 5 years. The morbidity was 16%. A satisfactory result was obtained in 54% of cases. The site and aetiology of the stricture did not influence the results. Better results were obtained in shorter, isolated strictures. Poor results were reported in cases with extensive stricture or in patients with a history of urethral surgery. These cases underwent repeated urethrotomy with less favourable results.

Adult↗

PubMed1998

[Priapism in adults. 16 cases].

Priapism is a rare disease, characterized by prolonged, painful and irreducible erection, not resulting in ejaculation. It is an andrological emergency with a poor prognosis, as the risk of impotence is 50% despite appropriate management. Treatment is essentially surgical. The authors report their experience of 16 cases of priapism observed over a 15-year period. The mean age of the patients was 36 years (range: 21 to 56 years). The diagnosis was clinical. The mean time to consultation was 8 days (range: 1-28 days). Priapism was secondary to neuroleptics in 6 cases (37%), chronic myeloid leukaemia in 2 cases, sickle-cell anaemia in one case, radiotherapy in 1 case and the cause remained unknown in 6 cases (37%). Treatment was surgical in every case and consisted of spongiocavernous anastomosis in 11 patients (Winter's procedure in 1 case, Al-Ghorab's procedure in 6 cases and transperineal in 4 cases, with saphenocavernous anastomosis in 5 cases). The overall failure rate of surgical treatment was 37%. The success rate of spongiocavernous fistula was 70% and the authors preferred the Al-Ghorab type of spongiocavernous fistula.

Adult↗

PubMed1998

[Paratesticular rhabdomyosarcoma. A case report].

The authors report a case of paratesticular rhabdomyosarcoma in a 21-year-old patient. The clinical features were dominated by left loin pain, inguinoscrotal pain and scrotal swelling. Transillumination was negative. Laboratory markers (alpha-foetoprotein, beta HCG) were normal. Testicular ultrasound showed an enlarged testis, comprising heterogeneous nodules with infiltration of the spermatic cord. Abdominal ultrasonography and CT scan showed a latero-aortic retroperitoneal lymph node mass and a large left kidney. Chest x-ray was normal. Treatment consisted of radical orchidectomy. Histological examination of the operative specimen confirmed the diagnosis of paratesticular rhabdomyosarcoma. The patient was treated by chemotherapy and subsequently developed recurrence with metastases.

Adult↗

PubMed1998

[Cancer of the kidney in adults. Apropos of 60 cases].

The authors report a series of 60 cases of renal cancer observed over a 10-year period. Patients consisted of 35 women (58%) and 25 men (42%), with a mean age of 52 years (range: 21-72 years). The clinical features were polymorphic, dominated by loin pain (76%), haematuria (75%), a lumbar mass (46%), alteration of the general state (30%). The diagnosis was established by ultrasonography in 58 patients and CT scan in 38 patients. The mean tumour diameter was 11.5 cm (5-25 cm) and two cases presented bilateral tumours. The tumour was located in the upper pole in 40% of cases and was mid-renal in 30% of cases. The time to diagnosis ranged from 2 months to 3 years. Staging reflected the advanced stage of the cancer. Treatment was surgical for 53 patients (88%). A lumbar incision was generally performed (83%). The surgical procedure consisted of nephrectomy and regional or hilar lymph node dissection. Nephrectomy was simple for 27% of patients, radical for 69% of patients and partial for 4% of patients. The postoperative course was marked by one death due to pulmonary embolism, and a stercoral fistula in 2 patients. Histological examination of the specimen showed clear cell adenocarcinoma in 92% of cases. The tumour weight was often considerable, with a maximum of 3.750 kg. The lymph nodes removed were invaded in 50% of cases. The mean follow-up was 46 months (12 to 120 months). Follow-up was normal at 3 years for 23 patients (43%) and at 10 years for 4 patients (8%). Tumour recurrence in the renal compartment was observed in 3 patients after 3 years. Asynchronous metastases occurred in 10 patients (23%). The mean interval to metastases was 20 months (4 to 36 months).

Adenocarcinoma, Clear Cell↗

PubMed1998

[Renal angiomyolipoma. Apropos of 11 cases].

The authors report their experience of 11 cases of renal angiomyolipoma over an interval of 20 years, observed in 10 women (90.9%) and one man (9.1%) with a mean age of 46 years (range: 21 to 63). Clinical symptoms were dominated by loin pain (100%), haematuria (45.4%), lumbar mass (72.7%), fever (18%). In one woman, AML was associated with "tuberous sclerosis". Preoperatively, the diagnosis was established by ultrasound and CT scan in 45.4% of patients. The size of the tumour varied from 7 to 14 cm in 10 patients and in one patient was only about 3.6 cm. Two women had bilateral tumours. Treatment consisted of total nephrectomy in 7 patients, partial nephrectomy in 3 patients and tumourectomy in one patient. The purpose of this study is to analyse the epidemiologic, diagnostic and therapeutic aspects of this disease.

Adult↗

PubMed1998

[Bilateral adrenal pheochromocytoma. A case report].

The authors report a case of apparently isolated bilateral adrenal phaeochromocytoma in a 25-year-old man presenting with abdominal pain and neurosensory signs of HT, but ignored and complicated by heart failure. Ultrasonography and abdominal CT revealed a bilateral adrenal tumour. The hormonal assessment, particularly metanephrines and normetanephrines, was normal. The diagnosis of phaeochromocytoma was proposed despite the negative hormonal assessment and was supported by positive MIBG scintigraphy, compatible with bilateral adrenal phaeochromocytoma with no other sites. Treatment consisted of right adrenalectomy and left tumour excision. The postoperative course was uneventful, and 3-year follow-up showed regression of the functional symptoms and control of blood pressure without any other treatment.

Abdominal Pain↗

PubMed1998

[Pathological horseshoe kidney. 30 case reports].

The authors report a series of 30 horseshoe kidneys observed over a 20-year period. This series consisted of 20 men (66.6%) and 10 women (33.4%) with a mean age of 35 years (20-65 years). The clinical features were dominated by abdominolumbar pain (22 cases), haematuria (12 cases) and pyuria (2 cases). Horseshoe kidney was associated with renal stones (20 cases), ureteropelvic junction syndrome (8 cases), upper urinary tract tumour (1 case). Treatment was surgical depending on the aetiology. The objective of this study was to analyse the epidemiological and diagnostic features of this disease, as well as the therapeutic features specific to each uropathy associated with horseshoe kidney.

Abdominal Pain↗