Biomedical subjects
F Derbel
Publications and source records attributed to F Derbel.
Primary epidermoid carcinoma of the submandibular salivary gland.
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[Painful erythema of the forefoot].
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[Primary hypertrophic osteoarthropathy without cutaneous involvement (Currarino's disease)].
INTRODUCTION: Hypertrophic osteoarthropathy (HOA) is a syndrome associating hippocratic fingers, arthropathy and periostosis of long bones. Currarino's disease, considered at present as a clinical form of primary HOA, is characterized by the absence of pachydermia. OBSERVATION: A 24-year-old Caucasian man, consulted for a painful swelling of both ankles that had developed over the past year. Clinical examination revealed hippocratic fingers without pachydermia. The ankles were swollen. The X-rays showed periosteal apposition and an acro-osteolysis. In view of this triad: arthropathy, hippocratic fingers and periostosis, primary HOA without cutaneous involvement or Currarino's disease was diagnosed. The search for a secondary cause remained negative. Clinical improvement was obtained after 15 months with non-steroidal anti-inflammatory drugs (NSAID) and colchicine. COMMENTS: Although exceptional, primary HOA without cutaneous involvement is a genetic disease which must not be ignored.
[Esophageal mucocele: report of 2 pediatric cases].
Two cases of esophageal mucocele in pediatric patients are reported: two children of 5 and 9 years respectively underwent surgical isolation of the esophagus and esophagocoloplasty for caustic stenosis related to accidental ingestion of caustic soda. Clinical pattern of mediastinal compression was proved with cervical fistulous tract in one case. In both cases, thoracic computed tomography was a sensitive imaging method to demonstrate the mucocele and its extension. Esophageal mucocele is rarely described in children, especially following esophageal corrosive stricture.
[Anal metastasis of colonic adenocarcinoma?].
Two cases of sigmoid and anal adenocarcinoma are reported. The two patients were treated by abdominoperineal resection of the rectum and resection of the sigmoid colon. The relationship between colonic adenocarcinoma and anal adenocarcinoma is not obvious but possible. The various mechanisms of tumoral spread are discussed and the most frequent mechanism seems to be cellular exfoliation.
[Mucocele of the appendix. Retrospective study of 10 cases].
PURPOSE: The purpose of our work was to assess the value of abdominal sonography (US) and computed tomography (CT) in the preoperative diagnosis of appendiceal mucocele. MATERIAL: and methods. We retrospectively reviewed 10 cases of mucocele of the appendix, 7 cases without pseudomyxoma peritonei, and 3 cases with pseudomyxoma peritonei. All cases were investigated radiologically by plain film and US, barium enema was performed in 3 cases and CT in 5 cases. RESULTS: Mucoceles of the appendix are rare and their clinical presentation is not specific. US confirms the appendicular involvement, but often poses the differential diagnosis with acute inflammation, abscess or localized appendicular peritonitis. CT appears as a mandatory examination since it allows accurate preoperative diagnosis period. In this series, the diagnosis was made preoperatively in the 5 cases where CT had been performed. CONCLUSION: US is useful to confirm the abnormal pattern of the appendix but does not allow accurate diagnosis of mucocele. CT is more specific and accurate for diagnosis of mucocele of the appendix.
[Diagnosis of a case. Incipient Dupuytren's disease].
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[Ambulatory surgery of hand pathology. Experience of the hand surgery service of the Kassab Institute].
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[Palpebral capillary hemangioma and amblyopia. Apropos of 2 cases].
Periorbital capillary hemangiomas of childhood can produce visual axis occlusion and anisometropia, resulting in amblyopia. We report our experience performing surgical resection of periorbital capillary hemangiomas. Partial resection of hemangiomas was performed in two infants under five months of age, and permitted clearing of the visual axis. This immediate effect is necessary to prevent amblyopia. Surgical resection should be considered a treatment option for managing periorbital capillary hemangiomas which threaten vision.
[Hydatid cysts of the liver ruptured into the thorax: which approach should be first choice?].
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[Hydatic cysts of the liver ruptured into the thorax. Diagnostic and therapeutic aspects].
Hydatic cysts of the liver can rupture into the thorax. The aim of this work was to demonstrate how abdominal access can be used in most cases. We report 44 cases of hydatic cysts which ruptured into the thorax among a series of 1411 hydatic cysts of the liver operated between 1974 and 1995. Abdominal ultrasound and chest x-ray provided the diagnosis preoperatively in 35/42 operated cases (one case of spontaneous elimination of a hydatic membrane via a cutaneous orifice and one case of preoperative death). Thoracophrenolaparotomy was used in 12 cases, thoracotomy with laparotomy in 6, thoracotomy alone in 5 and laparotomy alone in 19. Pulmonary resections were performed in 18 cases. No procedure could be performed in one patient who died at the beginning of surgery. A breach in the diaphragm was repaired in 41 cases. The dome of the cyst was resected in 29 cases and complete pericystectomy was performed in 12. There were 7 post-operative deaths. There were no deaths in the abdominal access patients. All emergency problems were controlled with abdominal access. Thoracic access was reserved for specific cases.
[Value of continuous measurement of mixed venous oxygen saturation (SVO2) during coronary angioplasty].
Mixed venous oxygen saturation (SVO2) is an haemodynamic parameter of cardiovascular function. The object of this study was to measure SVO2 during percutaneous transluminal coronary angioplasty (PTCA) with prolonged balloon inflation in order to evaluate haemodynamic tolerance more precisely in two groups of patients. Twenty-six patients undergoing PTCA were divided into two groups: Group I, N = 15, with single vessel disease and good left ventricular function (EF: 61.63 +/- 10.1%); Group II, N = 11, with triple vessel disease and poor left ventricular function (EF: 48.05 +/- 14%; p < 0.05). Continuous monitoring of SVO2 with an oximetrix fiber optic catheter was performed in all patients during PTCA. Irrespective of the duration of balloon inflation, a significant correlation was observed between the changes in cardiac output and VSO2. Given that arterial oxygen pressure, global oxygen consumption and haemoglobin concentrations remained constant during balloon inflation, SVO2 was an indicator of cardiac output.
[Results of transluminal coronary angioplasty. 42 patients].
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[Vascular complications in infectious endocarditis. Apropos of 86 cases].
During a 20 year period, 285 patients were hospitalised for infectious endocarditis (IE) in the Department of Cardiology of the Ernest-Conseil Hospital in Tunis and 86 of them, i.e. 30%, developed a vascular complication (VC). Among these 86 patients, there were a total of 108 lesions, including 52 neurological complications, 14 peripheral acute ischemic syndromes, 16 peripheral arterial aneurysms, 9 aortic aneurysms, 7 pulmonary embolisms, 6 splenic infarctions and 4 coronary lesions. The mortality in this patient group proved to be slightly greater than in the series as a whole, in particular concerning patients with multiple lesions and those with an artificial valve. No prognostic difference was seen between patients with a VC of aneurysmal type and of ischemic type, but the presentation and severity of lesions was very variable. The vascular complication was a presenting feature of IE in almost 40% of cases. The organism found most often was the streptococcus, above all in ischemic type IE as well as in the total patient group. Similarly, the preferential site was aortic, above all for aneurysmal type IE. Ultrasonography revealed a higher incidence of vegetations in this series of patients, above all in ischemic type VC, but anatomical studies have shown this to be an investigation of moderate sensitivity and poor specificity, poorly correlated from a prognostic standpoint with the risk of embolism. The conclusion of the study is above all the need to prevent such complications: embolic complications by early antibiotic treatment and valve replacement and aneurysmal complications by methodical routine angiographic evaluation and appropriate treatment.
[Clinical, angiographic aspects and 18-month follow-up of 134 cases of left coronary trunk stenosis].
A series of 134 patients with left main coronary stenosis was followed up for an average of 18 months. The majority of patients presented with unstable angina and per-critical ECG changes. Coronary angiography showed that left main coronary stenosis is rarely an isolated entity but generally associated with diffuse coronary atherosclerosis. Left ventricular function is usually normal. Treatment is surgical whenever the coronary lesions, left ventricular function and general condition of the patient allow it. The medium-term surgical results are excellent on clinical symptoms and quality of life at the price of low perioperative mortality and morbidity.
[Aortic coarctation surgically treated in patients over 15 years of age].
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[Auriculoventricular blocks in the acute phase of myocardial infarction. Course and prognosis. Apropos of 90 cases].
The objective is to study the clinical and electrocardiographic characteristics as well as the course of myocardial infarction complicated by atrio-ventricular block (AVB), and to propose a management to acute myocardial infarction with A-V block. This study concerns 90 patients (78 men and 12 women), with a mean age of 58 years. The overall frequency of AVB is 7.6 p. cent. The infarction is most of the time found posteriorly (51 p. cent of the cases). Syncopes are essentially seen in complete AVB (81 p. cent) and with deep antero-septal necrosis (73 p. cent). Heart failure is especially the complication of anterior (73 p. cent) and deep septal (78 p. cent) necrosis. The mortality of myocardial infarction complicated by A-V block (41 p. cent) is higher than that of uncomplicated necroses (15 p. cent). The prognosis is usually favorable in posteriorly located infarctions where the A-V block is usually regressive and benign while it is much more severe in other locations where the conduction disorders associated with severe myocardial lesions. Temporary and/or permanent electrosystolic stimulation must be well codified in its indications which should be broadened, especially in case of anterior or deep septal necrosis.