Biomedical subjects
Publications and source records attributed to H Achrafi.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Adrenal histoplasmosis is a rare infection that can be misdiagnosed as tuberculosis. We present here a case of adrenal histoplasmosis in a 65 year-old male diabetic with marked weight loss. Laboratory investigations noticed an inflammatory syndrome and the abdominal computed tomography scanner reported an heterogenous left adrenal mass of 6 cm in diameter. Hormonal as well as bacteriological studies were negative. The patient was operated and the histopathological examination proved that the mass was a tuberculoma and an anti-tuberculous treatment was started. Four months later, the patient suffered from recurrence of symptoms and laboratory investigations confirmed the inflammatory syndrome and the abdominal computed tomography scanner showed a right adrenal mass. A surgical biopsy was performed and specific fungal researches proved that the lesion was due to Histoplasma capsulatum. The patient experienced a remarkable improvement under anti-fungal treatment.
BACKGROUND: Diagnosis of primary hyperparathyroidism (PHPT) is increasingly suspected in elderly patients after the discovery of hypercalcemia by routine measurement of serum calcium levels. Surgery is commonly accepted as the optimal treatment of PHPT. We wanted to assess risk and results of neck exploration in elderly patients with PHPT. METHODS: We performed a retrospective study of the charts of 78 patients older than 75 years (mean age, 79.1 years) with PHPT who underwent neck exploration during a 15-year period. RESULTS: The most common presenting symptoms were neurologic and psychiatric disorders (47 patients). Preoperative localization investigations, performed in 72 patients, were successful in 42 of them (sensivity, 58%). Single adenoma, double adenomas, and hyperplasia were found in 74 patients (95%), three patients, and one patient, respectively. Overall postoperative mortality was 3.8% (three patients) with no death since 1984. Significant complications occurred in three patients (4%): one myocardial infarction, one pulmonary embolism, and one cerebral hemorrhage. Average length of postoperative hospital stay was 4 days. Among patients who could be followed up (65 cases with a mean follow-up of 3 years), 94% reported an improvement in their symptoms. This was especially marked for fatigue and intellectual function. CONCLUSIONS: These data support a liberal approach regarding surgical treatment in elderly patients with PHPT.
OBJECTIVE: Oesophagectomies have a high morbidity rate, mainly related to pulmonary complications. The aim of this work was to assess whether the thoracoscopic approach could reduce this morbidity. PATIENTS AND METHODS: We conducted a prospective study of the results of 26 attempts of esophagectomy using a right thoracoscopic approach. There were 17 males and 9 females having an average age of 47. The indication was a squamous cell carcinoma in 19 patients, an adenocarcinoma in 1 patient, a melanoma in 1 patient and a caustic stenosis in 5. The whole oesophagus was mobilized thoracoscopically, and the eosophagectomy was completed through the abdomen. The reconstruction was achieved using a gastric pull-through and a cervical anastomosis. RESULTS: There were 5 failures for the following reasons: unresectable carcinoma (1 case), large tumour making a thoracoscopic dissection unsafe (1 case) and incomplete lung collapse making the exposure of the posterior mediastinum difficult (2 cases). The average time of the thoracoscopic procedure was 135 min. The post-operative course was uneventful in all but 5 patients who had a pulmonary complication: atelectasis (3 cases), right purulent pleural effusion (1 case), acute respiratory distress syndrome (1 case). The latter complication was lethal. Four out of 5 respiratory complications occurred in patients for whom the dissection was considered as difficult. Among the other complications, there were 5 anastomotic leakages and 3 laryngeal nerve palsy. The mortality rate was 3.8%. CONCLUSION: These initial results do not show a real benefit of the thoracoscopic approach for eosophageal dissection, especially for difficult oesophagectomies. Further evaluation of the technique is needed.
From September 1986 to September 1994, 34 emergency laparotomies were performed in human immunodeficiency virus (HIV) seropositive patients. Patients were divided into 2 groups. Group A included 11 HIV seropositive patients without acquired immunodeficiency syndrome (AIDS). In these patients, indications for exploration included right lower quadrant pain consistent with appendicitis in 6 patients, right upper quadrant pain consistent with cholecystitis in 3 patients, small bowel obstruction in 1 patient, and blunt abdominal trauma in 1 patient. No postoperative deaths were observed. Group B included 23 AIDS patients. Indications for exploration were diffuse peritonitis in 8 patients, right lower quadrant pain consistent with appendicitis in 6 patients, right upper quadrant pain consistent with cholecystitis in 5 patients, bowel obstruction in 2 patients, diffuse abdominal pain in 1 patient, and massive rectal hemorrhage in 1 patient. The mortality rate in this group was 35% (8 out of 23 patients). Five of the 8 patients with diffuse peritonitis died postoperatively (62%). The importance of early diagnosis and prompt surgery is emphasized to improve the prognosis in AIDS patients, because of their poor general condition and the severity of abdominal complications.
To study the risk of wound infection in pediatric outpatients, two series of children operated on with an inguinal incision during a 5.2 year period in the same department, either in day-surgery or in standard hospitalization, are compared. It appears that the frequency of inguinal wound infection is lower for outpatients (1%; 18/1816) than for inpatients (4%; 17/427). This difference is due, on the one hand, to the way day-surgery hospitalization functions and, on the other hand, to the difference of population produced by the criteria for selection for admission in the Day-Surgery Unit.
The object of this retrospective (case-control) study of 513 carotid artery operations in 471 patients was to evaluate whether the presence of coronary artery disease at the time the decision to operate was taken, influence the prognosis of patients operated upon for stenosis of a carotid artery. Three groups were constituted and compared; no coronary artery disease (NC), stable coronary artery disease (CS) and unstable coronary artery disease (CI). Operative mortality was 1% (NC), 5% (CS) and 9% (CI) respectively (p < 0.001). The rate of neurologic deficits was 1.3% (NC), 2.4% (CS) and 3.1% (CI), and the 5 year actuarial survival rate 83% (NC), 78% (CS) and 63% (CI) (p = 0.040 by the Log-Rank test). Premature deaths were due to cardiac and neurologic causes. In the patients with coronary disease, local and regional anesthesia was followed by 0% mortality whereas the rate was 3% (CS) and 13% (CI) (p < 0.001) after general anesthesia. The cause of delayed death was determined accurately in 50% of cases; it was cardiac in 25% (NC) and 70% in patients with coronary disease. Results of the present study confirm that the presence of coronary disease has an adverse effect on the immediate and long term prognosis for patients undergoing coronary artery surgery, and demonstrate that the operative risk can be significantly reduced by the use of local and regional anesthesia. Long term close cardiology surveillance is justified, particularly if signs of coronary disease are noted perioperatively.
Two patients are reported in whom hypertrophic cardiomyopathy was associated with myocardial bridging of the left anterior descending coronary artery. One had a history of angina and recurrent syncope, the other had chest pain and exertional dyspnoea. In each case the diagnosis was made by cross-sectional echocardiography and coronary angiography.
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Venous leiomyosarcoma are rare malignant tumours that are usually revealed by an oedema of the lower limb, a sign of deep phlebitis. As the development is not linked with radiotherapy and chemotherapy, the prognosis depends mainly on a early diagnosis, which brings the best opportunities of complete surgical exeresis before the apparition of metastasis. The case reported below as well as ten other cases taken in the literature show the necessity to mention this diagnosis when confronted to any phlebitis appeared in the absence of usual precipitating factors. It is all the more necessary when mass is found by palpation, a small tumour is revealed by echography or when phlebography shows a lateral or circumferencial stricture that is different from usual pictures of phlebitis.