Biomedical subjects
Publications and source records attributed to M Moumen.
This article is concerned with 3 cases of the morbid association of autonomie adenoma and vesiculo-papillary carcinoma of the thyroïd. Based upon literature data the authors are discussing, clinic, paraclinic, histopathologic, physiopathologic and therapeutic problems of this association.
The authors report 7 cases of cervico-facial cystic hygromas. Cystic hygromas are rare affections that can pose redoubtable therapeutic problems because of their size and localisation. Their diagnosis is clinically easy but must be affirmed by an histologic investigation. The treatment of cervico-facial cystic hygromas is essentially a surgical resection that must be envisaged according to the patient's age and the characteristics of the tumor. The authors insist on the codification of the surgical attitude that is the only guarantee of the cure.
While reporting on 9 cases of bilio-bronchic fistulas of hydatic origin, and with the help of literature data the authors are underlying a number of points: Hidatic bilio-bronchic fistulas are rare and a serious condition responsible of lesions at 3 levels, hepatic, diaphragmatic, and pulmonary. The diagnosis gives no rise to any problem the biliptysia is the main symptom. The treatment is always surgical, the approach is the abdominal way that permits the hepato-bronchic deconnection and the treatment of the hydatic cyst and to ensure the liberty of the common bile duct and to realise an eventuly drainage of the common bile duct to close the fistulous diaphragmatic communication and permit an inter-hepatodiaphragmatic drainage. It's but in front of a preoperatory destruction of a pulmonary lobe or the absence of improval of a pulmonary state post operatively (irreversible bronchectasis, chronic pulmonary sepsis) that the thoracotomy is indicated. The prognosis is severe with an elevated rate of mortality of 12,2% in this series. Showing the necessity of the prenetion of such complication by operating on every hydatic cyst of hepatic dome.
The authors report 25 cases of iatrogenous laryngotracheal stenosis seen at the university hospital IBN Rochd of Casablanca these stenosis are frequent as well as in infant as (12 cases) as in males (10 cases) they are the consequence of prolonged intubation in cases of coma (12 cases) of traumatic intubation (10 cases) but also after laryngeal irradiation (2 cases) or partial laryngeal surgery (1 case). The seat of stenosis is laryngeal (56%) laryngotracheal (36%) and tracheal (8%). The treatment of these stenosis is difficult; our patients are usually tracheotomised (63.6%) with extensive stenosis. The treatment has used this rilling with laser (12 cases) an endoscopic microsurgery (4 cases) and open surgery 2 times. The dilatation by mean of Montgomery tube or by Traissac tube is often irispensable to avoid relapses. The results are favorable in spite of the length of the treatment (10 days to 30 months) with 15 succesS and 7 partial failures. The authors underline the stenagenous risk of intubations and tracheotomies and on the rules to prevent these iatrogenous laryngo-tracheal stenosis.
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This article is concerned with 36 cases of plunging goiters responding to Eschapasse and Merlier definition. The frequency of plunging goiters is 5.2%, women are predominating with 96% and the average of age is 45 years. In 34%, these goiters gave rise to fow symptoms, while there was mediastinal complication in the others cases. Paraclinic investigations are limited to a face and profile pulmonary roentgenographies, and scintigraphy of the thyroid. In the treatment, cervicotomy proved to the completely satisfactory to removal of all the goiters and there were no need to sternotomy or thoracotomy. The pathology revealed two malignant tumors. Post operative evolution was uneventful except one death in the 10th post operative day by pulmonary emboli.
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We report here the results of a series of 360 patients operated on for hydatic cyst of the liver, all of them have undergone a conservative procedure which is the resection of the bulging dome. Diagnosis has not raised any problems in an endemic country. We stay conservative although we are aware of the fact root of morbidity (Sub phrenic abscess 4.1% cholerragy 5.5%). The resection of the bulging dome has a feeble mortality (1.3%) which is the advantage of this method in regard of the radical ones, involving operative risks which can compromise vital prognosis.
Six cases of hydatid cyst of cervico-facial glands are reported: 4 involving the salivary gland and 2 the thyroid gland, insisting on their rareness even in endemic countries. Ultra sound scanning let us suspect the hydatid nature of the liquid when there are multiple echoes or compartmentation. Cytopuncture using a fine needle which provides a crystal clear liquid is important for the diagnosis. Treatment is surgical and avoids the spontaneous evolution that may be interrupted by complications.
Our retrospective study is based on 80 compressive goitres collected over a period of 7 years in the general surgical department of the Ibnou Rochd University Teaching Hospital, Casablanca. Dyspnea was the predominant clinical manifestation and was encountered in 82.5% of cases, followed by dysphonia (65%), dysphagia (46%) and finally venous compression (8.7%). Hyperthyroidism was encountered in 26.25% of cases, 57% of these being due to Grave's disease. The goitre extended mediastinally in 38% of cases but resection was possible on cervicotomy alone. Post-operative sequelae were minor in nature, though one death did occur. On histological examination 85% of these goitres were benign and only 15% were of a malignant nature. This is in agreement with the data in the literature which confirms that compression is not synonymous with malignancy.
Analysis of a series of 70 cases of closed trauma to the liver seen between 1983 and 1988, confirms the gravity of these lesions even when good transport and reception facilities exist for injured patients. The combined efforts of resuscitation and surgery fail for two reasons: the severity of actual hepatic disruption and the existence of extra-hepatic injury in patients with multiple trauma. The major threat comes from the hemorrhagic syndrome which is responsible for almost half the deaths. The dogma advising emergency surgical intervention still remains, if only to evaluate the exact degree of liver trauma and to deal with coexisting intra-abdominal lesions. The surgical intervention should be adapted to the hepatic lesion without attempting complicated technical procedures. In the absence of coagulopathy, resection should be reserved for massive lesions. Most often direct hemostasis and parenchymal suture are sufficient. This should always be attempted if it appears reasonable. In more severe situations, especially if a coagulopathy exists, packing is a wise and logical procedure. Surgical abstention should especially be reserved for cases of unruptured central or sub-capsular hematoma, in a stable hemodynamic situation, under strict surveillance in a specialised surgical department. In contrast to the high initial mortality (40%), the subsequent course is generally favorable and without specific sequelae even after major disruption or hepatic resection. The use of an appropriate therapeutic strategy will reward the surgeon with a cure in 6 out of 10 cases of closed hepatic trauma.
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Acute cholecystitis is a surgical disease. However, if the operative indication is strict and univocal, the timing of operation still debatable. The purpose of this study of 343 calculous acute cholecystitis is to point out the marked tendency of the early surgical therapy. Such attitude may be encouraged by the observed change on roentgenographic studies' strategy (gallbladder opacification supplemented by echography) and the obtained good results.