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What are the Uncommon Anaplastic Lymphoma Kinase (ALK) Fusions in Non-Small Cell Lung Cancer?
No full textLung cancer carcinogenesis is increasingly related to genetic disorders that lead to the use of specific targeted therapies which improve clinical outcome and survival. Gene fusion is one of the mechanisms of lung cancer pathogenesis besides gene mutation. The oncogenic echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK) fusion gene was the first described in non-small cell lung cancer (NSCLC) and it’s the most frequent ALK rearrangement which occurs in approximately 5% of NSCLC. The development of sequencing technology has allowed the discovery of other ALK partners that cause an ALK fusion in NSCLC. They are still less known, however. The aim of this review is to report the novel ALK fusions in NSCLC described in the literature and their particular characteristics. We will present the kinesin family member 5B (KIF5B) - ALK fusion, the huntingtin interacting protein 1 (HIP 1)- ALK fusion, and other uncommon ALK fusions.
Triple Localized Cranio-Facial Fibrous Dysplasia: A Case Report
No full textIntroduction: fibrous dysplasia of bones is a non-hereditary congenital benign bone disorder, where normal bone is replaced by pseudofibrous tissue containing immature osteogenesis.Case report: a 29-year-old patient with chronic hemodialysis who had a swollen mouth and hard palate that had been evolving for a year, impeding chewing and swallowing and causing facial asymmetry. Cranio-facial CT revealed multiple osteolytic bone-blast lesions, the histopathological study of which favored polyostotic fibrous dysplasia.Discussion: fibrous dysplasia lesions may be single or multiple and may be responsible for pain and fragility, causing neurological complications in craniofacial localization. Imaging and, when a biopsy is needed, histology can establish the diagnosis. The treatment is based on bisphosphonates or, in special cases, surgical excision
Factors Associated with Extra Articular Manifestations in Rheumatoid Arthritis
No full textIntroduction: Rheumatoid arthritis is a chronic, systemic and inflammatory joint disease that primarily affects the joints and can be associated with a variety of extra-articular manifestations. The aim of this study is to determine the frequency and the factors associated with those extra-articular manifestations.Materials and methods: Cross-sectional study of hospitalized cases of rheumatoid arthritis in our department between January 2012 and January 2018. We studied the prevalence of the extra-articular manifestations and associated factors. The analysis was done by the software EPI INFO 3.5.4.Results : 294 cases of rheumatoid arthritis included. The average age was 53.2 years +/- 12.3 with female predominance F / M = 6.1. The diagnosis lag time was 10.7 +/- 6.9 years. Half of our patients (50.7%) had systemic manifestations. In order of frequency, we distinguish: Osteoporosis (39.6%), Sjögren's syndrome (22.1%), pulmonary involvement (16.1%), dermatological manifestations (8.8%), cardiac involvement (8.8%), ocular involvement (3.1%) carpal tunnel syndrom (1.3%) and vasculitis (1.3%). The extra-articular manifestations were associated with several factors on bivariate analysis : advanced age (p = 0.014), longer duration of disease (p = 0.006), deformities (p = 0.000), seropositivity (p = 0.02), high titers of rheumatoid factor (p = 0.03), destruction (p = 0.02), bone erosions (p = 0.012) and non-use of biotherapy (p = 0.04). Factors whose association was statistically significant, after multivariate logistic regression analysis, were: advanced age (p = 0.04, OR = 1.02 [1.001-1.043], and longer duration of disease (p = 0.02 OR = 1.04 [1.005-1.082]).Conclusion: In our Moroccan context, half of the patients with rheumatoid arthritis had extra-articular manifestations. Older patients with longer disease evolution are the most involved
La Chirurgie Video-Assistee dans la Pathologie Inflammatoire et/ou Infectieuse Pleuropulmonaire
No full textIntroduction: La pathologie pleuropulmonaire dans notre contexte Marocain est dominée par les maladies inflammatoires. La chirurgie thoracique vidéo-assistée a été développée à travers le monde dont les indications sont surtout représentées par les résections pulmonaires pour cancer broncho-pulmonaire. Au Maroc, cette voie est en cours de développement et de généralisation. Notre contexte est particulier ce qui rend l’utilisation de la VATS un véritable challenge. Objectif: relever les caractéristiques techniques et les facteurs de risque de la chirurgie vidéo-assistée dans la pathologie inflammatoire pleuropulmonaire en dehors de la chirurgie de résection. Matériels et méthodes: Cohorte prospective de type cas-témoins analysant 65 patients pendant une durée de deux ans, comportant les cas pris en charge pour pathologie infectieuse ou inflammatoire pleuropulmonaire. Le détail des indications chirurgicales, des voies d’abord, et la possibilité des différents gestes chirurgicaux, ainsi que les données postopératoires ont été relevées. Une analyse comparative sera réalisée utilisant des tests statistiques avec le logiciel Epi-info 7. Conclusion: à travers cette étude préliminaire, nous suggérons que la VATS est une technique faisable, très efficace et bien adaptée dans notre contexte permettant la réalisation de tous les gestes malgré les contraintes inflammatoires. Une étude plus large est nécessaire pour mieux définir les indications et les possibilités chirurgicales dans notre contexte
Les Résections avec Reconstruction pour Tumeurs de la Paroi Thoracique : Expérience du Service de Chirurgie Thoracique du CHU Mohammed VI de Marrakech
No full textIntroduction : les tumeurs de la paroi thoracique sont rares. L’exérèse chirurgicale large et complète constitue le principal traitement. La reconstruction de la paroi est obligatoire en vue de rétablir sa morphologie et son rôle dans la physiologie respiratoire. Objectif : Présenter nos résultats concernant le traitement chirurgical de ces tumeurs. Patients et méthodes : Les données cliniques, paracliniques, chirurgicales et des suites post-opératoires sont relevés à partir des dossiers médicaux de 08 patients opérés dans le service de chirurgie thoracique du CHU Mohammed VI. Marrakech. Résultats : il s’agissait de 6 femmes et de 2 hommes. Les signes cliniques étaient des douleurs thoraciques associées à une tuméfaction sternale chez 5 patients, une masse pariétale laterothoracique chez deux patients et une masse laterosternale droite chez une patiente. L’évaluation pré-opératoire comprenait une radiographie thoracique et une tomodensitométrie thoracique. La biopsie chirurgicale préthérapeutique de la tumeur était réalisée chez 5 patients. Le geste chirurgical était une sternectomie subtotale avec reconstruction pariétale chez 3 patients, une manubriectomie chez 2 patients et une résection costale monobloc emportant la tumeur 3 patients. Toutes les résections étaient macroscopiquement complètes. L’examen anatomopathologique de la pièce opératoire objectivait une tumeur costale à cellules géantes, deux tumeurs desmoides, deux localisations secondaires d’un carcinome folliculaire thyroïdien, une localisation secondaire d’un carcinome vesiculaire thyroïdien, un leiomyosarcome primitif et un cas de chondrosarcome primitif. L’évolution postopératoire a été marquée par une bonne amélioration clinique, biologique et radiologique. Au dernier contrôle médical, les patients sont asymptomatiques. Conclusion: Les tumeurs de la paroi thoracique peuvent être primitives ou secondaires, leur diagnostic est évoqué devant une tuméfaction et une douleur thoracique. Le bilan lésionnel exact est basé essentiellement sur la tomodensitométrie thoracique. Le diagnostic définitif est anatomopathologique. Le progrès des techniques de reconstruction pariétale avec des résultats satisfaisants permet à la chirurgie de demeurer un traitement essentiel
Kikuchi-Fujimoto Disease in a 24-Years Old Saudi Female in Saudi Arabia
Get PDFKikuchi-Fujimoto disease (KFD) is a very rare, self-limited and benign inflammatory disorder. It was first reported in Japan in 1972. Diagnosis of Kikuchi disease is confirmed by histopathological investigation of lymph node (LN) biopsy under ultrasound guidance. Computed tomography (CT) and magnetic resonance imaging (MRI) help in the diagnosis of Kikuchi cervical lymphadenopathy but don’t provide a definitive diagnosis. We describe a case of KFD affecting the cervical lymph nodes of a 24-year old Saudi female
A Rare Presentation of Bilateral Vocal Cord Paralysis in Late Stage Parkinson’s Disease
No full textIntroduction: Vocal cord paralysis often causes mortality by upper airway obstruction in some neurodegenerative diseases such as Parkinson’s disease and multiple system atrophy. Vocal cord paralysis is uncommon in Parkinson’s disease (PD) on the contrary it is more common in multiple system atrophy (MSA). The pathogenesis of vocal cord paralysis in Parkinson’s disease is not well understood but may involve degeneration of the nucleus ambiguous. In terms of managing patients with bilateral vocal cord paralysis in PD, it can either perform a tracheostomy to relieve the upper airway obstruction or optimize the medical treatment. There are very few available reported cases whereby patients are treated with medical treatment alone.Case Report: We report a case of 65 years old lady who presented with stridor resulting from bilateral vocal cord paralysis and has been diagnosed with Parkinson’s disease for more than 10 years. She had her antiparkinson medication optimized and requiring no surgical intervention to relieve the upper airway obstruction.Conclusion: In conclusion, we would like to emphasize that it is important to recognize bilateral vocal cord paralysis in Parkinson’s disease and early optimization of medical treatment could avoid a need for tracheostomy
Peritonsillar Abscess (PTA) Management: A Literature Review Comparing Different Approaches of PTA Drainage
No full textBackground: Peritonsillar abscess (PTA) is the most common deep infection of neck space in adults and potentially life-threatening if not treated appropriately. The surgical treatment of peritonsillar abscess that is not complicated with upper airway obstruction remains controversial. Objectives: This review attempts to explore the controversies between different types of management and compare the efficacy of needle aspiration, tonsillectomy, and/or incision and drainage. Methodology: This study was done at King Abdulaziz University. All researchers, between 1988 to 2015 were recruited and reviewed in this study. Results and conclusion: Studying the three accepted methods of draining: incision and drainage, abscess tonsillectomy, or needle aspiration, incision, and drainage is an efficient and safe procedure to treat the peritonsillar abscess. As well as it is superior to Needle aspiration in terms of the post-procedure pain score. It can be performed as the first-line treatment of a peritonsillar abscess. Quinsy tonsillectomy can offer several advantages, by allowing full evacuation of the abscess cavity, effectively relieving symptoms, but holds risk in general anesthesia intubation. and also higher post-operative complications like Peritonsillar abscess make it not a favorable step
Evaluation of the Quality of Care Security Produced by the Room Theater of the Regional Hopital of Ngaoundere
No full textThe mission of the operating room is to provide an efficient framework for surgical interventions, programmed or emergency cases because patients increasingly claim the right to the best possible quality of care. The objective of this study was to improve the quality of care service produced in the operating room of the Regional Hospital of Ngaoundéré. It concerned an observational descriptive study going from August 1st to September 30th, 2016. Data collection was carried out through direct observation and interviews. Results reveal from this study that, 46.66% of the operating room infrastructures were not up to the required international standards. Skin cleaning was carried out in 31 % of the cases by standard products but the different steps were not respected. Concerning hand washing and preliminaries to surgical scrub, it was a forgotten practice or non-applied practice in the regional hospital of Ngaoundéré. The surgical disinfection of hands by friction in its two stages was not observed normally in 75.70 % and 97.10 % respectively. We realized that only 34.4 % of observations regarding the required time allowed for surgical friction was equal to or a little greater to the standards