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Vomer Agenesis as a Rare Cause of Hypernasality
No full textHypernasality which is a rare symptom commonly occurs as a consequence of velopharyngeal insufficiency (VPI). VPI usually manifested as nasal air emission and hypernasal resonance during speech. The cause can be divided into congenital, neuromuscular disorder, and surgical complication. Congenital cause of VPI includes cleft palate, nasal septum malformation such as vomer agenesis, submucous cleft palate, and velar dysplasia, while neuromuscular VPI can be due to cerebral palsy or cerebrovascular accident. The surgical cause of VPI could be due to adenoidectomy and scarring of the velum post palatoplasty in cleft palate repair. We present a 17-year-old man who was diagnosed with congenital left nasolacrimal duct obstruction referred to us for left endoscopic dacryocystorhinostomy in which during nasoendoscopic examination revealed the absence of vomer
Nicardipin Associated Pulmonary Edema : A Severe Complication of Tocolysis - A Case Report
No full textIn preterm labor, tocolytics are used to stop uterine contractions and to allow the administration of corticosteroids for fetal lung maturation, nicardipine is a calcium channel blocker increasingly used for this indication. Several adverse effects have been reported during tocolysis using nicardipine, one of the most serious complications is Acute Pulmonary Edema.
We report a case of a parturient who has admitted at 28 weeks of pregnancy for preterm labor and developed a respiratory failure two days following tocolysis with nicardipine. Echocardiography and Computed Tomography Pulmonary Angiography (CTPA) ruled out a pulmonary embolism and a decompensated heart disease. The patient received oxygen therapy and diuresis for Acute Pulmonary Edema with favorable outcomes.The purpose of this paper is to discuss the risk factors for the occurrence of pulmonary edema after tocolysis, the importance of the etiologic investigation to exclude differential diagnoses and therapeutic options for management of this complication
Thymectomie par Video-Thoracoscopie Bilatérale : Quelle Place Parmi les Nouvelles Techniques Chirurgicales ?
No full textThymic tumors account for about 50% of whole tumors of the anterior mediastinum. The classic approach is total sternotomy (ST). However, for small, well-encapsulated tumors, video thoracoscopy (VATS) may be an acceptable alternative. We discuss the evolution of surgical treatment in our department
How to Write a Case Report
No full textIn medicine, a case report can be defined as a detailed report of anthropometric characteristics, symptoms, physical signs, explorations, diagnoses, treatments, follow-up and evolution of a patient. The reasons for the publication of a case report are multiple, ranging from the rarity of the case to its didactic side. In this practical article, we will talk about the main points to follow in order to produce a case report that meets the standards
Unintentional Post-Operative Open Abdominal Wall in Non-Traumatic Patients: A Monocentric Retrospective Study in Tunisia
No full textIntroduction: Unintentional post-operative open abdominal wall (UPOAW) is a postoperative complication that consists of the early separation of the fascial layer after the primary closure of a laparotomy incision. This complication is associated with great morbidity and mortality. In this article, we studied the frequency of some of these known factors in our series and we briefly discussed the management of this complication.Methods: It was a monocentric retrospective and descriptive study. We enrolled patients with UPOAW, admitted in the department of surgery in Habib Thameur hospital in Tunis (Tunisia), between January 2010 and December 2015. We did not include traumatic patients. We excluded patients with missing data from medical records.Results: The study was conducted on fifteen patients. Eight out of fifteen were men. Patients were aged between 41 and 76 years, with a mean age of 66.6 ± 11.4 years. In the past medical history, chronic obstructive pulmonary disease was noted in three patients, cirrhosis in three patients, diabetes in one patient, and history for laparotomy in one patient. Eight out of fifteen underwent emergent surgeries. Two out of these eight patients had hemodynamic instability throughout the surgery. In the postoperative course, coughing was noted in three patients, abdominal distension from ileus in three patients, vigorous postoperative ventilation in two patients, and vomiting in one patient. UPOAW was diagnosed between postoperative day zero and postoperative day twenty-one, with a mean time of diagnosis of 10.1 ± 6.6. All patients had immediate closure of the fascial layer. The surgeon used retro-fascial polyglactin mesh in three patients. Relaxing incisions were used in 5 patients. Morbidity after reoperation was 46.7 % (7/15) and mortality was 33.3 % (5/15).Conclusion: UPOAW is a serious complication with high morbidity and mortality. Many factors can contribute to this complication. Every visceral surgeon is confronted with this problem at some point in his carrier and should apply adequate treatment to his patients depending on his decision and experience. A strong level of evidence is needed to establish clear guidelines for the management of this heterogenous complication
Granulomatous Mastitis - A Case Report
No full textGranulomatous mastitis is indeed a rare affliction, but it can constitute a veritable diagnosis and treatment predicament for several reasons. The etiology of this disease remains shrouded in mystery and the treatment depends on the gravity and extension of the lesions, ranging from corticosteroids to surgical excision with an important recurrence rate. We present the case of a 40-year-old woman with granulomatous mastitis for which clinical and radiological remission was obtained via medical treatment
Compte Rendu du Troisième Congres Scientifique de la Société Marocaine de Chirurgie Thoracique
No full textLa Chirurgie de l’Emphysème Paracicatriciel Post-Tuberculeux (A Propos de 20 Cas)
No full textIntroduction: L’emphysème post tuberculeux est un ensemble lésionnel juxtaposant des lésions fibreuses à des foyers emphysémateux, parfois bulleux. Il est en rapport direct avec une cicatrice de tuberculose pulmonaire ancienne. L’exérèse chirurgicale est parfois indiquée. But du travail: Le but de cette étude est de mettre le point sur cette forme de séquelles et de rapporter les résultats de sa prise en charge chirurgicale. Résultats: Notre travail est une étude rétrospective de 20 cas d’emphysème tuberculeux colligés au service de chirurgie thoracique de l’hôpital IBN SINA de Rabat durant la période de 2012 à 2016. L’âge de nos patients varie de 22 a 64 ans (une moyenne d’âge de 44,35+/-12,5ans), avec une prédominance masculine. Les antécédents étaient dominés par la tuberculose pulmonaire (12 cas) et le tabagisme chronique (13cas).La dyspnée et la douleur thoracique étaient les signes fonctionnels les plus retrouvés (chez 17 malades) et l’examen physique était le plus souvent normal. La confirmation du diagnostic était apportée par l’imagerie qui montrait des bulles d’emphysème, des séquelles fibreuses et les signes de complications. Le traitement chirurgical consistait en une bullectomie (17malades), une lobectomie chez (2malades) et une seule pneumonectomie. La durée de drainage post opératoire variait de 3 à 56 jours avec une médiane de 6 jours. Le bullage prolongé supérieur à 7 jours était retrouvé chez 9 patients. La mortalité post opératoire était déplorée chez un seul patient aux suites d’un choc hémorragique. Conclusion: La chirurgie est le traitement de choix de l’emphysème para cicatriciel compliqué. Un dépistage précoce et un traitement correct de toute tuberculose pulmonaire s’avèrent nécessaire afin de guérir les patients avec un minimum de séquelles
Correlation of Ultrasound and RIPASA Scoring System in the Diagnosis of Acute Appendicitis
No full textObjective: Correlation of Ultrasound and RIPASA scoring system in the diagnosis of acute appendicitis. Study Design: 50 patients presenting to emergency underwent ultrasound and evaluation as per RIPASA scoring system followed by emergency appendicectomy. The sensitivity, specificity, positive and negative predictive value calculated for each group. Results: The sensitivity, specificity, Positive Predictive Value, and Negative Predictive Value for ultrasound were 75.51%, 100%, 100%, and 7.69% respectively, and that for the RIPASA scoring system were 93.9%, 100% 100%, and 25% respectively. The negative appendicectomy rate was 2%. Conclusion: RIPASA scoring system may be used for correctly diagnosing acute appendicitis but the low sensitivity of ultrasound precludes its routine use and may be used as a complementary tool in diagnosing acute appendicitis. Keywords: Acute Appendicitis, RIPASA, Ultrasound
Acquired Tracheo-Esophageal Fistula : A Rare Case Report of the Neglected Denture
No full textIntroduction: Dentures are common accidental ingested foreign body (FB) especially among the elderly. It is frequent to have foreign body impacted at esophagus in adults however it is very unusual to have Tracheoesophageal fistula (TEF) caused by the denture. The diagnosis of TEF is challenging due to two reasons. Firstly, most of the dental prosthesis is radiolucent and not visible in the routine radiological investigation. Secondly, a patient with a history of swallowed dentures prosthesis may be asymptomatic initially and develops symptoms over time. On the contrary, the prolonged history of FB in the esophagus with TEF has a higher risk of developing serious complications such as pneumonia and lung abscess.Case Presentation: We report a case of a 62-year-old gentleman with a background history of hypertension and temporal lobe epilepsy presented with a history of choking on taking solid and liquid associated with significant weight loss past 2 months. He had lost his denture for almost 1 year during sleep. Endoscopic examination of the larynx showed normal anatomy but pooling of saliva. CT thorax showed a foreign body within a tracheoesophageal fistula. OGDS showed denture within a well-formed tracheoesophageal fistula. He had acquired TEF secondary to the dentures. Conclusion: Symptomatic elderly who lose their denture during sleep should not be neglected. They need immediate medical assessment thus will reduce further debilitating complications. Failing to identify and treat this condition urgently, the patient will suffer acquired trachea-oesophageal fistula on which the treatment is challenging and the morbidity and mortality are high