Abdellatif Benosman

Thoracic rupture of hepatic hydatidosis (123 cases)

BACKGROUND Hydatid disease is frequently endemic in countries with poor environmental sanitation and in geographic areas where interaction between humans and animals is common. Pulmonary complications result from the proximity of hydatid cysts in the liver and the diaphragm. METHODS The medical records of 123 patients, with established hydatid disease manifesting abnormal chest roentgenograms, were retrospectively analyzed for the period January 1990 to December 1999. RESULTS Chest roentgenogram and abdominal ultrasound provided a correct preoperative diagnosis in 108 patients (87.8%). Expectoration of bile, demonstration of fistula by ultrasound, expectoration of cyst contents, and additional ultrasound or imaging findings were the criteria used to establish the preoperative diagnosis. The remaining 15 cases were confirmed at operation. Men outnumbered women nearly 3:1. Mean age was 36.2 years. Pulmonary resection was performed in 67 cases. Sixty-eight patients presented with a bronchobiliary fistula (55.3%). Morbidity rate was 14.6% and mortality rate was 8.9%. CONCLUSIONS Thoracotomy offers adequate simultaneous access to both the chest and hepatic lesions with acceptable morbidity and mortality. Endoscopic sphincterotomy undertaken preoperatively is useful in reducing biliary complications.

Chirurgie des aspergillomes pulmonaires

Resume Objectifs Le but de notre travail etait de rapporter les resultats de la chirurgie des aspergillomes pulmonaires chez 278 patients, en insistant sur la necessite du traitement chirurgical de principe quand il est possible pour eviter les complications hemorragiques potentiellement fatales. Methodes Un bilan morphologique, phtisiologique et une serologie aspergillaire etaient necessaires au diagnostic. Tous les patients ont eu un bilan fonctionnel respiratoire preoperatoire. L’intervention etait indiquee soit de principe, soit de necessite, soit dans un but diagnostique. La thoracotomie posterolaterale dans le 5e espace intercostal a ete la voie d’abord de choix dans la plupart des cas. Le contenu de la cavite parenchymateuse etait examine en postoperatoire pour un diagnostic mycologique. La surveillance postoperatoire immediate etait basee sur les donnees de l’examen clinique, radiologique, biologique et le drainage pleural. L’evolution radio-clinique ulterieure etait evaluee au 1er au 3e mois puis tous les 6 mois. Resultats Entre 1982 et 2004, 320 cas d’aspergillomes pulmonaires ont ete colliges dans notre service de chirurgie thoracique, 278 patients ont ete operes. Il s’agissait de 161 hommes et 117 femmes, l’âge moyen etait de 32 ans. L’origine de la greffe aspergillaire etait dominee par les sequelles de tuberculose pulmonaire (73%). Le signe d’appel le plus frequent etait l’hemoptysie (83%). Le traitement etait exclusivement chirurgical chez l’ensemble de nos patients, avec 130 lobectomies, 51 segmentectomies, 45 pneumonectomies, 33 lobectomies elargies au(x) segment(s) adjacent(s), 17 bilobectomies et 3 thoracoplasties. Un patient a eu une bisegmentectomie bilaterale en 2 temps. On a deplore 16 deces, soit une mortalite hospitaliere de 5,7% dont 14 apres pneumonectomie. Cent douze complications ont ete enregistrees (40%) dominees par les pyothorax (12,5%) et les defauts de reexpansion (9,3%). Les autres complications etaient representees par 14 hemothorax, 13 infections respiratoires, 11 insuffisances respiratoires, 7 fistules bronchiques et 6 infections de la plaie operatoire. Neuf patients ont ete reoperes dont 3 pour hemothorax, 2 pour pyothorax et 4 pour thoracoplastie secondaire. Dans 54,1% des cas, les suites operatoires etaient simples. Conclusion La chirurgie des aspergillomes pulmonaires quand elle possible est difficile voire dangereuse. Elle reste le traitement de choix de cette mycose pulmonaire opportuniste, en depit d’une morbimortalite non negligeable.

Surgical Treatment of Hydatidothorax Series of 79 Cases

Abstract Objective: A retrospective review of 79 cases of ruptured intrapleural pulmonary hydatid cysts. We analyse and evaluate our experience in the surgical treatment of this complication. Materials and Methods: In a ten-year period, from 1990 to 1999, 79 patients were operated on in our service for intrapleural rupture of a pulmonary hydatid cyst. There were 51 males and 28 females with a mean age of 35.4 years. The diagnosis was established on the basis of different clinical signs and imaging studies. Surgical approach consisted of a posterolateral thoracotomy in all cases. After decortication, different procedures were performed on the pulmonary lesions according to the importance of lung destruction. Results: Radical resections were done in 48 cases, including lobectomies (15), segmentectomies (33) and conservative treatment: simple capitonnage and bronchial fistula closure (31). Postoperative complications occurred in 8 cases (10.1%), including one pyothorax, one haemothorax, one prolonged air leak, two pneumonias and two wound infections. There was one postoperative death, by respiratory failure. Ninety-five percent (95%) of patients were free of recurrence of thoracic hydatid disease in a follow-up ranging from 1 to 10 years (mean: 5.4 years). Conclusion: Hydatid cysts of the lung should be treated before complications occur, particularly intrapleural rupture because it considerably increases morbidity.

Tératome mature du médiastin

Study aim: The aim of this retrospective study was to report a series of 12 cases of mature teratoma of the mediastinum operated during a 10-year period in the same center. Patients and method: From 1990 to 2000, 12 patients (7 females and 5 males with a mean age of 32 years) were operated for mature mediastinal teratoma. Chest pain was present in 10 cases; cough, dyspnea and septic episodes were present in 5 cases and X-ray detected the mediastinal tumor in 10 cases. CT scan showed a tumor with liquid and fatty components and calcifications in 5 out of 9 cases. Tumors were resected via a posterolateral thoracotomy in 11 cases and an anterior thoracotomy in one case, associated with pneumonectomy in 1 case, basal segmentectomy in 1 case and thymectomy in 1 case. Results: There were no postoperative deaths. Morbidity included 2 phrenic nerve palsies, 1 pyothorax after pneumonectomy, 1 case of bleeding and 1 pleural effusion. No recurrences have been observed with a follow-up of 5 to 87 months. Nine of the 10 tumors reviewed by pathologist contained multiple tissue components and one only contained a single tissue. Conclusion: Mature teratomas are usually detected in young patients: they are usually located in the middle part of the anterior mediastinum and are only diagnosed by pathologic examination of the specimen. They have an excellent prognosis when tumor resection is complete and in the absence of immature tissue in the tumor.

Primary mediastinal leiomyoma: a case report

Leiomyoma of the mediastinum is rare. We report a case of a 57-year-old woman with a cervical mass diving to the intrathoracic. Chest radiography and computed tomography revealed a mass in the right superior mediastinum. The tumor was enucleated by cervicotomy. Histologically, the tumor was diagnosed as leiomyoma.

La place de la thoracotomie dans le traitement des kystes hydatiques abdominaux rompus dans le thorax

INTRODUCTION The purpose of this study was to assess the results of the surgical treatment of abdominal hydatid cysts ruptured in the thorax. PATIENTS AND METHODS We collected data from 160 patients who experienced the intra-thoracic rupture of an abdominal hydatid cyst during the period 1997 - 2008: 158 located in the liver, one in the spleen and one in the kidney, which had been treated surgically in a single centre. Diagnosis was based on a history of surgery for abdominal hydatid cysts, specific symptoms including biliptysis (40% of the cases) and expectoration of hydatid cysts, as well as radiological findings (chest x-ray; abdominal ultrasound and CT-scan). All patients were operated on through a thoracotomy. RESULTS In-hospital mortality was 7.5%. Postoperative complications occurred in 16% and mainly consisted of pleural and pulmonary disorders. CONCLUSION Thoracotomy offers simultaneous and adequate access to address thoracic and abdominal injuries with a reasonable mortality and morbidity in patients with this condition.

Pulmonary epithelioid hemangioendothelioma: a case report

IntroductionThe pulmonary epithelioid hemangioendothelioma is a rare vascular intermediate malignancy tumour.Case presentationA 45-year-old man, he shows an isolated chronic cough with a preserved general state of health. The thoracoabdominal Computed tomography showed three well limited opacities of the right lung, among them one shows some calcifications; which we entirely resected by enucleation after a pneumotomy. The histologic examination with immunomarking led to an epithelioid hemangioendothelioma.ConclusionsThe pulmonary epithelioid hemangioendothelioma is a tumour of unpredictable prognosis, bad when linked to the plurifocal and symptomatic forms.

Endobronchial lipoma a rare cause of pleural empyema: a case report

Benign neoplasm of the endobronchial tree is quite rare, while endobronchial lipoma is extremely rare. The irreversible pulmonary damage is due to progressive bronchial obstruction; even so, pleural empyema is exceptionally encountered in a case of endobronchial lipoma. We report a case of a 47-year-old man who had left lung pneumonia with hemoptysis. The chest computed tomography showed cystic bronchiectasis with pleural effusion, Flexible bronchoscopy revealed a round tumor on the left main bronchus.

Kyste hydatique du poumon révélé par une dysphonie

Resume Introduction La dysphonie par atteinte du nerf recurrent gauche dans sa portion intrathoracique est le plus souvent due a une compression ou un envahissement par un processus malin. Sa compression par un kyste hydatique du poumon est inhabituelle. Observation Nous rapportons le cas d’un patient de 56 ans, qui presentait une toux, une dyspnee et une dysphonie d’installation progressive. La radiographie et la tomodensitometrie thoraciques montraient une masse kystique du lobe superieur gauche, en contact etroit avec la crosse de l’aorte. En peroperatoire, la masse s’est revelee etre un kyste hydatique du poumon et le traitement avait consiste en une kystectomie. La nature hydatique a ete confirmee par l’analyse anatomopathologique. Le resultat postoperatoire etait satisfaisant avec disparition des signes fonctionnels et amelioration de la phonation. Conclusion Cette observation illustre que le kyste hydatique du poumon peut se manifester dans de rares circonstances par des signes de compression mediastinale.

Iatrogenic pneumothorax: Experience of a Moroccan Emergency Center

The incidence of iatrogenic pneumothorax (IPx) will increase with invasive procedures particularly at training hospitals, that is why we have made a retrospective study of the common diagnostic or therapeutic causes of IPx and its impact on morbidity. From January 2011 to December 2011, 36 patients developed IPx as emergencies, after an invasive procedure. Their mean age was 38 years (range: 19-69 years). Of the patients, 21 (58%) were male and 15 (42%) were female. The purpose was diagnostic in 6 cases and therapeutic in 30 cases. In 8 patients (22%) the procedure was performed due to underlying lung diseases and in 28 patients (78%) for other diseases. The procedure most frequently causing IPnx was central venous catheterization, with 20 patients (55%), other frequent causes were mechanical ventilation in 8 cases (22%) (of whom we reported 3 cases of bilateral pneumothorax), 6 cases of thoracentesis (16%) and 2 patients had life-saving percutaneous tracheotomy. The majority of our patients were managed by a small chest tube placement (unilateral n=30, bilateral n=3). The average duration of drainage was 3 days (range: 1-15 days), sadly one of our patients died of ischemic brain damage 15 days after tracheotomy. At training hospitals the incidence of IPnx will increase with the increase in invasive procedures, which should only be performed by experienced personnel or under their supervision.