Fayçal El Oueriachi

Monostotic fibrous dysplasia of the ribs

Fibrous dysplasia (FD) is a sporadic benign skeletal disorder that can affect one bone (monostotic form) or multiple bones (polyostotic bone). Around 6-20% of monostotic FD occurs in the ribs. The objective of this study was to report our experience in the management of the monostotic FD of the ribs. Between January 2004 and December 2009, seven cases of FD of the rib (six men and one woman, mean age 30.4 years, range 17-40 years) were operated on. The patients were evaluated with plain radiographs and computer tomography (CT). All our patients were symptomatic; two patients presented chest pain and swelling and other patients presented only chest pain. One rib was involved in all our patients (monostotic form): the site was fifth rib (four cases), sixth rib (two cases) or second rib (one case). Radiologically, plain films and CT showed an expansible lesion with a ground-glass centre and thinning of the cortex. Rib resection was performed in all patients; there were no postoperative complications and no recurrence in all cases at mean 43 month follow-up. In symptomatic monostotic FD of ribs, the involved segment of bone may be excised to rule out malignancy and for painful lesions.

Elastofibroma Dorsi: Clinicopathological Analysis of 76 Cases

Background We aimed to investigate the epidemiological, clinical, paraclinical, and treatment aspects of elastofibroma dorsi through a retrospective study of 76 patients who underwent surgery between January 2008 and December 2012 in our department. Methods Our study is retrospective between January 2008 and December 2012. We admitted 79 patients with a subscapular mass, and only 76 patients had ED. The others (n=2) had high associated risk of anesthesia and were managed by a medical treatment and one patient had a subscapular sclerotic hemangioma. Results The average age of the patients was 49 years (range, 38 to 70 years), with a female predominance (54 females and 22 males). Subscapular location was constant. The right, left, and bilateral form was noted in 41, 15 and 20 cases, respectively. The diagnosis was clinical in 60 cases. Ultrasound and computerized tomography scans confirmed the diagnosis of an ill-defined mass in a subscapular location in all cases. Surgical treatment consisted of complete resection of the mass. The clinical diameter of the mass remained significantly lower than that of the surgical specimen (7 cm versus 12 cm) because the major hidden part of the mass in the subscapular area was inaccessible to palpation. Complications were noted in 9 cases (11.8%), seroma in 8 cases (10.5%), infection of wound site in 4 cases (5%), and parietal textilome in one case (1%). No case of recurrence was noted. Conclusion Surgery of elastofibroma is unique because of the subscapular location of the parietal tumor, whose histological fibrous nature makes it very adherent to the chest wall.

Incidents and complications of permanent venous central access systems: a series of 1,460 cases.

Background Implanted venous access devices or permanent central venous access systems (PCVASs) are routinely used in oncologic patients. Complications can occur during the implantation or use of such devices. We describe such complications of the PCVAS and their management. Methods Our retrospective study included 1,460 cases in which PCVAS was implanted in the 11 years between January 2002 and January 2013, including 810 women and 650 men with an average age of 45.2 years. We used polyurethane or silicone catheters. The site of insertion and the surgical or percutaneous procedure were selected on the basis of clinical data and disease information. The subclavian and cephalic veins were our most common sites of insertion. Results About 1,100 cases (75%) underwent surgery by training surgeons and 360 patients by expert surgeons. Perioperative incidents occurred in 33% and 12% of these patients, respectively. Incidents (28%) included technical difficulties (n=64), a subcutaneous hematoma (n=37), pneumothoraces (n=15), and an intrapleural catheter (n=1). Complications in the short and medium term were present in 14.2% of the cases. Distortion and rupture of the catheter (n=5) were noted in the costoclavicular area (pinch-off syndrome). There were 5 cases of catheter migration into the jugular vein (n=1), superior vena cava (n=1), and heart cavities (n=3). No patient died of PCVAS insertion or complication. Conclusion PCVAS complications should be diagnosed early and treated with probable removal of this material for preventing any life-threatening outcome associated with complicated PVCAS.

Surgery of Myasthenia Gravis Associated or Not With Thymoma: A Retrospective Study of 43 Cases

OBJECTIVES Thymectomy is a surgical treatment of myasthenia gravis. Our goal is to report our experience in the surgical treatment of myasthenia gravis with or without thymoma and a review of the literature. MATERIALS AND METHODS This is a retrospective study over a period of 10 years (2001-2010) on 43 patients: 28 women and 15 men with a mean age of 39.3 years (range 16-68 years). The myasthenia gravis was confirmed by clinical, electromyographic data and the presence of antibodies to acetylcholine receptors. RESULTS Computed tomography objectified thymic mass in 14 cases (32.5%) enlarged thymus without visible mass in eight cases (18.6%). All patients received anticholinesterase, cortico steroids in 25 cases and in three cases plasmapheresis was required. The surgical approach was total sternotomy (n=32 cases), cervicotomy (n=2), cervical and manubriotomy (n=1), a manubriotomy (n=3) and a thoracotomy in five cases (lateralised thymoma). All patients underwent a total thymectomy associated or not with resection of the tumour. Intensive Care Unit was necessary for at least 24h up to six days. The postoperative course was marked by a myasthaenic crisis (n=2) and respiratory failure (n=3) with a favourable outcome. The prognosis was marked by a complete remission in 14 cases, partial remission in 11 patients, stabilisation (n=16 cases) and increasing crisis in two patients. CONCLUSION Thymectomy certainly allows clinical improvement and reduced crisis of myasthenia gravis. Long term monitoring will confirm the benefit of non-oncological thymectomy alone or in combination with standard treatments for patients with generalised myasthenia gravis without thymoma.

Primary mediastinal goiters

BackgroundPrimary mediastinal goiters (PMG) are very uncommon; few cases were reported in the literature.Patient descriptionWe report here two cases of mediastinal goiters that met all criteria of PMG. Transternal approach was necessary for complete removal and pathological diagnoses confirmed their adenomatous goiter nature. The rarity of their occurrence, their clinical characteristics and surgical management were discussed.ConclusionPMG is part of the differential diagnoses of mediastinal masses. Safe excision is ensured through transthoracic approach.

Primary axillary hydatid cyst.

Echinococcosis is a zoonotic infection, affecting humans in a characteristic geographic distribution. The disease generally involves the liver, the lung and sometimes an axillary location. We reported a case of 43-year-old man, who was diagnosed with a cystic lesion of the left axilla, which was presumed to be a hydatid cyst or a vascular malformation by ultrasound and computed tomography. Surgical excision of the lesion was performed confirming the hydatid cyst diagnosis by histological studies.

Mediastinal Cystic Haemangiomas: A Two Cases Report and Review of the Literature

According to the literature haemangiomas are rare benign vascular tumours (less than 0.5% of all mediastinal tumours). Preoperative diagnosis is difficult and manifest as a non-specific mediastinal mass on radiologic exploration. We report herein two cases of mediastinal haemangioma (MH), the first was a 63 year-old man with a MH in the posterior mediastinum, and the second was a 53 year-old man with a left paracardiac haemangioma. Surgical removal was successful and the follow-up was free four years after surgery.

Adenoma paratiroideo ectópico poco frecuente

Primary hyperparathyroidism (PHPT) caused by ectopic parathyroid adenomas in the mediastinum is uncommon. The main indications for resection are glandular hyperfunction, complications from hypercalcemia, and young age of the patient. A 20-year-old man was admitted due to several sudden pathologic fractures. Permanent tachycardia was found on clinical examination and standard X-ray revealed multiple fractures at varying stages, clear evidence of osteolysis and multiple bone tumors. Preoperative biochemistry results showed very high blood calcium: 170 mg/l (90–100 mg/l) and PTHi: 4000 pg/ml (15–65 pg/ml).

Tratamiento quirúrgico del bocio retroesternal: experiencia en un centro de Marruecos

INTRODUCTION AND OBJECTIVES This was a retrospective study reviewing 93 cases of retrosternal goitre (RG) operated in our department, with the aim of describing epidemiological and clinical data and discussing the surgical challenges of RG. PATIENTS AND METHODS From January 2004 to December 2012, 35 men and 58 women presenting with RG had surgery. Eighty-nine cases (95.7%) underwent cervicotomy, and a sternotomy was mandatory in 4 cases (4.3%). Laryngoscopy was performed in all cases. A second preoperative laryngoscopy by a senior was mandatory for patients with hoarseness or dyspnea even if the initial laryngeal exam was normal. RESULTS A cervical mass was noted in 81 cases (87.1%), dyspnea in 17 cases (18.3%), dysphagia in 2 cases (2.1%), hoarseness in 7 cases (7.5%), partial vena cava syndrome in 2 cases and recurrent goitre was noted in 2 cases (2.1%) after previous thyroid resection. Mediastinal extension was on the left side in 47 cases (50.5%), on the right side in 29 cases (31.2%) and bilateral in 17 cases (18.3%). A total thyroidectomy was performed in 86 cases (92.5%) and a unilateral isthmo-lobectomy was performed in 7 cases (7.5%). Mean goitre size was 9.3 cm. Postoperative complications were present in 9 cases (9.7%), 3 cases with hypoparathyroidism (3.2%) and 4 cases (4.3%) of recurrent nerve injury. There was no postoperative death. The histological study objectified 88 cases of multiheteronodular goitre, 4 cases of Basedow thyroid, and 1 case of thyroid carcinoma (papillary carcinoma). CONCLUSION Our experience confirms that cervicotomy often allows removing goitre with a mediastinal extension. However, intraoperative enlargement may be necessary, with increased operating time, hospital stay and morbidity.

Surgery of benign neurogenic tumors in adults: single institution experience

The objective of this work is to review retrospectively our experience with 17 patients presenting with benign neurogenic tumors, managed in the department of thoracic surgery, Mohamed V Military Academic Hospital, Rabat, Morocco. Between 2003 and 2011, seventeen patients were surgically treated for benign neurogenic tumors of the mediastinum, among 112 mediastinal tumors operated during the same period. The mean age of the 17 patients was 46 years, including 11 females and 6 males. The information about clinical presentation, diagnostic procedures, surgical techniques and postoperative follow-up were extracted and analyzed from medical records. Symptoms related to the tumor were found in 13 patients (76,4%). The posterior mediastinum was the principal location (16 cases: 94%). Intraspinal extension was shown through MRI in one case. Surgical extirpation was complete in all patients. There were no tumor-related deaths and no significant complications. There were 13 schwannomas, 2 neurofibromas and 2 ganglioneuromas. Neurogenic tumors of the mediastinum in adults are mostly benign. Their only treatment is surgical extirpation. Video-assisted thoracoscopic resection is currently the best approach in selected patients.