Mohamed Nabil Mhiri

Ectopic adrenal cortex tissue: an incidental finding during inguinoscrotal operations in pediatric patients.

Objective: The aim of the present study was to assess the occurrence of ectopic remnants of adrenal cortex tissue encountered in pediatric patients who underwent groin surgical explorations. Materials and Methods: We studied 1,862 patients with groin surgical explorations during a period of 12 consecutive years (1995–2006). Nodules resembling ectopic adrenal tissue were removed and the histopathological examination was performed using hematoxylin and eosin staining. Results: We found ectopic adrenal cortex tissue along the spermatic cord in 31 patients in 1,862 groin surgical explorations, an overall incidence of 1.66%. None were found in females. Of the 31 cases, 20 were diagnosed as having undescended testes, 8 communicating hydrocele, and 3 inguinal hernia. Median age at diagnosis was 6.5 years (range 2–14). The nodules were found located along the spermatic cord, in the apex of the hernial sac, and between the testis and epididymis. Macroscopically, the nodules were round to oval in shape, 2–6 mm in diameter, and bright yellow to orange in color. Microscopically, they had three well-defined layers of adrenal cortex, with predominance of the zona fasciculata, surrounded by a fibrous capsule and none contained any medulla. Conclusion: Ectopic adrenal cortical tissue is a benign lesion. Although a routine search for this lesion is not indicated, it should be resected for histological analysis and differential diagnosis when it is found during a surgical procedure in this area.

Primary renal angiosarcoma: Case report and literature review

Angiosarcoma is a rare malignant tumour occurring in less than 2% of soft tissue sarcomas. Angiosarcoma involving the kidney usually represents metastasis from skin or visceral primary lesions, while angiosarcoma primarily occurring in the kidney is a very rare neoplasm. We report a case of angiosarcoma of the right kidney in a 59-year-old male. The computed tomography scan showed a solid tumour with a low increased density after administration of contrast medium. Histological examination of the piece of nephrectomy confirmed the diagnosis.

Cystic lymphangioma of the kidney: Diagnosis and management

INTRODUCTION Cystic lymphangioma is a rare benign vascular tumor that may arise in various sites, revealed at any age. Abdominal locations represent less than 10% of the cases preferentially involving the mesentery. We report a case of primary lymphangioma arising from the kidney. PRESENTATION OF CASE A 50-year-old woman was admitted for severe left lumbar pain. Abdominal ultrasonography and computed tomography revealed a 6×10 cm multiloculated cystic mass with hydronephrosis, extending along the left renal hilum. Surgical exploration revealed a retroperitoneal cystic tumor. Anatomopathologic examination concluded it to be a cystic lymphangioma. DISCUSSION The cystic lymphangioma is a benign malformative tumor of the lymphatic system. Surgery is the best curative treatment with complete excision, the prognosis is excellent. CONCLUSION Primary renal lymphangioma is exceedingly rare. Medical imaging has certain limits for the diagnosis which required histological confirmation. The treatment of choice is surgical.

Persistent Müllerian Duct Syndrome With Torsion of a Transverse Testicular Ectopia: First Reported Case

Persistent Müllerian duct syndrome with transverse testicular ectopia is a rare pathologic association. A 7-month-old boy was admitted to the emergency department with a right testicular swelling. Physical examination revealed a tender right testis, the upper limits of which could not be palpated. The left testis was impalpable. An ultrasound revealed a normal right testis with an evident blood flow, overcome by a similar mass but avascular. At surgery, the right hernial sac contained both testes with an infantile uterus and fallopian tubes. The left testis was viable after manipulation. Proximal-salpingectomy with corporeal hysterectomy was performed to allow bilateral scrotal orchiopexy.

Appendicovésicostomie de Mitrofanoff chez I’enfant : indications et résultats

Resume But presenter les indications et les resultats a court et a long terme de I’appendicovesicostomie de type Mitrofanoff chez I’enfant. Patients et Methode Entre 1992 et 2004,13 garcons et 17 filles ont eu une appendicovesicostomie de type Mitrofanoff avec confection d’une stomie en fosse iliaque droite. L’âge moyen etait de 10 ans (5 a 15 ans). L’indication operatoire a ete une vessie neurologique (28 cas) et une vessie alteree sur valve de l’uretre posterieur (2 cas). Le diagnostic a ete fait a un stade evolue avec insuffisance renale moderee dans 16 cas (clearance moyenne de la creatinine 60 mYmn/1,73m 2 ). Resultats Le recul moyen a ete de 53 mois (24 a 156 mois). Tous les enfants ont ete continents dont 29 (96,66%) apres une seule intervention. Les complications ont ete mineures representees essentiellement par les difficultes du catheterisme intermittent (13,3%). La fonction renale a evolue vers le stade d’insuffisance renale terminale dans 1 cas 6 ans apres l’intervention, est restee stable dans 9 cas (clearance moyenne de la creatinine 72 ml/mn/1,73m 2 ) et s’est normalisee dans 6 cas. Par ailleurs, les auto sondages intermittents ont ete acceptes par tous les enfants avec complete readaptation aux activites quotidiennes. Conclusion L’appendicovesicostomie de type Mitrofanoff a eu de bons resultats chez I’enfant. Elle a permi d’assure une bonne continence, un faible taux de complications et une readaptation socio-educative satisfaisante. Nos resultats etaient comparables avec ceux de la litterature en terme de succes et de durabilite de ce type de derivation chez I’enfant.

Living and cadaver donor transplant programs in the Maghreb.

In the Maghreb, organ failure constitutes a major public health problem, especially given the increasing number of patients with chronic renal failure and the high cost of care. In this study, we attempted to seek the recommendations, through a questionnaire, of various officials related to organ transplantation as well as leaders of ethics committees and religious groups in different countries of the Maghreb. The objective was to improve the rate of organ donation and transplantation. We received 36 replies (62%) within the prescribed time limit. In our survey, 83% of the respondents felt that living donor transplantation should be promoted initially, followed gradually by measures to increase cadaver donor transplantation to achieve a target of about 30 transplants with cadaver kidney donors per million inhabitants. To expand the donor pool, 83% of the respondents proposed to expand the family circle to include the spouse and in laws. To improve the cadaver donation activity, one should improve the organizational aspects to ensure at least 50 renal transplantations per year (100%) and provide material motivation to the treatment team proportional to the activity of organ donation and transplantation. Finally, 93% of the respondents suggested suitable moral motivation of the donors.

Les carcinomes endocrines à petites cellules de la vessie: à propos d’une observation

IntroductionThe small cell carcinoma of the bladder is a rare entity representing 0.5% of the whole bladder tumours, it is highly aggressive. It is characterized by a very high metastatic potential. The treatment is multidisciplinary associating the surgery and chemotherapy and, sometimes, the radiotherapy in order to improve the forecast of the disease and the survival of the patients.ObservationWereport a case of endocrine carcinoma of the bladder in a 64-years-old patient. The immuno-histochemical study showed the positivity of the tumoral cells for the chromogranine, the synaptophysine, TTF-1, the cytokeratine and a negativity for the specific antigen of the prostate (PSA). The patient was treated by chemotherapy only. The evolution was marked by the death of the patient eight months after the diagnosis.ConclusionThe CPC of the bladder represents a particular histological entity being quickly aggressive and metastatic, with a severe forecast and a potentially effective intensive treatment, thus requiring a multidisciplinary assumption of responsibility.RésuméIntroductionLe carcinome a` petites cellules (CPC) de la vessie est une tumeur rare repré-sentant 0,5 % de l’ensemble des tumeurs vésicales, elle est hautement agressive. Elle est caractérise é par un potentiel métastatique très important. Sa prise en charge est multidisciplinaire associant la chirurgie et la chimiothérapie et parfois la radiothérapie afin d’améliorer le pronostic de la maladie et la survie des patients.ObservationNous rapportons un cas de carcinome neuroendocrine àpetites cellules de la vessie chez un patient âgéde 64 ans. L’étude immunohistochimique a montréla positivitédes cellules tumorales pour la chromogranine, la synaptophysine, la cytokératine et une négativitépour l’antigène spécifique de la prostate (PSA). Le patient a ététraitépar chimiothérapie seule. L’évolution a étémarquée par le déce’s du patient, apre’s un recul de huit mois par rapport au diagnostic.ConclusionLe CPC de la vessie représente une entitéhistologique particulie’re ayant un caractère rapidement agressif et métastatique, avec un pronostic sévère et un traitement intensif potentiellement efficace, nécessitant ainsi une prise en charge multidisciplinaire.

Intérêt de l'abaissement du testicule non descendu chez l'adulte. Etude à propos de 259 patients

ResumeNous avons mené une étude rétrospective portant sur 259 patients âgés de plus de 18 ans, présentant des testicules non descendus (TND). L’objectif de cette étude est d’évaluer les résultats de l’abaissement du TND chez l’adulte du point de vue de l’amélioration de la fertilité et de la prévention de la dégénérescence maligne.L’âge moyen des patients était de 24 ans. La maladie a été découverte dans la majorité des cas lors d’un examen médical systématique (76,8% des cas) ou lors d’un bilan d’infertilité (12,7%). Le TND était unilatéral dans 80,7% des cas et bilatéral dans 19,3% des cas. Parmi 37 couples notifiés dans notre série, seuls 4 avaient déjà eu des enfants (10,8%). Le spermogramme, pratiqué chez les 33 patients consultant pour infertilité, était altéré dans tous les cas. Tous les patients ont eu un abaissement du testicule, sauf 36 patients (13,9%) chez qui on a été amené à sacrifier le testicule car il était atrophique (27 cas), tumoral (8 cas) ou nécrosé suite à une torsion (1 cas). L’étude histologique du TND a été pratiquée chez 53 patients, montrant des altérations histologiques dans tous les cas.L’évolution tardive a été marquée par la survenue d’une atrophie testiculaire après l’orchidopexie chez 6 patients (2,7% des cas), par une dégénérescence maligne opérée secondairement chez 3 patients (1,3%), et par une amélioration des paramètres spermatiques chez 16 patients, soit 48,5% des patients consultant pour infertilité. De plus, 4 patients ont eu des enfants après traitement.A notre sens, l’abaissement du TND chez l’adulte pourrait entraîner une amélioration de la spermatogenèse et de la fertilité. Il pourrait aussi s’associer à une baisse relative de l’incidence de la dégénérescence maligne. Mais surtout, il permet une surveillance clinique plus aisée à la recherche d’une éventuelle cancérisation.AbstractIntroductionUndescended testis is a frequent congenital disease, more often diagnosed and treated during childhood. However, due to ignorance or negligence, this disease can be seen even after puberty, when it raises a therapeutic problem: is orchidopexy still useful?This study was designed to evaluate the outcome of orchidopexy at adulthood in terms of improvement of fertility and prevention of malignant degeneration.Material and methodsRetrospective study performed over a 23-year period (1983–2005). We have found 259 patients with undescended testis diagnosed and treated after the age of 18 years.ResultsThe mean age of patients was 24 years (range: 18–63). In the majority of cases, undescended testis was diagnosed at a systemic medical examination in 199 patients (77% of cases), and in a context of infertility in 33 patients, testicular malignancy in 8 patients, testicular torsion in 2 patients and, in 17 cases, undescended testis had been known since birth but was neglected by the parents.Undescended testis was unilateral in 209 cases and bilateral in 50 cases. Out of 37 couples, only 4 gave birth to children (10.8% paternity rate). Sperm analysis was abnormal in all infertile patients. All patients were treated by orchidopexy, except for 36 patients in whom orchidectomy was performed due to testicular atrophy (27 cases), malignancy (8 cases) or necrosis (1 case). Biopsy of the intrascrotal testis was performed in 3 patients with unilateral cryptorchidism. Histological examination was normal in two cases and abnormal in one case. The long-term outcome was characterized by:1.Testicular atrophy in 6 patients (2.7% of cases).2.Progression to malignancy in 3 patients (1.3% of cases).3.Improvement of sperm parameters in 16 of 33 infertile patients (48.5%); 4 patients fathered children after treatment.ConclusionOrchidopexy at adulthood can lead to improvement of infertility. It can also decrease the incidence of malignancy and facilitate clinical examination looking for possible malignancy. However, the best treatment remains preventive, based on early diagnosis and orchidopexy.

Priapisme veineux: traitement et pronostic fonctionnel. A propos de 26 cas

ResumeIntroductionle priapisme est une érection anormalement prolongée, douloureuse et irréductible survenant en dehors de toute stimulation sexuelle. Il continue de poser des problèmes, tant sur le plan thérapeutique, que pronostique. Les auteurs se proposent d’étudier les différents aspects étiopathogéniques, thérapeutiques, et évolutifs de cette affection.Matériel et méthodes26 cas de priapisme veineux d’étiologies variées ont été colligés en 23 ans (19857#x2013;2007). Il s’agit de 22 adultes et de 4 enfants (âge moyen: 32 ans). La prise en charge s’est faite sans délai en fonction de l’étiologie et du délai de consultation (variant de 16 heures à 15 jours).Résultatsl’obtention d’une détumescence complète et irréversible au cours des premières 24 heures a été notée dans 84% des cas, parfois au prix de plusieurs procédés thérapeutiques successifs. L’évolution à distance a été appréciée chez 21 malades avec un recul moyen de 2 ans. Aucun cas de récidive tardive n’a été observé. La récupération d’une fonction ’rectile normale a été observée dans 42,9% des cas.Conclusionle priapisme veineux doit être considéré comme une urgence uro-andrologique majeure. Le traitement médical peut être efficace dans les formes précoces mais il ne faut pas laisser passer l’heure de la chirurgie. Le traitement de tout facteur de risque doit être mené en parallèle afin de prévenir les récidives.AbstractIntroductionPriapism is a prolonged, painful and persistent erection, unrelated to sexual stimulation. The management of priapism is complex and requires various medical or surgical treatments. The authors review the aetiology, treatment and outcome of priapism.Material and methods26 cases of low-flow priapism were collected over a period of 23 years (1985–2007), corresponding to 22 adults and 4 children (average age: 32 years) with various types of priapism. The time to appropriate management after onset of priapism varied according to the aetiology and the time to consultation (range: 16 hours to 15 days).ResultsComplete and persistent detumescence for the first 24 hours was obtained in 84% of cases, sometimes with multiple successive procedures. No case of early recurrence was observed. 21 patients were regularly followed for a period of 3 months to 10 years (mean follow-up: 2 years). There were 9 (42.9%) successes (recovery of normal erectile function), 4 partial results (19%) and 9 (30.1%) failures (complete erectile dysfunction).ConclusionLow-flow priapism must be considered to be a serious andrological emergency. Medical treatment can be effective in early forms, but surgery must not be delayed to prevent permanent erectile dysfunction secondary to extensive corpora cavernosa fibrosis.

Thrombose post-traumatique de l'artère rénale et déficit en protéine C : À propos d'un cas

Resume La thrombose post-traumatique de l’artere renale est une complication rarement decrite dans la litterature. C’est une urgence diagnostique. La prise en charge therapeutique de cette pathologie reste encore un sujet de controverse. Sur le plan physiopathologique cette pathologie peut resulter, soit d’une lesion de l’intima (non elastique), soit de la compression de l’artere renale contre la colonne vertebrale par un impact sur la paroi abdominale anterieure. Cependant, l’association de cette pathologie a certaines maladies hematologiques constitutionnelles n’a jamais ete decrite. Pour cela, il nous a paru opportun de discuter cette observation originale qui rapporte un cas de thrombose post-traumatique de l’artere renale associee a un deficit en proteine C, afin de discuter le role potentiel des anomalies de la crase sanguine dans le developpement de ce type de complication. (J Mal Vasc 2006; 31: 277-279)Post traumatic renal artery thrombosis is rarely described in the literature. This pathology can result from stretch injury to inelastic intima of the renal artery, or by the direct flow to the abdomen causing compression injury to the renal artery against the vertebral column. However, the association of this pathology with hematologic diseases (in particular protein C deficit) was never described. We report an observation of a 28-year-old man with an uneventful history who was admitted to the intensive care unit for traumatic head injury associated with post traumatic renal artery thrombosis requiring nephrectomy. The etiologic investigation of this thrombo-embolic complication reveals a protein C deficit. Our patient was improved under treatment. This original observation confirms that post traumatic renal artery thrombosis can be associated with hematologic diseases (in particular protein C deficit).