[Thymoma-associated myasthenia gravis: Clinical features and surgical results]. / La myasthénie associée aux thymomes : particularités cliniques et résultats chirurgicaux.

OBJECTIVE: The aim of this study was to compare the characteristics of myasthenic patients with and without thymoma, and the results of thymectomy in both types of patients. MATERIAL AND METHODS: A retrospective study was conducted among 66 patients who underwent thymectomy for myasthenia gravis in our department over a 10-year period (2000-2010). The surgical approach was sternotomy or anterolateral thoracotomy. Patients were divided into two groups according to the presence of thymoma: with (T-MG) and without (NT-MG) thymoma. Complete stable remission (CSR) was the primary endpoint. RESULTS: Median age was 35.09±9.89 years. The NT-MG group had 38 patients (57.57%) and the T-MG group 28 patients (42.43%). There was no difference between the two groups regarding the surgical approach (P=0.52). T-MG patients were older (40.54±15.16 vs. 31.37±9.46) (P=0.008) and predominantly male. There were more generalized forms (P=0.01) and more bulbar involvement (P=0.02) in the T-MG group. The rate of CSR at 5 years was 7% and 17% in the T-MG and NT-MG patients respectively (P=0.70). At 10 years, it was 36% and 94.73% respectively (P=0.03). CONCLUSION: Thymomatous myasthenia gravis is characterized by the severity of its clinical features. Remission rate at 10 years was significantly lower in the myasthenia with thymoma group.

[Thymolipoma revelated by myasthenia]. / Thymolipome révélé par une myasthénie.

Thymolipomas are rare, often asymptomatic benign tumors; their revelation by myasthenia is exceptional. A 49-year-old patient with a one-year history of fluctuant muscular fatigability developed ptosis. Electromyography revealed a myasthenic neuromuscular block. The CT scan disclosed a thymic mass especially important on the left side. Thoracotomy under left mammary was performed for thymectomy. Pathology examination of the surgical specimen provided the diagnosis of benign thymolipoma. At 37 months follow-up, the myasthenia has remained unchanged.

[Pneumonectomy for active and sequelae forms of tuberculosis]. / La pneumonectomie pour les formes actives et séquellaires de la tuberculose.

OBJECTIVE: Lung resection retains an important place in the treatment of certain forms of tuberculosis. The purpose of this review was to review the indications for and outcomes of pneumonectomy both in the management of active TB and the treatment of its consequences. MATERIALS AND METHODS: Between 2003 and 2007 85 patients underwent a pneumonectomy for TB; 48 men and 37 women with a mean (sd) age of 36.7 (10.9) years. Chronic sputum production and haemoptysis were the main presenting features. RESULTS: The indication for surgery was a single destroyed lung in 34 cases, an aspergilloma in 29 cases, tuberculous empyema in 14 and multidrug resistant TB in 5. The procedure undertaken was a pneumonectomy in 32 cases a pleurectomy and pneumonectomy in 45 cases and a completion pneumonectomy in 8 cases. There were 4 deaths (4.7%) and in 13 cases (15.3%) a pyothorax developed in the pneumonectomy cavity. In 4 cases a broncho-pleural fistula occurred. Long term results were satisfactory with a median follow up of 2.8years (range 3 months to 5 years). Male sex (p=0.02), right sided pneumonectomy (p=0.01) diabetes (p=0.001), a low level of haemoglobin (p=0.03) or serum protein (p<0.001) were associated with an increased risk of pneumonectomy cavity infection. Right sided surgery (p=0.01), post operative transfusion (p=0.01) and pre-operative empyema (p=0.05) were all associated with risk of bronchial dehiscence. CONCLUSION: Optimising preoperative condition and identification of patients at risk of complications are essential for reducing the burden of post-operative complications.

[Glomerulonephritis and thymoma: a case report and review of the literature]. / Glomérulonéphrite et thymome : un cas clinique et revue de la littérature.

The authors present a case of nephrotic syndrome due to focal-segmental glomerulosclerosis, occurring three years after thymectomy and myasthenia gravis. Twenty-three other cases of nephrotic syndrome associated with thymoma and myasthenia gravis have been reported in the literature. The nephrotic syndrome may be related to T-cell dysfunction associated with thymoma.

[Endobronchial schwannoma in a child. A case report]. / Schwannome endobronchique chez l'enfant. A propos d'un cas.

Intrathoracic neurogenic tumors are rare and interest primarily the mediastinum. Their endobronchial localization is exceptional, a fortiori in the child. The authors report a case of endobronchial benign schwannoma in a 11 year-old-child treated by pneumonectomy.

[Multiple extrapulmonary thoracic hydatidosis]. / L'hydatidose thoracique extrapulmonaire multiple.

INTRODUCTION: Extrapulmonary intrathoracic hydatid cysts are unusual but they may be multiple, particularly during a secondary dissemination. With the aim to clarify the origins of this dissemination, we report our experience in the treatment of multiple thoracic extrapulmonary hydatidosis (MTEH). MATERIAL AND METHODS: Between January 1995 and December 2004, 41 patients were operated on for MTEH in our department. Chest roentgenogram and computed tomography were the main means of diagnosis. The treatment consisted of total surgical removal of the intact cysts. The approach was a postero-lateral thoracotomy (right in 29 cases, left in 8 cases, bilateral in 3 cases) and a median sternotomy in one case. All patients received complementary medical treatment with Albendazol. RESULTS: The MTEH was secondary to haematogenous dissemination in 6 patients (15%), to a hydatid cyst of the lung in 7 patients (17%) and to a hydatid cyst of the liver in 28 patients (68%). 75% of these patients had had a previous surgical intervention for hepatic cyst and 88% of them had diaphragm involvement. There were no deaths among our patients but the recurrence rate was 12%. CONCLUSION: Secondary intrathoracic extrapulmonary hydatidosis is generally seen among patients operated on for hydatid cyst of the liver. Necessary precautions must be taken at the time of surgery to avoid any intrathoracic dissemination.

[Benefit of hip ultrasound in management of the limping child]. / Apport de l'échographie de hanche dans les boiteries de l'enfant.

OBJECTIVE: To evaluate the contribution of sonography of the hip in the management of nontraumatic limping in children. PATIENTS AND METHODS: Prospective study including children consulting for nontraumatic limping (n=93). These children had a clinical examination, a biological and imaging workup (pelvis x-rays (n=88), initial sonograph of the hip (n=93), and follow-up sonograph of the hip (n=29)). RESULTS: Ninety-three children (69 boys, 24 girls) aged from 10 months to 13 years (median, 4 years) were included and divided into two groups: The sensitivity and specificity of sonography in establishing a serious diagnosis was 57% and 59%, respectively. CONCLUSION: The advantage of systematic hip sonography is challenged in this study because of low sensitivity and specificity. Its main advantage seems to be in its negative results, which prompt other investigations.

[Pulmonary hydatid cyst presenting as dysphonia]. / Kyste hydatique du poumon révélé par une dysphonie.

INTRODUCTION: Dysphonia due to compression of the intrathoracic part of the recurrent laryngeal nerve is usually the result of invasion by a malignant tumour. Compression due to an intrapulmonary hydatid cyst is uncommon. CASE REPORT: We report the case of a 56 year old man who presented with cough, dyspnoea and progressive dysphonia. The chest x-ray and thoracic CT scan showed a cystic mass in the left upper lobe in close contact with the arch of the aorta. At surgery the mass proved to be a hydatid cyst of the lung. The treatment was by cystectomy and histological examination confirmed a hydatid cyst. The post-operative result was satisfactory with relief of the compression and improvement in phonation. CONCLUSION: This report illustrates that hydatid cyst of the lung may occasionally present with signs of mediastinal compression.

[An unusual localization of a rare tumor: giant-cell tumor of the rib. Case report and review of the literature]. / Une localisation inhabituelle d'une pathologie rare: la tumeur costale à cellules géantes. A propos d'un cas avec revue de la littérature.

INTRODUCTION: Giant-cell tumors of bone are rare primary neoplasms commonly encountered in young adults. Women are slightly more affected than men. CASE REPORT: We report the case a 27 year old woman presenting with a twelve months history of painful and progressively growing thoracic mass in the right anterior chest wall. Physical examination found out a fixed thoracic mass in the right retro-mammary area measuring 8 x 6 centimeters. The overlying skin was normal. Chest roentgenogram demonstrated a large ill defined mass continuing the anterior arc of the fourth right rib. Computed tomography evidenced a well defined pathologic process originating from the fourth right rib without expansion of the surrounding soft tissue. Pulmonary functional tests were normal and other complementary investigations evidenced no abnormalities. Our patient first had a fine needle cytological biopsy that brought strong suspicion of Giant-cell tumor of the rib. She then underwent an "en bloc" resection of the tumor whose histopathologic analysis allowed a definitive diagnosis. The post-surgical follow up during 12 months showed no signs of tumor recurrence. CONCLUSION: Through this observation the authors emphasize not only the rarity of the giant-cell tumors of bone but also its unusual costal localization (few cases reported till date). They focus on the importance of precocious screening and treatment and underline the value of the follow up in order to detect timely any sign of local recurrence or sarcomatous transformation. Finally, they report a current review of the literature.

[Amelanotic pulmonary melanoma]. / Mélanome pulmonaire achromique.

We report a case of amelanotic pulmonary melanoma in a 52-year-old man. Histological diagnosis was established after right lower lobectomy. The primary source was not found. We describe the diagnosis, treatment and surgical follow-up of this type of pulmonary tumour.

[Thoracic gossypibomas]. / Textilomes thoraciques.

OBJECTIVES: Intrathoracic gossypiboma are exceptional, but diagnosis and treatment are difficult. The purpose of this study was to recall the clinical and radiological aspects of intrathoracic gosssyibomas and discuss the medicolegal consequences. MATERIAL AND METHODS: From January 1990 to June 2003, eight cases of gossypiboma were treated in our unit. The patients were aged 31 to 60 years (mean 40.5). Six had a history of thoracic surgery and two a history of biliary surgery. Clinically, the main symptom was hemoptysia (7 patients, 87.5%). Four patients (50%) presented thoracic pain and one a pleurocutaneous fistula. The chest x-ray revealed a poorly delimited opacity in six patients, a liquid effusion in one and a raised left diaphragm in one. The thoracic scan performed in two patients demonstrated an air image in one and a liquid image in the other. RESULTS: Surgical removal was difficult in all eight patients. Pulmonary parenchyma had to be sacrificed in certain patients. Two patients developed postoperative complications (one pneumothora and one thoracic wall infection). CONCLUSION: The diagnosis of intrathoracic gossypiboma should be suggested in all patients with a pulmonary mass and a history of thoracic surgery, more rarely laparotomy. Prevention remains the best treatment.

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.

Effects of triterpenes from the stem bark of Dysoxylum cauliflorum on a non-small-cell bronchopulmonary carcinoma cell line (NSCLC-N6).

Six triterpenoids and one sesquiterpene were isolated from the ethanolic extract of the stem bark of Dysoxylum cauliflorum. Their structures were determined from 1D and 2D NMR and mass spectral data. Only compound 1 was cytostatic. Kinetic studies with ethyl eichlerianoate 1 demonstrated that this growth arrest was irreversible and cytofluorimetric analysis with compound 1 showed a complete block of NSCLC-N6 cells in the G1 phase. These events were related to a terminal maturation induction.

Desmoid tumors of the chest wall.

OBJECTIVE: Desmoid tumors of the chest wall are uncommon fibromatous tumors characterized by their local invasion and frequent recurrences. They are considered low-grade malignant sarcomas. We analyze our results and evaluate our experience in their surgical treatment. PATIENTS AND METHODS: From 1980 and 1999, eight patients were operated in our service for desmoid tumors of the chest wall. There were five males and three females with a mean age of 32 years old (17-52 years). The diagnosis was established on the basis of clinical signs and imaging studies (Chest X-ray and computed tomography). Surgery was done by direct approach of the tumors. RESULTS: None of the patients had Gardner's syndrome. Complete resection was done in seven of the eight cases. Histology confirmed all cases. The follow-up ranged from 24 and 180 months, for a mean of 82 months. There was one death from cardiac and renal failure 3 months after a fifth resection associated with adjuvant radiation therapy. No other post-operative complications were observed. Recurrences occurred in 50% of cases, all treated by surgery, associated to radiotherapy in one case. CONCLUSION: Surgical treatment of primary desmoid tumors of the chest wall requires wide local resection. In cases of recurrences, multimodality therapies should be considered.

[Arterial complications of hydatic disease]. / Les complications artérielles de la maladie hydatique.

We report two cases of hydatic cyst with rupture into the aorta in two young patients cared for at the Ibn Sina hospital in Rabat, Morocco. In the first patient, a false hydatic aneurysm of the descending thoracic aorta was discovered at surgery performed for suspected hydatic cyst of the lower lobe of the left lung. Despite reconstruction with a prosthetic graft, the patient died peroperatively due to exsanguination via uncontrollable bleeding through the aneurysmal sac. The second case was a 20-year-old woman whose false hydatic aneurysm of the thoracoabdominal aorta was disclosed by embolic ischemia of the lower limbs. Aorto-aortic reconstruction was followed by medical treatment with albendazol. During follow-up, the patient developed a hydatic cyst of the kidney and a parietal cyst. Both were treated surgically. An analysis of these two cases and 9 others reported in the literature concerning arterial involvement in hydatic disease revealed the characteristic clinical, radiological and therapeutic features of this rare but serious complication.

Hydatid cyst: an unusual disease of the mediastinum.

BACKGROUND: Hydatid cystic disease is still a significant clinical problem in endemic countries, particularly in Morocco. Mediastinal localization is very rare. We report our surgical experience with this particular lesion. PATIENTS AND METHODS: In a retrospective review of the last ten years (1990-1999), we had seven cases of mediastinal localization out of total of 2332 (0.3%) intrathoracic hydatid cysts treated in our service. Imaging investigation consisted of chest x-ray and computed tomography. All diagnoses were confirmed peroperatively macroscopically and for some lesions, histologically. RESULTS: Complete resection of the cyst was performed in six cases. In one case, a small part of the wall intimately adherent to the superior vena cava was left in place. There were no complications, mortality or recurrence. CONCLUSION: Hydatid cysts can be found in many different sites in the body. Whenever possible, surgical management is the best treatment but extensive resection should be avoided. Medical treatment as an adjunct to surgery is indicated when there is a risk of dissemination.

Surgical treatment of hydatidothorax. Series of 79 cases.

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.

[Visceral and cutaneous leishmaniases in the north. Retrospective study of cases diagnosed in the Rabta Hospital of Tunis]. / Leishmanioses viscérales et cutanées du nord. Etude rétroactive des cas diagnostiqués à l'hôpital La Rabta de Tunis.

The authors report a retrospective study of 50 cases of infantile visceral Leishmaniasis (April 1994-April 1995), and 53 cases of sporadic cutaneous Leishmaniasis of north-Tunisia (August 1990-July 1994), diagnosed in parasitology laboratory of Rabta hospital. They insist on the recrudescence and the extension of the distribution geographical area of these two clinical forms of human leishmaniasis observed in Tunisia.

[Treatment of hydatid bilio-bronchial and bilio-pleuro-bronchial fistulas by thoracotomy]. / Traitement des fistules biliobronchiques et bilio-pleuro-bronchiques d'origine hydatique par thoracotomie.

STUDY AIM: The aim of this study was to report the results of surgical treatment of hydatid bilio-bronchial et bilio-pleuro-bronchial fistulas via thoracotomy. MATERIAL AND METHODS: From 1990 to 1998, 63 cases were observed in the same center. Biliptysis was the main symptom in 72% of cases. The diagnosis was based on chest radiography and abdominal ultrasonography; both examinations visualised the cyst, intrathoracic collections, a diaphragmatic breach and biliary lesions. All patients were treated by one-stage thoracotomy. The procedures consisted of lung resection (lobectomy and/or segmentectomy) (n = 47) and decortication (n = 16) in the chest, cyst dome resection (n = 61) or partial pericystectomy (n = 12) in the abdomen and suture of the diaphragmatic defect in all cases after hepato-diaphragmatic disconnection. An additional laparotomy was necessary in 4 cases. RESULTS: There were 8 deaths (12.7%): one intraoperative death due to haemorrhage and seven postoperative deaths, mostly related to pulmonary complications. Postoperative complications (14.3%) were mainly respiratory. Clinical and radiological results were good with a one-year follow-up. CONCLUSION: Bilio-bronchial and bilio-pleurobronchial fistulas due to hydatid cyst are rare, but severe diseases. They are responsible for lesions at three levels: abdominal, diaphragmatic and thoracic. A high perioperative mortality rate was observed. Thoracotomy is the best approach for surgical treatment at all three levels.

[Mature teratome of the mediastinum]. / 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.