A rare case of ureteral tuberculosis mimicking a tumor.

Isolated ureteral involvement in urogenital tuberculosis is rare. The diagnosis can be difficult to evoke. The radiological aspect often evokes tumor involvement, hence the importance of mentioning this pathology in endemic countries. The purpose of this study is to show that it will be necessary to think of ureteral tuberculosis in the presence of ureteral thickening living in an endemic country. We reported a case of ureteric tuberculosis in a 46-years old man mimicking a tumor.

[Sarcomas of the small intestine]. / Sarcomes du grêle.

Sarcomas of the small intestine are rare, clearly differentiated, malignant, mesenchymatous tumours that can be of smooth muscle, Schwann cell or fibroblastic origin. From a clinical point of view, the pain and abdominal mass are the 2 types of symptoms that frequently reveal the disease. In rare cases, sarcomas of the small intestine are manifested by an acute complication. No imaging method can clearly confirm the diagnosis. Before immunohistochemistry, differential diagnosis was made on undifferentiated mesenchymatous "stromal" tumours, which are also rare. Exeresis must be complete and without perforation of the tumour because of the risk of locoregional relapse. The benefits provided by chemotherapy and radiotherapy are limited because of the low mitotic activity of the tumour cells and its weak vascularisation. Long-term survival is limited by poor prognosis criteria: high grade malignancy, size greater than 5 cm, tumour extension, perforation of the tumour, quality of surgical resection and histological type.

[Internal trans-Oddi's sphincter fistula drainage of hydatid cysts communicating with the bile ducts]. / Drainage interne trans-fistulo-oddien des kystes hydatiques ouverts dans les voies biliaires.

OBJECTIVE: The purpose of this study was to examine the contribution of internal trans-fistulary drainage without opening the cystic cavity for the treatment of hydatic cyst of the liver. PATIENTS AND METHODS: Between 1985 and 1990, 14 patients with hydatid cyst of the liver communicating with the bile duct were treated by internal trans-fistulary drainage without opening the hydatic cavity. Choledocoscopy demonstrated good bile flow without a remaining cystic fragment in all cases. The residual cavity was drained via an external drain in the common bile duct. A second hydatic cyst of the liver was also treated in 4 patients. RESULTS: Internal trans-fistulary drainage was achieved easily. There were two treatment-related postoperative complications: bilary leakage in one patient and infection of the residual cavity leading to septicemia and death in another. CONCLUSION: Internal trans-fistulary drainage without opening the hydatic cavity is indicated for central hydatic cyst of the liver measuring less than 15 cm with a flexible pericyst and a large biliocystic fistula measuring more than 5 mm. Peroperative choledochoscopy of the hydatic cavity is necessary.

[Internal abdominal hernias. Report of 8 cases]. / Les hernies internes de l'abdomen. A propos de 8 cas.

Internal abdominal hernias are rare. There unexpected discovery at laparotomy confront the surgeon at anatomic diagnosis problem. 8 cases of internal abdominal hernias were observed between 1989 and 1998: transmesenteric in 3 cases, mesosigmoidal in 2 cases, paraduodenal in 2 cases, needing intestinal resection. Hernia foramen were sutured in all of cases without hernial sac's resection. The results of the present series were excellent without recurrence. Literature review show that internal hernias were responsible of complex anatomic and surgical presentations. The primary task of the surgeon is not so much to establish the diagnosis of internal hernia but intestinal occlusion to decide at time urgent operation.

[Effects of hydroxyzine on tolerance of facial mask during induction in children]. / Effets de l'hydroxyzine sur l'acceptation du masque à l'induction de l'enfant.

OBJECTIVE: To evaluate the effectiveness of hydroxyzine as a premedication agent for the acceptance of facial mask during induction of general anaesthesia in children. STUDY DESIGN: Prospective randomized single-blind study including ASA 1 and 2 children, aged between 1 and 9 years and undergoing outpatient surgery. PATIENTS AND METHODS: Patients were randomly allocated to receive orally either 1mg/kg hydroxyzine (G1) or water 0.1 ml/kg (G2) one hour before induction of standardized inhalational anaesthesia. Tolerance of facial mask was assessed with a 3-points scale (good, moderate or poor). Chi-square and Student's t-test were used in statistical analysis; p values less than 0.05 were considered statistically significant. RESULTS: One hundred patients were included (G1 = 49, G2 = 51). Demographic data were similar in both groups. Acceptance of facial mask was significantly better in G1 than in G2 (p = 0,002). CONCLUSION: Hydroxyzine provided better acceptance of facial mask than placebo during induction of general anaesthesia in children.

[Parasacral sciatic nerve block: new approach]. / Bloc du nerf sciatique par voie parasacrée : nouvelle approche.

INTRODUCTION: The usual technique of parasacral sciatic nerve block seems an approach easily achieved, however, the ischial tuberosity is difficult to palpate. [1] The purpose of the study was to propose new skin landmarks improved by an anatomical and clinical study. PATIENTS AND METHODS: Three cadaver dissections made previously have shown that our skin landmarks appeared correct. Twenty consenting patients, ASA I to III, proposed for lower limb surgery, were included in this descriptive and prospective study. The patient was positioned in the Sim position. A line was drawn between the anterior superior iliac spine (ASIS) and the sacral hiatus (HS). A second line was drawn from the posterior superior iliac spine (PSIS) and perpendicular to the 1st line. The puncture site (P) was the intersection of these two lines. At point P, the needle was inserted perpendicularly to the skin. Twenty milliliters of a mixture of lidocaine 2% and bupivacaine 0.5% were injected after obtaining an appropriate motor response. Sensory block was assessed 30 minutes after performing block in the territories of the tibial nerve, peroneal and posterior cutaneous of thigh. Parasacral block success was defined by the extension of sensory block in the territories of the tibial and fibular nerves. Complications were noted. An independent observer recorded: the time to perform blocks, the depth of the sciatic nerve, the number of needle redirections, the quality of nerve block of patient, and patient satisfaction. RESULTS: The success rate was 95% (19 of 20 cases). Seventy-five percent of blocks were performed by residents on training. The point P was determined at the first attempt. The time required to perform the block was 3 + or - 1.7 min and depth of the sciatic nerve was 81 + or - 17 mm. The rate of patient satisfaction was 85%. One vascular puncture was observed. We have not noted other complications. DISCUSSION: Access to the sciatic foramen appears to be facilitated by these new surface landmarks, which are simple and reliable. Our new skin landmarks seemed valid for all morphotypes.

[Ménétrier disease associated with a gastric adenocarcinoma. Apropos of 2 cases]. / Maladie de Ménétrier associée a un adénocarcinome gastrique. A propos de deux cas.

Two new cases of Menetrier's disease with gastric adenocarcinoma in two men aged 62 and 81 years, respectively, are reported. In both cases, the diagnosis was established by histologic examination of the operative specimen. Emphasis is placed on diagnostic difficulties and on the risk of malignant transformation of Menetrier's disease, which should be viewed as a precancerous gastric lesion.