Epithelioid hemangioendothelioma, an uncommon tumor of the eyelid: A case report.

Epithelioid hemangioendothelioma (EHE) is an infrequent vascular tumor that has an intermediate prognosis between the prognosis of the angioma and that of the angiosarcoma. Its evolution is characterized by a tendency to recurrence and metastases. EHE has been reported in locations such as: lungs, liver, bone and soft tissues. There are very few reports of cases involving the head and neck region. The occurrence of EHE in the orbital region and/or the eyelid is extremely rare. The authors report a case of EHE in the right upper eyelid. Surgical excision has been performed resulting in a good local control of the disease after a 5-year follow up.

[Saccharomyces cerevisiae invasive infection: The first reported case in Morocco]. / Infection invasive à Saccharomyces cerevisiae : le premier cas rapporté au Maroc.

Saccharomyces cerevisiae is a cosmopolitan yeast, widely used in agro-alimentary and pharmaceutical industry. Its impact in human pathology is rare, but maybe still underestimated compared to the real situation. This yeast is currently considered as an emerging and opportunistic pathogen. Risk factors are immunosuppression and intravascular device carrying. Fungemias are the most frequent clinical forms. We report the first case of S. cerevisiae invasive infection described in Morocco, and to propose a review of the literature cases of S. cerevisiae infections described worldwide. A 77-year-old patient, with no notable medical history, who was hospitalized for a upper gastrointestinal stenosis secondary to impassable metastatic gastric tumor. Its history was marked by the onset of septic shock, with S. cerevisiae in his urine and in his blood, with arguments for confirmation of invasion: the presence of several risk factors in the patient, positive direct microbiological examination, abundant and exclusive culture of S. cerevisiae from clinical samples. Species identification was confirmed by the study of biochemical characteristics of the isolated yeast. Confirmation of S. cerevisiae infection requires a clinical suspicion in patients with risk factors, but also a correct microbiological diagnosis.

Current and future imaging of the peripheral nervous system.

Peripheral nervous system (PNS) imaging is usually carried out by ultrasound and MRI. Thanks to its wide availability and excellent spatial resolution, ultrasound is a mature investigation with clearly established indications, particularly in entrapment syndromes and tumors. MRI is generally a second-line examination, which provides decisive additional information thanks to its excellent contrast resolution and its multiplanar abilities. This review describes the current methods for imaging the PNS, concentrating on acquisition techniques, normal results and basic pathological semiology. Ongoing and future developments are described in order to underline the forthcoming changes in this very dynamic field of musculoskeletal radiology.

[A comparison of Airtraq™ laryngoscope and standard direct laryngoscopy in adult patients with immobilized cervical spine]. / Comparaison de l'Airtraq™ et du laryngoscope Macintosh pour l'intubation trachéale chez l'adulte avec stabilisation manuelle en ligne du rachis cervical.

INTRODUCTION: Airtraq laryngoscope is a new and single use device for endotracheal intubation. Few studies showed the superiority of the Airtraq comparing to Macintosh laryngoscope in the setting of difficult intubation. STUDY DESIGN: To compare the performance of these two laryngoscopes by simulating a situation of reduced mobility of the cervical spine by applying the Manual in-line stablization (MILS) maneuver. PATIENTS AND METHODS: After obtaining the approval of the ethic committee, we realized a prospective single blind randomized study. During a 6-month period, 120 consenting patients scheduled for ORL or ophthalmologic surgery were included. They all had general anesthesia and orotracheal intubation. These patients were randomly and equally divided in two groups (n=60), depending on the type of the laryngoscope used (Airtraq or Macintosh). Were excluded from the study the patients with history or criteria predicting difficult intubation. Each patient was intubated by one of the five experimented anesthetists selected for this work. The principle judgment criteria were: i) the time taken for the orotracheal intubation and ii) the intubation difficulty score (IDS). The secondary judgment criterion was the hemodynamic modifications after the endotracheal intubation. RESULTS: Demographic and upper airway track variables were comparable between the two groups. There was no case of failure of intubation in this serie. Nonetheless, all the patients of the Airtaq group were intubated from the first attempt, whereas half of the patients of the Macintosh group were intubated after the third attempt. Comparing to the Macintosh, the Airtraq reduces the time taken for the orotracheal intubation (14±1s vs 19±3s, P=0.01), the necessity of additional maneuver to facilitate the intubation, and the intubation difficulty score (0.7±0.3 vs 3.8±1, P<0.001). Orotracheal intubation using the Airtraq laryngoscope caused less hemodynamic stimulation than using the Macintosh. CONCLUSION: Our study showed the usefulness of the Airtraq laryngoscope for endotracheal intubation for patients presenting conditions of difficult intubation such as reduced mobility of the cervical spine.

[Squamous Cell Carcinoma on burn scar: Summary of five cases]. / Epithelioma Spinocellulaire sur Cicatrice de Brulure (a Propos de Cinq Cas).

In order to study Marjolin's ulcer, all the case histories of patients admitted over a 5-yr period to a Service of Plastic Surgery and Burn Patients in Morocco presenting a histopathologically confirmed burn scar cancer were included in a data file with information regarding the medical background of the five patients concerned, their treatment, and the evolution of the case.After this data presentation, the problems set by spinocellular epithelioma, which is a serious and rare affection, are considered.The degeneration of burn scars is a dramatic development, caused by negligence. Preventive treatment, with systematic exeresis of any suspicious lesion, is strongly recommended as it guarantees almost certain recovery.

[Is the diagnosis of Stener's lesion echograph-dependent? A series of 25 gamekeeper's thumb]. / Le diagnostic des lésions de Stener est-il échographe-dépendant ? A propos d'une série de 25 entorses.

Acute injury to the ulnar collateral ligament of the metacarpophalangeal joint of the thumb is a condition frequently seen by hand surgeons. Most can be treated conservatively except in the presence of a Stener lesion, when surgical treatment is necessary. What is difficult is to obtain the diagnosis of the Stener lesion. Some authors have proposed the use of echography, because sensitivity and specificity can reach 100%. The goal of our study was to demonstrate that the quality of echography depends upon the type of device used. Our retrospective series contained 25 gamekeeper's thumbs studied from March 2005 to March 2007. The first echograph, a Toshiba Ecccocee SMA-736SA-7.5MHz (ECHO 1) was used for the first 18 patients. The second one, a Toshiba APLIO SSA-700A/SSA-770A (ECHO 2) was used for the following six patients. It was equipped with a "tissue harmonic imaging" mode. ECHO 1 was inaccurate in 30% of cases in detecting the presence or absence of a Stener lesion. In contrast ECHO 2 enabled the echographer to be confident in diagnosing the presence or absence of a Stener lesion and peroperative findings or clinical result at review confirmed all the data obtained by ECHO 2. Echography is useful to look for a Stener lesion in the emergency situation because it is available, cheap, non-invasive, and dynamic. Echography is "echographer-dependent", but also "echograph-dependent". Our study revealed the advantage in using an echograph with "tissue harmonic imaging".

[Solitary fibrous tumor of the scalp: a case report]. / Tumeur fibreuse solitaire du cuir chevelu : a propos d'un cas.

The solitary fibrous tumor is a rare tumor, ubiquitous, mesenchymatous essentially affecting serosal surfaces. The location in the scalp is exceptional. We report a case of tumor in left occipital scalp discovered after recurrence of a tumor initially taken for a lipoma. The motive for consultation was mainly aesthetic. The pathological examination is the main element of diagnosis. The assumption is based on a large lumpectomy and an extended and regular clinical monitoring. The forecast is favourable with a decline of one year. However, relapses may occur in the long-term and there are malignant forms.

[Imaging of traumatic injuries of the hip]. / Imagerie des traumatismes de la hanche.

Traumatic injuries of the hip, mostly fractures of the proximal femur, are in constant progression. Though morbidity has decreased due to improved surgical and anesthesiologic techniques and postsurgical rehabilitation, mortality from hip fractures remains significant. Radiographs of the hip remain helpful, but MDCT and MRI have become indispensable tools. Findings on imaging studies must be well characterized to ensure rapid and cost-effective management. Difficult or cases with imaging features that are difficult to interpret or misleading will be presented to avoid incorrect interpretations that could lead to inadequate management of patients.

[Surgical management of cutaneous pathomimia. A report case]. / Prise en charge chirurgicale de la pathomimie cutanée. A propos d'un cas avec revue de la littérature.

UNLABELLED: Cutaneous pathomimia is a behaviour disorder witch interest the skin. In some cases, self-mutilation can be serious and require a surgical treatment. CASE REPORT: A 60 year old woman consults for extensive scar interesting the face and the scalp and realising the aspect of burn face in cicatricle level. The treatment consisted on excision and skin graft. The patient was addressed to Psychodermatology consultation. Authors show the place of plastic surgery in management of cutaneous pathomimia.

[Granulomatous prostatitis (report of 6 cases)]. / Prostatite granulomateuse (à propos de 6 cas).

A retrospectively series of six patients with non-specific granulomatous prostatitis is reported. The diagnosis was revealed by the histological examination trans-urethral resection or enucleated prostatique. Only histological examination is able to established the definitive diagnosis. This study and a review of literature permitted us to notice the various epidemiological, clinical, histological of this affection.

Revisiting the enzymes stored in the laticifers of Carica papaya in the context of their possible participation in the plant defence mechanism.

In the tropical species Carica papaya, the articulated and anastomosing laticifers form a dense network of vessels displayed in all aerial parts of the plant. Damaging the papaya tree inevitably severs its laticifers, eliciting an abrupt release of latex. Besides the well-known cysteine proteinases, papain, chymopapain, caricain and glycyl endopeptidase, papaya latex is also a rich source of other enzymes. Together, these enzymes could provide an important contribution to plant defence mechanisms by sanitising and sealing the wounded areas on the tree.

[A new case of pseudotumoral renal tuberculosis]. / Un nouveau cas de tuberculose rénale à forme pseudotumorale.

The incidence of urogenital tuberculosis is still frequent and constitutes a current public health problem in Morocco, a country in which tuberculosis is endemic. The clinical presentation of this form of the disease may be misleading. The pseudotumoral type of renal tuberculosis is extremely uncommon, and in this study this disease has been described in a young patient. The radiological findings suggested the possibility of this lesion being renal cancer. The preliminary diagnosis was corrected and a definitive diagnosis of pseudotumor was made following pathological examination of the surgically-removed kidney.

[Surgical treatment of traumatic ruptures of the posterior urethra]. / Le traitement chirurgical des ruptures traumatiques de l'urèthre postérieur.

OBJECTIVES: To compare the therapeutic results of deferred urgent surgical treatment and late treatment of traumatic ruptures of the posterior urethra. MATERIAL AND METHOD: 35 patients with a mean age of 25 years (range: 7 to 79 years) were operated for trauma of the posterior urethra. In most cases, trauma was secondary to a road accident, associated with fracture of the pelvis. When rupture of the posterior urethra was diagnosed, the subsequent management depended on the patient's general condition and associated lesions. In the absence of serious skeletal or visceral lesions, the patient was operated within 3 weeks following trauma, after radiological assessment. This approach was applied in 16 patients (Group I). The other 19 patients (Group II) were only operated at the sixth month, after stabilization of all traumatic lesions. RESULTS: Results were assessed in terms of the quality of the urinary stream, urinary continence and sexual impotence. The stream was considered to be good in 93.75% of cases (Group I) and 78.8% of cases (Group II). Continence was perfect in 100% of cases (Group I), versus 89.4% (Group II) and sexual impotence was observed in 18.7% (Group I) versus 5.3% (Group II). CONCLUSION: Trauma of the posterior urethra, without any serious associated lesions, can be operated as a deferred emergency with excellent results in terms of voiding (80% of good results), but with a higher frequency of sexual impotence. In patients with serious associated lesions, the therapeutic management of the urethral trauma is performed after an interval of 3 to 6 months, at the stage of urethral stricture. In this case, surgery consists of resection of the fibrous callus, followed by urethral anastomosis. The results of this operation are good, at the cost of repeated stricture, treated endoscopically, but with a lower incidence of sexual impotence.

[Perineal recurrence of resected penile cancer. A case report]. / Récidive périnéale d'un cancer de la verge opéré. A propos d'un cas.

The authors report an unusual case of perineal recurrence of squamous carcinoma of the penis in a 50-year-old, white man, circumcised during infancy and operated 5 years previously for stage T3N0M0 squamous carcinoma of the penis by total amputation of the penis. Clinical examination revealed a very large, infected perineal tumour associated with bilateral inguinal lymphadenopathy. This stage T4N2M0 tumour was treated palliatively by cystostomy, emasculation with perineal tumour reduction and antibiotics. The patient became afebrile and the infection resolved and was referred to the radiotherapy department for further treatment.

[Diagnostic and therapeutic problems of an atypical cyst of the kidney]. / Problèmes diagnostique et thérapeutique d'un kyste atypique du rein.

Atypical renal cyst raises diagnostic and therapeutic problems. The authors report a case of atypical renal cyst which raised numerous diagnostic and therapeutic problems. The authors discuss theses problems in the light of this case. A farmer consulted for right lumbar pain without hematuria and hydaturia. Hydatic serology was negative. Ultrasonography and CT scan showed atypical cyst in favour of hydatic cyst. Surgical investigations showed a necrotico-hemorragic cyst, and cystectomy was performed. Histological examination revealed a chronic inflammatory process without malignancy. One year after the operation, clinical and radiological examination were normal.

[Treatment of cystoceles with urinary stress incontinence]. / Traitement des cystocèles avec incontinence urinaire d'effort.

Thirteen women were operated for cystocele associated with urinary stress incontinence. Cystoceles were grade I in 6 cases, grade II in 6 cases and grade III in 1 case. Five patients underwent retropubic colposuspension according to Burch (3 cases) and M.M.K. (2 cases). Eight patients were treated by RAZ's technique associated with anterior colporaphy in order to reduce the cystocele. In this latter group, only one recurrence was observed and was treated by repeat colporaphy with good results. Colposuspension associated with anterior colporaphy is a reliable method for the treatment of cystocele with urinary stress incontinence, associated with low morbidity and short hospitalization. Its results are probably comparable to those of retropubic colposuspension, at least for a 6 months follow-up.

[Tumors of the bladder in women. Epidemiologic and therapeutic aspects. Apropos of 40 cases]. / Tumeurs de vessie chez la femme. Aspects épidémiologiques et thérapeutiques. A propos de 48 cas.

Bladder tumours in women. Epidemiological aspects and treatments, based on a series of 48 cases. Bladder tumours are more frequent in men than in women, in whom they present certain epidemiological, clinical and therapeutic characteristics. The authors report a retrospective study of 48 cases of bladder tumour in women, observed in the urology department over a 20-year period. These tumours represented 4.2% of all bladder tumours. The patients had a mean age of 59 years (range: 29 to 77). Only one patient was a smoker (2%). Haematuria was present in 93% of cases, and signs of bladder irritation were present in 60% of cases. All tumours were transitional cell carcinomas. The tumour was classified as stage 0 in 10 cases (20.9%), stage A in 15 patients (31.2%), stage B in 22 patients (45.8%) and stage C in 1 case (2.1%); no patients (0%) were classified as stage D. Our therapeutic protocol was established as a function of the stage of tumour invasion. For example, superficial tumours were treated conservatively by transurethral resection, either alone or combined with intravesical instillation. Radical surgery was performed whenever possible for invasive tumours. External urinary diversion was performed in 11 cases, ureterosigmoidostomy in 3 cases and enterocystoplasty in 5 cases. The clinical course of the 15 superficial tumours was marked by recurrence in 5 cases, while that of the 23 invasive tumours was marked by local recurrence (3 cases), renal failure (1 case) and 3 deaths.

[Bladder tumors in young patients]. / Les tumeurs de vessie chez le sujet jeune.

Bladder tumours classically affect the elderly, but can also occur in young adults. The authors studied the prognosis of these tumours in patients under the age of 40. In their experience, these tumours represent 3.27% of all bladder tumours. 26 patients with a mean age of 34 years (20-40 years), 8 under the age of 30, were studied. There was a marked male predominance (23 males, 3 females). The tumour was a transitional cell carcinoma in 25 cases and a squamous cell carcinoma in 1 case. It was superficial in 11 cases and invasive in 15 cases. Transurethral resection and cystectomy were performed in 9 cases of superficial tumours and 11 cases of invasive tumours, respectively. In the group of superficial tumours, a favourable course was observed in 7 cases, with 3 cases of recurrence and 1 case of progression. In the group of invasive tumours, a favourable course was observed in 6 cases, recurrence was observed in 2 cases and 5 patients died. Superficial tumours therefore have a better prognosis in subjects under the age of 30. Invasive tumours are more frequent and often advanced, suggesting a marked potential for progression. Their prognosis depends on tumour stage, and is not correlated with age.

[Retroperitoneal ganglioneuroma. Apropos of a case]. / Le ganglioneurome rétropéritonéal. A propos d'un cas.

Ganglioneuroma is a rare tumour in adults. We report the case of a 26-year-old woman admitted in our department with right renal colic. Ultrasonography and computed tomography showed a heterogeneous retroperitoneal mass measuring 8 x 7 cm in diameter and displacing the ureteropelvic junction and right kidney anteriorly and laterally. The preoperative diagnosis was retroperitoneal tumour. Surgical exploration revealed a totally resectable retroperitoneal tumour with a histological diagnosis of ganglioneuroma.