[Surgery of tracheobronchial carcinoid tumours: Activity report]. / La chirurgie des tumeurs carcinoïdes trachéobronchiques : bilan d'activité.

INTRODUCTION: Our purpose is to evaluate our results of surgery for tracheobronchial carcinoid tumour as well as the long-term survival. METHODS: This is a retrospective and descriptive study performed in the department of thoracic surgery of CHU Hassan II (Marocco) over a period of 9 years. It concerns all patients with a tracheal or bronchial carcinoid tumour who underwent surgery. RESULTS: Twenty-three patients with a mean age of 39 years were operated on for 24 carcinoid tumours. The sex ratio was 0.29. The diagnostic delay ranged from 3 months to 8 years and the main symptom was haemoptysis in 74% of cases (n=17). The tumour was localized in the right bronchial tree in 70% of cases (n=16). The procedures performed were tracheal resection and end-to-end anastomosis in 1 case, lobectomy in 12 cases including 3 sleeve lobectomies, bilobectomy of middle and lower lobes in 7 cases and pneumonectomy in 4 cases. The prognosis was favourable in 91% after an average follow-up of 29 months. CONCLUSIONS: Surgery remains the only curative therapeutic option for tracheobronchial carcinoid tumours with acceptable morbidity and mortality.

[Surgery of primary tracheal tumours of the salivary gland type]. / La chirurgie des tumeurs primitives de la trachée de type glande salivaire.

INTRODUCTION: Primary tumours of the trachea are very rare and may develop from the tracheal salivary glands. CASE REPORTS: We describe four patients operated on in our service between 2010 and 2017 of whom two had an adenocystic carcinoma, one a mucoepidermoid carcinoma and one a pleomorphic adenoma of the trachea. All were treated by resection and tracheal anastomosis with clear margins in three cases. The malignant cases received adjuvant treatment consisting of radiotherapy in one case and radiochemotherapy in the second. Immediate postoperative recovery was uncomplicated in all patients. One death followed the developement of post irradiation tracheal stenosis two years after surgery in a patient with an adenocystic carcinoma where the resection margins were invaded by tumour. CONCLUSIONS: Resection and anastomosis of the trachea remains the best therapeutic option with a better prognosis when the resection is complete.

[Sporadic lymphangioleiomyomatosis: A rare cause of bilateral spontaneous pneumothorax in young woman]. / La lymphangioléiomyomatose sporadique : cause rare du pneumothorax spontané bilatéral chez la femme jeune.

Sporadic lymphangioleiomyomatosis is an orphan disease of the young woman. Its clinical manifestations are mainly respiratory, including spontaneous pneumothorax. The management is multidisciplinary. We report the case of a young patient with bilateral spontaneous pneumothorax revealing sporadic lymphangioleiomyomatosis.

[Left localization of biliobronchial fistula: Exceptional complication of hepatic hydatidosis]. / Localisation gauche d'une fistule biliobronchique : complication exceptionnelle de l'hydatidose hépatique.

INTRODUCTION: The biliobronchial fistula of hydatic origin is a rare complication and the left localization is exceptional. OBSERVATION: We report the case of a 26-year-old patient from the rural area who was referred to us for treatment of biliptysis. The thoracic and abdominal computed tomography diagnosed a left biliobronchial fistula was. Management consisted of primary endoscopic sphincterotomy, followed by left exclusive thoracotomy surgery to treat pulmonary, hepatic and diaphragmatic repair. The evolution was favorable with disappearance of the biliptysie. CONCLUSION: The diagnosis of left biliobronchial fistula requires a precise assessment not only by the imagery but also the bronchial fibroscopy allowing the acurate localisation of the lesion before any surgical enterprise.

Management for hydatid cysts of the lung ruptured in the pleural cavity.

INTRODUCTION: Our purpose is to report our experience in the management of pulmonary hydatid cysts ruptured in the pleura. Materiel and methods: We collected all records of patients with a ruptured hydatid cyst of the lung in the pleura who underwent surgery for this in the department of thoracic surgery of the CHU Hassan II of Fes during the 6-year period that started in 2010. RESULTS: The study included 20 men and 14 women with an average age of 30.44 ± 18.4 years. Radiological findings showed a hydropneumothorax in 21 cases, hydrothorax in 10, pachypleuritis in 29, and a floating membrane in 13 cases. In all cases, pleuropulmonary decortication was associated with pericystectomy in 20 cases and parenchymal resection in 3 cases. A hydatid membrane bathing in the pleural cavity was found in 32 cases. The postoperative course was uneventful in 28 cases. CONCLUSION: Long-term follow-up should be established to detect possible recurrences or pleural dissemination, which appear to be prevented by long-term use of anthelmintic agents.

Aspergillus pyothorax: Is surgery alone sufficient?

Aspergillus is a mycelial fungus formed of filaments that penetrate the airways when its spores are inhaled. It is rarely located in the pleura. We report two cases of patients, one aged 67 years and the other 37 years, with pleural aspergillosis. The first underwent a thoracostomy, followed later by a myoplasty for closure. Pleuropulmonary decortication was performed in the second patient. The pathology examination confirmed an intrapleural aspergilloma in both patients. Antifungal treatment was not performed. The postoperative course was simple and no recurrence was noted. Based on these two cases over a 7-year period and a review of the literature, we detail the issues in this management and emphasize the interest of surgery.

[What contribution for mediastinoscopy in non-tumor specific mediastinal lesions?] / Quelle contribution pour la médiastinoscopie dans les lésions médiastinales spécifiques non tumorales ?

INTRODUCTION: The aim of our study was to assess the interest of cervical mediastinoscopy in the management of benign mediastinal lymphadenopathy. METHOD: We performed a single-center retrospective descriptive study over a period of 5 years (2013-2017) in the department of thoracic surgery of university hospital Hassan II of Fez. RESULTS: During this period, a total of 137 cervical mediastinoscopies were performed among which 68 for a benign disease. This represents a frequency of 49.63 %. There were 22 men and 46 women with a mean age of 43.76 years±17.08. Chest CT showed isolated mediastinal lymphadenopathy in 52 %, associated with pulmonary images in 35 %. Cervical mediastinoscopy led to pathological diagnosis in 94 %. The pathological results showed a sarcoidosis in 51.5 %, tuberculosis in 41.2 % and a lymph node echinococcosis in 1 case. CONCLUSION: Cervical mediastinoscopy remains a low risk modality in expert hands, which allows pathological diagnosis with excellent sensitivity, acceptable morbidity and no mortality in our experience.

[Prognostic factors in pleuropulmonary decortications for tuberculous pyothorax]. / Facteurs pronostiques dans les décortications pleuropulmonaires pour pyothorax tuberculeux.

INTRODUCTION: Tuberculous pyothorax or empyema is one of the serious forms of tuberculosis and still poses public health problems. Through a series of patients who undergone pleuropulmonary decortication, we propose our model of management and determine the main factors prognostic. METHOD: We retrospectively retrieved for 8 years 93 cases of patients with pleuropulmonary decortication for tuberculous pyothorax confirmed by histological examination pre- or postoperatively. RESULTS: There were 33 women and 60 men with an average age of 28.4 years±10.35. In all cases, the radiological findings showed a pachypleuritis associated with an enclosed pyothorax in 79.6% of cases (n=74), a free cavity pyothorax in 8.6% of cases (n=8) and a passive atelectasis in all these cases. Chest tube was performed before surgery in 91.4% of cases (n=85) until the effusion was completely drained. The univariate analysis of the results of the surgery allowed to determine 4 factors of good prognosis: preoperative preparation (including chest tube with total drying of the empyema, respiratory physiotherapy and weight gain) P=0.04, complete peroperative pulmonary re-expansion P=0.03, the lowest stay in intensive care unit P=0.02 and the follow-up P=0.01. CONCLUSION: Pleuropulmonary decortication is a safe therapeutic alternative in the late stages of tuberculous empyema with acceptable morbimortality.

[About two huge bilateral bronchial atypical carcinoid tumors]. / À propos de deux énormes tumeurs carcinoïdes atypiques bilatérales bronchiques.

Carcinoid tumors are well differentiated neuroendocrine tumors of low grade malignancy or attenuated malignancy. Atypical bilateral bronchial forms are rarely reported. They pose a real problem of therapeutic strategy. We report a case of a 36-year-old woman with two large bilateral atypical carcinoid tumors. She received delayed bilateral parenchymal resection with postoperative uneventful course. Through a review of the literature, we discuss the therapeutic strategy. This observation remains special for several reasons. Not only by the rarity of the bilateral and atypical forms but also for the bilateral tumor sizes which led to a difficult intraoperative anesthetic management.

[The thoracic surgeon and the management of the bronchial biliary fistula of hydatid origin]. / Le chirurgien thoracique face à la fistule biliobronchique d'origine hydatique.

INTRODUCTION: The bronchial biliary fistula surgery is a major one, always going with a higher rate of complication especially in case of bile duct obstruction. The aim of this study is to find out the contribution of endoscopic sphincterotomy while reporting the results of surgical treatment of bronchial biliary fistulae by exclusive thoracotomy. METHODS: This was a retrospective study, which took place in the Department of Thoracic Surgery, University Hospital Hassan II, from January 2009 to March 2016. The parameters studied in connection with the bronchial biliary fistula of hydatid origin were: age, sex, origin, history of surgery especially for hepatic hydatid cyst, term of bilyptysie, imaging results, preoperative cholangiography indications, surgical treatment modalities and patients trends. RESULTS: A sample of 12 patients was included (6 men and 6 women) with an average age of 44 years old, with a gap spanning between 17 and 81 years. Seven patients had at least a history of hepatic hydatid surgery. The biliptysie was the main symptom in 8 patients. A biological cholestasis syndrome was found in 6 patients. The thoracoabdominal CT scan performed on all patients comes out with results in 100% of cases. Four patients received endoscopic retrograde cholangiography that allowed them to release the bile duct completely by sphincterotomy with extraction of hydatid membrane in one patient and with development of a biliary stent in another patient. The incision was a low posterolateral thoracotomy in 10 patients that went under surgery. It has allowed to deal in one-time liver and lung injuries combined with diaphragmatic breach repair. Inside the group of patients that went under surgery, the postoperative results were simple in 8 cases. We have noted an overall mortality rate of 18.2%. CONCLUSION: Bronchial biliary fistula surgery complications remains considerable despite the progress of diagnostic imaging. Preoperative endoscopic sphincterotomy is a milestone in the handling of this surgery. It may even be suggested as exclusive therapy in inoperable patients with significant biliptisy.

[The surgery of diaphragmatic hydatidosis and their complications]. / La chirurgie des hydatidoses diaphragmatiques et leurs complications.

Primary or secondary diaphragmatic echinococcosis is rare, accounting for 1% of the thoracic locations. They may be operative discovery or by their complication, hence a variable symptomatology making this localization a particular entity. The thoracic and abdominal CT allows a complete assessment. Surgery remains the only therapeutic approach. In complicated forms an additional surgery is required for complete care. The prognosis is generally good apart from the risk of recurrence. Through a series of 4 operated patients, we focus on the clinical and therapeutic features of this pathology and its complications.

[Which surgery for mediastinum tumor: Experience of the Department of thoracic surgery of CHU Hassan II of Fès]. / Quelle chirurgie pour quelle tumeur du médiastin : expérience du service de chirurgie thoracique de CHU Hassan II de Fès.

INTRODUCTION: Tumors of the mediastinum are a heterogeneous group of dysembryoplatic and neoplastic diseases essentially with different prognoses and therapeutic. These tumors develop slowly and remain long asymptomatic in 40-50% of cases. The purpose of our work is to bring the result of surgical management in diagnostic and therapeutic of principal mediastinum tumors framework. PATIENTS AND METHOD: We reviewed retrospectively the records of 68 patients in our training, between January 2009 and December 2013, for tumor of the mediastinum in the diagnostic framework and or therapy. RESULTS: There were 37 men and 31 women with a mean age of 37 years with extremes ranging from 11 to 73 years and 77.94% had an age between 11 and 50. In 39 patients, surgery had a diagnostic purpose (2 benign tumors and 37 malignancies including 27 cases of lymphomas). Curative surgery was performed in 34 patients, dominated by the tumors of thymic origin in 15 cases. Conventional surgery had involved 32 patients. The surgical approach was a total vertical sternotomy in 14 patients, in 17 patients was posterolateral thoracotomy and a left anterior thoracotomy in 1 patient. Video assisted thoracic surgery had been done in 3 patients under resection of a pleuropericardique cyst. Overall mortality was 4.41 percent. It is a death at D17 of the postoperative (thymoma with myasthenia) following a myasthenic crisis requiring a tracheotomy. A patient operated on for invasive thymoma developed myopathy and died at D44 of the postoperative following a difficulty of weaning. Another patient had a thymoma B3 benefited from 6 courses of neoadjuvant chemotherapy and then a thymectomy had presented a respiratory distress with bilateral pleural effusion, death at D10 of the postoperative by septic shock following a nosocomial infection. CONCLUSION: Tumors of the mediastinum are infrequent, discovered more often by chance. The main prognostic factor is the completeness of tumor resection without taking the break. Conventional surgery always keeps a place in our context, despite the advent of minimally invasive surgery.

[Results of bronchiectasis surgery: About 64 cases]. / Résultats chirurgicaux à propos de 64 patients opérés pour dilatations des bronches.

INTRODUCTION: Bronchiectasis is a serious and disabling disease. Surgical treatment is an interesting alternative to be proposed early to patients in case of complications or deterioration of quality of life, despite an optimal medical treatment. Through this retrospective study and literature review, we analyze surgical results for bronchiectasis. PATIENTS AND METHOD: We conducted a monocentric, retrospective, descriptive and analytical study in the Department of thoracic surgery of CHU Hassan II Fès, about 64 patients operated for bronchiectasis during the period from January 2009 to December 2016. RESULTS: There were 30 men and 34 women with an average age of 32years. Twenty six percent (26 %) had a history of recurrent lung infection, and 17.18 % would have been treated for pulmonary tuberculosis and declared cured. Productive cough (93 %), morning chronic bronchorrhea (92 %) and repeatedly hemoptysis (62.5 %) were the main symptoms. On CT scanning, the bronchiectasis was unilateral and localized in 49 cases. The right lung was involved in 27 cases and the location was bilateral in 15 cases. It was 38 cystic bronchiectasis, 16 cylindrical bronchiectasis, and 10 mixed lesions predominantly cylindrical. The flexible bronchoscopy carried out in 34 cases, had shown a carcinoid tumor in 1 case, a bronchiolithiasis in 1 case and a intrabronchial foreign body in 1 case. The incision was a conservative posterolateral thoracotomy in all cases. The performed surgical procedure was lobectomy in 53 % of patients. The morbidity rate was 32.80 % and dominated by septic complications. After a mean follow-up of 20.52months, 2 cases of recurrence minimal hemoptysis and 1 case of renewed bronchorrhea are noted. For all other patients the outcome was favorable and no deaths have been noted to date. CONCLUSION: The surgery of bronchiectasis requires a perfect collaboration between the pulmonologist, the thoracic surgeon, the anesthesiologist, the biologist and particularly the physiotherapist for an optimal care of patients.

[Can Tako-tsubo syndrome be integrated into post-pneumonectomy syndrome?] / Le syndrome de Tako-tsubo : peut-il être intégré dans le cadre de syndrome post-pneumonectomie ?

INTRODUCTION: Tako-tsubo syndrome, or "left ventricular transitory apical balloon syndrome", is an acute coronary syndrome with normal coronary arteries. OBSERVATION: We report the case of a 50-year-old patient operated for a post-tuberculous destroyed lung, for which she had a left pneumonectomy. Six months later, she presented with chest pain complicated by cardiorespiratory arrest. The Tako-tsubo syndrome was retained after eliminating the other causes. CONCLUSION: The diagnosis of Tako-tsubo syndrome should be considered before the sudden occurrence of an acute coronary syndrome in the aftermath of stress or emotional shock.

[The place of surgery in bilateral sequelae bronchiectasis]. / La place de la chirurgie dans les bronchectasies bilatérales séquellaires.

INTRODUCTION: The aim of our study is to report our surgery results in bilateral sequelae bronchiectasis and to assess its impact on the life quality of our patients. METHOD: This is a retrospective descriptive study in thoracic surgery department of Teaching Hospital Hassan II of Fez in Morocco. It involved all patients with bilateral bronchiectasis which is predominant on a few lobes or segments (localized) and who underwent surgery during the period 2010-2015. The epidemiological, clinical and paraclinical data, the surgery results, the evolution and the impact on life quality were assessed. RESULTS: From a total of 47 patients with bilateral bronchiectasis, 13 were operated, thus a frequency of 27.6%. The average age was 32years, ranging from 15 to 54years. Women were in majority (61.5%) representing a sex ratio of 1.6. The association of chronic bronchorrhea and hemoptysis was the main reason of medical consultation in 46.16%, followed by isolated chronic bronchorrhea in 38.46%. Surgical resection involved the left side in 61.5% of cases. The left lower lobectomy was the most accomplished gesture. An improvement in symptoms was found in 11 patients (84.6%) as a decrease in bronchorrhea, hemoptysis episodes and decreasing use of antibiotics. CONCLUSION: Bilateral bronchiectasis surgery can be performed with acceptable morbidity and mortality in well-selected patients with an improvement in symptoms.

[What surgery for recurrent Darier-Ferrand sarcoma of the chest wall?] / Quelle chirurgie pour la forme récidivante du sarcome de Darrier-Ferrand de la paroi thoracique ?

INTRODUCTION: Dermatofibrosarcoma protuberans (Darrier-Ferrand sarcoma, DFSP) is an uncommon tumor. This sarcoma has a tendency to local recurrence, requiring a wide surgical resection. OBSERVATION: We report herein two cases of patients presenting with recurrent dermatofibrosarcoma protuberans after several surgical resections. A wide surgical resection with guided tissue regenaration has been performed in one case, whereas the second case required a skin graft. CONCLUSION: Despite a short follow-up, our aim was to highlight the local aggressiveness of the DFSP and point out its therapeutic challenge, usually requiring a wide and aggressive surgery.

[Pneumonectomy for tuberculosis destroyed lung: A series of 26 operated cases]. / Pneumonectomie pour poumon détruit post-tuberculeux : une série de 26 cas opérés.

Pneumonectomy keeps a greatest place in the treatment of tuberculosis lung destroyed despite high morbidity and mortality. The aim of our study was to analyze the results of pneumonectomy in the treatment of tuberculosis lung destroyed in our institution. METHOD: A retrospective study over a period of 5 years (2009 to 2014) was realized. Are involved in the study all patients admitted to the thoracic surgery department of CHU Hassan II with tuberculosis lung destroyed and operated during the study period. RESULTS: This is a series of 26 patients, including 17 men and 9 women treated and cured for pulmonary tuberculosis of which 2 for multiresistant tuberculosis. The average age was 38.8 years. Hemoptysis (77 %) and recurrent respiratory infections (65.4 %) were the major clinical signs. Aspergilloma have been reported on cavitary lesion in 23 % of cases and in 11.5 % pyothorax was associated. Extra-pericardial pneumonectomy was performed in 65.4 %, intra-pericardial pneumonectomy in 19.3 % and pleural-pneumonectomy in 15.3 %. The outcome was favorable in 23 patients. We noted a pyothorax on pneumonectomy cavity in 3 patients. Postoperative mortality was 7.7 %. The regularly clinical and radiological control of all patients is satisfactory with a mean of 41 months. CONCLUSION: Pneumonectomy for tuberculosis lung destroyed remains effective in young patients with an acceptable complication rate.

[Neurogenic mediastinal tumors in adults]. / Tumeurs neurogènes du médiastin de l'adulte.

INTRODUCTION: Neurogenic mediastinal tumors are tumors develop at the expense of peripheral nerve elements of the mediastinum, the sympathetic nervous tissue and paraganglia. The series that we propose has the distinction of a high frequency of malignant forms and a wealth of clinical symptomatology. METHODS: This is a retrospective study of 9 patients collected over a period of 6 years. The epidemiological aspect, clinical, radiological, surgical treatment and his results, histological diagnosis and prognosis were reviewed. RESULTS: Five women and 4 men were identified. All patients were symptomatic at diagnosis. Tumor resection was complete in 8 cases. In 3 patients, there was a malignant tumor. Two of them had received chemo-radiotherapy. The others showed good clinical progress with a mean of 35 months. CONCLUSION: Neurogenic tumors in adults are usually discovered incidentally. When the malignant forms predominate or in the presence of large tumor, the symptoms can be quite marked. In all cases the treatment based on a complete surgical resection remains the only guarantee of a good prognosis.

[Hydatidosis bone wall chest: About three cases]. / Hydatidose osseuse de la paroi thoracique : à propos de trois cas.

INTRODUCTION: Bone hydatidosis of the chest wall is rarely reported in the literature. Costal and sternal location are uncommon. Through 3 observations and literature review, we report particular pathophysiological and diagnostic aspects of costal and sternal hydatidosis. We also discuss therapeutic and prognostic aspects of this disease. OUR CASES: we report the cases of 45, 41 and 17 years old male patients, 2 of them had previous surgery for thoracic wall mass in general surgery service. Clinical presentation was thoracic wall painful mass sticking to bone. One patient had isolated costal location, the 2 others had sternal location; in one of them, the disease is located in sterno-costo-clavicular area. In all 3 cases, the disease was diagnosed by computed tomography (CT) scan, showing bone lysis or mediastinum enlargement. Patients undergo extended bone resection removing away all destructed parts of the bone. After surgery, albendazole has been prescribed to all patients. No recurrence was observed after 12 months follow-up. CONCLUSION: Chest wall bone hydatidosis is unusual even in endemic regions, with slow evolution and inconspicuous symptoms. Radiology plays a key role in the management of this disease. Extended surgical resection associated with medical treatment (albendazole) is a reliable treatment without recurrence.