[A case of bronchopulmonary sequestration]. / Une séquestration pulmonaire particulière.

INTRODUCTION: Bronchopulmonary sequestration is a rare congenital abnormality characterized by the presence of a non-functioning mass of lung tissue which receives an aberrant arterial supply from systemic circulation. CASE REPORT: We describe the case of a 30-year-old man who presented with recurrent episodes of mild hemoptysis. CT angiography revealed a right inferior lobar sequestration supplied by three systemic arteries. The patient underwent thoracotomy with right lower lobectomy and section-ligature of the three abnormal vessels. CONCLUSION: This case highlights the radiological features as well as the intraoperative appearances of this rare anomaly.

[Coinfection with hydatid cyst and pulmonary tuberculosis]. / Coinfection pulmonaire par un kyste hydatique et une tuberculose pulmonaire.

Morocco is an endemic area for both hydatid cyst and tuberculosis (TB). The co-occurrence of these two diseases in lung is unusual, especially when localized in the same area. We describe the case of a patient with pulmonary hydatid cyst associated with tuberculosis infection where the diagnosis was unknown prior to surgery because TB tests were negative. The surgical resection was very difficult because of inflammation in the surrounding tissue and its fragility. However, the postoperative course was uneventful. The goal of this case report is to keep in mind that such co-infection is possible especially in endemic countries.

[Pleuropericardial cyst rupturing into the pericardium causing tamponade]. / Kyste pleuropéricardique fistulisé dans le péricarde avec tamponnade clinique.

Pleuropericardial cysts of the mediastinum are rare lesions, usually congenital but exceptionally acquired. They are often asymptomatic, but complications can occur. We report below the case of a 35-year-old man who presented with an acquired right-sided para-tracheal mesothelial cyst that ruptured into the pericardium and was responsible for clinical tamponade. Although the majority of mesothelial cysts are asymptomatic, only a strict clinical and radiological follow-up can provide an indication for surgical resection. This should be reserved for symptomatic patients or for those facing an uncertain diagnosis.

Role of both actin-myosin cross bridges and NO-cGMP pathway modulators in the contraction and relaxation of human placental stem villi.

INTRODUCTION: Human placental stem villi (PSV) present contractile properties. We studied the role of actin-myosin cross bridges (CBs) and the effects of NO-cGMP pathway modulators in the PSV contraction and relaxation. METHODS: In vitro contractile properties were investigated in 71 PSV from term human placentas studied according to their long axis. Contraction was induced by both KCl and electrical tetanic stimulation. Relaxation was induced by inhibiting the CB cycle with either 2,3-butanedione monoxime (BDM) or blebbistatin (BLE) and by activating the NO-cGMP pathway with isosorbide dinitrate (ISDN), sildenafil (SIL) or ISDN + SIL. RESULTS: PSV tension slowly increased by 140% of the basal tone after KCl exposure and by 85% after tetanus. The addition of BDM, BLE, ISDN, SIL and ISDN + SIL induced a relaxation of PSV, the overall time course of relaxation (in s) was respectively (means ± SD) 3412 ± 1904, 14,250 ± 3095*, 3813 ± 1383, 2883 ± 1188 and 2440 ± 477; significantly longer in BLE compared with BDM, ISDN, SIL and ISDN + SIL:*p < 0.001). the overall time course of relaxation (in s) was respectively (means ± SD) 3412 ± 1904, 14,250 ± 3095*, 3813 ± 1383, 2883 ± 1188 and 2440 ± 477; significantly longer in BLE compared with BDM, ISDN, SIL and ISDN + SIL:*p < 0.001). These relaxation kinetics were particularly slow. Other relaxation parametres, i.e., maximum lengthening, -peak dT/dt, and resting tension, did not differ between these 5 subgroups. DISCUSSION AND CONCLUSION: Isolated human PSV were able to contract after both KCl exposure and tetanus. This increase in contractility was reversed by inhibiting the CB cycle with BDM or BLE and by stimulating the NO-cGMP pathway with ISDN or SIL. The association ISDN + SIL did not potentiate the relaxing processes.

Surgical treatment of aspergilloma grafted in hydatid cyst cavity.

Aspergilloma is a saprophytic infection that colonizes pre-existing cavities in the lung. These cavities are caused by tuberculosis, bronchiectasis, lung cancer and other pulmonary diseases. Development of aspergilloma in the residual cavities after pulmonary hydatid cyst surgery is rarely described in terms of coexistence of the two conditions. We describe 3 cases of pulmonary aspergilloma grafted in a residual cavity of cystectomy for hydatid disease.

[Benign cysts of the mediastinum: series of 28 cases]. / Les kystes bénins du médiastin : à propos de 28 cas.

INTRODUCTION: Benign cystic mediastinal mass form a group of heterogeneous and uncommon lesions. Surgical resection is the gold standard in these conditions. We reported our institutional experience in management of these benign tumours. In this review, cardiac and ganglionary benign mass were excluded. METHODS: We retrospectively reviewed the records of 28 patients with benign cysts of the mediastinum, who are operated in our department between January 2003 and December 2009 (7years period). RESULTS: There were 13 females (46.4%) and 15 males (53.5%), with a mean age of 36.8years (range: 13-63years). Most lesions (n=22) were equally in the anterior and middle mediastinum, only six were in the posterior mediastinum. Seventeen patients (60.7%) were symptomatic, with chest pain and cough as the most common symptoms. The diagnosis of mediastinal cyst was fortuitous in 11 patients with the waning of an assessment made for another reason. Surgery was indicated in all patients in order to both diagnostic and therapeutic. Posterolateral thoracotomy incision is the most common. Complete resection of the cyst was possible only in 18 cases (64.3%), whereas in ten (35. 7%) other cases part of the cyst was left in place due to tight adhesions to vital structures. After histological study, there were: nine bronchogenic cysts (32.1%), seven hydatid cysts (25%), four cystic lymphangiomas (14.3%), three mature cystic teratomas (10.7%) and three pleuropericardial cysts, one thymic cyst and one parathyroid cyst. The postoperative course was uneventful and no recurrence has been observed until now. CONCLUSION: The benign cysts of the mediastinum is a rare entity, the hydatid etiology remains common in our context. Surgical treatment remains the treatment of choice for mediastinal cysts, when the patient is operable, to save the risk of complications or degeneration.

[Bilio-bronchial fistula due to hydatic disease: case report and review of the literature]. / Fistule bilio-bronchique d'origine hydatique : à propos d'un cas et revue de la littérature.

Bilio-bronchial fistula due to hydatid disease is a rare but severe condition. Three levels, abdominal, diaphragmatic and thoracic, may be involved, with high perioperative mortality. We report a case of bilio-bronchial fistula successfully managed by thoracotomy. Thoracotomy is the best approach for surgical treatment at all three levels.

[Pediatric Ewing sarcoma of the rib: role of neoadjuvant chemotherapy in tumoral shrinking and sterilization. A case report]. / Sarcome d'Ewing costal chez l'enfant : intérêt de la chimiothérapie néoadjuvante dans la réduction et la stérilisation tumorale. À propos d'un cas.

Ewing sarcoma is a rare tumor, which represents, nevertheless, the most common primary chest wall tumor in children. The management and prognosis of these tumors have markedly improved with the use of multimodal therapy including adjuvant chemotherapy, surgery and/or irradiation. A good response to chemotherapy often avoids the need for extensive local treatment without sacrificing local control or long-term survival. Here, we report a new case of a bulky rib Ewing sarcoma, well managed by neoadjuvant chemotherapy resulting in significantly tumor shrinking that allowed complete resection. At the histological examination of the specimen, there was only inflammatory and fibrosis tissues without viable tumoral tissue.

[Myopericytoma: an uncommon chest wall tumor]. / Le myopéricytome : une tumeur exceptionnelle de la paroi thoracique.

Myopericytoma is, according to the World Health Organisation classification of soft tissue tumours, a recently proposed term describing a group of tumours showing a perivascular myoid differentiation. It is a rare tumour with a predilection for the distal extremities and is often misdiagnosed. We report a new case of myopericytoma located exceptionally in the chest wall together with a review of literature.

[Pulmonary decortication: value of lung function recovery]. / La décortication pulmonaire : intérêt dans la récupération de la fonction respiratoire.

PURPOSE: Based on the experience in the thoracic surgery unit at Hôpital Militaire d'Instruction Mohammed-V in Rabat, this study analyses the indications as well as the results of pulmonary decortication. MATERIALS AND METHODS: Twenty-five cases of pulmonary decortication were examined over a period of 5 years ranging from January 2002 to December 2006. The aetiology of chronic pyothorax was dominated by non tubercular causes. The clinical symptomatology mainly involved fever and dyspnoea (48% and 44% respectively). Pachypleuritis, collapse of the lung and pleural effusion account for most of the lesions found on the thoracic imaging. Surgery was indicated after failure in the medical treatment after four months on the average. RESULTS: The respiratory function was assessed in 20 patients three months after the intervention. The improvement in the spirometry was good in 85% of the cases (n=17), was not highly satisfactory in 10% of the cases (n=2) and a deterioration was noted in 5% of the cases (n=1). This unfavourable evolution was correlated with the tubercular aetiology and the poor state of the pulmonary parenchyma. CONCLUSION: Non tubercular causes, early diagnosis and absence of parenchymatous lesion seem to be predictive factors of good results after decortication.

[The surgical extraction of foreign bodies after the inhalation of a scarf pin: two cases]. / Deux cas d'extraction chirurgicale de corps étrangers après inhalation d'épingle de foulard.

The inhalation of a foreign body (FB) is rare in the adult although more common in the child. The type of FB varies greatly according to the dietary and educational habits of the populations studied. In Morocco, metal FB are common, especially the pins used to attach scarves. These pins migrate easily and wedge at a distance making them difficult to extract by endoscopy, thereby resulting in thoracotomy. The authors present two cases of the inhalation of a pin held in the mouth during a sudden emotion. Since the clinical symptomatology is inconspicuous, thoracic imaging is used to locate the FB. After a failure to extract it by rigid bronchoscopy combined with flexible bronchoscopy, the two patients underwent surgery. The sequellae were simple. Prevention in both the child and in the adult are the best way to avoid this incident that may have dramatic results.

[Primary leiomyosarcoma of visceral mediastinum]. / Léiomyosarcome primitif du médiastin viscéral.

Primary leiomyosarcoma of the thorax is a rare malignant mesenchymatous tumour. Most of those tumours occurring in the mediastinum arise from the oesophagus and great vessels, whereas an appearance in the soft tissue of the mediastinum is extremely rare. The rare incidence of this tumour and its slow growth reflect the difficulties in differential diagnosis according to their histopathology and location. The most common treatment is surgical resection. The authors describe a case of a leiomyosarcoma arising from soft tissue of the mediastinum and present a review of the literature.

[Pulmonary actinomycosis in a child]. / L'actinomycose pulmonaire chez l'enfant.

Pulmonary actinomycosis is a rare bacteriological disease, characterized by local suppuration and an extensive fibro-inflammatory process, with a possible pseudotumoral outcome. We report on a case in a 15-year-old boy, admitted in our department for prolonged pleuropneumopathy. Clinical and radiological findings were not contributive. The diagnosis of actinomycosis was obtained by pathology after surgical resection. This disease can mimic on lung X-rays a number of disorders, such as pulmonary tuberculoma, invasive tuberculosis or lung carcinoma. Pleuropulmonary actinomycosis is a rare intrathoracic infection during childhood, of which poor outcome and tough diagnosis lead usually to a surgical attitude given a picture of recurrent pulmonary abnormality. When the diagnosis is established, the treatment is medical.