[Penetrating injuries of the abdomen. Results of two classical and selective attitudes in the management of 249 wounds]. / Les plaies pénétrantes de l'abdomen. Résultats des 2 attitudes classique et sélective dans la prise en charge de 249 plaies.

The systematic surgical exploration of each abdominal penetrating wound allows an exact out-come of lesions and an adequate treatment without delay. But these advantages are made upon a possibly 30% negative laparotomy. The selective attitude in the management of these abdominal's wounds has permitted to decrease this rate to 5% with a risk of secondary operation for non primary detected lesions in 5%. Our attitude toward 249 penetrative abdominal's wounds was classic and selectable respectively from 86 to 89 and 90 to 93. The results has confirmed the literature's date and especially has shown no significant difference between the two attitude concerning the morbidity and the mortality.

[Presacral cyst of vestigial origin in adults. Problems of diagnosis and therapy]. / Kyste présacré d'origine vestigiale chez l'adulte. Problèmes diagnostiques et thérapeutiques.

Concerning one case of cyst developing from embryological remnants in the retro-rectal space, the characteristics of these rare tumors are reviewed. The congenital cysts group is formed by teratomas and developmental cysts. Often they are uncovered when they become septic or when they compress adjoining organs. Computed tomography scan has proved valuable in the diagnosis of these lesions. But the precise diagnosis of a congenital cyst can only be made by pathological examination of the specimen after surgical removal. The possibility of malignant degeneration implies the systematic extirpation of any known pre-sacral cyst or tumor. Kraske's trans-sacral approach gives good access to the retro-rectal space. Sometimes, pelvic spread of these lesions requires the use of the abdominal approach. The prognosis for benign tumors is good, but it is poor for malignant tumors.

[Surgical treatment of primary hyperparathyroidism. Apropos of 11 cases]. / Traitement chirurgical de l'hyperparathyroïdie primaire. A propos de 11 cas.

Over a period of 10 years, 11 cases of primary hyperparathyroidism were operated on and identified as 7 adenomas and 4 hyperplasias. One post-operative death was noted in a 80 year woman with advanced disease. Three hypocalcemias and one temporary unilateral recurrent nerve plasy were observed. After the results of this series, various clinical forms were identified and surgical modalities were altered according to the intra operative findings.

[Differentiated cancer of the thyroid. Prognostic factors and therapeutic attitude]. / Cancer différencé de la thyroide. Facteurs pronostiques et attitudes thérapeutiques.

Differentiated cancer of the thyroid. Prognostic factors and therapeutic attitude. This study deals with a series of 43 cases of differentiated cancer of the thyroid operated in our unit of IBN ROCHD University Hospital of Casablanca between 1981 and 1985. Our purpose is to expose our therapeutic philosophy and to compare our results with those of the literature. The youngest patient is 16 years old, the oldest is 70. The averaged aged is 43 years, 84% of the patients are females and only 16% are male. Papillary cancer constitutes the main group with 62%, the vesicular carcinoma represents only 38%. Our treatment management is made of surgery associated or not to radioactive iodine, but systematically followed by permanent hormonotherapy. Prognostic factors are reported and discussed. Actually three different surgical attitudes are confronted: the maximalistic, the minimalistic and the eclectic ones. Regular and long term follow-up of operated patients is considered of importance.

[Residual lithiasis of the common bile duct. Surgical or endoscopic treatment?]. / Lithiase résiduelle de la voie biliaire principale. Traitement chirurgical ou endoscopique.

The authors report their experience concerning residual lithiasis of the common bile duct, while trying to define the respective place of surgery and endoscopy in this condition. There is a clear female predominance in their series, the mean age being 41 years. The indications for surgery and endoscopy are discussed and the means of prevention are reviewed.

[Caustic lesions of the upper digestive tract]. / Les lésions caustiques du tractus digestif supérieur.

A study of 108 patients who had ingested variable quantities of a caustic substance, most often for suicidal reasons. Hydrochloric acid was the substance most often encountered After stabilisation of any hemodynamic and respiratory disorders, all patients received emergency endoscopy. Subsequent therapy was based on the following endoscopic findings: --Patients, in whom the mucosa was normal, were not hospitalised. --The digestive tract of patients with stage I disorders was rested for 10 days. --Patients with stage III, disorders were operated on as an emergency especially when signs of gravity were present. --Patients with stage II disorders constituted the group which posed most problems in our study. These patients required enteral feeding as soon as possible, via a simple jejunostomy.

[Contribution of peritoneal puncture lavage in injuries of the abdomen. Retrospective study of 230 cases]. / Apport de la ponction lavage péritonéale dans la contusion de l'abdomen. Etude rétrospective de 230 cas.

The authors' aim was to study the reliability and limitations of peritoneal puncture lavage. They report 230 cases of abdominal contusion, collected between 1980 and 1984. The mean reliability was 93%, 6% of results were false positives. The risk of false negative results was 1%. Indications, sensitivity and specificity are analysed and discussed.

[Arterial complications following surgery or sclerotherapy of varices]. / Accidents artériels après chirurgie ou scléroses de varices.

Surgical treatment of varicose veins occasionally can be followed by severe limb ischemia either after surgery or sclerotherapy. We report here two cases with the clinical features and the therapeutic strategy. The first case concerned a woman operated by venous stripping. A post-operative acute ischemia occurred and was treated by femoro-femoral bypass and lumbar sympathectomy. However this procedure did not avoid persistent chronic ischemia, sciatica paralysis and equinus ankle blockage. A secondary arterial procedure associated with intensive physiotherapy and ankle arthrodesis led to a poor functional result, partly because of an irreversible algodystrophia. The second case concerned a woman treated by sclerotherapy. An injection of the drug in the retro-malleolar area was immediately followed by an acute foot ischemia. Heparin, xylocaine and sodium nitroprusside perfusion avoided a foot amputation, however osteoporosis and algodystrophia occurred. A sympathectomy was necessary two years later. These dramatic complications although unusual, may occur even with experienced physicians. Therefore a great attention is always necessary during these simple procedures. In case of acute ischemia, early diagnosis and aggressive treatment are necessary, but prevention remains more secure.