[Recurrent spontaneous pneumothorax revealing Marfan's syndrome]. / Pneumothorax spontané récidivant révélant un syndrome de Marfan.

INTRODUCTION: Because of its rarity and lack of specific symptoms, the diagnosis of Marfan's syndrome can be delayed. Though cardiovascular, skeletal and ophthalmological manifestations are the most frequent features, the respiratory system can also be involved. OBSERVATION: We report the case of a 35-year-old patient who presented with a large, right sided, encysted pyopneumothorax. The history revealed two episodes of spontaneous pneumothorax, cataract surgery ten years before his admission, and a similar case in the family. Clinical examination showed skeletal abnormalities of the wrist and thumb as well as deformity of the hindfoot with a flat foot. He had no characteristic thoracic deformity. Ophthalmologically, the right eye had a subluxed lens and the left eye had a totally subluxed cataract. CONCLUSION: The development of the third episode of pneumothorax led to the diagnosis of Marfan's syndrome thanks to the patient's combination of symptoms. To avoid diagnostic delay, criteria were established in 1996 and revised in 2010 to ensure an early diagnosis of this condition.

Chronic pulmonary aspergillosis: a frequent and potentially severe disease.

INTRODUCTION: Chronic pulmonary aspergillosis is a pulmonary fungal infection with various presentations that can occur on a pre-existing cavity, often a sequel of tuberculosis. The objective of our study was to report the diagnostic and therapeutic management of pulmonary aspergilloma in our structure. PATIENTS AND METHODS: We retrospectively studied 81 cases of pulmonary aspergilloma having occurred in the respiratory diseases unit of the Casablanca Ibn Rochd hospital, over 11 years. RESULTS: We included 48 male and 33 female non-immunocompromised patients, with an average age of 51 years (27-75). A history of tuberculosis was recorded in 78 cases. Hemoptysis was the revealing symptom in 73 cases. A characteristic "bell-like" image was observed in 25 cases. The serological results were positive for aspergillus in 54 cases. The treatment was surgical in 50 cases and medical in 24 cases. Five patients died. DISCUSSION: A significant number of pulmonary aspergilloma cases were recorded in our study, occurring most frequently on sequels of tuberculosis. This disease is currently common in countries highly endemic for tuberculosis; early and adequate management is required. CONCLUSION: Aspergillosis is a frequent and potentially severe disease occurring on pre-existing lesions, most often in our context sequels of tuberculosis. Surgical resection is the reference treatment but is the cause of a significant morbidity and mortality. Preventive measures are mandatory.

[Tracheobronchial rupture in childhood]. / Une rupture trachéobronchique chez l'enfant.

Tracheobronchial rupture after blunt trauma is rare, especially in a pediatric population. In this paper, we report the case of a 3-year-old child who presented with a rupture of the tracheobronchial tree as a result of multiple injuries (thoracic and cerebral) sustained from a traffic accident. The surgical repair consisted of a sleeve resection (right upper lobectomy with reanastomosis of the bronchus intermedius to the right stem bronchus). As tracheobronchial rupture is a rare condition, particularly in children, physicians must have a high index of suspicion. The diagnosis and treatment of this condition are discussed.

Liposarcoma of the pleural cavity.

We report a case of pleural liposarcoma in a 58-year-old male patient with a twenty-year history of smoking, who was admitted for chest pain and chronic cough. Pleural liposarcoma is a rare, highly malignant intrathoracic tumor arising from the soft tissue of the pleural cavity. Chest radiograph and CT scan revealed a homogeneous mass with subtotal opacification of the left hemithorax. Tumor diagnosis was based on histopathological examination of a transparietal biopsy and revealed a mixed type liposarcoma. Surgical resection was performed followed by adjuvant irradiation. No recurrence was diagnosed during the follow-up period of ten months and the patient continues to do well at the time of writing this paper.

[Recurrent pneumothorax revealing a tuberous sclerosis complex]. / Sclérose tubéreuse de Bourneville révélée par des pneumothorax à répétition.

Tuberous sclerosis complex (TSC) is an autosomal dominant phacomatosis. We report a 29-year-old woman who presented with recurrent pneumothorax in whom the diagnosis of TSC relied on the existence of family history (child with cardiac rhabdomyome), skin lesions, pulmonary lymphangiomyomatosis, hepatic lipomas, renal angiomyolipomas, uterine myomas and cerebral lesions on MRI. The diagnostic of TSC might be difficult as it could mimic pulmonary lymphangiomyomatosis.

[Long-term prognosis of hydatid lung cyst treated by video-assisted thoracic surgery]. / Pronostic à long terme du kyste hydatique du poumon traité par vidéo-chirurgie thoracique.

With the advent of mini-invasive surgery, video-assisted thoracic surgery (VATS) is a good means of diagnosis and therapeutic in thoracic surgery. We report 14 cases of hydatid cyst of the lung treated by VATS. Outcome as uneventful.

[Hypoglycemic coma revealing a solitary fibrous tumor of the pleura]. / Coma hypoglycémique révélant une tumeur fibreuse solitaire de la plèvre.

INTRODUCTION: Solitary fibrous tumor of the pleura (TFSP) is rare. When associated with hypoglycemia it is commonly referred to as Doege-Potter syndrome. CASE: A 51-year-old man was hospitalized for recurrent near-syncope associated with hypoglycemia. Clinical examination and then thoracic imaging clearly showed anomalies that corresponded to a mass occupying the entire left hemithorax. After resection, histological analysis diagnosed a fibrous tumor of the pleura. DISCUSSION: Solitary fibrous tumors of the pleura are observed most often in patients aged 50 and 70 years. Hypoglycemia is rare, occurring in approximately 4% of cases. It is explained by the abnormal secretion of a type-II insulin-like growth factor. This tumor is treated by complete surgical excision.

[Solitary fibrous mediastinal tumor. A case report]. / Tumeur fibreuse solitaire du médiastin. A propos d'un cas.

Solitary fibrous tumor is a rare tumor, generally located in the pleura. Recently, new sites have been described in the literature, particularly involving the peritoneum and mediastinum, as wekk as te-the bronchopulmonary and orbital regions. The diagnosis is established at pathology, but in some cases may be difficult to differentiate from other tumors. We report the case of a 60-year-old women who had undergone surgery 25 years ago for right pulmonary hydatid cyst and who presented inspiratory dyspnea and dry cough for four months. Physical examination revealed a right cervical tumefaction in the supraclavian region. The AP chest x-ray disclosed an opacity in the right laterotracheal upper cervicomediastinal zone laminating the trachea which was displaced to the left. Thoracic computerized tomography showed a tissular process in the superior and middle mediastinum. Surgical tumor resection was performed and pathology confirmed the diagnosis of solitary fibrous tumor. The postoperative period was uneventful. Frequency of the mediastinal localisation is the same in men and women. The tumor generally develops between the 5th and 7th decades, and is most often asymptomatic. Fortuitous discovery is the rule. The clinical course is unforeseeable.

[A rare and benign etiology of Pancoast-Tobias syndrome]. / Une étiologie rare et bénigne du syndrome de Pancoast-Tobias.

Although lung cancer is the leading cause of Pancoast-Tobias syndrome, benign etiologies have been rarely described in the literature. We report two cases of Pancoast-Tobias syndrome caused by hydatidosis of the apex. Outcome was favorable after surgical treatment.

[Abdominal stab wound injury with omentum evisceration]. / Plaies abdominales avec épiplocèle.

INTRODUCTION: The abdominal stab wound with omentum evisceration, represent 4 to 20% of abdominal injuries. It causes a problem of therapeutic indication between selective and mandatory laparotomy. The goal of this work is to give some answers to this dilemma. MATERIAL AND METHODS: A retrospective study from 1992 to 2000, concerning 75 patients presenting an omentum evisceration. Where there were 71 men et four women, the mean age was 25 years old. All the abdominal injuries are exclusively by the stab wound. These 75 patients were divided into three groups: group I: 24 patients (32) were immediately operated ahead of the existence of severity elements; group II: 18 (24%) patients had an isolated omentum evisceration without any elements of severity were operated immediately; group III: 33 (44%) were placed under clinical, radiological and ultrasound control. RESULTS: We have found four cases of negative laparotomy (16,7%) in group I, and 14 (77,8%) in group II. Five secondary laparotomies (15%) were performed in group III. Among the 51 patients (Group II and Group III) nine (17%) had visceral injuries... In all of the three groups, there was a high frequency of intestinal organs injuries, there was no mortality and 12% of morbidity. CONCLUSION: The isolated omentum evisceration is a penetrating injury of the abdominal wall but not synonym with visceral injuries, the interventionists authors had a high rate of negative laparotomy. However the selective authors in the asymptomatic patients under clinic examination appears logical: we believe that the laparoscopic diagnostic and therapeutic in doubtful cases can resolve this problem.

[Hydatid cyst of thoracic soft tissues]. / Kyste hydatique des parties molles thoraciques.

Hydatid cysts are uncommon in thoracic soft tissue. We report a case of hydatid cyst which had developed within the lattissimus dorsi presenting as a left parietal scapular mass diagnosed by ultrasound and CT scan, which remains the preferred primary examination for the investigation of masses of this type. We discuss the various possible clinical and paraclinical contexts and recommend total pericystectomy of a closed cyst as the best treatment for this kind of cyst.

[Larrey or Morgagni hernias treated by laparoscopy]. / Hernies de la fente de Larrey, ou hernies de Morgagni, traitées par laparoscopie.

INTRODUCTION: Diaphragmatic hernia or Morgagni-Larrey hernia is a rare entity. Its treatment is surgical and hence raises the question of the surgical approach. OBSERVATIONS: Two patients underwent laparoscopic surgery for Morgagni-Larrey hernia. The first, aged 17 exhibited a chromosomic abnormality (trisomie 21). The second was 18 years old. Both patients underwent surgery by laparoscopy. In both cases, the surgical act performed was resection of the hernia and closure of the orifice with separate sutures. Their post-surgical courses were uneventful, even two years later. COMMENTS: In the age of mini-invasive surgery, laparoscopy is an excellent alternative to laparotomy in this benign pathology.

[Serous fibrinous pleurisy disclosing hydatid cyst of the liver fistulizing into the pleura]. / Pleurésie séro-fibrineuse révélatrice d'un kyste hydatique du foie fistulisé dans la plèvre.

Hydatic cyst of the liver remains a serious public health problem in Morocco and several other Mediterranean countries. This benign affection can cause serious sometimes fatal complications such as cyst rupture into the biliary ducts or the thorax. We present the case of a patient with serofibrous pleurisy and recall the often late diagnosis of hydatic cyst. Biliary pleural fistulization is a rare but serious complication.

[Malignant mediastinal schwannoma in Recklinghausen's disease presenting as cardiac tamponade. Report of two cases]. / Tamponnade cardiaque révélatrice de schwannome malin médiastinal au cours de la maladie de Recklinghausen. A propos de deux observations.

The authors report two cases of Recklinghausen's disease admitted for cardiac tamponade. Two-dimensional echocardiography showed a pericardial tumour in addition to a compressive pericardial effusion. After pericardial drainage, the outcome was rapidly fatal. Histological examination confirmed the diagnosis of a malignant intrapericardial schwannoma. A review of the literature revealed the scarcity of mediastinal malignant schwannoma. Associated with Von Reckinghausen's disease in 2 to 13% of cases, the prognosis is poor. The presentation of malignant mediastinal schwannoma with cardiac tamponade remains very rare.

[Pancreatitis of hydatid origin]. / Pancréatite d'origine hydatique.

INTRODUCTION: Hydatic cysts of the liver are known to rupture into the biliary tree, but acute pancreatitis is an uncommon consequence. CASE REPORT: A 30-year-old woman who had undergone cholecystectomy 8 years earlier for gall bladder stones was hospitalized because of acute abdominal pain. Acute pancreatitis was diagnosed. Abdominal sonography showed a hydatic cyst. Fifteen days after admission after normalization of the amylasemia, surgical cure was successful. DISCUSSION: This case demonstrates that hepatic material can migrate via the main bile duct and provoke acute pancreatitis. Fistula drainage via the Oddi sphincter can be successful.

[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.