[Report of a case of isolated tuberculous arthritis of the knee: a difficult diagnosis in adolescents]. / L'arthrite tuberculeuse isolée du genou, un diagnostic difficile chez l'adolescent: rapport de cas.

Tuberculosis is a major global public health problem. Osteoarticular tuberculosis is very rare. In half of the cases it affects the vertebrae. Symptoms are insidious over a prolonged period and isolation of the pathogen is difficult, mostly leading to difficult and delayed diagnosis. We here report a new case of tuberculous arthritis of the knee in a teenager in whom the mean time between symtom onset and definitive diagnosis based on the detection of Mycobacterium tuberculosis genome by Xpert MTB/RIF test was eight months. This study emphasizes the importance of bacteriological sampling and diagnostic methods by molecular assay in early and definitive diagnosis of tuberculous arthritis.

Tuberculous False Aneurysm of the Aortic Isthmus Treated Using Stent Grafts.

Tuberculous aortic aneurysms are rare. Localization in the isthmus of the aorta is still exceptional. It often presents as a false aneurysm, which exposes to the risk of rupture, whatever the size of the aneurysm, and worsens the prognosis. The treatment of reference relies on surgery in association with antituberculosis treatment. The endovascular approach with stent grafts can be an alternative as presented in this case report, in which traditional surgery was judged to be at risk in a nonagenarian patient.

Radiation-induced chondrosarcoma of the scapula after radiotherapy for lung cancer: a case report and review of the literature.

BACKGROUND: Radiotherapy associated with chemotherapy is a well-established treatment modality for locally advanced non-small cell lung cancers. Radiation-induced second malignancies, particularly radiation-induced sarcomas, are rare. Some authors reported a recent increase in the incidence of this rare complication, especially because of the improved prognosis and survival of patients after radiotherapy. Pathogenic mechanisms of radiation-induced sarcomas are poorly understood. However, diagnosis criteria are well established. Treatment options must be discussed and adapted to the patient's profile. Surgery in irradiated tissue is challenging, with limited treatment options with chemotherapy and radiotherapy. CASE PRESENTATION: We report the case of a 62-year-old Moroccan man diagnosed as having chondrosarcoma of his right scapula, who was irradiated 10 years ago for stage IIIB non-small cell lung cancer. This case was managed by a complete resection of the tumor with good functional and oncological outcomes. To the best of our knowledge, the scapular location of radiation-induced sarcoma after irradiation for lung cancer has never been described in the literature. CONCLUSION: Radiation-induced sarcoma of the scapula represents a rare situation that must be actively researched to have access to an optimal therapeutic approach.

Solitary Fibrous Tumor: Case Report of Intrapulmonary Location.

Solitary fibrous tumors are relatively rare neoplasms that commonly occur in the pleura, especially visceral pleura. However, an intrapulmonary site of this kind of tumors is even rarer. These tumors can be characterized by a heterogeneous evolution and have a benign or malignant behavior. Wide surgical resection is essential to cure the patient and to avoid recurrence. We present here the clinical, imaging, and histological features of a case with solitary fibrous tumor growing inside the lung.

Primary leiomyoma of the lung: an exceptional localization.

Leiomyoma is a benign smooth muscle tumor usually encountered in the uterus. Primary pulmonary localization is extremely rare in adults and children. However, it must be included in the differential diagnosis of any nodular lung lesion. Its treatment is surgical, with good long-term results. Here, we report a case of leiomyoma of lung parenchyma diagnosed in a 26-year-old man.

Adenoma paratiroideo ectópico poco frecuente / Uncommon Ectopic Parathyroid Adenoma

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Adenoid cystic carcinoma of the trachea: a clinico-pathological analysis.

Primary malignant tracheal tumors are not common and adenoid cystic carcinoma (ACC) of trachea is very rare. The diagnosis is often delayed due to the atypical symptoms. We report an extremely rare case of ACC of proximal trachea, in a 55-year-old female who presented with a 12 month history of progressive dyspnea. Laryngoscopy and computed tomography revealed a broad-based polypoidal mass arising from posterior wall of the proximal trachea. Biopsy confirmed the diagnosis of ACC. The patient underwent a complete surgical resection and post operative radiotherapy. Six months follow-up of the patient did not reveal local recurrence or distant metastases. The literature of tracheal ACC is reviewed.

Primary mediastinal goiters.

BACKGROUND: Primary mediastinal goiters (PMG) are very uncommon; few cases were reported in the literature. PATIENT DESCRIPTION: We report here two cases of mediastinal goiters that met all criteria of PMG. Transternal approach was necessary for complete removal and pathological diagnoses confirmed their adenomatous goiter nature. The rarity of their occurrence, their clinical characteristics and surgical management were discussed. CONCLUSION: PMG is part of the differential diagnoses of mediastinal masses. Safe excision is ensured through transthoracic approach.

Tratamiento quirúrgico del bocio retroesternal: experiencia en un centro de Marruecos / Surgical management of retrosternal goitre: experience of a Moroccan centre

Introducción y objetivos: Se realiza un estudio retrospectivo para la revisión de 93 casos de bocio retroesternal (BR) operados en nuestro departamento, a fin de describir los datos epidemiológicos y clínicos y tratar los retos quirúrgicos de los BR. Pacientes y métodos: De enero de 2004 a diciembre de 2012, tratamos quirúrgicamente a 35 varones y 58 mujeres con BR. Realizamos cervicotomía en 89 casos (95,7%), y la esternotomía fue necesaria en 4 casos (4,3%). Se realizó laringoscopia en todos los casos. Fue imperativa una segunda laringoscopia preoperatoria realizada por un especialista para los pacientes con ronquera o disnea, incluso cuando el examen laríngeo inicial era normal. Resultados: Se observó una masa cervical en 81 casos (87,1%), disnea en 17 casos (18,3%), disfagia en 2 casos (2,1%), ronquera en 7 casos (7,5%), síndrome parcial de la vena cava en 2 casos y bocio recurrente en 2 casos (2,1%) tras la resección tiroidea previa. La extensión mediastínica se localizó en el lado izquierdo en 47 casos (50,5%), en el lado derecho en 29 casos (31,2%), y bilateralmente en 17 casos (18,3%). Se practicó tiroidectomía total en 86 casos (92,5%), e istmo-lobectomía unilateral en 7 casos (7,5%). El tamaño medio del bocio fue de 9,3 cm. Se presentaron complicaciones postoperatorias en 9 casos (9,7%), 3 casos con hipoparatiroidismo (3,2%) y 4 casos (4,3%) de lesión del nervio recurrente. No se produjeron muertes postoperatorias. El estudio histológico detectó 88 casos de bocio multiheteronodular, 4 casos de enfermedad de Graves-Basedow, y un caso de carcinoma tiroideo (carcinoma papilar). Conclusión: Nuestra experiencia confirma que la cervicotomía permite a menudo la extirpación del bocio con extensión mediastínica. Sin embargo, puede requerirse una esternotomía, alargándose el tiempo quirúrgico, la estancia hospitalaria y la morbilidad (AU)

Introduction and objectives: This was a retrospective study reviewing 93 cases of retrosternal goitre (RG) operated in our department, with the aim of describing epidemiological and clinical data and discussing the surgical challenges of RG. Patients and methods: From January 2004 to December 2012, 35 men and 58 women presenting with RG had surgery. Eighty-nine cases (95.7%) underwent cervicotomy, and a sternotomy was mandatory in 4 cases (4.3%). Laryngoscopy was performed in all cases. A second preoperative laryngoscopy by a senior was mandatory for patients with hoarseness or dyspnea even if the initial laryngeal exam was normal. Results: A cervical mass was noted in 81 cases (87.1%), dyspnea in 17 cases (18.3%), dysphagia in 2 cases (2.1%), hoarseness in 7 cases (7.5%), partial vena cava syndrome in 2 cases and recurrent goitre was noted in 2 cases (2.1%) after previous thyroid resection. Mediastinal extension was on the left side in 47 cases (50.5%), on the right side in 29 cases (31.2%) and bilateral in 17 cases (18.3%). A total thyroidectomy was performed in 86 cases (92.5%) and a unilateral isthmo-lobectomy was performed in 7 cases (7.5%). Mean goitre size was 9.3 cm. Postoperative complications were present in 9 cases (9.7%), 3 cases with hypoparathyroidism (3.2%) and 4 cases (4.3%) of recurrent nerve injury. There was no postoperative death. The histological study objectified 88 cases of multiheteronodular goitre, 4 cases of Basedow thyroid, and 1 case of thyroid carcinoma (papillary carcinoma). Conclusion: Our experience confirms that cervicotomy often allows removing goitre with a mediastinal extension. However, intraoperative enlargement may be necessary, with increased operating time, hospital stay and morbidity (AU)

Elastofibroma dorsi: clinicopathological analysis of 76 cases.

BACKGROUND: We aimed to investigate the epidemiological, clinical, paraclinical, and treatment aspects of elastofibroma dorsi through a retrospective study of 76 patients who underwent surgery between January 2008 and December 2012 in our department. METHODS: Our study is retrospective between January 2008 and December 2012. We admitted 79 patients with a subscapular mass, and only 76 patients had ED. The others (n=2) had high associated risk of anesthesia and were managed by a medical treatment and one patient had a subscapular sclerotic hemangioma. RESULTS: The average age of the patients was 49 years (range, 38 to 70 years), with a female predominance (54 females and 22 males). Subscapular location was constant. The right, left, and bilateral form was noted in 41, 15 and 20 cases, respectively. The diagnosis was clinical in 60 cases. Ultrasound and computerized tomography scans confirmed the diagnosis of an ill-defined mass in a subscapular location in all cases. Surgical treatment consisted of complete resection of the mass. The clinical diameter of the mass remained significantly lower than that of the surgical specimen (7 cm versus 12 cm) because the major hidden part of the mass in the subscapular area was inaccessible to palpation. Complications were noted in 9 cases (11.8%), seroma in 8 cases (10.5%), infection of wound site in 4 cases (5%), and parietal textilome in one case (1%). No case of recurrence was noted. CONCLUSION: Surgery of elastofibroma is unique because of the subscapular location of the parietal tumor, whose histological fibrous nature makes it very adherent to the chest wall.

Incidents and complications of permanent venous central access systems: a series of 1,460 cases.

BACKGROUND: Implanted venous access devices or permanent central venous access systems (PCVASs) are routinely used in oncologic patients. Complications can occur during the implantation or use of such devices. We describe such complications of the PCVAS and their management. METHODS: Our retrospective study included 1,460 cases in which PCVAS was implanted in the 11 years between January 2002 and January 2013, including 810 women and 650 men with an average age of 45.2 years. We used polyurethane or silicone catheters. The site of insertion and the surgical or percutaneous procedure were selected on the basis of clinical data and disease information. The subclavian and cephalic veins were our most common sites of insertion. RESULTS: About 1,100 cases (75%) underwent surgery by training surgeons and 360 patients by expert surgeons. Perioperative incidents occurred in 33% and 12% of these patients, respectively. Incidents (28%) included technical difficulties (n=64), a subcutaneous hematoma (n=37), pneumothoraces (n=15), and an intrapleural catheter (n=1). Complications in the short and medium term were present in 14.2% of the cases. Distortion and rupture of the catheter (n=5) were noted in the costoclavicular area (pinch-off syndrome). There were 5 cases of catheter migration into the jugular vein (n=1), superior vena cava (n=1), and heart cavities (n=3). No patient died of PCVAS insertion or complication. CONCLUSION: PCVAS complications should be diagnosed early and treated with probable removal of this material for preventing any life-threatening outcome associated with complicated PVCAS.

[Surgical management of retrosternal goitre: experience of a Moroccan centre]. / Tratamiento quirúrgico del bocio retroesternal: experiencia en un centro de Marruecos.

INTRODUCTION AND OBJECTIVES: This was a retrospective study reviewing 93 cases of retrosternal goitre (RG) operated in our department, with the aim of describing epidemiological and clinical data and discussing the surgical challenges of RG. PATIENTS AND METHODS: From January 2004 to December 2012, 35 men and 58 women presenting with RG had surgery. Eighty-nine cases (95.7%) underwent cervicotomy, and a sternotomy was mandatory in 4 cases (4.3%). Laryngoscopy was performed in all cases. A second preoperative laryngoscopy by a senior was mandatory for patients with hoarseness or dyspnea even if the initial laryngeal exam was normal. RESULTS: A cervical mass was noted in 81 cases (87.1%), dyspnea in 17 cases (18.3%), dysphagia in 2 cases (2.1%), hoarseness in 7 cases (7.5%), partial vena cava syndrome in 2 cases and recurrent goitre was noted in 2 cases (2.1%) after previous thyroid resection. Mediastinal extension was on the left side in 47 cases (50.5%), on the right side in 29 cases (31.2%) and bilateral in 17 cases (18.3%). A total thyroidectomy was performed in 86 cases (92.5%) and a unilateral isthmo-lobectomy was performed in 7 cases (7.5%). Mean goitre size was 9.3 cm. Postoperative complications were present in 9 cases (9.7%), 3 cases with hypoparathyroidism (3.2%) and 4 cases (4.3%) of recurrent nerve injury. There was no postoperative death. The histological study objectified 88 cases of multiheteronodular goitre, 4 cases of Basedow thyroid, and 1 case of thyroid carcinoma (papillary carcinoma). CONCLUSION: Our experience confirms that cervicotomy often allows removing goitre with a mediastinal extension. However, intraoperative enlargement may be necessary, with increased operating time, hospital stay and morbidity.

Mediastinal cystic haemangiomas: a two cases report and review of the literature.

According to the literature haemangiomas are rare benign vascular tumours (less than 0.5% of all mediastinal tumours). Preoperative diagnosis is difficult and manifest as a non-specific mediastinal mass on radiologic exploration. We report herein two cases of mediastinal haemangioma (MH), the first was a 63 year-old man with a MH in the posterior mediastinum, and the second was a 53 year-old man with a left paracardiac haemangioma. Surgical removal was successful and the follow-up was free four years after surgery.

Primary adenoid cystic carcinoma of the trachea: a report of two cases and literature review.

Adenoid cystic carcinoma (ACC) of the trachea is rare, it represents 1% of all respiratory tract cancers. It's generally considered as a slow-growing, with pronlonged clinical course. Most patients present with dyspnea, and the symptoms often mimic those of asthma or chronic bronchitis Surgical resection is the mainstay of treatment often combined to radiotherapy because of close surgical margins. When surgery isn't possible, most tumors respond to radiotherapy alone wich often results in long periods of remission We report two cases of primary ACC of trachea: a 49 year old male presented a distal unresectable tracheal ACC treated with chemo-radiotherapy who developed a recurrence and died 7 years after the diagnosis. And a 50 years old female with a proximal tracheal tumor treated by surgical resection and end- to- end anastomosis followed by adjuvant radiotherapy. At 10 months follow-up, our patient shows no evidence of disease with negative histological findings.

Surgery of benign neurogenic tumors in adults: single institution experience.

The objective of this work is to review retrospectively our experience with 17 patients presenting with benign neurogenic tumors, managed in the department of thoracic surgery, Mohamed V Military Academic Hospital, Rabat, Morocco. Between 2003 and 2011, seventeen patients were surgically treated for benign neurogenic tumors of the mediastinum, among 112 mediastinal tumors operated during the same period. The mean age of the 17 patients was 46 years, including 11 females and 6 males. The information about clinical presentation, diagnostic procedures, surgical techniques and postoperative follow-up were extracted and analyzed from medical records. Symptoms related to the tumor were found in 13 patients (76,4%). The posterior mediastinum was the principal location (16 cases: 94%). Intraspinal extension was shown through MRI in one case. Surgical extirpation was complete in all patients. There were no tumor-related deaths and no significant complications. There were 13 schwannomas, 2 neurofibromas and 2 ganglioneuromas. Neurogenic tumors of the mediastinum in adults are mostly benign. Their only treatment is surgical extirpation. Video-assisted thoracoscopic resection is currently the best approach in selected patients.

Surgery of myasthenia gravis associated or not with thymoma: a retrospective study of 43 cases.

OBJECTIVES: Thymectomy is a surgical treatment of myasthenia gravis. Our goal is to report our experience in the surgical treatment of myasthenia gravis with or without thymoma and a review of the literature. MATERIALS AND METHODS: This is a retrospective study over a period of 10 years (2001-2010) on 43 patients: 28 women and 15 men with a mean age of 39.3 years (range 16-68 years). The myasthenia gravis was confirmed by clinical, electromyographic data and the presence of antibodies to acetylcholine receptors. RESULTS: Computed tomography objectified thymic mass in 14 cases (32.5%) enlarged thymus without visible mass in eight cases (18.6%). All patients received anticholinesterase, cortico steroids in 25 cases and in three cases plasmapheresis was required. The surgical approach was total sternotomy (n=32 cases), cervicotomy (n=2), cervical and manubriotomy (n=1), a manubriotomy (n=3) and a thoracotomy in five cases (lateralised thymoma). All patients underwent a total thymectomy associated or not with resection of the tumour. Intensive Care Unit was necessary for at least 24h up to six days. The postoperative course was marked by a myasthaenic crisis (n=2) and respiratory failure (n=3) with a favourable outcome. The prognosis was marked by a complete remission in 14 cases, partial remission in 11 patients, stabilisation (n=16 cases) and increasing crisis in two patients. CONCLUSION: Thymectomy certainly allows clinical improvement and reduced crisis of myasthenia gravis. Long term monitoring will confirm the benefit of non-oncological thymectomy alone or in combination with standard treatments for patients with generalised myasthenia gravis without thymoma.

Parenchyma sparing procedures is possible for most pulmonary hydatid disease without recurrence and low complications.

OBJECTIVE: A retrospective review of 223 patients (242 operations) of pulmonary hydatid cysts. We analyze and evaluate our experience in the surgical management of this Moroccan endemic disease and concluded that parenchyma-saving must be always used. MATERIALS AND METHODS: In an 8 year period (2002 -2009), 223 patients (242 interventions, 282 pulmonary hydatid cysts) were operated on in our department. There were 166 males and 57 females with a mean age of 45.7 years. The diagnosis was established on the basis of different clinical signs and imaging studies. Surgical approach consisted of a posterolateral thoracotomy in all cases. Different surgical procedures were performed on the pulmonary lesions according to the localization, the size, the complicated or intact cyst and the importance of lung destruction. RESULTS: Parenchyma-saving were done in 217 patients (238 interventions) cases, including cystectomies (189 cysts), pericystectomies (47cysts) with capitonnage of the cavity in 177 cysts. Radical treatment as lobectomies is used in only 6 cases. Postoperative minors complications occurred in 13 cases (5.4%), including 6 prolonged air leak, 4 pneumonias, one wound infection and two transitory residual cavities. There was no postoperative death. All patients were free of recurrence of thoracic hydatid disease in a follow-up ranging from 3 to 90 months (mean: 49 months). CONCLUSION: Hydatid cysts of the lung should be treated before complications. Parenchyma saving is the best procedures for this benign disease; the radical resection must be reserved only for pulmonary destruction.