[Surgical treatment of scrotal lymphedema]. / Traitement chirurgical d'un lymphœdème scrotal.

Scrotal elephantiasis is defined as an increase in the scrotal volume which can reach a very large size. This study involved O.H, a married man aged 70 years, father of 4 children, farmer, native of and resident in Agadir (south of Morocco). Symptoms started 7 years before when scrotal edema and then an edema in both feet and legs gradually increasing in volume occurred. Physical examination showed scrotal elephantiasis with a circumference measured 80 cm and elephantiasis in both legs and feet. Locoregional assessment was based on pelvic magnetic resonance imaging (MRI). The patient was scheduled for monoblock scrotal resection under spinal anesthesia with removal of all of the tissue affected by the lymphedema around the testicle which were covered using the remaining skin and of the penis which was skin grafted using thin skin. The treatment aimed to ensure penis function and to manage the disfiguration. Conservative treatment based on lymphovenous bypass surgery or on the dilation of lymph vessels is no longer performed. Treatment is based on surgery. Surgery is avoided when there are absolute contraindications.

The bacteriological profile of the burned patients in the center of burns in CHU Mohamed VI Marrakech (about 123 cases).

The bacterial nosocomial infection is one of the leading causes of morbidity and mortality for burned patient; we conducted a retrospective study of 123 patients hospitalized in the burns center CHUMED VI of Marrakechover a period of 3 years, from January 1st, 2013 to December 31st, 2016. The criteria for nosocomial infection were those of the Center for Disease Control in Atlanta in 1988. Incidence rates were calculated. The bacterial ecology of the department was described as also antibiotype. The predominancy of the population was male. The cumulative incidence was 103 infections per 1000 days of treatment. Regarding the characteristics of bacterial infections, infected sites were skin (69%), blood (18%), urinary tract (12%) and lungs (1%). The main organisms were: Staphylococcus sp. (37.7%), Pseudomonas aeruginosa (19.8%), Enterococcus faecalis and Proteus mirabilis (18.5%). Staphylococci were resistant méticillo-in 22% of cases. Pseudomonas and Acinetobacter were multi-resistant (66%). The establishment of the bacterial ecology of the service, helped us set the right rules of prescription of antibiotics, which was based on the infected site, the type of organism, its sensitivity, the molecule used and the pharmacokinetics particular patient burned. The two main organisms being Staphylococcus and Pseudomonas aeruginosa, antibiotics used in the Service will then beta-lactams, glycopeptides, fluoroquinolones and aminoglycosides. Finally, to control the epidemic risk posed by the emergence of resistant organisms is necessary to combine the practice of good antibiotic therapy and prevention.