Terrible triad injury of the elbow: A PROCESS-compliant surgical case series from Eastern Morocco.

Introduction: The terrible triad of the elbow (TTE) is a lesion associating a dislocation of the elbow, a fracture of the radial head, and a fracture of the coronoid process, with a high potential of complication. The treatment is based on the restoration of bone lesions and external capsular ligament repair. The systematic repair of the medial collateral ligament (MCL) is still debated in the literature. The aim of this study is to evaluate the clinical and functional results of the surgical treatment in a real-world series from Easter Morocco. Patients and methods: This was a retrospective study of 6 cases of TTE operated by isolated external approach or combined approach (internal or anterior) of the elbow in the department of Traumatology-Orthopedics of the Mohammed VI University Hospital (Oujda Morocco), over a period of 7 years from 2013 to 2020. Radial head and coronoid process fractures were classified according to the Mason and Morrey-Regan classifications, respectively. The following clinical parameters were evaluated: Mayo Clinic Elbow Performance Score (MEPS), Quick Disabilities of the Arm, Shoulder and Hand (DASH), Visual Analog Scale (VAS), and arc of mobility in flexion-extension and prono-supination. Results: 6 male patients treated between May 2013 and December 2020 were included. The median follow-up was 48 months. All patients had frontal and lateral standard X-ray of over and under joints, and computed tomography (CT)-scan was delivered for 5 cases. The elbow dislocation was posterolateral in five cases, and posteromedial in only one patient. Radial head fractures were classified as type I in one case, type II in two cases, and type III in three cases. Coronoid fractures were type I in three cases, type II in one case, and type III in two cases. At the last follow up, the mean MEPS, Quick DASH, and VAS was 81, 28, 0.8, respectively. The mean arc of mobility in flexion was 120° and it was deficient by 20° in extension. In addition, the mean arc of mobility in protonation was 80°, while in supination it was 75°. Regarding complications, we noticed an instability of the elbow on valgus in a single case, elbow stiffness with heterotopic ossification in a single case, ulnar nerve damage in a single case during medial collateral ligament anchoring, and elbow hygroma in one single case. Conclusion: The surgical management of TTE can provide good and long-term functional results after restoration of the stabilization of bone structures and the lateral ligament complex, without the need to repair the medial collateral ligament.

Bilateral Lipoadenoma of the Adrenal Glands and Humeral Brown Tumor: An Unusual Association.

Adrenal adenolipomas are rare lipomatous adrenal tumors that can be either functional or not. Only 7 cases have been reported in the English literature so far. However, brown tumors are benign, rare, historical lesions, with histological similarity to giant tumors that can be encountered in 1% of all primary hyperparathyroidism cases. We report the case of an unusual association of bilateral lipoadenoma of the adrenal glands and humeral brown tumor in a 35-year-old patient. He presented to the emergency department with a pathological fracture of the left humerus secondary to a brown tumor. The medical investigations have concluded to primary hyperparathyroidism. The screening for multiple endocrine neoplasia type 1 revealed the presence of bilateral nonsecreting adrenal masses whose anatomopathological study concluded adenolipomas. Adrenal tumors may constitute a part of multiple endocrine neoplasia type 1 in 20 to 40% of cases. In this view, it is necessary to check for the presence of other endocrine gland tumor locations such as primary hyperparathyroidism, neuroendocrine tumors of the duodenum and pancreas, or pituitary adenomas.

Schwannoma of the external auditory canal: An exceptional site.

INTRODUCTION: Schwannomas are benign solitary neural tumours that are only exceptional located in the external auditory canal, as only a few cases have been reported in the literature. CASE REPORT: We report a case of schwannoma of the external auditory canal in an 18-year-old man admitted for an isolated mass of the initial segment of the right external auditory canal visible to the naked eye, obstructing all of the external auditory meatus. Computed tomography of the temporal bone showed an isolated mass of the external auditory canal. Management of this patient consisted of biopsy-excision of the mass, histological examination of which confirmed a schwannoma of the external auditory canal. DISCUSSION: Although rare, the possibility of a nerve tumour of the external auditory canal should always be considered. These tumours may be isolated or may occur in the context of von Recklinghausen's disease. The clinical presentation in the external auditory canal may correspond to recurrent otitis externa secondary to obstruction of the canal by the tumour, as in the case reported here. The definitive diagnosis must be based on the results of histological and immunohistochemical examination.

Seminome spermatocytaire: a propos d'un cas et revue de la litterature spermatocytic seminom

Le seminome spermatocytaire est une tumeur rare; representant moins de 2des cancers du testicule; survenant essentiellement chez le sujet age. Nous rapportons une nouvelle observation d'un patient age de 48 ans. La tumeur se presentait comme une proliferation de cellules en nappes compactes; avec 3 types cellulaires; des cellules de petite taille; des cellules intermediaires et des grandes cellules. Il n'a ete retrouve ni contingent sarcomateux; ni seminome classique. L'analyse en immun histochimie n'a retrouve aucune expression des cellules tumorales pour les anticorps classiques testes; notamment l'Ac anti PLAP et les marqueurs lymphoides. Le seminome spermatocytaire doit etre reconnu; car son evolution est tres favorable et ne necessite qu'une simple orchidectomie; en l'absence d'un exceptionnel contingent sarcomateux ou de metastase ou une chimiotherapie s'impose

[Encrusted cystitis due to Corynebacterium urealyticum]. / Cystite incrustante àCorynebacterium urealyticum.

We reported the case of a 61 year-old man who presented an encrusted cystitis by Corynebacterium urealyticum associated with bilateral hydronephrosis four months after adenomectomy complicated by vesicocutaneous fistula. Medical treatment by quinolones and oral acidification of the urine allowed regression of the encrusted calcifications and resolution of the hydronephrosis.

[Bladder paraganglioma (pheochromocytoma): report of a new case]. / Paragangliome vésical (phéochromocytome): à propos d'une nouvelle observation.

The authors report one case of vesical paraganglioma, not suspected in a 50-years-old female patient who presented gross hematuria as only symptom. The patient was not hypertensive. Radiologic and endoscopic investigations revealed a trigonal submucosal tumour. Complete transurethral resection of the tumor was performed with no intraoperative complications. The histopathological diagnosis indicated pheochromocytoma. Blood pressure was stable. There has been no recurrence for 18 months after transurethral resection.

[Bladder infiltrating tumor: retrospective study of 225 cases]. / Tumeurs infiltrantes de vessie: étude rétrospective à propos de 225 cas.

The authors report a retrospective serial of 225 patients presenting an infiltrating bladder tumor. The infiltrating tumors represent 29.2% of bladder tumors. The middle age of our patients is 59 years with a sex-ratio of 7.3. In the histology, 80% of the tumors are a cell transitional carcinoma and 65% of the patients are classified stage T3T4. The surgical treatment has could be achieved at 73.3% of the cases and 66.7% of the patients had a radical cystectomy. The urinary diversion was essentially an continent urostomy using Benchekroun's hydraulic valve. At 28 months mean follow-up, a locoregional recurrence has been noted from 18% of the Tur achieved alone and 4% of the radical cystectomy. A metastasis has been noted from 18% of the patients and this in a mean delay of 12 months.

[Perinephretic phlegmon: about 36 cases]. / Le phlegmon périnéphrétique: à propos de 36 cas.

The authors report a series of 36 cases of perinephric phlegmon during 15 years. The patients are 27 men and 9 women. Mean age was 37 years (ranging between 25 and 70). The promoting factors of PPN are diabetes (27.8%), and kidney calculi (22.3%). Delay diagnosis is more than 3 weeks in 80% of the patients. The clinical symptomatology was dominated by pain, fever and flank mass. Diagnosis is carried out by ultrasonography in 84% and by CT scan whenever it is done. The common germs are negative Gram bacilli and staphylococcus. The treatment consists in antibiotherapy associated to a percutaneous drainage of the collection in 6 patients (16.7%) and a surgical drainage in 30 patients (83.7%). The follow-up are favorable in all cases.

[Vesico-vaginal fistula: report of 1050 cases]. / Les fistules vésico-vaginales: à propos de 1050 cas.

The authors reports their experience of a large series of 1050 cases of vesico-vaginal fistulas recorded during 30 years and analyse their epidemiological, anatomo-clinical, and therapeutic aspects. Patients could be classified as a function of site of fistula into 3 types, according to the Benchekroun's classification: type I ureto-vaginal fistula (30%); type II cervico-vaginal fistula (22%); type III vesico-vaginal fistula (48%). Etiology was mainly obstetrical (93%). An associated lesion was detected in 10.4% of cases (uterine, ureteral and rectal). Treatment was only performed after a minimal period of three months with the following results in obstetrical vesico-vaginal fistulas. Type I fistula, using a low approach and requiring urethral refection in 100 cases, showed good results in only 60% of cases. Type II fistulae, usually treated through a low approach (80%), were treated with 80% good results. Type III fistula, were nearly always corrected (98%) after two procedures. The overall results are good in 80% of cases. The failures concerned in majority the complex vesico-vaginal fistulas type I, are treated by urinary diversion (51 Coffey, 5 Bricker) and since 1975, 73 continent ileocecal or ileal bladders using Benchekrouns' technique.

[Superficial pT1G3 bladder tumor: 24 case reports]. / Les tumeurs superficielles de vessie pT1G3: à propos de 24 cas.

The authors report 24 patients presenting a transitional tumor of bladder pT1G3 collected between January 1996 and December 2000. They represent 19% of the superficial tumors of bladder. Two patients had of straightaway a cystectomy after resection for an unverifiable tumor by endoscopy and another after a second resection discovering a real pT2. Only 5 patients received a BCG therapy is 24% of the cases. A recurrence without progression has been noted in 38% of the cases and a progression in 19% of the patients. These last patients had a cystectomy and with a follow-up to 28 months, no recurrence has been noted.

[Cutaneo-reno-colonic fistula in tubercular kidney with staghorn calculus: report of a case]. / Fistule cutanéo-réno-colique sur rein tuberculeux avec calcul coralliforme: à propos d'un cas.

We report a rare case of colorenocutaneous fistula, in a patient with a stone of the left kidney. The fistula was successfully managed by single stage surgery (nephrectomy, fistulectomy and suture of colon). Histopathological examination revealed renal tuberculosis. Surgery was completed by an anti-tubercular treatment.

[Foreign bodies of the bladder. Report of a new case]. / Corps étrangers de la vessie. A propos d'une nouvelle observation.

In this paper we are relating the medical history of 30 year-old female patient with psychiatric medical background. This patient introduced multiple foreign bodies in her bladder via the urethra. Throughout this observation, we analyse diagnosis and therapeutic aspects of bladder foreign bodies.

[Testicular metastasis of prostatic adenocarcinoma. Report of a case]. / Métastase testiculaire d'un adénocarcinome prostatique. A propos d'un cas.

Metastasis involvement of the testis form prostatic carcinoma is rare. Seventy cases have been reported between 1938 and 1990. We report another case treated by transurethral resection of the prostate, bilateral orchiectomy and nonsteroid androgens and a review of the literature is presented.

[Treatment of idiopathic retroperitoneal fibrosis]. / Le traitement de la fibrose rétropéritonéale idiopathique.

Idiopathic retroperitoneal fibrosis is a rare disease and a delay in diagnosis may cause renal failure. Medical treatment i.e. corticotherapy or more recently, tamoxifene has been used successfully. This approach is recommended in patients either with moderate obstruction of the upper urinary, risk of major surgery or in cases of recurrence after surgical treatment. Ureterolysis using conventional surgery or laparoscopy remains the treatment of choice. This procedure should be considered in patients with neoplasic fibrosis, corticoresistant fibrosis or in cases of peri-aneurysm fibrosis.

[Consultation skills in urology: a model for teaching and evaluation]. / Les compétences de consultant en urologie: une modélisation pour l'enseignement et l'évaluation.

OBJECTIVE: Consultation activity is an important aspect of urological practice, but the specific teaching of this activity is underdeveloped. The objective of this study was to establish a list of consultancy skills as a basis for a planned and structured approach to teaching and evaluation of consultancy skills in urology. MATERIAL AND METHOD: Two-step qualitative protocol: 1) Establishment of an initial list of skills based on data of the literature; 2) Submission of this list to a series of "focus groups" (urologists, interns, referring physicians) in order to validate and progressively refine the model. RESULTS: The items identified were classified into 3 distinct lists: 1) theoretical knowledge; 2) technical skills specific to urology, predominantly performed in the consulting setting, 3) interpersonal skills exclusively concerning the consultant-referring physician relationship. CONCLUSIONS: The consensual specification of these skills can be used to objectively define teaching and evaluation strategies for urology consultancy skills.

[Scrotal injuries. Report of 40 cases]. / Traumatisme des bourses. A propos de 40 cas.

Between 1986 to 1998, 40 patients, 16 to 52 years old, consulted for trauma of the scrotum. The trauma was closed in 36 cases. The trauma occurred by accident of traffic in 19 cases, an accident of work in seven cases, an accident during sport in seven cases, aggression in six cases and brawl in one case. The clinical symptomatology was dominated by inflammatory big scrotum or haematoma in the tunic. Ultrasound imaging was performed in 20 patients, showed a contusion of the testicle in five cases, haematoma of the scrotum in ten cases and albuginal rupture in two cases. Thirty patients underwent surgical repair. Five patients underwent orchidectomy. Atrophy of the testis occurred in two patients who underwent resection of the pulp and two others who had haematoma of the haematocele.

[Contribution of lumboscopy in the treatment of pyeloureteral junction syndromes. Report of 25 cases]. / Apport de la lomboscopie dans le traitement des syndromes de la jonction pyélourétérale. A propos de 25 cas.

OBJECTIVE: Evaluation of the results of lumboscopic repair of ureteropelvic junction syndromes. MATERIAL AND METHOD: Retrospective study of 25 consecutive lumboscopic retroperitoneal pyeloplasties performed over 3 years in 14 women and 11 men with symptomatic ureteropelvic junction syndrome. RESULTS: The mean operating time was 200 minutes (range: 120-360 minutes) and mean blood loss was 60 ml. Surgical conversion was necessary in three cases due to the difficulty of dissection and in one case because of rupture of the ureter. Analgesic prescription was generally only necessary for the first 2 postoperative days. The mean hospital stay was six days (range: 2-16 days). Patients were able to return to work an average of 10 days after the operation. With a mean follow-up of 9 months (range: 6 to 18 months), all patients were asymptomatic except for one patient who reported pain at a trocar site. Follow-up urography at 3 months showed marked improvement in 18 patients (85.7%), moderate pyelocaliceal dilatation in 2 cases and one failure. CONCLUSION: Lumboscopic pyeloplasty is an alternative to endopyelotomy. It provides a comparable success rate to that of conventional surgery, while reducing the morbidity, length of hospital stay and convalescence. However, it requires mastery of intracorporeal suture techniques.