[Role of multidetector CT scan in the diagnosis of congenital coronary artery anomalies with inter-aortopulmonary course: about two cases and literature review]. / Apport du scanner multibarrettes dans la détection des anomalies de naissance des artères coronaires avec trajet inter-aortopulmonaire : à propos de deux cas et revue de la littérature.

Coronary anomalies are a rare entity. The gold standard remains the coronary angiogram. However, the identification of the origin and the course of aberrant coronary arteries using angiography may be difficult. We report two cases regarding two patients who underwent coronary angiography in order to evaluate coronary heart disease. In the first case, angiography has shown a left anterior descending artery (LAD) originating from the right anterior sinus. A multidetector CT scan (MDCT) showed an inter-aortopulmonary course of the LAD. In the second case, selective catheterization of the right coronary artery could not be done. A MDCT scan was performed. An abnormal origin of the right coronary artery was detected. It originates from the left sinus with a separate ostium of the left main coronary artery. This artery had an inter-aortopulmonary course. The 64 MDCT scan can be useful as a complementary tool for the diagnosis of coronary artery anomalies. Detection of the inter-aortopulmonary course is essential, since this situation will require surgical treatment to avoid sudden cardiac death.

[Surgical management of extracranial carotid artery aneurysm]. / Traitement chirurgical des anévrismes carotidiens extracrâniens : à propos de dix cas.

OBJECTIVE: Aneurysm of the extracranial carotid artery is rare. The embolic risk mandates prompt intervention once diagnosed. The aim of this study was to determine therapeutic techniques, their indications and outcomes. PATIENTS AND METHODS: We report a series of ten patients who underwent surgery for extracranial carotid artery aneurysm in the cardiovascular surgery department of La Rabta hospital. RESULTS: There were six men and four women, mean age 43 years. All patients were symptomatic (swelling and pulsatile cervical mass). Two patients had dysphonia and one patient underwent an emergency procedure because of aneurismal rupture. Aneurismal excision was performed in most patients. The arterial reconstruction was performed by end-to-end anastomosis in four cases, interposition of an autologous venous graft in four, interposition of a prosthetic graft in one and suture of a small rent in the artery in one. There was no postoperative mortality. Early postoperative morbidity included one recurrent laryngeal nerve injury, one hypoglossal nerve injury, one stroke and one infection with thrombosis of a prosthetic graft. The follow-up was uneventful. CONCLUSION: Surgical treatment of extracranial carotid aneurysms is required, in most cases with good results. Endovascular treatment may be an effective therapy in selected cases.

[Primary hydatid cyst of the psoas muscle: description of 9 cases in Tunisia and review of the literature]. / Kyste hydatique primitif du psoas: 9 cas tunisiens et revue de la littérature.

The psoas muscle is an uncommon location for hydatid cyst accounting for only 1 to 3% of cases. The purpose of this report is to describe the epidemiologic, clinical, paraclinical, and therapeutic features of primary hydatid cyst of the psoas muscle. A retrospective study conducted in Surgery Department A at the Rabta Hospital in Tunisia compiled a total of 9 cases of primary hydatid cyst of the psoas muscle treated between 1980 and 2006. There were 6 men and 3 women with a mean age of 42.8 years. Symptomatology was nonspecific with pain in 6 cases. Discovery was coincidental in two cases. Clinical examination detected a mass in the presents of an abdominal mass in 7 cases. Radiologic findings (ultrasound and/or CT scan) confirmed diagnosis in 8 cases. In one case a mistaken diagnosis of psoas muscle abscess was made in a patient with an infected hydatid cyst. Serological tests were performed in 4 cases and were positive in 3. All patients underwent surgical treatment. The extraperitoneal approach (Leriche) was used in 7 cases and the transperitoneal approach via median laparotomy in 2. In all cases the surgical procedure consisted of partial cystectomy leaving a part of the pericystic against neurovascular structures. There was no operative mortality. The only postoperative complication was urinary infection in one patient. Mean follow-up was 2.5 years. One local recurrence was observed 4 years after surgical treatment and required reoperation.

[Nasopharyngeal angiofibroma: report of 15 cases treated by embolization]. / Le fibrome nasopharyngien: à propos de 15 cas traités par embolisation.

PURPOSE: To report a series of 15 new cases of nasopharyngeal angiofibroma treated with presurgical embolization along with a review of the literature. MATERIALS AND METHOD: Retrospective review of 15 cases of nasopharyngeal angiofibroma treated with presurgical embolization. The clinical, CT and MR features as well as postsurgical follow-up are reviewed. RESULTS: Presurgical embolization reduced surgical difficulties, especially hemorrhage, allowing complete tumor resection in most cases. Two cases of recurrent disease and 1 case of residual tumor were noted and treated by repeat embolization. CONCLUSION: Presurgical embolization reduces intraoperative hemorrhage and allows complete resection of these highly vascularized tumors.

Implantation cochleaire et malformation de l'oreille interne

Les indications de l'implant cochleaire se sont elargies depuis 1995. La plupart des candidats a l'implant sont des enfants sourds profonds congenitaux. L'implant peut actuellement se discuter dans certains cas particuliers notamment chez des enfants presentant une malformation de l'oreille interne (vesicule unique; malformation de type Mondini; Mondini-like; dilatation de l'aqueduc du vestibule). Les risques sont chirurgicaux et infectieux : geyser a la cochleostomie; paralysie faciale; otoliquorrhee secondaire et meningite. Nous rapportons le cas d'une fille agee de 4 ans et 8 mois qui a presente suite a un traumatisme minime une surdite brutale totale bilaterale qui n'a pas recupere sous traitement medical. L'audiometrie avait confirme la surdite bilaterale et l'examen orthophonique a retrouve un langage oral bien conserve. Une imagerie a ete pratiquee mettant en evidence une dilatation bilaterale des aqueducs du vestibule et des sacs endolymphatiques avec un aspect normal de la cochlee et des canaux semi-circulaires.La patiente a beneficiee d'une implantation cochleaire gauche avec des suites simples et un excellent resultat a 2 ans

[Necrotizing fasciitis complicating transthoracic biopsy]. / Fasciite nécrosante compliquant une ponction-biopsie transthoracique.

INTRODUCTION: Necrotizing fasciitis is a rapidly progressive and often fatal infection of the soft-tissue fascia deep to the skin but superficial to the muscles. We report a case of necrotizing fasciitis of the anterior chest wall complicating a percutaneous needle biopsy. CASE: A 49-year-old diabetic patient, presented persistent excavated right pulmonary opacities. A percutaneous biopsy was obtained and complicated by a necrotizing fasciitis. The patient underwent surgery for total resection of the necrotic tissues followed by antibiotic treatment. Outcome was favorable after 30 days of antibiotic therapy. DISCUSSION: Necrotizing fasciitis is a life threatening complication of transthoracic percutaneous biopsy. Prognosis depends on rapid diagnosis and treatment.

Spontaneous false aneurysm of the gastroduodenal artery in a hemophilic patient ruptured into the duodenum: case report.

Pseudoaneurysms of the splanchnic arteries are rare causes of gastrointestinal bleeding. We report a case of a spontaneous gastroduodenal artery false aneurysm ruptured into the duodenum in a patient with hemophilia. The diagnosis was confirmed by spiral computed tomography and magnetic resonance angiography. The patient died from massive gastrointestinal bleeding.

[Malignant paraganglioma with vertebral and skull metastasis]. / Paragangliome malin avec métastases vertébrales et de la voûte crânienne.

A paraganglioma is a rare tumor composed of chromaffin cells. Malignant paraganglioma is a very rare presentation diagnosed by local recurrence after total resection of the primary mass or findings of distant metastasis. We report a case of a 30-year-old man who had undergone a carotid body tumor resection 10 years before and who presented to us with recurrence of the tumor associated with lymph node, vertebra and skull metastasis. The diagnosis of malignant paraganglioma was based on loco-regional and distant metastasis.

[Not Available]. / Etiologie Rare de Sinusites Nosocomiales en Milieu de Reanimation - A Propos d'une Observation.

Les sinusites nosocomiales ne sont pas rares en réanimation. Elles surviennent en général dans les suites d'une intubation nasotrachéale voire même orotrachéale. Le tubage gastrique peut être à lui seul à l'origine d'une sinusite nosocomiale. Nous rapportons le cas d'une patiente hospitalisée qui a été victime de brûlures étendues chez qui la sonde nasogastrique a été à l'origine d'une pansinusite dont l'issue a été fatale.

[Lipoma of the skull base. A case report]. / Lipome de la base du crâne. A propose d'un cas.

OBJECTIVES: Intra osseous lipomas are rare benign tumours that occur most frequently within the metaphysis of long bones. Involvement of the skull base is exceptional. We report a case of a lipoma of the skull base discovered incidentally. METHODS: A 45 year-old female patient consulted for galactorrhea with Hyperprolactinemia. RESULTS: MRI showed, in addition to the microadenoma, a high signal intensity T1 and T2 and fat saturated expansive lesion of the body and the right greater wing of the sphenoid. CT-scan of the skull base showed that this lesion was a well circumscribed fat containing and trabeculated lytic lesion leading to the diagnosis of a lipoma of the sphenoid. CONCLUSIONS: Lipomas of the skull base are exceptional. They are well recognized on CT-scan and MRI and in typical cases biopsies are not necessary. No treatment is necessary for asymptomatic lesions.

[Lymphoepithelial cyst of the pancreas. A case report]. / Kyste lymphoépithélial inhabituel du pancréas. A propos d'un cas.

Lymphoepithelial cyst of the pancreas is a benign and rare pathology. Its histogenesis is still unknown. The diagnosis is difficult to establish before surgery. We report a new case of a 20-year-old woman admitted for abdominal pain and vomiting. Radiologic investigations described a multilocular cystic tumor of the tail of the pancreas. The patient underwent a left pancreatectomy with splenectomy. Histologic investigations revealed pancreatic cysts lined by squamous epithelium surrounded by dense lymphoid tissue. The diagnosis of lymphoepithelial cyst of the pancreas was done.

[Lymphocytic hypophysitis]. / Hypophysite lymphocytaire.

Lymphocytic hypophysitis is a rare inflammatory disease of the pituitary gland which may be related to an autoimmune process. Only twenty cases are reported in male. Patients usually present with symptoms of an expanding intrasellar mass or varying degrees of hypopituitarism. Most of the cases are misconsidered preoperatively as pituitary adenomas. We report a case of lymphocytic hypophysitis which has occurred at a 37-year-old-man.

Megapenis associated to corpus spongiosum agenesis with scrotal and pelvic hemangiomas.

An exceptional case of megapenis associated with corpus spongiosum agenesis and multiple hemangiomas of the scrotum, perineum and pelvis is reported. This is the first case in which three exceptional malformations are associated.

[Right paraduodenal hernia: a case report]. / La hernie paraduodenale droite: a propos d'un cas.

Paraduodenal hernia is a rare etiology of intestinal obstruction. Its preoperative diagnosis can only be made by a well-performed upper gastrointestinal series. We report a case of a 19 years old man with abdominal pains and recurrent Koenig's syndromes. The upper gastrointestinal series and CT scan showed a right paraduodenal hernia. we reviewed the anatomy. physiopathology, symptoms and radiographic criteria for the diagnosis of the paraduodenal hernia.

[Emphysematous pyelonephritis: report of 3 cases]. / La pyélonéphrite emphysémateuse: à propos de trois cas.

Emphysematous pyelonephritis is a rare and life-endangering suppurative infection characterized by the production of gas in the renal parenchyma and perirenal space. It affects mainly patients with diabetes mellitus. Authors report three cases of emphysematous pyelonephritis and insist on the role of radiological investigations in diagnosis. Through an exceptional case of emphysematous pyelonephritis revealed by hematemesis, they remind the progression route of infection from retroperitoneal to mediastinal space. Prognosis of emphysematous pyelonephritis depends on the patient's general health status and rapidity of diagnosis and treatment. Percutaneous drainage is an alternative to major surgery and is particularly indicated in cases of single kidney or in an inoperable patient.

[Management of percutaneous nephrolithotomy complications by shock wave lithotripsy. A report of 82 consecutive cases]. / Prise en charge des complications de la néphrolithotomie percutanée par lithotritie balistique. A propos d'une série de 82 NLPC consécutives.

In this paper, authors assessed the complication rate of percutaneous nephrolithotomy (PCNL) through a consecutive series of 82 PCNL performed on 80 patients with renal calculi (48 men and 32 women). Patients' mean age was 42 years. Stones were located in the pelvis or lower calyx in 75% of cases with a diameter exceeding 20 mm in 56%. 11 Patients had intraoperative problems: one ureteral false passage, one renal perforation by a ureteral stent, three cases of hemorrhage, three cases of punctate perforations of excretory cavities. In one case, nephrostomy tube fell and could not be replaced. 6 patients had post operative complications: three patients had postoperative fever, one patient developed acute pyelonephritis and two patients had transient urinary leakage after nephrostomy tube removal. After reviewing the literature, authors conclude to the low complication rates of PCNL.

[Orbital metastases of melanoma of the choroid. Value of imaging]. / Métastases orbitaires d'un mélanome de la choroïde. Intérêt de l'imagerie.

Choroidal melanoma is characterized by an unpredictable clinical course, during which metastatic disease may occur after a prolonged disease-free interval. However, metastases to orbit are quite rare; there have been only 6 reported cases in the literature. We report well documented examples of metastases to the orbit from a melanoma of the choroïd first diagnosed 8 years earlier. MR imaging is accurate in determining the exact location of lesions and their nature owing to the paramagnetic properties of melanin.