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.

[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.

[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.

[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.

[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.

[Urinary candidiasis revealed by ureteral obstruction: report of 2 cases]. / Candidoses urinaires révélées par une obstruction urétérale: à propos de deux cas.

There has been an increase in the frequency of candidiasis urinary infections, which mainly affect diabetic or immunodepressed patients. However, the obstruction of the upper urinary tract by fungal infection is a rare occurrence. The introduction of novel antifungal agents has improved the treatment of fungal infection. In this study, two cases have been reported of urinary candidiasis infections with obstruction of the upper urinary tract which were successfully treated with fluconazole in combination with ureteral catheterization.

[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.

[Carcinosarcoma of the prostate. Case report]. / Le carcinosarcome de la prostate. A propos d'un cas.

We report one case of carcinosarcoma of the prostate in a patient of 43 years old. The clinical symptomatology was dominated by pollakiurie, dysuria digestive disorders, oedema of the lower limbs and the alteration of the general status. Digital rectal examination showed a big prostate, hard and irregular. The rate of PSA increased. Echography revealed a pelvic echogenic mass corresponding to a bulky prostate. CT scan of the abdomen and the pelvis showed a tissular, heterogeneous mass of 11 cm occupying the vesicoprostatic space and invading the basis of the bladder and the adjacent muscles (muscles obturateurs internes). Histology of a biopsy fragment of the mass revealed an adenocarcinoma and a mesenchymatous component calling up a prostatic carcinosarcoma. The treatment consisted in chemotherapy VAC. The evolution was deadly after 2 months.

[Inguinal hernia of the bladder. Report of 6 cases]. / Les hernies inguinales de la vessie. A propos de 6 cas.

The authors report 6 cases of inguinal hernia of the bladder seen between 1976 and 1996. All patients were males with a mean age of 67 years (range: 53 to 80 years). The hernia was situated in the right groin in all patients. No patients presented any suggestive clinical features. In 5 patients, the diagnosis was established by IVU, indicated for another disease associated with the hernia and, in one patient, the hernia was discovered after an operative wound to the bladder. Treatment consisted of elimination of bladder neck obstruction in 3 patients and reintegration of the bladder and abdominal wall repair in 4 patients. The postoperative course was uneventful.

[Traumatic rupture of the bladder. Report of 12 cases]. / Les ruptures traumatiques de la vessie. A propos de 12 cas.

Over the previous 8 years, the authors have treated 12 patients (11 males and 1 female with a mean age of 32 years (26 to 54 years)) with traumatic rupture of the bladder. Rupture was secondary to direct trauma to the full bladder in one case and pelvic trauma in 11 cases. Associated lesions were pelvic trauma (11 cases), head injury (4 cases), chest trauma (2 cases), rupture of the spleen (1 case) and small bowel perforation (1 case). The clinical features were dominated by suprapubic pain (11 cases), haematuria (10 cases), haemorrhagic shock (4 cases) and peritoneal syndrome (3 cases). IVU confirmed the diagnosis in 6 out of 8 cases. Retrograde cystourethrography was conclusive whenever it was performed. The retroperitoneal rupture was treated by indwelling catheter for 15 days. Intraperitoneal ruptures were treated surgically. The breach was situated in the dôme in 10 cases and on the posterior surface in 1 case. The size of the wound ranged from 2 to 8 cm. Treatment consisted of suture of the rupture and indwelling catheter for an average of 12 days. Cure was always obtained without sequelae.

[Vesico-uterine fistulas. Report of 30 cases]. / Les fistules vésico-utérines. A propos de 30 cas.

The authors report a series of 30 vesico-uterine fistulas (VUF) observed over a 25-year period. The mean age of the patients was 28 years (range: 18 to 40 years). VUF were secondary to caesarean section (23 cases), abnormal delivery (5 cases) and rupture of the bladder and uterus (2 cases). The presenting complaint was a permanent total and isolated urinary incontinence (22 cases), partial urinary incontinence associated with menstrual haematuria (4 cases), vesical menstrual bleeding associated with a oligomenorrhoea (3 cases) and menouria (1 case). The diagnosis was established on clinical findings in 14 patients. IVU, performed in 30 patients, visualized the uterine cavity in only 12 patients. Retrograde cystography, performed in 4 cases, demonstrated opacification of the uterine cavity. Hysterosalpingography, performed in 6 cases, confirmed the diagnosis of VUF in all 6 patients. Treatment was surgical, via a transperitoneovesical incision (22 cases) or a transvesical incision (8 cases) and consisted of isolation of the bladder and uterus and uterine and vesical suture. Urine drainage was performed by urethral catheter (28 cases) or cystostomy (2 cases). Urinary continence was perfectly restored in 24 patients, 6 patients presented residual fistulas another patient had a reduction of her bladder capacity. The objective of this study is to analyse the aetiological, diagnostic and therapeutic aspects of this disease.

[Urethrorectal fistula. Report of 11 cases]. / Les fistules uréthro-rectales. A propos de 11 cas.

The authors report a series of 11 urethrorectal fistulas observed over a 25-year period. The mean age of the patients was 37 years (range: 15 to 70 years). The aetiologies were surgical trauma (5 cases), fracture of the pelvis (2 cases), inflammatory lesions (3 cases), and one fistula was congenital. The clinical features were dominated by urine discharge from the anus (11 cases), urinary tract infection (8 cases), spurious diarrhoea (6 cases), faecaluria (4 cases), pneumaturia (2 cases). Digital rectal examination was normal in 7 patients. IVU demonstrated opacification of the rectum in 5 out of 8 cases. Cystourethrography, performed in 9 patients, demonstrated the communication in each case. Urethrocystoscopy visualized the fistula in each case in which it was performed. Treatment consisted of bladder drainage by urethral catheter in all patients, allowing closure of the fistula in 2 patients. Colostomy was performed in 2 patients, internal urethrotomy and urethral catheter was performed in 2 cases. Surgical closure of the fistula was performed in 7 patients, via an abdominoperineal (3 cases), perineal (2 cases), transperitoneal (1 case) or transanosphincteric incision (1 case).

[Kidney injuries. Apropos of 30 cases]. / Les traumatismes du rein. A propos de 30 cas.

Renal trauma remains a topical subject due to its high incidence and the fact that it still raises therapeutic problems. The features of this disease were reviewed by means of a retrospective study of 30 cases of renal trauma observed over a 10-year period. The patients consisted of 27 males (90%) and 3 females (10%), with a mean age of 27 years (range: 20 to 60 years). The aetiology was largely dominated by road accidents (53%), falls (26%) and assaults (16%). Trauma was unilateral, predominantly affecting the left side (60%). The clinical features were dominated by haematuria (93%) and low back pain (90%). Trauma was associated with skeletal or visceral lesions in 46.6% of patients. Assessment of the lesions was based on IVU, ultrasonography and CT. Eight patients (26.6%) presented with moderate or minimal trauma (Chatelain stage 1 and 2) and were treated medically. Twenty-two patients (73%) were operated: 6 of them underwent total nephrectomy and 16 were treated conservatively. Seven of the operated patients subsequently developed complications.