Primitive necrotizing fasciitis of the thoracic wall: Fatal complication of diabetic patient.

INTRODUCTION: necrotizing fasciitis of the chest wall is a rare condition in subcutaneous tissues and deep fascia. Primary thoracic involvement is exceptional and is a diagnostic and therapeutic emergency. AIM: To report our experience in the management of this rare pathology of which clinical picture is unknown by most practitioners. METHODS: This is a retrospective study carried out over a period of 07 years, compiling 07 cases of primitive necrotizing fasciitis of the thoracic wall at the department of thoracic surgery at the CHU Hassan II in Fez. RESULTS: Patients were five men and two women, with an average age of 58 years. All our patients were known to have poorly balanced diabetes. The reason for consultation was a swelling of the chest wall with fever in all patients. On the results of thoracic computed tomography (CT), the presence of a deep collection of soft tissue was found   in all patients. The treatment was a large necrosectomy, taking away the skin as well as the adjacent muscle. Postoperative follow-up was favorable in five patients. We noted two deceased patients due to postoperaive septic shock. CONCLUSION: Necrotizing chest wall fasciitis is a medical and surgical emergency, requiring early diagnosis and rapid and appropriate management which will determine the prognosis.

A rare cause of bronchial obstruction: Endobronchial hamartoma case report.

Most of the pulmonary endobronchial lesions are malignant in origin. In rare instances, benign lesions such as endobronchial hamartoma may be the cause of the endobronchial tree obstruction. We present the case of a 57-year-old male patient from North Africa who presents with a history of a 5-month cough. Imaging, particulary CT scan, showed a mass on the right intermediate bronchus whose radiological characteristics are consistent with hamartoma. A biopsy of the mass obtained via bronchoscopy revealed chronic inflammation with no evidence for malignancy. The patient was treated surgically, and anatomopathology confirmed the diagnosis of hamartoma.

About a submucosal tracheal tumor.

The authors report the case of 46-year-old man with recurrent hemoptysis. Bronchoscopy revealed a submucosal tumor protruding into the tracheal lumen. Transbronchial biopsy failed to obtain a conclusive diagnosis; only surgery allowed complete resection of the tumor and confirmed the diagnosis of tracheal mucoepidermoid carcinoma. We discuss the unusual submucosal presentation of this tumor, and the contribution of surgery for diagnosis and therapy.

Mediastinal mature teratoma with complex rupture into the lung, bronchus and skin: a case report.

Mature teratoma is the most common primary germ cell tumor in the mediastinum. On rare occasions, cystic teratomas rupture in adjacent structures, such as pleural space, pericardium, lung or tracheobronchial tree. We present a case of a mediastinal mature cystic teratoma in 16-year-old female with complex rupture into the lung, bronchus and skin. Mature mediastinal teratoma fistulized to the skin has not been previously described.

Evaluation of cross-bar and parallel-bar techniques in MIRPE surgery in different countries: a multicenter study.

Parallel- and cross-bar techniques are surgical methods used in the pectus excavatum. While the parallel bar is used in many centers, the cross bar is a new technique. The aim of the study is to evaluate the data of centers using cross bar and parallel bar. The aim of this multicenter study is to retrospectively evaluate the data of centers have been using both cross-bar and parallel-bar techniques. 213 parallel bars and 205 cross bars were used. Parallel-bar advantages: the mean patient satisfaction score was 9.40 ± 0.95. Cross-bar advantages: the rate of patients with symmetric deformity was 75.6%, recurrence 0.5%. The mean patient satisfaction score was 9.40 ± 0.95 in operations performed with the parallel-bar technique and 9.13 ± 1.11 in operations performed with the cross-bar technique (p < 0.05). Recurrence was observed in 3.3% of patients undergoing surgery using the parallel-bar technique and 0.5% of patients undergoing surgery using the cross-bar technique (p < 0.04). The cross-bar technique is more advantageous in terms of the recurrence, while second, the parallel-bar technique is associated with greater patient satisfaction. Comparison of data from different countries reveals the differences between patients who have been treated with minimally invasive repair of pectus excavatum and the outcomes of surgery.

Which Role for Muscle-Sparing Posterolateral Thoracotomy in the Treatment of Spontaneous Pneumothorax?

Objective This study aims to show the place of muscle-sparing posterolateral thoracotomy in the treatment of spontaneous pneumothorax. Methods It was a single-center study performed in the Department of Thoracic Surgery of Teaching hospital Hassan II of Fez for 8 years. We adopted the nosological definition, which classifies spontaneous pneumothorax into three categories. We included patients over 15 years of age with primary or secondary spontaneous pneumothorax operated by posterolateral thoracotomy without muscle section, and we analyzed the specific indications of this approach. It included 49 patients with primary or secondary spontaneous pneumothorax, operated by muscle-sparing posterolateral thoracotomy. Data were collected from regularly updated computer files of patients, entered by Excel 2013, and analyzed using SPSS.20 software. These data are: epidemiological, clinical, radiological, surgical exploration, surgical procedure, the result of the surgery and the evolution. Results The average age was 42 years. Smoking was found in 61% of cases and pulmonary tuberculosis in 10% of cases. Thoracic computed tomography (CT) showed bullae and blebs in 31% of cases, pleural adhesions and pachypleuritis in 50% of cases, and hydropneumothorax with pachypleuritis in 37% of cases. There is a statistical correlation between pleuropulmonary decortication and pachypleuritis ( p = 0.002) or hydropneumothorax ( p = 0.001) on CT. Bullae and blebs resection was performed in 53% of cases and pleuropulmonary decortication in 63% of cases. A right pleuropneumonectomy was performed in one case. The follow-up was uneventful in 82% of cases. Conclusion Muscle-sparing posterolateral thoracotomy remains the best approach and leads to good results.

Pneumonectomy for non-tumoral diseases: etiologies and follow-up in 38 cases.

INTRODUCTION: Pneumonectomy is a surgical procedure associated with high rates of morbidity and mortality. Chronic inflammatory pathologies increase these rates, depending on the degree of pleural symphysis and the underlying pulmonary pathology. The occurrence of a bronchopleural fistula after pneumonectomy remains of great concern to the thoracic surgeon, because it leads to empyema in the pneumonectomy cavity, which requires protracted and difficult management. METHODS: A retrospective single-center study was carried out on 38 patients who underwent pneumonectomy for non-tumoral pathologies between 2010 and 2017. Of the 38 patients, 22 (57.8%) men and 16 (42.2%) women, the average age was 40.3 years, and 30 (79%) patients were treated for tuberculosis. RESULTS: The symptoms were predominantly hemoptysis with bronchorrhea in 22 (57.9%) cases. Chest computed tomography showed right-sided involvement in 15 (39.5%) patients, with destroyed lung in 31 (81.5%). Early postoperative complications included bleeding in 11 (28.9%) patients, postpneumonectomy empyema in 4 (10.5%), and death in 2 (5.2%). The average duration of follow-up was 2 years, without any recurrence. CONCLUSION: The endemicity of tuberculosis in our context, and the absence of screening for lung cancer, explain the frequency of pneumonectomy for chronic inflammatory diseases, and the rate of complications after this surgical procedure.

An Unusual Mass of Posterior Mediastinum: A Case of Retrotracheal Parathyroid Adenoma Presenting With Primary Hyperparathyroidism.

Although parathyroid ectopy in the mediastinum has been the subject of several publications, its location in the posterior mediastinum is very rarely reported. We report a case of a 69-year-old patient who presented with clinical symptoms of malignant hypercalcemia due to a retrotracheal mediastinal parathyroid adenoma. The surgical excision leads to a quick normalisation of the phosphocalcic balance with improvement of the clinical symptoms. Ectopic hypersecreting parathyroid adenoma with life-threatening hypercalcemia should prompt radiological assessment and appropriate surgical management to prevent further clinical complications.

Surgical management of hydatid Bilio-bronchial fistula by exclusive thoracotomy.

In the industrialized countries, most of Bilio-bronchial fistula are secondary to hepatobiliary trauma, hepatic resection surgery or in the case of congenital malformation of the biliary tract, Bilio-bronchial fistula is recognized as the complication of a number of infectious pathologies such as hydatidosis and hepatic amoebiasis. Among the causes, the Bilio-bronchial fistula of hydatic origin is by far the most frequent especially in the zones of hydatid endemic as Morocco. It is a serious complication of liver hydatid cysts. The surgical management has long been believed to be difficult, and often associated with a very pejorative prognosis due to the simultaneous attack of the thoracic and abdominal stage through the diaphragm. This tripartite involvement reflects the difficulty of choosing the first approach between the thoracic, abdominal or a combination of both approaches. However, progress, especially in the possibility of carrying out adequate preoperative preparation with the increasing introduction of retrograde endoscopic cholangiography with sphincterotomy, has made possible this exclusive thoracotomy surgery with acceptable outcomes.

Complete histologic response to chemotherapy in a patient with a mediastinal yolk sac tumor: a case report.

BACKGROUND: Malignant mediastinal germ cell tumors are a rare disease and represent only 1% to 4% of all mediastinal tumors. Gonadal germ cell tumors are generally the most common type and constitute 90% of germ cell tumors. The mediastinum is the second most frequently affected area ahead of other extragonadal areas, which include the retroperitoneum, the sacrococcygeal area, and the central nervous system. We report on the case of a mediastinal yolk sac tumor with a complete histological response to chemotherapy. CASE PRESENTATION: A 26-year-old Moroccan man, without a medical or surgical history, presented with a four-month history of chest distress, dyspnea, and a frequent dry cough for the previous month. A computed tomographic scan of the chest revealed a bulky mediastinal mass, which was biopsied. Histologically, the tumoral mass proved to be a yolk sac tumor. The serum level of alpha-fetoprotein of this patient was elevated to 19052 ng/ml.After 4 courses of preoperative chemotherapy, the patient underwent a surgical resection of the tumor, with a complete pathologic response.At the time of writing, the patient is alive with complete remission without any evidence of recurrence. CONCLUSION: Primary mediastinal Yolk sac neoplasm represent a unique entity, and as such require specialized management. The diagnosis should be made not only by morphological studies but the patient's age and the elevation of serum alpha-fetoprotein should also be considered. The utilization of cisplatin-based chemotherapy is associated with the best chance of a cure for this disease. This should be followed by surgical resection of the residual tumor in the nonseminomatous germ cell tumor.

Intratracheal ectopic thyroid tissue.

Intratracheal ectopic thyroid tissue is a rare finding that can cause airway obstruction. The symptoms can easily be confused with those of bronchial asthma. We describe the case of a 30-year-old woman with subglottic thyroid tissue who had been misdiagnosed earlier with bronchial asthma. After the correct diagnosis was established, the intratracheal nodule was removed by segmental tracheal resection extended to the anterior arch of cricoid ring, and thyrotracheal anastomosis was performed by cervicotomy. Currently, the patient is free of disease and complaint. We also discuss the clinical features and management of intratracheal thyroid tissue.

Traumatic manubriosternal dislocation: A new method of stabilization postreduction.

Traumatic manubriosternal dislocation is a rare lesion. In the literature, only a few case reports of patients treated surgically are published. In this case, we report an unstable posterior dislocation of the manubriosternal joint in a 50-year-old women caused by direct trauma. An open reduction was performed, and the manubriosternal joint was fixed by two staples. We are the first to use this alternative technique. At the last follow-up, the result was very good without complication.

Intrathoracic phrenic nerve neurofibroma.

The usual location of intrathoracic neurogenic tumors is the posterior mediastinum. Those in a mediastinal anterior or middle location arise from the intrathoracic phrenic nerve, which is extremely rare and causes a problem for etiologic diagnosis. We report what is, to our knowledge, the second case of a mediastinal neurofibroma originating from the phrenic nerve of a 59-year-old woman without von Recklinghausen disease. Diagnosis was suggested by the radiologic features and confirmed by histologic aspects after excision. The prognosis after complete resection is excellent.

Pulmonary epithelioid hemangioendothelioma: a case report.

INTRODUCTION: The pulmonary epithelioid hemangioendothelioma is a rare vascular intermediate malignancy tumour. CASE PRESENTATION: A 45-year-old man, he shows an isolated chronic cough with a preserved general state of health. The thoracoabdominal Computed tomography showed three well limited opacities of the right lung, among them one shows some calcifications; which we entirely resected by enucleation after a pneumotomy. The histologic examination with immunomarking led to an epithelioid hemangioendothelioma. CONCLUSIONS: The pulmonary epithelioid hemangioendothelioma is a tumour of unpredictable prognosis, bad when linked to the plurifocal and symptomatic forms.