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Surgical Management of Pyothorax: A Series of 172 Cases

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Open Journal of Thoracic Surgery 2018年第2期8卷 50-56页

作者： Harmouchi Hicham Rabiou Sani Issoufou Ibrahim Sidibe Kassim Belliraj Layla Ammor Fatimazahra lakranbi marouane Ouadnouni Yassine Smahi Mohammed Department of Thoracic Surgery CHU Hassan II of Fez-Morocco Fez Morocco Department of Imagery CHU Hassan II of Fez-Morocco Fez Morocco Faculty of Medicine and Pharmacy Sidi Mohamed Ben Abdellah University Fez Morocco

Introduction: The pyothorax or thoracic empyema is defined by the presence between the two pleural layers of a purulent liquid, or a non-purulent liquid, but with bacteriological or biochemical characteristics testifying to a microbial invasion. The use of early medical treatment prevents the passage to pleural encystment, whose management remains surgical. Material and Methods: Our study was performed retrospectively, in the department of thoracic surgery of CHU Hassan II of Fez, between 2010 and 2016, involving 172 patients operated for pyothorax. Results: Among the 172 patients included in our study, there were 110 men and 67 women. The average age was 32.11 years old. The clinical picture was dominated by pleural syndrome in 56% of cases, signs of tuberculous impregnation in 44.1% of cases. Preoperative preparation with thoracic drainage, bi-antibiotic therapy and respiratory physiotherapy was performed in 90% of cases. The attack was right in 55.8% of cases and left in 44.1%. A chest CT scan performed in all patients showed pachypleuritis in all cases. The tuberculous pyothorax accounted for 54% of cases, those by intra pleural rupture of a pulmonary hydatid cyst in 10.4%, para-pneumonic origin in 5.2% and post-traumatic in 4.06%. The origin was undetermined in 26.16%. A conservative posterolateral thoracotomy was performed in all our patients. The pulmonary release was done through the extrapleural plane in 94% of cases, and pleuropulmonary decortication performed in all cases. Atypical resection was associated in 4.3% of cases and peri-cytectomy in 13.9% of cases. Operative follow-up was simple in 79.6% of cases. The main postoperative complications were a prolonged aerial leak in 16.7%, atelectasis in 4.5%, a wall infection in 6.5%, a hemothorax refrained in 3.2% of cases. The average follow-up was 2.5 years. Conclusion:?Tuberculosis remains the most common etiology of pyothorax in our setting. Early management plays an important role in reducing the morbidi

关键词： Pyothorax Pachypleuritis Thoracic Drainage Decortication Surgery

About 2 Cases of Accidental Discovery of Broncholithiasis

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Open Journal of Thoracic Surgery 2018年第2期8卷 37-42页

作者： Harmouchi Hicham Rabiou Sani Sidibe Kassim Issoufou Ibrahim Belliraj Layla Ammor Fatimazahra lakranbi marouane Ouadnouni Yassine Smahi Mohammed Department of Thoracic Surgery CHU Hassan II of Fez-Morocco Fez Morocco Department of Imagery CHU Hassan II of Fez-Morocco Fez Morocco Faculty of Medicine and Pharmacy Sidi Mohamed Ben Abdellah University Fez Morocco

Broncholithiasis is the presence of calcified material in the bronchial lumen. Bronchial fibroscopy and thoracic CT are the main paraclinical elements for diagnosis. However, most broncholithiasis is fortuitous discovery intraoperatively. The evolution may be marked by complications in the underlying lung, or fistulization in the mediastinal structures especially the esophagus. Early on, management can be simple monitoring or endoscopic extraction of broncholithiasis. Surgery remains the only option in case of complications. The authors report 2 cases of broncholithiasis, one of which was diagnosed radiologically and the other of incidental discovery during the surgical exploration of a lesion of the right lower lobe.

关键词： Broncholithiasis Fistula Lymphadenopathy Tuberculosis

Single Pulmonary Nodule Management: Experience of a Moroccan Center about 24 Patients

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Open Journal of Thoracic Surgery 2018年第2期8卷 43-49页

Introduction: The management of single pulmonary nodule remains difficult, since it is of multiple etiologies. The endemicity of tuberculosis and hydatidosis in our context makes the etiological orientation even more difficult. Materials and Methods: This is a retrospective study, involving 24 patients, all operated on for a single pulmonary nodule in the department of thoracic surgery of CHU Hassan II of Fez over a period of 8 years. Results: There were 15 men and 9 women, with an average age of 51 years. 45.4% of patients had a history of known neoplasia. Discovery was fortuitous in 54% of cases. The radiologic diagnosis based on thoracic computed tomography had objectified an isolated nodule in all the patients with a right localization in 71% of the cases It was a solid pulmonary nodule in 91.5% of cases, and a frosted glass appearance in 8.5%. Bronchial fibroscopy was contributory in one case which was a carcinoid tumor. The approach was a conservative postero-lateral thoracotomy in 22 patients. The gesture was atypical resection in 67%, and lobectomy in 24.5% of cases, in the context of centrilobular nodules. The etiologies were dominated by pulmonary metastases in 29% of cases, pulmonary tuberculosis in 21% of cases. The postoperative course was simple in all patients. Conclusion: The pathological antecedents and the characteristics of the nodule on the imaging are essential elements allowing an etiological orientation. However, the pathological study remains the only method to confirm the diagnosis.

关键词： Pulmonary Nodule Computed Tomography Diagnostic Metastasis Tuberculoma Surgery

Intrathymic Parathyroid Adenoma

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Case Reports in Clinical Medicine 2015年第8期4卷 297-301页

作者： Ibrahim Issoufou Laila Belliraj Sani Rabiou Jamal Ghalimi Meryem Rchachi marouane lakranbi Farida Ajdi Yassine Ouadnouni Mohamed Smahi Thoracic Surgery University Hospital Hassan II Fez Morocco Endocrinology Diabetology Metabolic and Nutritional Desease Department University Hospital Hassan II Fez Morocco

Introduction: Mediastinal parathyroid adenoma localization is a rare entity. We report a case of excision by manubriotomy of intrathymic parathyroid adenoma detected by Computed Tomography scan of the chest and neck and confirmed by Technetium-99 m-sestamibi scan (99 mTc-MIBI). Case Presentation: A 68 years old woman with history of hypercalcaemia, PTH elevation and operation for pathological fracture of the left femur 7 days before was presented to our service. The patient underwent manubriotomy and the adenoma was found within the right lobe of the thymus gland. Conclusion: The Technetium-99 m-sestamibi scan evaluation can be useful in the preoperative localization of ectopic parathyroid adenomas. The surgical approach by manubriotomy is privileged when the ectopic adenoma is in the upper part of anterior mediastinum.

关键词： Intrathymic Parathyroid Adenoma Technetium-99 m-Sestamibi Scan Manubriotomy

Tuberculous Pleuro-Cutaneous Fistula

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International Journal of Clinical Medicine 2015年第7期6卷 506-511页

作者： Jamal Ghalimi Sani Rabiou Marwane lakranbi Nadia Anoun Yassine Ouadnouni Mohamed Smahi Department of Thoracic Surgery Hassan II University Hospital Fez Morocco Faculty of Medicine and Pharmacy Sidi Mohamed Benabdellah University Fez Morocco

Introduction: The pleural fistulas are defined by a fistula communicating the pleural cavity to the chest wall. They often occur in the immunocompromised individuals with pyogenic infections, much more rarely in immunocompetent patients with tuberculosis. Materials and Methods: Between February 2010 and August 2012, five patients were followed up and operated for tuberculous pleuro-cutaneous fistula in the thoracic surgery department of University Hospital Hassan II of Fez. Results: These were 2 female and 3 male patients, with the average age of 39 years, and the age ranging from 18 years to 60 years. One patient was operated on for tuberculous empyema;there are 20 years and another 15 years ago drained for tuberculous empyema. All patients had a fistula necessitated operating on an average of three years, with extremes ranging from 15 days to 6 years. The radiological assessment had objectified chronic pleural pocket in one case, a costal osteitis in 2 cases, multiple cystic lesions in one case and apseudotumor appearance and endo exothoracique in another. Patients had benefited from draining the abscess with fistula resection associated with a rib resection in 2 cases and thoracostomy with lung prosthesis in one case. Conclusion: Tuberculous pleuro-cutaneous fistula is a rare pathological entity, occurring most often in an array of multifocal tuberculosis, or as a complication of surgery for tuberculous empyema.

关键词： Pleuro-Cutaneous Fistula Abscess Tuberculosis Chest Wall Surgery

Posterior Mediastinal Mature Teratoma: A Case Report and Literature Review

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Case Reports in Clinical Medicine 2014年第3期3卷 122-124页

作者： Sani Rabiou Jamal Ghalimi Marwane lakranbi Yassine Ouadnouni Mohamed Smahi Department of Thoracic Surgery University Hos-pital Hassan II Fez Morocco Department of Thoracic Surgery University Hospital Hassan II Fez Morocco Faculty of Medicine and Pharmacy Sidi Mohamed Benabdellah University Fez Morocco

Mediastinal mature teratoma is the most common form of germ cell tumors, often located in the anterior mediastinum. A posterior mediastinum location has rarely been described. We report a case of a posterior mediastinal mature teratoma in a 37-year-old patient and a literature review, through which we describe the diagnostic and therapeutic difficulties inherent in this particular location of these tumors.

关键词： Posterior Mediastinal Mature Teratoma Computed Tomography Surgery

Does Exposure to Nitrate in Drinking Water Contribute Anything the Effect of Water Chlorination on Children Methemoglobin Levels?

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Journal of Environmental Protection 2012年第2期3卷 169-176页

作者： Mina Sadeq Redouane Abouqal Benaissa Attarassi Mohammed lakranbi Rajae ElAouad Larbi Idrissi Department of Toxicology Industrial Hygiene and Environmental Health National Institute of Hygiene Rabat Morocco

Previous studies showed contradictory findings regarding the relationship between nitrate in drinking well-water and abnormal methemoglobin (MetHb) level (>2%) among children. We studied the effect of water chlorination in this relationship in children aged up to 7. 240 subclinical children participated in this cross-sectional study. Water nitrate was analyzed for each participant, and so was blood MetHb. Analysis of two water nitrate exposure levels (50 mg/L as )-other extraneous factors (Breslow-Day-Test for interaction), bivariate and multivariate analyses were performed. Abnormal MetHb levels (up to 7.9%) were associated (p-value = 0.020) with exposure to drinking water nitrate. Only water chlorination was an effect modifier. Among those who do not disinfect water, the prevalence of ab- normal MetHb for those with nitrate level >50 mg/L was 4.95 (p-value = 0.001, 95% CI = [1.92 - 12.79]) times the prevalence for those with nitrate level <50 mg/L. Whereas, among those who do disinfect water, the prevalence for those with high nitrate levels was only 1.38 (p-value = 0.435, 95% CI = [0.62 - 3.07]) times the prevalence of those with low nitrate levels. The biological plausibility of a relationship between waterborne microorganisms, drinking water nitrate, drinking water chlorination, and development of an abnormal MetHb level needs to be further explored.

关键词： Methemoglobin Drinking Water Nitrate Chlorine Children