Le pseudomyxome péritonéal (PMP) ou l'ascite gélatineuse est une entité rare, décrite pour la première fois par R. Wyerth en 1884. Il correspond à une atteinte péritonéale diffuse, composée d'une ascite mucineuse et d'implants épithéliaux mucineux multifocaux. Cette maladie touche essentiellement les femmes. Son incidence est estimée à 2 cas par un million d'habitants. Le pseudomyxome péritonéal peut rester asymptomatique, découvert lors d'une laparotomie. Le symptôme le plus fréquent est représenté par une distension abdominale associée à des douleurs abdominales diffuses. Le scanner abdominal constitue le moyen diagnostique le plus spécifique. Il met en évidence des signes pathognomoniques de l'ascite gélatineuse. Les tumeurs mucineuses de l'appendice sont la cause la plus fréquente du pseudomyxome péritonéal avec 90% des cas. L'origine ovarienne en constitue une cause très rare. Il existe essentiellement deux types de traitement du PMP: premièrement le « debulking » chirurgical multiple et deuxièmement la chirurgie de cytoréduction avec chimiothérapie intra-péritonéale péri-opératoire consistant en une chimiothérapie hyperthermique intrapéritonéale avec ou sans chimiothérapie intrapéritonéale post opératoire immédiate. Nous rapportons un cas de pseudomyxome péritonéal secondaire à une tumeur mucineuse de l'ovaire gauche.
This is a retrospective study of 30 cases of first metacarpal fractures in adults collected in our service from March 2015 to March 2018. The average age was 31 years with a male predominance (80%). The etiologies were dominated by domestic accidents (50%). The mechanism of injury was direct in all patients. Imaging confirmed the diagnosis and allowed the classification. Surgery concerned types Rolando (40%), Bennett (30%), extra-articular (20%) and diaphyseal (10%), it consisted of pinning according Iselin 07 cases (70%), ascending pin according Kapandji 02 cases (20%) and direct screw 01 case (10%). Immobilisation after surgery was systematic in all patients (100%) for six weeks. Functional rehabilitation began early in all cases (100%). Bone healing was achieved in 06 to 08 weeks in 100% of cases. A complication was observed in 03 patients (10%), it was a malunion. Our results have been very satisfactory in 90% of cases.
Fatigue fractures are fractures that occur on a healthy bone following a rather intense and unusual activity. The diagnosis is based on anamnestic data (no notion of trauma), clinical data (especially pain, with poor clinical examination in general), and radiological data (the standard radiography allows in general to make the diagnosis, however, the use of other additional examinations such as ultrasound, MRI or scintigraphy may be necessary. The treatment of fatigue fractures is mainly functional and medical, but some cases require surgical treatment. The evolution of these fractures is generally satisfactory; however, complications are not uncommon, which can compromise the functional prognosis.
Diabetic nephropathy (DN) has a steadily increasing prevalence, particularly because of the increase in sedentary lifestyle and obesity. It is defined as the persistent presence of albuminuria in a diabetic patient and requires early management to prevent progression to end-stage renal failure. The purpose of this work is to describe the epidemiologic profile and the progression of DN for the first time in a southern Moroccan region: Guelmim Oued noun - Moroccan Sahara.Patients and methods: It is a retrospective study conducted at the 5th military hospital in Guelmim and including all diabetic patients seen in nephrology consultation between January 2015 and December 2018. We collected the following parameters of our patients: demographics, comorbidities, prescribed treatments and biological data (Albuminuria, renal function and glycated hemoglobin) during their nephrology follow-up.Résults: During the study period 267 diabetic patients were included among 1042 patients, which represented 25.9% of the nephrology consultation activity. Their average age was 64.3 years with a slight male predominance (60%) and only two patients had type 1 diabetes. At the first nephrology consultation the average duration of diabetes was 14.6 years, 61 (22.8%) patients were on diet alone, 95 (35.5%) on oral antidiabetic drugs (OADs), 94 (35.2%) on insulin and 35 (13%) on OAD and insulin. Half the patients were hypertensive and 107 (40%) already had a cardiovascular complication (arterial disease, coronary artery disease or stroke). The average initial albuminuria was 388 mg/24h and the average glomerular filtration rate (GFR) was 67 ml/min ; 115 (43%) patients being in renal failure. 46 (17%) patients had no renal function assessment during their previous follow-up and only 139 (52%) were on renin-angiotensin system inhibitors (RASIs). After 12-month-follow-up in nephrology, the average GFR was 70 ml/min and 64 ml /min after two years.Conclusion: Diabetic nephropathy accounts for at least a quarter of nephrology consultation activity in the region of Guelmim Oued Noun. It is characterized in this context by the delay in treatment using renin angiotensin system inhibitors and late nephrology referral hence the need to strengthen preventive strategies in this region especially continuous training.
Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor, of intermediate malignancy, its evolution is unpredictable and its treatment is essentially surgical. We report a case of an EHE involving the proximal portion of the left tibia in a 32-year-old woman, which caused a diagnostic issue. And in whom, the first step of the surgical treatment has been established up to now.
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