Place de la laparoscopie dans la prise en charge des anomalies de différenciation sexuelle: à propos de 4 cas

Les troubles de la différenciation sexuelle sont à l'origine d'une discordance entre le sexe proprement dit (phénotypique) et le sexe génétique (génotypique) ce qui pose un problème de détermination du sexe. Dans les pays de faible niveau socio-économique où le diagnostic anténatal est souvent absent et les plateaux techniques insuffisants, la prise en charge médico-chirurgicale est difficile. Le but de ce travail est de préciser la place de la laparoscopie dans la prise en charge de l'ambiguïté sexuelle à travers l'observation de 4 cas et une revue de la littérature.Pan African Medical Journal 2016; 2

Unusual toxicity of bevacizumab (Avastin®): Hyperlipemia?

Le bevacizumab (Avastin®) est un anticorps monoclonal exerçant une activité antiangiogénique. Son utilisation apporte un gain en survie dans plusieurs localisations tumorales en phase métastatique dont le cancer du sein, le cancer colorectal, le cancer du rein et le cancer bronchique non à petites cellules. Ce traitement est pourvoyeur de toxicités spécifiques comme l’hypertension artérielle, la protéinurie, les perforations digestives ou les évènements thromboemboliques artériels. Nous rapporterons une série de 7 cas d’hyperlipémies apparues (5 cas) ou s’étant aggravées (2 cas) lors d’un traitement par bevacizumab. Tous nos malades ont évolué favorablement par les mesures hygiéno-diététiques, associées ou non à un traitement médical par statines.Bevacizumab (Avastin®) is an antibody humanized monoclonal neutralizing anti-VEGF (anti-growth factor vascular endothelial) exerting anti-angiogenic activity. It has shown its impact on relapse-free survival of patients treated for metastatic tumors including breast cancer, colorectal cancer, kidney cancer and no small cell lung cancer. This treatment is a provider of specific toxicities such as hypertension, proteinuria, gastrointestinal perforation or arterial thromboembolic events. We report a series of seven cases who received this therapy including 5 patients who had no dyslipidemia before treatment and 2 cases who had increased their initial lipid profile. All the patients were placed under Lifestyle and diet, associated or not to medical treatment by statins. The evolution was favorable in all cases

Is there any advantage to combined trastuzumab and chemotherapy in perioperative setting her 2neu positive localized gastric adenocarcinoma?

We report here a 44-year-old Moroccan man with resectable gastric adenocarcinoma with overexpression of human epidermal growth factor receptor 2 (HER2) by immunohistochemistry who was treated with trastuzumab in combination with chemotherapy in perioperative setting. He received 3 cycles of neoadjuvant chemotherapy consisting of trastuzumab, oxaliplatin, and capecitabine. Afterwards, he received total gastrectomy with extended D2 lymphadenectomy without spleno-pancreatectomy. A pathologic complete response was obtained with a combination of trastuzumab and oxaliplatin and capecitabine. He received 3 more cycles of trastuzumab containing regimen postoperatively

Fracture couverte de la jambe chez l'enfant.

Introduction : Les fractures ouvertes de jambe sont définies par l’existence d’une communication entre l’extérieur et le foyer de fracture. Elles constituent l’urgence en traumato orthopédie, la plus fréquente et la plus difficile à prendre en charge. Matériels et méthodes : Notre travail comporte une étude rétrospective d’une série de 41 cas de fracture ouverte de jambe chez l’enfant traitées au service des urgences chirurgicales pédiatriques de l’hôpital IBN sina, durant une période de 4ans depuis le janvier 2004 à décembre 2008 . Discussion : On comparant les résultats de notre série et les séries de la littérature on note : La prédominance des fractures ouvertes de type I par rapport aux types II et III. Les fractures de type II viennent au deuxième lieu les fractures type III au troisième. Lieu ce qui va avec quelques séries et le contraire dans d’autres. D’après la comparaison entre la série de notre étude et les autres séries de littérature : Le traitement orthopédique constitue la base thérapeutique passant par l’immobilisation puis la réduction et le plâtre cruro pedieux fenêtré ainsi que la technique de gypsotomie. Cependant le fixateur externe occupe une place assez importante avec un pourcentage limité à 20% dans le traitement des fractures ouvertes stade III. Conclusion : Les fractures de jambe ouvertes sont les plus fréquentes des fractures ouvertes des os longs. Elles sont en général graves et surviennent le plus souvent après un accident de la voie publique. Le pronostic plus favorable que chez l adulte ; les complication sont surtout les cals vicieux et les pseudarthroses

Local recurrence after enlarged total nephrectomy

Local isolated recurrence of kidney cancer in the renal lodge after radical nephrectomy is rare and has a poor prognosis. Surgical excision, sometimes even extended to neighboring organs, is currently the only effective treatment for local recurrence of kidney cancer. The interest of new medical therapies remains to be defined. We report a case of local recurrence in a patient with radical nephrectomy

When tyrosine kinase inhibitor sunitinib can be discontinued in metastatic renal cell carcinoma to pancreas: a case report

Abstract Background Long-term survival with durable response remains possible in the area of targeted therapies. Discontinuation of sunitinib could improve quality of life and reduce treatment costs in metastatic renal cell carcinoma with long-term disease stabilization. We discuss a case of successful interruption of antiangiogenic therapy in a patient with persisting evidence of metastases. The discontinuation of antiangiogenic therapy seems to be an option, even in indolent oligo-metastatic renal cell carcinoma with long disease stabilization before sunitinib. This observation contributes important data to the ongoing discussion on the discontinuation of treatment with kinase inhibitors in selected patients with metastatic renal cell carcinoma. Case presentation We report a case of an 80-year-old Moroccan man treated for renal clear cell carcinoma with multiple pancreatic metastases. He was not on any other medications. He underwent active surveillance with deferred sunitinib at disease progression. He showed significant disease control on sunitinib therapy demonstrating partial response with stable disease after a total of 28 months of therapy. He experienced toxicities which were manageable with supportive care and dose adjustments. Our patient asked for a break of the sunitinib administration, and the treatment was stopped. The disease remained stable after 13 months’ discontinuation of sunitinib therapy. The patient was in excellent overall health. Conclusions All available agents for metastatic renal cell carcinoma have side effects, which may become serious in a minority of patients. Clinicians and patients must therefore carefully balance the goals of maximal efficacy with minimal toxicity. Sunitinib can be discontinued without negatively impacting outcomes in indolent disease. Further research is needed to characterize the molecular determinants of response and resistance to targeted therapy

The role of the general practitioner in promoting organ donation

Introduction: The effectiveness of a health system is based on primary care, the conductor of which is the general practitioner, who is also an integral part of the organ donation promotion chain. At present, as the indications for transplantation are more and more widespread, an immense shortage of organs is declared. This pushes more than ever to multiply creative tactics to reduce the gap between the number of high demand and stingy supply. The main objective of this work is to particularize the involvement of the general practitioner in this process of encouraging donation, as well as to highlight his attitudes and his motivation during the consultation, and to identify the possible obstacles to the donation. Information and patient education on organ and tissue donation. Material and method: A quantitative descriptive cross-sectional study, based on a questionnaire with 20 closed questions, self-administered, sent by email address, completed anonymously and voluntarily intended for the general practitioner of the region of Casablanca. Questionnaire data were collected, coded, and analyzed using SPSS-PC (Version 21.0). Results: In total, 200 general practitioners were targeted by our study. 165 responded to the questionnaire, which gives an overall response rate of 82.5%. 35.5% of the participants were women, the duration of exercise varies between 1 and 40 years, 65% of the doctors practiced in the urban environment and approximately 59.5% worked in the liberal sector. 87% of the doctors questioned were in favor of organ donation. only 38% of doctors have already discussed this subject with their patients, of whom more than 64% were following the sole initiative of the patient himself and in none of the cases was awareness-raising through posters in the waiting room. Conclusion: The general practitioner is a cornerstone of the success of public health programs. Continuous training of this category of doctors ensures better promotion of organ and tissue donation in Morocco. Keywords: tissue donation, blood donation, donors and non-donors of the without, federating donors, Morocc

The epidemiological profile of donors and non-donors of blood in Morocco

Introduction: In Morocco, blood donation is voluntary, anonymous, and voluntary. The promotion of blood donation has evolved favorably thanks to strategies based on the creation of a multi-sector promotion system. The transformation of family donors into voluntary donors and the retention of voluntary donors is the major challenge of the national blood transfusion center. Materials and methods: This is an analytical quantitative cross-sectional study on a target population made up of 1000 participants. The collection tool was a self-administered, anonymous questionnaire made up of closed questions concerning the socio-demographic profile of the participants, and their knowledge and attitudes about the blood donation operation as well as their motivation and limitations of the donation. The responses were collected and entered by a team of graduate students in sociology. Data were analyzed by SPSS 20 software. Results: Among the 953 participants, their mean age (Standard Deviation) is 32.56 (12.993) years, with 63.4% of the participants under the age of 34 (n = 429). For data relating to blood donation, 69.3% of the participants thought they did not know the blood group (n = 660), more than 70% thought of the existence of the illegal sale of blood in Morocco (n = 668). 69.3% of the participants think they do not know the blood type (n = 660), more than 70%, though of the existence of the illegal sale of blood in Morocco (n = 668), 70.8% do not know someone who has had or require an organ or tissue transplant (n = 479). Conclusion: The need for blood is sharply increasing. an enormous shortage hence the need for epidemiological study to highlight the various difficulties that hamper the promotion of blood donation. Keywords: Blood, transfusion, Blood donation, Promoting blood donation, Faithful donor, Morocc

Foreskin necrosis – Complication following self-circumcision

Male circumcision (MC) seems to be practiced since ancient times by Muslims and Jewish, and it is considered as commandment. Attempts at self-circumcision for any reason are very rare in our country. This article aims to highlight another case of self-circumcision in a 30 year-old male, using a sharp vegetable knife. The reasons behind this act are various and the most common complications, especially in the use of sharp tools, in addition to bleeding or laceration of the penis, are infection, penile curvature, urethral injury or necrosis of the foreskin and penile tissues. To our knowledge, this is the first case report with necrotic foreskin as complication

Renal damage induced by pemetrexed causing drug discontinuation: a case report and review of the literature

Abstract Background Pemetrexed maintenance therapy holds tremendous potential in improving the survival of patients with advanced pulmonary adenocarcinoma. Major side effects include myelosuppression and cutaneous reactions. However, little data are available on pemetrexed nephrotoxicity. Our case describes clinically relevant renal events leading to treatment discontinuation in routine practice. Case presentation We report a case of a 69-year-old Moroccan man treated for metastatic non-small cell lung cancer. He was not on any other medications and he did not receive any nephrotoxic agents. He was exposed to intravenously administered contrast from thoracoabdominal computed tomography in the week of his last pemetrexed treatment. He developed kidney disease related to pemetrexed. He was submitted to renal biopsy, which showed acute tubular damage and interstitial fibrosis. His kidney function remained impaired, but stable, after discontinuation of pemetrexed therapy. He died 5 months later. Conclusions Medical oncologists should be aware of renal adverse events for patients with advanced non-small cell lung cancer eligible for pemetrexed maintenance therapy. Suggestions for mitigating the risk for renal toxicities (dehydration, non-steroidal anti-inflammatory drugs and zoledronic acid, radiocontrast agents) during pemetrexed maintenance should be followed to enable early detection and management of this adverse event