Prise en charge de la maladie de Crohn fistulisante hors fistules ano-périnéales dans une population marocaine : à propos de 60 cas

Introduction

Crohn’s disease is an inflammatory enterocolitis, witch may be complicated by enterocutaneous, intestinal, entero-vesical and recto-vaginal fistulas.

Materials and methods

This is a retrospective study of 60 cases of fistulizing Crohn’s disease followed in the Department of Gastroenterology “B” at Ibn Sina Hospital in Rabat.

Results

Of a total of 245 cases of Crohn’s disease, 60 patients (24.5%) had a fistulizing form, excluding anoperineal fistulas. The location of fistulas was predominatly an intestinal fistulas (44%), followed by enterocutaneous fistulas (26%), enterovesical fistulas (10%) and recto-vaginal fistulas (7%). Medical treatment with immunosuppressors was prescribed in 15 cases of intestinal fistulas, 2 cases of enterocutaneous fistulas and 1 case of recto-vaginal fistula followed by a closure of fistula in 26% of the intestinal fistulas and treatment failure in the other locations. Surgical treatment was indicated immediately in 70% of the cases and after failure of medical treatment in 11.3% of the cases. Endoscopic recurrence was significantly more frequent in patients who postoperativelyreceived aminosalicylates (61.5%) compared to those treated with immunosuppressor (25%) (p <0.01). Clinical remission was also significantly associated with medical treatment with immunosuppressors (78.4%) compared with aminosalicylates (21.6%) (P = 0.04).

Conclusions

Surgical treatment remains indicated in themajority of cases of fistulizing Crohn’s disease (70%). In our study, endoscopic recurrence and clinical remission were significantly associated with the type of medical treatment postoperatively.     

Prise en charge thérapeutique des métastases hépatiques des cancers colorectaux. À propos de 22 cas

Introduction

Therapeutic management of hepatic metastases of colorectal cancer has progressed during recent years thanks to the development of surgical techniques, chemotherapy, portal embolisation and radiofrequency.

Study aim

To study the rate of resecability and the gain in resecability resulting from other therapies.

Patients and methods

We carried out a retrospective survey including 22 patients treated in our centre for hepatic metastases of colorectal cancer during the last four years.

Results

Six right hepatectomies were performed of which 3 after portal ligature, 2 left lobectomies, 2 central hepatectomies, 4 segmentectomies, 3 enucleoresections, 2 cases were resected after radiofrequency and 3 patients had chemotherapy as palliative treatment for diffuse hepatic metastases. The rate of resecability was 22.7 % and thanks to chemotherapy, radiofrequency and portal ligature this increased to 86.3%.

Conclusion

Our study confirmed that the rate of resecability can be increased by other therapies.     

Sarcome granulocytaire : à propos de 2 cas et revue de la littérature

Introduction

Myeloid sarcomas are uncommon proliferations of immature myeloid cells occurring in any extramedullary organ. We report here two cases of myeloid sarcomas in patients with, respectively, a polycythemia vera and a myelodysplastic syndrome.

Prise en charge infirmière des enfants atteints de coqueluche

Pertussis is again a modern disease. Most cases occur in infants younger than 1 year of age. Adults are the usual sources for index cases. Infants below 6 months of age should be admitted to hospital, those under 3 months being at maximal risk of apnea and bradycardia. Nurses play a major role by providing continuous monitoring, refeeding, counting paroxysms and avoiding nociceptive stimuli. Eradication of B. pertussis is hastened by macrolides which are prescribed to the index case and to close household contacts. The best protection is offered by pertussis vaccine.