Acrometastasis of the hand. Case report

The authors report a case of metacarpal metastasis in a young woman, diagnosed as a dorsal hand tumor, revealing a bronchial adenocarcinoma. Acrometastases are rare. The distal location makes biopsy easy. Treatment is palliative with radiation or amputation; the prognosis is poor.     

Pseudomonas stutzeri osteitis: A case study

We report a case of osteitis in a 46-year-old patient, caused by Pseudomonas stutzeri following an open fracture of the left femur. The patient was treated with 1g ceftazidime every 8 hours for two weeks combined with 160 mg/day of amikacin for 10 days. A second-line ofloxacin oral treatment at 400 mg/day was then given during 4 weeks. Surgical treatment consisted in debridement of the fracture region. Sterilization of the fracture region led to an osteosynthesis by blade plate and bone graft. The result was favorable.     

Pachydermoperiostosis. A case report

INTRODUCTION: The pachydermoperiostosis (PDP) or primitive hypertrophic osteoarthropathy (HOA) is a rare hereditary disease. CASE RECORD: We report a 22-year-old man born to consanguineous marriage who presented presented with PDP. This patient disclosed an arthropathy, a clubbing, a diffuse periostosis, and a pachyderma of the hands, the feet and the forehead. All the examinations that were performed to look for an etiology remained negative. Diagnosis of PDP was considered and the patient treated with colchicine. DISCUSSION: We discuss the diagnostic issues raised by PDP, especially with the secondary HOA and chronic inflammatory rheumatisms.     

Pancreatic Adenocarcinoma in Young Adults in a Moroccan Population

Introduction

Pancreatic adenocarcinoma (PAC) is diagnosed generally in patients older than 60 years old of age. It is rarely diagnosed in young adults. There is a dearth of data in younger population of patients with pancreatic ductal adenocarcinoma regarding epidemiology, prognosis, and outcome. The aim of our study of young PAC patients was to characterize the clinical features of this distinct young population who were treated in the National Institute of Oncology of Rabat. We selected the age of 45 years and under as the cutoff point in defining our patient population of interest.

Materials and Methods

A retrospective analysis of patients referred to the national institute of oncology of Rabat with PAC, who were ≤45 years at the date of histological diagnosis, between January 2005 and February 2010, was performed. Epidemiological, clinical, and pathological staging and therapeutic and follow-up data were extracted.

Results

The study included 32 cases of PAC. Male:female ratio was 2:1. It represents 17 % of the entire population (N?=?176) of PAC referred to the National Institute of Oncology over the time of study period. Mean age was 44 years old (range: 28–45). Age range distribution was 1, 5, and 26 patients in age subgroups 20–29, 30–39, 40–45 years, respectively. Four patients (12.5 %) had a smoking history and two patients (6 %) had diabetes. None of the patients had a positive familial history of PAC or chronic pancreatitis. Tumor was located in head of pancreas in 75 %, body in 12.5 %, and tail in 12,5 %. Six patients (18.7 %) had localized resectable disease and underwent resection with curative intent. Seven (21.8 %) presented with locally advanced, inoperable disease. Two of them received only concurrent chemoradiation. Nineteen patients (59.3 %) presented as AJCC Stage IV. Four (12.5 %) of the six patients with resected tumors underwent adjuvant chemoradiation. Median overall survival was 50 % at median follow-up of 6.8 months.

Conclusion

This is the first reported study in our patient population of young patients with PAC. The data suggested that patients with younger age seem to have the same poor prognosis as the typical (older) patient population with PAC. No risk factors have been identified. However, this study is retrospective and more larger studies are needed in this young population.     

Huge left atrial appendage aneurysm revealed by chronic hiccups

Left atrial appendage (LAA) aneurysm is an extremely rare anomaly. So far, less than one hundred cases only have been reported worldwide. Revelation modes are dominated by complications such as arrhythmias and thromboembolic events. We herein report a pediatric case of huge congenital LAA aneurysm with an original revelation mode that has never been described before in medical literature.     

Asymptomatic interventricular septal dissection and giant coronary artery aneurysms simulating cardiac cysts: Multi-modality imaging

we report an exceptionnel case of asymptomatic interventricular septal dissection and giant coronary artery aneurysms simulating cardiac cysts with a focus in the interst of Multi-modality Imaging.     

Résultats du pontage coronaire en cas de dysfonction ventriculaire gauche (comparaison du cœur battant et de la CEC)

Background

The aim of this study was to compare the results of myocardial revascularisation with or without cardiopulmonary bypass in patients with impaired left ventricular function.

Patients and methods

Five hundred and sixteen consecutive patients who underwent coronary artery bypass grafting from January 2000 through December 2007 were analyzed retrospectively. One hundred and eight cases had a left ventricular EF (ejection fraction) of 45% or less. Of these patients, 78 underwent conventional coronary artery bypass (CCABG) and 30 underwent off-pump procedure (OCABG). The CCABG group received 300 IU/kg of heparin while the OCABG received 100 IU/kg. The off-pump coronary surgery was carried out using a tissue stabilizer Octopus II. Different pre-, per- and postoperative variables were evaluated among both groups. Statistical analysis was performed by SPSS 11.5. The variables were compared between these two groups using univariate analysis (Chi² test, Fisher's test exact) for qualitative variable and (Student's t test, Mann-Whitney's test) for quantitative variable.

Results

Patients profiles and risk factors were similar among both groups except for age (CCABG: 57.8 ± 9.2 year vs OCABG: 52 ± 9.9 year; P = 0.004) and left ventricular EF (CCABG: 37.4 ± 6.3% vs OCABG: 34 ± 7.8%; P = 0.02). The number of grafts performed per patient was significantly more among patients who underwent extracorporeal circulation (CCABG: 2.53 ± 0.7 graft/patient vs OCABG: 1.77 ± 0.8 graft/patient; P < 0.0001). The hospital mortality was more among CCABG group 9% vs 3.3% in OCABG but the difference was not significant (P = 0.3). However, the operative time and the operative room stay were long in CCABG (252 ± 61 min vs 175 ± 38 min; P < 0.0001 – 389 ± 70 min vs 298 ± 54 min; P < 0.0001). The ventilation time was also long in CCABG (32.3 ± 67 hour vs 10.4 ± 5.9 hour; P = 0.15). There was more postoperative myocardial infarction in CCABG (P = 0.008), but the EF increased and was better in CCABG.

Conclusion

Off-pump coronary artery bypass surgery provides satisfactory operative results for most patients with reduced left ventricular function. Prospective and randomly study will be necessary before concluding.