[Cranial subdural haematoma following spinal anaesthesia].
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Biomedical subjects
Publications and source records attributed to W Maazouzi.
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We report a case of right atrial rupture due to blunt trauma by a hoof kick to the anterior chest wall. We describe our successful management of this case. We suggest that a diagnosis of cardiac chamber rupture should be considered in all cases of blunt thoracic trauma.
OBJECTIVE: To estimate qualitatively and quantitatively the anaesthetic activity in Morocco to identify of the priorities and the norm to recommend. STUDY DESIGN: The investigation was realised from July 1999 to December 1999. It lasted seven days from Tuesday 8 PM to the following Tuesday 8 PM. A questionnaire was addressed to each hospital. One responsible has been chosen for each city. Data has been processed using the programming languages Microsoft Visual Basic. SETTING: All Moroccan's hospitals practicing anaesthesia: university hospitals (UH), public hospitals (PH), and private sector (PS). PATIENTS: All anaesthetic procedures realised by an anaesthetists; anaesthesia in medical office or dental surgery was excluded. RESULTS: An inventory of 2,630 anaesthesia was made. Anaesthesia distribution according to the type of hospitals was the same; PH = 35.7%, UH = 34.3% and PS = 29.96%. The preanaesthetic consultation was achieved in 47% of cases. Premedication was done in 28.5% of cases. General anaesthesia represented 3/4 of total anaesthesia. Thiopental was the drug the more frequently used. Gallamine and pethidine were still used in PH. Locoregional anaesthesia was realised in only 15% of cases. Electrocardioscopic surveillance not constant (65%), capnography almost absent in PH, pulse oximetry used in UH and PS. Ambulatory anaesthesia was used in 20% and emergency surgery in 30% of cases. CONCLUSION: Questioning about the Moroccan practice of anaesthesia is raised by this survey mostly because of drugs and monitoring use.
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A 25-year-old male presented purulent meningitis associated with transverse myelitis. Spinal T2-weighted MRI showed a large spinal cord with an intramedullary high signal. Infection resolved with antibiotic therapy but spastic paraplegia persisted. Four months later, he developed a Guillain-Barré syndrome with clinical and biological signs of systemic lupus erythematosus. Final outcome was fatal despite corticosteroid and immunoglobulin treatment.
We report two cases of type III rupture of the left ventricle posterior wall, situated midway between the mitral annulus and the posterior papillary muscle and occurring in immediate continuations of a mitral valvular replacement. The first case has occurred at the moment of the canulas removal in a 28 years old patient operated for mitral stenosis. The tear was repaired with horizontal mattress sutures through felt strips on the external surface of the heart. The immediate post operative course was marked by bleeding recurrence and cardiac failure which has led to death. In the second case, a 68 years old man was operated for degenerative mitral insufficiency. The rupture has occurred just before closing the chest. The repair was realized successfully by using an intra-ventricular patch. The chordae tendinae removal constitutes a factor predisposing to the left ventricle posterior wall rupture. The repair has to use an intra-ventricular patch. The prevention is based on the preservation of the continuity between the mitral annulus and papillary muscles by preserving the sub-valvular apparatus or by using synthetic chordae.
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Multiple hydatidosis in a thoracic localization is unusual and a cardiac localization very exceptional. We report a case of multiple hydatidosis greatly improved by medical treatment with albendazole which was associated with a cardiac cyst successfully treated by surgical resection. No recurrence has been observed at 4 year follow-p. We point out therapeutic management options in these unusual forms of the disease.
The authors report the case of an acquired left ventricle-right atrial communication after open chest trauma. The initial clinical presentation was a haemothorax and haemopericardium responding well to emergency surgical drainage. Secondarily, a systolic murmur suggesting a ventricular septal defect and signs of right heart failure were observed. Colour Doppler echocardiography led to the diagnosis of a left ventricle-right atrial communication associated with tricuspid regurgitation with dilatation of the right heart chambers and pulmonary hypertension. At surgery, a defect in the membranous interventricular septum was confirmed with rupture of the septal tricuspid leaflet causing tricuspid regurgitation. The surgeon closed the defect with a patch and performed a De Vega tricuspid valvuloplasty. The postoperative outcome was uneventful.
The authors report a case of multiple myxoma of the right ventricle treated surgically. One of the myxomas infiltrated the right ventricular ourflow tract, the main pulmonary artery and its branches. This case underlines the difficulty of radical resection of infiltrating cardiac myxomas.
Multiple recurrences of cardiac myxomas are rare and high-light the problem of re-operation. We report a case of double recurrence of left atrial myxoma and analyse the causes of recurrence. In our case, the first myxoma was inserted in the left inter-atrial septum, and the first recurrent tumor was inserted near the pulmonary vein, forming adhesion with the inter-atrial septum. The second recurrent tumor was inserted in the inter-atrial septum. The first operation resected the tumor, including part of the inter-atrial septum, and the sides of the septum were sutured. The two following operations used a patch for the septoplasty. This case is sporadic and not included in the high risk myxoma recurrence syndrome. Incomplete tumor resection is incriminated in one third of recurrences but seems unlikely in our case.
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The authors underline the value of echocardiography in the diagnosis and postoperative management of a case of cor triatrium. The patient was a 22 year old male who presented with dyspnoea of effort (stage III of the NYHA classification) and clinical signs of an infundibulo-pulmonary syndrome with tricuspid regurgitation. Chest X-ray revealed cardiomegaly (CTI = 61%) and filling-in of the aorto-pulmonary window. The electrocardiogram showed left atrial and right ventricular hypertrophy. The echocardiogram, the key to diagnosis, showed an abnormal echogenic structure within the left atrium. Cardiac catheterisation demonstrated pulmonary hypertension and a difference of pressure between the two lungs. The membrane dividing the left atrium and partial anomalous pulmonary venous drainage from the left lung into the superior vena cava were visualised on late stage pulmonary angiography. Surgical excision of the membrane in the left atrium and ligation of the anomalous venous drainage provided a radical cure to all these malformations.
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