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Y Sahnoun

Publications and source records attributed to Y Sahnoun.

At least 19 recordsLinked to original sources

[Costo-vertebral collection complicating multifocal echinococcosis: surgical drainage via an anterior approach].

INTRODUCTION: Costo-vertebral echinoccoccus is a rare and serious condition which often presents with neurological complications requiring urgent surgical intervention. CASE REPORT: We report the case of a seven year old girl admitted with a clinical picture suggesting medullary compression secondary to multifocal Hydatid disease. As well as a costo-vertebral cyst with extension into the spinal canal, lesions were also seen in the lower lobe of her right lung and throughout the liver, confirmed by CT scan and by magnetic resonance imaging. A resection of Hydatid material as well as the posterior part of the 4th rib, the transverse process of the 4th costal vertebra and adjacent bone was carried out via a posterolateral thoracotomy. The cyst in the right lung was successfully excised at the same operation. Three months later six hepatic lesions were removed via a subcostal approach again without complication. A scan 23 months later revealed no evidence of residual hydatid disease. CONCLUSION: This case illustrates the pathophysiological features of costovertebral Hydatid disease and the advantages of an anterior surgical approach.

Child↗

[Cardiac multifocal hydatid cyst].

Hydatid cysts in the heart are rare, with an unpredictable outcome and numerous complications, requiring rapid surgical management. We report the case of a 19 year old female patient, who underwent surgery with extra corporeal circulation for a hydatid cyst of the interventricular septum of the heart, complicated by secondary pulmonary echinococcus infection, confirmed on CT and MRI. Resection of the cyst was performed via a right auriculotomy. The post operative period was favourable; the other pulmonary sites were treated medically. We emphasise the methods of diagnosis and management.

Adult↗

The effects of drainage with a Redon versus a conventional drain on postoperative pain and blood loss after valve replacements.

AIM: The aim of this study was to assess the influence of drainage with a Redon drain versus a conventional drain on postoperative pain and blood loss after valve replacements. METHODS: After approval by the local Ethics Committee and written informed consent, 30 patients, 20-60 years of age, scheduled for first elective valve replacement were included. After standardized anaesthetic regimens, cardiopulmonary bypass and coagulation therapy procedures and at the end of the operation, the patients were randomly assigned to 1 of 2 groups: (GI, n=15): drainage with 4 Redon drains; (GII, n=15): drainage with 2 conventional drains. Postoperative pain intensity at rest (VAS-R), during coughing and mobilization (VAS-M) in bed was independently evaluated using a visual analogue scale (VAS 100 mm) at 6 hourly intervals until 48 h after admission to the ICU (Ho). All patients received 2 g of paracetamol after obtaining the VAS score (8 g/24 h). No other analgesic agents were used. All patients were submitted to 2D echocardiography to verify the presence of pericardial effusion 24 h after surgery. Values are expressed as means. Pearson's chi squared and ANOVA (for repeated measurements) were used for statistical analysis. P<0.05 was considered significant. RESULTS: There was no statistically significant difference in the mean postoperative VAS-R and VAS-M, and in the mean postoperative total blood drainage 822.3 ml in GI, versus 704.3 ml in GII. Non pericardial effusion was found, and we did not see side-effects in any of the patients. CONCLUSIONS: We have shown that drainage with a Redon drains versus a conventional drain does not influence postoperative pain intensity and blood loss after valve replacements.

Adult↗

[Traumatic lung herniation in a child].

Traumatic lung hernia of the chest wall is unusual in pediatric patients. Most acquired traumatic lung hernia occur at the site of injury or on the anterior parasternal chest wall because the external intercostal muscle is absent from the cost cartilaginous junction to the sternum. A five-year-old girl presented with such a hernia after severe blunt trauma to her right torso. A chest radiograph, immediately after the injury and a CT scan showed lung herniation. She was treated surgically by direct repair of the chest wall defect. The recovery proceeded without complications. With early identification and appropriate surgical or video-assisted repair, symptomatic pulmonary hernia can have an excellent prognosis and very low probability of recurrence.

Child, Preschool↗

Culture-negative endocarditis due to Chlamydia pneumoniae.

We report on the case of a 54-year-old woman diagnosed as having culture-negative endocarditis (clinical and histopathologic evidence compatible with a recent episode of endocarditis). The responsibility of Chlamydia pneumoniae in this episode of endocarditis was suggested by a serological study and was then confirmed by the positive results of PCR and in situ hybridization tests with aortic and mitral valves tissues. To our knowledge, this is the first case of endocarditis due to C. pneumoniae confirmed by molecular biology-based techniques.

Blood↗

[Clinical case of the month. Iliac artery endofibrosis in a soccer player].

Arterial endofibrosis is a rare disease, usually affecting the external iliac artery in highly trained athletes. We report a case of external iliac endofibrosis in 42-year-old top level athlete. Clinical consequences were a high intensity exercise related sensation of swollen thigh, with normal clinical examination. Ultra sound investigation showed fibrotic thickening of the left external iliac artery. Angiography confirmed stenosis of the left external iliac artery. The patient was treated surgically, he underwent remodeling of his left external iliac artery with venous angioplasty. No complications occurred in the post operative course, and the patient return to training after three months.

Adult↗

[Thoracic aortic aneurysm complicating pseudo-coarctation].

INTRODUCTION: The aneurysm of the descending aorta complicating a pseudocoarctation, itself due to a congenital elongation with kinking of the aorta is a rare entity. OBSERVATION: We report a case of aortic aneurysm discovered in a 72 years old woman without notable antecedents, which was referred for recurrent bronchitis. The X-ray showed a calcified opacity of the upper mediastinum, 5 cm of large. A thoracic CT-scan evoked the presence of a circulating sacciform aneurysm with calcified walls, developing on the final part of the aortic arch, which was with abnormally ascending way going up to the cervico-thoracic orifice and carrying out an aspect of aortic kinking. The assessment was complemented by a RMI as well as an aortic opacification. A thoracic scintigraphy showed an hypoperfusion of the left lung. The remainder of the cardiac assessment was normal. The patient was operated under femoro-femoral extracorporeal circulation through a left posterolateral thoracotomy of the 4th intercostal space. The examination showed a 7 cm diameter calcified aneurysm of the descending thoracic aorta complicating a tight stenosis in connection with an elongation and a kinking. The upper section of the aorta was shifted towards the pleural dome. The aortic section above aneurism was of normal size whereas the lower section was dilated. The aneurism was excised and a prosthetic graft was carried out. The surgery follow-up was marked by an hemodynamic stability, without neurological deficit. A ventilatory assistance was necessary during 5 days. Currently with 8 months follow-up, the patient goes well. COMMENTS: A prosthetic replacement in front of this type of aneurism is legitimate given the risk of the occurrence of complications secondary to the pseudocoarctation (arterial hypertension, aortic insufficiency) or to the aneurism itself, dissection or compression of vicinity (pulmonary artery).

Aged↗

Hydatid cyst of the heart located in the interventricular septum.

Cardiac hydatosis is a rare condition, and the localization of a hydatid cyst within the interventricular septum is exceptional. A 61-year-old man found to have a hydatid cyst of the interventricular septum is reported. Presenting manifestations were congestive heart failure and signs suggestive of an aortic valvulopathy. Diagnosis was made by Doppler echocardiography and confirmed by magnetic resonance imaging. The cyst was approached surgically by right ventriculotomy. Despite a technically successful intervention without rupture of the cyst or appearance of a conduction delay, the patient died on the 20th postoperative day because of acute respiratory distress syndrome complicating infectious pneumonia.

Animals↗

[Acute dissection of the ascending aorta complicating aortic coarctation successfully treated with surgery].

Vascular complications and arterial hypertension are major risk factors in the evolution of disease connected with coarctation of the aorta. Supra- and sub-stenotic aortic aneurysms are classical findings, whereas a dissecting aneurysm is a rare occurrence. In this study, we report on a case of acute dissection of the ascending aorta complicating a poorly followed-up coarctation of the aorta in a ten-year-old girl. The diagnosis, determined by X-ray of the thorax, was confirmed by echocardiography and magnetic resonance imaging. The first operative stage consisted of treating the aneurysm. After resection of the latter, an impregnated dacron prosthesis was inserted in termino-terminal. The immediate result is satisfactory, and a second operation is planned for the aortic coarctation.

Acute Disease↗

[Therapeutic attitude in postcatheterization symptomatic stenosis of the subclavian vein].

We report 4 cases of subclavian vein stenosis after hemodialysis occurring in 4 women with a mean age of 36 years. The duration of subclavian catheterization was 1 to 11 months. The diagnosis was established by angiography or phlebography. The treatment was always surgical: axillo-internal jugular bypass: 1 case; deviation of the internal jugular vein: 1 case; basilo-internal jugular bypass: 1 case; axillo-axillary bypass: 1 case.

Adult↗

[Transposition of the external jugular vein onto the subclavian vein in the treatment of symptomatic stenosis of the right subclavian vein].

Subclavian vein stenosis is a classical complication of longterm venous catheterization in hemodialysis. We report the case of a 74 years-old woman, operated for multiple arteriovenous fistulae, admitted to hospital with upper-limb oedema. Venous angiography demonstrated subclavian stenosis. Surgical treatment was performed by transposition of the external jugular vein onto the subclavian vein with a good result.

Aged↗

Diagnosis of human hydatidosis: comparison between imagery and six serologic techniques.

Echography and/or chest radiograph in association with six serologic (immunologic) methods were tested for their ability to diagnose human hydatidosis. The immunologic techniques used were latex agglutination, counter immunoelectrophoresis, enzyme-linked immunosorbent assay (ELISA) with whole hydatid fluid and with antigen 5, a thermobabile lipoprotein that elicits the arc 5 precipitin line in immunoelectrophoresis. In this report, the results of examinations of 273 patients are presented. Of these, 243 cases were surgically proven to have hydatidosis, whereas 30 of the 273 that were strongly suspected of having hydatid cysts by radiology were shown to have other pathologies. The ELISA was more sensitive than the other methods, with 204 of 243 sera shown to be positive. The remaining 39 sera that gave false-negative results were tested using two recently developed methods, enzyme-linked immunoelectrodiffusion assay (ELIEDA) and immunoblotting (electrophoretic migration of hydatid fluid antigens under denaturing but nonreducing conditions, blotting, and immunoenzymatic assay). Immunoblotting, using our experimental conditions, had a greater sensitivity than the ELIEDA with this technique. Four of 37 sera showed one to three bands of 65, 12, and 8 kD. The sensitivity of the ELISA did not increase with either the size or type of cyst. Comparison of radiology with serology confirmed a good correlation between the two methods. Nevertheless, serology is more specific but less sensitive than imagery.

Adolescent↗

[Persistent sciatic artery. Apropos of a new case].

We report a new case of persistent sciatic artery. An 18-year-old girl was hospitalized with ischemia of the left foot. An arteriogram demonstrated a sciatic artery completely persistent. The superficial femoral artery was hypoplasic. A left femoro-popliteal by pass with saphenous vein graft was practised. After the operation, the patient did well and had no complications. We present this observation with a literature review about clinical arteriographic and surgical aspects of this vascular structure and its complications.

Adolescent↗

[A new case of false aneurysm of the superior mesenteric artery].

We report a case of successful management of a false aneurysm of the superior mesenteric artery. The only helpful clinical manifestations were episodes of previous abdominal pain and a history of bacterial endocarditis. The surgical management involved endo-aneurysmorrhaphy. The patient's post-operative course was unremarkable.

Adult↗

[Arteritis of the lower limbs in diabetics].

37 cases of diabetic arteritis of lower limbs in diabetic patients were retrospectively studied, from 1988 to 1991. Mean age was 66 years. Masculine predominance was evident with a sex ratio of 1/10. The majority of our patients have consulted at a late stage with trophic disturbance of inferior limbs, indeed 18 patients were seen at the 4th stage. Mortification was observed in 55% cases. Arteriography has allowed to show an elective localization of lesions at the femoralis arteria, profunda femoralis arteria and distal axes. Operative indication was made in 22 patients. Conservative surgery was performed for 50% of the operated patients. Conservative surgery results had been relatively less satisfactory than for others arteritis, particular because of late consultation and the condition of diabetic patients.

Aged↗

[Takayasu disease. Diagnostic criteria and therapeutic procedure].

A study of 11 cases of Takayasu's disease, collected from the cardio-vascular surgical service of Sfax, has been realized during the 4 year-period from 1988 to 1991. Womanly predominance was neat. The average age was 40 years, with extremes of 24 and 56 years. Dominant revealing symptoms was upper limb ischaemia found in 9 cases, a reno-vascular hypertension rebelled to medical treatment was noted in 2 cases. Arteriography have showed a preferential localization of lesions in the subclavian artery essentially at the post-vertebral segment. Lesions types were dominated by stenosis and obliteration, then aneurysms were rare. Operative indication was posed in 9 cases. 11 revascularisations procedures were performed of which 10 arterial by passes and one resection graft. Two bypasses were obstructed, the 9 remaining bypasses have a good previous checked clinically and by angiography (or echo-doppler) with a mean follow-up of 14 months.

Adult↗

[Extralobar pulmonary sequestration. A diagnostic pitfall].

The authors report a case of dual malformation: pulmonary (sequestration) and mediastinal (pericardial). This case is original in that clinically and at standard radiography sequestration was mistaken for hydatid cyst. The diagnosis was corrected after anatomico-pathologicale examination of the operative specimen.

Adult↗