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Neglected Giant Schwannoma of the Sciatic Nerve – A Case Report 被忽视的巨大坐骨神经鞘瘤1例报告
Pub Date : 2020-02-07 DOI: 10.15342/IJMS.V5IR.212
T. Awad, M. Mahmoud
Background :  Schwannomas originating from the sciatic nerve are extremely rare and usually present as a pathological mass in palpable examination or pain located in the thigh. Motor and sensory deficits are observed more often when the size of the tumor is more than 40 mm. Case Description :  A 19-years- old female patient was referred to Suez Canal University Hospital after 6 years of pain and 2 years of improper management. Neurological examination and MRI of the right thigh was done and revealed huge mass attached to the right sciatic nerve. Surgical excision was undertaken, carefully dissecting the lesion from the sciatic nerve. Histopathological examination revealed the tumor to be a schwannoma. The patient had marked postoperative recovery with marked pain reduction and improved neurological deficits. Conclusions :  Schwannomas of the sciatic nerve are rare tumors eccentrically located on the nerve. Although rare, schwannoma of the sciatic nerve should be systematically suspected if thigh mass or persistent sciatica is reported. Surgical excision has good prognosis.
背景:起源于坐骨神经的神经鞘瘤极为罕见,通常表现为可触及的病理肿块或位于大腿的疼痛。当肿瘤大于40mm时,运动和感觉功能障碍更为常见。病例描述:一名19岁女性患者在经历了6年的疼痛和2年的不当治疗后被转介到苏伊士运河大学医院。对右大腿进行神经学检查和MRI检查,发现右侧坐骨神经附着巨大肿块。手术切除,仔细解剖病变从坐骨神经。组织病理学检查显示肿瘤为神经鞘瘤。患者术后恢复明显,疼痛减轻,神经功能缺损改善。结论:坐骨神经神经鞘瘤是一种少见的位于神经外侧的肿瘤。虽然罕见,但如果报告大腿肿块或持续性坐骨神经痛,应系统地怀疑坐骨神经神经鞘瘤。手术切除预后良好。
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引用次数: 0
Breast cancer skin recurrence: a comprehensive review on pathogenesis, treatment, and prognosis 乳腺癌皮肤复发:发病机制、治疗和预后的综合综述
Pub Date : 2019-09-28 DOI: 10.15342/IJMS.V6IR.299
G. Pechlivanides, V. Kalles, G. Boutsikos, L. Papadopoulos
The manifestation of breast cancer recurrence in the form of skin lesions has always been a frustration for both the oncologist and the breast surgeon. Surgeons are asked to treat a recurrent disease that is yet unclear whether it represents disseminated or local disease. Cancer cells are found both in the lymphatics as well as the blood vessels, but, on the other hand, skin recurrence usually does not respond well to the current forms of systemic treatment, and it often needs some form of local treatment for symptom control.
乳腺癌以皮肤病变的形式复发一直是肿瘤学家和乳房外科医生的挫折。外科医生被要求治疗复发性疾病,但尚不清楚它是播散性疾病还是局部性疾病。癌细胞既存在于淋巴管中,也存在于血管中,但另一方面,皮肤复发通常对目前的全身治疗效果不佳,通常需要某种形式的局部治疗来控制症状。
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引用次数: 0
FACTEURS ASSOCIÉS AUX MANIFESTATIONS EXTRA ARTICULAIRES AU COURS DE LA POLYARTHRITE RHUMATOÏDE 类风湿性关节炎关节外表现的相关因素
Pub Date : 2019-09-28 DOI: 10.15342/IJMS.V6IR.277
Salma Ksir, N. Akasbi, Krystel Efemba, A. E. Aissaoui, El Kinany Khaoula, T. Harzy
Introduction :  Rheumatoid arthritis is a chronic, systemic and inflammatory joint disease that primarily affects the joints and can be associated with a variety of extra-articular manifestations. The aim of this study is to determinate the frequency and the factors associared with those extra-articular manifestations. Materials and methods:  Cross-sectional study of hospitalized cases of rheumatoid arthritis  in our department between January 2012 and January 2018.  We studied the prevalence of the extra-articular manifestations and associated factors. The analysis was done by the software EPI INFO 3.5.4. Results :  294 cases of rheumatoid arthritis included. The average age was 53.2 years +/- 12.3 with female predominance F / M = 6.1. The diagnosis lag time was 10.7 +/- 6.9 years. Half of our patients (50.7%) had systemic manifestations. In order of frequency, we distinguish: Osteoporosis (39.6%), Sjogren's syndrome (22.1%), pulmonary involvement (16.1%), dermatological manifestations (8.8%), cardiac involvement (8.8%), ocular involvement (3.1%)  carpal tunnel syndrom (1.3%) and vasculitis (1.3%). The extra-articular manifestations were associated with several factors on bivariate analysis : advanced age (p = 0.014), longer duration of disease (p = 0.006), deformities (p = 0.000), seropositivity (p = 0.02), high titers of rheumatoid factor (p = 0.03), destruction (p = 0.02), bone erosions (p = 0.012) and non-use of biotherapy (p = 0.04). Factors whose association was statistically significant, after multivariate logistic regression analysis, were: advanced age (p = 0.04, OR = 1.02 [1.001-1.043], and longer duration of disease (p = 0.02 OR = 1.04 [1.005-1.082]). Conclusion :  In our Moroccan context, half of patients with rheumatoid arthritis  had extra-articular manifestations. Older patients with longer disease evolution are the most involved.
类风湿关节炎是一种慢性、全身性和炎症性关节疾病,主要影响关节,并可伴有多种关节外表现。本研究的目的是确定这些关节外表现的频率和相关因素。材料与方法:对2012年1月至2018年1月我科类风湿性关节炎住院病例进行横断面研究。我们研究了关节外表现的患病率及相关因素。采用EPI INFO 3.5.4软件进行分析。结果:纳入类风湿关节炎294例。平均年龄53.2岁+/- 12.3岁,女性优势F / M = 6.1。诊断滞后时间为10.7±6.9年。半数患者(50.7%)有全身性表现。根据发生频率,我们区分为:骨质疏松症(39.6%)、干燥综合征(22.1%)、肺部受累(16.1%)、皮肤病表现(8.8%)、心脏受累(8.8%)、眼部受累(3.1%)、腕管综合征(1.3%)和血管炎(1.3%)。在双变量分析中,关节外表现与以下几个因素相关:高龄(p = 0.014)、病程较长(p = 0.006)、畸形(p = 0.000)、血清阳性(p = 0.02)、类风湿因子高滴度(p = 0.03)、破坏(p = 0.02)、骨侵蚀(p = 0.012)和未使用生物疗法(p = 0.04)。经多因素logistic回归分析,相关性有统计学意义的因素为:高龄(p = 0.04, OR = 1.02[1.001-1.043])和病程较长(p = 0.02 OR = 1.04[1.005-1.082])。结论:在我们摩洛哥的研究中,一半的类风湿关节炎患者有关节外表现。病情发展时间较长的老年患者最为常见。
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引用次数: 1
Unusual Presentation of a Rare Chest Wall Tumor: Giant Cell Tumor of Bone 罕见胸壁肿瘤的罕见表现:骨巨细胞瘤
Pub Date : 2019-05-17 DOI: 10.15342/10.15342/IJMS.V6IR.263
Y. Baiz, O. Afandi, H. Fennane, Y. Msougar
Introduction: Giant cell tumours account 5% of all bone tumours. However, the anterior chest wall is rarely involved .Clinical case: This is a 68-year-old housewife who has been thyroidectomized, for 11 years and is under hormone replacement therapy, and hysterectomized for 6 years after a uterine tumor. She is present for the onset of a 5 month old hard submammary mass on the left associated with left anterior chest pain under mammals. The clinical examination had found an irregular hard mass under left mammary which is fixed to the anterior arch of the 4th left rib. A thoracic x-ray showed a limited left hilo-axillary with an homogenously dense opacity. The thoracic CT scan showed the presence of a thoracic parietal mass of osteolytic tissue density centered on the anterior arch of the 4th left rib; without contrast agent, the surgical exploration through thoracotomy revealed a thoracic parietal tumoral process at the expense of the anterior arch of the 4th limb pushing the corresponding lung inwards. Surgical excision allowed ablation of the whole tumor in monobloc towards a healthy zone. The anatomopathological study of the operative specimen showed a morphological and histopathological aspect compatible with a costal tumor with giant cells. The postoperative recovery was marked by a good clinical and radiological improvement. The last check up after the surgery revealed that the patient was still asymptomatic. Good clinical, biological and radiological improvement was noted with a decline of 8 months.Conclusion: Giant cell tumors are aggressive bone tumors, yet histologically benign. The chosen examination is a thoracic CT scan with surgical treatment. A clinical and radiological monitoring is necessary. The recurrence is rare, but it usually necessitates a second surgery. The objective of this clinical observation is to highlight the possibility, although rare, of a giant cell tumor in case of the swelling of the soft parts, and a lytic lesion of the anterior part of a rib. Therefore, this tumor must be added to the list of diagnoses to be mentioned in this situation.
巨细胞瘤占所有骨肿瘤的5%。但很少累及前胸壁。临床病例:68岁家庭主妇,因子宫肿瘤行甲状腺切除术11年,现正接受激素替代治疗,子宫切除术6年。她因5个月大的左侧硬乳腺下肿块而就诊,并伴有哺乳动物左侧前胸痛。临床检查发现左乳房下一不规则硬块固定于左第四肋前弓。胸部x线片显示有限的左腋窝及均匀致密影。胸部CT扫描显示以左第四肋骨前弓为中心存在胸壁溶骨性组织密度肿块;在没有使用造影剂的情况下,通过开胸探查发现一个胸壁肿瘤突起,牺牲了第4肢的前弓将相应的肺向内推。手术切除使整个肿瘤在整体上向健康区消融。手术标本的解剖病理学研究显示,形态学和组织病理学方面与伴有巨细胞的肋部肿瘤相符。术后恢复表现为良好的临床和放射学改善。手术后的最后一次检查显示患者仍无症状。临床、生物学和放射学改善良好,下降8个月。结论:巨细胞瘤是侵袭性骨肿瘤,但组织学上是良性的。选择的检查是胸部CT扫描和手术治疗。临床和放射学监测是必要的。复发是罕见的,但它通常需要第二次手术。本临床观察的目的是强调的可能性,虽然罕见,巨细胞肿瘤的情况下,软部分的肿胀,并在肋骨前部的溶解性病变。因此,在这种情况下,必须将该肿瘤添加到诊断列表中。
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引用次数: 0
MANIFESTATIONS THORACIQUES DE L’ANGIOBEHÇET
Pub Date : 2019-03-08 DOI: 10.15342/IJMS.V6I0.247
L. Senhaji, B. Alami, B. Amara, M. Biaze, M. Benjelloun, M. Serraj
Introduction : L’atteinte vasculaire dans la maladie de Behcet touche 5 a 40% des patients. Tous les vaisseaux quel que soit leur type, taille ou localisation peuvent etre concernes. Cette atteinte est grave pouvant engager le pronostic vital. Observations : On a collige 12 cas de Janvier 2010 a Janvier 2017. Il s’agit de 11 hommes et 1 femme avec un âge moyen de 32,5ans. L’atteinte veineuse concernait 11 malades avec une thrombose de la veine cave superieure (VCS) chez 6 malades, thrombophlebite des membres inferieurs chez 5 malades et une thrombose de la veine cave inferieure et des veines sus hepatiques chez 1 malade. L’atteinte arterielle touchait 9 malades (75%) avec anevrysme des arteres pulmonaires chez 5 malades et une embolie pulmonaire chez 5 autres. L’atteinte cardiaque concernait la moitie des patients a type de pericardite chez 3 malades et de thrombus intra cardiaque chez 4 malades. Conclusion : L’atteinte thoracique de l’angiobehcet est frequente et grave necessitant un diagnostic rapide et une therapeutique specifique intense pour ameliorer son pronostic.
简介:5 - 40%的Behcet病患者受到血管损害。所有船只,无论它们的类型,大小或位置都可以被关注。这种损害很严重,可能危及生命。观察:2010年1月至2017年1月共收集病例12例。其中男性11人,女性1人,平均年龄32.5岁。静脉受累11例,6例为上腔静脉血栓形成,5例为下肢血栓性静脉炎,1例为下腔静脉和肝静脉血栓形成。动脉受累9例(75%),肺动脉动脉瘤5例,肺栓塞5例。一半的a型心包炎患者中有3例心脏受累,4例心内血栓形成。结论:血管成形术是一种常见而严重的疾病,需要快速诊断和强烈的特异性治疗来改善预后。
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引用次数: 0
TUBERCULOSE MULTIFOCALE VERTEBRO-MEDULLAIRE ETAGEE NON CONTIGUË ET MULTI-VISCERALE CHEZ UN SUJET IMMUNOCOMPETENT 免疫能力受试者的非连续多灶性椎脊髓结核和多内脏
Pub Date : 2019-03-08 DOI: 10.15342/IJMS.V5IR.226
Amina Mounir, Meryeme Karhate Andalousi, N. Akasbi, Mohammed Chakib Benjelloune, T. Harzy
La tuberculose est une maladie infectieuse due au bacille de Koch (BK). La forme multifocale s’associe habituellement a une immunodepression notamment du VIH. A ce propos, nous rapportons un cas inhabituel de tuberculose multifocale associant des foyers visceraux a une atteinte vertebro-medullaire etagee, cervicale dorsale et lombaire non contigue, chez un sujet immunocompetent. Le patient a eu un traitement medico-chirurgical. Il s’agit d’une maladie a diagnostic difficile. Nous discuterons, a travers ce cas, les particularites cliniques, diagnostiques et therapeutiques de cette entite clinique.
结核病是一种由科赫杆菌(BK)引起的传染病。多灶型通常与免疫抑制有关,特别是艾滋病毒。在这方面,我们报告了一个不寻常的多灶性结核病病例,在免疫能力强的受试者中,内脏病灶与非连续的椎体-脊髓损伤相关。病人接受了外科治疗。这是一种很难诊断的疾病。通过这个案例,我们将讨论这个临床实体的临床、诊断和治疗特性。
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引用次数: 0
ACQUIRED TRACHEO-ESOPHAGEAL FISTULA: A RARE CASE REPORT OF THE NEGLECTED DENTURE 获得性气管-食管瘘:罕见的被忽视的义齿病例报告
Pub Date : 2018-12-23 DOI: 10.15342/IJMS.V5IR.245
Sharir Asrul Bin Asnawi, M. Doi, A. Shaker, M. Azman
Introduction: Dentures are common accidental ingested foreign body (FB) especially among elderly. It is frequent to have foreign body impacted at esophagus in adults however it is very unsual to have Tracheo-esophageal fistula (TEF) caused by denture. The diagnosis of TEF is challenging due to two reasons. Firstly, most of the dental prosthesis is radiolucent and not visible in routine radiological investigation. Secondly, patient with history of swallowed dentures prosthesis may be asymptomatic initially and develops symptoms over time. In contrary, prolonged history of FB in esophagus with TEF has higher risk to develop serious complication such as pneumonia and lung abscess. Case Presentation: We report a case of 62 year old gentleman with background history of hypertension and temporal lobe epilepsy presented with history of choking on taking solid and liquid associated with significant weight loss past 2 months. He had lost his denture for almost 1 year during sleep. Endoscopic examination of the larynx showed normal anatomy but pooling of saliva. CT thorax showed foreign body within a tracheoesophgeal fistula. OGDS showed denture within a well formed tracheoesophageal fistula. He had acquired TEF secondary to the dentures. Conclusion: Symptomatic elderly who lose their denture during sleep should not be neglected. They need immediate medical assessment thus will reduce further debilitating complication. Failing to identify and treat this condition urgently, patient will suffer acquired trachea-oesophageal fistula on which the treatment is challenging and the morbidity and mortality is high.
假牙是常见的误食异物(FB),尤其是老年人。成人食管异物阻塞是常见病,而由义齿引起的气管-食管瘘是罕见的。由于两个原因,TEF的诊断具有挑战性。首先,大多数的义齿是透光的,在常规的放射学检查中是看不见的。其次,有吞咽假牙修复史的患者可能最初无症状,随着时间的推移出现症状。相反,长期食管FB病史伴TEF发生肺炎、肺脓肿等严重并发症的风险较高。病例介绍:我们报告一个62岁的男性患者,有高血压和颞叶癫痫的病史,在过去的2个月里,由于服用固体和液体导致窒息,体重明显下降。他已经在睡梦中失去了他的假牙将近一年了。喉部内窥镜检查显示解剖正常,但有唾液淤积。胸部CT示气管食管瘘内异物。OGDS显示义齿位于气管食管瘘内。他获得了继假牙之后的TEF。结论:有症状的老年人在睡眠中丢失义齿不可忽视。他们需要立即进行医疗评估,从而减少进一步的衰弱并发症。如果不能及时发现和治疗,患者将会出现获得性气管-食管瘘,治疗困难,发病率和死亡率高。
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引用次数: 0
COMMENT RÉDIGER UN CAS CLINIQUE 如何写临床病例
Pub Date : 2018-12-17 DOI: 10.15342/IJMS.V5IR.259
K. Bouti
En medecine, un cas clinique peut etre defini comme un rapport detaille des caracteristiques anthropometriques, symptomes, signes physiques, explorations, diagnostics, traitements, suivi et evolution d’un patient. Le fait de rapporter un cas clinique n’est pas de la recherche scientifique, c’est plutot de la communication scientifique ecrite, et c’est donc l’affaire de la grande communaute des cliniciens qui comprend egalement les chercheurs. Rediger un cas clinique est important pour le developpement professionnel continu des auteurs et aussi important pour la formation medicale continue des lecteurs. Un cas clinique est une source inestimable d’informations, il peut donner l’idee d’un projet de recherche, et c’est une experience d’apprentissage tres riche car il permet l’introduction a la recherche bibliographique, a la redaction scientifique, et a la procedure de publication.  ...
在医学上,临床病例可以定义为人体测量特征、症状、体征、检查、诊断、治疗、随访和患者发展的详细报告。报告临床病例不是科学研究的问题,而是书面科学交流的问题,因此是包括研究人员在内的广大临床医生群体的问题。撰写临床病例对作者的持续专业发展很重要,对读者的持续医学教育也很重要。一个临床案例是一个无价的信息来源,它可以提供一个研究项目的想法,它是一个非常丰富的学习经验,因为它允许介绍书目搜索,科学写作和出版程序。…
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引用次数: 0
EPIDEMIOLOGICAL AND BIOLOGICAL PROFILING OF BREAST CANCER IN SOUTHERN MOROCCO 摩洛哥南部乳腺癌的流行病学和生物学分析
Pub Date : 2018-10-24 DOI: 10.15342/IJMS.V5IR.240
Fatima zahra Aznag, Ezohra Elouilamine, Mohammed Amine Basselam, S. Chadli, M. Cadi, E. Izaabel
Breast cancer is one of the most frequent cancers that affect women. Risk factors include a combination of multiple factors such heredity, age and environment. The frequency of breast cancer in Morocco increased significantly in recent years, and it is now a major public health concern. A retrospective epidemiological study was produced for a cohort of 1559 patients attending the regional center of oncology and radiotherapy in Agadir, during a period comprised between January 2010 and December 2015. Our data shows that the average age of the patients is 48 years, the majority of them present grade II tumors 66.38%. The immunohistochemical analysis of tumors revealed that 64% of them are positive for hormone receptors. With 67.07% is positive for ER and 61.01% positive for RP, while 29.17% of tumors overexpress HER2 protein. The distribution of molecular subtypes of breast cancer shows that luminal A has the highest percentage 50.96% followed by basal-like 20.26%. To clarify the young epidemiological profile and the etiology of breast cancer a regional cancer registry is required. Furthermore, the awareness campaigns are crucial to avoid having patients with aggressive form of the disease. Therefore, to improve survival and reduce morbidity of breast cancer’s patients.
乳腺癌是影响女性的最常见的癌症之一。风险因素包括遗传、年龄和环境等多种因素的组合。近年来,摩洛哥的乳腺癌发病率显著上升,现已成为一个重大的公共卫生问题。对2010年1月至2015年12月期间在Agadir肿瘤和放疗区域中心就诊的1559名患者进行了回顾性流行病学研究。我们的资料显示,患者平均年龄为48岁,以II级肿瘤居多,占66.38%。肿瘤免疫组化分析显示,64%的肿瘤激素受体呈阳性。ER阳性67.07%,RP阳性61.01%,HER2蛋白过表达率为29.17%。乳腺癌分子亚型分布显示,腔内A型比例最高,为50.96%,其次为基底样型,为20.26%。为了明确年轻乳腺癌的流行病学概况和病因,需要进行区域癌症登记。此外,提高认识运动对于避免患者患上侵袭性疾病至关重要。从而提高乳腺癌患者的生存率,降低乳腺癌患者的发病率。
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引用次数: 2
EVALUATION OF THE QUALITY OF CARE SECURITY PRODUCED BY THE ROOM THEATER OF THE REGIONAL HOPITAL OF NGAOUNDERE 翁德雷地区医院病房病房护理安全质量评价
Pub Date : 2018-10-24 DOI: 10.15342/IJMS.V5IR.224
Ngaroua, Abomo Meva, Dah’ngwa Dieudonne, Djibrilla Yaouba, E. N. Joseph
The mission of the operating room is to provide an efficient framework for surgical interventions, programmed or emergency cases because patients increasingly claim the right to the best possible quality of care. The objective of this study was to improve the quality of care service produced in the operating room of the Regional Hospital of Ngaoundere. It concerned and observational descriptive study going from August 1 st to September 30 th , 2016.  Data collection was carried out through direct observation and interview. Results reveals from this study that, 46.66% of the operating room infrastructures were not up to the required international standards. Skin cleaning was carried out in 31 % of the cases by standard products but the different steps were not respected. Concerning hand washing and preliminaries to surgical scrub, it was a forgotten practice or non-applied practice in the regional hospital of Ngaoundere. The surgical disinfection of hands by friction in its two stages were not observed normally in 75.70 % and 97.10 % respectively. We realized that only 34.4 % of observations regarding the required time allowed for surgical friction was equal to or a little greater to the standards
手术室的使命是为手术干预提供一个有效的框架,无论是程序化的还是急诊病例,因为越来越多的患者要求获得尽可能高质量的护理的权利。本研究的目的是提高恩oundere地区医院手术室的护理服务质量。研究时间为2016年8月1日至9月30日,为观察性描述性研究。数据收集采用直接观察和访谈的方式进行。研究结果显示,46.66%的手术室基础设施不符合国际标准。31%的病例使用标准产品进行了皮肤清洁,但不同的步骤没有得到尊重。关于洗手和手术擦洗的预备工作,这是恩oundere地区医院被遗忘或未应用的做法。75.70%和97.10%的患者在手术消毒的两个阶段均未观察到手术消毒的正常情况。我们意识到,只有34.4%的观察结果关于手术摩擦所需时间等于或略大于标准
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引用次数: 0
期刊
International Journal of Medicine and Surgery
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