La Tunisie médicale
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La Tunisie médicale · Nov 2006
Case Reports[Tracheobronchopathia osteochondrodysplasias. About one case revealed by haemoptysis].
Tracheobronchopathia osteochondrodysplasias is a benign and rare chronic disease, whose etiology remains obscure. It is characterized by the presence of subepithelial osteocartilaginous focal lesions without any relation to tracheal rings, essentially localized in the lower two thirds of the trachea and the major bronchi. ⋯ The lesion was suspected by bronchoscopy and the diagnosis was made histologically, showing heterotopic bone formation. The evolution of this affection was marked by a good clinical tolerance with only a symptomatic treatment.
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Gallbladder agenesis is a rare malformation, that can lead to an unnecessary and dangerous surgery. We report a case of gallbladder agenesis in a 27-year-old woman who had a right upper abdominal pain described as intermittent without fever neither jaundice during 1 year and half. ⋯ The MRI-cholangiography confirmed the agenesis of gallbladder. Using this case report, we will try to remember outcome particularities of this bile duct malformation.
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La Tunisie médicale · Jul 2006
Randomized Controlled Trial Comparative Study Clinical TrialCo-analgesic effect of ketorolac after thoracic surgery.
Thoracotomies are painful surgical procedures and adequate pain relief is associated with improved respiratory function and fewer respiratory complications. After thoracotomy for lung resection, patients received morphine-based patient-controlled analgesia (PCA). Three groups were prospectively and randomised investigated: patients receiving preemptive ketorolac, those given postoperative ketorolac and controls. ⋯ At 48 h after surgery, compared to controls, morphine consumption was 36% lower for the preemptive ketorolac group and 17% lower for postoperative ketorolac group (p < 0.05). No statistically significant differences were observed for pulmonary function tests. These results suggest that non-steroidal anti-inflammatory drugs can reduce the opioid requirements after thoracic surgery but do not improve lung function.
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La Tunisie médicale · May 2006
Case Reports[Large ostium secundum atrial septal defect discovered after severe mitral regurgitation. A case report].
Mitral regurgitation is associated with ostium secundum atrial septal defect in about 22% of cases. mitral valve prolapse induced by atrial shunt is the main cause of this regurgitation. Ususually, atrial septal defect discovery precedes that of mitral regurgitation. The aim of this paper is to focus on clinical, hemodynamic and evolutive details of atrial septal defect and mitral regurgitation association. We report the case of large atrial septal defect in 37 years old girl referred for hemodynamic investigation of mitral regurgitation. The divergence of clinical data, electrocardiogram and echocardiography findings has led to atrial septal defect discovery. Hemodynamic data showed severe pulmonary arterial hypertension (medium pulmonary arterial pressure: 45 mmhg). Hence, mitral valve substitution by mechanical prosthesis and closure of atrial septal defect have been carried out. Ten hours after surgery, death occurred because of severe pulmonary arterial hypertension and heart failure. ⋯ Association of severe mitral regurgitation and large ostium secundum atrial septal defect is an original anatomo-clinic entity caracterized by mitral valve lesions diversity and severe secondary pulmonary arterial hypertension. Danger of such a hypertension is due to progressive and infra clinical rise of pulmonary resistances and association of increased pulmonary blood flow and capillary pulmonary hypertension.