Neglected Giant Schwannoma of the Sciatic Nerve – A Case Report

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.

Public Health Arab Conference

4-6TH APRIL 2019, CASABLANCA, MOROCCO

Factors Associated with Extra Articular Manifestations in Rheumatoid Arthritis

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%), Sjögren'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.

Cardiac Manifestations in Human Immunodeficiency Virus-Infected Patients: An Electro- and Echocardiographic Study

Background : Advanced novel therapies and antiretroviral medications for the treatment of human immunodeficiency virus (HIV) infection have led to the improved management and survival of the infected patients. However, I [i]t manifestations in late-stage diseases such as cardiac deformities, which are the major cause of fatality in HIV-infected patients. Hence the current study was undertaken to derive the association of cardiac dysfunctions in HIV-infected patients using electrocardiograph (ECG)and echocardiography (ECHO).Methodology : The study included a total of 100 consecutive patients with HIV infection and was performed during January–December 2016 in the Department of General Medicine. Prior to the commencement of the study, ethical clearance was obtained from the Institutional Ethical Committee. Patients underwent complete blood count, ECG, and ECHO. Data were analyzed using Microsoft Excel spreadsheet and R-3.4.1 software.Results : Majority of the patients were males (79) and 40–49 years was the most common age group. The duration of HIV infection in most of the patients (73) was 1–10 years. Among the study population, 79 patients received antiretroviral drugs. Chi-square test was used to find the association of clinical symptoms and cardiac abnormalities with CD4 count. Cardiac manifestations were observed in 62% patients; sinus tachycardia (29%) was found to be the most common cardiac manifestation on ECG. Diastolic and systolic dysfunctions were observed in 35 patients and 49 patients, respectively.Conclusion : Patients with HIV infection are at a higher risk of developing cardiac dysfunctions. Early identification through ECG and ECHO-revealed abnormalities might assist in cardiac-targeted interventions, which can significantly reduce the fatal outcomes in HIV-infected patients.

Ectopic Pregnancy: from Epidemiology to Management at the Regional Hospital of Ngaoundere (Cameroon)

Ectopic pregnancies constitute one of the principal complications of pregnancy. Their clinic is polymorphous with consequences such as infertility and death reliable to late diagnosis. The aim of this study was to determine the state of ectopic pregnancy in our context and to propose concrete actions that will permit a rapid diagnosis so as to ameliorate its management at the regional hospital of Ngaoundéré (RHN). As such, we carried out a descriptive cross-sectional, prospective and retrospective design study going from January 2008 to August 2017 in the gyneco-obstetric unit of the RHN. We had a sample size of 373 cases of ectopic pregnancies within study period. The data analysis was done by the means of the software’s Microsoft office tools and Sphinx Plus² v.5.1.0.6. A prevalence of 1.21% obtained and the most represented age group was that of 20 to 32 years with a rate of 69.1%. The most incriminated risk factor was a pelvic surgical history. Clinically the most reveal signs and symptoms was a pelvic pain in 96.51%. Tubal rupture was observed in 72.39% of the cases and the treatment of these ectopic pregnancies was possible through radical surgery in 94.10%. No death report due to ectopic pregnancy throughout study period.

Self-retaining Freedom Proflor vs. Lichtenstein Mesh Repair for the Reduction of Postoperative pain in Inguinal Hernia: A 1-year Randomized Controlled Study

Introduction : Lichtenstein tension-free mesh repair (LMR), surgical procedure for inguinal hernia, associated with postoperative pain. The study was aimed to compare self-retaining Freedom ProFlor versus LMR for the reduction of postoperative pain in inguinal hernia.Methodology : A total of 60 patients with inguinal hernia undergoing mesh repair were randomized into two groups of 30 each: group A (Freedom ProFlor mesh repair) and group B (LMR). Demographic data and clinical findings of all the patients including duration of pain, lump size, cough impulse, and the position of hernia were noted. Recorded findings such as postoperative pain and operative time were subjected to statistical analysis.Results : Most (31) of the patients had hernia on the right side. The operative time was significantly less in group A when compared to group B (P < 0.05). Significantly lower pain scores were observed in group A than in group B (P < 0.05). The mean post-operative pain was significantly lower in group A compared with group B during the fifth follow-up visit (0.2 ± 0.41 vs. 1.07 ± 1.28; P < 0.0001). Conclusion : The Freedom ProFlor mesh repair was better than the LMR regarding postoperative pain. Moreover, the dose of the analgesic needed in Freedom ProFlor mesh repair group was less and for a shorter time when compared to LMR group. However, further long-term studies are required for documenting hernia recurrences.

Thoracic Manifestations of the Angiobehçet

Introduction: Vascular involvement in Behçet's disease affects 5 to 40% of patients. All vessels regardless of their type, size or location can be affected. This impairment is serious and can be life-threatening.Patients and methods : We collected 12 cases from January 2010 to January 2017. These were 11 men and 1 woman with an average age of 32.5 years. The venous involvement involved 11 patients with thrombosis of the upper vena cava (VCS) in 6 patients, thrombophlebitis of the lower limbs in 5 patients and thrombosis of the lower vena cava and hepatic veins in 1 patient. The arterial involvement affected 9 patients (75%) with aneurysm of the pulmonary arteries in 5 patients and a pulmonary embolism in 5 others. The cardiac involvement concerned half of the patients with pericarditis type in 3 patients and intra-cardiac thrombus in 4 patients.Conclusion: Thoracic involvement of the angiobehçet is frequent and severe, requiring rapid diagnosis and intense specific therapy to improve its prognosis.

Odontogenic Myxoma of the Maxilla - A Case Report

Introduction : The odontogenic myxoma is a rare benign tumor of the maxilla, whose clinical and radiological manifestations are variable and nonspecific and can be confused with other radiolucent lesions. Its origin would be the embryonic mesenchyme of the dental follicle.Case report : We report the case of odontogenic myxoma of the right maxilla, discovered by chance in a 25 year old patient. Clinically, the patient had painless, firm on palpation, swelling of the right maxilla, impeding chewing and speech. Facial CT-scan showed an expansive osteolytic process blowing the right maxilla off. A biopsy was in favor of an odontogenic myxoma. The diagnosis was based on clinical, radiological and especially anatomopathological arguments.Conclusion : The local aggressiveness of the odontogenic myxoma and its high rate of recurrence justify a radical treatment beyond the lesion’s boundaries and thus imply a postoperative repair.

Chemotherapy of Prostatic Adenocarcinoma : State of the Art 2019

Prostate cancer is a heterogeneous disease, with different clinico-biological and evolutionary aspects. Most often it is a disease with indolent evolution. Chemotherapy has long been a therapy of last resort in the treatment of prostate cancer. Deploying chemotherapy in this context certainly implied the failure of all possibilities of hormonal manipulation. Thus, antineoplastic chemotherapy was first proposed in metastatic situation, with resistance to castration. Many molecules have confirmed the effectiveness of chemotherapy in this indication. Several phase III trials have placed chemotherapy as a serious option in less advanced situations, with very encouraging results in terms of survival and quality of life. Chemotherapy is currently considered as a therapeutic weapon that should be included in the management strategy, after discussion in a multidisciplinary consultation meeting. Through this review we will try to establish the state of the art of the use of antineoplastic chemotherapy in prostatic adenocarcinoma in 2018, in metastatic (de novo or in phase of resistance to castration), localized or locally advanced situations.

Contralateral Fracture-Dislocation of the Shoulder Due to Electric Shock

Electrical injuries are relatively common and can produce variable types of adverse effects to organs, but injuries to musculoskeletal system are less frequent. Bone injuries can involve both long and flat bones and they encompass several types : osteonecrosis, dislocation and fracture. Cases of shoulder dislocation with fracture have been reported in the litterature ; the mechanism is linked to the tetanizing effect from the alternating current flow through the shoulder without a fall or a violent trauma. Posterior dislocation is the most common shoulder injury. We report the case of an anterior fracture-dislocation of the shoulder contralateral to the entry point and we emphasize that any pain or functional impotence in the context of electric shock, even when it’s distant from the entry point, should trigger suspision of bone injury.