Ibn Rochd Research Articles

Troubles sexuels chez 78 hémodialysés chroniques marocains de sexe masculin : étude clinique et endocrinienne

To investigate the correlation between biochemical and endocrine variables with sexual disorders in 78 male patients on chronic hemodialysis at the Ibn Rochd University Hospital (Casablanca-Morocco). Seventy-eight male hemodialysis patients with chronic renal failure were evaluated with regard to their sexual function. All patients answered a personal questionnaire on their sexual activity. Hormone (FSH, LH, prolactin, testosterone, and parathyroid hormone) and zinc and ferritin assays were also performed. The men reported erection (44.9%), libido (44.9%), ejaculation (26.8%), and orgasm (21.8%) disorders. Gynecomastia was observed in 17.9% of the patients. There was no correlation with weight nor the nature of the causal nephropathy nor with duration of dialysis. Levels of gonadotropins (FSH, LH), prolactin, and parathyroid hormone were elevated. Testosterone levels were low. Ferritinemia was elevated but there was no significant variation in zincemia. There was a negative curvilinear relationship between serum testosterone and sexual disorders, and between gynecomastia and ferritinemia. LH and prolactin levels were positively correlated with gynecomastia. Abnormal hormonal and iron overload could be important factors involved in the complex pathogenesis of sexual dysfunction in chronic renal failure patients undergoning hemodialysis.

Troubles dépressifs chez les patients épileptiques suivis au sein d’une unité de consultation spécialisée

The overall prevalence of psychiatric disorders in epileptic patients is estimated between 19 and 62%. Depressive disorders may be the most common psychiatric disorders and the main reason for psychiatric hospitalisation and taking psychotropic drugs. The underdiagnosis and undertreatment of depressive disorders among epileptic patients represent a problem of considerable magnitude. The aim of the present study was to evaluate the prevalence of depressive disorders among patients with primary epilepsy and to determine the risk factors of the occurrence of the depressive illness. The survey was conducted in a outpatient epilepsy clinic in the Ibn Rochd University Hospital Centre in Casablanca. All patients with idiopathic or cryptogenic epilepsy aged 15 Years and above, were eligible, except for patients with severe physical and mental disabilities. Neurologists diagnosed the epilepsy based on clinical criteria with electroencephalograms data. The depressive disorders met a psychiatrist's evaluation of an ICD-10 criterion. Ninety-two subjects participated in the survey, 57.6% were men and the mean age was 30.3 +/- 10.8 Years. The epilepsy age of onset was 16.3 +/- 11.4 Years with an average duration of 14.1 +/- 9.2 Years. The prevalence of depressive disorders among epileptic patients in our survey was 18.5%. According to sex, the prevalence was 23.1% in women and 15.1% in men. The depressed patients were compared with the remaining patients without depression with regard to seizure variables and sociodemographic characteristics. The epilepsy-depression and epilepsy-control groups did not differ significantly in the duration of epilepsy or in the type of anticonvulsant therapy (mono versus polytherapy). Three variables were significantly different between the two groups. The mean age in the epilepsy-depression group was significantly higher (34.4 +/- 9.6 Years versus 29.4 +/- 10.9, p<0.03), the mean age of epilepsy age of onset was also higher in the epilepsy-depression group than in the epilepsy-control group (21.8 +/- 11.9 Years versus 15.04 +/- 11.0, p<0.03) and the seizure frequency per week was more important among depressed epileptic patients (2.4 + 5.2 seizures versus 0.4 + 1.5, p<0.007). The present survey confirms the findings of previous studies that the prevalence of the comorbidity between epilepsy and depression is common in specialised outpatient units. The detection and the treatment of depressive disorders among the epileptic patients remains a very great challenge in the management of the epileptic illness. It will improve the quality of life of these patients. A closer involvement of psychiatric and psychological treatment in patient management is necessary.

Tumeurs cutanées au cours du xeroderma pigmentosum au Maroc: Etude de 120 malades

Xeroderma pigmentosum is a rare recessive and autosomically transmitted genodermatosis. Its cutaneous manifestations are dominated by skin cancers. This investigation aims at studying the epidemiologic, clinic, histologic, therapeutic and evolutive aspects of the skin tumors during xeroderma pigmentosum. A retrospective monocentric study was carried out in the Dermatology and Veneorology Department of Ibn Rochd University Hospital of Casablanca, Morocco. It included all the xeroderma pigmentosum admitted to hospital or followed-up from 1990 to 2000. All the dossiers were included. The anatomopathologic study was carried out in all the skin tumor cases. One hundred and twenty xeroderma pigmentosum were admitted in 10 Years. Fifty-four percent of the cases were females and 46 p. 100 were males. The mean apparition of the first tumor was 7.7 Years. One hundred and fifty-three skin tumors were diagnosed in 96 patients (80 p. 100). These tumors were of basocellular carcinoma type in 32.6 p. 100, of squamous cell carcinoma type in 33.9 p. 100 and of melanoma type in 11 p. 100. Ocular tumors were found in 31 cases (25.8 p. 100) and buccal in 8 cases. Therapeutically, the surgical exeresis of one or many tumors was performed in all cases. Electrocoagulation was associated in 42 p. 100 of the cases and skin graft in 52 p. 100. Cutaneous relapses after surgery were noticed in 55 cases (57.2 p. 100). Twenty-five patients died and 31 were lost to follow-up. Our series is characterized by a large frequency of mainly cutaneous tumors (80 p. 100) in comparison with the largest review of literature (45 p. 100). These tumors were mainly represented by basocellular and squamous cell carcinoma with onset at an early age (7.7 Years). Our series is also characterized by a large frequency of cutaneous relapses after surgery (51.6 p. 100). Neglecting advice on photoprotection and the lack of regular control visits lead to the proliferation of large size tumors, making therapeutic strategies difficult or even impossible.

Vulvar pathology

We evaluated the main causes of vulvar dermatoses; in 785 patients with a vulvar diseases who visited Ibn Rochd Hospital Centre, Casablanca between January 1991 and December 2002. The average age was 31 years [range 2 months to 81 years] ; 362 patients [41.52%] had vulvar pruritus, 273 patients [34.77%] had warts and 157 [20%] had one or more vulva ulcers. The most common infectious pathology was papillomavirus infection, found in 273 cases [34.77%], followed by vulvovaginal candidiases in 102 cases [12.99%], syphilitic chancre in 18 cases [2.29%] and herpes genitalis in 17 cases [2.16%]. The most common non-infectious pathology was vulvar dermatosis: 259 cases [32.99%] ; idiopathic pruritus vulvae: 61 cases [7.7%] ; and tumour-related conditions: 45 cases [5.6%]. The frequency of infectious conditions was over 50% and these were generally sexually transmitted infections.

Léiomyosarcome du vagin. À propos de deux cas et revue de la littérature

The leiomyosarcoma of the vagina is extremely rare. This paper reports two observations treated at the Ibn Rochd oncology center of Casablanca. The first patient was 32 years old, and presented a tumor of 15 cm to the detriment of the posterior wall of the vagina. The treatment consisted of a large exeresis of the tumor followed by postoperative radiotherapy. After 50 months, she is still alive. The second patient who was 42 years old, had a 10 cm tumor of the posterior wall of the vagina. A tumorectomy was realized and then the patient was not heard of. The evolution was marked by the appearance of pulmonary metastasis and a palliative chemotherapy was prescribed. This patient is deceased after 31 months. Seventy-five cases only are described in the literature. The surgery is the basic treatment.whereas radiotherapy is still discussed. The prognosis of these tumors remains linked especially to the histological rank.

Adénocarcinome du col utérin : étude rétrospective de 83 cas

The frequency of the adenocarcinoma of cervix uteri is increasing. Aim of the study – To define the characteristics of the entity. Patients and methods – Between 1986 and 1992, 83 adenocarcinoma of cervix uteri, were treated at the Ibn Rochd Oncology Centre in Casablanca. It’s a retrospective study with univariable analysis of the prognostic factors. This analysis was done for patients who were followed until the death or have 5 years or more follow up and the survival was calculated according the Kaplan & Meier method at 5 years. The local and regional recurrence factors were evaluated statically according the χ[sup2 ] and those for survival rate according the Logrank test. Results – The frequency increased during the period with 2,1 % in 1986 and 8,2 % in 1992. The median of aged was 49 years. Fifty one patients have localised stage. Combined radiotherapy and surgery was performed in 66 cases and 17 received radiation alone. The loco-regional control was obtained in 83 % among 73 available patients for results. The univariable analysis showed that the histological type was not a significant factor. However, age, tumor size, stage, histological grade and lymph node involvement were significant factors. These factors, the degree of differentiation and the lymph node involvement were significant for the 5-years survival. Conclusion – The prognosis factors of the cervix uteri adenocarcinoma are, size tumor more than 4 cm, lymphe node involvement, microscopic involvement to the parameters and positives exicion marges.

La gangrène périnéo-scrotale : à propos de 31 cas

Fournier's gangrene is a fascitis of the perineum and of the external genitalia. It is a serious infection with rapid evolution and a severe prognosis. It is also unpredictable towards the necrosis. It concerns a series of 31 cases of the perineal scrotal gangrene supervised In the department of surgical visceral emergency of the Ibn Rochd University hospital of Casablanca between 1992 and 2000. In this investigation, the male predominance is important and the mean age is 49 years. The diagnostic delay is 12 days. The symptomatology was dominated by edema and erythema signs, fever and pain. The skin necrosis was seated in the perineum and the scrotum. A septic shock was noticed in six patients and a condition of deep coma in two other patients. Etiology of gangrene was of coloproctologic origin in 15 cases and of urogenital origin in five patients. The bacteriological parietal swabs was positive in 11 cases. The therapeutic take-in-charge consisted of urgent measures of reanimation for six patients. The likely wide spectrum antibiotic therapy consisting of a triple association ( β lactam antibiotic, nitrite-imidazole compound and aminoglycoside) with a secondary adaptation that was recommended for all patients. All the patients underwent surgical debridement of the necrotic tissue with incisions and drainage of the involved areas of the of all the operated-on patients, 26 had colostomy, five among them had both colostomy and cystostomy. The overall evolution was favorable except in eight cases of death. In all, the authors insist on the positive diagnosis as well as the early take-in-charge of the disease to avoid complications of local or general order and recommend the preventive treatment with the precocious treatment of the causing infection.

Traitement de l'abcès primitif à pyogène du muscle psoas : étude rétrospective à propos de 18 cas

The primitive abcess of psoas muscle is a rare affection which involves mainly the young. The autors report 18 cases of primitive pyogenic abcess of psoas collected during a period of six years in the urology service of UHC Ibn Rochd Casablanca. The purpose of this review is to discuss the different therapeutic attitudes. The study concerned 11 men and seven women, their mean age was 35 years. The mean delay of evolution was 45 days. The physical exam found a psoitisis (five cases) and a flunk swelling (14 cases). The ultrasound exam showed the collection which was hypoechogenic in seven cases and heterogenous in 11 cases. The CT scan showed an heterogenouse hypodense collection without enhansement in seven cases. The use of antibiotherapy alone (four cases) and percutaneous drainage (four cases) permited the recovery just respectively in one and two cases. Fifteen patients (83%) were operated through a postero-lateral lumbotomy route without costal resection. The bacteriological exam of the pus found a Staphylococcis aureus (ten cases) and Escherichia coli (two cases). The evolution was favorable in 14 cases; one patient was dead at fifth day post operatively by heart infarction. For the autors, the surgical drainage remains the treatment of choice.

Séminome primitif du médiastin : à propos d'un cas

In this study, the case has been reported of a 36-year old male who was treated at the Ibn Rochd Oncology Center in Casablanca for a primary mediastinal seminoma revealed by a symptomatology including cough, dyspnea, laterocervical swelling, rachidial pain and gait disorder. The preliminary investigation showed significant mediastinal enlargement with a right pleuritis and vertebral metastases; tumor markers were normal. The diagnosis of seminoma was confirmed by pathological and immunohistochemical analysis of the cervical adenopathy. Disease management consisted of BEP/cisplatin type chemotherapy and lumbar, mediastinal, and supraclavicular radiotherapy. The response after four courses of combined chemo-/radiotherapy was estimated at 25%, but the patient died from respiratory failure five months after the initiation of treatment.

Choriocarcinome pur du testicule : à propos d'un cas avec revue de la littérature

We report a case of a young man 31 years old treated at the Ibn Rochd Oncology Center for a pure choriocarcinoma of the right testis. The first examination note a skin metastasis without another localization. The β HCG level was 328 mu/mL. The diagnosis was confirmed by pathological examination of the testis after orchidectomy. The adjuvant treatment consisted in chemotherapy like using in germ cell neoplasm's of the testis. During the evolution, partial remission (50%) was obtained after the third course and complete remission one month after the end of treatment. The patient still alive after 20 months.

Le néphroblastome de l'adulte. À propos de trois cas

The authors report three nephroblastoma's cases occurred in adult and treated at Ibn Rochd Oncology Center at Casablanca. The average of age was 24 years (19–29 years) and the delay of diagnosis was five months (3–8 months). The most frequent clinical sign was a lumbar fossa mass. At diagnosis, radiological exams revealed that patients presented an advanced stage and metastatic disease in one case. The treatment was a total nephrectomy with ganglionnar dissection when the tumor was resecable followed by chemotherapy and radiotherapy. Two patients was in progressive disease despite treatment, and one patient was lost at follow-up. The prognosis of adult's nephroblastoma remains very severe, due to the advanced stage at diagnosis and the mediocre reply to the treatment.

Cancers rectocoliques chez le sujet de moins de 40 ans

Between 1988 and 1994, 326 patients with colorectal cancers were treated at the Ibn Rochd Oncology Centre in Casablanca; 88 patients were less than 40 years old (27%). There were 79 males and nine females. A family history of colorectal cancer was noted in 5%. The most frequent symptoms were bleeding and rectal pain. The localisation of the tumour was the rectum in 70 cases. According to the anatomopathological profile, Dukes stages C and D were the most frequent and mucosal adenocarcinoma was noted in 24 cases. Seventy patients had surgery, associated with radiation therapy in 59 cases. Adjuvant chemotherapy was given in 44 cases and palliative treatment in 17 cases. Recurrence occurred in 14 cases and metastasis in other six cases. At five years, overall survival and disease-free survival rates were 24% and 17%, respectively. Worse prognostic factors were mucosal adenocarcinoma, poor differentiated adenocarcinoma and Dukes C and D stages.

Nasopharyngeal carcinoma in children under 15 years of age: A retrospective review of 65 patients

Nasopharyngeal carcinoma constitutes comprises up to 5% of primary childhood cancers but literature lacks modern uniformly treated large series. A retrospective review was performed of sixty-five previously untreated patients younger than 16 years of age diagnosed and treated at the Ibn Rochd Centre in Casablanca between 1988 and 1992. Forty-four percent of them were stage T3 to T4 and 66% stage N2 or N3. All patients were irradiated. Prior adjuvant chemotherapy was administered in 33 patients. Thirteen patients were lost to follow-up. Local control was obtained in 85% of the 52 evaluable patients. The five-year overall survival was 42% and disease-free survival 38%. Ten relapses occurred at local and/or regional sites. Six patients have distant metastases. All 24 patients with relapse or persistent disease died despite salvage therapy. Stage, histology and dose of radiation, were statistically significant prognostic variables. Patients treated with chemotherapy followed by irradiation had a better outcome than those treated with radiation alone. Nasopharyngeal carcinoma in children is a rare chemosensitive tumor. However, conclusive treatment guidelines cannot be drawn from this series and prospective co-operative studies are needed for the development of more effective and less toxic therapeutic strategies.

Intérêt de la biopsie des glandes salivaires accessoires dans l'amylose

To assess the value of accessory salivary gland biopsy for the diagnosis of amyloidosis, a study was conducted in the nephrology and hemodialysis department at Ibn Rochd University Hospital from February 1996 to January 1998. Renal amyloidosis was confirmed by renal biopsy accompanying accessory salivary gland biopsy. The patient's mean age was 39 years old (range 15-80), with a 4:1-male/female ratio. An infectious cause (either tuberculosis or superinfection and dilatation of the bronchi) was the most frequent (70% of the cases) etiology. All the patients presented renal symptomatology. Nephrotic syndrome predominated. Amyloid deposits were observed in 100% of renal needle biopsies and in 80% of accessory salivary gland biopsies. Renal biopsy led to more positive cases than the other biopsies. It may be accompanied by severe complications. Furthermore, biopsy of the accessory salivary glands is a simple and very reliable technique for the diagnosis of amyloidosis. It is currently the best diagnostic test.

An Unusual Cause of a Double-Lumen Endotracheal Tube Obstruction

To the Editor: A 40-yr-old woman was scheduled for left pulmonary hydatit cyst resection. Preoperative fiberoptic bronchoscopy disclosed no airway malformation and a normal trachea. After the induction of anesthesia, a 37F left endobronchial tube was inserted into the trachea after minimal resistance at the cricopharyngeus, and the tube was rotated 45[degree sign] counterclockwise. The bronchial and tracheal cuff were inflated with 3 and 6 mL of air, respectively. Chest auscultation revealed a decrease of left breath sounds. Manual ventilation was difficult after clamping of the bronchial tube because of high airway resistance. An inability to pass a suction of catheter beyond the tip of the tracheal tube suggested tube obstruction. The double-lumen tube (DLT) was pulled back and the trachea was extubated. On examination of the DLT obstruction of the distal aperture of the tracheal lumen caused by the carinal hook was noted (Figure 1).Figure 1: Closeup of the Double-lumen tube. The carinal hook is bent into the distal tracheal aperture.Potential problems with carinal hook have been observed [1]. A similar incident was reported in a recently published case [2]. A possible mechanism is that the laryngeal lumen was too small for the tip of the DLT and that the hook was bent by the lateral wall of the larnynx and trapped in the distal orifice of the tracheal lumen. Lack of lubrication of the DLT and the use of an inappropriate size of the DLT could have contributed to the incident. We recommend that fiberoptic bronchoscopy of both lumens of the DLT be routinely performed when the DLT is used, and choice of an appropriate DLT size seems important. Bouaggad Abderrahmane, MD Abassi Omar, MD Department of Anesthesiology; Ibn Rochd University Medical; Center of Casablanca, Morocco 20000

Doors and thresholds: Jeddi's approach to psychiatric disorders

Professor Essedik Jeddi and his team have introduced a most significant institutional and therapeutic innovation at the Ibn Rochd and Pinel section of the Razi university long-term mental hospital in Tunis (Tunisia). The innovation focuses upon the ambiguity of doors and boundaries in the mental asylum. Doors and walls influence the rhythm of activity and the nature of contact between patients, therapists and the wider society and culture. If they are very rigid, they may disjoin the patient from him- or herself, from his/her body, social network and culture. On the other hand, if such boundaries are completely neglected they may merge these related dimensions as undifferentiated entities. Jeddi's innovation is primarily concerned with placing the spatio-temporal experience of the body and the intimate interpersonal interaction at the centre of treatment. It aims at establishing creative modes of expression, interaction and exchange such as tea-sessions, dancing, singing, verbal communication, clay-modelling, figurative or plastic expression, agricultural works. These relationships mediate and differentiate at the same time between the patient, his/her body-self, and his/her social and cultural world, thus avoiding both the disjunction and the merging. It would seem that the activities concerned with the distinction between ‘inside’ and ‘outside’, peasant and urban, self and other (e.g. dancing and singing) are of paramount importance in bringing about such mediating and differentiating relationships. In the present study we limit ourselves to one particularly revealing therapeutic activity, namely dancing to live music. Jeddi's innovation is a unique blend of current developments in psychiatry and psychotherapy with Arabo-Islamic science and philosophy.

The great problem in malocclusion of the teeth of the types of Class II

The aim of this work was to perform a cephalometric analysis of the craniofacial parameters and natural head posture of mouth-breathers compared with control subjects, and to study the relationship between nose-breathing and the vertical dimension.The headfilms taken at start of treatment of 53 cases (28 girls, 25 boys) aged 9 to 30 who consulted the dento-facial orthopedic department of the Ibn Rochd Casablanca dental consultation and treatment center were studied.Among the mouth-breathers, we noted mandibular retrusion (SNB) in association with posterior rotation and more pronounced tilt of the mandibular plane (PP-MP) compared with the controls (P < 0.05), a disproportionate increase in anterior face height and a lessening of posterior face height (hyperdivergence). These increases in anterior face height are often associated with retrognathism (and open bite).Our study has shown that there are cephalometric differences between mouth-breathers and nose-breathers. There are several studies in the literature with results that support ours. Collaboration between the pediatric dentist, the orthodontist and the ENT specialist is important so as to establish an early diagnosis of mouth-breathing in children and initiate appropriate treatment to recreate the best conditions for harmonious development.