Haut PDF Carcinome in situ du sein au CHU Mohammed VI de Marrakech

Carcinome in situ du sein au CHU Mohammed VI de Marrakech

Carcinome in situ du sein au CHU Mohammed VI de Marrakech

Au Maroc, selon le registre de population du grand Casablanca, le cancer du sein occupe la première place chez la femme avec une incidence de 36,5%, et un risque relatif de mortalité de 19,7%. [3] Le carcinome in situ (CIS) est un cancer du sein non invasif qui englobe un large spectre de pathologies. Parmi les cancers du sein in situ, on distingue les carcinomes canalaires in situ (CCIS) et les carcinomes lobulaires in situ (CLIS). Ces pathologies vont des lésions de bas grade de très bon pronostic aux lésions de haut grade qui peuvent évoluer en carcinome invasif. Au niveau histologique, le CCIS est défini par la prolifération anormale de cellules épithéliales qui ne dépassent pas la membrane basale du système ductulo-glandulaire. Il est décrit selon ses caractéristiques architecturales (solide, cribriforme, papillaire et micro papillaire), son grade tumoral et la présence ou non de comédonécrose.
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Tuberculose digestive au CHU Mohammed VI de Marrakech à propos de 85 cas

Tuberculose digestive au CHU Mohammed VI de Marrakech à propos de 85 cas

Le dosage de l’interféron gamma est un test sanguin développé récemment. Il est basé sur le fait que les lymphocytes T d’un individu infecté par mycobactérium tuberculosis relarguent l’interferon gamma lorsqu’ils sont mis en contact avec des antigènes mycobactériennes. Il s’agit de deux antigènes codés par une région préservée de M. tuberculosis, sont présentés in vitro : early secretory antigenic target 6 (ESAT-6) et culture filtrate protein 10 (CFP-10). Ces deux antigènes ne sont pas présents dans les souches de M. bovis utilisées pour le BCG et chez la plupart des mycobactéries environnementales, permettant une meilleure spécificité et donc une meilleure valeur prédictive positive [136 ; 137 ; 138 ; 139].
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Cancers de la vulve Exprience du CHU Mohammed VI De MARRAKECH

Cancers de la vulve Exprience du CHU Mohammed VI De MARRAKECH

Pour les patientes N+ après vulvectomie totale et lymphadénectomie inguino-crurale, l’irradiation du lit opératoire vulvaire au cours de l’irradiation des aires ganglionnaires atteintes est proposée par certains auteurs, au regard du taux de récidives locales après irradiation limitée à la seule région inguinale. Mais du fait de la mauvaise tolérance des tissus vulvaires à l’irradiation, cette attitude n’est retenue actuellement par la plupart des auteurs (in 104), d’autant que ces récidives locales sont souvent très bien prises en charge chirurgicalement avec un bon pronostic.
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Aspects épidémio-cliniques, thérapeutiques et évolutifs des cancers du sein inflammatoires au CHU Mohammed VI de Marrakech

Aspects épidémio-cliniques, thérapeutiques et évolutifs des cancers du sein inflammatoires au CHU Mohammed VI de Marrakech

This cancer represents 6.60% of all the mammary cancers. Our series show that half of our patients were menopaused women. The medium age was 48 years. Precursory signs were: self-examination of a nodule (40%), isolated inflammatory signs (45.45%), and mastodynia (14.54%). The medium delay of consultation was 15 months. The left breast was affected in majority of cases. We found the stage PEV3 in 72.72%. Metastases at diagnosis represented 40%. The majority of tumors were infiltrating ductal carcinoma (83. 63 %) with a high rank histopronostic SBR. The negativity rate of the hormonal receptor was 59.09%.
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Mortalité néonatale intra-hospitalière au CHU Mohammed VI de Marrakech

Mortalité néonatale intra-hospitalière au CHU Mohammed VI de Marrakech

January 1 st , 2005 to December 31 st , 2006. This study is based the use of hospital records of newborns from 0 to 28 days died during the study period. The mortality rate found was 29.4 ‰ live births. It is high during the first week of hospitalization, especially in the first twenty four hours. We identified as main causes of premature death, suffering neonatal, neonatal infections and respiratory distress. In addition, emerging risk factors for death are prematurity and low birth weight, the low Apgar score at birth, maternal age, the primiparity and high multiparity, low socio-economic parents, diseases during pregnancy, failure to use antenatal services. Our observations indicate that improved quality of care is needed, both in regard to the monitoring of pregnancy, delivery and resuscitation of the newborn, the care during the first week of life. The analysis of results suggests that in addition to a policy of pre-and perinatal prevention taking into account risk factors, the development of a neonatal medicine is necessary. The neonatal mortality remains a major public health problem in developing countries. This study allowed us to assess the incidence of neonatal mortality, to establish the causes and identify the main risk factors for early neonatal mortality in University Hospital Mohammed VI of Marrakech. It would be interesting to complete our work by a study on the quality of obstetric and perinatal care delivered in Neonatology.
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Prise en charge des traumatismes du rachis dorsolombaire au CHU Mohammed VI de Marrakech

Prise en charge des traumatismes du rachis dorsolombaire au CHU Mohammed VI de Marrakech

The thoracolumbar spine traumatisms are more frequent than the cervical ones 56%.The young adult of masculin sexe about thirty seven years old is the more frequently reached 67,8%. The etiologies are dominated by the falls in 68%, the highway accident are in the second place in 30% and finally by the agressions in 2%. The rachidian pain of the trauumatized region is the main revealing sign. The neurologic disturbances were frequent 58,8%.The associated lesions have been represented especially by limb traumatisms in 23,3 %. The most frequent location of injuries is the thoracolumbar link (58%) and the fracture compresse is the predominant lesion with elective seat at the level of the first lumbar vertebre revealed thanks to plain radiographs and computed tomography scans. The RMI have been used in only 9 cases. The surgical treatment occuring an efficient fixation of the unstable lesions has been used in 147 patients (62,33%), of whom 13 are without neurologic signs(8,80%).The orthopedic treatment has been used in 84 patients ( 24%). The evolution of the paraplegic remains yet threatened by some complications ( 13,1%), especially at the initial period.The evolution of neurologic distrubances was variable on the whole, the complete medullar injuries have a pejorative prognosis whereas the uncomplete injuries can evolve favorably.
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REGISTRE HOSPITALIER : EXPERIENCE DU SERVICE DONCOLOGIE DU CHU MOHAMMED VI DE MARRAKECH

REGISTRE HOSPITALIER : EXPERIENCE DU SERVICE DONCOLOGIE DU CHU MOHAMMED VI DE MARRAKECH

Issue: In Morocco, cancer is one of the major public health problems because the diagnosis is often late and the management is difficult and expensive. Several registers have already been established, including the Rabat city register (RECRAB), the cancer registry of the Greater Casablanca region, which gives an idea of the incidence of cancer in these different regions. However, at the level of the Marrakech Safi region, there is currently no reliable regional database to assess the frequency and distribution of cancers diagnosed in this region and from which cancer control could be set up.
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La prvalence de linfection nosocomiale au CHU Mohammed VI de Marrakech

La prvalence de linfection nosocomiale au CHU Mohammed VI de Marrakech

Dans la majorité des études, l’immunodépression a été reconnue comme étant un facteur prédisposant [93,94], d’autres auteurs n’ont pas trouvé de relation entre ce facteur et l’infection nosocomiale. Cette dépression immunitaire va s’aggraver sous l’effet des pathologies aigues telles que : le poly-traumatisme, les brûlures et viennent s’ajouter les effets de la chirurgie, l’anesthésie, les traitements immunosuppresseurs, les antibiotiques et la malnutrition. Tous ces états prédisposent aux IN. [95]

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Occlusions intestinales aigues au CHU Mohammed VI de Marrakech à propos de 103 cas

Occlusions intestinales aigues au CHU Mohammed VI de Marrakech à propos de 103 cas

108 During 4 years, from July 2004 to July 2008, we retrospectively reviewed 103 files of patients admitted for acute intestinal obstruction, at the visceral surgery department in UHC Mohamed VI in Marrakech. The purpose of this study was to gather the epidemiologic and diagnostic data, and to evaluate the therapeutic methods and the outcome of small bowel obstruction in our context. There were 67 men and 36 women with a mean age of 43.4 years. 44.66 % of the patients had histories of abdominal surgery, with ascendancy of the appendicular surgery in (9.70%). The clinical signs are polymorphic and varied, the main symptom is the cessation of matter and gas found in 87.37% with presence of hydroaéric levels in The ASP in 88.34% of the cases. The small bowel obstruction is the most frequent with 54.36%. The causes are dominated by reins and adhesions in (31.06%), tumors in (22.33%). All the operated patients were approached by laparotomy. The intestinal resection for intestinal necrosis was made in 15.53%. The immediate post-operative outcome was simple among 86 patients (83.49%). Besides, we noted 3 suppurations of wall (2.97%), 1Postoperative peritonitis (0.99%), 1 evisceration (0.99%), 1 pneumonia (0.99%) and 1sépticemie (0.99%). The overall mortality is 6.93%. It concluded before those results, all characters in our series epidemiological consistent with the literature except that age is advanced in developed countries, and increased frequency of strangulated hernias in developing countries. The early management of acute intestinal obstruction through good awareness may reduce the morbidity and mortality are increased in our developing countries.
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Insuffisance rénale chronique chez l'enfant : Qu'en est - il au CHU Mohammed VI Marrakech ?

Insuffisance rénale chronique chez l'enfant : Qu'en est - il au CHU Mohammed VI Marrakech ?

Chronic renal failure is not rare in childhood. Its gravity is its occurrence on a body during growth and it causes deleterious consequences on child development. It is often diagnosed at the terminal stage and poses a socio-economic problem. We analyze through a transversal study conducted in B pediatric unit between January 2005 and December 2010, including 50 children, the epidemiological, clinical, etiological patterns and the difficulties of management. The age of our patients is between 1 month and 15 years with a masculine predominance (60%). Chronic renal failure is discovered during clinical signs of Appeal in 86% of cases, a urinary tract infection in 8%, hypertension in 4% and a systematic review in a newborn with many malformations. Paleness was found in 74%, growth retardation in 70%, digestive disorders in 44%, hypertension in 28% and signs of osteodystrophy in 16% of patients. The clearance of creatinine calculated with Schwartz formula was >30 ml/min/1.73m² in 4 patients (8%), between 15 and 30 ml/min/1.73m² in 16 patients (32%) and <15 ml/min/1.73 m² in 30 (60%). The etiologies are dominated by interstitial nephropathies (50%), secondary in 46% of patients to obstructive uropathy, in one patient to chronic pyelonephritis and to bilateral urolithiasis in one other patient. Glomerular nephropathies are in the second rank (18%) and are mainly secondary to corticoresistant nephrotic syndrome, followed by hereditary nephropathies (8%) represented by autosomal recessive polycystic (6%) with one case of distal tubular acidosis associated with chronic pyelonephritis. In 24% of children the aetiology is undetermined. All patients received a medical treatment. Extra-renal purification was indicated in 28 patients but only 18 patients benefited from it. Transplantation is planned in 4 children. 16% of patients are died. Mortality was secondary to septicemia in 4 childrens, acute pulmonary edema in 3 patients and electrolytic disorders in one case. This work draws attention to the alarming situation of children with chronic renal failure. The late diagnosis, lack of access to replacement therapy and the absence of a strong project of renal transplantation are elements that increase the prognosis for these children.
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Lymphomes cutanes primitifs : Expérience du service de dermatologie CHU Mohammed VI Marrakech

Lymphomes cutanes primitifs : Expérience du service de dermatologie CHU Mohammed VI Marrakech

L’étude du réarrangement des gènes codant les immunoglobulines est également utile dans les lymphomes B en cas d’échec des immunomarquages. Cette étude est réalisée par la technique d’amplification génique in vitro (PCR). La sensibilité de la PCR est moyenne dans les infiltrats ténus et sa valeur prédictive de malignité n’est pas bonne puisque des réarrangements dominants sont observés dans certains pseudo lymphomes, en particulier ceux d’origine médicamenteuse, d’où la nécessité d’une interprétation prudente et d’une confrontation raisonnée avec la clinique et l’histologie.
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Prise en charge des encphalocles : exprience du service de neurochirurgie, CHU Mohammed VI, Marrakech

Prise en charge des encphalocles : exprience du service de neurochirurgie, CHU Mohammed VI, Marrakech

We report 18 cases of encéphalocèles in our study in Neurosurgery department of university hospital Mohammed VI in Marrakesh for a period of 9 years from 2002 until 2011. The occipital location was the most frequent (67%) followed by the nasoethmoidale location and the front location and finally the parietal localization. All malformations were diagnosed on computed tomography but one case was diagnosed by resonance magnetic imaging. All cases be treated with surgical resection of the dysgénésis brain (a reduction of functional brain made in a single patient) and closure of the bone defect and the mother takes, with a good evolution in most cases (cases of meningitis and hydrocephalus postoperatively were noted).
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Pathologie du sujet g au service d'accueil des urgences du CHU Mohammed VI de Marrakech

Pathologie du sujet g au service d'accueil des urgences du CHU Mohammed VI de Marrakech

Patients and methods : This is prospective study in Med VI Teaching Hospital in Marrakech, collated with a sample of 276 cases of 820 admitted over a period of six months from March to September 2012. Results and Discussion : In our study, 9.7% have more than 65 years old and the population is constituted from 40.9% of women and 59.1% of men. The average age is 82.5 years, the pathology of the musculoskeletal system (15.7%), the urology (14.5%), pulmonology (11.5%), cardiology (11.3%), general surgery (9.1%), neurology (8.4%), cardiovascular surgery (5.2%), gastroenterology (3.8%), hematology, endocrinology, nephrology, neurosurgery (3.5%). In our study 44.1% of patients had regained their home, 53.5% were hospitalized in various wards of the hospital with 11.9% in resuscitation room-intensive care unit, 1.7% died, this is due to the lack of structure in gerontology to receive and to taking care medically and socially. These problems are compounded by the lack of gerontological network-hospital whose main purpose is the accommodation and care of patients with chronic conditions or social problems incompatible with their return home.
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Le kratocne : Exprience du service dOphtalmologie, CHU Mohammed VI, Marrakech

Le kratocne : Exprience du service dOphtalmologie, CHU Mohammed VI, Marrakech

It is a retrospective and prospective study of 200 eyes followed for keratoconus at CHU Mohammed VI of MARRAKECH between 2009 and 2015. One hundred and ten patients were collected during this period, with a slight female predominance (Sex ratio: 1.27); the mean age of patients was 26 years [12-47]; one fourth of patients had allergic conjunctivitis in past medical history. Keratoconus was bilateral in 90 patients, bringing the number of eyes with keratoconus to 200. Visual acuity was less than 1/10 in 55% of the eyes. Refraction performed in all patients showed that 40% of the eyes had an impossible measure and 120 eyes (60%) had irregular myopic astigmatism with an average value of -5.67 diopters; the mean keratometry value was 54.87 diopters.The slit lamp examination revealed corneal ectasia in 85%, Fleischer's ring in 66%, Vogt striae in 57%, and corneal opacities were observed in 35% of the affected eyes. The specular topography was carried out in 60% of the eyes whereas the topography of elevation could only be achieved in 40%.
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Mortalit aux urgences pdiatriques du CHU Mohammed VI Marrakech

Mortalit aux urgences pdiatriques du CHU Mohammed VI Marrakech

Summary Analysis of the causes of death in children in the pediatric emergency department, may aid the development of management and prevention practices. The mortality of children under- five years constitutes a real problem of public health in the world. The children under-five years remain the age group most concerned for their vulnerability objectified by the scale of mortality. The reason why the United Nations set The Sustainable Development Goals that aims reduce under-five mortality to at least as low as 25 per 1,000 live births. To identify the causes of death in pediatric emergency department as well as to analyze its risk factors to highlight recommendations. This was a retrospective descriptive study including all patients whose death was in pediatric emergency department of the University Hospital Mohamed VI in Marrakech, between January 2012 and December 2016.
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Traitement chirurgical des cancers du sein au CHU MOHAMMED VI MARRAKECH

Traitement chirurgical des cancers du sein au CHU MOHAMMED VI MARRAKECH

6. Les marges d’exérèses L'atteinte des berges d'exérèse par du tissu tumoral (invasif ou in situ) est un facteur indépendant de risque de récidive locale (RL) après traitement conservateur radiochirurgical, Des recommandations américaines [2] concluent que le risque de RL après traitement conservateur radiochirurgical est multiplié par deux en cas d'atteinte des berges et que qu'une exérèse conservatrice peut être jugée adéquate (et donc ne justifie pas de reprise) dès lors qu'il n'existe pas sur l'examen histologique définitif de la pièce des cellules tumorales (contingent invasif ou in situ) dans la dernière assise cellulaire encrée. En France, le consensus de Saint- Paul-de-Vence 2007 concluait qu'il n'était pas possible de définir une marge optimale validant ou non l'indication d'une reprise. Il proposait, après évaluation microscopique des seules berges latérales(quand l'exérèse était menée de la sous-peau aufascia prépectoral), une reprise chirurgicale systématique uniquement lorsque la marge entre le tissu tumoral, invasif ou canalaire in situ, était inférieure à 1 mm, la reprise étant inutile si la marge était supérieure à 5 mm Pour une marge entre 1 et 5 mm, la décision de reprise ou non devait être discutée au cas par cas. L'existence de lésion de carcinome lobulaire in situ non pléomorphe au contact des berges n'était pas une indication de reprise, alors que les données actuelles étaient insuffisantes pour se prononcer s'il s'agissait de lésions de carcinome lobulaire in situ. Enfin, pour les carcinomes canalaires in situ purs, les recommandations de l'INCa 2009 proposaient une marge à 2 mm pour décider ou non d'une reprise[66].
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Eclampsie au CHU Mohammed VI de Marrakech

Eclampsie au CHU Mohammed VI de Marrakech

Abstract The occurrence of eclampsia during pregnancy is a dangerous obstetric situation and responsible for an important maternofetal mortality and morbidity, precisely in third world countries. The aim of this retrospective study is to clarify the epidemiological, therapeutic and evolutionary profile of eclamptic patients accepted at the department of Gynaecology and obstetrics at the CHU MOHAMMED VI of MARRAKECH over 3 years (from January 2004 till December 2006). The general incidence of eclampsia is 0,35%, affecting the primipares young persons especially in 66 % of cases. This disease reveals itself in last quarter of the pregnancy (52,6%), especially in antepartum in 62%. The anticonvulsant of choice in our study is Diazépam (82,7 %) and the first one as antihypertensive is Methyl Doped used at all our patients, especially in bitherapy (60,7 %) with Nicardipine. Our obstetrical attitude was based on immediate uterine evacuation with a rate of 48,2 % caesarians. The rate of morbidity is raised at the mothers with 54,4 % as rate of the patients which badly evolved in spite of an adequate care, with 37,2 % of the cases having presented the complications to type of renal insufficiency (3cas), OAP (4cas), HELLP syndrome (2cas), haemorrhage of the delivery (4cas) and of infection (7cas). To the fetus, this morbidity was especially represented by the hypotrophy in half of the cases, followed by the neonatal suffering (49 %) and the prematurity (40,2 %). The prognosis of eclampsia is bleak in our study both for the mothers with a rate of maternal mortality of 12,5 %, and for the fetus with 30,3 % as rate of perinatal mortality. Hence the extreme interest of early detection and supervision of high-risk pregnancies and the immediate and appropriate medical and obstetrical care to improve the materno-fœtal prognosis, especially after the introduction of magnesium sulfate, the reference anticonvulsant in the eclampsia.
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Lautotransfusion sanguine peropratoire au CHU Mohammed VI de Marrakech

Lautotransfusion sanguine peropratoire au CHU Mohammed VI de Marrakech

La mesure répétée in situ des concentrations des hémoglobines ou de l’hématocrite est nécessaire. La méthode de l’HDNI rend disponible des unités de sang total autologue pouvant être transfusées en fin d’intervention quand l’hémostase chirurgicale permet d’assurer l’absence de saignement notable. Ces produits sont peu exposés aux lésions de conservation, réduisent le risque de contaminations bactériennes et d’erreurs. Ils contiennent des facteurs de coagulation et des plaquettes pouvant être utiles dans certains types de chirurgie pour réduire le saignement postopératoire [18]. L’HDNI constitue aussi une pratique particulièrement intéressante chez les patients pouvant présenter des pertes hémorragiques importantes difficilement prévisibles [26,27].
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Expérience du service de gynécologie obstétrique A CHU Mohammed VI - Marrakech

Expérience du service de gynécologie obstétrique A CHU Mohammed VI - Marrakech

Ainsi, en connaissant bien les facteurs pouvant altérer la cicatrice utérine et en surveillant correctement la grossesse et le déroulement du travail des parturientes porteuses d’un uté[r]

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Greffe de cornée : Expérience du service d’Ophtalmologie au CHU Mohammed VI de Marrakech

Greffe de cornée : Expérience du service d’Ophtalmologie au CHU Mohammed VI de Marrakech

IX IX IX IX.... Techn Technique opératoire Techn Techn ique opératoire ique opératoire :::: ique opératoire Kératoplastie transfixiante versus kératoplasties lamellaires. Au service d’ophtalmologie au CHU Mohammed VI de Marrakech, nous pratiquons la kératoplastie transfixiante (greffe complète de la cornée), mais cette technique s’accompagne de plusieurs complications majeures et souvent imprévisibles. Parmi celles-ci, le rejet, l’hypertonie oculaire, et la décompensation œdémateuse mettant en jeu le pronostic de la greffe. Il faut également mentionner les autres complications ne compromettant en rien la survie du greffon comme l’astigmatisme secondaire induit par plusieurs facteurs (incongruence des berges, tension et asymétrie des sutures…) et la récupération visuelle qui est tardive s’échelonnant sur 6 mois à un an selon le terrain du receveur, la cause de la greffe et l’heure de retrait des sutures.
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