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Aftiss F, El Mezzeoui S, El Aidouni G, Merbouh M, Nasri S, Jabi R, Bkiyar H, Skikar I, Bouziane M, Housni B. Surgical and anesthetic management of paraganglioma diagnosed in a 2nd trimester parturient: Case report. Ann Med Surg (Lond) 2021; 72:103094. [PMID: 34934482 PMCID: PMC8654780 DOI: 10.1016/j.amsu.2021.103094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Neuroendocrine tumors represent a rare entity whose diagnosis is based on clinical, biological and radiological arguments. When they are secreting, they expose the patient to serious complications that can be much more severe during pregnancy and engage the vital prognosis of both the mother and the fetus, which requires multidisciplinary management: anesthesiologist resuscitator - obstetrician – endocrinologist. Case presentation In our article, we report the case of a patient with an estimated pregnancy at 25 weeks of amenorrhea (WA) with a history of 3 miscarriages related to atypical gravid hypertension. The treatment consisted of preoperative medical preparation followed by removal of the paraganglioma and postoperative monitoring. The maternal-fetal evolution was favorable. Conclusion The non-negligible morbi-mortality of this type of tumors require a multidisciplinary management. Neuroendocrine tumors represent a rare entity whose diagnosis is based on clinical, biological and radiological arguments. The treatment consisted of preoperative medical preparation, removal of the paraganglioma and postoperative monitoring. The anesthetic and surgical management of pheochromocytomas and paragangliomas in pregnant women presents a real challenge.
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Affiliation(s)
- F Aftiss
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco
| | - S El Mezzeoui
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco
| | - G El Aidouni
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco
| | - M Merbouh
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco
| | - S Nasri
- Department of Radiology, Mohamed VI University Hospital Center, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - R Jabi
- Department of General Surgery, Mohamed VI University Hospital Center, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - H Bkiyar
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Oujda, Morocco.,Oujda Medical Simulation Training Center, Morocco
| | - I Skikar
- Department of Radiology, Mohamed VI University Hospital Center, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - M Bouziane
- Department of General Surgery, Mohamed VI University Hospital Center, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - B Housni
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Oujda, Morocco.,Oujda Medical Simulation Training Center, Morocco
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Elkaouini A, Berrajaa S, Aabdi M, Merbouh M, El Mezzeoui S, El Aidouni G, Bkiyar H, Jabi R, Bouziane M, Housni B. Inferior mesenteric artery aneurysm revealed by massif rectal bleeding, case report. Ann Med Surg (Lond) 2021; 66:102425. [PMID: 34141412 PMCID: PMC8188245 DOI: 10.1016/j.amsu.2021.102425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/17/2021] [Accepted: 05/22/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Inferior mesenteric aneurysms are rare, usually asymptomatic. Their diagnostic is challenging based on clinical examination, ultrasonography, and abdominal CT scan; surgery remains the gold standard of treatment. CASE REPORT In this paper, we will report a clinical case of 62 years old man admitted to the emergency department for massif rectal bleeding due to inferior mesenteric aneurysm fistulization in the transversal colon one month after a left colectomy; the treatment was surgical consisted of a Ligation. CONCLUSION IMA aneurysm is a rare condition, usually asymptomatic, and it might be revealed by various symptoms, including massif rectal bleeding.
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Affiliation(s)
- A. Elkaouini
- Intensive Care Unit, Faculty of Medicine and Pharmacy Oujda, Mohammed VI University Hospital Center, Mohammed University 1st, Oujda, Morocco
| | - S. Berrajaa
- Intensive Care Unit, Faculty of Medicine and Pharmacy Oujda, Mohammed VI University Hospital Center, Mohammed University 1st, Oujda, Morocco
| | - M. Aabdi
- Intensive Care Unit, Faculty of Medicine and Pharmacy Oujda, Mohammed VI University Hospital Center, Mohammed University 1st, Oujda, Morocco
| | - M. Merbouh
- Intensive Care Unit, Faculty of Medicine and Pharmacy Oujda, Mohammed VI University Hospital Center, Mohammed University 1st, Oujda, Morocco
| | - S. El Mezzeoui
- Intensive Care Unit, Faculty of Medicine and Pharmacy Oujda, Mohammed VI University Hospital Center, Mohammed University 1st, Oujda, Morocco
| | - G. El Aidouni
- Intensive Care Unit, Faculty of Medicine and Pharmacy Oujda, Mohammed VI University Hospital Center, Mohammed University 1st, Oujda, Morocco
| | - H. Bkiyar
- Intensive Care Unit, Faculty of Medicine and Pharmacy Oujda, Mohammed VI University Hospital Center, Mohammed University 1st, Oujda, Morocco
| | - R. Jabi
- General Surgery Department, Faculty of medicine and pharmacy Oujda, Mohammed VI University Hospital Center, Mohammed University 1st, Oujda, Morocco
| | - M. Bouziane
- General Surgery Department, Faculty of medicine and pharmacy Oujda, Mohammed VI University Hospital Center, Mohammed University 1st, Oujda, Morocco
| | - B. Housni
- Intensive Care Unit, Faculty of Medicine and Pharmacy Oujda, Mohammed VI University Hospital Center, Mohammed University 1st, Oujda, Morocco
- Oujda Medical Simulation Training Center, Faculty of medicine and pharmacy Oujda, Morocco
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Toutai C, Berrajaa M, Aissaoui H, Elouafi N, Jabi R, Bouziane M, Latrech H, Housni B, Ismaili N. Rare association of aortoarteritis and pheochromocytoma: A case report. Int J Surg Case Rep 2020; 77:91-95. [PMID: 33157340 PMCID: PMC7649416 DOI: 10.1016/j.ijscr.2020.10.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 11/30/2022] Open
Abstract
Pheochromocytoma is a great masquerador. The coexistence of pheochromocytoma along with both aortoarteritis and renal artery stenosis is very rare. Management of vascular abnormalities is based on the control of catecholamine release. Pheochromocytoma should be included as differential diagnosis of aortoarteritis.
Introduction Pheochromocytoma is an uncommon but treatable cause of secondary hypertension, it may present with a wide variety of manifestations. The coexistence of pheochromocytoma and vascular abnormalities is described but rarely reported entity. Presentation of case A 36-year-old man was admitted to our hospital for severe hypertension, examination revealed absent femoral pulses with notion of intermittent claudication. Abdominal computed tomography revealed the presence of a right adrenal pheochromocytoma. CT angiogram showed thickening of the thoracoabdominal aortic wall and the proximal portions of some of its branches with stenosis of more than 50% of the origin of the celiac trunk, bilateral occlusion of the external iliac arteries and trunk stenosis of the right renal artery. The Pheochromocytoma was surgically removed. Discussion Coexistence of pheyochromocytoma and vascular abnormalities especially renal artery stenosis and aortoarteritis seems to be an association rather than a coincidence. Conclusion To the best of our knowledge, the coexistence of pheochromocytoma along with both aortoarteritis and renal artery stenosis has not been reported thus far. The diagnosis, management and potential mechanisms underlying such an association will be discussed in this case.
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Affiliation(s)
- C Toutai
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Laboratory of Epidemiology and Public Health, Oujda, Morocco.
| | - M Berrajaa
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Laboratory of Epidemiology and Public Health, Oujda, Morocco
| | - H Aissaoui
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Laboratory of Epidemiology and Public Health, Oujda, Morocco
| | - N Elouafi
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Laboratory of Epidemiology and Public Health, Oujda, Morocco
| | - R Jabi
- Department of General Surgery, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - M Bouziane
- Department of General Surgery, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - H Latrech
- Department of Endocrinology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - B Housni
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - N Ismaili
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Laboratory of Epidemiology and Public Health, Oujda, Morocco
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Bernstein C, Bernstein H, Garewal H, Dinning P, Jabi R, Sampliner RE, McCuskey MK, Panda M, Roe DJ, L'Heureux L, Payne C. A bile acid-induced apoptosis assay for colon cancer risk and associated quality control studies. Cancer Res 1999; 59:2353-7. [PMID: 10344743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Bile acids are important in the etiology of colorectal cancer. Bile acids induce apoptosis in colonic goblet cells at concentrations comparable to those found in fecal water after high-fat meals. Preliminary evidence indicated that cells of the normal-appearing (nontumorous) portion of the colon epithelium of colon cancer patients are more resistant to bile salt-induced apoptosis than are cells from normal individuals. In the present study, 68 patients were examined, and biopsies were taken at 20 cm from the anal verge, cecum, and descending colon. The patients included 17 individuals with a history of colorectal cancer, 37 individuals with adenomas, and 14 individuals who were neoplasia free. The mean bile salt-induced apoptotic index among normal individuals was 57.6 +/- 3.47 (SE), which differed significantly (P < 0.05) from the mean value of 36.41 +/- 3.12 in individuals with a history of colon cancer. The correlation between independent observers was 0.89 (P < 0.001), indicating good interobserver reliability. Components of variance comparing interindividual versus intraindividual sources of variation suggested that site-to-site variability, both between regions of the colon and for adjacent biopsies, was larger than the interpatient variability for individuals with a history of neoplasia. Therefore, there was "patchiness" of the susceptibility of regions of the colon to bile acid-induced apoptosis in individuals with a history of neoplasia (a patchy field effect). There was no obvious correlation of low-apoptotic index regions with regions in which previous neoplasias had been found and removed. On the other hand, for normal, i.e., neoplasia-free, individuals, there was relatively less intraindividual variation compared to interindividual variation. Our assay shows an association between resistance to bile acid-induced apoptosis, measured at 20 cm from the anal verge, and colon cancer risk. Thus, this assay may prove useful as a biomarker of colon cancer risk.
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Affiliation(s)
- C Bernstein
- Department of Microbiology and Immunology, College of Medicine, University of Arizona, Tucson 85724, USA.
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