Physiology and Anatomy

The aneurysms of the digestive visceral arteries constitute a rare vascular pathology, since they represent only 5% of all the aneurysms. The rupture remains the most formidable complication. The treatment is essentially based on conventional or endovascular surgery. This is a report of 4 cases presenting an aneurysm of different visceral arteries managed in the department of vascular surgery of the Mohammed VI-Oujda CHU.The mean age was 41 years, (30-57 years mean with SD), sex ratio is at 1, and two patients had a specific aneurysm related symptomatology with pulsatile abdominal mass and systolic murmur. The location of the aneurysms was variable with two cases of the splenic artery, one of the superior mesenteric artery and one of the cystic artery. The diagnosis was madein three patients by the abdominal ultrasound, supplemented by the CT-scann, and once by the abdominal CT- scann immediately. Three patients were treated surgically with resection of the aneurysm without restoration of continuity. The goal of DAA treatment is to prevent risk of rupture associated to a high mortality. The risk of rupture depends on the location, type, and etiology of the aneurysm.Atherosclerosis has the main etiology of digestive aneurysms, followed by mycotic and post-traumatic aneurysms. Fibromuscular dysplasia remains a rare and poorly understood entity.Surgical treatment is the therapy of choice. Endovascular techniques have developed and are being used successfully. They have indications more and more wide in the treatment of aneurisms of the digestive arteries.The advent of endovascular treatment has significantly increased the percentage of patients treated for aneurysm of the digestive arteries, thus reducing morbidity and mortality in patients at high surgical risk.

Tracheoesophageal fistula is a life threatening condition. Patients not managed surgically ultimately die of their disease. Surgical management is the only treatment of choice. We present a case of a patient that developed a tracheoesophageal fistula after tracheostomy. Surgical repair was done which failed due to infection. The patient was managed with the help of an esophageal stent and Trichloroacetic Acid cautery. This approach can be used in selected patients, depending upon the size and site of TEF. Larger fistulae and those situated lower down e.g. supra cardinal cannot be managed by this technique.

A developing nation like ours has been suffering with a tremendous cases of tuberculosis nationwide, in all forms expected. We here highlight a case of Tuberculosis of breast tissue in an adolescent girl which is rare as a presentation and was mis-lead and treated as a breast abscess of other origin. Confirmatory findings with use of tools like ultrasonography and biopsy made us to final the diagnosis and put the patient on anti-tubercular drugs.

Urinary stones are frequent. Prevalence rates vary from 1% to 20%. Young adults are the most frequent affected with about 11% of male and 7 % of female population. Stone incidence depends on geographical, climatic, ethnic, dietary and genetic factors. Diagnosis is based on imaging, biochemical laboratory work-up and stone analysis via infrared spectroscopy. Bladder stones are generally of small sizes caused by bladder outlet obstruction and their treatment is relatively easy via endoscopic instrumentation. Giant bladder stones are rare in current urological practice. We here-in report a case of a 80-year-old male patient who presented to our department with lower urinary tract symptoms mainly pollakiuria and dysuria evolving for 5 years. Clinical examination revealed hypogastric pain at palpation and an enlarged prostate. Computed tomography bladder imaging showed a 6-cm giant bladder stone and 150 g enlarged prostate. Open cystolithotomy was performed to concomitantly extract the stone weighing 400 g and treat the enlarged prostate.

Malnutrition in under five is a major concern in developing countries including Somalia. More than 1 billion people are malnourished and malnutrition contributes to more than 30% of all deaths in children below five years. This study will investigate determinants of malnutrition in children under five years old in Mogadishu-Somalia at Banadir and S0S Hospitals. The specific objectives are: to identify how income level of household influences determines malnutrition in children under five years old; how health education determines malnutrition in children under five years old and finally to find out how dietary intake determines malnutrition in children under five years old. The study involves a design for the collection, measurement and analysis of data. The population in study is 450, and its sample size is 212 and main data collection tool is a semi structured administered questionnaire. Qualitative data were analyzed on content matter of the responses. Quantitative data were coded and entered into Statistical Package for social Scientist (SPSS Version 22) using multiple Regression tool for analyzing the data. The result was presented in the form of summaries, such as statistical tables and discussions and illustrations. The study findings are useful for the health workers as reference in the determinants of malnutrition for children under five old and the community at large. The study findings showed that 77% of the respondents agreed that the income level of household affects child nutrition while 23% of the respondents disagreed. The study findings indicated that 21% of respondents had gone to the nutritionist 'once', 9% of them had gone to the nutritionist 'twice', 11% of them visited the nutritionist '3 times' while 4% of them had gone to nutritionist 'above 3 times' while 55% of them had 'never gone to a nutritionist. Education training on nutrition plays a very significant role in reducing malnutrition. Study findings indicated that 2% of the mothers with malnourished children breast-fed their children to provide their children balanced diet because breast milk for first six months is balanced diet. 85% of the them breast fed their children to protect them diseases. 13% of them breast-fed their children to take part their proper growth. The researcher is recommending that Income growth alone will not reduce rates of malnutrition, and so direct interventions to tackle malnutrition is needed. Things such as vitamin, mineral and micronutrient supplementation; kangaroo mother care, early initiation of breastfeeding, promotion of dietary diversity; community-based nutrition education, and school feeding programmes. Education may change women's preferences about the quantity versus the quality of children, with educated women choosing fewer children but of better "quality". Mother’s education has a greater impact on the educational attainment and school achievement of children than father's education.

Isolated right ventricular myocardial infarction is a rare entity in the spectrum of acute coronary syndrome. It is often overlooked during the assessment of patients suspected to have acute coronary syndrome.A 49 years old male presented with atypical chest discomfort associated with vagal symptoms. The initial ECGs were not supporting. The Echocardiography revealed an isolated right ventricular myocardial wall motion abonrmality that was initially missed. Coronary angiogram revealed a dominant right circulation and a selective occlusion of an acute marginal branch. Successful angioplasty was done .Cardiac MRI performed 48 hours later confirmed isolated character of the infarction by showing hyperenhancement of free wall of right ventricle.In the current report, we illustrates the importance of looking carefully for isolated right ventricular infarction during echocardiography in all cases of suspected myocardial ischemia.

We report the case of a 21-year-old patient, who had a stricture of the penile urethra. After failed endoscopic urethrotomy, he had resection of the stricture with end to end anastomotic urethroplasty. We describe this surgical technique and analyze epidemiological, therapeutic and prognostic characteristics of anterior urethral strictures.

 Describe the modalities for the management of anaplastic thyroid carcinoma in its sarcomatoid form. Material and method: We report the case of a 45-year-old woman who presented with anaplastic thyroid carcinoma in its sarcomatoid form. Clinical case: This is a 45-year-old patient admitted to the emergency department for the management of inspiratory dyspnea on a large mass in the anterior cervical region that has been developing for more than 3 months. A cervicothoracic CT scan was performed urgently showing an enormous thyroid mass of malignant appearance at the expense of the left thyroid lobe with extension to the other lobe, associated with thrombosis of the internal jugular vein and the superior vena cava, as well as a right pulmonary embolism. A surgical decision for tumor reduction with extemporaneous pathological examination associated with a tracheostomy was taken. The definitive anatomopathological examination revealed after immunohistochemical study anaplastic thyroid carcinoma in its sarcomatoid form Conclusion: The therapeutic approach to anaplastic cancers has changed in a few decades. Surgical treatment of goiters has reduced the incidence of these cancers, access to preoperative cytological diagnosis sometimes allows early management, at the stage of emerging intrathyroidal anaplastic foci in differentiated cancers. Combined treatments give back a place to surgery. 

we report a clinical case of a rare entity, the zenker's diverticulum, discovered in a young man, we present the clinical dilemma and the management challange.

Laryngomalacia is the most common cause of stridor in infants-strider results from upper airway obstruction due to supraglottic tissue collapse. Most causes of laryngomalacia are mild and self solve investigation and intervention required in severe causes. There is a strong association with gastroesophgeal reflux disease in patients with laryngomalacia and thus medical treatment with antireflux medications surgical treatment is preferred, while it indicate supraglottoplasty, severe cases are reserved. Proper identification of those patients when requires medical and surgical invention is key to providing with successful outcomes.