Physiology and Anatomy

Wilm’s tumor is the most common retroperitoneal tumor extending into the Inferior vena cava (IVC) in a child. In 1% of cases right atrial (RA) extension may be encountered. Anesthesia for intracardiac resection of tumor thrombus remains a challenge. We report 2 cases of Wilm’s tumor, one extending upto IVC-RA junction and the other with RA involvement managed successfully with resection on cardiopulmonary bypass. In both patients epidural catheters were inserted for perioperative analgesia. Considerable controversy exists regarding insertion of epidural catheters in the face of systemic heparinization. However we report good outcomes in terms of analgesic efficacy, shorter perioperative course and no complications. A short discussion on the various methods of bypass employed for the removal of these tumors is included. We also discuss the utility of newer equipment like Transesophageal echocardiography (TEE) and ultrasound for perioperative anesthetic management. 

Spermatocytic seminoma (SS) is a distinct testicular germ cell tumor, representing less than 1% of testicular cancers. The clinical features that distinguish (SS) from classical seminoma (CS) are an older age at presentation and a reduced propensity to metastasize. Currently, the management (SS) has changed to the increased use of surveillance, provided that there are no risk factors which may predict recurrence. Here, we report an additional case of SS and present a comprehensive relevant literature review concerning current clinical, histopathological, and therapeutic features.

Anorectal malformations (ARM) comprises, a wide spectrum of diseases, which can affect girls and boys, and involve the rectum and distal anus as well as the genital and urinary tracts. ARM occurs in around 1 in 5000 live births. Defects range varies from the very minor or “low” which are easily treated with an excellent functional prognosis, to those that are difficult to manage, complex, are often associated with other anomalies known as “high”, and have a poor functional prognosis. The surgical approach to repairing these defects changed intensely in 1980 with the introduction of the posterior sagittal approach, Better imaging techniques, and a improved knowledge of the anatomy and physiology of the pelvic structures at the time of birth.

Transposition of the great vessels is a type of congenital heart defect involving an abnormal arrangement of any of the great vessels such as the superior vena cava, pulmonary arteries and aorta. Congenital heart diseases concerning the primary arteries are further divided into sub-group called transposition of great arteries. There are different forms of anomalies like Dextro-transposition, Levo-transposition and Dextrocardia. It was first announced about two centuries ago, but the treatment became effective from the mid 21st century. Today the survival rate for infants is greater than 90%.

Mass violence invariably results in devastating consequences that may significantly impair an individual’s cognitive, emotional, physical, and behavioral functioning, besides destroying the community’s moral, cultural and social fabric. It inevitably results in trauma, which, if not confronted with psychotropic medicine or therapy, may never heal. Psychotherapeutic interventions facilitate the victim’s understanding and acceptance of the new realities, thus giving hope and meaning to an otherwise disintegrating life. Consequently, the preparedness of humanitarian agencies in psychotherapeutic interventions can greatly assist victims especially in mass violence settings, just as happened in Kenya’s 2007 post election violence (PEV). The purpose of the study was to gather information on, and evaluate the use of psychotherapeutic support as an interventional strategy in helping trauma victims. Also, the study investigated the prevalence, provision, influence of time response and intervener skills on the effectiveness of the strategy; and, discrimination in availability and accessibility of the service across geographical localities, ethnic communities, gender, and age grouping. An estimated 31% of the internally displaced persons (IDPs) randomly selected in 12 geographical localities across two provinces in seven districts participated in the study. The sample consisted of 59% females and 41% males and maintained a balance between adults and youth. In addition, the study utilized 10 humanitarian agencies by interviewing two of their professionals who intervened in trauma cases. The study employed the causal comparative design to explore relationships between variables and utilized a questionnaire, interview schedule and an observation form as primary tools in eliciting data. In addition, time response was found to be significant in improving the effectiveness of an intervention. Lastly, the study found that to a greater extent, humanitarian agencies acted responsibly and quickly

Physical inactivity is a strong predictor of mortality in patients with end-stage renal disease and is associated with poor physical functioning. Patients with end-stage renal disease are inactive even compared to sedentary individuals without kidney disease. We sought to analyze the level of physical activity in our chronic hemodialysis patients and to identify patient barriers to physical activity. Adult patients on hemodialysis in the Department of Renal Dialysis and Renal Transplantation at the Mohammed V Military Training Hospital in Rabat were recruited and asked to complete the update Baecke physical activity questionnaire in French named AQAP (Physical Activity Self-Questionnaire) A total of 52 patients participated in the study, the mean age of the patients was 50 years ± 16.55 with extremes ranging from 24 to 76 years, sex ratio (H / F) was 1.1. The majority of participants strongly agreed that a sedentary lifestyle was a health risk and that increasing exercise was a benefit. 23% report having no physical activity. 74% of patients report difficulty in performing significant physical exertion. 17 % of patients report having a regular physical activity and sport. However, 49% of participants reported at least one barrier to physical activity. The most commonly reported barriers were fatigue on dialysis days shortness of breath and depression. Exercise provides beneficial effects in end stage renal disease, our study identified a number of barriers to physical activity that can be addressed in studies aimed at increasing levels of physical activity.

Hamartomas are one of the most common benign tumors of the lung. We report a case of huge pulmonary hamartoma of the left lower lobe in a 33-year-old female patient. The pulmonary hamartoma was solid, measuring 30 x 16.5 x 14.5 cm, closing a cystic and calcium component. It was successfully treated by surgical resection and the final histology was a pulmonary hamartoma with no signs of malignancy. we report a new case of a giant hamartochondroma very little described in the literature

Isolated ischemia of the caecum is a rare condition, with only a few reported cases in the literature and most often manifested by pain in the right iliac fossa.The mode of revelation by occlusive syndrome is unique. With early medico-surgical management, the prognosis is relatively excellent.We report an original case of isolated ischemia of the caecum revealed by an occlusive syndrome.

Macular telangiectasias are characterized by the presence of microanevrysmal dilations around the fovea. This appellation brings together two very different entities, type 1 and type 2. We are talking in this work about Macular telangiectasia type 2. We report the case of a 48-year-old patient followed for macular telangiectasia 2, complicated by neovessels treated by anti VEGF

Myxedema coma, represents the extreme degree of severity of hypothyroidism, whose mortality can reach very high percentages, therefore, it is a true medical emergency. In general, its development is associated with the presence of a triggering factor in a controlled hypothyroid patient and manifests with multisystem alteration. Currently, tools have been developed for clinical diagnosis that use the profile and clinical models, and have good sensitivity-specificity. They allow an early diagnosis which favored the early start of treatment and therefore improves the prognosis. The patient with myxedema coma needs an integral approach, with intensive treatment and close monitoring of hemodynamic parameters. However, the basis of treatment remains hormone replacement, which should be initiated with a combination of levothyroxine and triiodothyronine