MO939: Role of The General Practitioner in Promoting Organ Donation

BACKGROUND AND AIMS

Organ transplants now play a significant role in the treatment of diseases that are nonetheless fatal. Organ and tissue transplantation in Morocco is severely delayed, and the number of transplants conducted in our country does not reach 10 per million inhabitants per year. Due to a scarcity of organs and tissues, the number of transplants and tissue grafts, which are primarily a Ministry of Health effort, is limited.

The main link in the medical chain is the general practitioner. In addition to his solitary practice of medicine, he is already responsible for a number of public health missions, primarily in the fields of disease prevention and detection, as well as organ and tissue donation promotion.

We conducted a quantitative cross-sectional study through a survey to measure the level of involvement and dedication of general practitioners in the promotion of organ donation.

METHOD

A quantitative descriptive cross-sectional study, based on a questionnaire with 20 closed questions, self-administered, emailed, completed anonymously and voluntarily intended to the general practitioner of the region of Casablanca. Questionnaire data were collected, encoded and analyzed using SPSS-PC (Version 21.0).

RESULTS

Our study targeted 200 general practitioners in total, of which 165 responded to the questionnaire, giving an overall response rate of 82.5%.

The average age of participants was 34.22. The duration of exercise varied between 1 and 40 years, with an estimated average of 11 years, 65% of the doctors practiced in the urban environment and ∼59.5% worked in the liberal sector.

A total of 87% of the doctors questioned were in favor of organ donation, and 13% were against organ donation, for which the religious cause represented 78% and 16% refused for medical reasons, 54.5% of them had never discussed the subject with their relatives, and 80.5% of practitioners declared having a patient waiting or who had received an organ transplant. Only 38% of doctors had already discussed this subject with their patients, of whom >64% were following the sole initiative of the patient himself, and in none of the cases was awareness raising through posters in the waiting room.

Only 1.5% of participants had brochures on organ donation in their waiting rooms, and >87% thought that TV shows in waiting rooms were a good means of information and awareness.

CONCLUSION

The involvement of general practitioners begins at the awareness stage, with the goal of disseminating information about organ donation.

Aneurysm and pseudoaneurysm of the left ventricle

The severity of myocardial infarction lies in its complications. Certainly, there was a significant decrease in their impact thanks to the improvement of medical care and advent of early reperfusion methods, but there is still a considerable rate of complications that pose diagnostic and therapeutic problems. Among them, there are left ventricular aneurysm and pseudoaneurysm. These two complications are relatively rare, their diagnosis and treatment are often difficult. We have attempted to review the existing literature and discuss the characteristic findings of each entity.

[Epidemiological profile and analysis of predictive factors of organ donation refusal in the Moroccan population]

Organ donation is influenced by several factors. A better understanding of the reasons for organ donation refusal would allow an increase in the number of donors. The objective of our study is to assess the knowledge and position of the general Moroccan population considering organ donation and to determine the factors that influence their positions. In this study, socio-demographic data, knowledge and attitude towards organ donation and reasons for refusing organ donation were collected from 677 Moroccan participants. Although only 1% of participants are enrolled in the donor registry, our survey showed that 64.7% of participants are in favor of organ donation. The level of education, the socio-professional category, the marital status, the ethnic origin and the medical coverage are the socio-demographic factors most discriminating concerning the will to donate organs or not. The binary logistic regression made it possible to identify the factors that prevent organ donation, namely the problem of confidence in the health system, personal and religious reasons but also the lack of valid reasons. Thus, a better knowledge of the legislation in force and of the position of the Islamic religion as well as the establishment of training and information programs through advertising campaigns will promote organ donation. LEVEL OF EVIDENCE: 3.

Malignant pheochromocytoma: A diagnostic and therapeutic dilemma

Introduction

Malignant pheochromocytomas are rare endocrine tumors that develop within chromaffin tissue. The diagnosis of malignancy is based on neoplastic recurrence or the presence of metastasis in organs that lack chromaffin tissue. We report a series of four cases because of their diagnostic and therapeutic particularities.

Presentation of case

we describe four clinical cases of patients with malignant pheochromocytoma whose Menard triad “headache-palpitations-sweating” was present in three out of four patients, the methoxylated derivatives were measured in 4 patients, 3 of which had high values, all of our patients carried out a CT scan which objectified signs of malignancy, MRI was performed on a single patient; presenting with a neoplastic recurrence; looking for a locoregional invasion.

Discussion

Pheochromocytoma (PC) is a rare neuroendocrine tumor derived from the chromaffin cells of the adrenal medulla. Its annual incidence is 2 to 8 per million adults. A peak frequency is observed between 30 and 40 years of age. Approximately 10% of pheochromocytomas are malignant and in 10% of cases, bilateral localization is observed. Criteria for malignancy include the invasion of neighboring organs, a large tumor, the presence of lymphadenopathy on imaging, or fixation on scintigraphy. Surgery for MAP is not always curative. In the case of multiple liver metastases, treatment is based on adrenalectomy, which can be effectively combined with chemoembolization, cryoablation, or radiofrequency techniques.

Conclusion

The main prognostic factors of the malignant pheochromocytomas are a large tumor volume, the existence or number of visceral metastases, and the presence of a mutation in the SDHB (Succinate dehydrogenase B) gene.

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Malignant pheochromocytomas are rare endocrine tumors that develop within chromaffin tissue.

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A very large part of pheochromocytomas are of genetic origin which can be part of hereditary syndromes.

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Criteria for malignancy include the invasion of neighboring organs, a large tumor, the presence of lymphadenopathy on imaging, or fixation on scintigraphy.

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Adequate management of this pathology requires a multidisciplinary consultation meeting

Mucosal urinary secretion revealing adenocarcinoma of urachus

Introduction

Urachus adenocarcinoma is an extremely rare malignant tumor characterized by its insidious evolution responsible for the delay in diagnosis. Several scientific works have tried to study the indication of adjuvant treatment, therefore the prognosis is still poor.

Presentation of case

We report the case of a 50-year-old patient with no pathological history who consulted for an episode of intermittent urinary mucosal secretion aggravated by the appearance of macroscopic hematuria. Without other associated clinical signs. Imaging examinations revealed a mass at the expense of the upper wall of the bladder. The cystoscopy allowed us to visualize the mass and the biopsy. Histological study revealed an adenocarcinoma of urachus. The patient underwent surgical exeresis and adjuvant chemotherapy. The evolution was marked by a deterioration of the general condition despite adequate management.

Discussion

Due to its topography, urachus cancer usually manifests as a bladder tumor, exceptionally as much as an anterior umbilical or extraperitoneal tumor. Few studies have been done on this neoplasm; however surgery still has a primary place in therapeutic management.

Conclusion

The scarcity of cases of urachus cancer makes the publications scarce and the lack of multicenter clinical and randomized trials explains the disagreement about adjuvant treatments.

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Urachus cancer is a rare malignant tumor.

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The tomodensitometry is the reference examination which makes it possible to think of the diagnosis in front of a mass of urachus.

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Surgery remains the gold standard for therapeutic management.

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The prognosis is pejorative because of the aggressiveness of the tumor of the delayed diagnosis.

Urachal carcinoma revealed by isolated hematuria

Urachal carcinoma is an aggressive and rare neoplasia of bladder cancer involving the urachus. The diagnostic failure is due to its insidious development as well as its non-specific clinical signs. Management constitutes a real dilemma for urological surgeons. We describe two pathological cases of urachal adenocarcinoma revealed by isolated hematuria.

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Urachus cancer is a rare malignant tumor.

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The tomodensitometry is the reference examination which makes it possible to think of the diagnosis in front of a mass of urachus.

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Surgery remains the gold standard for therapeutic management.

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The prognosis is pejorative because of the aggressiveness of the tumor of the delayed diagnosis.

Hypercalcemia an exceptional complication in upper urinary tract urothelial carcinoma

Tumors of the upper urinary tract are discovered, either by clinical symptomatology or as part of the evaluation of a bladder tumor. Hypercalcemia is one of the most common paraneoplastic syndromes and an exceptional complication of urothelial carcinoma of the upper tract. Several physiopathological mechanisms have been proposed to explain this rare and serious complication. Hypercalcemia is often correlated with tumors with a poor prognosis.

A rare entity of bilateral hutch diverticulum asymptomatic in adult revealed during the assessment of hematuria

Hutch diverticulum is a rare congenital entity that develops in the ureteral hiatus or in its proximity and is accompanied by reflux in most cases. There are very few reported cases and most of them are in children and predominately at solitary side. Adult cases are rare. We review the literature and present a case of a 65-year-old man with bilateral hutch diverticulum asymptomatic revealed during assessment of hematuria.

The ectopic vesical pheochromocytoma a diagnostic and therapeutic challenge case report and literature review

INTRODUCTION

Extra-adrenal localization of pheochromocytoma is rare. Its clinical revelation is paroxysmal but maybe in the form of permanent hypertension resistant to treatment. The main problem with these tumors is to affirm their benignity or malignancy, ectopic pheochromocytomas have a malignant development once in two.

CASE PRESENTATION

We report the observation of a 39-year-old woman hypertensive on Amlodipine. She presents for sweating, headache, and palpation. The dosage of urinary metabolites revealed a marked increase in metanephrine and normetanephrine. Imagery had shown, at the expense of the left lateral wall of the bladder, a budding tissue formation with irregular contours which was significantly enhanced after injection of PDC. The diagnosis of an ectopic pheochromocytoma was accepted. The patient underwent a partial cystectomy, the postoperative consequences of which were unremarkable.

DISCUSSION

Threatening secretory syndromes are rare medical situations that require urgent management. Pheochromocytoma can be seen at any age from childhood to old age. The treatment of pheochromocytoma is surgical, once the stages of positive and topographic diagnosis have been carried out, the patient must be immediately entrusted to a team of trained surgeons and anesthetists. The prognosis remains unpredictable, hence the interest in prolonged monitoring.

CONCLUSION

Pheochromocytoma is a tumor developed at the expense of chromaffin tissues, extra-adrenal localizations exist, but remain rare. It is a pathology that presents a diagnostic and therapeutic dilemma in which patients require regular and prolonged postoperative monitoring to detect a possible metastasis or recurrence.

Thrombus or vegetation?Importance of cardiac MRI as a diagnostic tool based on case report and literature review

Introduction

We report the Case of a 35 years old male patient admitted for pulmonary embolism in a febrile context. Transthoracic echocardiography showed a filamentary mass appended to the pulmonary valve whose thrombotic origin has been suggested on data of late gadolinium enhancement magnetic resonance imaging.

Case presentation

The patient had a history of deep vein thrombosis in the context of familial thrombophilia with factor V leiden gene mutation in two of his sisters and an inhaled drug addiction to heroïn. There was a biological inflammatory syndrome with negative blood cultures. Transthoracic echocardiography showed a very mobile homogeneous hyperechoic mass measuring 8 cm in the right ventricle appended between the pulmonary valve and the lateral wall of the RV. In LGE-MRI, an isointense, to the myocardium, marginal hall and a central rim enhancement were objectified, suggesting the diagnosis of thrombus rather than vegetation.

Conclusion

Despite the notion of drug addiction, the febrile context and the localization of the mass, a diagnosis of RV thrombus rather than infective endocarditis was favored relying on familial thrompbophilia, personal history of DVT and LGE-MRI aspect. The patient was treated with curative heparin therapy and antibiotic therapy. Due to the persistence of the mass after three weeks of treatment and after heart-team discussion, the patient underwent surgical mass removal. The anatomopathological study confirmed a fibrino-cruoric thrombus.

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Differential diagnosis between thrombus and vegetation is sometimes a real challenge for the clinician.

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Cardiac MRI with its LGE-MRI sequences can help characterizing thrombus with hypointense edges and brighter central zone called “the etched appearance”.

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Even in the multimodality imaging era, anatomopathological stady sometimes is needed to reach the correct diagnosis.

Hypofertility in a persistence of mullerian duct syndrome: Case report

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PMDS is a rare, autosomal recessive sexual development abnormality characterized by the coexistence of Mullerian derivatives in a male phenotype and genotype patient.

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Can be identified during the surgery of cryptorchidism, and more rarely by an ectopic testicular degeneration.

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The PMDS has a good prognosis despite the increased risk of infertility as well as testicular and Mullerian degeneration.

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The treatment requires a multidisciplinary approach.

Introduction

Persistent Mullerian duct syndrome is a rare form of pseudohermaphroditism, possibly resulting from the absence of Mullerian duct inhibiting factor.

Presentation of case

We report the case of a 36 year-old patient with a syndrome of persistent Müllerian ducts (PMDS) of the female type. The Clinical examination revealed avacant scrotum, a normal penis. The spermogram analysis found azoospermia. Imaging using ultrasound and tomotensidometry found the presence of amass in the back of bladder.

A Laparoscopic exploration revealed two slightly enlarged testicles, in a pelvic situation intimately confined to a rudimentary uterus with two tubes. The histological examination was in favor of a uterine endometrium and two fallopian tubes. The karyotype requested later was male 46 XY.

Discussion

Since the first case, between 200 and 262 cases have been reported in literature around the world, this might reveal that the incidence and prevalence of this type of diseases are not well-estimated. The diagnosis is often a fortuitous discovery during a cryptorchidism surgery or inguinal hernia, more rarely during the management of a state of infertility or the degenerescence of the testis or Mullerian derivative. It is caused by either the anti-Mullerian hormone deficiency (AMH) or a dysfunction of its receptor.

Conclusion

A multidisciplinary approach is necessary for surgical management. long-term prognosis is favorable, though fertility seem to be decreased and also it might lead to a riskiness of malignancy owing to cryptorchidism and preserved Mullerian remants.

Hypocalcemia secondary to hypomagnesemia in a patient on liraglutide

A 73-year-old man with type 2 diabetes on Liraglutide with a history of coronary artery disease. Admitted to emergency for abdominal pain, severe diarrhea and episodes of tetany attacks. Laboratory workup reveals hypomagnesemia, hypocalcemia and normal parathormone (PTH).

After intravenous administration of magnesium and calcium, the blood ionogram quickly normalized. In addition, plasma levels of intact parathyroid hormone increased immediately after magnesium administration.

Strongly suggests that hypocalcemia resulted from a disruption of adequate parathyroid hormone secretion caused by hypomagnesemia which in turn was caused by severe diarrhea under treatment with Liraglutide.

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Serum magnesium concentration is determined by the interaction of intestinal absorption and renal excretion.

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Hypomagnesemia may occur following an insufficient intake of magnesium, an increase in renal or gastrointestinal losses.

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Severe diarrhea from drug like Liraglutide may lead to significant drop in magnesium and calcium levels.

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Several drugs are known to cause hypomagnesemia, including proton pump inhibitors (PPI).

Fronto-orbital metastasis of a prostatic adenocarcinoma

Prostate cancer often spreads to bony sites, but other metastatic sites are exceptional. Brain localization accounts for less than 4% of postmortem cases.The cerebral metastases of a prostatic ADK are rare, the prognosis is unfortunate and the treatment is based on androgen deprivation and radiotherapy. We describe a case of orbital metastasis of prostatic adenocarcinoma and we highlight the diagnostic and therapeutic singularity of this affection.

Pneumoscrotum: A rare complication of ruptured emphysema bullae

Subcutaneous emphysema and pneumoscrotum due to spontaneous pneumothorax is a rare clinical situation. We present the case of an 82 year old man who was admitted to the emergency department in state of respiratory distress and scrotum increased in size, painful and rapidly progressive installation. Clinical evaluation revealed scrotal emphysema associated with diffuse subcutaneous emphysema in the trunk, the face and both upper limbs. The treatment of this pathology is not yet standardized; antibiotic therapy and close monitoring are recommended.

[Predictors of catheter-related bladder discomfort]

INTRODUCTION

Establish a descriptive epidemiological profile of patients with Catheter Related Bladder Discomfort (CRBD) and identify its predictive factors.

MATERIAL AND METHOD

Between June 2019 and December 2019, 300 patients have been evaluated. Different parameters were taken into account including: sex, age, body mass index (BMI), historical health data, duration and indications of the urinary catheterization, type of the transurethral catheter used, lubrication of the catheter and the existence of CRBD. We grouped our patients according to the intensity of CRBD syndrome. The various factors likely to be correlated with the occurrence of CRBD were subject of a univariate then multivariate analysis.

RESULTS

300 patients were included. The average age was 49 years (133 men and 167 women). 68 patients (22.6%) had history of urinary catheterization. 19% of patients were catheterized for acute urinary retention, while 81% were catheterized before surgery. The average duration of the urinary catheterization was 2.5 days. 54% showed CRBD symptoms, including more than 92% on the first day of the urinary catheterization. The significant risk factors in multivariate analysis were: the caliber of the catheter ≥18 Fr, the absence of lubrication, laparotomy, age <50 years, Cesarean and urinary catheterization medical history.

CONCLUSION

This study identified various factors incriminated in the occurrence of CRBD. The role of the hospital practitioner is to prevent this syndrome by reducing predictive factors, particularly the technical ones.

LEVEL OF EVIDENCE

3.

[Urethral diverticulum occurring after urethromeatoplasty: a case study]

Nous rapportons l'observation d'un diverticule de l'urètre pénien chez un garçon de 14 ans survenu après une urétro et méatoplastie suite à un accident de circoncision. À travers cette observation et une revue de la littérature, nous décrirons les aspects diagnostiques et thérapeutiques des diverticules de l'urètre.