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To evaluate the midterm results of myotomy for achalasia by thoracotomy procedure with the introduction of anti-reflux system by diaphragmatic flap.This was a prospective study involved 21 patients (14 women and 7 men) operated for idiopathic megaesophagus during a period of 3 years. All the patients were operated by thoracotomy procedure. An anti-reflux system was performed using a diaphragmatic flap over the entire length of the myotomy.The mean age was 32 years (range 16 and 68 years). After the surgery we have seen a complete disappearance of dysphagia in 21 patients (100 %) (p0.001) and a significant weight regain. Short term outcomes were marked by the occurrence of clinical gastroesophageal reflux disease in 1 patient (4.76%) who has received the anti-reflux system (p0.05).Oeso-cardio-myotomy of Heller by transthoracic procedure associated with the establishment of an anti reflux system by diaphragmatic flap has goods results.Evaluer les résultats à mi-parcours de l'œsocardiomyotomie de Heller par voie transthoracique avec la mise en place du système anti-reflux par un lambeau diaphragmatique pour le mégaoesophage idiopathique.Il s'agissait d'une étude prospective ayant concerné 21 patients (14 femmes et 7 hommes) opérés pour un mégaoesophage idiopathique durant une période de 3 ans. La voie d'abord a été la voie transthoracique gauche pour tous nos patients. Un système anti-reflux avait été réalisé en utilisant un lambeau diaphragmatique sur toute la longueur de la myotomie de l'œsophage thoracique.L'âge moyen était de 32 ans (extrêmes : 16 et 68 ans). Les suites immédiates étaient simples. Après l'intervention nous avons assisté à une disparition complète de la dysphagie chez 21 patients (100 %) (p0,001) et une reprise pondérale conséquente. Les suites à court terme étaient marquées par la survenue d'un reflux gastro-œsophagien clinique chez 1 patient (4.76 %) qui avait bénéficié d'un système anti-reflux (p0,05).L'œsocardiomyotomie de Heller par voie transthoracique associée à la mise en place systématique d'un système anti-reflux par lambeau diaphragmatique donne de bons résultats.

Necrotizing cellulitis of dental origin is a serious disease and requires prompt and effective management to avoid adverse outcomes. The purpose of this work is to describe the diagnostic and therapeutic difficulties encountered in this condition.This was a prospective study in the thoracic surgery department of Mali Hospital from January 2011 to February 2015. We collected consecutively 19 cases of complicating cervico-facial cellulitis of dental origin. The anatomical and clinical aspects, therapeutic modalities and difficulties are described.Dental pain and fever were the predominant symptoms followed by cervical edema. Chest CT-scan was the basis for the diagnosis in all cases. Cervicotomy with debridement was the most performed surgical procedure. Pleural drainage was performed in 6 cases. Three patients (15.8%) died.Necrotizing cellulitis of dental origin is a serious disease with high morbidity and mortality. The key radiological examination is the thoracic CT-scan. Early medico-surgical management by emergency care, tailored antibiotic therapy, removal of necrotizing tissues and drainage of collections are required to deliver a good outcome.

Navelbine (NVB) (5'-noranhydrovinblastine) is a new semi-synthetic vincaalkaloid (VA) exhibiting a high affinity for tubulin and considerable anticancer activity in patients. A better hematologic tolerance and a weak neurotoxicity have been reported for this drug as compared to other VA. Moreover, NVB presents a relatively high bioavailability and a good digestive tolerance, thus offering original perspectives for the treatment of ambulatory cancer patients. A clinical pharmacokinetic study of NVB was carried out on 12 patients after oral administration of the drug. The pharmacokinetic parameters were similar to those of intravenous administration and also showed a high interindividual variability. Studies on the in vitro metabolism of NVB using hepatic microsomal fractions from 22 different donors demonstrated the formation of 3 metabolites. The biotransformation rate quantitatively varies from one human liver specimen to another, a fact which could be, in part, at the origin of the interindividual variability of the therapeutic response.