[Pathology of the processus vaginalis in urological practice]

PURPOSE

To describe the epidemiological, anatomico-clinical and therapeutic aspects of the patent vaginoperitoneal canal (PVPC) in urological practice and to compare our results with those of pediatric teams.

PATIENTS AND METHODS

We performed a retrospective descriptive study of PVPC cases operated in a urology unit. The following parameters were studied: medical history, age, method of installation, the anatomo-clinical type, side and the results of the treatment.

RESULTS

A total of 163 cases were collected over a period of 5 years. The average age was 7.5 ± 7 years with a range of 2 months and 39 years. Thirty-four patients had less than or equal to age 2 ears and 28 patients were adults. The reason for consultation was an inguinal or scrotal inguinal, painless and intermittent swelling in 72.3% of cases. Installation mode was progressive in 45 patients (27.6%). The PVPC was sitting right in 81 patients (49.7%) and was bilateral in 12 patients (7.3%). The anatomo-clinical types were dominated by the communicating hydrocele (52%). The treatment was carried out in controlled surgery in all patients and the mean duration of hospitalization was 24 hours. The postoperative course was marked by 5 cases of scrotal hematoma and 2 cases of parietal suppuration. Postoperative mortality was zero. After a mean postoperative decrease of 2 years we observed 3 cases of testicular atrophy and two recurrences.

CONCLUSION

Our results in terms of morbidity and mortality although satisfactory were lower than those of pediatric teams.

LEVEL OF EVIDENCE

5.

[Primitive neuroectodermal tumor of the vagus nerve]

Primitive neuroectodermal tumors are a rare type of malignant neuroectodermal tumor that is very aggressive. Cervicofacial location is rare, even exceptional. We report a case of a 4-month-old male infant, referred from the pediatric clinic for severe supralaryngeal dyspnea, a firm mass under the left mandibular angle, mobile and extended to the parotid area, painful, with a curve of the left side wall of the oropharynx. Cervical computed tomodensitometry showed a well-limited mass in the carotid area, enhanced by the contrast product. A vascularized mass, which had developed at the expense of the vagus nerve, was removed surgically. Histology found a primitive neuroectodermal tumor.

[Post-hysterectomy vesicovaginal fistula]

OBJECTIVE

Describe the epidemiology, diagnosis and treatment of vesicovaginal fistula (VVF).

PATIENTS AND METHODS

We conducted a retrospective descriptive study of all cases of VVF secondary to hysterectomy. The following parameters were studied: age, parity, indication for hysterectomy, risk factors, the consultation period, the anatomical type of VVF, the paraclinical, the surgical approach and results of the cure.

RESULTS

Fourteen cases were identified over 10 years. All hysterectomies were performed by laparotomia. The average age of patients was 54.3±13 years. Hysterectomy was performed in view of a uterine leiomyoma in eight cases, a cancer of the cervix in four cases, a menometrorrhagia in one case and a choriocarcinoma in one case. Four patients had received neoadjuvant radiotherapy. The mean time from injury was 13.5±18 months. Examination under valve was allowed to find 11 VVF type 1 and three type 2 VVF. IVU was normal in seven patients and allowed to find an ureterohydronephrose stage III in one patient. VVF was addressed by high in ten cases including 5 by transperitoneovaginale and 5 by transvesical pure. The postoperative course was uneventful in 11 patients (78%) but marked by vesicocutaneous fistula, parietal suppuration and one failure.

CONCLUSION

In this short series of post-hysterectomy VVF treated by laparotomia, we observed a rate of cure satisfying in spite of an important psychosocial morbidity.

[Prevalence and factors related to therapeutic adherence among black African outpatients with stable coronary artery disease in a cardiology department of Dakar in Senegal]

INTRODUCTION

The management of coronary artery disease has made important progress. Adherence to therapeutic measures is a great challenge for improving the long-term prognosis. In this work, we evaluate factors related to therapeutic adherence in black African patients with stable coronary artery disease.

METHODOLOGY

We conducted a survey over three months (February-May 2008) in three cardiology departments in Dakar. We studied the regularity of drug intake, the adherence to the dietary advices and the appointments for consultation as well as the factors related to adherence. Good adherence was defined by a compliance rate greater or equal to 80% and a compliance rate less than 40% defined poor adherence.

RESULTS

We included 105 patients (61 men) with a mean age of 60.67±11.29 years. Good compliance was noted in 56.2% of cases for drug treatment, 42% for dietary advices and 65% for appointments for consultation. A history of acute coronary events (P=0.04), a good knowledge of the disease (P=0.03) and a healthcare (P=0.02) were the factors related to a good adherence to drug treatment, whereas ischemic cardiomyopathy was a factor for poor adherence (P=0.002). Knowledge of coronary disease was the only factor correlated with good adherence to lifestyle (P=0.014).

CONCLUSION

Therapeutic adherence remains unsatisfactory in Black African patients with stable coronary artery disease, hence the importance of patient education to reach a good adherence for therapeutic, because better adherence improves long-term prognosis of coronary artery disease.

[Anderson-Hynes open pyeloplasty: which indications in the area of laparoscopic surgery?]

OBJECTIVES

To evaluate the results of Anderson-Hynes open pyeloplasty in our institution. And then to compare them to those of laparoscopic procedure and identify what can be considered now as the indications of the open procedure.

PATIENTS AND METHODS

It was a retrospective study on 30 cases of ureteropelvic junction syndrome managed by Anderson-Hynes open procedure. The clinical, biological and radiologic characteristics of the patients as well as the surgical technique and its results were taken into account. The patients were classified, according to Valdeyer and Cendron classification as type II in eight cases (26.7%), type III in ten cases (33.3%) and type IV in four cases (13.3%). There were also eight cases of giant hydronephrosis (26.7%). The operating time, the length of hospital stay and the outcomes were studied and compared with those of the laparoscopic pyeloplasty found in the medical literature.

RESULTS

The mean operating time was 115 ± 33.4 minutes (90-230 min). The mean length of hospital stay was 10.4 ± 5.1 days. Six patients (20%) had postoperative complications. After a mean follow-up of 28 ± 13.7 months (13-48 months), our first-hand success rate was 90% (n=27).

CONCLUSION

Anderson-Hynes open pyeloplasty reached good results but nowadays its indications can be limited to laparoscopic contraindications, severe hydronephrosis (grade IV or giant hydronephrosis) and second-hand cases. The two latter indications depend on the surgeon experience in laparoscopic surgery.

Cancer du pénis au Sénégal : aspects cliniques et thérapeutiques

Buts

décrire les aspects cliniques et thérapeutiques des cancers de la verge au Sénégal.

Patients et méthodes

nous avons effectué une étude rétrospective qui s’est intéressée aux dossiers des patients suivis pour cancer de la verge au service d’urologie du CHU Aristide Le Dantec entre janvier 2000 et décembre 2011.

Résultats

huit patients d’âge moyen de 51,5 ans avec des extrêmes de 27 à 77 ans ont été répertoriés. Ils étaient tous circoncis dans l’enfance. L’examen clinique avait mis en évidence une tumeur ulcérobourgeonnante intéressant le gland et une partie du corps de la verge dans cinq cas; dans deux cas, elle intéressait la totalité de la verge alors que seul un cas était limité au gland. Les patients étaient ainsi classés selon le système TNM 2002 de l’UICC en cT2 (quatre cas), cT3 (trois cas) et cT1 (un cas). Le type histologique de la tumeur était le carcinome épidermoïde chez tous les patients. Il n’y avait pas de localisation secondaire au scanner thoracoabdomino-pelvien. Sur le plan thérapeutique, une pénectomie partielle a été réalisée dans cinq cas, une pénectomie totale avec curage ganglionnaire dans un cas. Deux patients ont refusé le traitement chirurgical. Aucune récidive n’était notée chez les cinq patients ayant subi une amputation partielle du pénis. La survie globale était donc de 83,3 % pour les patients opérés.

Conclusion

le cancer de la verge est rare au Sénégal. La prise en charge est délicate du fait du diagnostic tardif avec des lésions évoluées, d’où l’importance d’une sensibilisation des populations.

[Pyonephrosis: 44 cases in Senegal]

PURPOSE

To report epidemiological, clinical and paraclinical features of pyonephrosis and describe current management methods in Senegal.

PATIENTS AND METHODS

This retrospective study includes a series of patients admitted for pyonephrosis to the Urology Department of the Aristide Le Dantec Hospital in Dakar between 1995 and 2009. The following information was collected for each patient: age, sex, clinical manifestations, diagnostic findings, treatment modalities and outcomes.

RESULTS

A total of 44 patients with a mean age of 34 years were included. The most common clinical manifestations were acute flank pain, sepsis and renal mass. Diagnostic was usually based on medical imaging, i.e., renal utrasonography and computed tomography. Urolithiasis was the underlying etiology in 73.2% of cases. Nephrectomy was performed in 83% of cases with or without preliminary nephrostomy catheterization.

CONCLUSION

Development of both diagnostic (medical imaging) and therapeutic methods for management of pyonephrosis has been consistent with the rarity of this condtion in Senegal.

Aspects diagnostiques et thérapeutiques de la torsion du cordon spermatique au CHU Aristide-Le-Dantec de Dakar

Objectif

Étudier les aspects diagnostiques et thérapeutiques de la torsion du cordon spermatique (TCS) dans notre pratique quotidienne et faire une revue de la littérature.

Patients et méthodes

Étude rétrospective de janvier 2002 à décembre 2009 sur tous les cas de suspicion de TCS reçus en urgence.

Résultats

La TCS était confirmée chez 58 patients après scrototomie exploratrice. L’âge moyen des patients était de 21 ans (avec des extrêmes de 1 et de 44 ans) et 48 patients (83 %) étaient âgés de plus de 15 ans. Le délai moyen entre le début de la symptomatologie douloureuse et l’arrivée aux urgences était de 102 heures (avec des extrêmes de 2 et de 480 heures); 47 patients ont été reçus après la sixième heure et 19 patients ont été référés d’une structure périphérique. La torsion était supravaginale chez cinq sujets âgés de plus de 15 ans et était sanctionnée d’une orchidectomie chez 30 patients (52 %).

Conclusion

Notre série est caractérisée par un taux élevé de castration d’où l’intérêt de mettre l’accent sur la sensibilisation des populations qui doivent venir consulter en urgence devant une grosse bourse douloureuse aiguë.

[Three-point bending moment of two types of resin for temporary bridges after reinforcement with glass fibers]

One of the concerns of the dental surgeon in the realization of any operational act is the durability of this one. The mechanical resistance of the provisional prostheses contributes in a large part to the durability of those. The resins in general, have weak mechanical properties. The purpose of this study is to evaluate the resistance in inflection of temporary bridges reinforced with glass fibre. To remedy the weak mechanical properties of resins, we thought in this study, to reinforce them with glass fibres. For this purpose, we realized with two different resins, four groups of temporary bridges of 3 elements, including two groups reinforced fibreglass and the others not. Tests of inflection 3 points have been made on these bridges and resistance to fracture was analysed. The statistical tests showed a significant difference in four groups with better resistance for the reinforced bridges.

[Acute transverse myelopathy after intramuscular injection of benzathine-benzylpenicillin. Case report in Dakar, Senegal]

Intramuscular injection of benzathine-benzylpenicillin can cause acute transverse myelopathy. The purpose of this report is to describe a case of acute transverse myelopathy observed after injection of benzathine-benzylpenicillin in a 38-year-old man. The patient who was married and had a history of eczema was admitted to the Department of Neurology of the Fann University Teaching Hospital in 2006. All laboratory findings were normal except high serum immunoglobulin E level. An immunoallergic reaction involving inflammatory transverse myelopathy secondary to vasculitis was proposed as the most likely underlying mechanism. Treatment with corticosteroid and physiotherapy led to a favorable outcome. Health personnel should know the indications for use of benzathine-benzylpenicillin and be aware of the possible medullary complications.

[A prospective longitudinal study of coma in the intensive care unit in an African setting: case of Dakar, Senegal]

Little is known on coma in neurological intensive care unit (NICU) in the setting of developing country in Sub-Saharan Africa. The aim of this study was to determine the morbi-mortality and survival of coma in the NICU of Dakar, Senegal. We carried out a prospective longitudinal study in the NICU of the teaching hospital of Fann in Dakar during a period of 15 months (with 12 months of inclusion) on comatose patients. Were included all patients presenting with a Glasgow score inferior to 9. Standard biological analyses were prescribed for each patient while CT scan was performed if indicated. Daily evaluation was done and complications recorded. Each patient was followed for at least 3 months. Survival was determined by the Kaplan Meier method. 345 patients were admitted in the NICU and 169 were included (48,99 %). The mean age of the patients was 58.04 +/- 17.55 years with a sex ration of 0.92. The mean time from installation of disorders and initial consultation was 47.30 +/- 138.34 hours. Etiologies were vascular disease (71 %), status epilepticus (9.47 %), meningoencephalitis (8.88 %) and metabolic disorders (8.88 %). The mean duration of hospitalization was 8.89 +/- 9.53 days associated with a mortality rate of 82.25 % for the same period. Survival at day 90 was 10.65 %. Mortality was related to infectious condition (28.4 %), renal failure (14.78 %), cardiovascular failure (13.61 %), cerebral engagement (12.43 %), multivisceral failure (11.24 %), pulmonary embolism (1.18 %) and unknown cause (18.34 %). In conclusion, coma is associated with a high mortality rate in our context and suggests that early consultation, a good control of vascular risk factors and better management of infectious condition should reduce this impact.

[Prognosis of intracerebral hemorrhage with coma in a neurological critical care unit in the tropics]

Thirty-five percent of stroke events observed in Dakar, Senegal involve hemorrhaging. Coma is a frequent revealing sign of the disease and a severe prognostic factor. Since specific therapy is unavailable in sub-Saharan Africa, only symptomatic medical treatment is proposed to most patients presenting intracerebral hemorrhage. The purpose of this longitudinal study was to evaluate prognosis and survival in patients presenting with intracerebral hemorrhage in a neurological critical care unit in Senegal. Study was conducted from April 15, 2006 to July 18, 2007 in the neurological critical unit of the Fann University Hospital Center in Dakar. Mortality and probability of survival were estimated using Kaplan Meier methods. The predictive value of factors significantly correlated with prognosis was determined by multivariate analysis using a Cox proportional hazards model. A total of 51 cases of intracerebral hemorrhage were included in this study. Mean patient age was 64 years and the sex ratio was 1.13. Median survival was 7 days and mortality in the neurological critical care unit was 80.4%. The probability of survival at days 10, 30 and 90 were 43.14%, 21.57% and 13.73% respectively. Occurrence of a complication on day 3 was shown to be an independent risk factor for early death. Intracerebral hemorrhage with coma is associated with a high mortality rate. Better primary prevention is necessary.

[Determination of the average value of the condylar slope of black Africans]

The objective of this work was to determinate the average value of the condylar slope of Black African subject and to set up its variation according to whether the localization of the hinge axis is real or arbitrary. With this intention, we made an axiographic study at 63 subjects presented complete natural teeth, with a normoclusion in class 1 of Angle. The results of this study reveal that the average value of the slope condylar is 44,28 degrees in arbitrary hinge axis and 45,7 degrees in hinge axis real; and this difference is not statistically significant. The graphic recording of condylar displacement by the "Quick-Axis" is thus possible without risk of error in the layout and the reproduction of the mandible movements which is of a great interest for the general practitioner taking into account the simplicity of handling of the FAG system.

[Survival of comatose stroke victims in a neurological department in Dakar]

BACKGROUND

In Dakar, stroke is the most frequent neurological disease with the highest mortality. Victims may present in a critical state of coma. The objective of this study was to evaluate survival among comatose stroke patients in Dakar, Senegal.

METHODS

This was a longitudinal prospective study from April 2006 to July 2007 conducted in the Neurological Intensive Care Unit (NICU) of Fann University Teaching Hospital in Senegal. Were included in the study, all stroke patients confirmed by CT scan with a Glasgow coma score less than or equal to 8/15. Patients with subarachnoid hemorrhage were excluded.

RESULTS

A total of 105 patients were evaluated with 54 cases of ischemic stroke among them. The mean age was 61.87+/-14.16 years. The mean duration of hospital stay in the NICU was 10.82+/-11 days with an estimated mortality of 82.9%; the three-month survival was 9.52%. The median overall survival was 7+/-1 days (CI(95%): 5-9).

CONCLUSION

Comatose stroke patients have a poor prognosis, emphasizing the crucial importance of primary prevention.

[Epilepsy in a cohort of Senegalese children]

Epilepsy is a significant health public problem in Senegal with an estimated prevalence of 8 to 14%. The aim of this study was to determine the clinical and electroencephalographic features of epilepsy in a cohort of Senegalese infants, search for etiological factors and determine the impact of disease on school life. This retrospective study concerned 459 children who attended the neurological outpatients clinic at the Fann hospital, Dakar, Senegal, between July 2003 and December 2006. All were aged under 19 years. Among the 135 children with idiopathic epilepsy, 23.7% had parental consanguinity and 37.77 % familial epilepsy. Rolandic epilepsy and epilepsy with absences were more frequent but several infants with idiopathic epilepsy were not classified. Non-idiopathic epilepsy was noted in 312 children. In this group, estimates of parental consanguinity and familial epilepsy were of 21.79 and 17.94%, respectively. Etiological factors were predominantly pregnancy and birth abnormalities (28.84%) and central nervous system infection (20.19%). Twelve children had febrile seizures. Of patients with idiopathic epilepsy, 65.18% were attending school versus only 9.29 with non-idiopathic epilepsy.

[Epidemiology of stroke at the Clinic of Neurology, Fann University Teaching Hospital, Dakar-Senegal]

OBJECTIVE

Describe the epidemiology of stroke among patients hospitalized at the Clinic of Neurology , Fann University, Dakar-Senegal.

METHODOLOGY

Retrospectively, sociodemographic, medical history and clinical data were collected for patients hospitalized for stroke from January 1st 2001 to November 1st 2003 and to whom a Computed Tomography scan of the brain was done.

RESULTS

The population of study (314 patients) had a mean age of 61.3 years (+/-13.8) and was composed of 56.1% of women. The mean time of admission was 8.4 days (+/-23.5). The leading risk factors of stroke were hypertension, history of stroke and diabetes. Ischemic stroke represented 60.2%. The occurrence of stroke was associated with coma and hypertension. The letality rate was 24.8%.

CONCLUSION

It is necessary to develop and implement health education program against risk factors for the population to reduce stroke morbidity and mortality.

[Vascular aphasias: clinical, epidemiologicaland evolutionary aspects]

INTRODUCTION

Aphasias constitute an acquired disorder of the language. Aetiologies are dominated by stroke. The aim of this study was to describe the clinical, epidemiological and evolutionary aspects of the vascular aphasias.

MATERIALS AND METHODS

We conducted from August 2003 to May 2005 a descriptive cross-sectional study at the Neurology department in Dakar. This study concerned all patients admitted at the Neurology department for stroke confirmed by the cerebral tom densitometry. All patients were subjected to an examination of the language allowing to confirm the diagnosis of aphasia and to determine the type. The follow-up was monthly during one year.

RESULTS

55 cases of aphasia were reported on 170 cases of stroke (frequency: 32.35%). Our patients were all right-handed. Mean age was 56.8 (28 to 86 years) with a sex-ratio of 0.61.76.36% of the patients could neither read nor to write. Only two made higher studies. The nature of stroke was ischemic in 73.7% and hemorrhagic in 26.3%. The aphasias with expressive language impairment were observed in 96.4% against 3.6% of the cases for aphasias with comprehensive language impairment. After one year of evolution, a regression of the disorders was observed only in 9 cases, and the regression was partial in 25 cases. The evolution of the aphasia was correlated with that of the motor deficit. Age, low educational level, ischemic stroke constitute factors of bad prognosis.

CONCLUSION

Vascular aphasias are frequent and of reserved prognosis. It disturbs social professional and family reintegration.