[Typhoid peritonitis in children: Evaluation of morbi-mortality at the Gabriel Touré teaching hospital in Bamako]

AIMS

To determine related factors of complications typhoid perforations in the small intestine in children.

MATERIAL AND METHOD

A retrospective study was conducted between June 1^st, 2005 to June 30^th, 2010 in all children aged 0 to 14 years treated for peritonitis by ileal perforations in the service of paediatric surgery at the Gabriel Touré teaching hospital. Traumatic perforations and patients with incomplete files were not included in this study.

RESULTS

In 5 years time we gathered 105 cases of ileal typhoid perforation. After surgical treatment early outcomes were simple in 70 patients (66.6%), a parietal suppuration had been noted in 15 patients (14.3%) and fistula in 4 (3.9%). Sixteen patients (15.2%) died. Complications were related to patient's age, ASA Score, time frame of care, quantity of peritoneal fluid, number and site of perforation, surgical techniques and the duration of surgery P(<0.05). Sex, anaemia, surgeon, and perforation diameter did not significantly influence the rate of complications.

CONCLUSION

Reduction of morbi-mortality happens through prevention, earlier diagnosis and appropriate management of typhoid fever.

[Intestinal invagination occurring during pregnancy: 1 case]

Acute intestinal invagination is a rare pathology in adults; even more so on specific fields as in pregnant women. Therapeutic indications depend on the duration of the invagination. We noted a cases of acute intestinal invagination after 72 hours of evolution in a multiparous 35 year old woman, 27 weeks pregnant, successfully treated by surgery and tocolysis.

[Acute generalized peritonitis in Sominé Dolo's Hospital of Mopti: Epidemiologic and therapeutic aspects]

Acute generalized peritonitis requires precocious diagnosis and immediate treatment.

MATERIALS AND METHODS

The purpose of this study is to determine hospital case frequency, to describe the clinical and therapeutic aspects and to evaluate the operating suites. We conducted a prospective study, lasting 16 months, from January 2005 to April 2006, looking at 40 cases of generalized acute peritonitis operated in several services, including a general surgery department, of the Sominé Dolo's hospital of Mopti.

RESULTS

We noted a hospital admittance rate of 3.1% with an average age of 26.3 years old and a 1.66 men to women ratio. Peritonitis at the Sominé Dolo hospital was dominated by intestinal perforation. The diagnosis was essentially made using the clinical approach. The treatment was medico-surgical. Operative mortality was recorded in 7 cases (17.5%) with 7 cases of inner-wall abscesses. The delay of consultations and the Mannheim score were the main factors causing bad prognostics. Excision - sutures associated with a cleansing drainage of the abdominal cavity was the most practised surgical procedure.

CONCLUSION

Mortality remains high. The two factors for a bad prognostic are the delay of consultation and the lack of means for reanimation.

[Peritonitis by perforation on gastric cancer at the Gabriel Touré teaching hospital]

OBJECTIVE

Describe the therapeutic and diagnostic aspects of gastric cancer perforations at the general surgery department of the Gabriel Touré teaching hospital.

PATIENTS AND METHOD

A retrospective survey was conducted over 11 years (January 1999 to December 2010). It included all patients having had surgery for peritonitis by gastric cancer perforation at the service during that time frame.

RESULTS

We found 14 cases of peritonitis due to gastric perforation, of which 9 were male and 5 female. The main clinical symptoms were abdominal pain (100%), weight loss (100%) and abdominal contraction (98.8%). Endoscopy allowed to note a pyloric antrum budding tumor in 4 patients before perforation. Radiography of the abdomen without preparation showed pneumoperitoneum in 8 cases. In all cases, the histological type recorded was adenocarcinoma. The antral seat was the most common (64.3%). Palliative surgery was immediately performed in all cases. We recorded two cases of fistula tract and 3 cases of infection of the lining, as well as 2 cases of postoperative mortality.

CONCLUSION

Gastric cancer perforation is rare and of bad prognosis as it survives on advanced cancer.

[Peritonitis by typhoid ileal perforation: evolutionary aspects in the Teaching Hospital of Bamako and Kati in Mali]

OBJECTIVE

The objective of this study was to determine the frequency of peritonitis by typhoid ileal perforation in the teaching hospitals of Bamako and Kati.

PATIENTS AND METHODS

We conducted a retrospective study over a 24 years period (1984-2007). Every patient admitted and operated in urgency for peritonitis by ileal perforation were listed and included in this study.

RESULTS

During the study period, 1868 acute peritonitis were operated on in the three major health centres of Bamako and Kati. We collected data concerning 543 typhoid ileal perforations which represented 29.0% of all peritonitis. The peritonitis by typhoid perforation constituted 28.5% of the peritonitis in the teaching hospital of the Point G, 30.6% in the Gabriel Touré teaching hospital and 6.4% in the teaching hospital of Kati. Among the peritonitis by typhoid perforation, 56.7% were listed in the Point G teaching hospital, 43.0% in the Gabriel Torre teaching hospital and 0.3% in the Kati teaching hospital. Between 1984-2004 we collected data from two hundred and fifty seven (257) patients suffering from peritonitis by typhoid ileal perforation, a total of 24.4% of the peritonitis recorded. Between 2005-2007, the data for two hundred eighty six (286) patients suffering from peritonitis by typhoid ileal perforation was collected, a total of 35% of the peritonitis recorded. The typhoid ileum perforation remains the 2nd overall cause of generalized peritonitis after that of appendicular origin.

CONCLUSION

Peritonitis by typhoid ileum perforation has seen a significant increase from 2004 in the teaching hospitals of Bamako and Kati.

[Penetrating abdominal wounds caused by weapons in the service of general surgery in the Gabriel Touré teaching hospital]

INTRODUCTION

Providing care for penetrating abdominal wounds is a controversial subject. The aim of this project was to describe their epidemiological, clinical and therapeutic aspects.

MATERIALS AND METHODS

This retrospective study conducted over 4 years, from January 2006 to January 2010 concerned 70 cases of penetrating abdominal injury in the general surgery department of the Gabriel TOURE teaching hospital. Non-piercing and animal horn related abdominal injuries were not included.

RESULTS

We collated 70 cases of penetrating abdominal wounds; representing 1.2% of hospitalisations during the studied time frame. The patients were 12 to 59 years old with a mean age of 27.7 years and a sex-ratio of 9 to 1 for men. 27 patients (38.36%) came from districts I and II of Bamako. Criminal injuries was the main cause of injury encountered representing 70% cases. 3 of the patients had psychiatric antecedents and 45.7% of patients regularly consumed drugs. The epiploon and small intestine were the main eviscerated organs (51.4% cases). 17/53 patients received non-surgical treatment. The rate of laparotomia was of 30.2% and postoperative morbidity 15.1%.

CONCLUSION

Treating penetrating abdominal injury remains difficult. A good selection of patients allow the service to lower the rate of laparotomia.

[Prevalence of tuberculosis and brucellosis in intra-urban and peri-urban dairy cattle farms in Ouagadougou, Burkina Faso]

A study of the prevalence of bovine tuberculosis and brucellosis was conducted in dairy cattle farms in and around the city of Ouagadougou, Burkina Faso. It reveals the potential economic and health impact of these two major zoonoses in the study area. Three farming systems were included in the study. A total of 1,420 cattle were tested for tuberculosis and 1,689 cattle were tested for brucellosis. The intradermal tuberculin test was used for tuberculosis, and the buffered antigen test and indirect enzyme-linked immunosorbent assay were used for brucellosis. The overall prevalence rate is estimated to be 6.05% for tuberculosis and 3.61% for brucellosis. The prevalence rates of tuberculosis and brucellosis in urban and peri-urban dairy cattle farms in Ouagadougou were found to be high. As these two production-linked diseases are zoonotic, they could pose a major risk to human health and contribute significantly to reducing animal production and productivity in the areas covered by the study. Animals should be checked systematically prior to introducing them into dairy herds, with the ultimate goal of eradicating these two zoonoses.

Distal femoral fractures treated with condylar buttress plate in a West African hospital

OBJECTIVES

The aim of this retrospective study was to present our experience using condylar buttress plate in the treatment of distal femoral fractures.

PATIENTS AND METHODS

Thirty-two patients underwent open reduction and internal fixation with condylar buttress plates for distal femoral fractures from October 2000 through May 2010. Patient demographics, type of fracture, treatment, complications, results achieved, and follow-up assessment were reviewed. The fractures were classified with the AO system. The functional outcome was rated according to Schatzker and Lambert criteria.

RESULTS

There were 22 men and 10 women with an average age was 44 (range 19-87) years. The fractures were classified as A1 (n = 7; 21.8%), A2 (n = 4; 12%), A3 (n = 5; 15.6%); C1 (n = 4; 12.5%), C2 (n = 6; 18.8%), and C3 (n = 6; 18.8%). The mean delay from injury to operation was 15 (range 1-27) days. Iliac bone graft was performed in four patients. Postoperatively, a posterior splint or a plaster cast was applied for 3 weeks. No patient had an intra-articular step-off of more than 2 mm. Sepsis of the operative wound occurred in two patients. Fractures healed in 22 (91.7%) patients with a mean duration of 4 (range 3-8) months. Twenty-four patients were followed up on an average of 15 (range 7-28) months. Varus deformity (>10°) was observed in five (20.8%) patients. Knee flexion was less than 90° in 11 (45.3%) cases. Non-union occurred in two (8.3%) patients. Functional results were good to excellent in 11 (45.8%) patients and considered as fair or failure in 13 (54.2%).

CONCLUSION

The current report also identifies varus deformity as a major concern of this implant. The main finding of this study was the ensuing knee stiffness after a prolonged immobilization and delay in performing surgery and rehabilitation program due to socioeconomic and logistic reasons.

Livestock production in central Mali: Reproductive performance and reproductive wastage in ruminants in the agro-pastoral system

Results of a 7-yr field study and a 3-yr slaughterhouse study into reproductive performance and reproductive wastage of ruminants in central Mali are reported. Cattle had delayed age at first puberty (40), long calving intervals (644) and produced few young (3.02) per lifetime. Goats and sheep first conceived at about 11 mo, had shorter parturition intervals (298 and 280 d) but also produced few young (2.64 and 1.92) per lifetime. Conceptions showed a strong seasonality in cattle and mainly occurred during and shortly after the short rainy season. Seasonality was less marked in small ruminants, but most females conceived before the rains. However, maximum litter sizes were associated with late-rain and post-rain conceptions. Early embryonic wastage did not appear to be a major problem but abortions, stillbirths and heavy preweaning mortality were sources of loss of reproductive potential. Additionally at a secondary (government controlled) abattoir, 15.0 % of cows, 31.7 % of goats and 20.0 % of sheep that were slaughtered were found to be pregnant.

Mitochondrial analysis sheds light on the origin of hair sheep

A total of 180 mtDNA sequences from hair Caribbean (93), West African (73) and Canarian-wooled (14) sheep were analysed to shed light on the origin of hair sheep. A comparison of 360 Iberian sheep sequences retrieved from GenBank was performed to assess a possible European origin of the Caribbean hair sheep. These 180 sequences gave 48 different haplotypes (16 in Caribbean sheep). All Caribbean and Canarian-wooled sequences and 91.8% of the West African samples belonged to haplogroup B. The sheep analysed showed wide haplotypic identity. Caribbean sheep shared roughly two-thirds of their samples with Canarian-wooled and West African samples, respectively. Principal component analysis showed that the Caribbean and the Canarian-wooled sheep clustered together. Additional analyses showed that hair and Iberian sheep had wide genetic identity. It was not possible to ascertain a single Canarian, African or European origin of the Caribbean hair sheep using mtDNA markers only. European, African and Caribbean hair sheep maternal genetic backgrounds likely result from related domestication events.

[Darier's disease: three cases of psychosocial difficulties in an African setting]

BACKGROUND

Darier's disease is a rare disease. Multiple clinical forms have been observed, but the psychosocial aspects in Africa are rarely described. We report three cases involving difficulties regarding social integration.

OBSERVATIONS

Case no. 1: a 19-year-old woman consulted for hyperchromic, greyish, keratotic papules, grouped in small plaques scattered all over the body. She had trouble finding a husband and was rejected by her peers. Case no. 2: a 20-year-old woman presented generalized keratotic, vegetative lesions. She was rejected by her husband because of the lesions. Like patient no. 1, she was unable to purchase her prescribed treatment. Case no. 3: a 33-year-old blacksmith presented Darier's disease with lesions on the interscapular region and chest. He was epileptic and depressive and was partly rejected by his family.

DISCUSSION

Darier's disease, diagnosed on the basis of anatomoclinical factors, had a major impact on the social integration of all three patients. These generalised disfiguring forms of the disease adversely affect the quality of life and their association with neuropsychiatric disorders is another major handicap.

CONCLUSION

Difficulties concerning social integration and therapeutic problems must be considered in the management of Darier's disease in Africa.

[Estimation of the execution of the national strategy of leprosy elimination in the "Hauts Bassins" region in Burkina Faso]

BACKGROUND

Burkina Faso achieved the leprosy elimination as a public health problem but this benefit was being lost. So, the National Program for Fighting against Leprosy has defined a strategy to reverse this situation. The aim of this survey was to evaluate the performance of the national program in the execution of this strategy in the region of "Hauts Bassins" (Burkina Faso) from 2005 to 2009.

METHOD

The survey was led through the five sanitary districts of the region. It consisted in interview with the mean actors of leprosy control program and the analysis of the data notified on the leprosy cases, in order to estimate the progression of the key indicators of detection and follow-up care for patients having leprosy.

RESULTS

During the survey period, 248 cases of leprosy were recorded including 236 new cases and 12 relapses. The prevalence of leprosy was 0.28 per 100 000 inhabitants in 2009. The detection rate decreased from 3.77 per 100 000 in 2005 to 2.75 per 100 000 in 2009. Among the 236 new cases of leprosy, 194 (82.2 %) were multibacillary form (MB). MB patients proportion increased from 69,3 % in 2005 to 91.1 % in 2009. The proportion of children was on average 3.8 %, the one of female cases 38.9 %. Newly diagnosed cases with grade 2 disabilities moved up from 21.4 % in 2005 to 42.2 % in 2009. The completion of cure rate was globally 88.26 %. The losts from follow-up among the patients who started multi-drug therapy were 7.14 %.

CONCLUSION

The aim of the leprosy elimination as a public health problem is achieved but some challenges may be taken up, particularly in the organization of leprosy detection by the heath structures.

[Non-resecable gastric cancers at the department of general surgery at CHU Gabriel TOURE Bamako]

Our objectives were to determine the frequency of non-resecable gastric cancers, to analyse its clinical, and therapeutic aspects, and to assess patients follow-up.

METHOD

Our retrospective study has been from 1st January 2008 to 31st December 2009. It included all patients operated or not having non-resecable gastric cancers at general surgery at CHU Gabriel TOURE

RESULTS

We have recorded 305 cases of advanced gastric cancers, accounting for 71.4% of gastric cancers (n=425), 47.8% of digestive cancers (n=766) and 2.2% of hospitalisations. The sex ratio was 1.6 in men favour; the average age was 57 } 12 with extremes of 25 and 90. The average evolution delay was 15.5 months with extremes of 5 and 7, and standard deviation 19.2. 14 patients have been admitted in an emergency context. (8 cases of gastric perforation related peritonitis, 6 cases d’haematemesis). The main found signs were: epigastric tumours 187 (61.3%) cases, lower limbs oedema 105 (34.4%) cases, ascitis 105(34.4%) cases, hepatomegaly 68(22.3%), lymphadenopathy ≪ ganglions de Troisier ≫21(7%), ≪ ecailles de Brumer ≫ (= Brumer’s scales) from rectal touch 17(6%) cases More than half of patients have been classified ASA 4.105(34.4%) ASA 5, and 74(24.2%) ASA . The tumour location was antrum in 260(85.2%) cases Cardiac orifice in 17(5.5%) cases, fundus i n 11(3.6%), the gastric linitis in 17(5,5%) cases. The imaging has found the ascitis in 119(39%) cases, the hepatic metastases in 54(17.7%) cases, pulmonary in 36(19%) cases, pancreatic 5(1.6%) cases, splenic in 4(1.3%), and ovarian in 3(1%) cases 105(34.4%) patients had no surgery, 4(1.3%) had chemotherapy, and 200(65 %) had surgery. The mortality rate was at 16.5% and the one year survival at 15.5%.

Primary aneurysmal bone cyst of the patella: a case report

An aneurysmal bone cyst is rare in the patella. We report the case of a 28-year-old woman who presented with chronic pain and no previous trauma history. Treatment included curettage of the cyst and filling with a corticocancellous graft. Thirty-one months after surgery, the knee was mobile and painless and graft incorporation was good.