[Role Of Imaging In The Management Of A Case Of Intrauterine Device Migration]

We report a case of intrauterine device (IUD) migration in order to describe the contribution of imaging in its diagnosis. It was a 35-year-old woman received on 06/01/2018 for pelvic ultrasound for pelvic pain. Ultrasound examination revealed a hyperechoic right para-uterine tubular image. A hysterosalpingography revealed an IUD in the pelvis in extra-urine position. Surgical extraction was done without complications. Intrauterine device migration is rare in our context. The radiological means make it possible to specify its topography.

[Compliance's assessment of ultrasound and x-ray requests at Mopti's Sominé Dolo hospital]

OBJECTIVE

To assess the compliance of requests for ultrasound and radiography examinations at Mopti's hospital.

MATERIALS AND METHODS

This was a cross-sectional study from January 2018 to June 2018. The variables analyzed were the different compliance criteria grouped into administrative, clinical and minor.The data analysis was done with SPSS version 20 and Excel 2013 software.

RESULTS

Out of 2000 requests, radiography represented 61.05% compared to 38.95% of ultrasound cases. The administrative criteria were completed in more than 95% of the cases. The purpose of the review was absent in 95% of the requests. The non-compliance rate for the requests was 95.65%. The requests of general practitioners, specialists and medical assistants were respectively non-compliant with 93.62%; 95.68% and 100%.

CONCLUSION

At the end of this study, we observed an insufficiency in the quality of prescriptions for requests for medical imaging examinations with a high rate of non-compliance. This could lead to examination practice not suited to the clinical situation, interpretation errors, complications for the patient and high and unnecessary economic cost.

[Radiochemotherapy for the treatment ofmuscle invasive bladder tumors in a west african radiotherapy service]

OBJECTIF

The aim of this study was to describe the results of radiochemotherapy in patients after transurethral resection of muscle invasive bladder tumors.

MATERIAL AND METHODS

A retrospective study from May 2014 to May 2016 in the radiotherapy department of the Mali Hospital. Have been included, all patients with bladder cancer infiltrating the muscle. Secondary cancers of the bladder and metastatic forms have been excluded from our study. Transurethral resection of bladder was performed. Neoadjuvant chemotherapy with paclitaxel- carboplatin was administered every three weeks in all patients, then external phototherapy 6 MV at a dose of 66 Gy due to 2 Gy of 5 sessions per week 6MV photon of external beam radiotherapy at a dose of 66 Gy due to 2 Gy of 5 sessions per week associated with concomitant cisplatin at dose of 40mg / m2 / week.

RESULTS

Eight patients were included in ourstudy. The average age of 53.75 ± 14.84 years. The male sex was predominant 87.5% (n = 7). The history of chronic smoking wasfound in four patients. The main carcinogenic risk factor identified in our patients was urogenital bilharzia (6 cases / 8).The histological type found was urothelial carcinomain 12.5% (n = 1) and invasive squamous cell carcinomain 87.5% (n = 7). Transurethral resection of the tumor was performed in 62.5% (n = 5). Endoscopic biopsy was performed in 37.5% (n = 3). The tumor was classified pT2N0M0 in 50% (n = 4), pT3aN0M0 in 37.5% (n = 3) and pT3bN0M0 in 12.5% (n = 1). Neoadjuvant chemotherapy with paclitaxel - carboplatin every three weeks was administered to all patients. The results of radiochemotherapy (see Table: evolution).

CONCLUSION

Concomitant radiochemotherapy is a conservative curative treatment that can be proposed as a replacement for cystectomy, for non-metastatic infiltrating tumors after the most complete endoscopic resection.

[Infections associated with the care in the department of gynecology - obstetrics of the University Hospital Center Gabriel Touré]

OBJECTIF

the purpose of this work was to study the infections associated with the care in the department of gynecology - obstetrics of the University Hospital Center Gabriel Touré (CHU G. Touré).

PATIENTS AND METHODS

This was an epidemiological, descriptive, and analytical study carried out in the gynecology-obstetrics department of G. Touré University Hospital, from April 11, 2016 to August 29, 2016 (4 monthset 18 days), with a prospective collection of data that focused on the characteristics clinical and laboratory-based care-associated infections in patients during their hospitalization. Included in the study were all hospitalized patients (operated or not) in the gynecology obstetrics department, who agreed to participate in the study. The criteria used to diagnose the infection associated with care were those of the CDC Atlanta and making a thick drop in our context. Operative wound monitoring was performed until the 30th postoperative day.

RESULTS

We recorded 200 patients, including 138 operated and 62 nonoperated patients, of which 30 patients developed a care-associated infection at a rate of 15%. The mean age of the patients who presented an infection was 32.52 years ± 13.36 years against 29.36 years ± 10.28 years for the patients who did not present the infection. Seven point five percent of the evacuees had an infection associated with care. The most common types of infections were surgical site infection with 56.60% followed by malaria with 23.30% and urinary tract infection with 20.00%. Escherichia coli and Acinetobacter baumaniiwere the most recovered germs. Isolated organisms were 100% resistant to Amoxicillin, 88.88% were resistant to Ciprofloxacin and 77.77% were resistant to Amoxicillin + Clavulanic acid. The average duration of hospitalization for patients who developed the infection was 14.70 days with extremes of 5 and 46 days. The mortality rate was 1.50%. The average cost of management of patients who developed the infection was 119837 FCFA; the extremes were 17750 and 825750 FCFA and the standard deviation of 174998 CFA francs.

CONCLUSION

the infections associated with the care remain frequent in our service and dominated by the infections of the operating site. The isolated organisms were all 100% resistant to Amoxicillin in 88.88% Ciprofloxacin.

[Problem of the referral-for-referral system of obstetrical emergencies and the community involvement in the Bamako district]

AIMS

This study aims to evaluate the difficulties of the referral-for-referral system in the V municipality sanitary district of Bamako.

PATIENTS AND METHOD

A descriptive cross-sectional study was carried out from 5th September to 5th November 2011 in the sanitary district of the V municipality in Bamako. Included in the study were patients referred or evacuated for obstetrical care in the health center during the period of study. Not included were the patients referred or evacuated from other sanitary districts and patients referred or evacuated or self-referred for no obstetrical reasons. Data was recorded on the Excel 8.0 software and analyzed on the software packages Epi info 3.5.3 and STATA.

RESULTS

During the period of study we recorded 1824 deliveries among which 180 fit the inclusion criteria. During our study 92.2% of references were adequate; 78.3% were justified and 72.2% were opportune. Only the sanitary district of the V Municipality had paid its quotation due at the time of the study.

CONCLUSION

Our study showed that inadequate logistics and the lack of involvement of communities hamper the proper functioning of the referral system.

[Obstetrical complications of genital mutilation in Malian rural environment]

OBJECTIVE

To describe maternal and fetal complications during delivery of mutilated women.

MATERIALS AND METHODS

It was a case study, witnesses with matching going from February 1st, 2008 till January 31st, 2009 which took place in Mopti's region. We compared maternal and fetal complications of mutilated and non-mutilated women. Using statistical tests were Chi(2) (P<0.05), Odd-Ratio (OR) and its 95% confident interval (CI95%).

RESULTS

We recorded 410 deliveries among which 280 mutilated women (68%). One hundred and forty excised women were included. There is a significant difference between duration of eviction>30 mm (RC=8.27 [4.66-14.76], P<0.001); simple perennials lacerations (RC=14.54 [4.79-49.56], P<0.001) and full perennials lacerations (RC=8.90 [1.91-57.23], P<0.001) in the two groups. The scores of morbid Apgar (RC=9.70 [4.35-22,29], P<0.001) were more important in groups of cases. Moreover, we recorded 3 neonatal deaths and 4 complicated perennials lacerations in the group of cases only.

CONCLUSION

Maternal and fetal complications are significantly more important for the excised woman's than for the not excised women.

[Reduction Of Maternal And Neonatal Mortality Due To Free Caesarean In Segou's Nianankoro Fomba Hospital In Mali]

INTRODUCTION

Emergency obstetrical treatment influences maternal and neonatal mortality and so the government of the republic of Mali decided on June 23, 2005 to establish a free caesarean policy in public health establishments. After 3 years and half, we evaluated the impact of the policy on maternal and neonatal mortality.

METHOD

A comparative transversal study was conducted. The data of women who had a caesarean performed in the Segou regional hospital covering the span of 5 years (18 months before the policy and 42 following the new law) was collected. The data was analyzed using the Info 6.4 software. We employed a Pearson's Chi-2 with significance set at p<0.05.

RESULTS

Frequency of the caesarean increased following the policy to 25.48 % in 2008 versus 9.33 % in 2004 (p=0.0067). Maternal mortality rate was improved: 3.85 % in 2004 versus 0.23 % in 2008. The rate of neonatal mortality in the same period dropped from 25.39 % to 9.36 % (p=0.021).

CONCLUSION

It is noted that the free caesarean policy enabled an increase in the number of caesareans performed and a significant reduction in maternal and neonatal mortality rates.