Anterior dislocation of the shoulder associated with a diaphyseal fracture of the ipsilateral humerus: a case report

Background

Anterior dislocation of the shoulder associated with a diaphyseal fracture of the ipsilateral humerus is a rare and controversial occurrence, with very few cases reported in the literature.

Case presentation

We present a case of a 39-year-old right-handed driver who presented with an anterior dislocation of the shoulder associated with a diaphyseal fracture of the ipsilateral humerus following a road traffic accident. The lateral approach to the fracture allowed us to use two forceps to gain a good grip on the proximal fragment and perform the maneuver to reduce the dislocation. The fracture was reduced and fixed with a molded Lecestre-type plate.

Conclusion

In this case, we employed the approach of initially reducing the shoulder dislocation with forceps, followed by osteosynthesis of the humeral fracture. The functional results were excellent after 6 months.

Atypical fibromuscular dysplasia or carotid web revealed by cerebral infarction: A review of 2 cases

Atypical fibromuscular dysplasia of the bulb or carotid web is a nonatheromatous pathology more common in African and African-American populations. It is implicated in the occurrence of cerebral infarcts of unknown causes. Its diagnosis is made by angio-CT of the supra-aortic trunks and is characterized by a defect in the posterior wall of the bulb. Treatment with antiplatelet agents prevents the occurrence of stroke, but radical treatment remains surgical and endovascular. We report 2 observations of carotid web diagnosed and medically managed at the regional hospital of Saint Louis.

Irreducible posterolateral elbow dislocation: A case report

Elbow dislocations are very common, particularly in the posterolateral variety. Closed reduction is usually easy. However, an irreducible elbow dislocation without associated fracture is rare. We report the case of a 21-year-old patient who presented with an isolated posterolateral irreducible elbow dislocation. Open reduction revealed the buttonhole radial head in the capsule and the complex ligaments. A significant protrusion of the radial head associated with a closed reduction failure is highly suspicious of an irreducible dislocation.

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Irreducible elbow dislocation without associated fracture is extremely rare.

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A buttonhole aspect of radial head is characteristic.

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An enormous radial head protrusion with a reduction failure made the diagnosis.

Hand compartment syndrome secondary to contrast media extravasation: A case report

Introduction

Contrast media extravasation injury is a recognized complication of contrast media use. Compartmental syndrome of the hand secondary to contrast extravasation is exceptional. We describe a case of compartment syndrome of the hand secondary to contrast media extravasation.

Case presentation

We present a 47-year-old woman with a history of pulmonary embolism who was diagnosed of compartment syndrome of the left hand after injection of contrast medium during a CT scan. Whose first diagnosis was mild contrast medium extravasation injury 24 h before the compartment syndrome. Standard radiography showed an accumulation of contrast medium in the left hand. The patient underwent a fasciotomy and secondary healing. Follow-up showed good radiographic, clinical, and hand function after 2 months.

Discussion

The occurrence of hand compartment syndrome secondary to contrast media extravasation is rare. Most of the time, they are initially diagnosed as medium extravasation before the worsening of symptoms. Because of its unknown incidence, treatment is not codified. The goal of treatment is to save the limb and restore function. This can be achieved rapidly with early surgery because of the unpredictable course.

Conclusion

Contrast media injection is not a harmless gesture. Hand compartment syndrome after contrast extravasation is rare and is a severe injury, our experience with this case suggests that early surgery helps save the limb and restore function. Always fear a compartmental syndrome in case of extravasation of contrast medium.

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Contrast media injection is not a harmless gesture.

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Always fear a compartmental syndrome in case of extravasation of contrast medium

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Our experience suggests that early surgery helps save the limb and restore function

Treatment of obstetrical brachial plexus palsy sequelae: Preliminary results about 18 cases

Background

Severe obstetrical injuries of the brachial plexus lead to a complete or incomplete paralysis resulting in a significant functional handicap of the limb.

This study aimed to assess the preliminary results of our management.

Materials and methods

This prospective study involved 18 patients, with an average age of 7.7 years. The choice of the surgical technique depended on the type of palsy. We evaluated our patients using the Mallet, Gilbert-Raimondi, Brachial plexus World Group Heerlen, and Raimondi scores.

Results

Patients in groups I and II of Narakas had an anterior shoulder release (n = 2) and transfer of the latissimus dorsi (n = 8). For those in group III, we performed 5 biceps rerouting and 2 radius derotation osteotomies, one of which was associated with a Zancolli I and an arthrodesis of the thumb MCP joint. In the wrist and hand, we performed two tendon transfers from the flexor carpi ulnaris to the extensor tendons of the fingers.

After a mean follow-up of 30.52 months, in the first 9 patients, active external rotation of the shoulder increased from a mean value of −22.5°–38.8° and mean active abduction from 78.3° to 141.1°. In Group III, the mean spontaneous supination position of 75.5° was improved to 45° pronation. Regarding the two patients with tendon transfers, active wrist extension increased from 0° to 45° and from −60° to 0°, respectively.

Conclusion

Palliative surgery in the treatment obstetrical brachial plexus palsy sequelae retains an important place in the restoration of upper limb function.

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Obstetrical brachial plexus palsy lead to a complete or incomplete paralysis.

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Several techniques are proposed to improve the upper limb functions.

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Functional results depend on the severity of the injury and the age of the patient.

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Palliative surgery redistributes remaining muscular forces.

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Treatment requires a collaboration between doctor, physiotherapist and parents.

[Not Available]

There is a real risk of electrical accidents in the operating theatre, with the growing number of electrical, electronic and flammable liquids used. Electrocautery remains the most commonly used device for its electrosurgical effect of coagulation or tissue section. When it is defective or misplaced on a small area of the skin, it can cause a typically deep, slow healing skin burn. It adds an unexpected iatrogenic morbidity to the initial condition, with devastating consequences for the patient, the surgeon and sometimes the hospital. We report two cases of cutaneous burn by the neutral plate that occurred intraoperatively when using electrocautery in monopolar mode, and discuss etiology, clinical and prevention aspects.

Mesenteric myofibroblastic tumor: NSAID therapy after incomplete resection

Myofibroblastic tumors are inflammatory tumors that arise in viscera and soft tissue; their etiopathology is poorly understood. They are capable of infiltration of adjacent organs, local recurrence after surgical resection, and even of distant metastasis. These characteristics result in persistent debate as to the nature of these lesions - whether they are inflammatory or neoplastic, benign or malignant lesions? Diagnosis is almost always made based on histopathological findings. Traditional management is complete surgical excision, but this may be difficult or impossible when the lesion develops in proximity to vital structures. We report the case of a 59-year-old man who was treated in our institution for mesenteric myofibroblastic tumor. Complete resection was not possible due to local infiltration of the mesentery. Recurrence was noted 3 months after surgery; treatment with steroidal and then non-steroidal anti-inflammatory medications (NSAIDs) resulted in clinical and radiologic regression of the tumor.

[Aetiology of AFB negative pneumonias in hospitalized HIV patients in Dakar]

A prospective study was carried out in two tertiary hospitals in Dakar to determine the main causes of sputum acid-fast bacillus (AFB) smear-negative pneumonia in HIV-infected patients. All clinical and microbiological records were reviewed by experts. Seventy patients were finally enrolled. Most of them were hospitalized at an advanced stage of AIDS. The median CD4 cell count was 62/mm(3) and the median body mass index (BMC) was 18 kg/m(2). Thirty-one patients (44 %) were known as seropositive for HIV infection prior to admission. Radiological opacities were localized in 70 % of patients and diffuse in 21 %. Fiberoptic bronchoscopy was performed in 50 patients (71 %). A definite or probable diagnosis was obtained in 55 patients (79 %). Bacterial pneumonia (usually due to Enterobacteriaceae and Pseudomonas aeruginosa), tuberculosis, Pneumocystis pneumoniae and other causes (Kaposi's sarcoma, atypical mycobacteria) were diagnosed in 67 %, 24 %, 5 %, and 13 % of these patients respectively. In conclusion, pneumonia of bacterial origin and tuberculosis can be incriminated in the majority of cases of AFB negative pneumonia observed in HIV patients in Dakar.

[Drainage of liver abscess by "mini-hepatotomy"]

We have developed a a "mini-hepatotomy" technique to prevent rupture of large superficial liver abscesses.

AIM

The purpose of this report is to describe our results using this technique.

PATIENTS AND METHOD

Data was extracted from the files of 40 patients hospitalized in our department for liver abscess from January 2000 to June 2005. Antimicrobrial therapy including metronidazole was administered to all patients and was the sole treatment in two. Additional treatment included laparotomy for ruptured abscess in 4 cases, pleural drainage for rupture in the right pleural cavity in one, and "mini hepatotomy" in 33. This study includes the 33 patients who underwent mini-laparotomy. There were 30 men and 3 women with a mean age of 38 years. The mean delay for consultation was 51 days.

RESULTS

Liver abscess was classified as amoebic abscess in 28 cases and pyogenic abscess in 5. The mean diameter of the abscess was 11.5 cm. The abscess was located in the right lobe in 21 cases and left lobe in 12. The mean quantity of liquid drained from the abscess was 1060 mL. Outcome was favorable in 28 cases (success rate: 84.8%). In the remaining 5 cases abscess persisted after drain removal including two that required a second drain procedure and three that resolved after medical treatment. The failure rate was 6% (2/33). No patient died.

CONCLUSION

Large size and superficial location are risk factors for rupture of liver abscess. Drainage is warranted in patients at risk for this complication. The results of this study show that our "mini-hepatotomy" drainage technique has a high success rate and can achieve good results.

[Peritonitis from liver abscess: retrospective study of 5 cases]

AIM

To report the clinical, paraclinical and therapeutic aspects of peritonitis from liver abscess and to study the risk factors of rupture

MATERIAL AND METHOD

From January 2000 to March 2007, we retrospectively studied 5 cases of peritonitis secondary to ruptured of liver abscess at the surgery department of the University Teaching Hospital Le Dantec. These cases were selected among 48 cases of liver abscess managed during the same period.

RESULTS

There were four men and one woman. The mean age was 40.5 years. In 4 cases the Peritonitis was generalised and it was localised in one case. Percutaneous needle aspiration was already performed in 2 cases in a medical department. The abscesses were located in the right hepatic lobe in 3 cases and in left hepatic lobe in 2 cases. The mean diameter of the collection was 10.6 cm with extreme of 8 cm and 15 cm. The right liver abscesses were larger than the left ones (12.3 cm versus 8 cm). There were 2 cases of amoebic liver abscess and 3 cases of pyogenic liver abscess. All our patients underwent resuscitation prior and after the surgical treatment which consisted of abscess evacuation, peritoneal lavage and drainage. We noticed one case of recurrence successfully treated with antibiotics and percutaneous drainage. No death was recorded.

CONCLUSION

The big size of the abscess, the superficial location or on left hepatic lobe are risk factors of rupture. It justifies the necessity of instrumental evacuation of large hepatic abscess. Surgical drainage offer better results than other modalities in management of ruptured liver abscess.

[Actinomycetomas in Senegal: study of 90 cases]

Mycetoma is a pathological process during which eumycetomic (fungal) or actinomycotic causative agents from exogenous source produce grains. Medical treatment is available for actinomycetomas and surgery is still the main treatment for eumycetoma. We report 90 cases of actinomycetoma occuring in male adult patients coming mainly from central Senegal. Patients living far from health structures consult after a long evolution period for tumors and pains which prevent them from carrying out their activities. The three etiological agents in our patients were Actinomadura pelletieri (60 cases), Actinomadura madurae (25 cases) and Streptomyces somaliensis (5 cases). The three clinical features are inflammatory forms (75 cases) mainly due to Actinomadura pelletieri, tumoral forms (13 cases) and cystic forms (2 cases). Lesions are localized on the foot in 50% of cases and in other part of the body for the other half. Bone damage was observed in 55% of cases. 83% of the patients were cured after a one-year treatment of sulfametoxazole adminstered orally. Two patients died of visceral involvement.

[Trichobezoard revealed by intestinal perforation. A case report]

This paper presents a case of gastric and ileal trichobézoard on a 12 years-old girl. It was revealeds by ileal perforation which was confirmed by abdominal X-ray. Trichobézoard diagnosis was not performed before surgery despite two contradictory/abdominal ultrasound scans. The trichobézoard was removed surgicaly by ileotomy and gastrotomy. The patient had an satisfactory post-operative convalescence after a follow-up of six months.

AIDS caused by HIV1 and HIV2 infection: are there clinical differences? Results of AIDS surveillance 1986-97 at Fann Hospital in Dakar, Senegal

OBJECTIVE

To compare the clinical manifestations observed in AIDS patients infected with HIV2 and HIV1 infection.

METHODS

The medical records of AIDS patients hospitalized between January 1986 and July 1997 at the Department of Infectious Diseases of Fann Hospital, Dakar, were reviewed.

RESULTS

599 hospitalizations (76%) were HIV1 seropositive patients, 137 (17%) were HIV2 seropositive patients and 54 (7%) were patients serologically dually reactive to HIV1 and HIV2. There was no significant difference in medium CD4 lymphocyte count between patients with HIV1 and HIV2 infection. Chronic diarrhoea and diarrhoea caused by bacterial infections were more frequently observed in HIV2-infected individuals. Oral candidiasis and chronic fever were more often noted in patients with HIV1 infection. Bacterial and cryptococcal meningitis was only observed among patients with HIV1 infection.

CONCLUSIONS

Certain clinical differences were observed comparing AIDS patients with HIV1 and those with HIV2 infection. As there is no clear physiopathological explanation for these differences, additional studies with larger numbers of AIDS patients are needed to determine whether these differences are real.

[Knowledge and treatment of malaria in rural Senegal]

Evaluating knowledge about the diagnosis and treatment of malaria is a prerequisite for both understanding the development of chemoresistance and improving ongoing programs of chemotherapy and chemoprophylaxis. To gain such knowledge we distributed a questionnaire to 900 household heads in twelve villages in the M'Backe district of Senegal. Awareness of the main symptoms of malaria was satisfactory in comparison with previous references. Public health care facilities such as dispensaries were cited as the first resort for treatment by 72.6% of respondents. Chloroquine was mentioned as the first line antimalarial by 23% of respondents who practiced self-medication. Improper dosages were stated by 60% of the respondents. A total of 52.3% of respondents practiced chemoprophylaxis mainly using chloroquine. In 65.8% of cases antimalarial drugs were obtained from public health care units but drugs were purchased on the market in 15.7% of cases. These findings indicate the threefold Bamako initiative should be reinforced and that a campaign should be undertaken to educate people living in rural areas about malaria.

[Low prevalence of ant-hepatitis c virus antibodies in hepatocellular carcinoma in Senegal]

Senegal is a country with a high incidence of hepatocellular carcinoma (HCC). The role of the hepatitis B virus (HBV) in the genesis of HCC is well established. To evaluate the role of the hepatitis C virus (HCV) in the occurrence of HCC in Senegal, second-generation serologic tests were used to compare the prevalence of anti-HCV antibody in subjects with HCC and in controls without liver disease. A polymerase chain reaction assay was used to look for HCV RNA in sera from patients with HCC and anti-HCV antibody. HBV markers were assayed in all study subjects. Prevalences of anti-HCV antibody were 10.9% (7/64) in the HCC group and 5% (3/58) in the control group (NS). In the HCC group, anti-HCV antibody was found in 2.4% (1/42) of subjects positive for the hepatitis B antigen (HBsAg) versus 27.2% (6/22) of subjects negative for the HBsAg (p < 0.01). HCV RNA was detected in five of six anti-HCV-positive HCC patients. Prevalence of the HBsAg was 65.6% (42/64) in the HCC group versus 17.2% (10/58) in the control group (p < 10-8). Anti-HBV antibody was detected in 48.3% (28/58) of controls versus 6.3% (4/64) of HCC patients (p < 10-8). These data do not support a close epidemiologic association between the HCV and HCC in Senegal, where the HBV remains the main viral cause of HCC.

Epidemiology of hepatitis B virus infection in the rural community of Tip, Senegal

The distribution of responses to hepatitis B virus infection in the rural community of Tip, Senegal, has been determined. Children are rarely persistently infected before two years of age, at which time about 25% of the population are infected. Uninfected members continue to be at risk. Vaccination programs instituted at an early age could prevent infection in most of the population and considerably decrease the risk of chronic liver disease and primary cancer of the liver in adults.

Persistence of circulating complexes between HBsAg and immunoglobulin M in sera of hepatitis B surface antigen positive patients suffering from liver cirrhosis or primary liver cancer

Complexes between hepatitis B surface antigen (HBsAg) and immunoglobulin M (IgM) have been detected in acute type B hepatitis. Sequential serum testing for the presence of these complexes has been shown to be the best method for predicting disease chronicity. The presence of HBsAg/IgM complexes was investigated using an enzyme-linked immunosorbent assay with selected sera from Senegal. The three population groups studied were composed of 405 Senegalese soldiers as well as 84 liver cirrhosis and 169 primary liver cancer patients. Only one of the 122 HBsAg negative sera tested was found to be positive for HBsAg/IgM complexes. Complexes were detected 13.9% of the HBsAg positive soldiers, in 40% of the HBsAg positive liver cirrhosis patients, and in 50% of the HBsAg positive primary liver cancer patients. HBsAg/IgM complexes were also detected in 53.6% of the hepatitis B e antigen (HBe) positive soldiers, compared to 75 and 76% for the HBeAg positive liver cirrhosis and primary liver cancer patients, respectively. In anti-HBe positive sera, an increased proportion of HBsAg/IgM complexes was observed during the sequence chronic hepatitis (5%)-cirrhosis (29%)-primary liver cancer (42%). On the other hand, it has been reported that in the sequence of events leading from chronic hepatitis to primary liver cancer, there is an increase in anti-HBeAg prevalence and in alpha-fetoprotein levels. In this study, only alpha-fetoprotein levels were found to increase. Values higher than 15 IU/ml were observed in 4.3, 27.3, and 86.4% of the HBsAg positive individuals from the three groups. No significant variation was observed in the anti-HBe prevalence between the population group (64-75%).

[Infantile diarrhea in Senegal: epidemiologic survey in a suburb of Dakar]

Before the launching of a national program against diarrhoea in Senegal it was interesting to survey the exact impact of this disease on the under 5 children and the way the mothers and the community are dealing with it. We investigated a very crowded suburb of Dakar where we found that diarrhoea was the first cause of death among under five children. This investigation showed us that Oral Rehydration Therapy (ORT) is widely known by the approximately 1000 mothers interviewed, thanks to the gambian and senegalese broadcasts . However, only 1% of the mothers consider it as a useful and efficient treatment of diarrhoea. Expansive and inefficient medical treatments as well as traditional therapy are systematically preferred to ORT. We analyzed the reasons of that failure and we proposed a new strategy to generalize the use of ORT.

Diagnosis and symptoms of mental disorder in a rural area of Senegal

A study was carried out in a rural area of Senegal to ascertain the pattern of mental disorders among patients presenting at primary health facilities. Among 545 children aged 5-15 years, attending health centres and posts, 17% were found to be suffering from some form of emotional problem, behaviour disturbance or neuro-psychiatric disorders. Using a 10-item screening questionnaire, it was shown that the symptoms "never plays with others' and "speech disturbance' were the strongest predictors of mental disorder among children. Among 933 adults, it was found that 16% reported more than seven symptoms commonly associated with psychiatric illness on a 24-item self-reporting questionnaire. The order in adults does not allow a precise estimate of morbidity to be made. Health workers diagnosed 9% of the patients as suffering from a mental health problem, usually in association with a physical problem. It was found that psychotic and suicidal symptoms (e.g. hallucinations, delusions) were more likely to be recognized by health workers as diagnostic of mental disorder, whereas psychophysiological symptoms (e.g. anorexia, insomnia, headache) and psychological symptoms (e.g. anxiety, depression) were less frequently recognized. The study supports the view that psychological symptoms and mental disorders occur relatively frequently among adults and children attending primary health facilities. Data allowing insight into the diagnostic sensitivity of primary health workers can provide a rational basis for planning training programmes in mental health.

[Contribution to the study of endocrinopathies in black Africans (author's transl)]

For a long time endocrine pathology was unrecognized or even denied to exist in Black Africans, but this is not true. It seems to be recognized more frequently since medicalization has increased. This pathology does not present any particularities. Hyperthyroidism appears frequently, at least in urban areas. A series of 87 personal cases has permitted a review of the principal clinical and biological aspects; myasthenia seems to be particularly important; radical treatment is preferred over prolonged medical treatment which is not within the financial possibilities of our patients. There have been 30 observations of cortico-adrenal anomalies of which 7 known personally. It must be noted that the Black living in his traditional rural environment presents a certain degree of physiological hypocorticism with respect to whites and especially Blacks of higher social standing. Pathological hypocorticism is essentially due to tuberculosis; the melanodermia is evident to an alert observer. Metabolic hypercorticism produces the usual manifestations. Only 9 cases of Sheehan syndrome have been reported (5 personal). In the Black African woman, it appears earlier than in Europe often due to premature nuptiulity and the higher incidence of tachyparity. One is surprised that this syndrome is detected so rarely; it is, without a doubt, often well tolerated during a long period of time therefore goes undetected.

[Examination of the enzymatic functions of the normal liver in black Africans (Apropos of 50 Senegalese cases)]

In order to establish the hepatic enzymogram in healthy African black people, four enzymes have been studied in 50 apparently healthy male Africans: transaminases (GOT, GPT), alcaline phosphatases, ornithine carbamoyltransferase (OCT) and gamma-glutamyl transpeptidase (GGT). The findings do not show any difference with the usually admitted levels in European countries, except for alcaline phosphatases which are situated at the upper limit of the normal.