Olanexidine gluconate formulations as environmental disinfectants for enveloped viruses infection control

This study investigated the potential of olanexidine gluconate as environmental disinfectant against enveloped viruses in the suspension test and three non-porous surface tests. In the suspension test, olanexidine gluconate showed immediate virucidal activity. In addition, non-porous surface tests demonstrated that, although the immediate effect of aqueous formulations was weak, the final virucidal efficacy outcompeted that of ethanol for disinfection. Furthermore, the effectiveness of olanexidine gluconate persisted even after drying on environmental surfaces. This study demonstrated the potential usage of olanexidine gluconate formulations as an environmental disinfectant in the infection control of enveloped viruses.

Selection of cellular genetic markers for the detection of infectious poliovirus

AIMS

Cellular responses of an established cell line from human intestinal epithelial cells (INT-407 cells) against poliovirus (PV) infections were investigated in order to find cellular genetic markers for infectious PV detection.

METHODS AND RESULTS

Gene expression profile of INT-407 cells was analysed by DNA microarray technique when cells were infected with poliovirus 1 (PV1) (sabin) at multiplicity of infection of 10^-3 and incubated for 12 h. Poliovirus infection significantly altered the gene expressions of two ion channels, KCNJ4 and SCN7A. The expression profile of KCNJ4 gene was further investigated by real-time RT-qPCR, and it was found that KCNJ4 gene was significantly regulated at 24 h postinfection of PV1.

CONCLUSIONS

KCNJ4 gene, coding a potassium channel protein, is proposed as a cellular genetic marker for infectious PV detection.

SIGNIFICANCE AND IMPACT OF THE STUDY

This is the first study to show the availability of cellular responses to detect infectious PV. The selection of cellular genetic markers for infectious viruses using DNA microarray and RT-qPCR can be applicable for the other enteric viruses.

Bayesian modeling of virus removal efficiency in wastewater treatment processes

Left-censored datasets of virus density in wastewater samples make it difficult to evaluate the virus removal efficiency in wastewater treatment processes. In the present study, we modeled the probabilistic distribution of virus removal efficiency in a wastewater treatment process with a Bayesian approach, and investigated how many detect samples in influent and effluent are necessary for accurate estimation. One hundred left-censored data of virus density in wastewater (influent and effluent) were artificially generated based on assumed log-normal distributions and the posterior predictive distribution of virus density, and the log-ratio distribution were estimated. The estimation accuracy of distributions was quantified by Bhattacharyya coefficient. When it is assumed that the accurate estimation of posterior predictive distributions is possible when a 100% positive rate is obtained for 12 pairs of influent and effluent, 11 out of 144, 60 out of 324, and 201 out of 576 combinations of detect samples gave an accurate estimation at the significant level of 0.01 in a Kruskal-Wallis test when the total sample number was 12, 18, and 24, respectively. The combinations with the minimum number of detect samples were (12, 9), (16, 10), and (21, 8) when the total sample number was 12, 18, and 24, respectively.

244 INVOLVEMENT OF Na+/H+ ANTIPORTER 1 IN EMBRYONIC DEVELOPMENT OF RAT OOCYTES ACTIVATED BY ETHANOL

In mammalian oocytes, artificial activation is essential for further embryonic development of somatic cell nuclear transferred or round spermatid-injected oocytes. Unlike the protocol for mice, the optimal activation protocol for rat oocytes is not well established. Recently, we showed for the first time that a combined treatment with ethanol and 6-dimethylaminopurine (6-DMAP) efficiently induced activation of rat oocytes, resulted in a higher proportion of blastocyst formation as compared with other combined treatments or with the 6-DMAP treatment alone (Sano et al. 2009 Zygote 17, 29–36). Although the ethanol treatment has been used for oocyte activation not only in rats, but also in other species to date, it is unclear why the ethanol treatment is effective, especially in activating rat oocytes. Because it has been reported that alcohol alters intracellular pH via exchangers, transporters, or both on the membrane surface in the myocardium, it leads us to the possibility that the ethanol treatment regulates such exchangers, transporters, or both in rat oocytes. The aim of the present study was to clarify the role of Na+/H+ exchanges (NHE) in activating rat oocytes treated with ethanol. First, we examined which types of NHE are expressed in rat ovaries, oocytes, and parthenogenetic embryos. Expression of the NHE1 protein was also confirmed in both oocytes and parthenogenetic embryos, but not in NHE2 and NHE3. Treatment with 5-(N-ethyl-N-isopropyl)amiloride hydrochloride, an NHE inhibitor, did not affect the development of ethanol-activated oocytes to the 2-cell stage; however, it decreased the rate of blastocyst formation in a dose-dependent manner. The 5-(N-ethyl-N-isopropyl)amiloride hydrochloride treatment did not decrease development to either the 2-cell or the blastocyst stage of oocytes activated by 6-DMAP alone. Taken together, we conclude that ethanol treatment was involved in NHE1 activation, resulting in high developmental ability of rat oocytes. This work was supported in part by a Grant-in-Aid for Scientific Research from JSPS (KAKENHI; 21780253) to J. I. The work was also supported in part by the Promotion and Mutual Aid Corporation for Private Schools of Japan, Grant-in-Aid for Matching Fund Subsidy for Private Universities, to J. I. and N. K.

273 REMOVAL OF ACROSOME FROM SPERM HEADS IMPROVES DEVELOPMENT OF RAT ZYGOTES THROUGH INTRACYTOPLASMIC SPERM INJECTION

In intracytoplasmic sperm injection (ICSI), sperm chromatin is introduced into the oocyte together with acrosome, which does not enter cytoplasm of oocytes during normal fertilization. In mice, acrosome of sperm head has a detrimental effect on embryonic development of the ICSI oocytes (Morozumi et al. 2006 Proc. Natl. Acad. Sci. USA 103, 17 661–17 666). We examined the effect of acrosome removal of frozen/thawed (F/T) rat sperm on development to term of the ICSI oocytes in order to improve production efficiency of live offspring from F/T rat spermatozoa through ICSI. In experiment 1, epididymal spermatozoa of the Wistar rats were frozen as described previously (Seita et al. 2005 Reprod. Fertil. Dev. 18, 256 abst). The F/T spermatozoa were sonicated to separate sperm heads. The sperm heads were divided into 3 treatment groups; nontreated sperm head (control), sperm heads exposed in 0.02% of Triton X-100 solution for 1 min (TX), sperm heads exposed in 0.02% lysolectin solution for 1 min (LL). Acrosomal status of the sperm heads was then examined by FITC-peanut agglutinin stain. In experiment 2, sperm heads of the control, TX, and LL treatments were microinjected into denuded oocytes obtained from superovulated females (Hirabayashi et al. 2002 Transgenic Res. 11, 221–228). The ICSI oocytes were cultured and observed for the formation of pronuclei (2PN) for 6 h and blastocyst formation at 120 h of culture. In experiment 3, the ICSI oocytes cultured for 6 h were transferred to recipient females to examine development to term. Statistical analyses of the results were carried out by 1-way ANOVA. In experiment 1, the TX (76%) and LL (89%) treatments showed higher rates of acrosome removal than that of the control (24%) group (P < 0.05). In experiment 2, the percentage of 2PN formation at 6 h after ICSI was not significantly different among sperm-treated groups, although the TX (76%) and LL (70%) groups were higher than the control (24%) group at 4 h (P < 0.05). The percentages of blastocyst formation were not significantly different among sperm-treated groups (control: 10%; TX: 25%; and LL: 25%). In experiment 3, the efficiency of development to term of the TX treatment group (21%: 12/57) was significantly higher than the control (5%: 3/55; P < 0.05), although the LL treatment group (16%: 12/75) was not significantly different from the control and TX treatment groups. These results indicate that acrosome removal using TX of F/T rat sperm heads before ICSI improves development to term of the ICSI oocytes. This benefical effect of acrosome removal may be due to the quick release of sperm-activating factors from sperm heads after ICSI in the rat.

79 DEVELOPMENT TO TERM OF RAT ZYGOTES DERIVED FROM CRYOPRESERVED MATURE OOCYTES AND SPERM THROUGH INTRACYTOPLASMIC SPERM INJECTION

The rat, as well as the mouse, is one of the most valuable experimental animals for biomedical and physiological research. There are numerous valuable mutant rats including transgenetic strains. Cryopreservation of rat oocytes and sperm as haploid germ cells is a key technology for banking the genetic resources efficiently. The aim of the present study was to examine survival of vitrified/warmed oocytes and developmental competence of resultant zygotes in the rat. Rats used in the present study were all Wistar rats. Epididymal spermatozoa were frozen as described previously (Seita et al. 2005 Reprod. Fertil. Dev. 18, 256). After thawing, spermatozoa were sonicated to obtain sperm heads for intracytoplasmic sperm injection (ICSI). Oocytes were collected from immature females superovulated with eCG and hCG. Oocytes were equilibrated in 7.5% (v/v) ethylene glycol (EG) + 7.5% (v/v) dimethylsulfoxide (DMSO) + 20% (v/v) FCS in PB1 for 5 min and then transferred into 15.0% EG (v/v) + 15.0% DMSO (v/v) + 20% FCS + 0.5 m sucrose in PB1 (vitrification solution) for 1 min at room temperature (22–24�C). During exposure to the vitrification solution, oocytes were loaded on a Cryotop� (Kitazato Supply Co., Tokyo, Japan). At warming, the film of Cryotop was directly immersed into PB1 containing 0.5 m sucrose and 20% FCS at 37.5�C. The warmed oocytes were washed three times and put into a HEPES-buffered (22 mm) modified R1ECM (310 mOsm) medium. The sperm heads were microinjected intracytoplasmically into the warmed oocytes. Then, presumptive zygotes were transferred surgically into the oviducts of recipient females (Day 0), and Caesarean section of the recipients was performed on Day 22. After vitrification and warming, 245 of 275 (88%) oocytes survived morphologically, 240 of the warmed oocytes were injected, and 156 oocytes (65%) were morphologically normal after the injection. To confirm development to term of zygotes derived from cryopreserved oocytes and sperm, 143 injected oocytes were transferred to 9 recipients, resulting in 3 pregnancies and the generation of one live pup. The results indicate that rat zygotes derived from cryopreserved oocytes and sperm through ICSI can develop to term, and full developmental competence can be preserved in rat oocytes after cryopreservation.

[Darier and Ferrand dermatofibrosarcoma. About 7 cases at the Ouagadougou teaching hospital, Burkina Faso]

The authors report 7 cases of dermatofibrosarcoma of Darier and Ferrand over a 7 year- period at the Yalgado-Ouédraogo teaching hospital, that is to say an average of 1 case per year. A male predominance was noted (4 males and 3 females), average age: 48; 5 recurrences out of 7, with an average delay of 3 years for recurrence, preferentially localised on the trunk (5 cases) and thigh (2 cases). They emphasize the importance of wide surgical exeresis and histopathology essential to confirm the diagnosis. Finally they point out the importance of clinical surveillance because of frequent recurrences.

313 IMPROVEMENT OF FERTILIZATION IN VITRO BY PRE-INCUBATION OF FROZEN - THAWED RAT SPERMATOZOA WITH CAFFEINE-SUPPLEMENTED MEDIUM

We previously reported the successful production of live offspring from cryopreserved rat spermatozoa through IVF (2006 Reprod. Fertil. Dev. 18, 256). The objective of the present study was to improve the IVF system with frozen–thawed spermatozoa for more efficient reproduction of live offspring. We examined the effect of caffeine-supplemented medium on post-thaw sperm fertility in vitro. Epididymal spermatozoa of Wistar rats were cryopreserved in 2.0 mL of freezing medium containing 23% (v/v) egg yolk, 8.0% (w/v) lactose monohydrate, and 0.7% (v/v) Equex STM. Post-thaw spermatozoa were diluted to 0.5 to 1.5 � 106 sperm mL-1 in a droplet of 200 �L of R1ECM as the pre-incubation medium. In Experiment 1, the effect of caffeine-supplemented medium on fertility in vitro was examined. The post-thaw spermatozoa were incubated for 5 h in pre-incubation medium with added caffeine at concentrations of 0, 1, 2, and 4 mM. Ovulated oocytes were introduced into droplets of the pre-incubation medium and co-cultured for 10 h. The oocytes were denuded and fixed to examine for 2 pronuclei formation (2PNF). In Experiment 2, the effect of caffeine-supplemented medium on post-thaw sperm function was examined using the chlortetracycline (CTC) fluorescence assessment. The post-thaw spermatozoa were incubated in pre-incubation medium with added caffeine at concentrations of 0 (Caf+) and 2 mM (Caf-), and CTC patterns were examined hourly until 6 h later. Statistical analyses of the results were carried out by one-way ANOVA. In Experiment 1, the percentages of 2PNF were 14 � 6, 32 � 8, 42 � 4, and 27 � 5% for the 0, 1, 2, and 4-mM groups, respectively, and only the 2-mM group was different from the 0-mM group (P &lt; 0.05). In Experiment 2, the rate of capacitated spermatozoa was not significantly different (P &gt; 0.05) among incubation times in the Caf+ group, but the rates at 5 and 6 h were lower (P &lt; 0.05) than the rate at 1 h in the Caf- group. Although the rates of acrosome-reacted spermatozoa were not significantly different (P &gt; 0.05) in the Caf+ group after 3 h of incubation, the accelerated trend of the acrosome reaction was observed in the Caf- group with increasing incubation time. The results demonstrated that frozen–thawed rat spermatozoa pre-incubated in medium containing 2 mM caffeine could improve in vitro fertility. This positive effect of caffeine would be provided to induce and keep sperm capacitation, and to inhibit the spontaneous sperm acrosome reaction in frozen–thawed rat spermatozoa.

[Hyperthyroidism in surgery at the Teaching Hospital Yalgado Ouedraogo Burkina Faso. About 95 cases]

The authors pay in a retrospective study, 95 cases of hyperthyroidism, listed in the teaching hospital Yalgado Ouedraogo of Ouagadougou from January 2000 to June 2005. These hyperthyroidism represent 39% of the thyroid affections, with a female prevalence (97%), 32 years of average age, the urban source of the patients (90% of the cases) and the importance of self medication (73%). They stress the importance of sonography, allowing a classification in diffuse goiter (44%) and multi nodular (56%). They insist on a good preparation of the patient before the intervention and on the interest of the sub total thyroïdectomy. They estimate that a correct binding of the vessels, the dissection of recurring, the visualization and the dissection of parathyroid and their vascular pedicle should make it possible to reduce the post-operative complications: null morbidity and death rate 12.5%.

Membrane separation of indigenous noroviruses from sewage sludge and treated wastewater

In this study, feasibility of membrane separation for the removal of indigenous noroviruses (NVs) is evaluated. The indigenous NV gene was never detected from ultrafiltration (UF) permeates of sewage sludge and treated wastewater. Indigenous NV gene was also not detected from permeates of sewage sludge and treated wastewater by microfiltration (MF) with a pore size of 0.1 microm (MF0.1). Even though the pore size of MF (0.1 microm) was much larger than the diameter of virus particle (approximately 30-40nm), more than 4-log10 reduction value (LRV) at maximum was achieved by membrane separation with MF0.1. NV genes were often detected from permeates of sewage sludge and treated wastewater by MF with a pore size of 0.45 microm (MF0.45), although the maximum log10 reduction values were more than 3.59 for sewage sludge and more than 2.90 for treated wastewater. It is important to verify factors determining the removal efficiency of viruses with MF membranes.

Heavy metal-binding proteins from metal-stimulated bacteria as a novel adsorbent for metal removal technology

Water pollution with toxic heavy metals is of growing concern because heavy metals could bring about serious problems for not only ecosystems in the water environment but also human health. Some metal removal technologies have been in practical use, but much energy and troublesome treatments for chemical wastes are required to operate these conventional technologies. In this study, heavy metal-binding proteins (HMBPs) were obtained from metal-stimulated activated sludge culture with affinity chromatography using copper ion as a ligand. Two-dimensional electrophoresis revealed that a number of proteins in activated sludge culture were recovered as HMBPs for copper ion. N-termini of five HMBPs were determined, and two of them were found to be newly discovered proteins for which no amino acid sequences in protein databases were retrieved at more than 80% identities. Metal-coordinating amino acids occupied 38% of residues in one of the N-terminal sequences of the newly discovered HMBPs. Since these HMBPs were expected to be stable under conditions of water and wastewater treatments, it would be possible to utilize HMBPs as novel adsorbents for heavy metal removal if mass volume of HMBPs can be obtained with protein cloning techniques.

Detection of infectious pathogenic viruses in water and wastewater samples from urbanised areas

Regardless of the remarkable improvement in sanitary conditions in urbanised areas, infectious diseases caused by pathogenic viruses in water have been reported year after year. The actual situation for the behaviour of pathogenic viruses in urbanised society should be understood. In this study, infectious enteroviruses and adenoviruses in water and wastewater samples from urbanised areas were investigated. Infectious enteroviruses were continuously detected from sewage and sewage sludge during the summer season. The detection of infectious viruses in sewage and sewage sludge was facilitated by the enzymatic virus elution (EVE) method. The concentration of infectious enteroviruses in positive samples of sewage and sewage sludge was >400 virions/L. Infectious viruses were also detected from water samples at levels >4 virions/L.

Functional metal-binding proteins by metal-stimulated bacteria for the development of an innovative metal removal technology

Heavy metal pollution has become an environmental problem throughout the world because heavy metal can be accumulated into the food chain and bring about serious problems, not only for ecosystems but also for human health. In this study, functional metal-binding proteins (FMBPs) were isolated from a metal-stimulated activated sludge culture with the aim of applying them to an innovative metal removal technology. Activated sludge bacteria was cultured in growth media including copper ion, and the stimulation of protein production by copper ion led to the 14% increase in a quantity of extracted crude proteins per 1 g of bacterial cell pellet (wet). In order to isolate FMBPs, extracted crude proteins were applied to the immobilized metal affinity column in which each of copper, nickel and zinc was used as a ligand. Several FMBPs were succesfully isolated from copper-stimulated bacteria. One of FMBPs (molecular weight of about 40 kDa) exhibited an ability to adsorb all three metals. The multi metal-binding property of this FMBP could be applied to an innovative metal removal technology. Furthermore, isolated FMBPs that could capture only one kind of heavy metal would also be attractive as a metal adsorbent in recovering a specific metal as a resource from wastewater, including several heavy metals.

Risk evaluation for pathogenic bacteria and viruses in sewage sludge compost

Composting can be regarded as the most available option for recycling of sewage sludge. However, the existence of pathogenic bacteria and viruses in the compost has been scarcely investigated until now. So there is little information on the infectious risk through agricultural activities or gardening in using the compost. In this study, several kinds of composts were investigated for detection of pathogenic bacteria (Salmonella spp. and Escherichia coli O157) and enteric viruses. It was concluded from the result that these bacteria and viruses could not be detected in 1.0 g-wet of any kinds of composts. Infectious risks through agricultural activities or gardening were evaluated by Monte Carlo simulation in the case that the compost was polluted by Salmonella spp., E. coli O157:117 and Poliovirus 1. Criteria satisfying the acceptable risk (less than 10(-4) per year) for these pathogenic bacteria and virus in the compost were determined from the result of simulations. 1.0 [CFU or PFU/g-wet] was available as the criteria for E. coli O157 and Poliovirus 1 in the compost. On the other hand, the criterion for Salmonella spp. in the compost should be established on a lower concentration than 0.001 CFU/g-wet.

[Warm saline enema for reduction of intestinal invagination under the ultrasonographic guidance: preliminary results apropos of 2 cases]

The authors describe the use of isotonic normal saline enema under US guidance in the treatment of acute uncomplicated intestinal intussusception in infants. The technique was successfully used in two patients aged respectively 18 and 16 months, with 11 and 9-month follow-up. The various steps of this technique and the results are analyzed and discussed. It is a valuable alternative to surgical treatment or hydrostatic reduction with opaque x-ray contrast under fluoroscopic guidance.

[Hysterectomies in tropical zones: experience of one African maternal health service. 141 cases in Burkina Faso]

We conducted a retrospective study of all hysterectomies performed in our setting over a two year period (1995-1996). The objective was double: define the indications and precise the outcome. A total of 141 cases were recorded. The main characteristics of the patients were the following: a mean age of 38 years, mean gravidity and parity of 5 and an average number of living children of 3. Hysterectomy was performed by the abdominal route in 86.52% of the cases. The main indications were: uterine rupture (39.71%), uterine myoma (25.53%), genital prolapse (19.89%) and cervix cancer (7.09%). Adnexectomy was associated in 51 cases and it was bilateral in 22 cases. The following complications occurred: 5 deaths, 8 wound abcess, 2 bladder injury, 1 ureter injury and 1 case of post-operative hemorragea.

Enhanced virus recovery from municipal sewage sludge with a combination of enzyme and cation exchange resin

There is a great difficulty in virus enumeration in sewage sludge because viruses in sludge are firmly captured by sludge solids. In order to determine the precise number of viruses in sludge, an enhanced virus recovery method with a combination of an enzyme and a cation exchange resin (CER) was developed. Test viruses were seeded to a sample sludge obtained from a municipal wastewater treatment plant, and the sludge were incubated with various eluents. The quantity of eluted viruses in the liquid phase was then measured by the plaque assay technique. Using the eluent containing only water, CER, and CER with enzyme exhibited 0%, 19% and 39% of virus recovery, respectively. While the conventional USEPA method exhibited a virus recovery of 21%. Furthermore, viruses eluted by the eluent containing the CER and the lysozyme included not only surface-attached viruses but also solids-embedded viruses.

[Duodenal diaphragm in children (two cases)]

Duodenal diaphragm is a rare cause of intestinal obstruction. Two pediatric cases are reported in which vomiting of bile-stained material and distension of the epigastrium were the main clinical signs. Roentgenograms and sonograms were highly suggestive. Duodenal bypass was easy to perform and effective. Nevertheless, it must be kept in mind that associated anomalies are frequent and may be severe.

[Contribution of medical imaging to visceral manifestations of sickle cell anemia in the child]

Sickle cell anemia is one of the qualitative hemoglobinopathies which are the most widespread in the world. In a retrospective study on 11 drepanocytary patients (10 SS and 1 SC) observed at the BORDEAUX children's hospital. 3 Processus were identified: Hemolysis: 3 hepatomegaly, 3 splenomegaly, 1 hematochromatosis and 4 pigmentary lithiasis; Thrombosis: 1 infarctus case of spleen, kidney, lung, 1 papillary necrosis and 1 brain vascular ischemic appearance;

INFECTION

1 spleen abscess and 1 pneumopathy. In 15% of instances, visceral appearances are allowed to discoverer sickle cell anemia. Hemolysis type appearances were currently observed (63.6%) like pigmentary lithiasis and hepatomegaly. The authors analyze the major radiological appearances of this hemoglobinopathy and recall the interest in knowing this disease even in low endemicity countries.

[Osteogenesis imperfecta diagnoses early, apropos of a case at the Yalgadou Ouédraogo National Hospital Center of Ouagadougou]

Osteogenesis imperfecta which represents a family tragedy for parents, a curiosity for physicians and radiologists, constitutes a real constitutional osteoporosis, usually rare with dominant autosomic transmission. Authors report a case of a 37 week amenorrhea living foetus, presenting an osteogenesis imperfecta. This affection, with early in utero manifestations, has a bad prognosis (baby deceased 72 hours after birth). Diagnosis was suspected at echography and conformed by x-rays investigations. The new born got also clinical and pathological examinations. Authors emphasize the unusualness and the gravity of these early clinical features. They insist on doing echography and radiography for the location of osseous and visceral lesions before and afterbirth.

[Management of the diabetic foot, apropos of 42 cases at the Ougadougou University Hospital Center]

Feet lesions are the most important cause of diabetic's consultation in general surgery. A retrospective study was conducted in Ouagadougou National Teaching Hospital, in order to analyse epidemiology, clinic, and evolutive aspects of this affection. In the same period, 222 cases of diabetes mellitus were admitted in general surgery and internal medicine. We noticed 42 cases of feet lesions. The mean age of patients was 53 years. Anterior knowledge of diabetes has not been a factor of early consultation. Consultation mean delay was a month. In 28 cases, feet lesions were 4 or 5 Wagner grade. The role of ischemia and neuropathy have not been evaluated, but sepsis was highly determinant factor. Insulin has been used in 83.3% of cases. Amputation concerned 19 patients. Mean length of hospital stay was 16.6 days and mortality rate was 38.1%. Prevention of complications can be much more effective if it is applied as a part of global approach to diabetes mellitus management.

[Congenital urachal fistulas: apropos of 2 cases in children]

Two paediatric cases of patent urachus are reported. In one of these cases, the anomaly was isolated whereas in the other case an omphalocele was also noted. Radical excision of the urachus with segmental resection of the bladder was easy and highly effective. Anatomy, complications and therapeutic aspects of this rare condition are discussed.

[Thyroid tumors. 83 operated cases]

The existence of a thyroïd tumour causes serious diagnostic problems. The retrospective analysis of 83 files collected between 1988 and 1993 (i.e. 6 years) allowed reviewing various diagnostic and therapeutic problems related to thyroid tumoral pathology in Burkina Faso. This pathology is more frequent in women (the sex ratio is 0.22). Clinical data show a high frequency of nodular goitre (87.95%) dominated by the multinodular form. The tumoral volume often proved impressive in most of our patients. Yet, at the histological analysis, 92.68% of thyroid tumours are benign, adenoma being in the lead (68.29% of cases). On the therapeutic level, in the absence of an isotopic exploration and extemporane analysis, surgical gesture was straightaway wide (60% of total or subtotal exerese). The post surgeries were satisfactory in general.

[Small-bowel duplication, apropos of a case in a child]

A pediatric case of small bowel duplication is reported. Non-specific abdominal pain was the main complain. A fixed hypogastric mass was found. Abdominal palpation under general anesthesia disclosed a movable intraperitoneal mass which proved at laparotomy to be a cystic duplication of the small bowel. The cyst was excised according to Norris procedure. Recovery was uneventful. Complications and therapeutic aspects of this rare condition are discussed.

[Breast cancer: diagnostic and therapeutic problems at the Ougadougou University Hospital Center]

A retrospective study on a 4 years period (1991-1994) enabled the authors within the digestive and general surgery of the Ouagadougou Teaching Hospital Center in Burkina Faso to list 39 breast cancers. During the same period, 3788 patients were hospitalized within the service out of which, 120 for mammary tumoral pathology. Patients, most of the time come late and sometimes with very severe and progressive lesions. Mammography and extemporaneous biopsy were not possible. Fine-needle aspiration for cytologic diagnosis practiced in 17% cases revealed to be insufficient. PATEY's mastectomy was done on 59% of patients. As far as chemotherapy is concerned, it is too expensive and inaccessible, only 9 patients have benefitted from this practice. Te histological test on surgical parts retrieved ductal infiltrating carcinoma 61.5%, medullary infiltrating carcinoma 15.3%, comedo-carcinoma infiltrating 5.1%, lobular infiltrating carcinoma 5.1%, papillary carcinoma 5.1%, carcinoma with fibrous stroma 2.5%, undifferentiated carcinoma 2.5%, scirrhous carcinoma 2.5%.

[Complications of thyroid surgery, apropos of 104 thyroidectomies at the Ougadougou University Hospital Center]

We report a series of 104 thyroidectomies collected in Surgery and ENT departments of the University Hospital Center (UHC) of Ouagadougou. This study was composed of 85 women (81.73%) and 19 men (18.27%) 8 to 73 years old. 49 unilateral resection and 85 bilateral one were realized. Histopathologic examination has been done for 54 specimen only: 49 benign lesions (95.20%) and 5 malignant lesions (4.80%) were noted. We have observed: 7 cases of hemorrhagic complications (6.73%) with 1 death, 10 cases of unilateral laryngeal recurrent nerve palsy, permanent in 4 cases (3.85%), 2 cases of upper laryngeal nerve palsy (1.92%), 2 cases of permanent hypoparathyroidism (1.92%), 5 cases of post operative infection (4.80%). There were 2 deaths (1.92%). These results are similar with other authors results but the frequency of thyroidectomy complications is still important. Improvements in clinical practice, more specialists and great experience would improve post operative results of thyroidectomy.

[Eighty cases of uterine rupture at the maternity service of the National Hospital Center of Ouagadougou , Burkina Faso]

In this retrospective study, we recall the frequency of uterine ruptures within a national health center of West Africa and propose solutions in order to reduce the incidence. This very high frequency was 23/1000, i.e. one uterine rupture for 44 deliveries. The feto-maternal prognosis was poor with a high stillbirth rate and maternal mortality. Maternal mortality which was 35% of cases represented 22.7% of the causes of maternal mortality observed within the unit during the survey. The stillbirth rate was 95% representing 145/1000 of the hospital stillbirth rate recorded during the survey. Maternal morbidity was also high because 14% of those who survived presented a parietal suppuration with the release of suture during the immediate postsurgical period. The seriousness of the feto-maternal prognosis is linked to a lack of adequate patient management. The importance of uterine ruptures in the obstetrical activity of the unit needs a joint and urgent action of all intervening parties within the sanitary system in order to contend with this scourge, which is the sign of poor quality health care in Obstetrics.

[Adnexal torsion during pregnancy. Diagnostic and therapeutic problems in Burkina Faso]

The authors report a case of adnexal torsion during early pregnancy. Because of a late diagnosis they had to practise an unilateral adnexectomy with a conservative medical treatment of the pregnancy. They recommend an early surgical treatment, that will save the adnexa and permit a normal evolution of the pregnancy. In a young patient, the loss of an ovary may be a tragic event.

[Male breast cancer in Africa, Apropos of 5 cases at the Ouagadougou University Teaching Hospital (Burkina Faso)]

A retrospective study of male breast cancer was undertaken at Ouagadougou University Teaching Hospital over a 3 year period (1993-1996). Authors report 5 cases representing 4.16% of all breast cancers. The patients' mean age was 61 years. The average duration of signs and symptoms before the diagnosis was 13 months. Clinically all the 5 cases presented advanced cancers (4 T4N2M0, 1 T4N2M1 according to UICC TNM System) with size ranging from 5.5, to 11.5 cm. Histology found: 2 medullary infiltrating carcinoma, 1 canalar infiltrating carcinoma, 1 colloid mucous carcinoma and 1 lobular infiltrating carcinoma. All patients had mastectomy associated with axillary clearance in 4 cases. Radiotherapy, chemotherapy and hormonotherapy were not associated because unavailable in Burkina Faso. Three patients died: the first, 10 days after surgical treatment and the 2 others respectively after 14 and 17 months. We have lost sight 1 patients. The last one is still alive. Authors find that to get better prognosis, it is important to improve medical and technical means, to increase information and to promote early detection.

[Problems after thyroid gland surgery in Burkina Faso, 83 cases]

Management of thyroid tumor can be problematic in developing countries due to poor diagnostic and therapeutic facilities. This is true in Burkina Faso where there are no facilities for radioisotope scans and intraoperative biopsy is usually unfeasible due to a shortage of histologists. The purpose of this retrospective analysis of the files of 83 patients who underwent surgery of the thyroid between January 1988 and December 1993 at the National Hospital Center of Ouagadougou was to obtain information necessary to define suitable pre-, per-, and post-operative strategies for these conditions. The mean delay to consultation for the 83 patients studied was 8 years. The fact that dysphonia and/or dysphagia was present at the first examination in 68 cases and that paralysis of the recurrent laryngeal nerve was observed in 17 cases testifies to the advanced stage at which patients were seen. Cancer was confirmed in only 3 of the 41 surgical specimens that were examined (7.3%). In cases involving only one nodule with no signs of malignancy, resection of the nodule is justifiable (18.1% of cases). In other cases radical resection is indicated either by lobo-isthmectomy or subtotal thyroidectomy for diffuse or multinodular goiter (74.7% of cases) or by total thyroidectomy (7.2% of cases). The immediate postoperative period was marked by the occurrence of hemorrhage (n = 7), transient paralysis of the recurrent laryngeal nerve (n = 4), and infection of the surgical wound (n = 5). There were 2 deaths.

[CHolelithiasis in Burkina Faso (apropos of 44 cases operated on at NHC YO]

The authors relate 44 cases of cholelithiasis, operated on between 1986 and 1990 at the General and digestive Surgery Unit of the National Hospital Center YALGADO OUEDRAOGO of Ouagadougou. They established a progressive increase in the frequency of this affection thanks to the echographic diagnosis. The patients average age is 35 years old and paradoxically, the sex-ratio is for men. It is about lithiasis with some predominant pigment constituent, located in the vesicule area in 98% of the cases, associated in 18% with a localization in the common bile duct. The clinical symptomology is atypic. But the complicated forms with acute cholelithiasis, or with a big cholostasis liver and dilatation of the common bile duct, are not rare. The preoperative cholangiography is not used. All this resulting in frequent surgical procedures on the common bile duct. Anyway, the therapeutic results are satisfactory: the surgery death rate is 2.27% and there are few complications.