[Sexuality assessment of homozygous adult sickle cell patients with a history of priapism in Senegal]

OBJECTIVES

The objective of this study was to evaluate the sexuality of SS sickle cell patients with a history of priapism.

METHODS

This was a case-control study of adult SS sickle cell patients. The occurrence of priapism as well as the nature of the priapism had been investigated. The patients were subdivided into three groups: Group 1 (no priapism), Group 2 (intermittent priapism) and Group 3 (acute priapism). The patients' sexuality was studied using the IIEF-15 questionnaire.

RESULTS

We interviewed 191 SS sickle cell patients. The mean age was 27.1±7.1 years. Priapism was observed in 43.5 %. Only 77 patients were eligible for the IIEF15 questionnaire. Groups 1 and 2 performed significantly better than group 3 on erectile function (EF) and orgasmic function (OF) scores. There was no significant difference in the EF and OF scores between groups 1 and 2. No significant difference was observed between the three groups for the scores of sexual desire (SD), intercourse satisfaction (IS), and overall satisfaction (OS). The impairment of erectile function in group 2 was related to the age of the first episode of priapism and the last episode. The impairment of erectile function in group 3 was related to the duration of evolution (P<0.05).

CONCLUSION

This study shows that priapism is responsible for impaired erectile function in SS adult sickle cell patients. A program to prevent intermittent episodes of priapism should be put in place.

Traumatic right diaphragmatic hernia in children: Diagnostic difficulties

Traumatic right diaphragmatic hernia is rare in children. Its diagnosis can be difficult in the acute phase of trauma because its signs are not specific, especially in a poly trauma context. We report two cases of traumatic right diaphragmatic hernia following a blunt thoraco-abdominal trauma, highlighting some difficulties in establishing an early diagnosis and the need for a high index of suspicion.

[Advanced prostate cancer in Senegal. Clinical aspects at the General Hospital of Grand Yoff]

Prostate cancer is a common disease, which continues to be discovered at advanced stages in Africa, despite improved diagnostic tools.

AIM

The authors report the experience of the Department of Urology, General Hospital of Grand Yoff Dakar in the diagnostic of advanced prostate cancer.

MATERIAL

This was a retrospective descriptive study on patients followed for advanced prostate cancer during the period from January 1st, 2004 to May 31st, 2010.

RESULTS

There were 102 people aged from 51 to 96 years with an average of 71 ± 9 years. A comorbid condition was associated in 24.5 % of cases. The circumstances of discovery were pain (32 cases), neurological signs (17 cases), and urinary disorders. DRE had objectified an abnormality in all patients. The serum levels of prostate specific antigen ranged from 5.88 ng/mL to 21,660 ng/mL, with an average of 1447.57 ± 812 ng/mL. A prostate biopsy was performed in 44 patients and prostatic adenocarcinoma was found in 97.7 % of cases with Gleason scores greater than 7 (33 cases). We found different metastatic sites at vertebral column (23 cases), at lung (14 cases), and on pelvic bones (11 cases).

CONCLUSION

The prostate cancer is a serious condition with high morbidity and mortality. The diagnosis is not made early in developing countries. We need a strategic plan to improve the early screening and we should develop supportive care too because of the high number of advanced cases diagnosed in our context.

[Management of prostate cancer in Senegal: what is being done?]

OBJECTIVE

To evaluate the management of patients with prostate cancer in Senegal.

MATERIALS AND METHODS

We performed a retrospective descriptive study, based on the medical records of patients managed for prostate cancer during a period of six years and a half from January 1, 2004, to June 30, 2010. All records of inpatients and outpatients managed for prostate cancer were collected. Data collection was performed through a standardized survey form, and included the following parameters: age, presence or absence of known history of prostate cancer in siblings, circumstances of discovery, clinical and paraclinical examination, histology and therapeutic modalities.

RESULTS

We studied the records of 164 patients with prostate cancer. The mean age of our patients was 65years, ranging from 43 to 96years. The circumstances of diagnosis were mostly due to lower urinary tract symptoms. Digital rectal examination was suggestive in 87% of cases, and PSA levels were high in 100% of cases, ranging from 5.88ng/ml to 21,660ng/ml, with a mean of 1447.57ng/ml. Half of the patients had PSA levels greater than or equal to 100ng/ml. The most common histological type was adenocarcinoma. During the study period, 49 radical prostatectomies were performed. The mean PSA levels of patients who underwent a prostatectomy were 23.4ng/ml. Radical retropubic prostatectomy was performed in 35 patients, and radical perineal prostatectomy was performed in 10 cases. Pulpectomy was the method most commonly used in metastatic prostate cancer; it was performed in 48 patients. After resistance to castration, antiandrogens were reintroduced in 13 patients, and diethylstilbestrol in four patients. Only two patients underwent a taxane-based chemotherapy regimen.

CONCLUSION

The diagnosis of prostate cancer was usually tardive in Senegal. Treatment often involves surgical castration. Prostatectomy was only very seldom indicated.

La fracture de verge à Dakar. À propos de 25 cas

Buts

Présenter les caractéristiques épidémiologiques, cliniques et thérapeutiques des fractures de verge dans le service d’urologie-andrologie de l’hôpital général de Grand Yoff de Dakar.

Matériels et méthode

Il s’agit d’une étude descriptive portant sur 25 cas de fracture de verge pris en charge dans le service d’urologie-andrologie de l’hôpital général de Grand Yoff de Dakar entre janvier 2001 et décembre 2011. Les paramètres suivant ont été étudiés: l’âge, la résidence, les antécédents, les données cliniques, les données de l’exploration chirurgicale et les résultats du traitement.

Résultats

En dix ans, 25 cas de fractures de verge ont été enregistrés soit une moyenne de 2,5 cas par an. L’âge moyen de survenue était de 36 ans avec des extrêmes de 22 et 60 ans. Les circonstances de survenue sont dominées par les manipulations forcées (52 %) et les rapports sexuels (32 %). La douleur associée à une latérodéviation controlatérale de la verge, une tuméfaction localisée de la verge ou extensive à la région sus-pubienne ou périnéale sont les principaux signes retrouvés. Une prise en charge urgente (délai moyen de prise en charge de deux heures avec des extrêmes de 45 minutes et 48 h) en milieu chirurgical avec réparation des corps caverneux et albuginorraphie a été la règle.

Conclusion

La fracture de verge est une urgence urologique relativement peu fréquente dans notre contexte. Son diagnostic reste aisé et est essentiellement clinique. Une prise en charge précoce et correcte en milieu chirurgical est garante d’un bon résultat fonctionnel et esthétique.

Cοngenital diaphragmatic hernia in dakar, senegal

BACKGROUND

Congential diaphragmatic herniae pose serious challenges in their management in this environment.Aim & Objective: To determine the pattern, as well as the diagnostic and management challenges of congenital diaphragmatic hernia in Dakar, Senegal.

PATIENTS AND METHODS

This is a retrospective review of 14 children with congenital diaphragmatic hernia (CDH) managed within eleven years in Dakar, Senegal.

RESULTS

There were nine boys and five girls with the age range of one day to 22 months and a mean of 5 months. Respiratory signs (respiratory distress, cough, current pulmonary infection) were found in 13 patients and gastrointestinal symptoms (vomiting, Difficulty sucking, anorexia) in 6 patients. The thoracic-abdominal radiography was performed in all patients and revealed a Bochdalek hernia on the left in 10(71%) cases and 4(29%) were Morgagni hernia. Treatment was by repair of the diaphragmatic defect with non-absorbable sutures. The postoperative course was uneventful in 13 children while one patient died on the first postoperative day one.

CONCLUSION

Congenital diaphragmatic hernia presents mainly with postnatal respiratory features in this setting. Thoracic-abdominal radiography allows for early diagnosis, prompt and effective treatment with good outcome.

KEYWORDS

Congenital diaphragmatic hernia, Respiratory insufficiency, Radiological features, Good surgical outcome.

Osteogenesis imperfecta in a pediatric surgical center in dakar, senegal: clinical and radiological aspects

INTRODUCTION

Osteogenesis imperfecta presents with a set of constitutional disorders of varying severity, genetically determined and characterized by an abnormal production of collagen and matrix of the bone leading to bone fragility responsible for multiple fractures and many skeletal deformities. The aim of our study was to analyze the clinical and radiological aspects of the pathology.

PATIENTS AND METHODS

This was a retrospective study of 10 cases of children with osteogenesis imperfecta who consulted the Pediatric Surgery Unit of the University Center Aristide Le Dantec Hospital over a period of 6 years. The parameters analyzed were the reasons for consultation, physical examination findings and findings on standard radiographs. After collecting all the data, children were divided according to the classification of Silence and Glorieux.

RESULTS

Pain was the reason for consultation in eight children. The saber blade deformity of the legs was found in nine children. Physical examination found tenderness in 80% of cases. Blue sclera was found in one child. The teeth were normal in eight patients. Standard radiographs showed an osteopenic skeleton with multiple fractures (3.7 fractures on the average) associated with vicious callus formation and deformity. According to the classification of Silence and Glorieux, six children were type VI, two children type IV, a child type III and one type I.

CONCLUSION

Osteogenesis imperfecta is a rare disease. In our environment, the diagnosis is made late - a stage associated with deformity. Of these, the occurrence of sabber deformity of the lower limbs is the most common. Radiological aspects are dominated by vicious callus formation, deformed bones and osteopenia. Moderate forms are predominant. Parents need to be educated about the risk of repeat fractures and the need to present deformed children to hospital early.

[Management of nasolabial clefts: the issue in Dakar]

The management of patients with a cleft lip in developing countries is often the prerogative of humanitarian missions from developed countries. The goal of our work is to conduct a first epidemiological, clinical and therapeutic assessment of the management of cleft lips by a local team and to evidence the difficulties faced by us in our working conditions. In a retrospective study covering a period of about five years (January 2004 to March 2009), 205 cases of nasolabial clefts are assembled. The mean age at the time of the first visit is 17 months. A slight female predominance is observed. The majority of patients are from the capital city. A close relative with a cleft is found in 6.8% of them. In 44.9% of cases, it is a simple cleft lip. A cleft palate is associated in 47.8% of cases. Associated malformations are observed in 10.5% of cases. We operated on 110 patients. The mean age at the first surgery is two years. Millard's technique is our technique of choice. No operative mortality is observed. In 17.4% of cases, operative morbidity occurred in the form of suppuration with partial or complete early suture release. The esthetic result is satisfactory in 67.7% of cases. This management could be improved by creating a multidisciplinary team including--in addition to surgeons--dentists, speech-language pathologists, psychologists, etc.

[Paediatric head and neck burns sequelae]

The skin is the body's protective barrier and is very much exposed to assaults and thus to burns. The aim of this work is to consider the special features of cervicofacial burns sequelae in children in a sub-Saharan environment and to review their management. This retrospective study, performed in the Department of Paediatric Surgery at Aristide Le Dantec Teaching Hospital in Dakar (Senegal), examined 27 patient files dating between May 2001 and April 2008. The children’s average age at first visit was 6.7 years and the m:f sex ratio was 1.7:1. The sequelae were topographically distributed as follows: face (66.7%), neck (29.6%), scalp (11.1%). Regarding the type of sequelae observed, adhesions predominated (33.3%), followed by keloid or hypertrophic scars (25.9%), eyelid ectropions (18.5%), scalp alopecias (11.1%), chronic ulcerations (7.4%), and discolorations (3.7%).Surgical treatment was used in 55.7% of the cases: Z-plasty, followed or not followed by skin graft for adhesion treatment, as well as adhesion lysis followed by grafting for eyelid ectropion treatment. The surgical morbidity rate was 20% and no mortality was reported. Keloid scars were treated medically with intralesional corticosteroid injections. Apart from the emergency situation, cervicofacial burns in children lead to severe aesthetic and functional damage. Any improvement in prognosis in such burns depends on improvements in the quality of initial care and on raising parents' awareness of accidents in the home.

[Urinary incontinence in woman: epidemiologic profile in Sub Saharian countries]

The objective of this study was to describe the epidemiologic profile of urinary incontinence of the African woman of three Sub Saharan African countries.

MATERIAL AND METHODS

A multicentric study summarized the epidemiological data collected in female from Nouakchott, Dakar and Ndjamena using a questionnaire. All participants filled an anonymous questionnaire including demographic data and marital status, medical, surgical, gynecological and obstetrical history and the characteristics of the urinary incontinence.

RESULTS

Overall, 3021 questionnaires were distributed, only 2070 answers (69%) could be processed. Mean age of the overall population was 28 years. Adult women aged less than 30 years accounted for 56% of the study population. The age group 30-49 years accounted for 42% of the population and only 2% of the study group had more than 50 years. The prevalence of incontinence was 367 cases over 2070 (17,7%). The types of incontinence found were: urgency in 28.6% of cases, stress incontinence in 38.4% of cases and mixed in 33% of cases. Approximately 23,9% of nulliparous and 23,5% of the multiparous had urinary incontinence. The leakage was occasional in 75% of the cases and regular in 25% of the cases. According to gravity, in 31% of cases the volume of urines lost necessitated a change of underwear. Of the women presenting urinary incontinence, 85 (23%) consulted a doctor. A psychosocial repercussion was found in 31% of the cases.

CONCLUSION

Urinary incontinence is much more frequent in our areas than it was thought to be because it was rarely acknowledged.

[Post-burn scar contractures in children in the lower limb]

Il s'agit d'une étude faisant ressortir les aspects épidémiologiques, cliniques et thérapeutiques des séquelles de brûlures du membre inférieur chez l'enfant, à propos de 42 cas colligés au service de chirurgie infantile de l'Hôpital Aristide Le Dantec (Sénégal). L'âge moyen retrouvé est de 5 ans et 3 mois, et le sex-ratio garçons/filles de 1,8/1. La brûlure thermique est causée par une flamme dans 33% des cas, par un liquide chaud dans 21% des cas, et par des braises dans 21% des cas. Les cicatrices rétractiles intéressent le genou et le creux poplité dans 47% des cas et le pied dans 45% des cas. Elles sont bilatérales dans 21% des cas, et concernent une autre localisation associée dans 21% des cas. Quant aux brides, 21% ont bénéficié d'une chirurgie, avec un délai moyen de 3 ans et 2 mois après la brûlure. Cette procédure chirurgicale consiste en une plastie en Z dans 91% des cas, à laquelle est associée une greffe de peau dans 54% des cas. Une rééducation fonctionnelle est pratiquée chez 54% des opérés. Parallèlement aux données de la littérature, nos résultats montrent que l'optimisation de la prise en charge passe par une meilleure prévention des accidents domestiques et une bonne codification thérapeutique.

Profil épidémiologique et clinique de l’infertilité masculine à l’hôpital général de Grand-Yoff, Sénégal: à propos de 492 cas

Objectif

Décrire le profil général de l’infertilité masculine, au Sénégal, en milieu hospitalier.

Matériels et méthodes

Il s’agit d’une étude rétrospective, descriptive, portant sur 492 dossiers de patients vus en consultation pour infertilité conjugale du couple entre 2000 et 2004. L’ensemble des paramètres étudiés portait sur les éléments cliniques et les explorations paracliniques.

Résultats

L’âge moyen des patients était de 39 ans. La durée d’évolution de l’infertilité était en moyenne de six ans. L’infertilité était de type primaire dans 66,5 % des cas. Sur le plan clinique, la varicocèle était l’anomalie la plus souvent retrouvée, soit dans 64,6 % des cas. Le spermogramme était perturbé dans 84,3 % des cas. Les principales perturbations étaient une oligospermie inférieure à 5 millions de spermatozoïes/ml (35,6 %) et une azoospermie dans 28,6 % des cas.

Conclusion

Le profil général de l’infertilité est polymorphe. L’exploration est limitée par la non-disponibilité de la partenaire et l’absence de coordination entre gynécologues et andrologues. L’amélioration de la prise en charge de l’infertilité doit passer par de nouvelles voies de recherche, notamment génétiques et immunologiques, afin d’identifier les causes habituellement cachées de l’infertilité. Elle doit aussi reposer sur une bonne collaboration entre praticiens de santé de la reproduction et la mise en place d’unités d’assistance médicale à la procréation (AMP).

[Risk factors for neonatal mortality. The pediatric surgery service, Aristide Le Dantec University Hospital, Dakar]

OBJECTIVES

To determine neonatal mortality factors at the paediatric surgeon service in Aristide Le Dantec University Hospital in Dakar.

PATIENTS AND METHODS

It is a retrospective study of 245 cases collected between January 1997 and December 2006 at the paediatric surgeon service, the surgery emergency and intensive care unit of Aristide Le Dantec University Hospital. We studied the age, sex, geographical origins, consultation time, weight at birth, evacuation means to the reference medical structure, consultation motives, clinical diagnosis, associated malformations, treatment methods, surgery follow ups and death causes.

RESULTS

The neonatal death rate at the paediatric surgery service was 36.7 %. Our patients' average age was eight days. A masculine predominance was observed with a 1.57 sex ratio. The average admission time was 08 days. Sixty-five per cent (65%) of our patients came from suburbs. Thirty-eight per cent were transported by an ambulance from a health centre. Fifty-three per cent (53%) weighed less than 2,500 grams at birth. The occlusive syndrome was the commonest reason for consultation (38.5 %). The most frequently observed pathology was the ano-rectal malformations. Associated malformations were observed in 12% of the cases. The majority of the patients (52%) died before the surgical operation after an average duration of 5 days. The commonest causes of death are the digestive malformations (66%).

CONCLUSION

Male newborn babies, aged less than 8 days are the most vulnerable age group. The lack of hospital transportation means, the weak weight at birth, the caring time and the digestive pathologies are other factors of wrong diagnosis. A multidisciplinary collaboration, the improvement of the technical capacity and of the available emergency therapeutic means and the creation of an intensive paediatric care unit would certainly contribute to lower the mortality rate.

[Tuberculosis dactylis: a case report]

INTRODUCTION

Tuberculosis dactylis is exceptional. We report one case in an 11 years old girl.

OBSERVATION

N.D., 11 years old, was admitted for a right hand second finger tumour evolving since six months and linked to a trauma. Clinical examination founded a painful fusiform of the right second finger with limited movements of the finger. The hand radiography showed a second phalange osteitis of the finger without periosteitis reaction. The sedimentation rate was accelerated to 130 mm at the first hour. The intracutaneous reaction with tuberculin was positive to 19 mm. In her preceding, her mother would have suffered from pulmonary tuberculosis two years before incompletely treated during eight months. Histological examination showed a caseous necrosis and an epithelial giant cellular follicle. A twelve months antituberculosis polychimiotherapy permitted a healing without sequelae.

DISCUSSION

Tuberculosis dactylis has to be evoked with epidemiological, clinical, radiological and immunological arguments. The antituberculosis treatment permitted to do the retrospective diagnosis and to get a healing.

[Perforation and haemorrhage duodenal bulbar ulcers in a child: a case report]

A perforation rarely reveals a primary duodenal ulcer. The occurring of digestive haemorrhage in post operative followings evokes spontaneously a stress ulcer. We report an observation of a child who presented on fourth day delay after operation an ulcer of the anterior duodenal bulbar face and a haemorrhage of the posterior bulbar face. A 7-year-old girl with no particular pathological antecedent was admitted for abdominal pain, bile vomiting and constipation evolving since 6 days. Clinical examination revealed a general state thickening, an infectious syndrome, a meteoric and general abdominal sensitivity. The abdominal radiography without preparation showed a pneumoperitoneum. The surgical exploration discovered a perforated ulcer on the bulbar anterior face. A simple closure associated with omental patch was performed. Four days after operation, she presented an abundant digestive haemorrhage with shock. The resuscitation did not improve the patient's general state. The upper digestive endoscopy revealed a haemorrhage of the posterior bulbar face. An adrenalin injection stopped the bleeding. The treatment by neutron pump inhibitors and an eradicating treatment of Helicobacter pylori permitted the healing of the ulcers. The occurring of digestive haemorrhage in the followings of surgical intervention for perforated ulcer involves an upper digestive endoscopy. This examination can reveal misdiagnosed ulcer during the surgical exploration and permits to perform a haemostatic act.

Strangulated umbilical hernias in children

Umbilical hernia is a frequent pathology of the anterior abdominal wall in children. The hernia ring closes usually before 4 years, but a strangulation can occur. It is an exceptional complication according to the literature data. Since this complication is rare, we undertook a retrospective study of these strangulations in a 5-year period from January 1997 to December 2001 at Aristide Le Dantec hospital. We collected 41 cases that underwent emergency surgery operations for strangulated umbilical hernias, which represent about 15% of umbilical hernias operated during the same period. The age range was 8 months to 10 years and the average age was 14 months. All the children were examined within 24 h after the onset of the disease and the surgery was immediately performed. In five cases the bowel was necrosed and perforated and we performed a resection followed immediately by an anastomosis. In the follow up, two children presented wound infections and a hernia recurred in one child. There was no mortality. This study conducts us to question western reports which recommend conservative therapy for umbilical hernia in children.

[Management of thermal severe burns in children in Le Dantec University Teaching Hospital]

INTRODUCTION

Bums in children are serious public health problem. Burns management in developing countries encounters huge problems at any stage. The goals of this study were to descrive the epidemiological, clinical and therapeutic characterics.

MATERIALS AND METHODS

In the university Teaching Hospital of Dakar from January to December 2003, we conducted a retrospective survey of 41 patients less than 16 years admitted for severe thermal burns. We carried a year retrospective study in ICU and pediatric surgery unit of Aristide Le Dantec Hospital. Were involved all. The following parameters were studied: age, sex, mechanism and circumstances of the burns, period time between the injury and the admission, clinical status of the patient, management and outcome.

RESULTS

The age range between 5 days and 13 years, 47.72% are less than 3 years. The average period before admission was 33 hours (2 hours to 7 days). The accident occurs in 75% of cases in the kitchen. Bum by hot water was the most frequent mechanism with a percentage of 62%. Areas interested the whole body with frequent face localisation (n=18) and the perineal region (n=22). Immediate complications were shock in 37% of children and acute respiratory failure in 7 patients. Fluids and electrolytes resuscitation using Parkland formula (75%) or Carvajal formula (25%). Feeding was done to enteral route. Spontaneous epitheliasation through secondary heeling was the main therapeutic attitude, skin grafting was performed in 10 childrens. Total mortality was 18.18%; These death concerns patients for whom the UBS score range between 75 and 140 UB and the ABSI score between 9 and 12. Sepsis was the direct main cause of death. Sequellaes were jointed a nd facial contractures.

CONCLUSION

The authors emphasize on the need in setting up adequate preventive measures towards high risk population (under 3 years), and specialized unit for adapted management.

[Umbilical reconstruction in children. Prospective report of 77 cases]

Umbilical hernia is as frequent pathology in our country. The skin excess is a real problem for the surgeon because it is inesthetical. We report 77 cases of children with umbilical hernia who we operated between 1999 and 2000. Fifty-five of them have a umbilical plasty. For this, we used three surgical techniques: lateral left plasty, "horseshoe" plasty and umbilical graft. We classed our results into three groups: 40 good results, seven middle results and three bad results. Twenty-seven patients are lost. These three surgical techniques are a simple and safe solution to this problem of skin excess in the umbilical hernia.

[Ectopia testicular in child: about 3 cases]

The authors report 3 cases of testicular ectopia. Of these 3 cases, two proved tobe cases of penial ectopia whose diagnosis was mentionned before the intervention. One case proved tobe a case of tranverse testicular ectopia diagnosed as an inguino-scrotal hernia. Surgical exploration has always allowed to reach a correct diagnosis. In all three cases the testicle was of normal size and the cord long enough to lower the testicle between the skin an the dartos Surraco's procedure. The authors discuss the pathogenis of this affection, echography contribution in the diagnosis, and the therapeutics aspects.

[Evaluation of the management of omphalocele at Dakar]

Omphalocele is a congenital malformation of the abdominal wall of children, characterized by an ombilical defect living the abdominal organ visible through a translucent amniotic membrana. The goals of this study were to describe the epidemiological, clinical and therapeutic characteristics at the University Teaching Hospital of Dakar. We conducted a retrospective study at the UniversityTeaching Hospital of Dakar from January 1997 to December 2002. Fifty cases of Omphalocele diagnosed at the Unit of Paediatric Surgery of the Department of General Surgery at Aristide Le Dantec Hospital, were included in this study. We described the epidemiological, clinical and therapeutic characteristics of omphalocele. Omphalocele is a condition diagnosed late in boys from poor sphere. The study revealed that weight from birth, omphalocele size, local state, and existance of associated malformation correlated with death rate. The treatment option was a spontaneous epidermisation as described by Grob in the absence of omphalocele rupture wich imposed a primary closure of abdominal wall. The overall death rate was 42%. The improvement of results will need an antenative diagnosis, paediatric reanimation unit wich will notably reduce death rate.

[Evaluation of the management of femoral shaft fractures in children by flexible intramedullary nailing]

The purpose of this study was to evaluate the morphological and functional outcomes of femoral shaft fractures of the child using a centromedullary elastic nailing. We led a retrospective study including 22 children operated from January 1997 to December 2000 at the surgical emergency department of "Hôpital Aristide Le Dantec". The follow-up was made in the department of paediatric surgery. The patients included 16 boys and 6 girls presenting a total of 23 femoral shaft fractures. The main circumstance was traffic accident(15 cases). All the children underwent an ascending centromedullary elastic nailing controlled by a C-arm after a period of traction. The outcomes were appreciated after a period of 10 months. We observed: A union in all cases, four infections well managed by antibiotics, one vicious callus of 15 degrees, a mobility limitation of knee in two cases (45 degrees and 100 degrees), an inferior limb length inequality in one case, scabs in one patient who died at the 3rd month of a septicopyohemia. The functional evaluation of the outcomes (flexion, extension, limb length inequality) and morphological outcomes (axis, consolidation) showed 21 good results and one bad result. The centromedullary elastic nailing is a safe procedure owing to the low complication rates and the rapid consolidation allowing an early walk in femoral shaft fractures, compared with the orthopaedic treatment.

[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.

[The ovarian tumors in children. A report of 12 cases]

The objectives emphasize the diagnosis and therapical problems concerning the child's ovary tumors for a better care in our conditions of work. We collected in a retrospective study 12 cases of ovarian tumors during 30 years. The middle age of the patients was of 11 years with extremes of 2 years and 15. The circumstances of discovery of the tumor were represented by order of frequency by an abdominal tumor (10 cases), an abdominal pain (8 cases) and of the compression signs digestive or urinary (6 cases). The medical imagery (echography, intravenous urography, Chest X-ray) permitted to evoke in the majority of the cases the ovarian origin of the mass. The surgical treatment consisted in an ovariectomy (5 times), an salpingo - ovariectomy (6 times) and a surgery of partial exeresis associated to a chemotherapy. The operative continuations were simple. A patient died of intercurrentes complications. The histological exam of the operative piece showed that it was about benign tumors. However a brought closer surveillance proves to be necessary had consideration to the two noted recidivisms.

[Intussusception in children: about 20 cases]

The authors report on a retrospective study 20 cases of intussusception in senegalese children. The diagnosis is essentially clinical. In difficult cases plane abdominal X-rays, barium meal and echography are indispensable exams. In our context the diagnosis is most of the time late and it is due to the unknown nature of the affection and early consultation to the traditional practitionners. The lateness of the diagnosis leads to the lateness of the management. This explains the importance of intestinal necrosis noticed in our serie and the high mortality rate which is 10%. The authors suggest recommendations to ameliorate the prognosis of this ailment which is good elsewhere.

[Fractures of the medial humeral epicondyle in child: preliminary study about 18 cases]

The aim of this work is to study the epidemiological, radiological, clinical views of fractures of the medial humeral epicondyle in child and mainly to appreciate the results of surgical treatment. For this, we looked at again in a retrospective study eighteen (18) files of children with fracture of the medial humeral epicondyle. The average age of children was eleven (11) and the male sex most represented (16 boys versus 2 girls). Medial humeral epicondyle's fracture often occurs by accident in playing (15 cases). Accurate diagnostic of the fracture of the medial humeral epicondyle was rarely formulated on the clinical plan. It's the radiography who shown the fracture of the medial humeral epicondyle and permitted to specially the type in accordance with Marion's and Faysse's classifications and also Lechevallier. It was always surgical and consisted on a open reduction and fixation by pins or a periostee's stich. With ten (10) months of background, we assessed our results either on morphological plan than the functional plan. 1/ On morphological plan: an hypertrophy of the medial humeral epicondyle is 3-fold mentioned. Others children have not presented a morphological animaly. 2/ On functional plan: Ten children had an elbow's mobility considered as normal after self reeducation at home. Six enjoyed physical therapy in a specialized department. Two of the children had an extension gap from 30 degrees to 35 degrees respectively. We obtained thirsteen (13) good results in general, three (3) means results and two (2) bad results. In conclusion, the fracture of medial humeral epicondyle occurs around ten (10) years old in boy victim in playing. Diagnostic is sometimes difficult. Surgical treatment gives good results. However, it can be the origin of sequellaes which can justify correct previous refunding.

[Burn-induced contraction cicatrix in children. Review of 79 cases]

Post-burn flexion contractures of the hands are evaluated in this retrospective study concerning eighty-six hands of seventy-nine children in the pediatric surgery unit of the University hospital of Dakar from 1971 to 1995. A peak frequency was found among 2-months-old males. Fire (flames or embers) is the most frequent etiology (49.5%). The initial treatment of these burns is more often inadequate because it is performed in dispensaries (small clinics) or at home and then causes severe sequelae. Among the methods of treatment, excision with graft gives the best results in short flexion contractures. Isolated Z plasty can be used successfully. Our follow-up is short (6 months) but the results are relatively good. Among the factors influencing the results, the seriousness of the lesions, the type of surgical treatment, immobilization and physiotherapy are the most significant.

[Cervical teratomas in the child (apropos of 8 cases)]

Eight cases of cervical teratomas in children are reported including 4 boys and 4 girls. Six patients presented within the first 10 days of life. The tumor was congenital in 7 cases. In 3 neonates it produced severe respiratory distress. Neural and chondral tissues were predominant but all three germ layers were represented. All patients were operated upon, with a 2/8 mortality. The main clinical and histopathological features of these rare tumors are reviewed. Early total surgical removal is the cornerstone of treatment.

[Gastric volvulus in the infant. Clinical and radiological diagnosis]

The authors reported two cases of gastric volvulus in female and male babies respectively 5 and 3 months old. Patients presented functional symptoms as vomiting, regurgitation. Baryum meal X ray allows to make diagnosis in meso-axial and organoxial varieties. They showed the interest to evocate this diagnosis related to an infant vomiting's diagnosis and discussed about therapeutic modality.

[Posterior urethral valves in Senegalese children. Fourteen cases]

Fourteen pediatric cases of posterior urethral valves in patients aged 6 months to 14 years (with four infants and ten older children) are reported. The main symptoms were vesical, including dysuria, acute urinary retention and dribbling. One patient presented with diarrhea, vomiting and dribbling. Urethral valves were looked for as part of the evaluation for urinary lithiasis in one patient, and in another urinary lithiasis developed following the diagnosis of urethral valves. In half the cases, onset of symptoms occurred within one year of birth. Urethrocystography allowed to evidence the valves and to evaluate repercussions on the bladder including hyperplasia (7 cases) and diverticula (2 cases). The intravenous urogram disclosed bilateral ureterohydronephrosis in eight cases. Pathogens recovered from the urine included Klebsiella (3 patients), Pseudomonas (4 patients), Proteus (one patient), and E. coli (one patient). Most patients were treated by catheter lamination under antimicrobial therapy. Two patients died from renal failure. Results were considered satisfactory in nine cases with follow-ups ranging from 1 month to 4 years. Three patients were lost to follow-up. Early diagnosis is essential and management should rely mainly on endoscopic resection which reduces the length of the hospital stay and the risk of infection.

[Hypertrophic pyloric stenosis of the infant. Apropos of 8 cases]

Eight cases of Infantile Hypertrophic Pyloric Stenosis collected in 10 years (1980-1989) in the Pediatric Surgery Unit of the Surgical Clinic of Dakar are reported. The rarity of this pathology among Blacks and a male predominance are noted. The clinical onset occurred after an average period of 3,25 weeks marked by food vomiting. At the start of the surgical management the age of patients was 6 weeks. X-ray examination following a barium meal showed no passage of contrast in 3 cases. However a narrowed and elongated pyloric canal was noted in 5 cases. Abdominal sonography was used in 3 cases and showed gastric stasis with a hypertrophy of pyloric muscle. A rammstedt pyloromyotomy was performed after a period of few hours to 13 days of resuscitation. A duodenal perforation complicated the operation twice and was subsequently repaired. In the post operative period, two patients died within 2-3 days. One of them had duodenal perforation. Six patients made a good recovery.

[Ureteral-pelvic junction syndrome in the child. Apropos of 8 cases]

Eight cases of uretero-pelvic junction syndrom collected in the ten past years are reported. They are 4 males and 4 females ranged from 18 months to 15 years with a mean age of 4.5 years. This age too late is probably due to the misknowlege but also to the lack of information about the pathology. The main characteristics of this syndrome are analysed according to the literature. All patients except one underwent nephrectomy because the irreverible lesions of the kidney. The authors emphasize the importance of early diagnosis done by antenatal echography but it can be made with a good clinical examination followed by the results of I.V.P. It is necessary for them to make parents, general practitioners and paediatricians sensitive to that pathology to avoid such operating act whose consequence are very serious where as it is benign.

Partial splenectomy for benign cystic lesions of the spleen

Cystic lesions of the spleen are uncommon, about 600 cases being reported in the world literature. This report concerns three pediatric patients treated by partial splenectomy for benign cyst. In the world literature most of the cystic lesions of the spleen are treated by splenectomy and more recently by partial splenectomy. The infected lesions are treated by splenectomy or by incision and drainage only. Partial splenectomy has evident advantage over splenectomy. Although in the world literature we have not found a single case of infected splenic benign cyst treated by partial splenectomy, we believe that this procedure also has an advantage over drainage as the infected and necrotic part of the cyst is removed, thereby reducing morbidity and further possible complications.

Omphalocele: a 25-year experience

Between 1958 and 1983, 92 neonates with omphalocele were admitted to Ste-Justine Hospital. The male to female ratio was 3:2. Birth weight ranged from 1,450 to 5,100 g (mean 2,786 g). Associated anomalies, apart from malrotation, were present in 45%. They were cardiovascular (18.4%), vesico-intestinal fissure or bladder exstrophy (11.9%), Beckwith Wiedeman (6.5%), and chromosomal abnormalities (7.5%). Seven patients were not treated. Topical applications were used in seven cases (1 survivor). In 65%, primary closure was achieved; the mortality rate was 20% with a mean hospital stay of 17.5 days. Silastic was used in 12 cases with a mortality of 5/12 and a mean hospital stay of 82.1 days. The mean number of reductions was 6.7. Omphalocele rupture did not influence mortality. Prior to 1974 the mortality rate was 50%. Since 1974 it has decreased to 31.5%. The advent of total parenteral nutrition (TPN) was an important factor in decreasing the mortality. Prior to 1974, 23 patients survived, only one with a major associated anomaly (Fallot). After 1973, 35 survived, 13 having a major associated anomaly. Overall mortality was 9% when no other major malformations were present. A retrospective study of 92 cases of omphalocele over a 25-year period reveals an overall mortality rate of 37%. Death was associated almost exclusively with additional congenital anomalies. Birthweight in itself was not a determining prognostic factor. With the advent of TPN and a better knowledge of the mechanical ventilation of the neonate the results are better and involve the survival of a greater number of patients with serious associated malformations.

Perforated appendicitis presenting as torsion of spermatic cord

A case of perforated appendicitis presenting as acute scrotal swelling and erythema is reported. A hydrocele containing cloudy fluid was encountered on surgical exploration suggesting the intra-abdominal pathology.