ATP2B4 regulatory genetic variants are associated with mild malaria

BACKGROUND

Genome-wide association studies have identified ATP2B4 as a severe malaria resistance gene. Recently, 8 potential causal regulatory variants have been shown to be associated with severe malaria.

METHODS

Genotyping of rs10900585, rs11240734, rs1541252, rs1541253, rs1541254, rs1541255, rs10751450, rs10751451 and rs10751452 was performed in 154 unrelated individuals (79 controls and 75 mild malaria patients). rs10751450, rs10751451 and rs10751452 were genotyped by Taqman assays, whereas the fragment of the ATP2B4 gene containing the remaining SNPs was sequenced. Logistic regression analysis was used to assess the association between the SNPs and mild malaria.

RESULTS

The results showed that mild malaria was associated with rs10900585, rs11240734, rs1541252, rs1541253, rs1541254, rs1541255, rs10751450, rs10751451 and rs10751452. The homozygous genotypes for the major alleles were associated with an increased risk of mild malaria. Furthermore, the haplotype containing the major alleles and that containing the minor alleles were the most frequent haplotypes. Individuals with the major haplotypes had a significantly higher risk of mild malaria compared to the carriers of the minor allele haplotype.

CONCLUSIONS

ATP2B4 polymorphisms that have been associated with severe malaria are also associated with mild malaria.

Adult ileocecal intussusception induced by adenomatous ileal polyp: case report and literature review

Intussusception is a rare cause of bowel obstruction in adults, and has generally an organic etiology. However, adenomatous polyp of the small bowel is an uncommon etiology. Moreover, there’s a great difference with childhood intussusception in its presentation, etiology and management. We describe herein a case of adult ileocecal intussusception due to an adenomatous ileal polyp with a preoperative diagnosis made on computed tomography. We performed a right hemicolectomy, without attempting to reduce the intussusception, and an end-to-end ileotransverse anastomosis. The pathological examination of the surgical specimen revealed an adenomatous polyp with a high grade dysplasia on the terminal ileum, being the cause of the ileocecal intussusception.

[The Study Of Biomedical Waste Management In Sanitary District Of Goudry In Senegal]

AIM

Of this study was to explore, in the sanitary district of Goudiry, the practice of biomedical waste management and to analyze its impact.

MATERIALS AND METHODS

The sample consisted of seven health posts, among a total of 11, drawn by simple random sampling and a health centre (district hospital). Data were collected through structured interviews with all staff, participant observation and from secondary data.

RESULTS

The district facilities surveyed produced 111.9 kg (or 16.0 kg/d) over seven days. Waste management is inadequate at all levels.

CONCLUSION

Actions needed to improve waste management are sensitization and training of actors, the involvement of all the stakeholders (local authorities, population, health workers), and advocacy with policy makers.

[How Bone Densitometry contributes to the diagnosis of Osteoporosis at the Gerontology and Geriatrics Center of Ouakam, Dakar City: 102 observation]

INTRODUCTION

This study aims at assessing the morbidity rate and risk factors of osteoporosis.

METHODS

This is a cross-sectional study conducted at the Gerontology and Geriatrics Center of Ouakam from 2010 to 2012 with patients who had benefited from a bone densitometry examination. The study variables were: sex, current age, menopausal age, past individual fractures, past family fractures, prolonged corticoid intake, prolonged immobilization, tobacco addiction, and alcoholism. Epi-info version 6 Software was used to process and analyze the data.

RESULTS

The study included 102 patients the majority of which were women (75%), with an average age of 74 years; among these people, 31% had individual past fractures and 10% had family fractures; 8% of the patients had used a prolonged corticoid-based therapy and 2% were tobacco-addicts. The average age of menopause was 48 years. The prevalence rate for osteoporosis was 44%, based on Rachis T-score, 20%, based on Femur T-score and 45%, based on Rachis and Femur T-score. It has been noted that being a woman and past individual fractures rated among the major risk factors of osteoporosis.

CONCLUSION

These results speak in favor of health authorities setting-up a program to fight osteoporosis centered mainly on primary prevention and screening.

Perforated mesenteric Meckel's diverticulum in an adult: a real variant?

A Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. It is a real diverticulum that is usually located on the anti-mesenteric edge in the last meter of the ileum. Its location on the mesenteric edge has been rarely reported. It may lead to several complications including perforation that may be life-threatening for the patient. We report herein a case of perforated mesenteric Meckel's diverticulum in an adult patient. Upon surgical exploration by laparotomy, we found a perforated Meckel's diverticulum located on the mesenteric edge of the ileum 60 cm from the ileocoecal junction and 400 ml of seropurulent peritoneal fluid. The patient underwent a segmental ileal resection and an end-to-end anastomosis. The postoperative outcomes were marked by a persistent peritonitis that required successful revision surgery.

[IgG responses to candidate malaria vaccine antigens in the urban area of Dakar (Senegal): evolution according to age and parasitemia in patients with mild symptoms]

Malaria remains a major problem in African countries despite substantial decreases in morbidity and mortality due to sustained control programs. Studies for the evaluation of qualitative or quantitative Ab responses to key targets of anti-plasmodium immunity were mostly done in rural endemic setting compared to urban area. In a cohort of 200 patients with mild malaria and living in Dakar, we analyze total and subclasses IgG responses to a panel of P. falciparum blood stage antigens: MSP1p19, MSP3, EB200, GST-5 and R23. A mean age of 15 yrs (4 to 56 yrs) and parasitemia between 0.1 to 17% were found. Levels of IgG anti-MSP3 were higher in patients with low parasitemia (≤1%) and appear negatively correlated to parasite densities (Rho =. 0.54; p= 0.021). This correlation is more significant in children (≤ 15 yrs). In addition, an increase of IgG responses against MSP1p19 is highly observed in adults having a parasitemia less than 1%. In those patients, we find that IgG1 subclasses were predominant (p <0.01). Our study shows an association between Ab responses and parasitemia. This association is dependant to IgG anti-MSP3 in children and IgG anti-MSP1p19 in adults living in urban area.

[Assistance and Support Units for the elderly: A tool for promoting health in seniors: Example of the CAAPA unit of "Sicap Rue 10", in Dakar]

As a body for reflection, dialogue and integration, the CAAPA Assistance and Support Unit of "Sicap Rue 10" allows the elderly to fully participate in the life of their society while being in good health. The unit has been set up by the local authorities following recommendations from interdepartmental cabinet meeting on 13 November, 200. Nine years after the creation of the unit, it becomes important to evaluate the degree of community participation of the elderly within that unit. This is a qualitative, descriptive and analytic study that took place from 9 October to 23 October, 2010. The two methods used to collect the data are interviewing and focus group. Using Bichmann's scale, which has been modified and adapted, the results have shown an "average-level" participation of the elderly in the creation of the CAAPA unit, its implementation as well as the follow-up and the evaluation of its activities; this participation being "open" in the composition of the piloting committee and "restricted" in mobilizing and managing material and financial resources. Recommendations have been stated for the CAAPA unit to fully play its role.

[Incarcerated internal hernia through a breach of the broad ligament, a case report]

We report a case of 44-year-old women presented with an acute small bowel obstruction revealated by tomodensitometry. Laparotomy showed an incarcerated internal hernia through the broad ligament. We performed liberation of the ileal segment and closed the hernial orifice. The patient evolution was excellent.

Photochemistry of atmospheric dust: ozone decomposition on illuminated titanium dioxide

The ozone decomposition onto mineral surfaces prepared with traces of solid TiO2 in a matrix of SiO2 in order to mimic mineral dust particles has been investigated using a coated-wall flow-tube system at room temperature and atmospheric pressure. The ozone uptake coefficients were measured both under dark conditions and irradiation using near UV-light. While uptake in the dark was negligible, a large photoenhanced ozone uptake was observed. For TiO2/SiO2 mixtures under irradiation, the uptake coefficients increased with increasing TiO2 mass fraction (from 1 to 3 wt %), and the corresponding uptake coefficient based on the geometric surfaces ranged from 3 x 10(-6) to 3 x 10(-5). The uptake kinetics was also observed to increase with decreasing ozone concentration between 290 and 50 ppbv. Relative humidity influenced the ozone uptake on the film, and a reduced ozone loss was observed for relative humidity above 30%. The experimental results suggest that under atmospherically relevant conditions the photochemistry of dust can represent an important sink of ozone inside the dust plume.

[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.

[Incarcerated procidentia due to giant cervical fibromyoma: a case report]

The authors report a sparse case of incarcerated procidentia due to cervical fibromyoma in a 43-year-old Senegalese woman. This is about the second case known around the world. Clinic was about a giant cervical mass, irreducible with haemorrhage and procidentia.

[Giant leiomyoma of fallopian tube: a rare aetiology of abdominal tumor]

Leiomyomas of the fallopian tube are extremely rare. They are often managed with autopsy or surgery. We report a revealed case by a voluminous-abdominal mass in a 35-year-old woman. Neither the tomodensitometry nor, even, the laparoscopy did not permit specifying the tubal origin of the tumor. The diagnosis has been finally carried to the laparotomy. An annexectomy had been achieved. The histological examination concluded to a leiomyoma without malignant-cellular atypia.

[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.

[Postoperative peritonitis at the department of general surgery of Aristide le Dantec Hospital: report of 15 cases]

INTRODUCTION

Post-operative Peritonitis (PPO) put some diagnostic and therapeutic problems to surgeons. The aim of the study was: first, to analyze the epidemiological, diagnostic, and therapeutic factors of post-operative peritonitis; then, to define a strategy to improve their prognosis.

MATERIAL AND METHOD

We did a retrospective study carried out at department of general surgery of the Aristide Le Dantec hospital from January 2001 to March 2007 on cases of PPO. Fifteen cases were included. It was about 12 men and 3 women of middle age of 38.2 years with extremes of 17 and 70 years.

RESULTS

Clinical signs were dominated by the abdominal pain (73.3%) and the fever (66.7%). Abdominal collections were multi-microbial. The digestive suture failure was the dominant reason. All patients have been managed in the 48 hours that followed the diagnosis of PPO. The treatment consisted, essentialy in temporary digestive derivation, washing and drainage of the abdominal cavity framed by an adequate resuscitation. The recovery was 67.7%. Morbidity rate is 33.3%. Mortality concerned 5 patient (33.3%) especially carriers of 2 or 3 visceral failings. Criteria of precocious re-laparotomy have been specified.

CONCLUSION

The improvement of the prognosis passes indeed by a precocious diagnosis and a coherent multidisci lina a roach.

[Strangulated groin hernias in adults: a survey of 228 cases]

Strangulation is the most complication of groin hernias in adults.

OBJECTIVE

To report our experiment in the treatment of strangulated groin hernias and their presentation in adults.

MATERIAL AND METHOD

It is a retrospective study carried out from January 1997 to June 2002, involving 228 patients operated for strangulated groin. Epidemiologic, clinical and therapeutic aspects were studied.

RESULTS

The average age of the patients was 45 years with extremes of 17 and 85 years. There were 220 men (96%) and 8 women (4%). Inguino-scrotal hernia was seen in 176 cases (77.2%), inguinal hernia in 46 cases (20.1%), and femoral hernia in 6 cases (2.7%). The hernia seat on the right side in 145 cases (63.6%) and on the left side in 83 cases (36.4%). The average duration of symptoms was 24 hours. Elective oblique kelotomy was realised in 140 cases (61.4%), elective transversal kelotomy in 87 cases (38.2%) and median laparotomy in 1 case (0.4%). Bowel resection is required in 16 cases (7%). Bassini procedure was carried out in 158 cases (69%) and modified Mac Vay procedure in 70 cases (31%). The average duration of hospital stay was 3.6 days. One death (0.4 %) caused by cardiopathy was noted. The morbidity rate was 8.3% (19 cases). Those following complications were noted: bowel injury (2 cases), caecal injury (1 case), bladder injury (1 case), wall abscess (5 cases), post-operative pain (5 cases), late transit restart (2 cases) and scrotal haematoma (3 cases). On 108 patients (47.4%) followed regularly with a median follow-up period of 42 months, 8 cases (7.4%) of recurrence were noted.

CONCLUSION

In our survey, the mortality rate is very low, the rate of bowel resection is low, and the morbidity rate is negligible. Despite the current tendency to use prosthetic mesh in emergency, traditional procedure in particular Bassini procedure gives good results with an acceptable rate of recurrence in a short and medium follow-up period.

[Glimpse of infectious diseases associated with HIV infected patients at general surgery department]

Because surgery is a bloody treatment its constitutes a situation of risk trannsmissibles disease like viral infections in peculiar the HIV.

PURPOSE

To identify infectious pathologies associated with the ground with the HIV-infected patients and to report socio-demographic characteristics of the infected patients.

METHOD

This descriptive and analytical study covered one period active of January 1, 1995 to December 31, 2005. We exploited the data base of the laboratory of bacteriology and virology of the CHU Aristide Dantec of Dakar. Thus on 530 requests for serology coming from the department of general surgery, 61 was positive with the HIV. And among these 61, 32 (52,4%) had an infectious disease and were the subject of this present study.

RESULTS

There are 19 (59,3%) men and 13 (40,7%) women including 30 Senegalese, 1 Rwandan and 1 Guinean with an average age of 41,1+/-13,1 years. The housewives (7 cases), the tradesmen (5 cases) and the craftsmen/workers (5 cases) constituted the most represented professions. Matrimonial status was distributed as follow: 20 (62,5%) married, 6 (18,9%) unmarried, 2 (6,2%) widowed, 2 (6,2%) divorced, and for 2 (6,2%) patient this status was not specified. The HIV 1 was found at 25 (78,2%) patients, the HIV 2 at 5 (15,6%) patients and the association of the two viruses at 2 (6,2%) patients. Twenty seven (84,4%) patients was received in emergency and 5 (15,6%) had a programmed intervention. Suppuratives diseases of the proctologic area were in the first rang with 10 (31,2%) cases, followed by pleuro-pulmonary suppuratives diseases, 8 (25%) cases, then of the suppuratives wound infections, 6 (18,8%) and finally of the intra abdominal suppuratives infections and of the candidosis of the esofagus, 4 (12,5%) cases each one.

CONCLUSION

Socio-demographic characteristics of HIV-infected patients and presenting a suppurative disease "surgical" is identical to those of the other HIV positive patients. These patients were generally received in an emergency context for anorectal, pleuro-pulmonary or parietal suppuratives diseases.

[Etiology and therapeutic aspects of generalized acute peritonitis of digestive origin. A survey of 207 cases operated in five years]

Generalized acute peritonitis is defined as a brutal and diffuse peritoneum inflammatory.

AIM

To assess the organic aspects of acute peritonitis of digestive origin and to evaluate the results of their surgical treatment.

MATERIAL AND METHOD

Between January 1997 and December 2001, 221 patients were operated for generalized acute peritonitis. Among them, 207 patients (93.6%) had a digestive aetiology and were included in this study. They were 188 men (91%) and 19 women (9%). The average age of patients was 31.1 +/- 10.1 years old with extremes of 16 and 74 years. The organic (aetiologies) and therapeutic aspects as well as the remote follow-up were studied.

RESULTS

The following aetiologies were found: perforation of gastro-duodenal ulcer, 109 cases (52.7%), complicated appendicitis, 76 cases (36.7%), ileal perforation, 13 cases (6.3%), colic perforation, 5 cases (2.4%), jejunal perforation, 1 case (0.5%), rupture of liver abscess, 1 case (0.5%) and pyo-cholecyst, 2 cases (0.9%). Complications had occurred among 65 patients i.e. 31.4% of the cases and were distributed as follows: local wound abscess, 42 cases (20.3%); evisceration, 10 cases (4.8%); post-operative peritonitis, 6 cases (2.9%); digestive fistula, 4 cases (2%) and resumption of ileostomy, 3 cases (1.4%). Mortality concerned 19 patients and the rate was 9.1%. Aetiology of death was septic shock or multiorgan failure in most of cases. The average time in which the continuity of the digestive tract was restored after stoma was 36.3 +/- 10.7 days. The late complications were: incisional hernia in 7 cases (3.5%), small bowel obstruction in 3 cases (1.5%) and pylorus stenosis in 1 case (0.5%).

CONCLUSION

The perforations of gastro-duodenal ulcers, in first, followed complicated appendicitis are the most frequent aetiology. Mortality and morbidity, especially in parietal peritonitis, are not negligible.

[Penetrating wound of the abdomen. Profile of the suffering patient at Dakar teaching hospital]

INTRODUCTION

In Senegal, the rate of penetrating wound of the abdomen seems to be in great progression. The purpose of this study was to make a descriptive analysis of the epidemiological data on the patient suffering from a penetrating wound of the abdomen.

MATERIAL AND METHOD

It is about a retrospective study performed on a 5 years period from January 1997 to January 2002. This study covered 90 cases of penetrating wounds of the abdomen listed at the emergency department of Dakar teaching hospital. The rate, age, sex, responsible agent, circumstances of the wound, place of the injury, evacuation mode, time of admission and check-up injury were studied.

RESULTS

The average absolute rate of the penetrating wounds of the abdomen was 18 cases per year. The average age was about 27 +/- 10 years with 88 men for 2 women. The responsible agent was a knife (87%), a firearm (6%), a broken glass (4%), a bullock horn (2%) and a piece of iron (1%). Circumstances of the injury was aggression (91%), accident (6%), self-mutilation (2%), suicide attempt (1%). Evacuation was done by firemen (60%), by the ambulances of the medical structures (22%), and by private individuals (18%). The average time of admission was 5 hours. Nearly 61% of the wounds were located in the umbilical, epigastric, left hypochondre and left side areas. Wound was single in 93,4% of cases and linear in 71,8% of cases. We noted an exit of epiploon (38 cases), peritoneal signs (13 cases) and a small bowel evisceration (9 cases). The treatment was a systematic laparotomy (68%) and a simple closure of the wound with a good follow-up for any further aggravation (32%).

CONCLUSION

The patient admitted at the surgical emergency unit of Dakar teaching hospital for penetrating wound of the abdomen is generally a young man, victim of aggression by knife, evacuated by firemen within 5 hours, which present a single and linearwound in perish-umbilical area with exit of epiploon and/or small bowel evisceration, which would undertaken a surgical operation in 68% of cases.

[A case report of intrapelvic foetal osseous remains localization after clandestine caused abortion]

A 26 year old women, unmarried, second gesture, primiparous, had been hospitalized in our departement for the management of a hypogastric mass. Ultrasonography had shown: an uterus of normal size, a normal uterine vacuity line with presence of many osseous and fibrous constituents inside the inter-vesico-uterine area, including one femoral osseous of 18,6 mm corresponding to 15 weeks of amenorrhoea. A few months before, the patient had undergone a clandestine caused abortion on a progressive intrauterine pregnancy of 12 weeks of amenorrhoea certified by ultrasonography. It is an exceptional complication of clandestine caused abortion. It gives the opportunity to us to discuss its etiopathogenic mechanism. It also enables us to point out the complications of the clandestine caused abortion and to insist on the need for its prevention.

[Liver arterial ischemia after cephalic pancreatico-duodenectomy. A case report]

Cephalic pancreaticoduodenectomy is the best treatment for cephalic pancreas cancers. A rare complication is the liver ischemia after the divison of gastroduodenal artery. This complication can occur when a celiac trunk stenosed by the median arcuate ligamentous is not recognised. We report the case of a 40 old woman who underwent cephalic pancreaticoduodenectomy for an adenocarcinoma of pancreas head. There was no complication immediatly. Two weeks later, she presented two episodes of angiocholitis. An abdominal tomodensitometry showed a liver arterial ischemia associated with a celiac trunk stenosis. There was a left hepatic artery wich came from the left gastric artery. Medical treatment of the angiocholitis was successful. Surgical revascularization was not necessary. Nine months after, arterial revascularization by the left hepatic artery and biological hepatic tests were restored. This case report talks about the importance of angioscanner before pancreatic surgery when celiac and mesenteric angiography is not available. Also, it underlines the importance of the gastroduodenal artery occlusion test before his ligation during pancreaticoduodenectomy.

[Congenital choledocal cyst of adult: report of two cases]

INTRODUCTION

Congenital choledochal cyst is a congenital dilatation of the biliary tract often associated with a long common bilio-pancreatic duct without obstruction.

PATIENTS AND METHOD

We report the case of two women who presented a congenital choledochal cyst.

RESULTS

For the first patient, the diagnosis was effected during a laparoscopic cholecystectomy for a gall bladder lithiasis. The second one presented repeted access of angiocholitis. Echography and abdominal tomodensitometry found the congenital choledochal cyst. Percutaneous opacification of the cyst found a long common biliopancreatic duct in the second patient. A complete resection of the cyst with a cholangiojejunal anastomosis was performed for both patients. The treatment was successfull for the first one and the second one was deceased three days after the operation.

CONCLUSION

This case report underlines the clinical polymorphysm, the morphologic anomaly and the treatment of congenital choledochal cyst which require total resection.

[Solitary ulcer of the rectum. Report of two cases treated by the Orr-Loygue technique]

We report two cases of solitary ulcer of the rectum treated by Orr Loygue rectopexy technique in a ten-year period at the Surgery Department of Aristide Le Dantec. The first case is about a 39 year-old female who was constipated since approximately seventeen years and had a rectal prolapse associated later to bloody stools. In 1990, she underwent haemorrhoids surgery operation with unsatisfactory results. After the recurrence of the disease, she was admitted at Aristide le Dantec Teaching Hospital, rectoscopy revealed a solitary ulcer. Orr Loygue rectoplexy technique was performed by laparotomy. In the follow up, there was no complication. The second case is about a 43 years old female who suffered from rectal syndrome since twenty years and had pelvis pains with bleeding and phlegmatic diarrhoeas. The physical examination and biologic analysis showed no particularity. Rectoscopy has revealed a solitary ulcer of the rectum which was confirmed by biopsy. Orr Loygue rectoplexy technique was performed. In the follow-up, there was a recurrence and this was confirmed by rectoscopy. The rectopexy alone does not summurize the therapeutic. A final dyskesia or an associated perineal insufficiency must be integrated in a total therapeutic strategy.

[The Burch intervention: report of 24 patients]

The Burch standard colposuspension consist with the suspension of the bladder cervix and the urethral segment to the pectinate ligament from the vaginal wall, in order to reposition the bladder cervix inside the manometric abdominal pression. The aim of this study was to evaluate our results in this technic. It was a retrospective study including all cases of Burch colposuspension, carried out in our departement. This study covered over one 6 years period, from January 1995 to January 2001. Twenty four patients underwent this type of intervention during the study period. The average age of the patients was 45.4 years old. The natural menopause was noted in 45.8% of the cases. The multiparous patients constituted 95.8% of the cases and the 4.2% were the nulliparous ones. A pelvic surgical gesture was carried out in 16.6% of the cases in patient medical past-history. A dystocic childbirth in the patient medical past-history was found in 20.8% of the cases. The missing rate into post-operative near period (urinary incontinence) was 8.4%, therefore 91.6% of good results was observed. The rate of good results into post-operative late period was 84.2%. The Burch colposuspension provides good immediate post-operative results with very little rate of failure. Nevertheless a delayed degradation of long-term results is usual.

[Penetrating wounds of the abdomen. Evaluation of conservative treatment in 40 cases]

Stabbed penetrating abdominal wounds are becoming more and more frequent in our emergency surgical unit due to increase of aggressions. The goal of our study is to evaluate the conservative treatment of these wounds. This concerns a study carried out between January 1997 and October 1998. Exploratory laparotomy was proposed at each time when one or more of the following criteria was noticed: choc, evisceration of intestines, digestive hemorrhagy or hematuria, outlet of digestive fluids, sign of peritoneal irritation, wounds by gunshots or wounds at the frontal regions. In the other cases, the conservative treatment with wound dressing following an antibiotic and serovaccination therapy of tetanus was the therapeutic option. Our study was carried out on 40 patients of whom were 37 males and 3 females of average age 24.9 years with extremities of 7 to 52 years. It arrived to the following results: 32 of the patients (80%) were victim of aggression and 29 cases were stabbed wounds. The wounds were in the central region (umbilicus 29.5%) and superior to the abdomen and were associated with outlet of the omentum (50%) outlet of the intestines (12.5%), peritoneal irritation (27.5%), digestive hemorrhagy (10%), hematuria (2.5%) outlet of faeces (2.5%). 17 patients (42.5%) underwent exploratory laparotomy on the basis of criteria afor mentioned and the 23 others (57.5%) underwent medical surveillance and 3 of them developed peritonitis and underwent surgery. The rate of negative laparotomy was 5% and retarded interventions was 13%. The morbidity was also 13% and mortality 2.5%. The average period of internship in hospital was 11,4 days with extremities of 1 to 101 days. The conservative treatment of penetrating stabbed abdominal wounds out of the criteria mentioned were quite satisfactory.

[Nodular euthyroid goitre: value of ultrasonography versus scintigraphy in the initial assessment]

PURPOSE

The aim of this study was to show that in exploration of nodular goiter with euthyroidy ultrasonography was higher than scintiscanning.

MATERIAL AND METHODS

It was to show that when it was necessary to specify the topography and the number of thyroid nodules, the proportion of right results was larger with ultrasonography than with scinticanning. These proportions being respectively indicated Pe and Ps, hypothesis of search was formulated H1: Pe > Ps. Null hypothesis was written H0: Pe < Ps. Twenty three patients (21 women and 2 men with an average age of 41 years) carrying thryroïd nodules with euthyroidy had respectively undergone a scintiscanning (scintiscanning with sweeping after ingestion of iode 131) and an ultrasonography (conventional ultrasonography with a probe of 7.5 MZ) of the thyroid gland between February 26, 1996 and June 19, 1997. Per-operativedatahaving beenused as references from which the results of scintiscanning and ultrasonography were appreciated nominally, discreet: right results or false results. In this way, proportions of right and false results were collected respectively for scintiscanning and for ultrasonography, which made it possible to test null hypothesis (H0: Pe < Ps). The results were distributed on a 2 x 2 cotigence table. The chi 2 test was applied with a risk error of 5%.

RESULTS

For all patients the scintiscanning found on the whole a minimum number of 39 nodules contrary with ultrasonography and surgical exploration which respectively found a minimum number of 56 and 59 nodules. Comparison of right and false results had shown a superiority of ultrasonography (17 right and 6 false) on the scintiscanning (10 right and 13 false) with statistically significant difference (P < 0.05).

CONCLUSION

Ultrasonography is more precise when it is necessary to specify the number and the topography of the thyroid nodules. In addition ultrasonography is alleviating and less expensive compared to scintiscanning.

[Vaginal hysterectomy for hysterocele (report of 36 cases)]

Vaginal total hysterectomy get to better qualily of lite to patients who have genital prolapse. It gives no abdominal scar. The feeding and rising are early. Among a serie of 36 total vaginal hysterectomies for hysteroceles we performed, we report few complications. One patient presented a plentiful peroperative haemorrhage : three others present a vesical wound. We report one case of releasing suture, one had setting of bladderand one case of vaginal infection. One patient died from a cause not reliable to the procedure. The mean duration of the hospital stay was 8.36 days. After 4 years following up, 2 patients have elytrocele recurrence, and one other presents a bad reducing of cystocele. We hope to pursue this serie strenghen then our results.

[Recent traumatic peroneal tendon dislocation: a case report]

Peroneal tendons dislocation describes a permanent or intermittent displacement of these tendons out of the retro malleolar sucket to its lateral side. It was described in fist in 1803 by Monteggia. It remains a rare affectation, dominantly of traumatic causes, mostly by passed in emergency situation. Also in its rarity, it remains remarkable for its diagnostic interest but also for its management which remains only surgical. This case concerned an adult of 24 years old, victim of closed trauma of the right ankle, the ankle was forced in varus and supine position. Ths initial diagnosis was a benign sprain which was later rectified 14 days after for a diagnosis of peroneal tendons dislocation. During the operation, a rupture of the retinaculum like type II of Eckert and Davis was noticed. A simple suture technique using Exner method give a good result 14 months later. The authors insist after this case indifferential diagnosis with sprain and recommended a surgical repair in recent lesions.