[Septo-optic dysplasia (De Morsier's syndrome). About one case discovered during the pregnancy]

The authors report a case of septo-optic dysplasia discovered during the pregnancy without another abnormality. It's a rare cerebral abnormality that is characterized by an absence of septum pellucidum associated to a hypoplasia of ways and optic chiasm to variable degrees. Discovery is often made for adulthood. Future is extremely wide. It is determined with the arisen to different degrees of incapacity of Pituitary gland, psychomotor delay of variable intensity with mental deficiency, a visual confusion, and a confusion of the regulation of the temperature.

[Placenta percreta: A rare etiology of spontaneous uterine perforation in the second trimester of pregnancy]

Placenta accreta is an abnormal adherence of placenta to the uterine wall without interposition of decidua basalis. Placenta percreta is the rarest form but may complicate the pregnancy with acute severe hemorrhage. We report a case of placenta percreta with multiple perforations of an unscarred uterus reaveled by hemoperitoneum at 22 weeks in a 33-years-old gravida 2 para 1. Emergency total hysterectomy was performed. Risk factors, clinical approach and therapeutic managements are discussed.

[Value of hand disinfection by rubbing with alcohol prior to surgery in a tropical setting]

OBJECTIVE

The purpose of this study was to assess the value of hand disinfection by rubbing with alcohol in terms of prevention of surgical site infection (SSI) and cost in a tropical setting.

MATERIAL AND METHOD

This prospective cohort study carried out in the Gynecology Obstetrics Department of the Yopougon University Teaching Hospital from May to September 2005 was designed to compare two different methods of hand disinfection, i.e., traditional 3-step hand scrubbing using an antiseptic preparation versus handwashing without an antiseptic preparation followed by two applications of an aqueous alcohol solution.

RESULTS

The study population included 318 patients who underwent surgery during the study period. The SSI rate was 13.2% in patients operated on after traditional hand scrubbing and 11.5% after handwashing followed by rubbing with alcohol (not significantly different). Hand disinfection by rubbing with alcohol did not increase the risk of SSI and was considered as easier than traditional hand scrubbing by 90% of users. Skin tolerance was deemed good by 52% of users. Most users (69%) wished both hand disinfection methods to be available. Hand disinfection by rubbing with alcohol was much more cost-effective than traditional hand scrubbing both with regard to initial investment and to consumable costs (50% lower).

CONCLUSION

This study shows that hand disinfection by rubbing with an alcoholic solution is not only as effective as traditional hand scrubbing for prevention of SSI but also more cost-effective. These findings indicate that rubbing with alcohol is a suitable alternative to traditional scrubbing for hand disinfection prior to surgery in our tropical setting.

[Craniopagus conjoined twins: difficulties of management in Africa]

Conjoined twins are the rare malformations of monozygotic-twins pregnancies associated with bad fetal prognosis. Craniopagus are even more rarely encountered and their management is complex particularly in our low-medical-equipment countries. From an observation of craniopagus twins, we present several difficulties in the management of the case. Diagnosis was late; because of the onset of labour, delivery was not prepared; the conditions of neonatal and social management were not adapted. Surgical treatment was not considered owing to the absence of appropriate technological conditions and means.

[Management of rhesus alloimmunisation by spectrophometry: about one case at the Yopougon Teaching Hospital, Côte-d'Ivoire]

The authors report a care management of a patient presenting a severe alloimmunisation treated by spectrophotometry, a very efficient method but difficult of access in developing countries. Beyond the restrictive paraclinical exams which do not allow an efficient monitoring of this pathology, the lack of alloimmunisation prevention during illegal abortions and the lack of information about patients'medical files are highly responsible for the difficult management of Rhesus- negative patients. However the authors remind that only the scan at best combined with the Doppler, are effective exams helping to avoid the constraints of spectrophotometry. Although quite well-known this pathology induces very severe foetal consequences and may involve the obstetric prognosis of young women. The caesarian section will still remain for a long time the only means to prevent foetus from alloimmunisation complications in developing countries.