Search

Introduction: The goal of this study is to access the surgical management of the prostate cancer., Patients and Methods: It was a retrospective study including 96 cases of prostate cancer between June 2002 and December 2004. Parameters studied for every patient was: age, the complaints, results of rectal digital examination, the initial TPSA rate, gleason score, results of extension, the clinical grade according to TNM 2002 classification, the treatment and the future of treated patients., Results: The mean age of our patients was 70.9 years with extremes of 50 years and 93 years. The complaints at presentation were dominated by prostatism (43.5%) and urine retention (37.7%). At rectal digital examination, the prostate was suspicious of cancer in 42.7%. The majority of our patients (79.8%) had a TPSA rate superior to 20 ng/ml. The examination revealed that the tumour was an adenocarcinoma in all patients. The majority of our patients (50.3%) had a gleason score inferior to 7. The extension outcome revealed: a loco-regional extension in 63 patients, dorso-lombar bone metastases in 19 patients and absence of secondary localisation in 14 patients. The repartition of patients according TNM classification was as following: T1 (1%), T2 (14.6%), T3 (18.8%) and T4 (65.6%). The patients were managed as following: bladder neck resection (surgically or endoscopically), pulpectomy and radical prostatectomy., Conclusion: To ameliorate the prostate cancer management, the highlights of radical prostatectomy is imperative as the spreading of endoscopic surgery in the place of opening surgery.

Traumatic manubriosternal joint dislocations are rare in adult and occur readily during a violent traumatism of the chest and/or the dorsal spine. We report two cases treated between September 1997 and August 2002 at the Surgical Emergency Department of Le Dantec Hospital. The first observation was related to a 26 year old lady. On September 27, 1997, she fell down from a tree and received all the weight of the body on her two arms. She was referred because of anterior chest pains, increasing with respiration associated with injuries of the 2 wrists. On conventional X-ray, a type II manubriosternal joint dislocation (anterior dislocation of the sternal body with respect to the manubrium) was diagnosed. The mechanism of the dislocation was indirect: flexion-compression of the sternum caused by a hyperflexion of the dorsal spine when the patient touched the ground. There was also a Pouteaux-Colles fracture of the 2 wrists. The dislocation was surgically treated: open reduction followed by manubriosternal stabilization using wires. The 2 wrists were treated by Kapandji procedure. At the 21st postoperative day, a traumatic rupture of the wires required a 2nd internal fixation of the sternum by wires. After 9 years, the patient is without complaint and the chest X-ray is normal. The second observation was that of a 19 year old young woman, referred on August 15, 2002 after a frontal crash with a car while crossing the road. She fell down on her back. She was complaining from severe posterior headaches with a normal Glasgow Scale (15), anterior chest and right hand pains. Radiological examinations showed a fracture of the occipital bone without embarrure and a type I manubriosternal joint dislocation (posterior displacement of the sternal body in relation to the manubrium) which mechanism was direct: direct shock against the sternum. There were also an isolated fracture of 4 right sided ribs and a fracture without displacement of the 3 last bones of the right metacarpus. An orthopaedic treatment was carried out for the lesions of the right hand and an abstention-monitoring suggested for the occipital fracture. The manubriosternal joint dislocation was surgically reduced and stabilized by using a braided polyester thread number 2. After 4 years, the patient is asymptomatic and the manobriosternal joint is stable. We emphasize on the scarcity and the mechanism of traumatic manubriosternal joint dislocations in adult, the frequency of associated injuries and the absence of consensus about their treatment.

Introduction: Cranial and intracranial complications can be observed during middle ear cholesteatoma's evolution. We report our experience of management of infectious cholesteatoma's cranioencephalic complications., Material and Methods: In a three year period, we had consecutively admitted 4 patients with cranioencephalic complications of middle ear cholesteatoma, in the Ear Nose and Throat (ENT) department of the university teaching hospital of Dakar. After preoperative investigations with computed tomography scan (CT scan) of brain and temporal bone. The patients had been operated after paraclinic assessment., Results: The finding showed one case of temporal bone otogenic extensive osteomyelitis with multifocal extradural empyema, 3 cases of brain abscess associated with subdural empyema and meningitis in 1 case. For 3 patients (75%), neurosurgical drainage and mastoidectomy were performed, associated with antibiotic treatment. The mastaidectomy was performed in the same time of the surgical procedure or delayed. One patient, with brain abscess, died before surgical intervention. With a follow up of 15 months, we have noticed stable mastoidectomies cavities and no neurological recurrence symptoms., Conclusion: These complications can be prevented by early treatment of chronic otitis media diseases. The appropriated management of these complications necessitate collaboration between otorhinolaryngologists and neuro surgeons.

Aim: To insist on clinical and therapeutical aspects of chronic prostatitis., Patients and Methods: The authors relate a prospective study about 30 patients who were followed for chronic prostatitis. All patients were treated and followed up to 6 months., Results: The mean age of the patients was 31,82 years. Sixty percent of them where send by a physician after failure of medical treatment. Mean delay before consultation were 31.5 months. The main symptoms were pain (pelvic pain, perineal pain, or post ejaculatory pain). The distribution of patients according to the US NIH has shown 13 cases of category II, and 17 cases of category III. Outcome of these patients was favourable in ten cases for category II and nine cases for category III., Conclusion: If important efforts were realized for classification and diagnostic approach, many patients often fair to respond to treatment.

The authors report a prospective study comparing pre and immediate post operative complications of non complicated hernia of the groin in adult treated by operations based on Bassini and Mac Vay technics. It concerned a total of 100 patients made up of two groups of 50 age ranging from 13 to 84 years with an average age of 47 years of whom were 93 males and 7 females. No mortality was registered. The rate of complications was 20% in Bassini's technic and 22% in Mac Vay's technic. There were: bladder injurie, accidental skin wound incurred by the electric surgical blade, meningeal irritation, urinary retention, scrotal sac hematoma, parietal suppuration, intestinal occlusion and immediate recidivation before 6 months. As well as our study as in literature, specific complications related to both technics were rare. We could draw the conlusion that there is no significant superiority of one technic in comparison with the other one.

Introduction: Diagnosis of carcinomas of unknown primary site has proved to be difficult for many reasons., Patient and Methods: In this study, case in which cerebral metastasis is confirmed by biopsy technique with no identified primary site at the onset of treatment is presented here in., Results: The multimolity medical images was used to detect pulmonary hearths compatibles with a malignant histology. Further analysis diagnosed a primitive neoplasm., Conclusion: This study illustrates the interest of this technology in medical imagery in the early detection of primitive cancers on which the forecast depends.

Meningioma is an uncommon tumor of childhood. In this group, supra tentorial forms predominate. We report the case of a 14 years old boy without any past medical history. He presented headaches, vomiting and cerebellar syndrome. CT scan shows cerebellar tumor, enhanced by contrast and surrounded by edema, looking like tuberculoma. After fail of tuberculosis treatment, the boy is operated by suboccipital approach. Histology and immuno histochemical examination show fibroblastic meningioma. Even if it is rare, meningioma can occur in childhood, without neurofibromatosis disease. It can present many points of likeness with tuberculoma and therefore biopsy is mandatory before tuberculosis drugs giving.

The authors report their experience about 80 cases operated for lumbar spinal stenosis. Etiological clinical aspects and prognosis are studied. Lumbar arthrosis (83.8%) is the most frequent aetiology. The mean age is 50.7 years. Men are most affected than women (sex-ratio 2/1). Heavy work has a part to play in the genesis, in effect it tends to low the age of symptomatic stenosis. Lumbar and radicular pains are the most frequent symptoms (82.5%). Neurogenic intermittent claudication is less frequent (65%). Heavy cases with neurologic complications are frequent (32.5%). Surgical results are satisfactory in 74.3% of the cases. The authors insist in the interest of extensive laminectomy, respecting however as much as possible, the structure of stability of the vertebral column.

A retrospective study of 9 cases of fronto-ethmoïdal encephaloceles is reported. Cases have been gathered from the files of Dakar University Neurosurgical Unit. Fronto-ethmoïdal encephaloceles were about 9.8% of all encephaloceles. In all the cases the exit hole from the anterior cranial fossa is at the site of the foramen caecum. The location of the tumor was fronto-nasal in seven patients and naso-ethmoïdal in two. The cranio-facial deformity consisted of increase of local volume and a lateral displacement of medial canthus in six cases, a down ward drift of the tip of the nose in two cases and one case of orbital hypertelorism. Eight cases were meningo-encephaloceles and the last a meningo-encephocystocele. Diola was the most ethnic group involved. All patients have been operated by a simple neurosurgical procedure without obstruction of the cranial defect nor bony displacement. In five cases mental and aesthetic results were good when operation was done during the first year of live. The authors stress early surgical treatment for fronto-ethmoïdal encephaloceles.

The aim of this study is to assess mortality rate of low birth weight newborns admitted to a neonatal care unit of Dakar after transfer. This retrospective study include all newborns weighing less than 2500 g transferred to Abass Ndao neonatal care unit between January 1st,1998 and December 31, 1999. Maternal, newborns and transfer related parameters were studied. Data of 180 new-borns were recorded from a sample of 247 babies transferred. The mean weight of these babies were 1452.5 +/- 432 g. An ambulance was used for transport in only 10% of cases. The median time of admission after birth was 3 hours. Median delay of admission and methods of transfer, maternal age and parity, apgar score at 1st and 5th minute were comparable between the newborns deceased and survivors (p > 0.05). To reduce mortality associated with newborns transfer, we insist on a better organisation of neonatal transport in under developed countries by promoting obstetricians and paediatricians collaboration and prevention of low birth weight.

The Objectives of this study were to Report a rare malformation and to try to understand the embryological origin of such lesion. We reported the case of an eight-month-old female infant, without any particular past medical history, who was refered for seizures and vomiting. The examination revealed normal anthropometric constants, a soft painless and renitent tumefaction of the vertex and a psychomotor delay. Skull x-ray showed a parietal lacuna opposite to an opacity. Ultrasound scan showed an encephalocystocele communicating with dilated ventricles. CT x-ray revealed a single ventricle with an important back and upper extension, which evokes a cystic formation of the centre line. The existence of this cystic formation suppose an agenesis of diencephalic and telencephalic structures notably commissural. Interest of such observation is in its rarity, its complexity, the possibility of its antenatal diagnosis and in the etiopathogenic discussions that she gives rise to.

The empyema thoracis remain a current pathology in under developed countries. The aim of this study was to evaluate the incidence of empyema thoracis in the Surgical Emergency Unit, to analyze their causes, therapeutic procedures and their results. Between 1997 and 1998, 54 patients were received in urgency for empyema thoracis; 34 of them had a complete and exploitable file. Mean age was 20 years (3 weeks and 83 years) with 64.70% of children (0 to 15 years) and the sex ratio 3.25. Fever (85.70%) and cough (73.52%) were the most frequent symptoms. Twenty nine patients (85.3%) had pleural empyema and 5 a hydropneumothoracic image. Empyemas were related to pneumonia in 11 cases, associated to tuberculosis in 5 cases and were primitive in 18 cases. Bacteriological exam of the pus performed in only 18 patients had revealed a pneumococcus in 4 cases (22.23%) and was negative in 9 cases (50%). Closed chest drainage associated with antibiotics, pleural washing and respiratory kinesitherapy was done in all the cases. The average duration of hospitalisation was 24.56 days (1 to 55 days). Five deaths (14.70%) occurred. Two cases of recurrence were noted requiring a second drainage. Three cases of pachypleuritis had required a thoracotomy for pleural decortication in average time of 6 months. The duration of follow-up was 1 year. For the other 24 patients (70.58%) the evolution was good. Urgent closed chest drainage of empyema thoracis combined with antibiotics, pleural washing and respiratory kinesitherapy allows a good evolution and reduces the risk of pachypleuritis.

Malignant hemopathies are not considered as public health priority in Senegal because of their infrequency in comparison with infections and malnutrition. However they remain usually lethal instead of a great improvement of their prognosis in suitable therapeutic conditions. The objective of this study was to determine the epidemiologic and evolutionnal profile of these pathologies, and identify practical management problems in a reference public pediatric service in Senegal. We retrospectively analysed hospitals registers and records of all patients followed up in Albert Royer Children Hospital of Dakar from january 1989 to december 1998. During this ten years period 25 cases of malignant hemopathies were diagnosed among 32,789 hospitalised children, representing an hospital prevalence of 0.08 per cent. Mean age at the desease diagnosis was 9.5 years and sex ratio 2.57 (18 boys and 7 girls). The malignant type was acute leukemia (AL) in 11 cases (44%) including 9 cases of of acute lymphoblastic leukemia (ALL) and 2 cases of acute myeloblastic leukemia (AML); chronic myeloid leukemia (CML) in 2 cases (8%), Hodgkin's desease (HD) in 9 cases (36%) and non hodgkinian lymphoma (NHL) in 3 cases. NHLwere Burkitt type in 2casesand lymphoblastic type in 1 case. Their was no maxillary or facial localisation in Burkitt type lymphoma. The mean duration between the first clinical symptomes and the diagnosis of the disease was 4 months and delayed diagnosis was mainly due to delayed transfer from peripheral health services to hospital. Among 19 patients whose records were available, 17 were subjected to chemotherapy. However reference protocols were completely applyed in only 2 cases, one with HD and an other with lymphoblastic lymphoma. Transfusion managementwas not sufficient because of the lack of blood derived products (packed platelets or leucocytes) when needed. Thirteen patients died while followed up and mean survival after first hospitalisation in these cases was 120 days in ALL, 38 days in AML, 2.5 years in HD and 18 months in NHL The other patients were lost of sight and presumed to be dead at home. Eventually, this study showed that, in our hospital, children with malignant hemopathies did not derive benefit of therapeutic progress enregistered long time ago in developed countries, since they remain constantly lethal. The main factors of lethality could be delayed transfer to hospital because of lack of knowledge about these pathologies in the peripheral health services and poor therapeutic conditions in reference hospitals. Creation of specialised clinical haematology department could enable us to improve the prognosis of these affections by an optimal use of available human and material ressources.

The objective of the study was to describe risks factors of cerebral palsy and to determine clinical forms. From November 1998 to July 2000,we conducted a prospective study to select outpatients showing cerebral palsy symptoms: so 93 children with age between 5 months and 11 years old entered on this study. For 44.08% cerebral palsy was related on pregnancy abnormalities, 32.26% have central nervous system infection and 8.6% have convulsions unknown cause . The cause of cerebral palsy was untraceable in 13.98% of the cases. 82.8% of the children have cerebral palsy associated with other handicaps. The commonest type of cerebral palsy was spastic forms (74.2%) followed by hypotonic cerebral palsy (16.13%), dystoniaathetosis and ataxic forms in 5.37% and 4.3% of the cases respectively. The overall prevalence of epilepsy was 46.23%. The other handicaps were neurosensoriel abnormalities (visual impairment, deafness), speech disorders and behavioural problems. Computerised tomography (CT), performed in 45 cases showed cortical/subcortical atrophy as the commonest brain lesions. The electroencephalographic abnormalities were identified frequently.

Major thrombocytosis associated with severe anemia is uncommon in pediatrics. We report 9 consecutive cases observed in Albert Royer Children Hospital of Dakar. They were 7 boys and 2 girls 4 to 15 years old (mean age = 10 years). Six patients had a history of geophagia and 3 presented recent emission of worms by the stools. Anemia was clinically well tolerated in all cases. In initial blood count platelet levels varied from 800 10(3) to 1180 10(3)/mm3 (mean = 1032 10(3)/mm3), while hemoglobin level varied from 3.4 to 7.4 g/dl (mean = 4.9 g/dl). Anemia was microcytic, hypochromic and associated with low serum iron level in all patients. We considered the diagnosis of reactive thrombocytosis induced by iron deficient anemia in all cases. Platelet count and red cell indices were progressively normalised with iron treatment and no complication of thrombocytosis was observed. Considering published data, iron deficiency is one of the most frequent causes of reactive thrombocytosis in children. The physiopathologic mechanism, still unknown, could involve cytokines of thrombopoiesis. Reactive thrombocytosis induced by iron deficiency or other factors have usually a benign course and need no specific treatment other than that of the etiology.

Every patient operated for nodular goiter by a partial surgery is exposed to recurrence. In order to verify this idea, the authors followed 36 patients operated on for nodulargoiterat least 10 years ago. A clinical examination for all the patients and echographic study for 24 of them allowed the detection of recurrence and the evaluation of survival and recurrence without any opotherapy. It seemed that clinical recurrence is observed in 16.65% of cases whereas echographic study revealed recurrence in 50% of patients examined. Only two patients were reoperated on. The predictive factors of the recurrence are geographic endemic origin and ethny, partial surgery and vesicular goiters. With 66.65% of survival without recurrence at 18 years without opotherapy, the authors argue about the utility of such treatment.

Arachnoïd cysts are rare. 1% of cranial neoformation. We report the case of a six years old boy who presented an arachnoid cyst impressive by its compressive phenomena. Present complaint are macrocrania and right orbitary tumor. Tomodensitometry reveal a huge liquid collection which starts from the right cerebellopontine angle to the frontal region and invading the orbital cavity. In addition we have a thalamic fusion Its congenital origin is obvious. The associated malformations seem to be related to an anomaly of the centre line. This case point out the primum movens of malformations which are often complex and whose antenatal diagnosis is rare in our countries

Authors report the case of 3 years old boy. He represented a severe head injury with dura mater damage and skull fracture. He has been operated and few years later, he present a vault tumefaction. CT scan show a very large bone defect, a cerebral and ventricular hernia. Mecanism and causal factors are discussed.

Varicose disease and venous thrombosis were reputed exceptional among black africans and almost all leg ulcers were called "tropical". We have treated 20 cases of postphlebitic ulcers in the teaching hospital of Dakar between march 1989 and december 1992. There were 12 men and 8 women. Mean age was 40 years (24 to 60 years). The initial venous thrombosis dated at mean 8 +/- 3 years. It was confirmed in a hospital in 10 cases and found in the medical history of all patients. All patients presented leg ulcers with non systematised venous varicose and trophic troubles. The ulcers treated only by dressings lasted a duration of 4 months (2 weeks to 9 months) without healing. In view of this failure we have added an ambulatory elastic contention with elastic bandage putted on at hospital after that biweekly dressing until cicatrisation followed by putting elastic socking with degressive compression. We have observed a quickly cicatrisation in mean time of 4 weeks (2 to 6 weeks) with good tolerance of socking. Only 3 patients showed recurrence. Elastic contention has a great place in the treatment of postphlebitic ulcers which are not that exceptional among black Africans.

This report is a retrospective study carried out from records of diseased of asthma, fallowed up in a paediatric national center of reference during the period from 1st of November 1987 to 31 st of august 1993. The goal was to describe the epidemiological and clinical factors linked to that affection in order to better contribute to improve its managment. For all the diseaseds of this report we notice and analysed the socio economical data, the promoting factors the occurring mode of the disease, the main clinical manifestations of the affection and their consequences. The morbid association and the data of the paraclinical exploration particularly the functional breathing exploration. Thus we noticed that the consultation in a specialized center occurs relatively late because of bad orientation of the deseaseds. In effect the mean age of diseaseds at the first consultation is 7.5 years while the disease begins in average at 3.5 years. By elsewhere we notice that 15% of these diseaseds live in an aggressive mesologic medium. With an atopy in 78.4% of the cases, loaded personal case history in 96.6% of the cases and that the releasing factors are not known for most of them (81.9%). Asthma in our diseaseds is not very frequent (77%) in general with a moderate intensity of crises (69%). However disturbances of physical activity are noted among 23% of the sample which corresponds nearly to the number of subjects with severe respiratory obstruction (25%). We quoted that there is an relation ship between the frequency of the cases the intensity of the crisis and the disturbances of physical activities of the diseaseds (x2:25.9, df = 2, p= 0,000002). Tacking count of all these factors may serve to set up a asthma prevention and treatment project in Senegal based on populations education and care providers training.

Calcified brain abscesses are rare. A huge one is reported. A six years old feale had a fistula at the left frontal region for about three years. Patient was gored by a cow. Three years later Staphylococcus aureus was identified in the pus. The post operative neurological recovery was good.

Hemolytic uremic syndrome (HUS) is an nonexceptional complication of infectious gastroenteritis. No one has already been reported in Senegalese publications. We made a retrospective study of the record of 7 patients with HUS among 256 cases of children with bloody diarrhea presenting to the pediatric unit of Aristide Le Dantec between august 1998 and july 1999. The mean age of the children was 33,14+/-25 months and the weight was -2,29 DS. The diagnosis is supported by the findings of an acute renal failure with urea at 1,28+/-0,51g/ l and creatinine at 41,46+/-25,48mg/l. An hemolytic anemia was constant, the blood film revealed schizocytes. We found a thrombocytemia only in two cases. A hight white blood cell count (more than 50000/mm3) was noted in for cases. Only one child made a good recovery. We insist on preventing gastroenteritis and aggressive and adapted management of the HUS.

The recent introduction of laparoscopic surgery in the therapeutic arsenal of duodenal ulcer enabled us to carry out these interventions by abdominal route in order to appreciate the early results. It concerned a prospective study from March 1999 to August 2000 of 53 cases of which were 47 men and 6 women, aged from 16-75 years average age 52 years. Twenty six patients had pyloro-duodenal stenosis, the rest, chronic duodenal ulcer. Vagotomy was carried out on a patient on dorsal decubitus under general anesthesia with oro-tracheal intubation operator within the legs of the patient and the monitor at the right hand side. The process required four trocars depending on the morphology of the patient. A pneumoperitoneum of 3-5 litres permitted to attain the oesophagial hiatus by collapsing the pars-flaccida of the minor epiploon, the reperation of the right diaphragmatic pillar and the discovery of the posterior vagus nerve which was coagulated and sectioned. The traction of the body of the stomach towards the ombilious exposed the anterior portion of the stomach, thanks to the coagulator, the anterior branches of the vagus nerve are sectioned. Drainage by minilaparotomy terminates the intervention if only stenosis existed. Mortality was nul. The time of intervention was 35 to 135 minutes with an average of 71 minutes. The hospital stay was between 3 and 12 days with an average of 5 days. Three conversions to laparotomy (difficultdissection, liver cirrhosis, breakdown of materials), pleural wound consisted the morbidity. Two cases of re-operation due to evacuaton poorly appreciated in pre-operation period were observed. The results according to Visick criterias were: 1 : 51; II : 0; III : 0; IV: 2 patients for a follow up of 3-17 months. Vagotomy under coelioscopy is an intervention which permits to obtain results comparable to those of conventional surgery.

The authors report in a retrospective study, 20 cases of cauda equina compressions operated in the Neurosurgical department of the University Hospital of Dakar. Clinical aspects, aetiologies, and prognosis are discussed. Cauda equina compressions represented 13.2% of all medullar and radicular compressions. Diagnosis was delayed with a mean duration of 11.2 months. Chronic lumbar pain is the main initial sign, diagnosis is made at the state of paraplegia with sphincter dysfunction. Lumbar canal stenosis (40%) and herniated disc (30%) were the most frequent causes, tumors were rare. Surgical treatment gave good results about motor deficit; urinary incontinence is a frequent sequella. The authors emphasize an early diagnosis for prognosis improvement.

The authors report the results of a retrospective study on the effect of traumatic injuries observed among newborns from forceps deliveries in the maternity ward of Abass Ndao hospital between January 1st, 1995 and December 31, 1996. Forceps deliveries represent 5.89 for 1000 of total deliveries and 47 for 1000 of nursery admissions. Traumatic injuries are found in 44.77 % of the newborn by forceps deliveries. They are dominated by the hematoma of scalp in 23 cases and facial nerve injuries in 6 cases. The were about 76.66 percent of primipare among which 30 percent were adolescents. Maternal age, parity, gravity as well as birth weight for forceps deliveries were not significantly different from those without any injuries (p < 0.05). However, traumatic injuries of the newborn were more frequent when the forceps were performed by medical resident. The neonatal mortality is 10.44%. We recommend the teaching of the technique for an improvement of technical competence.

Authors record a preliminary study led so as to develope techniques of preparation of the cardiac homograft valves. Eight human hearts have been appropriated in the course of medico-legal autopsy. Under sterile hodd, the heart was dissected, aortic and pulmonary valves as well as a mitral valve fragment were collected for a total of 24 valvular levies. After sterlization in an antibiotic solution, valves were preserved at 4 degrees C for the mitral fragment specimen of fresh allograft and to - 196 degrees C in Nitrogen liquidates for the pulmonary and aortic valves. The control of graft quality had consisted in tests of competence during the dissection, to the evaluation of the histological study as well as tests of sterility. Cellular cultures had shown a fibroblast proliferation in 3 cases. It concerned an indeed reliable method but difficult and little sensitivity. Histological tests had shown two types of injurie: the myxoid degeneration (7 times on 8 valves) cryopreserved and a coagulative necrosis whose distribution was identical forthe two modes of conservation. Antibiotic's solution seemed to induce these injuries as do heart ischemia, and the traumatism lihleed to the great cold. The tests of sterility had shown a rate of contamination to 25 % essentially by Pseudomonas. In view of the installation of a behle of allograft bank of quality, we'll need to improve conditions of leavy, to use a freezer adaptation for progressive cryocongelation and the choice of simple method to evaluate valvular viabilty.

Objective: to study the particularities of the bladder lithiasis in our countries. This was a retrospective study of 94 cases (62 men and 32 women) of bladder lithiasis over a period of 13 years. The lithogenic factors; clinic, paraclinic and therapeutic aspects have been studied. Morphoconstitutional analysis has been carded out in collaboration with Cristal Laboratory (St Cloud hospital center in France)., Results: mean age was 24.2+/-20.7 years old. The principals mains of consultation were: dysuria (n =36), mictionnal pain (n = 28), hematuria (n = 15). Facilitating factors have been found in 27% of cases. In 10 cases, there was an association bladdder lithiasis and bladdder-vaginal fistula. Radiologic test was dominated by intraveinous urographic (53.19 of cases). The metabolic test showed hypercalcemia and cristalluria in 2 cases. In 7,45 % of cases, we have founding a renal failure. An urinary tract infection have been noticed in 42 % of cases. Open surgery has been the main treatement (96 %) associating in 15 % of cases the treatement of an uropathy. In one case the bladder lithiasis weighed 1120 g. The morphologic and spectrophotometric analysis of the lithiasis have been achieved in 13 % of cases showing the predominance of struvite., Conclusion: the bladder lithiasis is still common in our countries; it could be good for us to access endoorporeals and extracorporeals therapeutic equipements in orderto reduce the indications of open surgery.

Second reason for consultations in proctology in our department after hemorroïds-linked illnesses, fistulas in ano constitute a chronic disease which causes therapeutic difficulties linked mainly to the futur functionning of the sphincter, especially in its most complex types. In our group of 43 patients in whom surgical exploration with stylet was the key of the diagnosis, the anorectoscopy and even less chirurgical examination were not often contributive, the fear of post-operative incontinence forced us to prefer ligation-section with rubber every time that the sphincter was involved. With our results, the majority of patients (41/43) healed in normal periods with a sufficient functionning of the anus. This result confirmed our attitude towards the sphincter: that is to save if possible.

Rubella is an innocuous illness in adult unless it is contracted by a pregnant woman. We recently observed a case of congenital rubella in the department of neonatology of Abass Ndao hospital in Dakar. It's a female new-born, born after 40 week gestation, with a well followed pregnancy. The first clinical examination shows a severe intrauterine growth retardation and bilateral comeal opacity. Maternal and new-born serologic confirmation is obtained with positive rubella specific IgM and IgG. We also find severe ocular pathology, hearing deficit and associated cardiac disease. This case shows the needs for preventive strategies, such as vaccination against rubella for women of child bearing age.

The intramedullary abscess (I.M.A.) is an uncommon and heavy etiology of intramedullary mass syndrom. Since the first description by HART in 1830, about 82 cases have been reported in literature and in one case, it was associated to H.I.V. infection. The authors report a new case in a 52 years old Senegalese man with per operative diagnosis of I.M.A. and post operative diagnosis of H.I.V. infection. They set up difficulties of pre operative diagnosis, and poor results of treatment in such an association. Also they discuss pathogeny and share Magnetic Resonance Imaging (R.M.I.) studies in management.

We studied the preschool (2-5 years) group of child's oral health status in Ziguinchor, the southern regions of Senegal. Our objective was to make the inventory of fixtures dealing with dental caries, gingivitis and tartar among the children of this age group. It's a transversal study based on a clinical examination of a sample size of 168 children collected by stratified random sampling in 12 neursey schools in the region. We used carious (dmf/t), gingival and plaque indices to estimate, orodental status of the population constituting the sample. In the lump, 60.71% of the children have a natural history of dental caries with a mean dmf/t of 2.47 and gingivitis and or tartar are observed in 42.86% of the children. Even children less than 3 years are affected. None age may no longer be free from these diseases. That lead us to suggest to set up in this regional area a preventive program involving mainling the parents and the educators and based on the oral health education and the optimal use of dental products with fluoride since the drinking water in the region is poor in fluoride. The aim of this program would be to reduce the prevalence of the diseases in the proportions indicated by the world health organization and even eradicate these diseases among the prescolar children during the coming years as it's going on actually in the developed countries.

The objective of this work was to describe the clinical and therapeutical aspects of pathology of the peritoneo-vaginal process. We have performed a retrospective study including 160 patients operated between January 1990 up to December 1996. Mean age at diagnosis was 8 years, ranged from 1 month to 13 years old. All patients were male. The abnormality was located in the right side in 60% of cases and was bilateral in 6.7% of cases. The main clinical features were scrotal mass (81%) and scrotal pain (13.46%). The diagnosis was made at birth only in 20% of cases. A maldescended testis was associated in 7.5% of cases. A groin incision have been used in 91.25% of patients. The average hospital stay after surgery was 1 day. Thus, the pathology of the peritoneo-vaginal process is common and apparently banal. Need for treatment through a groin incision owing to the possibility of associated maldescended testis.

From January 1991 to July 1998, 24 patients were operated for pulmonary aspergilloma. All the patients presented previous tuberculosis treated. Hemoptysis had been the revealing elements of the illness in 80% of cases. Treatment was by resection in all the cases: 13 pneumonectomy (54%) and 11 partial resections (46%). The procedures were usually difficult and hemorrhagic. The global mortality was 20%, can be explained by the high number of major resections and the unfavourable general state of health of our patients. Post operative complications are mainly due to secondary empyemas encountered in 15% of the surviving ones. The surgical resection of pulmonary aspergilloma is still difficult and risky for extended underlying parenchymal disease. Minima procedures such as speleotomy and intra cavitary aspiration technique must be indicated in patients with very poor general condition.

Prostate's surgery is an haemorrhagic one owing to difficulties of surgical haemostasis and anomalies of the blood coagulation. The aim of this study to assess haemostasis anomalies after protatectomy for benign prostatic hyperplasia (BPH). We have performed a prospective study including 50 men of more of 55 years old. All of them underwent suprapubic open prostatectomy. Significant pertubation of haemostasis, particularly fibrinolysis has been found. We have noticed fibrin degradation product in 88% of cases after intervention versus 62% before (p < 0.001) and a decrease of plasminogen rate in 94.4% of operated patients versus 82% before. The older the patient were, more important were the pertubations. Moreover, the anomalies were most important when the duration of surgery lasted more than one hour and when the BPH was voluminous. However, the disturbance of haemostasis was rarely associated to clinical symptoms. So, we do not recommend any therapeutic when clinical symptoms are absent. Biological screening the day of surgery, the day after and one week later are necessary to prevent haemorrhage.

We report a case of giant ovarian cyst in pregnancy of 23 weeks of amenorrhea revealed by digestive and respiratory compression. As the absence of ultrasonographic and biologic malignancy criterias, several punctures of the cyst were done permitting the evolution of pregnancy until the preterm period. An annexectomy done in the immediate post-partum permitted to avoid the frequent mechanical accidents during this period. From this case, we discuss clinical and therapeutic problems of this association.

The association of benign prostatic hyperplasia (BPH) and inguinal hernia still pose the problem of the chronology of their repair. Indeed, first hernial repair without removing the cervicoprostatic obstruction exposes to a high rate of recurrence due to the dysuria. The objective of this work was to report our experience about the simultaneous cure of the BPH and inguinal hernia. We have performed a retrospective study including a non consecutive series of 92 patients presenting both BPH and inguinal hernia. Studied parameters was age, occupation, clinical symptoms, the procedure and operative continuations. Mean age was 70.22 years old, range from 57 to 90 years old. Past history of inguinal hernia repair was found in 18.5%. 19.13% had hernial recurrence while 6.5% had contralateral hernia. Main clinical features were inguinal mass (43.5%) and acute urinary retention (11.9%). The average weight of prostatic tumor was 87.1 g. Surgery was performed under spinal anaesthesia in 96.8%. All patients underwent suprapubic transvesical prostatectomy. Hernial repair was done according to Bassini procedure in 82.6%, Mac Way procedure in 14.2% and Forgues procedure in 3.2%. The overall morbidity rate was 15.2%. The hernial recurrence rate was 7.6%. There was no postoperative mortality. The simultaneous repair of BPH and inguinal hernia offers some advantages. First of all, it reduces considerably the anaesthetic risk owing to the importance of cardiovascular diseases in aging patients. On and other hand, the low recurrence rate of the hernia and the substantial savings are adjunct advantages. We conclude that simultaneous repair of BPH and inguinal hernia is simple, safe and economic.

This cross sectional survey carried in april 1995 aimed to assess the nutritional status of the women old enough to procreate++ and the children less than 5 years old in the community of Mpal (District of St Louis). The method of sampling used was the method of stratified poll. The assessment of the nutritional status is carried among the women by measuring the brachial circumference and the corporal mass index. Among the children, the indicators used were the ratios: weight-age, weight-height and the brachial circumference. The results showed a rate of malnutrition very high in comparison to the national averages as well in ythe women old enough to procreate (31% versus 17.4%) as in the children (11% of acute malnutrition versus 8.7% and 24.4% of chronic malnutrition versus 21.7%). The young mothers and the children more than 3 years old were the more frequently reached. It urges to set up in this locality a programme of struggling against malnutrition based on the integration of the economics activities of the communitary groups to their health activities.

Cervical spondylotic arthRosis may lead to a myelopathy and the question which can rise is: posterior surgical decompression is adequate regarding the others surgical technics discussed? In this paper the authors describe the postoperative results of 42 patients who have been operated on by laminectomy from 1971 to 1995 at Fann Hospital in Dakar. The median age was 42 years and the median delay between the onset of neurological disorders and operation was 5.9 months. All patients showed symptoms of spinal cord and root disturbances. Neuro-imaging studies with plan X-rays and myelography reveal arthrosis and the impact of this arthrosis on nervous system. With a follow up of 6 months we found a mortality rate of 4.7% (two cases of death), 66.8% of good results and 28.5% of fail. Eighteen months post surgery results were respectively 52.3% and 45.7% of good and poor results. The complications of the laminectomy were peri operative hemorrhage (19%); sepsis (21.4%); spine cord traumatic injuries (9.5%) spondylolisthesis (4.7%). Laminectomy has been found to improve "spine syndrome"; paresthesia; fasciculations, and sensory deficits. Also three level laminectomy and surgery which can take place before six months are good prognosis factors. The authors stressed on laminectomy because of our low medical care situations particularly that no other surgical procedures through the modern literature leads to better results.

The authors proceeded to a 7 month long prevalence survey on epilepsy in the schools of the regions of Dakar and Thies in Senegal, West africa. It consisted to a cross sectional descriptive study targeting the children between 3 and 10 years old. The W.H.O. questionnaire on epilepsy was used for data collection. Among the 2803 children of the population study, 58 were detected suffering from epilepsy, realizing a prevalence rate of 21%. The males were more represented (62% of the epilepsies). All the epileptic children presented generalized seizures represented either by "Grand Mal" generalized tonic-clonic form (84.4% of the epilepsies), or by "Petit Mal" absences (15.6% of the epilepsies). The etiological forms were dominated by idiopathic epilepsies. Secondary generalized cases represented 31% of the epilepsy and were essentially detected in rural areas. They were usually related to obstetrical traumas (61.1% of the secondary generalized epilepsies) or to child encephalopathy with seizure attacks (38.9% of the secondary generalized epilepsies). It appears also from this study that epilepsy remains a dramatic public health reality and is more frequent among low economy income people who have less access to the health care system.

The authors report a surgical experience on eight case of intra spinal lipomas. These lumbo-sacral malformations belong to post-neurulation defect, in such conditions spinal cord undergoes tethering while child growing that lead to a slow neurological disturbance. Through this study, authors show that female is more involved than male (5/3. On 6 cases the diagnosis have been made before the age of 2 years old. Three groups of signs characterize dramatically intra spinal lipomas: skin-median lumbo-sacral stigmata (8 cases) such as hypertrichosis, nevi etc. neuro-orthopedic disturbance(3 cases): club foot, paraparesis. sphincter disturbance: vesical or anal incontinence. In the lack of C.T. scan and M.R.I. contrast medium myelography confirm the diagnosis. Surgical excision lead to characterization of 4 extra dural lipomas, one sub dural, and 3 mixed lipomas. 75% of the patient improved well. One dealing with this kind of pathology must avoid the misdiagnosis of enuresis.

The association between Peyronie's disease and diabetes mellitus or Dupuytren's disease is well described in the literature with a certain frequency. Through our 10 patients with Peyronie's disease, when have noticed that only one of them is undergoing diabetes mellitus and no one has Dupuytren's disease. But 7 of them presented clinical and/or electromyographical signs of peripheral neuropathy. So after clinical examination in neurology and urology, we performed measurement of motor conduction velocity of tibial posterior nerves and peroneal nerves, then, we measured sensitive vetocity of sural nerves and dorsal nerve of the penis and we studied the cortical somesthesic evoked potential of the internal hontous nerve and the sympathetic evoked response of the skin. So we hypothesize that peripheral neuropathy with or without autonomic disorders might be an etiological co-factor of Peyronie's disease.

Authors present 13 cases of spinal neurinomas and neurofibromas out of 418 non- pottic, non-traumatic medullary compression operated between 1965 and 1995. All cases were histologically documented. Neurinomas and neurofibromas represent 3.1% of all non pottic, non traumatic medullary compression and 12.8% of tumour medullary compression operated in our service. The illness started with radicular pains (6 cases) and spinal ache (5 cases) and most of the time, the medullary compression diagnosis is completed at the spasmodic paraplegia status. No patient has done any C.T. scan but in the other hand a myelography has been completed in all cases, resulting in the blockage of the contrast product which in 4 cases was of an epidural type, and in 2 cases of intra dural type. All patients were operated through a posterior approach, which ended in 10 cases to a total removal, and in 3 cases to a partial one. 7 extradural localizations were noticed and 3 neurinomas, 3 neurofibromas and 1 neurofibrosarcoma were histologically identified. A post operative follow-up was done on 11 patients and a satisfactory result was obtained on 6 of them. In 2 cases, the neurological status remained unchanged. In 2 cases a deterioration occurred and a patient with neurofibrosarcoma passed away.

The authors report here by a retrospective study 58 cases of Staphylococcus aureus empyema at Albert ROYER child hospital located in the Fann University Teaching Hospital of Fann between January 1st 1992 and December 31, 1995. In this study staphylococcus aureus is the bacterium involved in pleural effusions of the children (54%) a long way ahead Streptococcus pneumoniae (16%). Infant less than 30 month is more affected (86%). The average age of the patients is 16.8 month +/- 16.6. The resistance of the germ to usual antibiotics, the precariousness of the research field and mechanical complications linked to the outpouring explain their seriousness. The treatment lies upon an adapted antibiotic and bactericidal therapy associated to closed chest tube drainage.

A retrospective study carried on between april 1st and september 31st 1997 has helped in collecting. 69 cases of low birth weight new-born (weight < 2500 g) at Abass Ndao hospital center in Dakar. The above population has been compared to 79 eutrophic new-born of mean birth weight equal to 3047.7 +/- 311 g (witnesses). The goal of this study is to appreciate the relationship between the maternal age, the number of the gestation, the parity, the nutritional status, the maternal pathologies during pregnancy and the low weight at birth. There was no difference between both groups as regards to the mean age (p = 0.44), the mean number of gestation (p = 0.7) and the mean parity (p = 0.48). On the other hand, the weight of the mother is smaller as for the group of low birth weight but the mean body mass index stand at normal in both groups. The pathologies during pregnancy period were obviously more frequent in the group of low birth weight new-born. There is a real need to insist on the preventive measures to be taken and the treatment of the maternal pathologies during pregnancy.

Adolescence is a period of change where the person is seeking an identity. This period is characterized by an early sexuality with early pregnancies and risky deliveries. The objectives of our study are to show the epidemiologic aspects of adolescent pregnancy and to identify its obstetrical factors. It is a prospective study held in one year, from August 1st 1991 to July 31 1992 including all pregnant adolescents and those coming for delivery at the Obstetrics and Gynecology clinic at the University teaching hospital Le Dantec. The prevalence of adolescent pregnancy is 3.7% and 84% are primiparous. The non-educated represent 65% and 55% are married. Early sexuality and early pregnancy are mostly seen among Pulars. The complications during pregnancy are toxemia and its accidents (17.6%), premature rupture of membrane (4.4%) and anemia (2.5%). Adolescent who had not received prenatal care represent 11% and 38% had not received enough care. Normal delivery happened in 67.5% and the C-section represented 7.5%. 3% of the adolescents had done unsafe abortion. No maternal death was observed. 89.1% live births were reported, however, 18.4% needed intensive care. Because of the obstetric and neonatal problems, early pregnancy should be prevented through a active collaboration of divers partners.

Penetrating spinal cord injuries (P.S.C.I.) are rarely described in Sub Saharian countries in spite of an increasing number of wars. To study epidemiology management and prognosis of P.S.C.I. in Senegal, population of 16 patients collected from Fann Hospital in Dakar has been studied. 9 cases were related on gunshot or shrapnel injuries and 6 were stab-wounded. 8 came from war practice and 7 from civilian practice. The point of entry was at the posterior or lateral part of the body and continuous leaking of cerebral spinal fluid from this point was founded only in one patient. Patients showed a clinical picture of a complete spinal cord section syndrome, 3 spinal cord hemisection Brown Sequard syndromes, 3 cauda equina syndromes and 1 monoradicular syndrome. Spinal X-rays or myelography may lead to an accurate evaluation of the extent of bone tissue destruction. Anatomical evaluation of roots and spinal cord lesions were more difficult when C.T. scan or R.M.I. is not available. Penetrating spinal cord injury with foreign body included or myelography stop or showing cauda equina syndrome should be operated on. 9 of our patients has benefited of spine surgical posterior approach (laminectomy). Immediate vital prognosis is good regarding the fact that visceral associated lesions were rare (2 cases). Functional recovery is fair only 46.6% of patients expressed partial or complete recovery. Prognosis factors such as injuring agent and initial neurological status has been discussed. Prognosis of penetrating spinal cord injuries could be improved by immediate and multidisciplinary management.

From 1975 to 1995, 335 patients were operated for hydrocephalus in neurosurgical clinic of CHU Fann, and got ventriculo-peritoneal shunt. 3 cases of patients presenting an uncommon complication of ventriculo-peritoneal shunt: abdominal pseudo cyst, are reported and discussed. The digestive symptoms are the first to manifest themselves for a period of time, then confusing with other forms of abdominal cysts. The suggested treatment is to remove the shunt from the peritoneal cavity and perform a ventriculo-atrial shunt, then to proceed to a laparotomy, drain the fluid and resect the cyst wall. The results are excellent.

Spinal cord compressions are mainly due to Pott disease. We present a rare case. A 31 years old woman presenting a spinal cord compression due to an aspergilloma. Our patient presented also a pulmonary aspergillosis. The spinal compression was due to a contiguous extension of aspergillus to the epidural site. The treatment associated surgery and medical treatment (Ketoconazole), with efficient results.

In this paper, one case of syndrome of caudal suppression associated with a syndrome of Klippel Feil is discussed. It concerned a 14 years old boy, born form a diabetic mother with congenital abnormalities such as: urinary incontinence, facial dysmorphia, a short neck, an arachnodactylia, a lumbar kyphosis, a permanent flexion of the knee, a kalipe cavus, the spine, a partial agenesis of the third and fourth lumbar vertebrae a total agenesis of the fifth and sacrum; This syndrome is infrequent and the pathophysiological mechanisms are still under discussion and no therapeutic strategy is proposed. This case offers an opportunity to the authors to make review of the medical literature on this subject. They emphasized on the interest to look for a vertebro-medullary malformation every time a child comes to us with walking problem or enuresia, this fact should be enforced when mother is diabetic.

The authors report 8 cases of facial palsy collected in the Abass Ndao hospital center. Risk factors are dominated by the instrumental manipulations during delivery. Prognosis is however generally good.