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Traumatisms represent the first reason of death in people less than 40 years in the developed countries. In Senegal, with the growth of urbanization, road accidents are more and more frequent and mortality by polytrauma is raised. The aim of this study was to evaluate the management of polytrauma patients in our hospital and to determine factors of mortality. This prospective study was carried out from January to June 2000 at the surgical emergencies department and the intensive care unit in Le Dantec Teaching Hospital of Dakar. One hundred and six polytrauma patients were taken care of during the study period. The mean age of patients was 30 years. There were 85 men and 21 women. Circumstances of trauma were dominated by road accidents (74.5%) and in 77.4% of cases patients were evacuated without prehospital care. The mean delay from the accident to the arrival at emergencies was 8 hours. Half of the patients presented to the admission a clinical picture of circulatory failure; respiratory distress was also present among 50% of patients and 53.8% of patients had a serious head injury with a Glasgow coma scale lower than 8. The global mortality was 69.8% and 80.6% of these deaths were attributable to serious head injury. Management of trauma patients in Dakar could be improved by setting up a medical transport system and by the improvement of the technical means in the hospitals. These measures, in combination with the prevention of road accidents, will surely allow to reduce the number of accidents, polytrauma and deaths.

The goal of this prospective work is to study the per- and post-operative complications of spinal anaesthesia for cesarean and to evaluate their management. We included in the study all parturients undergoing cesarean section to the maternity of hospital Aristide Le Dantec since December 1998 to March 1999. Patients presented contra-indications of spinal anaesthesia, arterial hypertension and/or acute fetal distress were excluded. After a vascular preload of 1000 ml of Ringer lactate, a spinal anaesthesia was realized through a 25 G needle between L3 and L4 in a sitting position with 12.5 mg of 0.5% bupivacain associated with 1 ml of 10% dextrose. Patients were installed after a left light lateral position and oxygenated via a facial mask with 3 1 per mn until the extraction of the child. Studied parameters are following: the sensitive level block before surgical incision, per- and post-operative complications and their management. Sensitive level block was up to T4 in 14.9%, between T4 and T6 in 74.6% and at T8 in 23.6%. Maternal hypotension was the only per-operative complication in our study: 52% with 2 cases of cardiac arrest who needed tracheal intubation and injection of epinephrine. Post operative complications were represented by post-dural headaches about 5.4% and no epidural blood-patch were necessary for their management. We have noted any neurological or infectious complication during supervision of our patients.

The objective was to verify if the introduction of ultrasonography in our practice has entailed modifications of the epidemiology and the clinic of pancreatic cancer in Senegal. We have performed a retrospective study of cancer of the pancreas diagnosed on the basis of clinical signs, ultrasonography, surgical findings and necropsy from March 92 to October 97. The chi-square test according to Mantel-Haenszel has been used to compare qualitative variables. The routine practice of ultrasonography has allowed to establish the diagnosis of 107 cases of pancreatic cancer within 5 years and half. The sex ratio was 1.05 and the average age was 60 years +/- 13 without significant difference according to the sex. The mean period of diagnosis was 5 months. However the classic form associating thinness and cholestatic jaundice or palpable abdominal mass dominated the clinical symptoms (74.5% of cases). A very deep alteration of the general status has been noticed in 25.5% of cases. At surgery, according to the TNM classification, 22% of our patients were at stage II and 78% from stage III to IV. In Senegal, the prevalence of pancreatic cancer is increasing since the introduction of ultrasonography. This technique has shown that the male predominance is less than reported in previous studies. Nevertheless the diagnosis remains late. As far as we cannot identify risk groups, recent appearance of digestive disturbance even atypical after 50 years old, is enough to suspect the diagnosis.