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Majaliwa Shabani,1 Seydina Alioune Beye,2,* Abdoulaye Traore,3 Pablo Echave,4,* Xavier Raingeval,5,* Daouda Coulibaly,6 Sophie Crespo7,* 1Health_unit, International Committee of the Red Cross, Bamako, Mali; 2Anesthesia Department, Clinique Périnatale Mohamed VI, Bamako, Mali; 3Anesthesia Department, Hôpital Somine Dolo de Mopti, Mopti, Mali; 4Anesthesia Department, Université de Sherbrooke, Sherbrooke, Quebec, Canada; 5Association de Développement et de Recherche en Anesthésie Locorégionale Echoguidée (ADRALE), Paris, France; 6Surgery Department, Centre de Santé de Référence de Kidal, Kidal, Mali; 7Health Unit, International Committee of the Red Cross, Geneva, Switzerland*These authors contributed equally to this workCorrespondence: Majaliwa Shabani, Health Unit, International Committee of the Red Cross, HAMDALLAYE RUE 239, Postal Office Box: 58, Bamako, Mali, Email mshabani2001@gmail.comPurpose: The posterior femoral cutaneous nerve (PFCN) block is used in regional anesthesia for lower extremity surgery. This study introduces a new ultrasound-guided technique called the “Gluteus-Deep Investing Fascia compartment Block (GDIF block)“ for blocking the PFCN. This approach involves injecting local anesthetic into the potential space between the gluteus maximus muscle and the deep investing fascia, named the ‘Gluteus Deep Investing Fascia Compartment’. The study discusses the anatomical and sonographic features crucial for identifying this compartment and explores the potential benefits of this approach for achieving effective PFCN block. Additionally, it examines the clinical application of the GDIF block for PFCN block as part of the Complete Lower Extremity Fascia Tri-compartment Block technique, named ”CLEFT Block.” This technique combines the suprainguinal fascia iliaca block with GDIF compartment block for PFCN and a sciatic nerve block as exclusive anesthesia technique.Patients and Methods: Nine patients with weapon-related lower limb injuries underwent surgery at district hospitals supported by the International Committee of the Red Cross. Between October and December 2023, seventeen above-knee procedures were performed for the nine patients using the GDIF block as part of a CLEFT block technique. Anesthesia was performed with a CLEFT block technique using a volume ratio of 1:1 of 1% lidocaine and 0.5% levobupivacaine.Results: The GDIF block technique for PFCN blockade was performed successfully in all patients without complications, achieving complete PFCN blockade. The CLEFT block technique proved effective as the sole anesthetic technique for seventeen above-knee procedures. All surgeries were completed successfully without additional pain medication or conversion to general anesthesia.Conclusion: The GDIF block appears to be a promising technique for anesthetic management, alone or as part of the CLEFT block. Further research with a larger patient population is necessary to validate these findings.Keywords: posterior femoral cutaneous nerve block, deep investing fascia, sciatic nerve block, gluteal deep investing fascia compartment block, GDIF block, CLEFT block

Majaliwa Shabani,1,* Seydina Alioune Beye,2,* Abdoulaye Traore,3,* Xavier Raingeval,4,* Daouda Coulibaly,5,* Sophie Crespo6,* 1Health_Unit, International Committee of the Red Cross, Bamako, Mali; 2Anesthesia Department, Clinique Périnatale Mohamed VI, Bamako, Mali; 3Anesthesia Department, Hôpital Somine Dolo de Mopti, Mopti, Mali; 4Association de Développement et de Recherche en Anesthésie Locorégionale Echoguidée, Paris, France; 5Surgery Department, Centre de Santé de Référence de Kidal, Kidal, Mali; 6Health Unit, International Committee of the Red Cross, Geneva, Switzerland*These authors contributed equally to this workCorrespondence: Majaliwa Shabani, Health Unit, International Committee of Red Cross (ICRC), Rue 239, Hamdallaye /ACI2000 – B.P. 58, Bamako, Mali, Email mshabani2001@gmail.comPurpose: The management of unstable patients with weapon-wounded lower limb vascular injuries presents significant anesthetic challenges. Regional anesthesia blocks, which combine lumbar and sacral plexus blocks, or their respective branches, minimize systemic effects and are deemed appropriate for high-risk patients requiring lower limb surgery. This case series aims to share our preliminary experiences with a combined anesthetic technique—sciatic nerve (SN), posterior femoral cutaneous nerve (PFCN), and supra-inguinal fascia iliaca (SIFI) blocks —in patients sustaining weapon wounds and undergoing lower limb vascular injury repair in austere environments.Patients and Methods: Seven patients with lower limb vascular injuries resulting from weapons who required surgery at district hospitals supported by the International Committee of the Red Cross were included in this study. Included patients underwent surgery for vascular repair and debridement using a combined nerve block technique involving the SN, PFCN, and SIFI blocks between May and December 2023. The blocks were administered using a 1:1 mixture of 1% lidocaine and 0.5% levobupivacaine.Results: The combined block technique for the Sciatic Nerve (SN), Posterior Femoral Cutaneous Nerve (PFCN), and the Supra-Inguinal Fascia Iliaca (SIFI) were performed without complications in all patients. Three of the patients received light sedation prior to the initiation of the block procedure. All surgeries were completed successfully without the need for additional analgesics or conversion to general anesthesia.Conclusion: The combined block technique for the Sciatic Nerve (SN), Posterior Femoral Cutaneous Nerve (PFCN), and the Supra-Inguinal Fascia Iliaca (SIFI) appears to be a safe anesthetic option for unstable or high-risk patients requiring lower limb surgery. Further research with a larger cohort is necessary to validate our findings and to potentially standardize this approach.Keywords: war surgery, posterior femoral cutaneous nerve block, anesthesia in austere environments

Objectif : Identifier les antibiotiques utilisés et évaluer notre pratique en médecine humanitaire. Patients et Méthode : Etude prospective de 30 jours. La saisie et l’analyse des données ont été faites par Windows 8, Epi info 3.5.3 fr et le khi² pour le test statistique. Résultats : Soixante-trois (63) patients répondaient aux critères. L’âge moyen était de 33,3 ± 18, 5 ans. Les femmes rurales prédominaient. Les urgences représentaient 65,1% des cas. L’indication de l'antibioprophylaxie était Gynéco-obstétricale dans 63, 5% suivie de la chirurgie viscérale dans 20,6%, de l’urologie dans 11,1% et de la traumatologie dans 4,8%. Les patients étaient ASA I dans 69,8%. La classe d’Altémeier était II dans 81%. Une antibioprophylaxie a été faite dans 88,9%. Les β lactamines en monothérapie ont été les plus utilisées dans 84,1% suivies de l’association β lactamine-imidazole dans 9,5%, de l’association β lactamine-aminoside dans 1,6% et les quinolones dans 1,6%. Le délai entre l’administration de l’antibiotique et l’induction anesthésique était de : 6 ± 2,4 minutes. L’antibiotique a été administré entre 25 et 40 minutes avant l’incision chirurgicale. Une complication infectieuse a été observée dans 11, 1%. L’évolution était favorable dans 98,4%.Conclusion : Même en situation de crise sanitaire, l’utilisation de l’antibiotique au bloc opératoire doit répondre à des critères dont l’écologie microbienne et le site opératoire sont déterminants.

La cellulite cervico-faciale et thoracique est une diffusion cellulaire d’un foyer infectieux vers les tissus cellulo-adipeux. L’objectif de ce travail était de passer en revue la prise en charge de cette affection, de décrire d’ notre expérience de la prise en charge des cellulites et d’identifier les facteurs favorisants. Il s’agissait d’une étude rétrospective et descriptive d’octobre 2015 à Mars 2016 au Centre Hospitalier Nianankoro Fomba de Ségou. Elle a concerné 09 patients, 05 hommes pour 04 femmes. La porte d’entrée était essentiellement dentaire. Nous avons noté 02 cas de grossesse associés à la cellulite. Nous avons noté une nécrose cervicale et thoracique dans 6 cas et une tuméfation cervicale dans 03 cas. Le traitement était médical avec une antibiothérapie et chirurgical dans tous les cas. Le traitement chirurgical a constitué à un débridement - excision des tissus nécrosés et lavage abondant à l’eau oxygénée et au Dakin avec un multiple drainage. Un drainage thoracique était réalisé chez 3 patients. L’évolution était favorable dans 7cas avec une guérison complète et 2 cas de décès dans un tableau de mort subite. La cellulite cervico-faciale est une pathologie grave du sujet jeune pouvant mettre en jeu le pronostic vital en absence d’une prise en charge rapide et adaptée et pluridisciplinaire.

The aim of this study was to determine the hospital prevalence of nosocomial infections., Patients and Methods: This was a prospective cross-sectional descriptive study conducted over a period of six (6) weeks., Results: 463 patients stayed for at least 48 hours. Of these, 57 patients were included, representing a prevalence of 12.3%. Mean age was 45.4 ± 20.8 years. Average length of stay was 21.7 ± 12.7 days. Patients came from intensive care (17.5%), internal medicine and neurology (15.8% each). HIV immunodepression was found in 14%. An invasive device was present in 93% of cases. Microbiological samples taken were: urine cytobacteriological examination (36 cases), pus sampling (19 cases), blood culture (23 cases). Infections were urinary (30 cases), surgical site (16 cases), bacteremia (15 cases), ventilator-associated pneumonia (2 cases). A germ was isolated from these samples in 94.4% of cases. The germs found were enterobacteria (33 cases), non-fermenting Gram-negative bacilli (12 cases), Gram-positive cocci (6 cases) and yeasts (3 cases). The ecology was dominated by a high level of resistance among the germs involved in these infections., Conclusion: This study showed a high prevalence of nosocomial infections, with a varied resistance profile of the germs involved. It is important to extend this work in order to learn from it.

Background: Lung ultrasound is a non-invasive tool available at the bedside for the assessment of critically ill patients. The objective of this study was to evaluate the usefulness of lung ultrasound in assessing the severity of SARS-CoV-2 infection in critically-ill patients in a low-income setting., Methods: We conducted a 12-month observational study in a university hospital intensive care unit (ICU) in Mali, on patients admitted for COVID-19 as diagnosed by a positive polymerase chain reaction for SARS-CoV-2 and/or typical lung computed tomography scan findings., Results: The inclusion criteria was met by 156 patients with a median age of 59 years. Almost all patients (96%) had respiratory failure at admission and many needed respiratory support (121/156, 78%). The feasibility of lung ultrasound was very good, with 1802/1872 (96%) quadrants assessed. The reproducibility was good with an intra-class correlation coefficient of elementary patterns of 0.74 (95% CI 0.65, 0.82) and a coefficient of repeatability of lung ultrasound score < 3 for an overall score of 24. Confluent B lines were the most common lesions found in patients (155/156). The overall mean ultrasound score was 23 ± 5.4, and was significantly correlated with oxygen saturation (Pearson correlation coefficient of - 0.38, p < 0.001). More than half of the patients died (86/156, 55.1%). The factors associated with mortality, as shown by multivariable analysis, were: the patients' age; number of organ failures; therapeutic anticoagulation, and lung ultrasound score., Conclusion: Lung ultrasound was feasible and contributed to characterize lung injury in critically-ill COVID-19 patients in a low income setting. Lung ultrasound score was associated with oxygenation impairment and mortality., (© 2023. The Author(s).)

Point-of-care ultrasound (POCUS) is an increasingly accessible skill, allowing for the decentralization of its use to nonspecialist healthcare workers to guide routine clinical decision-making. The advent of ultrasound-on-a-chip has transformed the technology into a portable mobile health device. Because of its high sensitivity to detect small consolidations, pleural effusions, and subpleural nodules, POCUS has recently been proposed as a sputum-free likely triage tool for tuberculosis (TB). To make an objective assessment of the potential and limitations of POCUS in routine TB management, we present a Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis based on a review of the relevant literature and focusing on Sub-Saharan Africa (SSA). We identified numerous strengths and opportunities of POCUS for TB management, e.g., accessible, affordable, easy to use and maintain, expedited diagnosis, extrapulmonary TB detection, safer pleural/pericardial puncture, use in children/pregnant women/people living with HIV, targeted screening of TB contacts, monitoring TB sequelae, and creating artificial intelligence decision support. Weaknesses and external threats such as operator dependency, lack of visualization of central lung pathology, poor specificity, lack of impact assessments and data from SSA must be taken into consideration to ensure that the potential of the technology can be fully realized in research as in practice., (Copyright © 2022. Published by Elsevier Ltd.)

Introduction: Over the past two decades, the incidence of acute rheumatic fever (ARF) and chronic rheumatic heart disease (RHD) have dramatically declined in wealthier regions of the world as a result of preventative programmes, improved living standards and access to cardiac surgery. Nevertheless, ARF and RHD are still public health problems in less-developed regions of the world such as Oceania, south Asia and sub-Saharan Africa., Aim: We report on clinical, therapeutic and prognostic aspects as well as the difficulties encountered during this first series of surgery for rheumatic valve disease in Mali., Methods: This was a prospective, descriptive study conducted at the Andre Festoc Cardiac Surgery Centre from September 2018 to August 2019., Results: The frequency of patients having been operated on for rheumatic valve disease was 44.73% (68 patients). The mean age of the patients was 18 ± 10 years with extremes of five and 60 years. The gender ratio was 0.7. The delay to treatment was between one and three years for 39.7% of the patients. The main diagnoses found were: mitral regurgitation in 50% of patients, mitral stenosis in 16.2% and aortic regurgitation in 10.3%. Pulmonary artery systolic pressure was 35-50 mmHg in 19.1% of patients and more than 50 mmHg in 25%. The median cardiopulmonary bypass time was 132 minutes (60-276) and median extubation time was three hours (0-96). The main complications were cardiac, renal, neurological, respiratory, gastrointestinal and infectious. In the immediate postoperative period, we recorded three deaths, which is a mortality rate of 4.4%., Conclusions: Humanitarian efforts have led non-governmental organisations (NGOs) to launch surgical programmes in low-and middle-income countries in an attempt to fill the gap in these fragile healthcare systems. Cardiac surgery requires much expertise from the medical staff, as well as many material and financial resources. Empowerment of the local team is a challenge that is being realised since taking these essential steps of companionship with the NGO la Chaine de l'Espoir.

Objective: to report the epidemiological, clinical, paraclinical and therapeutic characteristics of the first COVID 19 patients in intensive care., Patients and Method: retrospective descriptive and analyticalstudy over 4 months, covering all adult patients tested positive for SARS-Cov-2 and admitted to intensive care., Results: 49 patients, 35 men and 14 women (2% of cases) were admitted to intensive care. The median age was 64 years [26 - 92]. Hypertension (16; 32.6%), and diabetes (11; 22.4%) were the mostcommoncomorbidities. The most common symptoms on admission were cough (38; 80.9%), shortness of breath (35; 74.5%), and fever (33; 70.2%). The median time to onset of symptoms was 11 days. Non-invasive ventilation (NIV) was used in 21 patients (42.9%). Fourteen (28.6%) wereintubated and put onassisted ventilation. The mean hospital stay was 7.77 ± 7.30 days. We recorded 20 (40.8%) deaths. Factors associated with death were high blood pressure, onset of shock, and on mechanical ventilation., Conclusion: Covid-19 remains a public healthproblemwith high morbidity and mortality. The morbidity and mortalityfactorsare: comorbidities and the severity of the clinicalpicture., (Le comité de rédaction se réserve le droit de renvoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de conserver un exemplaire du manuscrit, des figures et des tableaux.)

Ophidian envenomations are a public health problem in Africa, causing 20.000 annual deaths. This mortality reflects the difficulties in the management of these complications, in particular of bleeding complications. We report the case of Mr SL, aged 35 years, farmer, victim of snake bite causing haemorrhagic syndrome followed by a progressive onset of acute abdomen. Ultrasound objectified high abundant effusion. Effusion puncture was performed which showed unclotting blood. Given the re-establishment of the hemoperitoneum after three doses of antivenin serum as well as the coagulation of the samples collected using drying tube, exploratory laparotomy was performed on day 9. It showed retroperitoneal hematoma, with bulging appearance, in the mesocolon which flowed in the peritoneal cavity. Aspiration of 1500ml of blood and rinsing with physiological serum were performed. The postoperative course was uneventful. The patient was transferred to the department of surgery three days after surgery and was discharged on day 19., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts.

Envenomation by snakebite remains a public health problem in Africa. The purpose of our work was to study the acute complications of snakebite envenomation and the risk factors for its complications., Method: This was a retrospective and prospective study over a period of 07 years, which was performed in the department of anesthesia resuscitation and emergencies of CHU-Mother Child "Luxembourg" of Bamako., Results: During this period, 76 cases of Ophidian envenomation were recorded. The average age of the patients was 34 ± 12 years old. . The family of vipers (Echis and Bitis) was the most incriminated 84,61% of the cases. Hemorrhagic complications were observed in 78.94% of patients, other complications (cardiovascular, neurological, dermatological, ophthalmological ...) were observed in 21.05% of patients. The main risk factor for complication observed was the delay in management (> 6 hours delay) in 100% of patients. The absence of serotherapy and or the initial resort to traditional treatment have been complicating risk factors. Almost all victims of Elapidae bites, 89.9% (5/6 cases) died. Serotherapy was performed urgently in 97.4% of cases. The morbidity in our study was 10.52% with a 7.8% mortality., Conclusion: in our context, the management of envenomations by snake bite remains dependent on a multitude of complications. The prognosis is conditioned by the early administration of symptomatic treatment and a specific antidote., (Le comitée de rédaction se réserve le droit de revoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de sonserver un examplaire du manuscrit, des figures et des tableaux.)

Traumatic Brain Injury (TBI) is the second cause of admission in the emergency department at the Nianankoro Fomba hospital of Ségou. Young adults with low income are the most affected. The objective of this study is to evaluate the direct cost of the management of TBI at the emergency ward and to make a proposal for future financing of this management in Mali. We conducted a prospective study from September 2009 to December 2010 at the Nianankoro Fomba hospital of Ségou. All patients admitted in the emergency ward for TBI for more than 24 hours were included. The age range between 21-40 was the most affected. All socioprofessional categories were affected. The average cost of prescription was 55,392 CFA. Medical evacuation was necessary in 15 cases for an average fee of 60,700 CFA. Due to lack of money, 75% of deceased patients were not evacuated at the third level. The average cost of management was 99,385 CFA [range: 39,115-282,944]. The total cost of services was 7,269,320 CFA. The high cost of the management of TBI is a major determinant of morbidity and mortality of this disease., (Le comitée de rédaction se réserve le droit de revoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de sonserver un examplaire du manuscrit, des figures et des tableaux.)

We conduct a longitudinal descriptive study in the department of infectious diseases to CHU of Point G during 18 months. It concerned adult patients referred from another care center. All the patients underwent systematic clinical examination and complementary exploration. Our sample was 352 HIV+ patients, with a mean age of 37.8 ± 9.8 years and a sex ratio (M/F)=0.94 shared among patients receiving ARV treatment (ART-s) and not (n-ART). Delay of reference was 5 ± 4.4 days. All patients benefited from clinical and paraclinical examinations. In both groups patients were mostly from level II. On admission, 132 cases were ART-s (38%). The main reasons for consultation were mainly fever [87.9%, p <0.05] and vomiting [17.4%, p =0.005] in the ART-s. Cough (p=0.9), and diarrhoea (p=0.5] were most noted in the n-TARV no statistically significant (no SS). Other reference reasons were similar in the 2 groups: headache (p=0.4), dyspnea (p=0.1). Selected diagnoses were dominated by tuberculosis (p=0.6) for n-ART no SS. Nontuberculosis infectious pneumonia (p=0.8) and cerebral toxoplasmosis (p=0.8) were comparable in the two groups. Severe systemic bacterial infections occurred more noted in the n-TARV (p=0.7). Malaria has been the main non-AIDS defining disease in the n-ART [-p=0.07] no SS. Patients were seen to late stage a corollary of a more collapsed of immunity in n-ART group [93.3%, p <0.05]. The fatality rate was similar in both groups (43.2%). Pathological factors were mainly tuberculosis (p=0.3) no SS. The factors involved significantly in TARV-s were non-tuberculosis bacterial pneumonia (p=0.001). The hospital mortality of HIV and AIDS is still important. Despite free ARVs and the large number of support center, the delay in diagnosis is a key as well as the lack of monitoring of patients factor.

Introduction: The admission of a patient in intensive care justified by the severity of the disease, is a stressful situation for his heirs. A fair and understandable information is a major component of the process quality of care., Objective: Evaluate the practice of informing families of patients and their satisfaction in intensive care unit., Method and Material: We conducted a prospective study of 90 families of patients. The demographics of family representatives, and satisfaction data were collected., Results: The majority of parents were aged between 20-40. The sex ratio was 2.9 for men. The siblings had accounted for 23 parents whether 25,6%. In 46 cases whether 51%, the relatives of families were satisfied with information received. 57.8% did not have good information on the risks of treatment complications. The lack of explanation about the evolution of the disease remained a major concern for 36 families. 69 of parents whether 76.7% felt that the frequency of visits was satisfactory. In our series no contradiction has been recorded in the information provided in 87 (96.7%) parents of patients. 80 (88.9%) of parents of patients showed the courtesy of staff at the reception. 54 relatives of patients whether 60% said they could not have been involved in the therapeutic management of the patient. 41 parents of patients whether 45.6% do not differentiate between the role of different caregivers. 45 parents felt uncomfortable., Conclusion: Despite the lack of normative information , most family members of patients were very satisfied with the information they were provided. Efforts to improve the satisfaction of families go through identifying the needs of the latter and effective communication strategy.

Object: Studying the Epidemiological and clinical profile of accidents on public ways at the welcome service of emergencies, CHU Gabriel Touré within the scope of accident reduction on public ways and an improvement of their taking in charge., Methodology: Retro prospective study over a three-year- period including all the files of any patient emitted for accident happening on public ways without regard to race and sex., Result: Over a three-year-period (from January 2007 to December 2009). Our team has analized 2450 hospitalization files with a follow-up going from 0 to 45 days. The most concerned ages range from 15 to 29 years (43 per cent) with a male predominance (81 per cent). The mechanism motorcycles-pedestrians (30.9 per cent) was the most represented. The mains lesions observed were cranial traumatisms (58.9 per cent), followed with fractures of limbs (13.5 per cent). Death-rate has been risen at the level of young men above all (from 15 to 29 years) and it was mainly due to cranial traumatisms., Conclusion: Accidents on public ways represent a keen problem in matter of public health. The taking in charge of the curse should be very urgent. Information, communication and education of all the professional and social stratums seem necessary.

Maternal mortality remains a serious threat especially to developing countries. We proposed to determine the frequency, causes and contributing factors to maternal mortality in order to improve the quality. of care. This is a retrospective study on 138 cases from 1 January 2005 to 31 December 2008 at the Maternity Center Hospital Régional of Ségou. The maternal mortality rate was obtained in 2031 for 100000 live birth. The causes were dominated with obstetric hemorrhage (38.4%), anemia (26.8%), hypertensive complications (20.2%), infections (13.0%). Risk factors such as age, parity, without the occupation, the non-educated; associated with delayed evacuation and the lack of the technical burden contributed to the clinical picture of our patients. The issue of maternal mortality calls everyone of us, mainly health staff. Its reduction passes by a coordinated and effective action on all the levels of care in pregnancy and childbirth.

Mitral valve repair is a better therapeutic alternative than valve replacement for rheumatic valve disease in children. Repair procedures are especially well suited to developing countries where heart prostheses and life-long anti-coagulation therapy are largely unaffordable. The purpose of this study was to evaluate medium-term outcome of mitral valve repair in children in Senegal. A retrospective review was conducted in a cohort of 100 patients who underwent mitral valve repair for rheumatic mitral lesions over the 8-year period from 1999 to 2007. Mean age was 12 +/- 5 years (range, 7 to 17 years). The most common symptom of valve disease was dysypnea (stage IV in 26 cases and stage III in 74). Valve lesions were complex with anterior leaflet prolapse in 62 cases, posterior leaflet restriction in 35, commissural fusion in 30, and fusion of chordaes in 54. Repair procedures consisted of transfer and shortening of chordaes in 73 cases in association with commissurotomy in 22 cases and cleft closure in 17. Ring annuloplasty was performed in 84 patients. Hospital mortality was 2%. Postoperative morbidity was characterized by residual mitral regurgitation in four cases. Mean follow-up was 5 years. No late deaths were observed. Outcome was satisfactory in 84 patients with low-grade mitral regurgitation (grade I-II). Reduction of left ventricle diameter was statistically significant during systole and diastole, i.e., from 29.5 +/- 6.2 mm to 33.1 +/- 5.3 mm (p<0.05) and from 47.1 +/- 8.6 mm to 50.5 +/- 9.4 mm (p<0.05) respectively. Improvement in cardiac function was not significant, i.e., from 63.3 +/- 4.8% to 62 +/- 6.4% (p = 0.99). Mitral valve repair was successful in stabilizing myocardial function and remodeling the left ventricle. Outcome is dependent on careful patient selection and evaluation of lesions. Middle-term outcome is encouraging.

The aim of this study was to evaluate the anaesthetic assumption of responsibility of the surgery of the aneurism of under renal abdominal aorta. It was a retrospective study over two years (April 2005 - April 2007). Seven patients were operated, the mean age was 69,4 years. An operational pre evaluation was carried out among all patients including/understanding an interrogation, a clinical examination and a clinical assessment. All the patients profited from a general anaesthesia with controlled ventilation. Arterial hypertension (5 cases) was the independent factor of risk followed by the nicotinism (2 cases) with a patient at the stage of obstructive chronic broncho-pneumonopathy (BPCO). A patient was allowed in a table of rupture with acute abdominal pain and a cardiovascular collapse. Electrocardioscopic anomalies were noted among three patients with type of: HVD+ HBAG; HVG; HAG. A patient presented a hypertrophy cardiopathy with deterioration of the function of the VG and an important pulmonary arterial hypertension. A tensionnelle fall was found among three patients after induction with the midazolam. The aortic time of clampage varied between 20 and 120 mn with an average of 57, 6 mn. The incidents at the time of the clampage were: a bradycardia, a hypertensive push and a hypotension. No incident was observed at the time of the declampage. The blood losses per operational were estimated on average at 1000 ml and the numbers of transfusion by patient was on average of 4 pockets. The post operative issue was simple among 5 patients. A surgical recovery was necessary in front of a case of thrombosis of prosthesis. An oligoanurie, an acute respiratory insufficiency was found at the patient admitted in a table of rupture. The intermediate duration of stay threw 11 days. The maintenance of a homodynamic stability per and post operational remainder a good strategy to prevent the operational complications post.

Objectives: The purpose of this study is to illustrate a rare vascular malformation and to make a literature review., Patient: Klippel-Trenaunay's syndrome is a congenital disorder which characterized by capillary malformation, varicosities and bony or soft tissue hypertrophy. This disease is subject to significant morbidity like bleeding, deep vein thrombosis, embolic complications and in some cases enlargement of limb that may require amputation. Our case study was a young woman of twenty years suffering since birth, from a painful, heaviness and enlarged left lower limb that reached 2.5 cm. The distal hypertrophy at the big toe which the site of a botriomycoma (telengectasic granuloma). The inner side of the thigh was also the site of small port-wine stains and varicose of the great saphenous vein. Vascular Doppler ultrasound, skeletal computed tomography and angio-MRI of the limb indicated a klippel-Trenaunay disease. A surgical abstention was decided. The patient underwent only to resection of the toe's botriomycoma followed by an elastic contention associated with "a heel pad compensation" and an anti platelet therapy to prevent deep vein thrombosis and embolic complications., Conclusion: The syndrome of Klippel-Trenaunay is a rare vascular malformation. The basic pathology can not be corrected. The treatment's aims are to control varicose veins, to prevent complications and to preserve aesthetic and functional prognosis of the leg.