[Sexuality assessment of homozygous adult sickle cell patients with a history of priapism in Senegal]. / Évaluation de la sexualité des drépanocytaires adultes homozygotes ayant des antécédents de priapisme au Sénégal.

OBJECTIVES: The objective of this study was to evaluate the sexuality of SS sickle cell patients with a history of priapism. METHODS: This was a case-control study of adult SS sickle cell patients. The occurrence of priapism as well as the nature of the priapism had been investigated. The patients were subdivided into three groups: Group 1 (no priapism), Group 2 (intermittent priapism) and Group 3 (acute priapism). The patients' sexuality was studied using the IIEF-15 questionnaire. RESULTS: We interviewed 191 SS sickle cell patients. The mean age was 27.1±7.1 years. Priapism was observed in 43.5 %. Only 77 patients were eligible for the IIEF15 questionnaire. Groups 1 and 2 performed significantly better than group 3 on erectile function (EF) and orgasmic function (OF) scores. There was no significant difference in the EF and OF scores between groups 1 and 2. No significant difference was observed between the three groups for the scores of sexual desire (SD), intercourse satisfaction (IS), and overall satisfaction (OS). The impairment of erectile function in group 2 was related to the age of the first episode of priapism and the last episode. The impairment of erectile function in group 3 was related to the duration of evolution (P<0.05). CONCLUSION: This study shows that priapism is responsible for impaired erectile function in SS adult sickle cell patients. A program to prevent intermittent episodes of priapism should be put in place.

[Non-antiretroviral drugs uses among HIV-infected persons receiving antiretroviral therapy in Senegal: Costs and factors associated with prescription]. / Médicaments non antirétroviraux chez les personnes vivant avec le VIH sous traitement antirétroviral au Sénégal : coûts et facteurs associés à la prescription.

BACKGROUND: In addition to antiretroviral therapy, non-antiretroviral drugs are necessary for the appropriate care of people living with HIV. The costs of such drugs are totally or partially supported by the people living with HIV. We aimed to evaluate the overall costs, the costs supported by the people living with HIV and factors associated with the prescription of non-antiretroviral drugs in people living with HIV on antiretroviral therapy in Senegal. METHODS: We conducted a retrospective cohort study on 331 people living with HIV who initiated antiretroviral therapy between 2009 and 2011 and followed until March 2012. The costs of non-antiretroviral drugs were those of the national pharmacy for essential drugs; otherwise they were the lowest costs in the private pharmacies. Associated factors were identified through a logistic regression model. RESULTS: The study population was 61 % female. At baseline, 39 % of patients were classified at WHO clinical stage 3 and 40 % at WHO clinical stage 4. Median age, body mass index and CD4 cells count were 41 years, 18kg/m2 and 93 cells/µL, respectively. After a mean duration of 11.4 months of antiretroviral therapy, 85 % of patients received at least one prescription for a non-antiretroviral drug. Over the entire study period, the most frequently prescribed non-antiretroviral drugs were cotrimoxazole (78.9 % of patients), iron (33.2 %), vitamins (21.1 %) and antibiotics (19.6 %). The mean cost per patient was 34 Euros and the mean cost supported per patient was 14 Euros. The most expensive drugs per treated patient were antihypertensives (168 Euros), anti-ulcer agents (12 Euros), vitamins (8.5 Euros) and antihistamines (7 Euros). The prescription for a non-antiretroviral drug was associated with advanced clinical stage (WHO clinical stage 3/4 versus stage 1/2): OR=2.25; 95 % CI=1.11-4.57 and viral type (HIV-2 versus HIV-1/HIV-1+HIV-2): OR=0.36; 95 % CI=0.14-0.89. CONCLUSION: Non-antiretroviral drugs are frequently prescribed to people living with HIV in developing countries; mainly those infected with HIV-1 and those at an advanced clinical stage. Their costs can be a barrier to appropriate care and necessary efforts must made to make them available. However, early initiation of antiretroviral therapy and the registration of some non-antiretroviral drugs on the list of essential drugs, as well as social protection systems, should reduce their use and costs.

Traumatic right diaphragmatic hernia in children: Diagnostic difficulties.

Traumatic right diaphragmatic hernia is rare in children. Its diagnosis can be difficult in the acute phase of trauma because its signs are not specific, especially in a poly trauma context. We report two cases of traumatic right diaphragmatic hernia following a blunt thoraco-abdominal trauma, highlighting some difficulties in establishing an early diagnosis and the need for a high index of suspicion.

[Urological emergencies in paediatric surgery: a survey of 40 cases]. / Les urgences urologiques en chirurgie pediatrique: a propos de 40 cas.

AIMS: The objective of this study is to report our experience on the epidemiology of urological emergencies in pediatric surgery, and to analyze the diagnosis and therapeutic process. MATERIALS AND METHODS: It was a prospective survey which was carried out between January 2010 and June 2011 in the pediatric service of Aristide Le Dantec Hospital (HALD). All the children who came for a urological emergency consultation were included in the study. THE RESULTS: the urological emergencies accounted for forty cases which represented 2.57% of pediatric surgery emergencies. The average age of our patients was 4.5 years with extremes of 10 days and 15 years of age. 29 cases of severe big bursae were observed and among them there were strangulated hernia and ten cases of suspicious spermatic cord torsion. The other admission motives consisted of three cases of urine retention, two pyelonephritis cases, two cases of post circumcision glans sections, two paraphimosis cases, one tight phimosis case, one case of penis traumatism provoked by a game incident. The scrotum ultrasound performed on six patients helped find out a specificity of 66.6%. 60% of strangulated hernia have been reduced through under sedation taxis. In case of confirmed torsion, a detorsion followed by an orchidopexy were performed. Two orchidectomy were performed for a testicular necrosis. CONCLUSION: the painful big bursa is the number one cause for a urology pediatric consultation. It implies a fast and adequate diagnosis and treatment so as not to miss a digestive or testicular pain.

BUTS: Rapporter notre expérience sur l'épidémiologie des urgences urologiques en chirurgie pédiatrique, d'analyser la prise en charge diagnostique et thérapeutique. MATÉRIELS ET MÉTHODES: Il s'agissait d'une étude prospective réalisée dans le service de chirurgie pédiatrique de l'hôpital Aristide Le Dantec de Dakar (HALD), de janvier 2010 à juin 2011. Tous les enfants reçus pour une urgence urologique ont été inclus. RÉSULTATS: Les urgences urologiques représentaient 2,57% des urgences chirurgicales pédiatriques. L'âge moyen des patients était de 4,5 ans avec des extrêmes de 10 jours et de 15 ans. Nous avons noté 29 cas de grosses bourses aigues dont 15 hernies étranglées et 10 suspicions de torsion du cordon spermatique. Les autres motifs d'admission étaient représentés par 3 cas de rétentions aigues d'urine, 2 cas de pyélonéphrites, 2 cas de sections de gland post circoncision, 2 cas de paraphimosis, 1 cas de phimosis serré, 1 cas de traumatisme pénien. L'échographie scrotale réalisée chez 6 patients avait une spécificité de 66,6%. Soixante pour cent des hernies compliquées ont été réduites par taxis sous sédation. Deux orchidectomies ont été effectuées pour nécrose testiculaire. CONCLUSION: la grosse bourse aigue est le 1er motif de consultation en urologie pédiatrique. Elle implique une prise en charge rapide et adéquate pour ne pas passer à coté d'une souffrance testiculaire ou digestive.

[Advanced prostate cancer in Senegal. Clinical aspects at the General Hospital of Grand Yoff]. / Cancer avancé de la prostate au Sénégal. Aspects diagnostiques à l'hôpital de Grand Yoff.

UNLABELLED: Prostate cancer is a common disease, which continues to be discovered at advanced stages in Africa, despite improved diagnostic tools. AIM: The authors report the experience of the Department of Urology, General Hospital of Grand Yoff Dakar in the diagnostic of advanced prostate cancer. MATERIAL: This was a retrospective descriptive study on patients followed for advanced prostate cancer during the period from January 1st, 2004 to May 31st, 2010. RESULTS: There were 102 people aged from 51 to 96 years with an average of 71 ± 9 years. A comorbid condition was associated in 24.5 % of cases. The circumstances of discovery were pain (32 cases), neurological signs (17 cases), and urinary disorders. DRE had objectified an abnormality in all patients. The serum levels of prostate specific antigen ranged from 5.88 ng/mL to 21,660 ng/mL, with an average of 1447.57 ± 812 ng/mL. A prostate biopsy was performed in 44 patients and prostatic adenocarcinoma was found in 97.7 % of cases with Gleason scores greater than 7 (33 cases). We found different metastatic sites at vertebral column (23 cases), at lung (14 cases), and on pelvic bones (11 cases). CONCLUSION: The prostate cancer is a serious condition with high morbidity and mortality. The diagnosis is not made early in developing countries. We need a strategic plan to improve the early screening and we should develop supportive care too because of the high number of advanced cases diagnosed in our context.

[Management of prostate cancer in Senegal: what is being done?]. / Cancer de la prostate : quelle prise en charge au Sénégal ?

OBJECTIVE: To evaluate the management of patients with prostate cancer in Senegal. MATERIALS AND METHODS: We performed a retrospective descriptive study, based on the medical records of patients managed for prostate cancer during a period of six years and a half from January 1, 2004, to June 30, 2010. All records of inpatients and outpatients managed for prostate cancer were collected. Data collection was performed through a standardized survey form, and included the following parameters: age, presence or absence of known history of prostate cancer in siblings, circumstances of discovery, clinical and paraclinical examination, histology and therapeutic modalities. RESULTS: We studied the records of 164 patients with prostate cancer. The mean age of our patients was 65years, ranging from 43 to 96years. The circumstances of diagnosis were mostly due to lower urinary tract symptoms. Digital rectal examination was suggestive in 87% of cases, and PSA levels were high in 100% of cases, ranging from 5.88ng/ml to 21,660ng/ml, with a mean of 1447.57ng/ml. Half of the patients had PSA levels greater than or equal to 100ng/ml. The most common histological type was adenocarcinoma. During the study period, 49 radical prostatectomies were performed. The mean PSA levels of patients who underwent a prostatectomy were 23.4ng/ml. Radical retropubic prostatectomy was performed in 35 patients, and radical perineal prostatectomy was performed in 10 cases. Pulpectomy was the method most commonly used in metastatic prostate cancer; it was performed in 48 patients. After resistance to castration, antiandrogens were reintroduced in 13 patients, and diethylstilbestrol in four patients. Only two patients underwent a taxane-based chemotherapy regimen. CONCLUSION: The diagnosis of prostate cancer was usually tardive in Senegal. Treatment often involves surgical castration. Prostatectomy was only very seldom indicated.

[Peritonitis following gastroduodenal ulcer perforation disease in children: report of 4 cases]. / Les péritonites par perforation d'ulcère gastroduodénal chez l'enfant : à propos de 4 observations.

Peritonitis due to gastroduodenal ulcer perforation disease is a rare entity in pediatric surgery. In Senegal, no study has been dedicated to ulcer complications in children. The aim of this study was to describe the epidemiology, diagnosis, and treatment of perforated peptic ulcer in patients less than 15 years old. This retrospective study was conducted in the Surgical Emergencies and Paediatric Surgery Department at Aristide Le Dantec University Hospital Center in Dakar, Senegal, during a period of 11 years (January 1999 to December 2010). We found 4 children who presented perforated gastroduodenal ulcer: 3 females and 1 male. The average age of these patients was 9 years (range, 7-14 years). No family history was found. We noted 3 cases of perforated duodenal ulcer and one perforated gastric ulcer. The clinical diagnosis was suspected based on a peritoneal irritation syndrome. A plain x-ray of the abdomen was taken in all patients, which objectified a pneumoperitoneum image in 3 cases. The leukocytosis was constant. Treatment in all patients consisted on pre-, intra-, and postoperative intensive care, supra- and infraumbilical midline laparotomy, which allowed us to perform a debridement-suture of the gap followed by epiploplasty and extensive washing with lukewarm physiologic serum. Adjuvant therapy based on anti-ulcer and antibiotic therapy was initiated. Bacteriological examination of peritoneal fluid isolated a polymicrobial flora. Helicobacter pylori was not isolated. Histological examination of the biopsied perforation edges showed a benign ulcer in all cases. The follow-up endoscopy was performed 4 weeks after surgery and showed cicatrization of the ulcer in all patients. After a mean of 2 years, no recurrence was noted. The gastric or duodenal ulcer in children is rare. It is often discovered at the stage of perforation, a complication for which the essential treatment is surgery. Routine screening would certainly help to reduce the risk of this complication.

[Management of nasolabial clefts: the issue in Dakar]. / Prise en charge des fentes nasolabiales: problématique à Dakar.

The management of patients with a cleft lip in developing countries is often the prerogative of humanitarian missions from developed countries. The goal of our work is to conduct a first epidemiological, clinical and therapeutic assessment of the management of cleft lips by a local team and to evidence the difficulties faced by us in our working conditions. In a retrospective study covering a period of about five years (January 2004 to March 2009), 205 cases of nasolabial clefts are assembled. The mean age at the time of the first visit is 17 months. A slight female predominance is observed. The majority of patients are from the capital city. A close relative with a cleft is found in 6.8% of them. In 44.9% of cases, it is a simple cleft lip. A cleft palate is associated in 47.8% of cases. Associated malformations are observed in 10.5% of cases. We operated on 110 patients. The mean age at the first surgery is two years. Millard's technique is our technique of choice. No operative mortality is observed. In 17.4% of cases, operative morbidity occurred in the form of suppuration with partial or complete early suture release. The esthetic result is satisfactory in 67.7% of cases. This management could be improved by creating a multidisciplinary team including--in addition to surgeons--dentists, speech-language pathologists, psychologists, etc.

Cοngenital diaphragmatic hernia in dakar, senegal.

BACKGROUND: Congential diaphragmatic herniae pose serious challenges in their management in this environment.Aim & Objective: To determine the pattern, as well as the diagnostic and management challenges of congenital diaphragmatic hernia in Dakar, Senegal. PATIENTS AND METHODS: This is a retrospective review of 14 children with congenital diaphragmatic hernia (CDH) managed within eleven years in Dakar, Senegal. RESULTS: There were nine boys and five girls with the age range of one day to 22 months and a mean of 5 months. Respiratory signs (respiratory distress, cough, current pulmonary infection) were found in 13 patients and gastrointestinal symptoms (vomiting, Difficulty sucking, anorexia) in 6 patients. The thoracic-abdominal radiography was performed in all patients and revealed a Bochdalek hernia on the left in 10(71%) cases and 4(29%) were Morgagni hernia. Treatment was by repair of the diaphragmatic defect with non-absorbable sutures. The postoperative course was uneventful in 13 children while one patient died on the first postoperative day one. CONCLUSION: Congenital diaphragmatic hernia presents mainly with postnatal respiratory features in this setting. Thoracic-abdominal radiography allows for early diagnosis, prompt and effective treatment with good outcome. KEYWORDS: Congenital diaphragmatic hernia, Respiratory insufficiency, Radiological features, Good surgical outcome.

[Paediatric head and neck burns sequelae]. / Les séquelles de brûlures cervicocéphaliques chez l'enfant.

The skin is the body's protective barrier and is very much exposed to assaults and thus to burns. The aim of this work is to consider the special features of cervicofacial burns sequelae in children in a sub-Saharan environment and to review their management. This retrospective study, performed in the Department of Paediatric Surgery at Aristide Le Dantec Teaching Hospital in Dakar (Senegal), examined 27 patient files dating between May 2001 and April 2008. The children's average age at first visit was 6.7 years and the m:f sex ratio was 1.7:1. The sequelae were topographically distributed as follows: face (66.7%), neck (29.6%), scalp (11.1%). Regarding the type of sequelae observed, adhesions predominated (33.3%), followed by keloid or hypertrophic scars (25.9%), eyelid ectropions (18.5%), scalp alopecias (11.1%), chronic ulcerations (7.4%), and discolorations (3.7%).Surgical treatment was used in 55.7% of the cases: Z-plasty, followed or not followed by skin graft for adhesion treatment, as well as adhesion lysis followed by grafting for eyelid ectropion treatment. The surgical morbidity rate was 20% and no mortality was reported. Keloid scars were treated medically with intralesional corticosteroid injections. Apart from the emergency situation, cervicofacial burns in children lead to severe aesthetic and functional damage. Any improvement in prognosis in such burns depends on improvements in the quality of initial care and on raising parents' awareness of accidents in the home.

[Flexible ureteroscopy in the treatment of kidney stone between 2 and 3 cm]. / Urétéroscopie souple dans le traitement des calculs du rein de 2 à 3cm.

PURPOSE: Our aim was to evaluate the outcome of flexible ureteroscopy (F-URS) with Holmium Laser as a minimal invasive procedure for kidney stone between 2 and 3 cm in diameter. MATERIAL: We prospectively evaluated 101 patients (103 kidney units) with kidney stone between 2 and 3 cm, who underwent flexible ureteroscopy (F-URS) with Holmium Laser. Patient age, sex, body mass index (BMI), stone size, stone composition, associated lower calyx stone, prestenting, congenital abnormalities, urological history, operating time and complications were evaluated. The outcome was determined at 4 weeks on plain radiograph (KUB) and noncontrast CT scan (NCCT) or by endoscopic second look if needed. Ureteroscopy success rate was defined as stone free (SF) or remaining fragments (RF) less than 3 mm. RESULTS: After F-URS session we obtained a stone free status in 35 kidney units (34%), residual fragment less than 3mm in 30 kidney units (29.1%) and 38 kidney units (36.9%) with significant residual fragment. F-URS success rate was 89.3% and 97.1% after second and third session, respectively. CONCLUSIONS: F-URS with Holmium Laser is a very effective and safe technique in treating kidney stone. This technique should be proposed to patient with kidney stone between 2 and 3 cm as one of the treatment modalities, F-URS offers excellent results, low rate of complications and short hospital stay. Patients should be informed about staged therapy.

[Total cystectomies for cancers locally advanced of bladder about 12 cases in the service of urology of the general hospital of Grand-Yoff]. / Cystectomies totales pour cancers localement avancés de vessie au service d'urologie de l'hôpital général de Grand-Yoff.

OBJECTIVE: The goals of the study is to evaluate the feasability of the total cystectomy for cancer infiltrating locally advanced of bladder and to evaluate perioperatitive morbidity and short-term results. PATIENTS AND METHODS: We made a retrospective study concerning 12 first patients having profited from a total cystectomy for cancer infiltrating of the bladder in our hospital over one period of 1 year. The parameters of study were: the age at the time of the diagnosis, circumstances of the diagnosis, antecedents of the patient, the histological type and stage TNM before and after intervention, the type of derivation associated, duration of the intervention, the anesthesia, complications and morbidity per- and postoperational. We carried out calculations of average and frequency for the data analysis. RESULTS: The mean age was 51 years (extreme: 32; 83). They were nine men and three women. The circumstances of diagnosis were dominated by the total hematuria and in less frequency by the bladder irritative symptoms. The antecedents of the patients were dominated by the schistosomia (five cases) and the tobacco addiction (two cases). The histological type obtained in preoperative after biopsy or trans urethral resection of bladder found, seven cases of squamous cell carcinoma, four cases of transitional cell carcinoma and one case of adenocarcinoma. Into preoperative, three patients were at the stage pT2, eight patients pT3, one pT4. Four patients had a replacement of bladder: three by a bladder in Z and a patient had Camey II. They were the three patients pT2 preoperative and a patient pT3. Two patients had a standard ureterosigmoidostomy type coffey: the patient pT4 and a patient pT3. The six other patients had Bricker. All the patients profited from a blood transfusion peroperational (two units on average). We did not record any operational mortality. The complications and morbidity are represented by the suppurations of wall (three cases), the vesicocutaneous fistula (one case), the infections urinary and the anemia which was constant. CONCLUSION: The management of bladder cancer poses a real problem in our countries because of the diagnosis at advanced stage.

Osteogenesis imperfecta in a pediatric surgical center in dakar, senegal: clinical and radiological aspects.

INTRODUCTION: Osteogenesis imperfecta presents with a set of constitutional disorders of varying severity, genetically determined and characterized by an abnormal production of collagen and matrix of the bone leading to bone fragility responsible for multiple fractures and many skeletal deformities. The aim of our study was to analyze the clinical and radiological aspects of the pathology. PATIENTS AND METHODS: This was a retrospective study of 10 cases of children with osteogenesis imperfecta who consulted the Pediatric Surgery Unit of the University Center Aristide Le Dantec Hospital over a period of 6 years. The parameters analyzed were the reasons for consultation, physical examination findings and findings on standard radiographs. After collecting all the data, children were divided according to the classification of Silence and Glorieux. RESULTS: Pain was the reason for consultation in eight children. The saber blade deformity of the legs was found in nine children. Physical examination found tenderness in 80% of cases. Blue sclera was found in one child. The teeth were normal in eight patients. Standard radiographs showed an osteopenic skeleton with multiple fractures (3.7 fractures on the average) associated with vicious callus formation and deformity. According to the classification of Silence and Glorieux, six children were type VI, two children type IV, a child type III and one type I. CONCLUSION: Osteogenesis imperfecta is a rare disease. In our environment, the diagnosis is made late - a stage associated with deformity. Of these, the occurrence of sabber deformity of the lower limbs is the most common. Radiological aspects are dominated by vicious callus formation, deformed bones and osteopenia. Moderate forms are predominant. Parents need to be educated about the risk of repeat fractures and the need to present deformed children to hospital early.

[Urinary incontinence in woman: epidemiologic profile in Sub Saharian countries]. / Incontinence urinaire de la femme: profil épidémiologique au sud du Sahara.

UNLABELLED: The objective of this study was to describe the epidemiologic profile of urinary incontinence of the African woman of three Sub Saharan African countries. MATERIAL AND METHODS: A multicentric study summarized the epidemiological data collected in female from Nouakchott, Dakar and Ndjamena using a questionnaire. All participants filled an anonymous questionnaire including demographic data and marital status, medical, surgical, gynecological and obstetrical history and the characteristics of the urinary incontinence. RESULTS: Overall, 3021 questionnaires were distributed, only 2070 answers (69%) could be processed. Mean age of the overall population was 28 years. Adult women aged less than 30 years accounted for 56% of the study population. The age group 30-49 years accounted for 42% of the population and only 2% of the study group had more than 50 years. The prevalence of incontinence was 367 cases over 2070 (17,7%). The types of incontinence found were: urgency in 28.6% of cases, stress incontinence in 38.4% of cases and mixed in 33% of cases. Approximately 23,9% of nulliparous and 23,5% of the multiparous had urinary incontinence. The leakage was occasional in 75% of the cases and regular in 25% of the cases. According to gravity, in 31% of cases the volume of urines lost necessitated a change of underwear. Of the women presenting urinary incontinence, 85 (23%) consulted a doctor. A psychosocial repercussion was found in 31% of the cases. CONCLUSION: Urinary incontinence is much more frequent in our areas than it was thought to be because it was rarely acknowledged.

[Post-burn scar contractures in children in the lower limb]. / Les Cicatrices Retractiles Post-Brulures Du Membre Inferieur Chez L'Enfant.

Il s'agit d'une étude faisant ressortir les aspects épidémiologiques, cliniques et thérapeutiques des séquelles de brûlures du membre inférieur chez l'enfant, à propos de 42 cas colligés au service de chirurgie infantile de l'Hôpital Aristide Le Dantec (Sénégal). L'âge moyen retrouvé est de 5 ans et 3 mois, et le sex-ratio garçons/filles de 1,8/1. La brûlure thermique est causée par une flamme dans 33% des cas, par un liquide chaud dans 21% des cas, et par des braises dans 21% des cas. Les cicatrices rétractiles intéressent le genou et le creux poplité dans 47% des cas et le pied dans 45% des cas. Elles sont bilatérales dans 21% des cas, et concernent une autre localisation associée dans 21% des cas. Quant aux brides, 21% ont bénéficié d'une chirurgie, avec un délai moyen de 3 ans et 2 mois après la brûlure. Cette procédure chirurgicale consiste en une plastie en Z dans 91% des cas, à laquelle est associée une greffe de peau dans 54% des cas. Une rééducation fonctionnelle est pratiquée chez 54% des opérés. Parallèlement aux données de la littérature, nos résultats montrent que l'optimisation de la prise en charge passe par une meilleure prévention des accidents domestiques et une bonne codification thérapeutique.

[Risk factors for neonatal mortality. The pediatric surgery service, Aristide Le Dantec University Hospital, Dakar]. / Facteurs de mortalite neonatale dans le service de Chirurgie Pediatrique du Chu Aristide le Dantec de Dakar.

OBJECTIVES: To determine neonatal mortality factors at the paediatric surgeon service in Aristide Le Dantec University Hospital in Dakar. PATIENTS AND METHODS: It is a retrospective study of 245 cases collected between January 1997 and December 2006 at the paediatric surgeon service, the surgery emergency and intensive care unit of Aristide Le Dantec University Hospital. We studied the age, sex, geographical origins, consultation time, weight at birth, evacuation means to the reference medical structure, consultation motives, clinical diagnosis, associated malformations, treatment methods, surgery follow ups and death causes. RESULTS: The neonatal death rate at the paediatric surgery service was 36.7 %. Our patients' average age was eight days. A masculine predominance was observed with a 1.57 sex ratio. The average admission time was 08 days. Sixty-five per cent (65%) of our patients came from suburbs. Thirty-eight per cent were transported by an ambulance from a health centre. Fifty-three per cent (53%) weighed less than 2,500 grams at birth. The occlusive syndrome was the commonest reason for consultation (38.5 %). The most frequently observed pathology was the ano-rectal malformations. Associated malformations were observed in 12% of the cases. The majority of the patients (52%) died before the surgical operation after an average duration of 5 days. The commonest causes of death are the digestive malformations (66%). CONCLUSION: Male newborn babies, aged less than 8 days are the most vulnerable age group. The lack of hospital transportation means, the weak weight at birth, the caring time and the digestive pathologies are other factors of wrong diagnosis. A multidisciplinary collaboration, the improvement of the technical capacity and of the available emergency therapeutic means and the creation of an intensive paediatric care unit would certainly contribute to lower the mortality rate.

[Perforation and haemorrhage duodenal bulbar ulcers in a child: a case report]. / Perforation et hémorragie d'ulcères du bulbe duodénal chez une enfant.

A perforation rarely reveals a primary duodenal ulcer. The occurring of digestive haemorrhage in post operative followings evokes spontaneously a stress ulcer. We report an observation of a child who presented on fourth day delay after operation an ulcer of the anterior duodenal bulbar face and a haemorrhage of the posterior bulbar face. A 7-year-old girl with no particular pathological antecedent was admitted for abdominal pain, bile vomiting and constipation evolving since 6 days. Clinical examination revealed a general state thickening, an infectious syndrome, a meteoric and general abdominal sensitivity. The abdominal radiography without preparation showed a pneumoperitoneum. The surgical exploration discovered a perforated ulcer on the bulbar anterior face. A simple closure associated with omental patch was performed. Four days after operation, she presented an abundant digestive haemorrhage with shock. The resuscitation did not improve the patient's general state. The upper digestive endoscopy revealed a haemorrhage of the posterior bulbar face. An adrenalin injection stopped the bleeding. The treatment by neutron pump inhibitors and an eradicating treatment of Helicobacter pylori permitted the healing of the ulcers. The occurring of digestive haemorrhage in the followings of surgical intervention for perforated ulcer involves an upper digestive endoscopy. This examination can reveal misdiagnosed ulcer during the surgical exploration and permits to perform a haemostatic act.

[Perioperative management of laparoscopic cholecystectomy in children with homozygous sickle cell disease]. / Prise en charge périopératoire de la cholécystectomie par voie laparoscopique chez l'enfant drépanocytaire homozygote.

OBJECTIVE: Sickle cell disease is a public health problem in Africa. The aim of this prospective study was to evaluate per and post-operative complications of laparoscopic cholecystectomy in sickle cell children in Senegal. METHODS: from January 1999 to December 2006, an anesthetic protocol was applied to 39 sickle cell children undergoing a cholecystectomy. Among them, 20 experienced laparoscopic cholecystectomy. RESULTS: All these 20 patients had previously suffered from sickle cell visceral complications and were classified as ASA II (11 cases) and as ASA III (9 cases). Blood transfusion program aimed at sustaining haemoglobin level between 10 and 12 g/dl was implemented. The preoperative monitoring and anesthesia management were the same for these patients. During perioperative period, the prevention of pain, hypovolemia, hypothermia and acidosis was achieved. The mean insufflation duration of laparoscopy was 23 min (17-60 min), the mean surgery duration was 55 min (40-110 min), and the mean anesthesia duration was 78 min (88-135 min). Postoperative complications occurred in 9 patients: acute chest syndrome (n=2), postoperative hemolysis (n=5), vaso-occlusive crisis (n=2). CONCLUSION: Laparoscopic cholecystectomy can be carried out in sickle cell children affected with gallstones, provided that general anaesthetic rules were respected. An appropriate pre-, per- and postoperative anaesthesia is mandatory to reduce postoperative complications in children with sickle cell disease. Searching for early diagnosis of gallstones before occurrence of visceral complications should allow further optimal laparoscopic surgery.