[Surgical site infections at surgery service B of Point "G" hospital]. / Infections du site operatoire en chirurgie « B ¼ CHU du Point G.

BACKGROUND: Surgical site infections (SSI) complicate most operations in developing countries. A variety of germs is responsible for it. The purpose of this study was to determine the incidence of surgical site infections and the bacteriological profile. PATIENTS AND METHODS: We conducted a prospective study for descriptive purposes. The included patients were treated between August 2016 and July 2017 in the Surgery B department of the University Hospital Center Point G. The study population consisted of all patients operated on and hospitalized for at least 72 hours. Patients who had an infection of the operative site were retained. The incidence of ISOs, the different bacterial strains and their susceptibility to antibiotics were studied. Data was analyzed on SPSS 12.0. RESULTS: The incidence of surgical site infections was 4.7%. The median age of the patients was 29.5 ± 4.34, the sex ratio was 1.66. The average time to onset of infections was 7.33 days. Of the samples taken, 4 bacterial strains were identified: Escherichia coli, Staphylococcus aureus, Acinobacter baumanii and Enterobacter spp. Isolated strains of Escherichia coli and Staphylococcus aureus were sensitive to Cefotaxim, Amikacin, Nitrofurantoin, but resistant to Ceftriaxon, Amoxicillin + Clavulanic acid. The species of Acinobacter baumanii and Enterococcus spp. Were sensitive to Colistin, but resistant to Ceftriaxone, Amoxicillin + clavulanic acid. CONCLUSION: Escherichia coli and Staphylococcus aureus are the main germs of the generally antibiotic-resistant ISOs commonly used in the service.

INTRODUCTION: Les infections du site opératoire (ISO) compliquent la plupart des opérations dans les pays en développement. Une diversité de germes en est responsable. Le but de cette étude était de déterminer l'incidence des infections du site opératoire et leur profil bactériologique. PATIENTS ET MÉTHODES: Nous avons réalisé une étude prospective à visée descriptive. Les patients inclus étaient pris en charge entre Aout 2016 et Juillet 2017 dans le service de chirurgie B du centre hospitalier universitaire du Point G. La population d'étude était constituée de tous les patients opérés et hospitalisés pendant au moins 72 heures. Les patients ayant présenté une infection du site opératoire étaient retenus. L'incidence des ISO, les différentes souches bactériennes et leur sensibilité aux antibiotiques ont été étudiées. Les données ont été analysées sur SPSS 12.0. RÉSULTATS: L'incidence des infections du site opératoire était de 4,7%. L'âge médian des patients était de 29,5 ans ±4,34, le sex ratio de 1,66. Le délai moyen d'apparition des infections était de 7,33 jours. Sur les prélèvements réalisés, 4 souches bactériennes étaient identifiées : Escherichia coli, Staphylococcus aureus, Acinobacter baumanii et Enterobacter spp. Les souches d'Escherichia coli et de Staphylococcus aureus isolées étaient sensibles au Cefotaxime, à Amikacine, à Nitrofurantoïne, mais résistantes à Ceftriaxone, à Amoxicilline+Acide clavulanique. Les espèces d'Acinobacter baumanii et d'Entérocoque spp étaient sensibles à Colistine, mais résistantes à Ceftriaxone, à Amoxicilline+Acide clavulanique. CONCLUSION: Escherichia coli et Staphylococcus aureus sont les principaux germes des ISO généralement résistants aux antibiotiques couramment utilisés dans le service.

[Diagnosis and treatment of acute surgical abdomen in Koutiala]. / Abdomens aigus chirurgicaux a Koutiala : Diagnostic et traitement.

PURPOSE: To describe the epidemiological, clinical and therapeutic aspects of acute surgical abdomens at the Koutiala Reference Health Center. PATIENTS AND METHOD: This was a prospective and descriptive study from August 1, 2017 to May 31, 2018. It included all patients operated on for acute abdomen in the General Surgery Department of the Koutiala Reference Health Center. The study did not include the nonoperated surgical acute abdomens, the non-surgical acute abdomens. Clavien-Dindo classification was used to evaluate complications. RESULTS: One hundred patients were registered. Acute surgical abdomens accounted for 8.4% of consultations (n = 1190), 27.7% of surgical procedures (n = 361) and 70% of surgical emergencies (n = 142). The average age was 34.4 years ± 18.5. Men were in the majority with 70%. The mean duration of change in symptomatology was 4.8 days ± 5.4. Patients consulted for abdominal pain (100%), fever (60%), vomiting (88%) and discontinuation of materials and gases (32%). The physical examination noted abdominal distension (53%), abdominal contracture (36%), abdominal defense (56%) and pain in the cul de sac of Douglas (95%). X-rays of the abdomen without preparation and abdominopelvic ultrasonography contributed to the diagnosis in 46% of cases and 18% of cases, respectively. Acute appendicitis (35%) was the most common etiology followed by acute peritonitis (31%) and acute intestinal obstruction (15%). We performed an appendectomy in 45 patients (45%), resection anastomosis (15%) and excision-suture (13%). The average duration of hospitalization was 4.7 days. The morbidity was 12%. According to the Clavien-Dindo classification, 9 patients were grade III and 3 grade V. The mortality was 3%. CONCLUSION: Acute surgical abdomens are the most common emergencies in our practice. The diagnosis is clinical and para-clinical most often. Morbidity and mortality remain elevated. The outcome of treatment depends on early management and mastery of abdominal surgery techniques.

BUT: Décrire les aspects épidémiologiques, cliniques et thérapeutiques des abdomens aigus chirurgicaux au Centre de Santé de Référence de Koutiala. PATIENTS ET MÉTHODES: Il s'agissait d'une étude prospective et descriptive allant du 1er Aout 2017 au 31 Mai 2018. Elle a porté sur tous les patients opérés pour abdomen aigu dans le service de chirurgie générale du centre de santé de référence de Koutiala. N'ont pas été retenus dans notre étude les abdomens aigus chirurgicaux non opérés, les abdomens aigus non chirurgicaux. La classification de Clavien-Dindo a été utilisée pour évaluer les complications. RÉSULTATS: Cent patients ont été enregistrés. Les abdomens aigus chirurgicaux ont représenté 8,4% des consultations (n=1190), 27,7% des interventions chirurgicales (n=361) et 70% des urgences chirurgicales (n=142). L'âge moyen était de 34,4 ans±18,5. Les hommes étaient majoritaires avec 70%. La durée moyenne d'évolution de la symptomatologie était de 4,8 jours±5,4. Les patients ont consulté pour douleur abdominale (100%), la fièvre (60%), les vomissements (88%) et l'arrêt des matières et des gaz (32%). L'examen physique a noté la distension abdominale (53%), la contracture abdominale(36%), la défense abdominale (56%) et la douleur au cul de sac de Douglas (95%). La radiographie de l'abdomen sans préparation et l'échographie abdominopelvienne ont contribué respectivement au diagnostic dans 46% des cas et 18% des cas. Les appendicites aigues(35%) étaient les étiologies les plus fréquentes suivies des péritonites aigues (31%) et les occlusions intestinales aigues (15%). Nous avons réalisé une appendicectomie chez 45 patients (45%), la résection anastomose (15%) et l'excision-suture (13%). La durée moyenne d'hospitalisation était de 4,7 jours. La morbidité était de 12%. Selon la classification de Clavien-Dindo, 9 patients étaient de grade III et 3 de grade V. La mortalité était de 3%. CONCLUSION: Les abdomens aigus chirurgicaux sont des urgences les plus fréquentes dans notre pratique. Le diagnostic est clinique et para clinique le plus souvent. La morbi-mortalité reste élever. Le résultat du traitement dépend de la prise en charge précoce et la maitrise des techniques de chirurgie abdominale.

[Non-traumatic digestive perforation in Koutiala: epidemiological and therapeutic aspects]. / Perforation digestive non traumatique a Koutiala : aspects epidemio-cliniques et therapeutiques.

PURPOSE: the aim of this study was to evaluate the clinical and therapeutic aspects of non-traumatic digestive perforations at the Koutiala Reference Health Center. PATIENTS AND METHODS: This was a prospective and descriptive study from August 1, 2017 to December 31, 2018. Patients admitted and operated on for non-traumatic digestive perforation were included. The parameters studied were age, sex, frequency, clinical aspects, etiologies, treatment and operative follow-up. RESULT: Sixty-one patients were registered. Non-traumatic digestive perforations accounted for 78.2% of cases of acute peritonitis (n = 78). Men were in the majority with 73.8%. The average age was 34.5 years old. The symptomatology was represented by abdominal pain in all patients, vomiting in 56 patients and fever in 42 patients. The mean duration of evolution of the symptomatology was 5.5 days. On physical examination, the most common signs were abdominal contracture with 81.9%, disappearance of prehepatic maturation (52.4%) and pain in rectal examination (95.1%). Radiological pneumoperitoneum was found in 39 patients. The serodiagnosis of Widal was positive in 15 cases. The etiologies were dominated by perforation of infectious origin with 77.0% (46). The perforation was ileal in 28 patients, appendicular in 18 patients and gastroduodenal in 11 patients. Excision-suturing of the perforation was done in 30 patients, resection anastomosis in 8 patients and appendectomy in 18 patients. Morbidity and mortality were respectively 14.7% and 6.5%. CONCLUSION: Non-traumatic digestive perforations are the first cause of peritonitis in our department. The ileal seat is the most common and is most often secondary to typhoid fever. Morbidity and mortality remain high and this result is a reflection of late diagnosis which is the main factor of severity of digestive perforations.

BUT: Evaluer les aspects cliniques et thérapeutiques des perforations digestives non traumatiques au Centre de Santé de Référence de Koutiala. PATIENTS ET MÉTHODES: Il s'agissait d'une étude prospective et descriptive allant du 1erAoût 2017 au 31 décembre 2018. Les patients admis et opérés pour perforation digestive non traumatique étaient inclus. Les paramètres étudiés étaient l'âge, le sexe, la fréquence, les aspects cliniques, les étiologies, le traitement et les suites opératoires. RÉSULTAT: Soixante-un patients ont été enregistrés. Les perforations digestives non traumatiques ont représenté78,2% de causes de péritonite aigue (n=78). Les hommes étaient majoritaires avec 73,8%.L'âge moyen était de 34,5 ans. La symptomatologie était représentée par la douleur abdominale chez tous les patients, les vomissements chez 56 patients etla fièvre chez 42 patients. La durée moyenne d'évolution de la symptomatologie était de 5,5 jours. A l'examen physique, les signes les plus fréquents étaient la contracture abdominale avec 81,9%, la disparition de la matité pré hépatique (52,4%) et la douleur au toucher rectal (95,1%). Un pneumopéritoine radiologique a été trouvé chez 39 patients. Le sérodiagnostic de Widal était positif dans 15 cas. Les étiologies étaient dominées par la perforation d'origine infectieuseavec77,0% (46). La perforation était iléal chez 28 patients, appendiculaire chez 18 patients et gastroduodénale chez 11 patients. L'excision-suture de la perforation a été faite chez 30 patients, la résection anastomose chez 8 patients et l'appendicectomiechez18 patients. La morbidité et la mortalité ont été respectivement de 14,7%de 6,5%. CONCLUSION: Les perforations digestives non traumatiques sont la première cause de péritonite dans notre service. Le siège iléal est le plus fréquent et qui est secondaire le plus souvent à la fièvre typhoïde. La morbi-mortalité reste élever et ce résultat est le reflet du diagnostic tardif qui constitue le principal facteur de gravité des perforations digestives.

[Brachial Plexus: Dissection At The Laboratory Of Anatomy Of Bamako]. / Plexus Brachial : Dissection Au Laboratoire D'Anatomie De Bamako.

INTRODUCTION: The brachial plexus consists of the ventral twigs of the last four cervical nerves and the first thoracic nerve. It ensures the motor and sensitive innervations of the thoracic limb. AIM: Our goal was to describe the brachial plexus of the cervical region to the middle third of the arm. METHODOLOGY: We conducted a prospective study at the anatomy Laboratory of the Faculty of Medicine and Dentistry in Bamako from September 2016 to October 2017. We dissected the brachial plexus (PB) of 13 fresh adult corpses on both sides. The inclusion criteria were: Fresh adult corpses with cervical regions and brachial without scarring. The injected or scar-carrying corpses were not included in the cervical and brachial regions. RESULTS: Twenty-six brachial plexus of which 18 bp in men and 8 bp in women were dissected. The average age of the subjects was 42 years (extreme: 18 and 70 years). We noted nerve block variations in 3.8%, fascicular in 3.8% and late terminal in 73.1%. The involvement of the anterior branch of the fourth spinal nerve (C4) was found in 46.2%. CONCLUSION: The brachial plexus is the seat of many anatomical variations whose knowledge is indispensable to treat its lesions.

INTRODUCTION: Le plexus brachial est constitué des rameaux ventraux des quatre derniers nerfs cervicaux et du premier nerf thoracique. Il assure l'innervation motrice et sensitive du membre thoracique. BUT: Notre but était de décrire le plexus brachial de la région cervicale au tiers moyen du bras. MÉTHODE: nous avons réalisé une étude prospective au laboratoire d'anatomie de la Faculté de Médecine et d'Odontostomatologie de Bamako de septembre 2016 à octobre 2017. Nous avons disséqué des deux côtés les plexus brachiaux (PB)de 13 cadavres frais d'adultes. Les critères d'inclusion étaient : cadavres frais d'adulte avec les régions cervicale et brachiale sans cicatrice. N'ont pas été inclus les cadavres injectés ou porteurs de cicatrice au niveau des régions cervicale et brachiale. RÉSULTATS: Vingt-six plexus brachiaux dont 18 PB chez les hommes et 8 PB chez les femmes ont été disséqués. L'âge moyen des sujets était de 42 ans (extrême : 18 et 70 ans). Nous avons noté des variations tronculaires dans 3,8%, fasciculaires dans 3,8% et en fin terminales dans 73,1%. La participation du rameau antérieur du quatrième nerf spinal cervical (C4) a été trouvée dans 46,2%. CONCLUSION: Le plexus brachial est le siège de nombreuses variations anatomiques dont la connaissance est indispensable pour traiter ses lésions.

[Epidemiology of bacterial infection materno-fetal at Abidjan- Ivory Cost: prospective study of eighty (80) cases]. / Epidemiologie de l'infection bacterienne materno-fœtale a Abidjan-Cote d'Ivoire: etude prospective a propos de 80 cas.

The aim of our study was to describe the risk factors, clinical symptoms and bacteria isolated during fetal-maternal bacterial infections in hospitals. MATERIALS AND METHODS: This was a prospective, descriptive study conducted from August 2, 2007 to October 3, 2007 at the neonatology department and the delivery room of the Yopougon teaching hospital . All newborn babies presenting a risk factor of infection have been included in this study. A bacteriological evaluation including containing central, peripheral and gastric fluid samples was performed. Bacteriological tests (NFS, CRP, PCT) were also performed on those newborn babies. RESULTS: Eighty newborn babies were included. The maternal risk factors were dominated by prolonged breaking of membranes 62.5%. In the newborn bad APGAR score 56.3% and prematurity 18.8%, were noted. The main clinical symptoms were neurological, , respiratory and digestive 52.5%, 44.4% 37.5%, respectively. The main pathogens isolated were 65.5% Staphylococcus coagulase negative, 13.8% Staphylococcus aureus, 6.9% Pseudomonas aeruginosa, 3,4% Klebsiella pneumoniae, and 3.4% Acinetobacter Sp. CONCLUSION: The clinical symptoms of the fetal-maternal bacterial infections are polymorphic. Germs found in our study differ from those usually found in the fetal-maternal bacterial infections in Europe.

L'objectif de notre étude était de décrire les facteurs de risques, la symptomatologie clinique et les bactéries isolées au cours des infections bactériennes materno-fœtales (IBMF) en milieu hospitalier. MATÉRIEL ET MÉTHODES: Il s'agissait d'une étude prospective à visée descriptive menée du 2 août 2007au 3 octobre 2007 dans le service de néonatalogie et la salle d'accouchement du CHU de Yopougon. Tous les nouveau-nés présentant un facteur de risque infectieux ont été inclus dans l'étude. Un bilan bactériologique comportant des prélèvements centraux, périphériques et liquide gastrique à été effectué. Un bilan biologique (NFS, CRP, PCT) a également été réalisé chez ces nouveau-nés. RÉSULTATS: Quatre vingt nouveau-nés ont été inclus. Les facteurs de risques maternels étaient dominés par la rupture prolongée des membranes 62,5%. Chez le nouveau-né on notait le mauvais APGAR 56,3 %, la prématurité 18,8%. Les principales manifestations cliniques étaient neurologiques 52,5%, respiratoires 44,4% et digestifs 37,5%. Les principaux germes isolés étaient Staphylocoque coagulase négative 65 ,5%, Staphyloccus aureus 13,8%, Pseudomonas aeruginosa 6,9%; Klebsiella pneumoniae 3,4 %; Acinetobacter Sp 3,4%. CONCLUSION: La symptomatologie clinique des IBMF est polymorphe. Les germes retrouvés au cours de notre étude diffèrent de ceux habituellement retrouvés au cours des IBMF en Europe.

[Diagnostic and surgical approach to an hourglass-shaped nasopalatine glioma in an infant]. / Approche diagnostique et chirurgicale d'un gliome naso-palatin "en sablier" chez un nourrisson.

The authors report a case of glioma nasopalatine Multifoil in wallet, location-intra nasal and palatal left. The nasal glioma is a rare congenital malformation presenting as a nasal mass composed of neuroglial tissue heteropias resulting from an abnormality in embryonic development. It is a benign tumor that fits into the nosology of the masses of the midline. This abnormality arises primarily a diagnostic problem because often mistaken for a meningo-encephalocele or a nasal dermoid cyst. Localization nose and palate, an hourglass, is extremely rare if not exceptional; The computed tomography (CT) has enabled the accurate assessment of injury and has guided the choice of surgical technique. The resection was done successfully without recurrence. Histology examination of the surgical specimen confirmed the nature of astrocytic neuroglial tumor. The location of the tumor pedide palate to that of the left nostril is special and especially histological diagnosis of this congenital malformation.

[Investigation of the collateral branches of the external carotid artery in a population from West Africa. About 60 cadaver dissections]. / Contribution à l'étude des branches collatérales de l'artère carotide externe chez le sujet originaire d'Afrique de l'Ouest. A propos de 60 dissections cadavériques.

OBJECTIVE: The goal of this survey was to study the level of emergence of the external carotid artery and the origin of its collateral branches about a dissection of 30 cadavers subjects of West Africa. MATERIAL AND METHOD: We dissected to the laboratory of Abidjan anatomy 30 cool adults' cadavers corresponding to 28 men and two women. At these 30 cadavers, we dissected 60 external carotids. We studied the level of bifurcation of the carotid artery in relation to hyoid bone and thyroid cartilage and the level of the emergence of the collaterals branches of the external carotid artery according to classic description. RESULTS: The origin of the external carotid artery was variable: in 46 cases (75%), the origin was between the hyoid bone and the thyroid cartilage; in 10 cases (15%), this origin was below the thyroid cartilage and in four cases (13%), this origin was over to the hyoid bone. In 46.5% of cases, we find five collaterals branches of the external carotid artery. According to classic description, we find some variations of the emergence of collateral arteries: the facial artery is not below the lingual artery in 28 cases (46.5%); the ascending pharyngeal artery do not emerge at the same level of lingual artery in 46 cases (76.5%) and in 44 cases (73%), the occipital artery do not emerge of the same level of the facial artery. CONCLUSION: Levels of collateral branch emergence in population of West Africa is variable. It is important to know that for practice cervical surgery safety.

[Susceptibility to antibiotics of Staphylococcus strains isolated in Ouagadougou, Burkina Faso]. / Sensibilite aux antibiotiques des souches de Staphylocoques isolees a Ouagadougou, Burkina Faso.

INTRODUCTION: The sensibility of bacteria in a general way decreased a lot, staphylococci present a resistance to the penicillin in more than 80% of the cases. The aim of our work was to determine the level of sensibility of staphylococci, particularly that of resistant Staphylococcus aureus to Meticilline (SARM). MATERIAL AND METHODS: It is a retrospective study concerning the profile of sensibility of the isolated strains of staphylococci of diverse pathological products.The antibiogramme was realized according to the classic technique and for the test in the oxacilline, the Mueller Hinton + 5% of NaCl was used. RESULTS: during the period of study 1296 strains of staphylococcus were isolated, 153 from hospital Staphylococcus aureus were little sensitive to the penicillin G (10%); however the oxacilline, the gentamicine and the erythromycine were very active (more than 80% of sensibility.The meticillino-sensitive Staphylococcus aureus were also sensitive to the gentamycine, erythromycine and ciprofloxacine; the character of meticillino resistant did not influence the activity of antibiotics as pristinamycin and the vancomycine (100%); however we note a resistance crossed with the erythromycine in more than 95% of the cases. CONCLUSION: the existence although weak of the strains meticillino resistant brings us to propose a regular surveillance of the SARM and to hold as active antibiotics of first line the pristinamycine, ciprofloxacine, gentamicine, with vancomycine as the alternative of last choice in a hospital environment.

[Oro-facial manifestations during AIDS/HIV infection. Apropos of 60 cases seen at the Ambulatory Treatment Center in Ouagadougou and at the Yalgado University Hospital Center]. / Les manifestations bucco-faciales au cours de l'infection VIH/SIDA. A propos de 60 cas vus au Centre de Traitement Ambulatoire de Ouagadougou et au Centre Hospitalier Universitaire Yalgado (CHU-YO).

The opportinistics complaints of the AIDS occur all along the episode of the infection and depend on the individual's body immunity and on the existence or no of an anti-retroviral treatment. The buccal appearences on the face are relatively frequent. They are dominated by the buccal mycosis, the lymphatic ganglion's complaints, the inflammation of gums and buccal mucous, and the tooth decay in our context. Some authors suggest a classification that can make easy their study and treatment. Complaints like the herpes simplex infection, the herpes zoster infection, are usually found during the symptomatic stage non AIDS, whereas others like KAPOSI's disease are typical to AIDS disease. The availlability of an anti-retroviral treatment and a specialized one strenghten the efficiency of the reimbursement and improve the prognosis.

[Contribution to subscapularis nerve supply. 18 dissections]. / Contribution à l'innervation du muscle subscapulaire. A propos de 18 dissections.

INTRODUCTION: Dividing the subscapularis muscle along its fibers axis allows approaching the glenohumeral joint. The more medial its division, the more possible injury of its nerve supply. AIM: The aim of our study was to assess the subscapularis nerve supply through cartography of the entry points of subscapularis nerves from simple landmarks, reproducible by triangulation. MATERIAL AND METHODS: On 18 formalin-preserved shoulders, after dissection of the subscapularis nerves, distances were measured between entry points of subscapularis nerves and the following landmarks: center of the minor tubercle (tm), upper and lower poles of the glenoid cavity (cgs and cgi), apex of the coracoid process (pc). RESULTS: There were in average 3.33 subscapularis nerves (2-4). These different nerves split most often before entering subscapularis muscle; there were in average 5.05 entry points (3-6). Distances between entry points and clinical landmarks were as follows: cgs, 3.9-6.45 cm; cgi, 3.7-5.54 cm; tm, 5.9-7.15 cm; pc, 4.9-7.66 cm. Reporting these measurements onto a frame allowed to show that all these points were located in average medially to the scapular notch and at more than 3 cm from the anterior border of the glenoid cavity. CONCLUSION: If the transverse division does not extend farther than 3 cm from the anterior border of the glenoid cavity and from the medial border of the root of the coracoid process, there should not be any injury of the subscapularis nerves.

[Portal vein: variations of its branches (about 32 dissections)]. / Veine porte: mode de division et ses variantes A propos de 32 dissections.

PURPOSE: The aim of this study is to precise the variations of portal vein branches and also to elucidate anatomic basis of partial hepatectomy. MATERIAL AND METHODS: Thirty-two post-mortem specimens, with ages ranged from one day to sixty-five years in both two sexes, were dissected. Latex and Rhodopas were used for visualizing and drawing the portal vein course and its branches. RESULTS: Nine types of different variations of portal vein branches were observed. Most of cases were similar to those previously reported in literature. But four types must be especially noted, because they were not available in literature. DISCUSSION: this study updates the anatomy of portal vein and its tributaries, and also finds out four types of distribution which must be known by surgeons with regards to partial hepatectomy.

End-to-side neurorrhaphy for defects of palmar sensory digital nerves.

Ten traumatic nerve defects at the palm or digit level were treated by end-to-side (ETS) neurorrhaphy. The technique included removal of an epineurial window on the donor nerve and coaptation of the sharply cut distal end of the injured nerve by epineurial stitches under microscopic magnification. At final follow-up, the static two-point discrimination test (2 pd) scored at an average of 9.1 mm (range, 6-12 mm) on the repaired nerve, compared to an average of 4.6 mm (range, 4-6 mm) on the contralateral uninjured control side. Moving 2 pd scored at an average of 7 mm (range, 4-9 mm) on the repaired nerve compared to an average of 2.6 mm (range, 2-4 mm) on the control side. This short series showed that ETS neurorrhaphies are effective and give comparable results with those of nerve grafts or vein conduits.

[Value of perineal sonography for diagnosing anterior urethral stenosis]. / Valeur de l'échographie de surface par voie périnéale dans le diagnostic des sténoses de l'urètre antérieur.

OBJECTIVES: To determine the value of perineal sonography in the diagnosis of urethral stenosis and evaluation of surrounding fibrosis. Materials and methods. Fifty-eight healthy subjects underwent urethral sonography. Thirty-two patients with suspected urethral stenosis underwent sonography after retrograde distension of the urethra using normal saline and retrograde urethrogram and voiding cystourethrogram. RESULTS: The mean diameters of the healthy urethra varied from 11 to 15 mm. The mean thickness of normal periurethral tIssue was between 2 and 4mm. Sonography detected 34 stenoses (97.4%). The length of the stenosis was significantly longer at sonography compared to retrograde urethrogram and voiding cystourethrogram. No significant difference was found between both techniques when measuring urethral diameter. In all cases, the thickness of periurethral tIssues was greater at the stenotic level than at a normal level, irrespective of the involved segment. There was no correlation between the thickness of periurethral tIssues and the degree of stenosis. CONCLUSION: Urethral sonography is a method that permits diagnosis of urethral stenosis and evaluation of periurethral fibrosis. It may replace retrograde urethrogram and voiding cystourethrogram in the diagnosis of post infectious stenosis.

[Treatment of Buruli ulcer desease by excision and skin graft]. / Traitement de l'ulcère de Buruli par excision-greffe: à propos de 118 observations.

INTRODUCTION: Buruli ulcer is the most common mycobacteria disease after leprosy and tuberculosis. The purpose of our study is to make our contribution to the surgical treatment of Buruli ulcer and to asses our results. METHOD: One hundred eighteen patients presenting progressive Buruli ulcers were operated on. The surgical procedure included excisions for necrotic lesions and grafts for clean wounds. The results were estimated on the time of hospitalization and appearance of complications. RESULTS: Seventy-three patients (62%) were subjected to excision followed by thin skin grafts and 35 patients (30%) were subjected to grafts only. The number of excision times varies from 1 to 7 per patient and from 1 to 4 for the skin grafts. All our patients heal within a period of 120 days with extremes going from 14 to 265 days. We deplored 26 complications (22%): eight new focus, seven infectious complications, six recurrences, five stiffnesses and ankyloses. CONCLUSION: The treatment of Buruli ulcer by excision and grafts is efficient but does not prevent recurrences and new focus from happening and for their prevention, it is necessary to discover pharmaceutical molecules that are efficient on Mycobacterium ulcerans.

Anatomical study of the variations in innervation of the orbicularis oculi by the facial nerve.

While the divisions of the facial nerve in the face are well known, the innervation of the orbicularis oculi by the different distal branches of the facial nerve is poorly described. To determine which branches of the facial nerve play a role in this innervation, the facial nerve was dissected in 30 fresh cadavers. The innervation of this muscle was in the form of two plexuses, a superior one, most often (93%) formed by the union of the temporal and superior zygomatic branches, and an inferior one, usually formed (63%) by the union of the inferior zygomatic and superior buccal branches. This new mode of innervation explains how, without damage to both plexuses, innervation of orbicularis oculi by the facial nerve remains functional. It also explains the often unsatisfactory results of treatment of primary blepharospasm, and the unusual character of palsies of this muscle in cervicofacial lifts.

[Renal artery vascularization in the African black. Report of 44 dissections]. / La vascularisation artérielle rénale chez le noir africain. A propos de 44 dissections.

Studies on the anatomy of the renal arteries in Black Africans being scarce, the authors have made their contribution to the knowledge of the renal arteries. They have provided a comparison between the anatomy of the renal arteries studied in the literature in relation to a white patient and black patient. It is a prospective study based on the change in the number of the renal arteries of 44 Black Africans' maccabees quite fresh, not yet embalmed that have been dissected in order, as received in the anatomy laboratory of Abidjan. That work has allowed to notice some results that are more or less similar to those revealed in the literature, i.e. in 80% of the cases, the kidney is irrigated by an artery, and in 20% of the cases, we have more than one artery for one kidney. No kidney is vascularized by more than two arteries. These results underline how important it is to have good anatomical knowledge of this region in renal surgery. This is possible thanks to medical imagery and arteriography which helps in preventing operative accidents and in preserving the kidney.

[Facial localizations of Buruli ulcers: two cases]. / Les localisations faciales de l'ulcère de Buruli: à propos de deux cas.

We report the first two published cases of a facial localization of Mycobacterium ulcerans ulcer (Buruli ulcer). M. ulcerans is the third most common mycobacteriosis, after leprosy and tuberculosis. Clinical manifestations involve large necrotic ulcerations with protruding edges, mainly localized on the limbs. Both of our patients, 9 and 45-year-old females, resided in endemic areas of Buruli ulcer in the Ivory Coast. The ulcers were located on the left zygomatic malar region in one patient and the submental region in the other. Treatment involved resection of the ulcer followed by total skin graft. Ulcer healing was observed after two months hospitalization in one patient. The other patient died.

[Plastic surgery treatment of Buruli ulcer sequelaes. A retrospective study of 16 patients]. / Les procédés de couverture cutanée dans le traitement des séquelles de l'ulcère de Buruli. A propos de 16 observations.

INTRODUCTION: Thirteen percents of the patients suffering from Buruli ulcer in Ivory Coast show sequels at a result of their spontaneous healing. The purpose of our study is to report and estimate the first series of the sequel treatment of Buruli ulcer, with standard reconstructive procedures used in plastic surgery. METHOD: Sixteen patients totalizing 18 sequels were classified into 2 groups:13 patients showed functional sequels in connection with cicaticial retractions about level with joints;3 patients showed aesthetic sequels with no repercussion on the functional aspect. The surgical treatment included for the functional sequels, the excision of the retractile scar, the restoration of the underlying structures followed by the coverage of the defect with skin grafts or muscle or musculo cutaneous flaps and for aesthetic sequels, the excision of the scar tissues and the coverage with full-thickness skin grafts. RESULTS: The results were considered good because the patients found an acceptable physical activity again that enable some of them to resume a professional activity and others a school activity. Motherless, a certain number of complications are to be deplored:1 case of distal necrosis of a skin flap autonomized which required excision and conducted healing but without repercussions on the functional result;1 residual edema about level with the fingers at the time of the covering of a hand with a groin flap;1 haematoma at the donar site of a full-thickness skin graft. CONCLUSION: Distance flaps are more advisable for hand sequels in Buruli ulcer considering the regional character of the disease and the necessity to preserve the main vascular axes about level with the hand. On the lower limb, autonomized skin flaps enable provide important tissue and preserve the major vascular axes of the lower limb.

[Multifocal forms of Buruli ulcer: clinical aspects and management difficulties in 11 cases]. / Formes plurifocales de l'ulcère de Buruli: aspects cliniques et difficultés de prise en charge, à propos de 11 cas.

OBJECTIVE: A certain number of authors have in literature pointed out multifocal forms of Buruli ulcer but no study was ever dedicated to them. The purpose of this study is to be more specific about the clinical aspects and to show how difficult it is for those multifocal forms of Buruli ulcer to be operated on. METHOD: The 11 patients who were accepted for the study were subjected to an interrogation, a thorough clinical examination, research of BAAR in ulcers and operative pieces with a direct examination after Ziehl-Neelsen colouring. Each of these patients underwent a surgical treatment under general anaesthesia or spinal anaesthesia depending on the seat of the lesions under cover of pre and post operative therapy by antibiotics. RESULTS: Initial lesions preferentially were located at limbs level; new foci appeared within an average period of 3 months, ranging from 1 to 15 months in some cases. All body parts could be the seats of secondary foci. Depending on the patients, the number of foci varied from 3 to 7. Furthermore, amputation has been necessary for the complete healing of four patients. The average operation was 2.4 by patient ranged from 2 to 5. We observed the healing of all the patients within an average hospitalisation time of 6.3 months running sometimes from 4 to 13 months. In addition to amputations, 4 patients presented after-effects as articular stiffness, retractions of the hand's dorsal face and knee's retraction. CONCLUSION: Those multifocal forms can, with good reason, be considered as malignant form of Buruli ulcer.