[Clinico-scanographic profile of acute encephalic cranial trauma in adults in Kinshasa]. / Profil clinico-scanographique des traumatismes cranio-encephaliques aigus de l'adulte a Kinshasa.

AIMS: To determine the frequency of acute encephalic cranial injuries by CT-Scan and to describe the clinical profile of patients. MATERIAL AND METHODS: This was a retrospective and multicentric study including patients with encephalic cranial trauma (ECT) hospitalized in Kinshasa from January 2006 to December 2010 who underwent a CT-scan. Injuries were classified as encephalic cranial potentially surgical and non surgical encephalic cranial injuries. The demographic and clinical parameters of each patient have been analyzed. RESULTS: The average age of patients (n=552) was 37.34 ± 14.51 years with a sex ratio man:woman of 5:1. Traffic injuries were the main cause for injuries. About 68.3% of patients had a GCS ≤ 8. 90% of encephalic cranial potentially surgical were mostly hematoma (64%), subdural hematoma (46%) versus epidural hematoma (12%). Of these patients, only 6.6% had benefitted from a surgical treatment. The non potentially surgical lesions were often associated with potentially surgical lesions and were mostly outclassed by the dome of the skull fracture (43%). The isolated non potentially surgical lesions were predominantly diffuse axonal injury. CONCLUSION: The majority of patients with encephalic cranial trauma seen on CT-scan in Kinshasa have serious lesions potentially surgical. Men are more affected than women, with the 20-40 years old age bracket being the most represented.

BUT: Déterminer la fréquence des lésions crânio-encéphaliques aigues post-traumatiques au scanner et décrire le profil clinique associé. MATÉRIEL ET MÉTHODES: Etude rétrospective de janvier 2006 à décembre 2010 des patients avec traumatismes crânio-encéphaliques (TCE) hospitalisés à Kinshasa et ayant réalisé un scanner. Les lésions étaient classées en lésions crânio-encéphaliques à potentiel chirurgical (LCEPC) et lésions crânio-encéphaliques non chirurgicales (LCENC). Les paramètres clinico-démographiques ont été analysés. RÉSULTATS: L'âge moyen des patients (n=552) était de 37,34±14,51 ans, avec un sex-ratio homme sur femme de 5/1. L'accident de la voie publique était la principale cause des TCE. Environ 68,3% des patients avaient un GCS ≤ 8. Les LCEPC (90%) étaient dominées par les hématomes intra-cérébraux (64%). De ces patients, seuls 6,6% ont pu bénéficier d'un traitement chirurgical. Les LCENC étaient souvent associées aux LCEPC et dominées par les fractures de la voûte (43%). Les LCENC isolées étaient en majorité des lésions axonales diffuses. CONCLUSION: La majorité des patients avec TCE vus au scanner à Kinshasa sont des traumatisés graves et présentent des LCEPC. Les hommes sont plus touchés que les femmes, la tranche de 20 ­ 40 ans est la plus concernée.

Predictors of stroke - associated mortality in Africans.

BACKGROUND: The objective of the study was to examine the association of the stroke-related mortality with gender, age, ethnicity, social class, blood pressure, fibrinogen, selected clinical data and meteorologic parameters in hospitalized Africans. METHODS: A series of 1032 consecutively hospitalized incident cases of acute stroke between 1987 and 1991 was studied. Univariate and multivariate analyses were used to estimate the risk (odds ratio=OR) of stroke mortality for meteorologic parameters on the month before the accident onset and selected sociodemophysiological variables on the day of admission. RESULTS: The variables significantly associated with stroke mortality in multivariate analysis were male sex (OR= 2.3 [1.3 - 4.1]), low social class (OR= 2.0 [1.2 - 4.0]), migrant tribes (OR= 1.7 [1.5 - 1.8]), ischemic stroke (OR= 1.4 [1.2 - 1.6]), heart rate >=100 bpm (OR= 1.1 [1.0 - 1.2]), age > or =60 years (OR= 1.03 [1.01 - 1.06]), systolic blood pressure> 160 mmHg (OR= 1. 02 [1.01 - 1.03]), and fibrinogen > or =400 mg/dl (OR= 1.01 [1.002 - 1. 02]). However, diastolic blood pressure > 90 mmHg and global radiation< 340 Cal/cm(2)/day were significantly (p< 0.05) and inversely associated with stroke mortality. CONCLUSION: Our results indicate that male sex, older age, low social class, migration, ischemic stroke and higher baseline levels of heart rate, systolic blood pressure and fibrinogen are significant predictors of stroke mortality, but lower global radiation and higher diastolic blood pressure are inversely linked.

[Influence of anesthesia on the localization of Schistosoma mansoni. Intestinal schistosomiasis in white mice]. / Influence de l'anesthésie sur la localisation de Schistosoma mansoni. Cas de la bilharziose intestinale de la souris blanche.

General anesthetics or hypnotics (ketamine, propanidid, thiopental, althesin, halothane, enflurane, ether), were tested on white mice infested with Schistosoma mansoni to study possible changes in the migration of this trematode from the mesentery to the liver. With this in mind, populations of 25 mice of the same sex and age were chosen at random; they were divided into a control group and a group submitted to an anaesthetic agent. The mice were perfused after dissection and catheterization of the abdominal aorta. A vacuum-pump was used to collect separately the parasites from the mesenteric and portal vessels and those from hepatic vessels. The parasite counts in the hepatic vessels of the mice which had received an anesthetic were compared with those found in the vessels of the control group; they were found to be significantly raised. It would appear that anesthetic agents altered the neuromuscular function of the parasite which was thus carried away towards the liver. This massive migration of the parasites would deprive the hepatic lobules of portal blood by worsening the already existing obstruction at the precapillary level caused by the schistosomiasis.

[Reversibility of the effects of general anesthetics on Schistosoma mansoni]. / Réversibilité de l'action des anesthésiques généraux sur Schistosoma mansoni.

In order to verify whether the migration of Schistosoma mansoni from mesenteric vessels towards the liver under the action of general anesthetics (althesin, ether, enflurane, halothane, propanidid and thiopental sodium) is reversible, 65 mice were submitted to an anaesthetic and then perfused after dissection 24 hours later. The Schistosoma counts from porto-mesenteric vessels of the mice from control groups (60 mice) were compared with those of the mice under experiment. The counts from the hepatic area of the groups were also compared. No significant difference in the counts in the mice under experiment and those of control groups was noted.