[Members lymphedema in CNHU-HKM of Cotonou: Results of the rehabilitation treatment]. / Lymphoedemesdes membres au CNHU-HKM de Cotonou : Resultats du traitement reeducatif.

AIM: To report results of patients followed in physical medicine and rehabilitation (PMR) in CNHU-HKM of Cotonou. PATIENTS AND METHODS: Retrospective, transversal study, aimed to be descriptive and analytical type. Were enrolled, 39 files of patients treated in PMR / CNHU-HKM, from 1st January 2014 to 31st December 2018, for unilateral lymphedema, who had done beginning and ending evaluations. Were excluded, venous, systemic or lipid edema. The severity and the result of the sessions were assessed taking into account the reports of perimeters of the member segments. Factors associated with the result were sought, by the Mann-Whitney test. RESULTS: The localization of lymphedema was in thoracic and pelvic limbs, respectively in 64.1 and 35.9%. Were associated with the oedema functional difficulties (61.54%), muscle paresis (33.33%) and joint stiffness (30.77%). Patients benefited from 5 to 20 physiotherapy sessions. Has been associated with physiotherapy, the use of compression stockings (58.97%). The results have been satisfactory, mainly influenced by the development time. CONCLUSION: Satisfactory results in the physiotherapy management of lymphedema have been noted in our context, especially in patients seen early.

BUT: Rapporter les résultats des patients suivis en médecine physique et de réadaptation (MPR) au CNHU-HKM de Cotonou. PATIENTS ET MÉTHODES: Etude rétrospective, transversale de type descriptif et analytique. Ont été enrôlés, 39 dossiers de patients traités en MPR/CNHU-HKM, du 1er Janvier 2014 au 31 Décembre 2018, pour un lymphoedème unilatéral, ayant eu des évaluations de début et de fin de séances. Ont été exclus, les cas d'œdème veineux, systémique ou lipidique. La sévérité et le résultat des séances ont été appréciés en tenant compte des rapports des périmétries des segments de membre. Les facteurs associés au résultat ont été recherchés, par le test de Mann-Whitney. RÉSULTATS: La localisation du lymphoedème a été aux membres thoracique(s) et pelvien(s), respectivement dans 64,1 et 35,9%. Y étaient associées, des difficultés fonctionnelles (61,54%), parésie musculaire (33,33%) et raideur articulaire (30,77%). Les patients ont bénéficié de 5 à 20 séances de kinésithérapie. A été associée à la kinésithérapie, l'utilisation de bas de contention (58,97%). Les résultats ont été satisfaisants, influencés essentiellement par le délai d'évolution. CONCLUSION: Des résultats satisfaisants de la prise en charge kinésithérapique du lymphoedème ont été notés dans notre contexte, surtout chez les patients vus tôt.

Iatrogenic retractile quadriceps fibrosis within children in Benin: epidemiological, clinical, therapeutical aspects.

BACKGROUND: In tropical countries, iatrogenic retractile quadriceps fibrosis (IRQF), the cause of walking handicap in children, is often the result of intraquadricipital injection of quinine salts. The aim of this review was to analyse the epidemiological, clinical, therapeutic aspects and outcome of IRQF in children admitted in three hospitals in Benin Republic. PATIENTS AND METHODS: It was a 10-year retrospective, descriptive and analytic survey of IRQF, involving 81 children aged from 8 months to 15 years. Iterative mobilization of the knee (IMK) or modified distal quadriceps plasty by Thompson-Payr's technique (MDQTPT), with a POP on the knee in flexion position, was performed with additional functional rehabilitation. The results were evaluated on knee flexion gain and walking quality. Data were processed using Epi Info 3.2 software. RESULTS: Patients' average age was 7.60 years. Children of 6-10 years were most affected; sex ratio was 1.02. Lesions were unilateral (71.6%) and bilateral (28.4%). The knees' stiffness was in flexion (10.57%), rectitude (64.42%) and recurvatum (25%). The amyotrophy of the thigh was found in 79.42 %. The IMK was successful in eight cases (7.69 %) and the MDQTPT was done in 98 cases (94.23%) associated with femoral osteotomy in 13 cases (12.50%). In post-surgical period, skin necrosis and fractures occurred respectively in 15.31% and 5.10%. Results were good in 92.31% of cases. CONCLUSIONS: IRQF in children do exist in our settings. The treatment that is based on MDQTPT associated to rehabilitation leads to acceptable outcome.

Verbal communication disorders in brain damaged post-stroke patients in Benin.

UNLABELLED: In Western countries, progress has lessened the severity of numerous sequels of verbal communication disorders (VCD). For Africa and more particularly Benin, few data on the subject are presently available. OBJECTIVE: To analyze the occurrence and development of post-stroke VCD in Benin. METHOD: A retrospective, descriptive and analytical study focused on 563 post-stroke patients treated in rehabilitation department of the National university hospital of Cotonou (CNHU) from January 2006 through December 2010. RESULTS: VCD prevalence was 42.10%. Average age was 57.17 ± 12.62 years, sex ratio was 1.75, and 74.69% were right-handed. VCD affected oral expression (95.78%), written expression (2.11%), oral comprehension (13.08%) and written comprehension or reading (0.84%). Type of stroke, sex and age had no impact on VCD occurrence following stroke. Only 5.91% of the patients underwent speech therapy. Progression was favorable in 21.09% of the cases studied. CONCLUSION: In Benin, post-stroke VCD is exceedingly common and occasions major social difficulties. Prevalence of VCD in a predominantly oral culture underscores the need for speech therapists to develop a more broadly ecological approach toward treatment.

Suprascapular nerve entrapment in a patient with a spinal cord injury.

STUDY DESIGN: Case report. OBJECTIVES: To describe a case of suprascapular nerve entrapment (SNE) in a patient with a spinal cord injury (SCI) as a cause of shoulder pain. SETTING: Physical Medicine and Rehabilitation Institute, Nancy, France. REPORT: Six months after the occurrence of acute paraplegia T9 ASIA, a 45-year-old man complained of pain in the posterior and lateral areas of the left shoulder. A clinical assessment found an atrophy of the infraspinatus muscle and a muscular weakness during external shoulder rotation. SNE was suggested as a cause of pain and confirmed by nerve conduction recording. Magnetic resonance imaging excluded any compressive cyst. SNE at the spinoglenoid notch, related to upper limb overuse, was suggested. A gluco-corticoid injection in the proximity of the suprascapular nerve eliminated the pain in a few hours. Two months after the injection, the pain had not reappeared, the infraspinatus muscle atrophy was resolved, and supraspinal nerve conduction was normalized. CONCLUSION: Shoulder pain is common in individuals with paraplegia, but this is the first time that SNE has been reported as a cause of pain. This micro-traumatic pathology, well known in athletes, is probably under-diagnosed in patients with SCI who overuse their upper limbs for wheelchair propulsion and body transfers.

[Problems of rehabilitation in patients with sickle cell disease in Cotonou, Benin]. / Problèmes de rééducation posés par la drépanocytose à Cotonou.

BACKGROUND: Manifestations of sickle cell disease (SCD) are polymorphous from childhood to adulthood. OBJECTIVE: The purpose of this study was to assess outcomes of rehabilitation in the patients with SCD. METHOD: This retrospective analytical descriptive study included 160 SCD patients rehabilitated from 1998 to 2006 at the National University Hospital in Cotonou, Benin. RESULTS: Mean patient was 31 years (range, 3 to 73 years). There was a female predominance (62.5%) with a sex ratio of 0.6. The type of SCD was HbAS in 53.1% of patients, HbSS in 21.3%, HbSC in 16.9%, and HbAC in 8.1%. The main clinical manifestations were classified as ischemic/infectious in 40% of patients, rheumatologic in 40%, and neurologic in 10%. Ischemic manifestations were observed in all patients with HbSS, HbSC, and HbAS while manifestations were preferentially neurological in patients with HbSS (p = 4,43.10(-3)) and rheumatologic in patients with HbAS (p<10(-3)). At the end of rehabilitation, persistent deficiencies, disabilities and limitations involved pain in 43.8% of patients, articular stiffness in 43.8%, muscular weakness in 46.9%, gait anomalies in 33.1%, amyotrophy in 21.2%, shortening of lower extremity in 16.9%, and tilting of the pelvis in 6.3%. CONCLUSION: This study shows that SCD is a highly debilitating disease. Although rheumatologic manifestations are not specific to SCD, the other complications described including femoral head necrosis, osteomyelitis, and stroke have been extensively documented in the literature. If primary prevention is unfeasible, early multidisciplinary management appears to be the most effective approach to reducing SCD-related disability.

[Hip paraosteoarthropathy after sciatica nerve injury by quinine intramuscular injection]. / Paraostéoarthropathie de la hanche sur lésion du nerf sciatique par injection intramusculaire de quinine.

INTRODUCTION: Often occurring in central nerve injuries, paraosteoarthropathic conditions are revealed by a stiffness or ankylosis of the joint. Their occurring during peripheral nerve injuries is rare. OBJECTIVE: To report a case of hip paraosteoarthropathy features after sciatica nerve injury by quinine intramuscular injection. MATERIALS AND METHOD: We report a case of a 24-year-old patient presenting with pain, oedema of the left buttock, limitation of bending of the left hip, and antalgic limping associated with a small step because of axonal left sciatic nerve injury. Initial pelvis X-ray and laboratory findings were normal. Reviewed 4 months later with important stiffness of the left hip, a second X-ray showed an atypical paraosteoarthropathy (POA). Chemotherapy and physiotherapy alleviated neurological muscle weakness but did not have any effect on the hip functionality. Surgical excision was the only treatment that improved the amplitude of movements. Evolution 7 years later showed the disappearance of the peripheral nerve-injury signs and the conservation of the movement amplitude obtained after excision, without a return to normal. CONCLUSION-DISCUSSION: Factors pointing to this POA were initial oedema, immobilization because of pain, and trauma by quinine intramuscular injection. The interest is the exceptional occurrence of POA on a peripheral nerve injury (sciatica nerve injury by quinine injection) outside the context of length resuscitation and that sciatica nerve injury is frequent in tropical countries but anachronistic in a developed one.