Isolated gastric outlet obstruction due to corrosive ingestion.

OBJECTIVES: To analyze the diagnostic and therapeutic aspects of isolated gastric outlet obstruction secondary to corrosive ingestion. PATIENTS AND METHODS: Retrospective chart review of eight patients who developed gastric stricture following corrosive ingestion and were treated in the Digestive and General Surgery Service of Yopougon Teaching Hospital in Abidjan from 1991 to 2009. RESULTS: Six men and two women (mean age of 34.3 [range 21 to 48 years]) had isolated gastric outlet obstruction following accidental (n=2) or suicidal (n=6) acid ingestion. Two patients sought hospital medical attention two days after ingestion, whereas six patients came to hospital with a mean delay of 60.8 days (range 12 and 96 days). Patients sought medical attention for poor general status (n=6), postprandial vomiting (n=4), early satiety (n=2) and retrosternal pain (n=2). Two patients, who presented early to hospital, underwent upper gastrointestinal tract endoscopy the day after admission and then received a feeding jejunostomy whereas the esogastroduodenal barium swallow and feeding jejunostomy were performed after a mean delay of 2 days (range 1 and 3 days) and 3 days (range 1 and 5 days), respectively. The findings at upper endoscopy and barium swallow were: microgastria (n=2), midgastric stricture (n=1), antropyloric stricture (n=4) and gastric body stricture (n=1). One patient died preoperatively as the result of severe nutritional depletion. A follow-up endoscopy and barium swallow were performed respectively 21 and 35 days later. Definitive surgery was performed after a mean delay of 85 days (range 74 to 123 days) in the remaining seven patients. Gastric lesions were managed by total gastrectomy with Roux-en-Y esophagojejunostomy (n=2), partial gastrectomy with gastrojejunostomy (n=2) or simple gastrojejunostomy (n=3). During the mean follow-up period of 4 years (range 1 to 7 years), all patients were free of symptoms. CONCLUSION: Isolated corrosive gastric stricture is relatively rare. Surgery tailored according to the extent of gastric stricture provides excellent results.

[Rectus abdominis muscle endometrioma: sparse tumor of scarred abdominal wall in a woman]. / L'endometriome du muscle grand droit: tumeur rare de la paroi abdominale cicatricielle chez la femme.

Muscular tumors in scared abdominal wall in a woman are unfrequent reason of counselling. In rare case these tumors are the result of ectopic graft of endometrial cells after abdominal or pelvic surgery with or without opening of uterus cavity. We report the case of a not typical abdominal wall endometrioma in the rectus abdominis muscle without variation of signs and volume related to menstruation ; Diagnosis was made by histological examination after carcinological excision because of recurrence and degeneration risk.

[Prognosis of post-operative digestive fistulas in Chu de Yopougon: Abidjan/Cote d'Ivoire]. / Pronostic des fistules digestives post-operatoires au Chu de Yopougon : Abidjan/Cote d'Ivoire.

OBJECTIVE: Because of the difficulties to manage the post-operative digestive fistulas (FDPO) and their disappointing results, the authors led this survey. It's objective is to identify the prognosis factors in order to optimize their management and improve their prognosis. PATIENTS AND METHOD: It is a retrospective survey during 12 years, from January 1992 to December 2004 in the general and digestive surgery adult service of CHU Yopougon. It included 86 files of patients aged of 15 years at least presenting a FDPO. RESULTS: The middle age was of 36.8 years. The death rate was 29.06%. It rose with age. The risk of death was multiplied by 5.54 over age of 55 years (OR = 5.54 and p = 0.012). The number of death rose meaningfully with the length of the diagnostic delay (p = 0.016 for OR1 = 1.64 and OR2 = 8.94. The death rate was raised more in the exposed fistulas that in the controlled fistulas (87% against 45%). In 50% of the cases the death occurred when the debit was superior or equal to 500 cc daily. Among the patients submitted to the medical treatment 69.70% had a spontaneous closing of their fistula in a middle delay of 27.18 days for extremes varying between 13 and 47 days. CONCLUSION: The affection is very serious considering it's death rate. A precocious diagnosis and a fast and adapted management should permit to reduce this higher mortality.

[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.

Leaf extract of Caesalpinia bonduc Roxb. (Caesalpiniaceae) induces an increase of contractile force in rat skeletal muscle in situ.

The pharmacological properties of Caesalpinia bonduc Roxb. (Caesalpiniaceae) are not well known, but it is used traditionally to treat snake bite (Bellomaria and Kacou, 1995; Schaffner, 1997). In the present study, the mechanism through which Caesalpinia bonduc extract (Cebo) affects gallamine-induced relaxation in rat tibial muscle contractility were studied via measurement of isometric-tension-anesthetized, 10-12-week-old, male rats. Isometric twitch contractions of the indirectly-stimulated anterior tibia muscle of the right hindleg were recorded in situ. Cebo administered intravenously (i.v.) increased twitch contractions in a dose-dependent manner. The ED50 value is 2.75 x 10(-4) g/kg body wt. Similar results were obtained using the anticholinesterase neostigmine. In contrast, gallamine (a non-depolarizing muscle relaxant) or the venom of the puff adder Bitis arietans reduced the force of contraction. Treatment with Cebo or neostigmine, however, reversed the relaxation induced by either gallamine or puff adder venom. In conclusion, Cebo stimulates the muscle contractile activity, an effect which may be due to an activation of the cholinergic mechanism.

[Peritonitis by fish bone. Review of the literature. Pathogenic discussion]. / Péritonite par arête de poisson. Revue de la littérature. Discussion pathogénique.

From one case of peritonitis by fish bone, we have reviewed medical literature in order to explain the mechanism of this type of peritonitis perforation, which can be assimilated to peritonitis in three phases.

[Deep cerebral venous thrombosis]. / Les thromboses veineuses cérébrales profondes.

Deep cerebral venous system thrombosis is uncommon and is usually encountered in children, generally in the neonatal period. In adults, this pathology is even more exceptional. We report two cases in adults. Deep cerebral venous system thrombosis mainly affects women taking oral contraception. The most common clinical pattern combines headaches and confusion. A comatose state is rather exceptional. This pathology, formerly considered to have poor prognosis, has benefited from diagnostic and therapeutic progress. Favorable outcome has been achieved in several recent cases, as one of ours, without after-effects. Diagnosis, often suggested by the CT-scan, is based on MRI associated with MRA. Thrombus formation is easily diagnosed by MRI at the subacute stage, but far less easily at the acute and chronic stages as the low signal is identical to the normal flow void. MRA, in phase contrast or time of flight sequences, is highly interesting at the acute phase. In case of doubt, an angiography can be applied. Therapy is based on heparin. The contribution of local infusion of thrombolytic agents, recently used with success, remains to be determined.

[Use of a stimulated echo sequence in the MRI study of the brain and spine]. / Application de la séquence d'écho stimulé dans l'exploration IRM de l'encéphale et du rachis.

We describe in this paper how the STEAM sequence can be an efficient tool to obtain images free of flow artifacts in anatomical situation where the spin echo failed. The simplest way to eliminate flow artifacts is to exploit the dephasing induced by motion in magnetic field gradients and to reduce to zero the signal from moving tissues. This can be achieve by increasing the time elapsed between the spin excitation and the signal observed. Because of T2 relaxation, such an increase results in a signal decrease when the spin echo sequence is used. The STEAM sequence has the unique property that the time elapsed between observation and excitation can be increased without change in T2 value and so allows a good suppression of signals from the moving spins with short TE. Our results demonstrate that, although the stimulated echo intensity is only half that of a spin echo taken at the same read out time, the advantages of STEAM imaging can compensate for this partial loss in signal to noise in some particular clinical situations. The influence of mixing time on contrast has been evaluated using thoracic spine imaging and it has been shown that contrast between spine and CSF can be significantly improved (+ 60%) when TM is increased (from 17 ms to 50 ms). In the same time, the contrast between spine and fat issue decreases (40%). This last effect facilitates the adjustment of contrast window. Suppression of motion artifacts has first been evaluated with thoracic spine imaging, using a whole body coil. Suppression of artifacts was better than that obtained with a flow compensated spin echo sequence, especially in the case of kyphotic patients when a presaturation band was inefficient. In a second step suppression of motion artifacts has been evaluated from posterior fossa examination after injection of a paramagnetic contrast agent. The images obtained with the stimulated echo sequence show a dramatic reduction of signal from blood in the lateral sinus, and therefore an increase of quality by elimination of motion artifacts.

[MRI and computer-assisted tomography in Kufs disease. Apropos of a familial form]. / IRM et scanographie de la maladie de Kufs. A propos d'une forme familiale.

Kufs disease is the adult form of ceroid neurolipofuscinosis, and an uncommon cause of degenerative nervous system disease affecting young adults. We present here 4 cases of family form revealed by a demential syndrome. In all 4 patients MRI showed diffuse cortical atrophy predominant in the parietal regions. In 3 of these 4 patients MRI also exhibited a low signal in T2-weighted sequences on the putamens. There was no abnormality of the white matter. Diagnosis was made by cerebral biopsy in one case and by rectal biopsy in all other cases. Although the MRI images are not specific, they must be used when the diagnosis of Kufs disease is suspected in young patients with demential syndrome.

[Primary intramedullary melanoma. Apropos of a case]. / Mélanome intra-médullaire primitif. A propos d'un cas.

Primary melanoma is a rare spinal tumour first reported by Hirschberg in 1906. Since then, only 34 cases have been reported. When present here a new case of primary intramedullary thoracic melanoma developed in a 64-year old male patient. MRI showed a paramagnetic signal with reactive cysts. Macroscopy and histology confirmed the diagnosis. Spinal cord melanoma is presumed to be primary when no other melanoma is found outside the CNS. The tumour is often located in the middle or lower thoracic cord, may be intra- or extra-medullary and leptomeningeal or extradural. It frequently progresses slowly. MRI is the essential examination as it demonstrates a lesion with paramagnetic properties. Its image is not specific and may correspond to other pigmented tumours (meningeal melanocytoma, melanotic schwannoma), to a lipoma or to a vascular or tumoral haemorrhagic lesion. Treatment is uncertain, but surgery is frequently associated with radiation. Postoperative follow-up aims at detecting a local regrowth of the tumour or leptomeningeal dissemination which affects the prognosis.

[Sequela of hand burns in children: 32 cases followed and treated in the Plastic Surgery and Reconstruction department of the University Hospital Center of Treichville, Abidjan]. / Les sequelles de brûlures de la main chez l'enfant: a propos de 32 cas suivis et traités à la Consultation de Chirurgie Plastique et Reconstructrice du Centre Hospitalier Universitaire de Treichville-Abidjan.

An investigation on the effects of hand burns has been undertaken about 32 children admitted in the plastic surgery outpatients Department. Accident occurs among the lower class population and heat is the major factor pointed out. The most frequent effects are hand palmar contracture. The surgical treatment completed with the functional re-education has given very good results in 79% cases. However the cheloid contractures are the most difficult to cure. Indeed the authors insist or the prevention and the creation of a center of burned patients and a plastic surgery Service to take care of patients whose life prognostic is optimistic.

[Ileo-sigmoid knot. 16 cases]. / Le noeud iléo-sigmoïdien (ileo-sigmoid knot). 16 cas.

A retrospective study of 16 cases of ileo sigmoid knot, treated at Treichville Hospital in Abidjan Côte-d'Ivoire, is reported by the authors between 1970 and 1989. This pathology is not so seldom and concerned 14 men and 2 women from 14 years old to 61 years old with an average of 42 years. The more precise description of the physiopathology of this occlusion allows to classify this pathology as an independent entity from the other types of volvulus. The physiopathologic knowledge described allow a more precise diagnostic approach and a better codified therapeutic attitude.

[Treatment of Buruli's ulcers by excision-graft]. / Le traitement des ulcères de Buruli par excision-greffe.

Buruli's ulcer is a real disease of public health. In Ivory Coast, 50 patients were treated from February 1987 to August 1991. It realizes a real destruction of skin and subcutaneous tissues. The germ is Mycobacterium ulcerans. The preferential localisation is the limbs in children of 14 years old. Large ulcer with polycyclic margin are treated by extended excision and thin skin grafts. But deformities persist after the surgical treatment. Hospitalisation is long and drugs are expensive.

[Dupuytren's contracture: review of the literature. Case report of a black African]. / La maladie de Dupuytren: revue de la litterature. A propos d'un cas chez l'Africain noir.

In one case of Dupuytren's contracture the authors make an important literature review. The affection is rare with the black man but frequent in caucasian population. Its origin is therefore european. They point out alcoholism and microtrauma due to the patient's antecedents and job.