[Profile of Buruli ulcer treated at the National Reference Centre of Togo: a study of 119 cases]. / Profil de l'ulcère de Buruli pris en charge au Centre national de référence du Togo: étude de 119 cas.

The purpose of this study was to describe the epidemiological, clinical, therapeutic profile and the outcome of Buruli ulcer (BU) in the National Reference Center for Buruli ulcer treatment (NRCBUT) in Togo. It was a retrospective and descriptive study of records of patients treated for BU in the NRCBUT between June 2007 and December 2010. During the study period, 119 patients (56.3% males) were treated in the NRCBUT for BU. The median age of patients was 14 years. The proportion of children (< 15 years) was 56.3%. On admission, 85 patients were at ulcer stage and 34 patients at the pre-ulcer stage. BU wounds were mainly located on lower limbs (50.4%), followed by upper limbs (32.6%) and trunk (13.3%). The location of the wounds on the lower limbs were more frequent in patients older than 15 years (P < 0.001), while those on the upper limbs (P = 0.002) and trunk (P = 0.03) were more frequent in patients aged less than 15 years. All patients had received medical treatment which was based on rifampicin-streptomycin combination for eight weeks. This treatment was coupled to surgery in 30 cases. The outcome was punctuated by complications in 7 patients, limb amputation in 3 patients, and sequels in 10 patients. This study confirmed that the BU is the prerogative of young subjects and the exposed areas in the skin facilitates transmission. Apart from these classic features, some unique aspects including the age-dependent distribution are related to the pathogenesis of this disease.

[Typhoid intestinal perforation in children: renewed interest in the Veillard technique in tropical zones]. / Les perforations typhiques du grêle chez l'enfant: un regain d'intérêt de la technique de Veillard en milieu tropical.

GOAL: to value the results of the ileo colic intubation of Veillard in relation to the resection anastomosis and the ileostomy. PATIENT AND METHOD: It is about a randomised survey on 12 months (January 1st to December 31st, 2006). This study took place in the St. Jean de Dieu hospital of Afagnan. It was about children aged of less than 15 years having presented more a perforation of bowel. The diagnostic methods of the spindly shackle perforation were clinics and radiographic. It is about an observational randomized study in simple insu for the choice of the technique (resection anastomosis or ileostomy and ileo colic intubation). It was about a choice with two arms: ileo colic intubation versus resection anastomosis and ileostomy. The realization of the resection anastomosis or the ileostomy was left to the choice of the surgeon. Forty patients have been drawn by lot and have been distributed in tow groups: Group A (ileo colic intubation), group B (resection - anastomosis and ileostomy). The patients were distributed in 28 boys (70%) with 20 boys in the group A and 8 in group B and 12 girls (30%) with 8 girls in group A and 4 in group B whose middle age was of 8 years and 5 months (ranges: 4 to 14 years). The middle age were 8 years 10 months (ranges: 4 to 14 years) in group A and 8 years (ranges: 5 to 13 years) in group B. In operative meadow, a standard antibiotherapy was instituted in all patients: Ciprofloxacin and Metronidazole in 24 patients (60%), and Ceftriaxone and Metronidazole in 16 patients (40%). We have used the statistic test of KHI2 with a threshold 5% for statistical analysis. RESULTS: The ileo colic intubation technique has been practiced 22 times (55%), the resection - anastomosis technique has been practiced 15 times (37.5%) and the ileostomy technique has been practiced three times (7.5%). The middle length of hospitalization of the patients was of 15 days (ranges: 10 to 45 days) with 13 days (ranges: 10 to 25 days) in group A and 19 days (ranges: 15 to 45 days in group B. The post operative complications were significantly more frequent with the resection anastomosis (53.3%) than with ileo colic intubation (4.5%). CONCLUSION: The ileo colic intubation still rivets an interest in the intestinal typhoid perforation in tropical environment.

[The circumcision: why and how is it practiced in the newborn and the infant in the Lomé teaching hospital?]. / La circoncision: pourquoi et comment est-elle pratiquée chez le nouveau-né et le nourrisson au CHU de Lomé ?

OBJECTIVE: To identify the different indications, to analyze the conditions of realization of the circumcisions and to evaluate the results. PATIENTS AND METHOD: It is about a prospective survey study done in the operative room of the Tokoin teaching hospital (Lomé) and on a period of 12 months (15th June 2007 to 15th June 2008). It was about newborns and infants circumcised in the operative block by a pediatric surgeon. One hundred and thirty-four newborns and infants were circumcised during the period of our study. The medan of age was of 5.86 months (range: 1 to 27 months). RESULTS: One hundred and seven newborns and infants (79.85%) were circumcised for religious motive, 20 (14.92%) for hygiene motive, one (0.75%) for a lesion of the foreskin (burn of the foreskin by hot water), five (3.73%) for a phimosis and one (0.75%) for a paraphimosis. One hundred newborns and infants (74.63%) were circumcised under anesthesia by the fluothane associated to a caudal block, 29 (21.64%) were under local anesthesia (infiltration of anesthetic to the base of the penis) and five (3.73%) under general anesthesia by fluothane only. One hundred and two children (76.12%) were circumcised by the technique using the clamps and 32 (23.88%) by the technique using the Gomco clamp. CONCLUSION: The circumcision is a surgical act whose indications are variable in our surroundings. It is mainly practiced for a religious motive.

Myomectomies for massive hemoperitoneum from spontaneous bleeding of a uterine myoma.

Massive hemoperitoneum from spontaneous bleeding of uterine myoma is an extremely rare condition, that needs urgent surgical exploration. We report a 40-year-old woman, admitted for acute onset of abdominal pain. Physical examination revealed hypovolemic shock. The hemoglobin level was of 5 g/dL. Ultrasonography revealed hemoperitoneum. Emergency surgical exploration was planned. There was hemoperitoneum of 3 L, uterine myomas with multiple subserous myomas, bleeding from superficial ruptured varice overlying the most largest subserous myoma, which measured 15 cm. Glove adapted as a tourniquet, was applied at the base of the uterus, and myomectomies were performed with removal of around twenty myomas. The postoperative course was uneventful. Myomectomies can be safely and effectively performed by using a tourniquet, for massive hemoperitoneum with precarious hemodynamic status due to subserous myoma bleeding, despite the number and the size of myomas.

Management of peptic pyloroduodenal stenosis in Sylvanus Olympio teaching hospital in Lome (Togo).

This study's aim was to describe the management of ulcerous pyloroduodenal stenosis in Sylvanus Olympio teaching hospital of Lomé (Togo). It was a retrospective study of medical files of all patients managed for peptic pyloroduodenal stenosis at the visceral surgery department of Sylvanus Olympio teaching hospital in Lomé (Togo) from january 1(st), 2002 to december 31(th), 2011. Twenty-five patients were selected. Mean age was 38 ± 7.4 years. Sex-ratio was 5. Twenty four patients underwent upper digestive tract endoscopy, completed by upper gastrointestinal series in 18 cases. One patient had only an upper gastrointestinal series. Pyloroduodenal stenosis was improved by antisecretory therapy in 3 cases. Twenty two patients underwent laparotomy. Truncal vagotomy was performed in 15 cases associated with pyloroplasty in 8 cases, and gastrojejunostomy in 7 cases. An antrectomy was performed in 5 cases. Selective vagotomy was associated with pyloroplasty in 1 case, and a gastrojejunostomy in 1 case. One patient died in postoperative period. Functional results were classified Visick I (17 cases) and II (4 cases). Peptic pyloroduodenal stenosis affects young adults. Its tight nature requires association of upper gastrointestinal series and esophagogastroduodenoscopy for diagnosis. Its surgical treatment is exclusively performed by laparotomy at present. Mortality is low and functionnal prognosis is good.

[Diagnostic, therapeutic, and prognostic aspects of typhoid intestinal perforations in Dapaong, Togo]. / Aspects diagnostiques, thérapeutiques et pronostiques des perforations typhiques du grêle à Dapaong, Togo.

PURPOSE: This study's aim is to describe the diagnostic, therapeutic, and prognostic aspects of typhoid intestinal perforations (TIP) at the Dapaong regional hospital (Togo). MATERIAL AND METHODS: This retrospective study covered all patients with such perforations seen and managed in the Dapaong regional hospital's general surgery department during the 3-year period of 2009-2011. RESULTS: There were 110 patients with TIP during the study period, and they accounted for 67.9% of the patients treated for generalized peritonitis (162 cases). Their mean age was 10.2 years. The sex-ratio was 1.4. A single perforation was present for 69 patients (62.7%) and multiple perforations for the other 41 (37.3%). Sixty (54.5%) patients underwent simple closure, 36 (32.8%) had an ileal resection and enteroanastomosis, and 14 (12.7%) had loop or double-barrelled ileostomy. The postoperative course was complicated in 26 cases (23.6%), most often by surgical site infection, seen in 19 patients (17.3%). Overall, 23 patients died during the postoperative period, for a mortality rate of 20.9%. CONCLUSION: Typhoid intestinal perforations are the most common cause of generalized peritonitis at the Dapaong regional hospital. Most patients have only a single perforation, which is repaired by excision-suture. Their morbidity and mortality rate are high.

[Analysis of a series of 44 cases of peritoneal tuberculosis diagnosed in the pathology laboratory of the Tokoin teaching hospital of Lomé (1993-2014)]. / Analyse d'une série de 44 cas de tuberculose péritonéale diagnostiqués au laboratoire d'anatomie pathologique du CHU Tokoin de Lomé (1993-2014).

It is a descriptive and cross-sectional study on all issues relating to peritoneal tuberculosis histological diagnosed in the pathology department (LAP) of the Lomé Tokoin CHU from January 1993 to December 2014 (20 years). A total of 44 cases of peritoneal tuberculosis were included. They were 18 women and 26 men, with a mean age of 37.6±0.2 years. The circumstances of discovery were dominated by ascites (84.1%), fever (75%), weight loss (63.6%) and abdominal pain (59.1%). The peritoneal involvement was isolated in 31.8% of cases, and associated with pleuropulmonary tuberculosis in 54.5% of cases. Co-infection with HIV was present in 63.9% of cases. Twenty-five patients (69.4%) with information about their social conditions had low socioeconomic level: unemployed (10 cases; 40%), workers (10 cases; 40%) and retired (5 cases; 20%). An increase in cell count was observed in 94.6% of cases. Histology revealed the epithelial giant cell granuloma associated with caseous necrosis in 38 cases (86.4%) and cheesy isolated in 6 patients. Peritoneal tuberculosis is not exceptional in our country. The diagnosis should be considered in febrile ascites, and will be confirmed by laparoscopy with histological samples for a histological diagnosis.

[Management of surgical abdominal emergencies in Kara teaching hospital (Togo): 10-year retrospective study of 594 cases]. / Prise en charge des urgences abdominales chirurgicales au centre hospitalier universitaire de Kara (Togo): étude rétrospective à propos de 594 cas sur une période de dix ans.

PURPOSE: The aim of this study was to describe the epidemiologic, diagnostic, and therapeutic aspects of surgical abdominal emergencies in a teaching hospital in a developing country (Togo). MATERIAL AND METHOD: This retrospective study included the medical files of all patients managed for surgical abdominal emergencies from March 1, 2002, to March 1, 2012. RESULTS: The study included 594 patients, with a mean age of 30.3 years (range: 1 month to 80 years) and a 2.1 male:female sex ratio. The emergencies were acute generalized peritonitis (54.5%), intestinal obstruction (26.6%), acute appendicitis (14.5%), and abdominal trauma (4.4%). Plain abdominal radiographs were taken for 414 patients with acute generalized peritonitis (324 cases) and intestinal obstructions without a strangulated hernia (90 cases). Nine patients had abdominal ultrasounds for abdominal trauma (5 cases) and appendicular abscess (4 cases). No abdominal CT scan was performed. All patients underwent surgery, 316 (53.2%) by physician assistants and 278 (46.8%) by surgeons. Resuscitation and anesthesia were performed by nurse-anesthetists. The postoperative course was complicated in 182 cases (30.7%). These complications included parietal suppurations (18.2%), eviscerations (5.1%), ileal fistulas (4.4%), and postoperative peritonitis (3%). The death rate was 11.4%. CONCLUSION: Surgical abdominal emergencies at the Kara teaching hospital were both common and serious. Their particularly high morbidity and mortality might be reduced through the adoption of reasonably practicable measures: paramedical personnel training, public awareness, establishment of management protocols, and improvement of technical equipment (laboratory).

[Management of spinal cord compression in Togo]. / Prise en charge des compressions médullaires lentes au Togo.

PURPOSE: The aim of this study was to describe the epidemiologic, clinical, diagnostic and therapeutic aspects of spinal cord compression at the Lomé-Campus teaching hospital. MATERIAL AND METHOD: We retrospectively analyzed the files of all patients hospitalized for spinal cord compression at Lome-Campus teaching hospital from January 1, 1998, through December 31, 2007. RESULTS: 39 files were selected, mostly of men (77%). The mean age was 53 years (range: 22 to 79). Median time from the start of symptoms to hospital admission was 14.9 ± 24.5 weeks. The spinal cord compression was confirmed by myeloscan in 35 cases (90%), myelography in 2 (5%) and magnetic resonance imaging in 2 cases (5%). The thoracic spine was the most common site of involvement. The principal cause was malignant neoplasm (17 cases: 44%), followed by cervical spondylotic myelopathy (9 cases: 23%) and Pott's disease (7 cases: 18%). Only one patient underwent surgery. CONCLUSION: Spinal cord compression appears to be a rare condition in Togo. It is a true medical emergency and immediate intervention is required. Its management remains precarious and its prognosis poor.