[Zuckerkandl's tubercle: incidence and relationship with the inferior laryngeal nerve]. / Le tubercule de Zuckerkandl: incidence et rapport avec le nerf laryngé inférieur.

UNLABELLED: The iatrogenal lesion of the inferior laryngeal nerve (ILN) during thyroid surgery is an incident, which can have greatest functional after-effects. Its research is recommended during cervicotomy for thyroidectomy and it can be easily found by the presence of Zuckerkandl tubercle, which is a postero-lateral excrescence of the thyroid gland. OBJECTIVES: The main objective of our study was the researching of the presence of this Zuckerkandl tubercle and appreciating the reports with the ILN. PATIENTS AND METHODS: From 1st October 2010 to 30th September 2012, we realized a continuous prospective study on a mono-operator series of 48 patients operated on for thyroidectomy. The Zuckerkandl tubercle has been researched from all the patients and classified according to the classification of Pelizzo et al. RESULTS: From 21 patients (43.75%), the Zuckerkandl tubercle has been well identified and it was grade 3 and grade 2. In those cases, the ILN was very closed to the tubercle. For the 27 other patients (56.25%), the tubercle was practically undetectable or reduced to a small glandular mound (grades 0 and 1). The connections with the nerve in this case were less evident. CONCLUSION: The zuckerkandl tubercle is comparatively frequent and is refound more than one time over 3 in our study. Its presence makes easier the identification of the ILN, which entertains a dangerous connection with the thyroid gland.

[Lower extremity venous thrombosis in Togo]. / La thrombose veineuse des membres inférieurs au Togo.

The purpose of this report was to describe epidemiologic, clinical, and paraclinical aspects and to identify etiologic factors associated with lower extremity venous thrombosis in Lome, Togo.

[Bristow-Latarjet repairs for anterior instability of the shoulder: clinical and radiographic results at mean 8.2 years follow-up]. / Traitement des instabilités antérieures de l'épaule par la technique de Bristow-Latarjet: résultats cliniques et radiologiques au recul moyen de 8,2 ans.

PURPOSE OF THE STUDY: We reviewed, at a mean follow-up of 8.2 years, clinical and radiographic results after 93 Bristow-Latarjet procedures for anterior instability of the shoulder. MATERIAL AND METHODS: There were 84 men and nine female. The average age was 23 years at the time of operative intervention. Forty-four shoulders were on the dominant side. Eighty patients practiced sports activities, with 74 patients a risk sport. Seventy-seven patients have had five or more recurrent of dislocation of the shoulder. The operations were performed by a senior surgeon. Evaluation was done by a clinician, who did not perform the operation. Clinical outcome was assessed with the Duplay score, and the satisfaction of the patients. Radiographic evaluation was done using the standard radiography of the shoulder. RESULTS: According to the Duplay scoring system, we have had 30.1% of excellent results, 43% of good results, 16.1% of fair results, and 10.8% of poor results. The mean Duplay score was 84.7 points with 19 points for the return in sports, 23 points for the stability, 21 points for the pain, and 22 points for the movement. The loss of rotation was less than 13 degrees (mean). Among the patients, 57.4% returned to their former sports activities at the same level, with 59.8% a risk sports. Five patients reported redislocation and eleven patients reported apprehension. The patients were painless in 75.8%. Forty-four patients were very satisfied or satisfied at follow-up. At review, there were radiological degenerative changes in nine shoulders: six in Samilson grade I, one grade II, and two grade III. There was no radiological evidence of loosing, migration or fracture of the coracoid screws, and no nonunion. We have had six cases of resorption of the coracoid tip. DISCUSSION: We are aware of the limitation of the study. It is a retrospective study and there is no control group. However, we believe that, in regard of our result, the Bristow-Latarjet procedure for anterior glenohumeral instability is safe and effective with good objective and subjective result, and a high degree of patient satisfaction. Radiological findings do not always correlate with the functional outcome and patient satisfaction. CONCLUSION: Although it is a non-anatomical repair, the Bristow-Latarjet procedure provides desirable functional results.

[Not Available]. / Pansement versus absencede pansement au delà de 48 heures en milieu tropical : essai randomisé

UNLABELLED: D Dosseh Ékoué, A Doleaglenou, Y-K Fortey, A-E Ayite Objective: to see whether there was a difference in therisk of local infection for surgical wounds in a tropical settingdepending on whether a wound was dressed or left open beyond 48hours post-operatively. METHOD: Over a four month period, 102 patients undergoingintra-abdominal surgery classified as clean or clean-contaminatedwere randomized into two equal groups. The "with dressing" groupunderwent a wound dressing change and re-application every two days.In the "without dressing" group, the wound wasleft open to the air after a first dressing change at 48 hours. RESULTS: There was no difference in post-operative temperaturecurve; post-operative wound infection rate was 2% in eachgroup. Suture removal was performed two days earlier in the "withoutdressing" group and hospital stay was decreased by twodays. The expense of repeated dressing changes was also lessened. CONCLUSION: There is no benefit to leaving a wound dressingin place longer than 48 hours after surgery; costs related to prolongedhospitalization and expenses of dressing changes are decreased bya policy of leaving incisions undressed after 48 hours.

[Randomized trial comparing dressing to no dressing of surgical wounds in a tropical setting]. / Pansement versus absence de pansement au delà de 48 heures en milieu tropical: essai randomisé

OBJECTIVE: to see whether there was a difference in the risk of local infection for surgical wounds in a tropical setting depending on whether a wound was dressed or left open beyond 48 hours post-operatively. METHOD: Over a four month period, 102 patients undergoing intra-abdominal surgery classified as clean or clean-contaminated were randomized into two equal groups. The "with dressing" group underwent a wound dressing change and re-application every two days. In the "without dressing" group, the wound was left open to the air after a first dressing change at 48 hours. RESULTS: There was no difference in post-operative temperature curve; post-operative wound infection rate was 2% in each group. Suture removal was performed two days earlier in the "without dressing" group and hospital stay was decreased by two days. The expense of repeated dressing changes was also lessened. CONCLUSION: There is no benefit to leaving a wound dressing in place longer than 48 hours after surgery; costs related to prolonged hospitalization and expenses of dressing changes are decreased by a policy of leaving incisions undressed after 48 hours.

[Surgical treatment of the single non traumatic perforation of small bowel: excision-suture or resection-anastomosis]. / Traitement chirurgical des perforations non traumatiques uniques de l'intestin grêle: excision-suture ou résection-anastomose.

OBJECTIVE: To evaluate morbidity and mortality following excision-suture and resection-anastomosis for single non traumatic perforations of small bowel (SNTPB). METHODS: From July 2002 to June 2003, a simple blind randomized study comparing excision-suture with resection-anastomosis SNTPB. RESULTS: Of the 125 patients included, 112 were operated by surgeons on training (89.6%). The perforation sat on the antimesenteric edge of the last ileal portion with an average diameter of 0.8 cm (extreme 0.1 and 4 cm). An excision-suture was performed 66 times (52%) including 5 times by an experienced surgeon. 56 patients had simple continuations (45.2%). Morbidity concerned 68 patients (54,8%). 06 patients died of general complications (4.8%). The technique did not influence the mortality. All dead patients were operated by surgeons on training, P=0.25. The complications were significantly more frequent after resection-anastomosis (79.7%) than after excision-suture (32.3%). The difference was significant for the parietal abscesses (P=0,01), the exteriorized fistulas (P=0.04), the septic shocks (P=0.05). CONCLUSION: Whereas mortality was not influenced by the technique, the postoperative course was more complicated after resection-anastomosis (performed in majority by less experienced surgeons). We recommend excision-suture to repair SNTPB.

[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 secondary hyperparathyroidism in patients with chronic kidney disease undergoing dialysis in Togo]. / Prise en charge des hyperparathyroïdies secondaires chez des patients dialysés au Togo.

PURPOSE: To evaluate the means for diagnosis and treatment of secondary hyperparathyroidism in patients with end-stage renal disease undergoing regular hemodialysis. METHODS: This prospective investigation studied patients with chronic renal kidney disease requiring and receiving hemodialysis at the Tokoin University Hospital in Lomé, from January 21, 2008, through December 31, 2008. RESULTS: The study population comprised 42 patients: 24 men and 18 women ranging in age from 20-82 years (mean: 42.62 years). Hyperparathormonemia was found in 20 of 24 patients for whom parathormonemia was assayed. Two patients with hyperthyroidism received a phosphorus chelator, and another went to Egypt for renal transplantation. The various other treatments we applied were not efficacious. We noted three cases of pathological fractures and one case of sudden death. CONCLUSION: The risk of parathyroidism in patients receiving hemodialysis is unavoidable. Its course is marked by a risk of sudden death due to the cardiovascular damage it causes. Numerous factors impede its effective management in Togo.

Resultats preliminaires du traitement de luxations anterieures redicivantes de l'epaule par la methode de Boitchev II modifiee

Vingt deux cas de luxation anterieure redicivante de l'epaule ont ete traites dans le service de chirurgie generale du CHU de Lome par l'operation BOITCHEV II modifiee; de mars 1988 a novembre 1992. Aucun critere particulier n'a preside au choix des patients; en dehors du caractere redicivant de la luxation antero-interne. L'operation BOITCHEV II; qui consiste a derouter le coraco-biceps entre capsule articulaire et sous scapulaire; a ete completee par un platre thoraco-brachial permettant une mobilisation active precoce. Cette methode a donne; dans tous les cas; une recuperation fonctionnelle rapide et complete avec une parfaite stabilite de l'epaule 1 a 5 ans apres l'operation. Mais ces resultats preliminaires doivent etre verifies par une serie plus grande et avec un recul plus important

Le traitement des gangrènes périnéales et de la sphère genitale par le miel

Les gangrenes du perinee et des parties molles se rencontrent sous les tropiques avec une frequence non negligeable. Leur prise en charge therapeutique se heurte souvent au cout des produits pharmaceutiques utilises. Depuis deux ans ces lesions sont traitees avec du miel en raison de ses proprietes antibiotiques et cicatrisantes(3;7)

Traitement des plaies au miel

Le miel est utilise dans le traitement des plaies depuis la haute antiquite. Son utilisation se poursuit dans les pays africains et indo-pakistanais ou les plaies infectees constituent un probleme majeur de sante dans les populations rurales. Depuis deux ans; les auteurs testent l'efficacite du miel sur les plaie de nature diverses. Ils rapportent dans ce travail; les resultats preliminaires de leur etude

Autotransfusion differee en chirurgie et economie de sang

Une etude prospective portant sur l'autotransfusion differee a ete faite au C.H.U. de Lome sur une periode de dix mois allant d'avril 1990 a janvier 1991. les resultats suivants ont ete obtenus : au total 38 malades ont ete retenus a la suite d'une selection multiphasique. Chacun des 38 malades a subi un a quatre prelevements a raison d'un prelevement d'une unite (500ml) de sang par semaine. Au total; 84;5 unites de sang ont ete preleves. La quantite moyenne de sang prelevee etait de 2;49+0;78 unites. Sur les 38 malades preleves; 32 ont ete operes dont 24 transfuses. La quantite totale de sang transfusee etait de 55 unites et la quantite moyenne de sang transfusee etait de 2;29+0;94 unites. Les unites de sang non transfuses a leurs patients autologues ont ete donneesa la banque de sang du C.H.U. pour un usage homologue. Les malades ont presente une bonne tolerance clinique et biologique a l'autotransfusion differee malgre une anemie moderee notee au debut des prelevements. [abstract terminated]

Volvulus de l'intestin grele: revue de 55 cas operes au CHU de Lome (Togo)

Une enquete retrospective a ete menee sur les cas de volvulus de l'intestin grele operes dans le service de Chirurgie Generale du CHU de Lome dans le but de se faire une idee des caracteristiques etio-pathogeniques; cliniques; et du pronostic de cette affection peu etudiee dans notre sous-region. Le volvulus du grele; 55 cas; correspondant a 65;47 pour cent des volvulus intestinaux; a represente 14;66 pour cent des causes d'occlusion intestinale aigue mecanique. Il a ete d'une nette predominance masculine (67;27 pour cent) avec un age moyen de 40 ans. Sur le plan pathogenique; il y avait une legere predominance des volvulus secondaires (52;73 pour cent) qui etaient dus dans 82;75 pour cent des cas aux brides et adherences spontanees ou post-operatoires. Tous les patients ont ete operes avec le diagnostic d'occlusion intestinale aigue. Dans aucun cas le diagnostic de volvulus du grele n'a ete pre-operatoire. Le retard therapeutique a ete responsable; dans 31 cas; de gangrene intestinale obligeant a une resection chez des patients en mauvais etat general: d'ou une lourde mortalite de 34;54 pour cent. Il faut convaincre les patients de consulter plus tot pour esperer une amelioration du pronostic

Les aspects psychosociaux de la transfusion autologue differee au Togo

Une enquete hospitaliere etudiant les facteurs psychosociaux de la transfusion autologue differee a ete menee au CHU de Lome sur une periode de dix mois allant d'avril 1990 a janvier 1991. Au total 45 malades de 15 a 65 ans ont ete enquetes dont 26 hommes et 19 femmes. La transfusion autologue differee (ATD) est une therapeutique transfusionnellle qui etait totalement inconnue de tous nos malades. Malgre cette meconnaissance de l'A.T.D.; elle a ete acceptee par la grande majorite (89;89 pour cent) de nos malades qui l'ont effectivement subie apres une explication detaillee de sa realisation et de ses avantages. Les principaux motifs d'acceptation de cette therapeutique etaient: la recherche de securite transfusionnelle; la recherche d'une satisfaction morale qui etait inherente au caractere mystique que l'Africain donne au sang; et le desir d'etre vite opere. [abstract terminated]