[Vascular relationships of the right great splanchnic nerve in the thorax]. / Rapports vasculaires thoraciques du nerf grand splanchnique droit.

AIM: The surgical assumption of responsibility of the pancreatic pain requires either a truncular coelioscopic or radicular neurectomy of greater splanchnic nerves (gsn). The goal of our work is to describe the way and relations of the right gsn which are variable and rarely described. This constitutes an undeniable peroperational hemorrhagic risk during splanchnicectomy. MATERIAL AND METHODS: After a double side thoracotomy and a bilateral sterno-clavicular desarticulation on 15 adult cadaveric subjects preserved by method of Winckler we removed the sterno-costal drill plate as well as the ventral rib arch and proceeded to a mediastinal evisceration of the thorax. Then we respected only the thoracic aorta and the oesophagus, the azygos venous system, the thoracic duct and the thoracic sympathetic chain. In some of the subjects, the azygos vein was injected (after catheterization of its stick) using gelatine coloured with blue paint. We studied the way and vascular relations of the right gsn. We measured the transverse distances between the origin of the gsn on one hand and the longitudinal axes of the azygos vein and the thoracic duct on the other hand. RESULTS: The relations of the right gsn trunk during its way related to the azygos vein in particular its constitutive origin and its affluents: ascending lumbar vein and twelfth intercostal vein. Sometimes the thoracic duct even a lymphatic node was near the gsn in the posterior infra-mediastinal space. A classification of the way and vascular relations of the right gsn in the thorax identified 3 anatomical types. The average distances separating the right gsn on one hand from the azygos vein and the thoracic duct on the other hand were respectively 5.7 mm and 11.2 mm. CONCLUSION: The vascular relations of the right gsn are very variable from one subject to another but primarily venous, sometimes lymphatic. They concerned the great thoracic vessels whose respect is essential in particular at the time of mini-invasive access procedure for a cœlioscopic splanchnicectomy.

Solar energy: A panacea for the electricity generation crisis in Nigeria.

In assessing the status of solar energy in Nigeria, efforts have been made to review researchers' works. This review article presents the status of solar energy in Nigeria. Also, it provides an all-inclusive contemporary analysis of the extensive research carried out in this field by Nigerians and renewable energy researchers in general. With her large population, Nigeria requires enormous energy for sustainability; this has caused somewhat an overdependence on crude oil and natural gas for energy. This overdependence constantly puts the country in an energy consumption crisis when these resources are not readily available. It has its disadvantages as it affects climate change and her economy. Solar energy growth and application/adoption from the global, African, West African, and Nigerian perspectives were expounded with that of Nigeria buttressed on to bring into view the contrast between her adoption of this technology and the world. Albeit, the electricity generation from solar energy in Nigeria has also been estimated from solar radiation data, results of this analysis showed some areas in Northern Nigeria as the regions with the highest electricity generation capacity; the estimation using 1 kWp (Kilowatt-peak) PV (photovoltaic) modules were made from obtained data for possible electricity generation in kWh. The challenges to adopting these technologies were noted together with some recommendations/policies on how to curb these challenges and their implications. This review article will be of massive benefit to both the government and researchers in this research area and scientists who are currently working on renewable-related projects.

[The common celiacomesenteric trunk: about one case]. / Observation d'un tronc artériel coeliomésentérique commun.

The discovery of a coeliacomesenteric trunk is often fortuitous in a context of morphological or vascular exploration. About one case of this rare arterial remind us of its characteristic and different type. We emphasize the interest of not being unaware of this variation in radiological practice and vascular pathology. In our observation, the coeliacomesenteric trunk's ostium is oval with a tall axis of 14 mm; its route of 8mm is median and its arterial ending divide into hepatosplenogastric trunk and superior mesenteric trunk. It is a type I coeliacomesenteric trunk which is the most frequent type of this arterial variation in Higashi's classification.

[Mesenteric venous thrombosis and antithrombin III deficiency: diagnosis before an acute digestive hemorrhage]. / Thrombose veineuse mésentérique et déficit en antithrombine III: diagnostic devant une hémorragie digestive aiguë.

Mesenteric venous thromboses are often associated with antithrombin III deficiency. We can suspect this clinical diagnosis in patients with nonspecific abdominal pain syndrome and personal or familial history of mesenteric venous thrombosis. We report the case of a 63-old-male caucasian with antithrombin III deficiency and rectal bleeding who was diagnosed with mesenteric venous thrombosis at exploratory laparotomy. This case emphasizes the necessity of a careful history in all patients without an obvious diagnosis. In this way, we can invoke the diagnosis of mesenteric venous thrombosis quickly and begin the heparin therapy while waiting for the results of further confirmatory tests.

[Effect of intestinal necrosis in the postoperative prognosis of acute intestinal obstruction. Experiences with 123 cases surgically treated at Bujumbura Hospital (Burundi)]. / Influence de la nécrose intestinale dans le pronostic post-opératoire des occlusions intestinales aiguës. Expérience de 123 cas opérés à l'Hôpital de Bujumbura (Burundi).

The review of 123 cases of patients operated for acute intestinal obstruction emphasises the principal epidemiological factors and the necessity of a very brief delay between the first signs of obstruction and the therapeutic procedure. The high mortality in the series (25%) was due to the high incidence of necrosis observed (40%).

[Complicated colonic diverticulosis. Results of surgical treatment between 1981 and 1998 in 370 patients]. / Les diverticuloses coliques compliquées. Résultats du traitement chirurgical entre 1981 et 1998 chez 370 patients.

AIM OF THE STUDY: The aim of this retrospective study was to analyze case reports of all the patients with complicated diverticular disease of the colon admitted in the same surgical center during an 18-year period and to report the postoperative results in patients operated on in emergency and in patients operated on electively. PATIENTS AND METHOD: From 1981 to 1998, 501 patients were admitted for complicated diverticular disease. There were 233 men and 268 women. Mean age was 66 years (range: 27-96). One hundred and thirty-one patients were only treated medically and 370 patients were operated on, either as an emergency (n = 211) or electively (n = 159). The complicated diverticular disease was located on the left colon in 362 cases and in the right colon in 8 cases. RESULTS: In the emergency group, 103 patients were operated on for pelvic (n = 24) and generalized purulent (n = 67) or stercoral (n = 12) peritonitis, mainly with Hartmann procedure (n = 80) with 14 postoperative deaths; 67 were operated on for pericolic abscess with 6 deaths, 19 for colonic obstruction with two deaths and 22 for profuse hemorrhage with 4 deaths. The overall postoperative mortality rate was 12.3%, and morbidity rate 38.7%. Intestinal continuity was restored in 74% and eventrations were present in 10%. In the elective group, there were two postoperative deaths in patients with a colic fistula (n = 30), no mortality and a 10.8% morbidity rate in the other patients (n = 129). CONCLUSION: This series of an 18-year duration emphasizes the severity of surgery for acute complications in diverticular disease of the colon and the advantages of elective surgery. Large progress in the management of peritonitis and pericolic abscesses has made possible the improvement of their prognosis.

[Techniques, indications and early results of splenic preservation during left pancreatectomy]. / Techniques, indications et résultats précoces de la conservation splénique dans les exérèses pancréatiques gauches.

STUDY AIM: Splenic preservation is rarely performed during left pancreatectomy. We compared retrospectively the early results of left pancreatectomy with and without splenic preservation to define the place of this procedure. PATIENTS AND METHODS: From 1979 to 1997, among 54 left pancreatectomies for another indication than adenocarcinoma, 13 were performed with and 41 without splenic preservation. The technique used for splenic preservation was prograde dissection of the left pancreas with (n = 4) and without (n = 9) preservation of both splenic artery and vein. The preoperative characteristics of the patients, peroperative data, postoperative morbidity and length of stay were compared. RESULTS: Mean operative time was longer with splenic preservation (262 +/- 67 min versus 215.6 +/- 59 min, p < 0.05), particularly in case of splenic vessels preservation (295 +/- 38 min, p < 0.02) whereas no difference was noted with splenic vessels ligation (240 +/- 76 min, p > 0.05). No mortality occurred. Prevalence of preoperative or postoperative haemorrhage, morbidity, or length of stay (intensive care unit and whole hospitalisation) did not differ with or without splenic preservation. Five patients developed pancreatic fistula without influence of splenic preservation: 1/13 (7.7%) versus 4/41 (9.7%); conversely, surgery following acute pancreatitis was associated with an higher risk of pancreatic fistula: 3/5 versus 2/49 (p < 0.005). No splenic necrosis occurred after splenic preservation. CONCLUSION: During left pancreatectomy, splenic preservation increases the operative duration (only in case of preservation of splenic vessels) but does not increase morbidity. This technique should be used whenever possible to allow long term immunological benefits of splenic preservation.

[Intraductal papillary adenocarcinoma of the pancreas. Case report and review of the literature]. / Adénocarcinome papillaire intracanalaire du pancréas. Un cas et revue de la littérature.

In 1974, cephalic duodeno-pancreatectomy was performed in a 48-year old patient with papillary adenocarcinoma within the pancreatic duct. The patient is still alive without overt recurrence. The authors emphasize the rarity of such lesions (8 cases published to date), the diagnostic value of retrograde contrast radiography of the main pancreatic duct, the need for wide pancreatectomy, the quality of survival and the possibility of cure.

[A new case report of traumatic rupture of the diaphragm (University Hospital Center Kamenge-Bujumbura)]. / Une nouvelle observation de rupture traumatique du diaphragme (Centre Hospitalier Universitaire Kamenge-Bujumbura).

Classified as a part of thoraco-abdominal traumas and polytraumas, midriff traumatic rhexis must be operated as soon as possible. A new case of the rhexis of a left dome confirms this notion admitted by all. Their peculiar prognosis is generally very good but all depends on the possible associated lesions able to hamper the vital prognosis.

The treatment of Eikenella corrodens soft tissue infection in an injection drug user.

Eikenella corrodens is a gram negative rod considered normal mouth flora and is commonly linked to human bite injuries. In rare cases, E. corrodens can cause systemic infections. This article describes the case of a 30-year-old injection drug user who presented with a serious polymicrobial infection of the arm. Usual empiric antibiotic coverage resulted in little improvement, and eventually 300 milliliters of purulent material was drained from his upper arm. Cultures of the drainage grew E. corrodens as well as other oral flora. After surgical drainage, specific antibiotic therapy directed towards E. corrodens was added to his antimicrobial therapy and the patient fully recovered. We conclude that E. corrodens is common in the injection drug user population as part of mixed infections, and that empiric antibiotic coverage for this organism, namely penicillin, may be warranted in certain clinical situations.

[A rare cause of intestinal obstruction revealed during pregnancy (Kamenge University Hospital Center, Bujumbura, Burundi)]. / Une cause rare d'occlusion intestinale revelee lors de la grossesse (Centre Hospitalier et Universitaire Kamenge, Bujumbura Burundi).

Acute intestinal occlusion is rare during pregnancy, and more exceptional is the source itself of the occlusion we are reporting embryonic. This is actually an embryonic remains: the omphalo-mesenteric (vitellin) duct that did not resorb and has developed into a fibrous cord. The latter, owing to physiological modifications, is responsible of the occlusion. The authors analyse the two facts which, when associated, represent an interesting clinical fact.

[A new case report of omphalocele in a newborn (Kamenge University Hospital Center at Bujumbura, Burundi)]. / Une nouvelle observation d'omphalocèle du nouveau-né (Centre Hospitalier Universitaire Kamengé Bujumbura-Burundi).

A new case report of new born baby's omphalocele allows us to precise the embryological data indispensable to understand the genesis of this pathology. The future of the primitive intestinal loop and the explanation of the temporary physiological hernia, are the basis of such phenomenons rarely reported and they complete the three cases' report recently published.

[Non-obstructive necrotizing acute enterocolitis (apropos of a case report) )University Hospital Center Kamenge-Bujumbura)]. / Les entérocolites aigües nécrosantes non obstructives (à propos d'une observation) (Centre Hospitalier Universitaire Kamenge-Bujumbura).

The authors report on a new case of acute necrotic non obstructive enterocolitis. Discussion is mainly centered on the nosological framework of this uncommon affection, occurring in an infectious background, and on its etiopathogenetic mechanism. Several hypothesis are formulated. Because of the seriousness of its prognosis, it is emphasized on the necessity of a rapid surgical intervention.

[Osteogenesis imperfecta in monozygotic twins in Burundi]. / Ostéogenèse imparfaite chez des jumelles monozygotes au Burundi.

Little data is available about osteogenesis imperfecta in Black African children. This defect was diagnosed in monozygotic twins from Rwanda who presented multiple fractures, in particular of the femur, when they began to walk. Osteogenesis imperfecta was confirmed by lower limb deformity, presence of wormian bones in the skull, blue sclera, and tooth defects. In addition to the fact that it is uncommon to encounter this condition in monozygotic twins, this case is interesting for several reasons. Was osteogenesis imperfecta in these patients type I, frequent, or type III, exceptional? More importantly, this case stresses the high prevalence of type III in Black Africa which could constitute a hot-bed in the world.

[The inferior rectal nerve. Anatomical bases of perineal pain]. / Le nerf rectal inférieur. Bases anatomiques des algies périnéales.

MATERIAL: 4 corpses (1 fresh, 3 formoled) without preliminary injection; age: 84 to 90. METHOD: a front access enabled us to show the origin of the inferior rectal nerve from the pudendal plexus, its course across the Alcook canal and the ischiorectal fossa. Then a posterior transgluteal access showed the short intragluteal course across the "biligamentary tunnel" (between sacrospinal and sacrotuberal ligaments) of nerves and vessels related to the anus, in particular the inconstant Morestin's nerve. RESULTS AND CONCLUSION: the compression of nerves causing perineal pain can occur at different places. Depending on the localisation of the origin and the course of the inferior rectal nerve (which change) in relation to the place of that compression, and also the existence or not of Morestin's nerve, the changing topography of these pains can be explained.

[Radio-anatomic study of the ophthalmic artery]. / Etude radio-anatomique de l'artère ophtalmique.

It is possible to have a good definition of structures with modern neuro-imaging. Ophthalmic artery is a neat vessel with lot of branches and sinous pathway, which are difficult to have in the same frame. A good knowledge of the classical anatomy is necessary to interpret correctly the pictures obtained with neuro-imaging. The aim of this study is to compare classical dissections (dissections after latex injection, corrosion with Altufix P.10, radiography after Minimum injections) with radio-anatomical images (computed scanns, angiographies, MRI). We have also studied origin, pathway, collateral branches of ophthalmic artery.

[Duodenal duplications in adults. Apropos of 3 cases]. / Duplications duodénales de l'adulte. A propos de 3 observations.

Duodenal duplication is a rare congenital malformation and it is quite exceptional for it to be discovered in adult life. Three recently observed cases are discussed and used as a basis for reviewing diagnostic and surgical therapeutic problems. Pathology provides confirmation of diagnosis.

[Post-appendectomy fistulas of the cecum. Apropos of 22 cases]. / Fistules caecales post-appendicectomies. A propos de vingt-deux cas.

Appendicitis, usually a benign disease, can have its prognosis worsened in case of postoperative fistula. The latter occurs rarely after open appendectomy (0.133%), but accounts for 10% of the morbidity rate. The authors reviewed 22 cases of these fistulas, treated during a 24-year period (January 1970 to December 1993). The aim of these retrospective study was to precise their clinical features, to evaluate paraclinical examinations in diagnosing these complications and to give guidelines for their treatment. Fistulas occurred at day 14 in the postoperative course. In 21 case, appendicitis was severe (suppurative, gangrenous or perforated) or appendectomy quoted as technically difficult. Location of the appendix was atypical in 7 cases. Drainage of the site was performed in 17 cases at the time of appendectomy. Diagnosis was made on the aspect of the drainage fluid in 14 cases. Diagnosis workup of the fistula associated plain abdominal radiograph and abdominal ultrasonography (n = 22). Fistulography (n = 6) confirmed the clinical diagnosis of fistula, showing the leaking in all cases. Medical treatment was attempted first in 14 cases and was successful in 11 cases with a healing time from 13 to 72 days. Surgical treatment (open drainage of the site) was attempted first in 11 cases, and was mandatory in 3 other cases because of medical treatment failure: one patient died and 5 patients underwent re-operation (right colectomy in 3 cases, bypass in 1 case and re-drainage in 1 case). Fistulography in our experience, is highly reliable and is considered to be a great assistance in management of these fistulas. Medical treatment remains the best initial treatment modality. Surgery must be contemplated in case of established external fistulas, and of purulent or faecal fistulas. Nevertheless, prognosis remains poor (50% re-operation rate).

[Update on lateral and medial spaces of the dorsal wall of the axillary fossa]. / Mise au point à propos des espaces latéral et médial de la paroi dorsale de la fosse axillaire.

Lateral and medial axillary spaces (also named quadrilateral and triangular spaces) correspond to orifices of the posterior wall of axillary fossa communicating with deltoid and scapular areas. We attempt to become clear the anatomic boundaries of these spaces and the structures passing through. We studied by dissection 18 fresh and embaulmed human upper limb of both sex. Lateral axillary space was limited by lateral edge of the long head of the triceps muscle medialy, the medial edge of the surgical neck of the humerus lateraly. The tendon of teres major and latissimus dorsi muscles constituted lower limit and the superior boundary was the scapulohumeral capsule rather than the teres minor muscle. Structures passing through the quadrilateral space where the axillary nerve and the posterior humeral circumflex vascular pedicle. Boundaries of the triangular space where, lateraly the medial edge of the long head of the triceps, superiorly the inferior edge of the teres minor and the axillary border of the scapula; the upper edge of the teres major corresponded to the superior limit. Abduction of the upper limb is a movement which increase the risk of entrapment phenomenon of the axillary nerve in relation to rigid anatomic structures like the surgical neck of the humerus, the scapulohumeral capsule and the tendon of latissimus dorsi and teres major muscles. Neverless genetics cause of anatomic predisposition is evocated in the quadrilatere space syndrome.