The paediatric surgeon and his working conditions in Francophone sub-Saharan Africa.

BACKGROUND: This study described the current conditions of work of paediatric surgeons in Francophone sub-Saharan Africa (FSSA) and set the debate at the level of the humanist thinking in medicine. PATIENTS AND METHODS: This was a multicentre study from 1 st May to 30 th October 2008. The African Society of paediatric surgeons' directory was used to identify paediatric surgeons in the Francophone's countries in Sub Saharan Africa. The parameters studied were number of surgeons per country, means of training, working conditions, remunerations, needs for continuous training and the research. RESULTS: A total of 41 paediatric surgeons (68.33%) responded. The average number of paediatric surgeons per country was 5. The means of training included government scholarships among 7 paediatric surgeons (17.07%), scholarship from a non-governmental organisations in 14 (34.15%) and self-sponsorships in 20 (48.78%). The average salary was 450 Euros (€) (range: 120-1 400 Euros). Most of the paediatric surgeons (68.29%) had internet services for continuous update courses and research. Thirty six paediatric surgeons (87.80%) had no subscription to specialised scientific journals. CONCLUSION: The paediatric surgeon in FSSA faces many problems related to his working and living conditions that may have a negative impact on their competences.

[Reconstruction using non-vascularized fibula of an aneurysmal bone cyst of the humerus in a child]. / Reconstruction par Fibula non Vascularisee d'un Kyste Osseux Anevrysmal de L'Humerus Chez L'Enfant.

Aneurysmal bone cyst is a pseudotumoral bone dystrophy which accounts for 1.5 to 4% of benign bone tumours. We report the case of a bulky aneurismal cyst of the left superior humeral metaphysis in a seven year old child revealed by a repeated pathologic fracture. Exeresis of the cyst was performed with reconstruction by a non vascularized fibula. After a follow up of one year the patient recovered safely with normal range of motion and anatomically. The cystic exeresis sparing the growth cartilage with fibula graft is indicated in the management of active and aggressive aneurismal cyst of long bones.

Reconstruction par fibula non vascularisee d'un kyste osseux anevrysmal de l'humerus chez l'enfant

Le kyste osseux anevrysmal est une dystrophie osseuse pseudo-tumorale qui represente 1;5 a 4des tumeurs osseuses benignes. Nous rapportons l'observation d'un volumineux kyste anevrismal de la metaphyse humerale superieure gauche chez un enfant de 7 ans decouvert a l'occasion d'une fracture pathologique iterative. Il a ete pratique une exerese sous periostee du kyste avec reconstruction par transfert de fibula non vascularise. Les resultats fonctionnel et anatomique ont ete satisfaisant a 1 an de recul.. L'exerese kystique epargnant le cartilage de croissance avec reconstruction par fibula non vascularise est indiquee pour le traitement du kyste anevrysmal agressif des os longs

Transfer of surgical competences in the treatment of intersex disorders in Togo.

BACKGROUND: To evaluate the impact of scientific seminar on the sexual ambiguity on patients and paediatric surgeons in French-speaking African countries. MATERIALS AND METHODS: This was a report of the proceeding of a teaching seminar on intersex management, which was held from December 4 th to 8 th , 2006, in the Paediatric Surgery Department of Tokoin Teaching Hospital and the Surgery Department of "Saint Jean de Dieu" Hospital of Afagnan, Togo. RESULTS: There were 107 participants [five professors of paediatric surgery, 62 African paediatric surgeons (including 15 from African French-speaking countries), and 40 general surgeons]. The workshop involved a two-day theoretical teaching session (aimed at understanding, recognising, and treating the sexual ambiguities), and practical session; during these sessions different intersexes (one case of mixed gonadal dysgenesis, two of female pseudohermaphroditism, and two of male pseudohermaphroditism), were operated free of charge. Participants expressed satisfaction and confidence with regard to the management of intersex after the seminar. CONCLUSION: This scientific forum allowed possible exchange of competence among the paediatric surgeons with regard to efficient treatment of sexual ambiguities.

Transfer of surgical competences in the treatment of intersex disorders in Togo

Background: To evaluate the impact of scientific seminar on the sexual ambiguity on patients and paediatric surgeons in French-speaking African countries. Materials and Methods: This was a report of the proceeding of a teaching seminar on intersex management; which was held from December 4 th to 8 th ; 2006; in the Paediatric Surgery Department of Tokoin Teaching Hospital and the Surgery Department of ""Saint Jean de Dieu"" Hospital of Afagnan; Togo. Results: There were 107 participants [five professors of paediatric surgery; 62 African paediatric surgeons (including 15 from African French- speaking countries); and 40 general surgeons]. The workshop involved a two-day theoretical teaching session (aimed at understanding; recognising; and treating the sexual ambiguities); and practical session; during these sessions different intersexes (one case of mixed gonadal dysgenesis; two of female pseudohermaphroditism; and two of male pseudohermaphroditism); were operated free of charge. Participants expressed satisfaction and confidence with regard to the management of intersex after the seminar. Conclusion: This scientific forum allowed possible exchange of competence among the paediatric surgeons with regard to efficient treatment of sexual ambiguities"

[Surgery of congenital clubfoot in Don Orione, Health Center for physical handicaps of Ivory Coast (About 554 feet)]. / Chirurgie du pied-bot varus équin congénital au centre pour handicapés physiques Don Orione de Côte-d'Ivoire (A propos de 554 pieds).

OBJECTIVES: Treatment of congenital clubfoot improved in occidental country. We have studied the epidemiology, clinical and therapeutic aspects of this malformation in the context of Africa. PATIENTS AND METHODS: This was a retrospective study. Two thousand five hundred and sixty-two patients were hospitalised and operated during 12 years, 362 of them were diagnosed with congenital clubfoot. This represented 14,1% of the surgical diseases, with an incidence of 30,2 cases per year. The male to female ratio was 1,6:1, and ages ranged from 4 months to 38 years old, 59% of which were less than 15 years old. Two hundred and four (56,3%) patients had bilateral disease, 93 (25,7%) had right side disease and 65 (18%) had left sided disease. Considering the classification types we noted in our patient population 82% type III, 5% type II, 3% type I and 10% were undefined. RESULTS: Posteromedial approach describe by Codivilla was used in 45,5% of cases. Codivilla approach associated with lateral access to the foot in 44,4% of cases, with dorsal access in 2,3%. Few patients (7,8%) have had another approach. One hundred and seventeen patients received physiotherapy prior, but all the patients operated have postoperative physiotherapy while wearing orthopaedic shoes. Results obtained were: good in 510 cases (92%), quite good in 35 cases (6,3%), fairly good in 7 cases (1,3%) and mediocre in 2 cases (0,4%). CONCLUSION: The surgical aspect is still only a fraction of the entire treatment. It is imperative that physiotherapy is started immediately and orthopaedic shoes be worn postoperatively.

[Primitive psoas abscess in children; diagnostic difficulties and non surgical treatment: apropos of 2 cases]. / Abcès primitif du psoas chez l'enfant, difficultés diagnostiques et traitement non chirurgical: à propos de 2 cas.

From an analysis of two files of children carriers of primitive psoas abscess, the authors report the difficulties of diagnosis due to the rarity of this affection and the similarities of its symptomatology with ostearthritis of the hip which is a common pathology at the pediatric surgery unit of C.H.U. Yopougon (Republic of Côte d'Ivoire). A non surgical treatment made of antibiotherapy and traction fixed in the axis of the limb is proposed, since it helped the two patients who had presented an echographical stage II of psoas abcess to recover without after-effects.

[Intra-abdominal small round-cell desmoplastic tumor: ultrasonographic and computed tomographic aspects. Apropos of a case]. / Tumeur desmoplastique intra-abdominale à petites cellules rondes: aspects échographiques et tomodensitométriques. A propos d'un cas.

We report a case of small round-cell desmoplastic tumor located in the abdomen. We describe the ultrasound and CT features of this uncommon tumor with poor prognosis.

[Ultrasound scanning of abdominal contusions in children: experience at the Yopougon CHU (Ivory Coast)]. / Exploration échographique des contusions abdominales chez l'enfant: expérience du CHU de Yopougon (Côte d'Ivoire).

Ultrasound scans were used to study 23 cases of abdominal contusion in children, between January 1992 and December 1993. Thirteen boys and 10 girls were studied. They were all aged between 4 and 14 years, with a mean age of 6 years. The main causes of their injuries were road accidents (12 cases) and play (11 cases). Ultrasound scans were normal in 6 patients and pathological in 17 patients. The most frequently observed injuries were visceral effects (12 cases), almost always associated with hemoperitoneum. In three cases, hemoperitoneum was detected in the absence of visceral effects. The spleen (4 cases) and the liver (4 cases) were the most frequently injured organs. The other injuries detected included renal hematoma, bladder rupture and parietal hematoma. Diagnosis on the basis of ultrasound scans was found to be incorrect in three cases where diagnosis was repeated after the scan. One case involved a blocked perforation of the rectum, one a benign cyst and the other a mesenteric cyst. Despite these misdiagnoses, ultrasound scanning is a highly sensitive and specific method for examination of contusions in children. It is very useful and often sufficient for accurate diagnosis, particularly in units with only modest technical support.

[Use of antibiotics in pediatric surgery at the University Hospital Center at Yopougon, Abidjan (Ivory Coast)]. / Utilisation des antibiotiques en chirurgie pédiatrique au CHU de Yopougon, Abidjan (Côte d'Ivoire).

Considering 901 files of in-patients (68% of boys and 32% of girls, mean of ages: 2 days to 16 years) and prescriptions at the hospital of Yopougon during a period of two years (1991-1992), the authors have made a retrospective and critical study of the use of antibiotics in this department. Antibiotics, either demanded by strong presumption of infection, either indicated as a prophylaxis, have been administered to 54% of the patients. When this antibiotic therapy has been curative (56% of the cases of first intention), it was considered correct in 97% of the cases. On the other hand, it was ill-done when it was a matter of antibioprophylaxis. An antibiotherapy of second intention has been prescribed when antibiotherapy of first intention had failed and also when the antibiotic reserve of the hospital was over. The average number of antibiotics given to a patient was 2.12, frequently associating aminoside and penicillin. The total cost of antibiotics was 78% of the whole drugs used to cure these patients and among them, the biggest cost was for cephalosporines of third generation.

Lymphagiome kystique cervical: apport de l'echographie et de la tomodensitometrie: a propos d'un cas. [Lette]

Les auteurs; a partir d'un cas de lymphagiome kystique cervical; signalent l'apport de l'imagerie medicale; surtout de l'echographie et la tomodensitometrie; dans le diagnostic de cette affection rare

A propos d'un cas de barytome iatrogene chez un nourrisson de 5 mois. [Lettre]

Les auteurs rapportent une observation de peritonite aigue consecutive a une perforation colique lors d'un lavement baryte. L'accident est survenu chez un nourrisson de 5 mois presentant une invagination intestinale aigue. La precocite du diagnostic et du traitement encadre par une reanimation efficace; ont permis l'evolution favorable. Des complications (infection; desordre hydroelectrolytique; trouble hemodynamique) ont emaille cette evolution. Les auteurs font une revue de la litterature sur la question et attirent l'attention des praticiens (chirurgiens; radiologistes et reanimateurs) sur la gravite de l'accident; la necessite de son diagnostic et des difficultes de sa prise en charge tout au long de son evolution. Ils preconisent le suivi a long terme des malades vivants a la recherche de sequelles et de complications ulterieures et enoncent des mesures prophylactiques

[Urethral prolapse in young girls: a rare pathology in pediatric surgery. Our experience apropos of 22 cases observed at the Cocody and Yopougon University Hospitals]. / Le prolapsus urétral chez la fillette: pathologie rare en chirurgie pédiatrique. Notre expérience à propos de 22 cas observés aux CHU de Cocody et Yopougon.

Twenty-two cases of prolapse of the urethral mucosa, a benign affection mainly encountered in young black girls, were observed over a 9-year period (1983-1992). This pathology is still poorly understood and the aetiology has not been clearly determined. Treatment protocols, medical and surgical, vary. We prefer exeresis of the prolapsed mucosa, followed by suture. The results have been quite satisfactory.

[Nephroblastoma at the hospital unit in Abidjan. Apropos of 60 cases]. / Le néphroblastome au centre hospitalier d'Abidjan. A propos de 60 cas.

A series of 60 cases of nephroblastoma treated at the Abidjan University Hospital from 1971 to 1981 were reported. Nephroblastoma is a frequent childhood tumour representing 26.40% of malignant childhood tumours. It is a tumour of the young child. There is no sex predominance and both sides are equally involved. The tumour is the only clinical manifestation and is always palapable. Factors of poor prognosis were often observed in our patients including: age less than 2 years with major tumour volume (56.6%), advanced stage (89.3%). Antimitotic treatment was used in all cases and in 16 surgery was required. The poor prognosis criteria observed in this series explain the poor outcome in most of the cases.

[Surgical treatment of hepatosplenic bilharziosis in the Ivory Coast. Apropos of 34 cases]. / Traitement chirurgical de la bilharziose hépato-splénique en Côte d'Ivoire. A propos de 34 cas.

Portal hypertension due to hepato-splenic bilharziasis is common in Abidjan, where we operated on 34 cases in 15 years. The indications for surgical intervention include gastrointestinal haemorrhage due to rupture of esophageal varices, a very bulky enlarged spleen and, more, rarely, recurrent ascites. Simple splenectomy (9 cases) suppresses discomfort and pain, corrects the hypersplenism and brings about a moderate reduction of portal pressure. Spleno-renal anastomosis (19 cases) remains the operation of choice. The long-term results, difficult as these are to assess under ill-regulated African conditions, appear satisfactory on the whole, due to less serious damage to the hepatocyte than in the cirrhoses (62% Child A and 29% Child B). We therefore continue to advocate splenectomy followed if possible by a spleno-renal shunt in bilharzial portal hypertension.

[10 cases of retrosternal colonic esophagoplasty for caustic stenosis of the esophagus in children]. / 10 cas d'oesophagoplasties coliques rétrosternales pour rétrécissement caustique de l'oesophage de l'enfant.

This study is the authors' account of their experience of oesophagoplasty with the colon carried out among children in an african population. From 1978 to 1982, they performed 10 substernal intrathoracic transplantation of the colon to replace accidentally strictured oesophagus. The stricture in all cases is one to swallowing of corrosive substance, basic products (potassium lye and locally made bases) in half of the cases and battery acid in the other half. Follow-up has been between 9 months and 5 years. The results are as follows: In the immediate postoperative period there were: -- 1 death after surgery due to anesthetic error, -- 6 complications : -- 4 upper (cervical) anastomotic leakage, -- 1 incomplete stricture of the cervical anastomosis, -- 1 temporary dumping syndrome, -- 1 purulent pleurisy and parietal abscess; -- 3 cases without any complications. Before discharging the patients from the hospital, the functional results were evaluated on clinical features (quality of the deglutition, weight increase) and radiographically by a barium swallow (permeability of the colon transplant); these results were satisfactory. Long term follow-up was possible in 4 children (one monthly for the first 6 months, then once every 3 months for 6 months). Follow-up was less regular for the remaining 5 children. Except for a case of recurrent stricture of the cervical anastomosis which required reoperative surgery, normal deglutition was restored in all the patients, as was confirmed by a barium meal and a satisfactory weight gain.