[Ambulatory treatment of penile fracture at teaching hospital in Lomé]. / Traitement ambulatoire des fractures de la verge au centre hospitalier universitaire de Lomé.

OBJECTIVES: To study the feasibility of outpatient management of fractures of the penis and to identify factors that promote their occurrence. MATERIALS AND METHOD: This were a prospective, monocentric study of patients who received emergency treatment for fractured penises. It took place from January 2016 to January 2019. The data analyzed were circumstances of occurrence, time elapsed before management, clinic, type of anesthesia, functional outcomes (assessment based on IIEF5 questionnaire) and complications. RESULTS: Seven cases were recorded. The average age of the patients was 35 years. The diagnosis was clinical and surgical treatment in all our patients. Management was outpatient in 6 patients. Sexual function was normal in six patients with an IIEF-5≥21 with a normal erection and no pain at intromission. No complications were objectified. CONCLUSION: Emergency surgical management of patients with clinical and confirmed per-operative penis fractures may be outpatient without negative impact on functional outcomes and regardless of the cause of fracture. LEVEL OF EVIDENCE: 3.

Infections du site operatoire en chirurgie generale dans un hopital regional au Togo

Objectifs : etudier la frequence des pathologies operees et relever les principaux germes retrouves au cours des infections de la plaie post-operatoire en chirurgie generale au CHR-Tsevie. Methodologie : etude retrospective sur les dossiers d'infections post-operatoires des patients operes dans le service de chirurgie generale au CHR - Tsevie du 1er Janvier 2012 au 31 Decembre 2013 (deux ans). Les parametres etudies etaient socio-demographiques; diagnostiques; le type d'intervention; le delai de survenue de l'infection; le traitement; l'evolution et la duree d'hospitalisation. Resultats : durant la periode d'etude 30 dossiers d'infections de la plaie post-operatoire ont ete colliges sur un total de 271 patients operes; soit 11%. Deux cent vingt neuf patients avaient ete operes en urgence soit 84;5% et 42 patients (15;5%) operes en chirurgie programmee. La sex ratio etait de 1;72. La tranche d'age de 19 a 30 ans constituait 40% des cas. Les patients etaient des cultivateurs (30%) et des eleves (23;3%). Les antecedents notes etaient : une hypertension (2cas); un diabete (1cas); une hypertension associe au diabete (1cas); un alcoolisme (30%) et un tabagisme (10%). L'infection post-operatoire a ete notee apres la prise en charge en urgence des affections comme la peritonite aigue generalisee (11cas/49 soit 22;4%) et l'appendicite aigue (6cas/34 soit 17;6%). L'antibio-prophylaxie a ete systematique chez tous les patients operes. Les germes retrouves etaient le Staphylococcus aureus (15 cas/50%); Escherichia coli (07 cas/23;3%) et le streptocoque (05 cas/16;6%). Les infections etaient notees entre 7 et 14 jours post-operatoire dans 70% des cas. La duree moyenne d'hospitalisation etait de 34 jours. Conclusion : l'infection de la plaie operatoire est frequente chez les patients operes en urgence. Les germes isoles a la culture sont souvent des bacteries cutanees. La prevention de l'infection du site operatoire necessite un respect rigoureux de regles d'asepsie

[The circumcision in newborn and infant in the operating room of the Lomé Teaching Hospital: technique using Gomco clamp versus technique using only the grips]. / La circoncision chez le nouveau-né et le nourrisson au bloc opératoire du CHU de Lomé : technique utilisant le Gomco clamp versus technique utilisant uniquement des pinces.

OBJECTIVES: To describe the various techniques used for the circumcision in newborns and infants in the operating room of the Lomé Teaching Hospital (Togo) and to compare their results. PATIENTS AND METHODS: It is about a prospective study carried out in the operating room of the Lomé Teaching Hospital from June 15th, 2007 to December 15th, 2008 (18 months). It concerned newborns and infants circumcised according to two techniques: the technique using grips only (group A: n=138; 69%) and the technique using Gomco clamp (group B: n=62; 31%). The Khi(2) test with the threshold 5% was used for the statistical analysis. RESULTS: According to the duration of the intervention, 34 newborns and infants (24.6%) were circumcised within less than 15 minutes in the group A and 27 (43.5%) in the group B (p<0.05). According to the importance of the bleeding and to the type of material used, 28 newborns and infants (20.30%) had bled much in the group A and one (1,61%) in the group B (p<0.05). According to the postoperative complications and to the technique used, nine newborns and infants (9.4%) had postoperational complications in the group A and two (3.2%) in the group B. The wound had healed within less than 6 days in one infant (0.7%) in the group A and six (9.7%) in the group B (p<0.05). One hundred penises (72.46%) were considered to be very satisfying in the group A and 55 (88.7%) in the group B (p<0.05). CONCLUSION: The technique using Gomco clamp for circumcision had more advantages than that using only the grips. It was much more safe for the child.

[Value of genitography after late discovery of abnormal sexual development: 5 cases in Lome, Togo]. / Génitographie dans les anomalies de développement sexuel de découverte tardive: 5 observations a Lomé (Togo).

The purpose of this report is to describe the value of genitography in management of abnormal sexual development abnormalities discovered at a late age (> or = 10 years). Genitography was performed in 5 patients ranging from 10 to 23 years of age. No procedural difficulty was encountered in any of these patients. Genitography allowed correct determination of anatomical sex in all patients.

[Bilateral anterior dislocation of the shoulders]. / Luxation antérieure bilatérale des épaules : à propos d'un cas.

Bilateral anterior shoulder dislocation is a very rare clinical entity. We report another case of traumatic bilateral anterior dislocation of shoulders. We discuss the mechanism of the dislocation which is unusual and the treatment.

[Hip septic arthritis in young children with sickle-cell disease]. / L'arthrite septique de hanche chez l'enfant drépanocytaire.

PURPOSE OF THE STUDY: Sickle-cell anemia is an inherited disorder exposing patients to diverse complications, particularly bone and joint disease. Septic arthritis of the hip joint is a frequent infection in sickle-cell anemia. Without early management, there is an important risk of invalidating hip dysfunction. The purpose of this study was to analyze the epidemiological, clinical and therapeutic aspects of septic arthritis of the hip joint in order to focus on the need for early diagnosis, the best way to improve the prognosis of hip function. MATERIAL AND METHODS: This was a retrospective study over a 10 year period (1987-1996) which included nine children (seven boys and two girls), mean age six years who were managed in our hospital for septic arthritis of the hip joint. These children had at least one hemoglobin S: phenotypes SS (n=5), SC (n=2), AS (n=2). RESULTS: In these sickle-cell anemia children, the septic arthritis developed in a non traumatic context with osteonecrosis of the femoral head. One hip was involved in six children and both in three (12 hips). Mean time from symptom onset to consultation was eight days. Salmonella sp. were identified in nine hips (including all of the bilateral cases) and Staphylococcus sp. in three. The treatment included antibiotics for six weeks, puncture-drainage, and immobilization for three to four weeks. Outcome was excellent in nine hips and good in three. DISCUSSION: The diagnosis of septic arthritis of the hip joint must be made early, based on ultrasound or scintigraphic findings. Bacteriological samples of joint fluids are required to adjust the antibiotic regimen. Salmonella sp. were the most common agents in our patients, but other series have reported Klebsiella pneumoniae and Staphylococcus or Pneumococcus sp. Drainage is preferred, if possible by arthroscopy. Arthrotomy should be reserved for cases with a thick discharge which is difficult to evacuate via puncture drainage. Early diagnosis, careful evacuation of the joint collection, and adapted antibiotic therapy with hip immobilization are the keys to good functional outcome.

[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.

[Non operative treatment for perforated peptic ulcer: results of a prospective study]. / Traitement non opératoire des perforations d'ulcère gastroduodénal. Résultats d'une étude prospective.

BACKGROUND: The conservative management of perforated peptic ulcer has not gained widespread acceptance despite introduction of proton-pomp inhibitors because surgical procedures can achieve immediate closure by eventually using a laparoscopic approach. The aim of this prospective study was to evaluate the results of Taylor's method and to identify predictive factors of failure of medical treatment in patients presenting with perforated peptic ulcer. METHOD: Between 1990 and 2000, 82 consecutive patients, with diagnosis of perforated peptic ulcer were prospectively included in this study. They were initially treated with non-operative procedure (nasogastric suction and intravenous administration of H2-blockers or proton-pomp inhibitors). No clinical improvement after 24 hours required a surgical treatment. Predictive factors of failure of non-operative treatment were tested in univariate or multivariate analysis. RESULTS: Clinical improvement was obtained with non-operative treatment in 54% of the patients (44/82). The overall mortality rate was 1%. In univariate analysis, significant predictive factors of failure of non-operative treatment were: size of pneumoperitoneum, heart beat >94 bpm, abdominal meteorism, pain at digital rectal exam, and age >59 years. In multivariate analysis, the significant factors were the size of pneumoperitoneum, heart beat, and abdominal meteorism. The association of these criteria: size of pneumoperitoneum >size of the first lumbar vertebra, heart beat >94 bpm, pain at digital rectal exam and age > 59 years , led to surgical treatment in all cases. CONCLUSION: These results suggest that more than 50% of patients with perforated peptic ulcer respond to conservative treatment without surgery and that the association of few criteria (size of pneumoperitoneum, heart beat, pain at digital rectal exam and age) require emergency surgery.

[Treatment of colovesical fistula: predictive factors of the maintenance of long-term digestion continuity]. / Traitement des fistules colovésicales: facteurs prédictifs du maintien de la continuité digestive à long terme.

AIM OF THE STUDY: Colovesical fistulas (CVF) may occur in inflammatory or tumoral pelvic diseases. The aim of this study was to analyze the surgical management of patients with a CVF in order to define predictive factors of good results and long term digestive continuity. PATIENTS AND METHODS: From 1989 to 1999, this retrospective study included 37 patients, 19 men and 18 women, mean age: 69 years (range 37-93 years). Main etiologies were colonic diverticulitis (n = 22) in 60% of the patients, cancer (n = 6) in 16%, previous radiotherapy (n = 5) in 14%. Treatment was a diverting colostomy in 13 cases, a colectomy in 24 cases without diverting colostomy in 10 cases. RESULTS: Overall postoperative mortality rate was 16%. With a mean follow-up of 47 months, digestive continuity was restored in 40% of the patients (100% in ASA 1 patients, 55% in ASA 2, 19% in ASA 3 and 0% in ASA 4). CONCLUSIONS: Our study suggests that long term digestive continuity following surgical treatment of colovesical fistulas does not depend upon etiology or surgical treatment but mainly upon the patient's ASA score.

[Role of complementary tests in the management of colo-vesical fistulae]. / La place des examens complémentaires dans la prise en charge des fistules colo-vésicales.

OBJECTIVE: Colo-vesical fistulas (CVF) are a complication of inflammatory or neoplastic diseases of the lesser pelvis. Although the clinical diagnosis is obvious in the presence of pneumaturia or faecaluria, a number of patients require complementary diagnostic and/or pretreatment investigations. The objective of this study was to analyse the management of these patients in order to define the place and cost-effectiveness of complementary investigations. MATERIAL AND METHODS: This retrospective study was based on 37 patients with a colo-vesical fistula, secondary to sigmoid diverticulitis in 60% of cases. RESULTS: Cystoscopy was the most cost-effective examination for the diagnosis of CVF with a sensitivity of 94%. The preoperative assessment of CVF and the underlying disease was optimally performed by a combination of cystoscopy, opaque enema and CT. CONCLUSIONS: Our study defined the place of the various examinations in the assessment of colo-vesical fistula, but the value of magnetic resonance imaging, not performed in this series, remains to be defined.

[Fish hooks: an unusual and sharp foreign body in the hypopharynx]. / L'hameçon: un corps étranger inhabituel et vulnérant de l'hypopharynx.

Foreign bodies in the hypopharynx occur commonly. A myriad of objects have been observed. In this report we describe a case involving a fish hook in a 10-year-old girl. The presence of this uncommon, sharp-pointed object was disclosed by plain radiography. The child was hospitalized three days after ingestion. Two attempts to perform endoscopic retrieval failed. Open cervicotomy was undertaken and allowed successful removal. The authors discuss management of this special type of foreign body and review several other unusual case reports in the literature.