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.

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.

[Accidents of circumcision in children in Abidjan, Côte d'Ivoire]. / Accidents de circoncision chez l'enfant à Abidjan, Côte d'Ivoire.

Circumcision is the most common surgical procedure carried out in boys in our countries. It is performed by medical members but also by traditional practitioners. Circumcision is considered as a benign operation but its complications are common, sometimes severe and the treatment delicate. Authors reported 35 cases of circumcision's complications in boys, aged of 2 days to 14 years old who were circumcised by traditional practitioners and by medical members. The most frequent complications were urinary meatus stenosis (17 cases), haemorrhage (5), total glans section (3), urethral fistula (3), and incomplete circumcision (3). These complications were caused by traditional practitioners in 19 cases, paramedical members in 11 cases, and 5 cases by physicians. Among these complications, fistula and amputation had required delicate surgical procedure. All the stenosis were treated by meatal plasty and fistula were sutured with one recurrence. Partial glans section underwent Mathieu's procedure and the total sections were referred to the plastic surgeon. Authors recommend surgical procedure for circumcision which must be performed in medical center or by well trained practitioners.

[Prolapse of the urethral mucosa in young girls from the Ivory Coast]. / Le prolapsus muqueux de l'urètre de la fillette en Côte-d'Ivoire.

In this retrospective study covering a nine-year period, 65 cases have been analyzed of prolapse of the urethral mucosa in young girls (aged between six weeks and 14 years) from the Ivory Coast. The aim of this study was to describe the etiology of this disorder, and to demonstrate the utility of ambulatory surgery. The main reason for the detection of this disorder was mild genital hemorrhage in 37 cases, which was related to rape in eight instances and to other types of trauma in nine cases, thereby raising serious medico-legal problems. Various forms of treatment were used (medical and/or surgical). The medical approach consisted of antibiotic and antiinflammatory treatment, combined with a local antiseptic. Two surgical approaches were adopted, either the Doria method in which the necrosed tissue is spontaneously eliminated after three to five days, or surgical excision under general anesthesia of the prolapsed mucosa followed by seromucosal stitching. The results were satisfactory in all cases, and in the surgically operated cases no complications or recurrence were noted at one-year follow-up.

[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.