Traitement chirurgical du Mal de Pott et de ses séquelles au Centre Hospitalier de l'Ordre de Malte Dakar / Surgical treatm ent of Pott's diseaseand its sequelae at the Hospital of the Order of Malta/Daka

Introduction. Evaluer les résultats du traitement chirurgical du Mal de Pott et de ses séquelles au Centre hospitalier de l'ordre de Malte de Dakar. Patients et méthodes. Nous présentons les résultats préliminaires d'une série consécutive de 23 patients (13 hommes et 10 femmes) d'âge moyen de 32,35 ans [6 ­70 ans] présentant des Maux de Pott ou de leurs séquelles nécessitant un traitement chirurgical. L'échelle d'incapacité d'Oswestry, l'échelle visuelle analogique et le score ASIA ont été utilisés pour l'évaluation clinique. Les radiographies pré opératoires, post opératoires et au recul ont été utilisés pour les résultats anatomiques. Tous ces patients ont été opérés selon trois stratégies opératoires sur une période de 67 mois (Avril 2014- Novembre 2019). Nous avons réalisé une laminectomie arthrodèse postérieure dans 52,2% ; une laminectomie plus OTP et arthrodèse postérieure dans 43,5% ; une discectomie et hémicorporectomie avec arthrodèse antérieure par plaque vissée de Roy Camille à l'étage cervical dans 4,3%. Résultats. La symptomatologie était dominée par la douleur rachidienne, la cyphose et les troubles neurologiques. La cyphose post opératoire était significativement améliorée (la moyenne passe de 48,52° en pré opératoire à 17,09° en post opératoire). On a obtenu 100% de fusion vertébrale. On note une nette amélioration de la douleur rachidienne (avec une baisse au recul de 55,44 points pour l'OID et de 5,66 pour l'EVA) ; 78,3% des patients étaient très satisfaits, 17,4% satisfaits et 4,3% mécontents. Conclusion. Le traitement chirurgical du Mal de Pott et de ses séquelles a fortement amélioré les rachis au Centre hospitalier de l'Ordre de Malte.

Introduction. To evaluate the results of the surgical treatment of Pott's disease and its sequelae at the Hospital Center of the Order of Malta in Dakar. Patients and methods. We present the preliminary results of a consecutive series of 23 patients (13 men and 10 women) with an average age of 32.35 years [6-70 years] presenting with Pott's disease or its sequelae requiring treatment. surgical treatment. Oswestry Disability Scale, Visual Analogue Scale and ASIA score were used for clinical assessment. Preoperative, postoperative and followup radiographs were used for anatomical results. All these patients were operated according to three operating strategies over a period of 67 months (April 2014- November 2019). We performed posterior laminectomy-arthrodesis in 52.2%; laminectomy plus OTP and posterior arthrodesis in 43.5%; discectomy and hemicorpectomy with anterior arthrodesis by Roy Camille screwed plate at the cervical level in 4.3%. Results. The symptomatology was dominated by spinal pain, kyphosis and neurological disorders. Postoperative kyphosis was significantly improved (the average goes from 48.52° preoperatively to 17.09° postoperatively). We got 100% spinal fusion. There is a clear improvement in spinal pain (with a drop at follow-up of 55.44 points for the OID and 5.66 for the EVA); 78.3% of patients were very satisfied, 17.4% satisfied and 4.3% dissatisfied. Conclusion. The surgical treatment of Pott's disease and its sequelae greatly improved the spines at the Hospital Center of the Order of Malta.

[Locoregional Anaesthesia in a Country with Limited Resources: Lidocaine 1.5% Adrenaline, Alternative to Ropivacaine 0.5% for Ultrasound-Guided Axillary Block]. / Anesthésie Locorégionale dans un Pays à Ressources Limitées: La Lidocaïne 1,5% Adrenalinée, Alternative à la Ropivacaine 0,5% Pour le Bloc Axillaire Échoguidé.

Objective: The aim of this study was to evaluate lidocaine 1.5% adrenaline as an alternative to ropivacaine 0.5% for the echo guided axillary block. Methode: We conducted a 28-month prospective and randomized study (January 15, 2017 to May 15, 2019) conducted in the anesthesia department of the Ignace Deen National Hospital in Conakry, Guinea. Results: A total of 38 patients were enrolled: 19 in each group. Their average age was 46 ± 17 years in the lidocaine group compared to 44 ± 20 years in the ropivacaine group. The average time to fix the block in the lidocaine group was 6.8 ± 2.1 minutes compared to 8.3 ± 2.4 minutes in the ropivacaine group (p = 0.04). The average duration of action was 233 ± 57 minutes in the lidocaine group versus 260 ± 74 minutes in the ropivacaine group (p= 0.21). The block efficiency rate was identical in both groups with 89.5% of effective blocks in the lidocaine group and in the ropivacaine group (p =1). The cost of consumables for the lidocaine group was 15 euros compared to 60 euros for the ropivacaine group. Conclusion: 1.5% adrenaline lidocaine is a good alternative to ropivacaine 0.5% for the production of echoguided axillary blocks in resource-limited countries.

Open wounds of the Achilles tendon in tropical settings: 36 cases at the Donka University Hospital in Guinea Conakry.

The aim of this study was to analyze the epidemiologic, etiologic, and therapeutic aspects of open wounds of the Achilles tendon managed in the Donka University Hospital. This 3-year prospective included all patients admitted for an Achilles tendon injury. Closed injuries, suppurating wounds, and those that occurred more than 24 hours before admission were excluded. Surgical treatment consisted in debridement and tendon repair, with plaster cast protection for 6 weeks. The study included 36 patients with a mean age of 23.4 years, 29 of whom were male. The primary cause was traffic accidents (n = 21), mainly due to motorcycle taxis (n = 18). The mean follow-up was 9 months. Infection (7 cases) and skin necrosis (5 cases) were the main postoperative complications. The functional result, evaluated by the McComis score, was excellent in 20 cases, good or satisfactory in 10, and poor in 6 cases. Open injuries of the Achilles tendon are common in Guinea-Conakry and mostly due to motorcycle taxis. Outcome of surgical treatment depends on the severity of the injury. Infection and skin necrosis are frequent complications, and their management is challenging in this setting.

Evaluation des résultats de l'embrochage intra-focal selon Kapandji des fractures de Pouteau-colles

INTRODUCTION. Le but de ce travail etait d'evaluer les resultats des embrochages intra-focaux selon Kapandji des fractures de Pouteau-Colles realises dans la plupart des cas sous anesthesie locale et sans amplificateur de brillance. MATeRIEL ET MeTHODE. Il s'agissait d'une etude dynamique sur une periode de 12 mois qui a consiste a l'examen clinique complet et a la radiographie du poignet qui nous permettaient de calculer les indices radiologiques de face et de profil. Nos criteres d'inclusion concernaient les patients presentant une fracture de Pouteau-Colles vraie ages de 18 ans au moins; traites par embrochage intra-focal selon la technique de Kapandji effectivement suivis; revus et evalues. L'evaluation des patients se faisait apres un recul moyen de 9 semaines et nous avons utilise les criteres de Castaing.ReSULTATS. Pendant la periode d'etude nous avons enregistre 57 patients pour fracture de Pouteau Colles Parmi eux 35 ont ete operes selon la technique de Kapandji soit 61;4%. L'age moyen des patients etait de 38 ans. Nous avons note une predominance masculine de 16 hommes avec un sex-ratio de 1;2. Par rapport a la comminution posterieure (classification de Grumillier); nous avons note type I 34%; type II 43%; type III 23%. L'operation a ete realisee sans utilisation de l'amplificateur de brillance dans 74;3% des cas. A l'evaluation nous avons obtenu les resultats suivants ont ete obtenus :- Resultats subjectifs; 74;19% de tres bon et bon resultats ; 6;45% de mauvais resultats; - Resultats objectifs; 90;33% de tres bon et bon resultats ; 3;22% de mauvais resultats - resultats radiologiques; 83;88% de tres bon et bon resultats ; 6;45% de mauvais resultats. CONCLUSION.L'embrochage intra-focal selon Kapandji est une methode qui permet de traiter avec succes la plupart des fractures de Pouteau-Colles. L'aspect particulier de notre etude reside sur le fait que; cette technique chirurgicale s'etait executee dans la majeure partie des cas sous anesthesie locale et sans l'utilisation de l'amplificateur de brillance

Effects of trypanosome and helminth infections on health and production parameters of village N'Dama cattle in The Gambia.

The effects of trypanosome and helminth infections on health and production parameters in 2000 village N'Dama cattle were assessed periodically. Blood examination showed Trypanosoma congolense and Trypanosoma vivax to be prevalent, while strongylid-type eggs were those most frequently encountered in faecal samples. A distinct seasonal fluctuation was detected for both blood levels of trypanosomes and helminth egg output. Strongylid burden and trypanosome infection had significant negative effects on packed red cell volume levels and body weights mainly in animals of 2-3 years old. Clear indications of an increased susceptibility to trypanosomosis were found in animals affected by helminths. Similarly, animals infected with trypanosomes were more frequently infested with strongyles and egg counts were higher than in cattle in which no trypanosomes were detected.

Productivity of trypanotolerant cattle kept under traditional management conditions in The Gambia.

The productivity of trypanotolerant N'Dama cattle, kept under traditional management conditions in The Gambia, West Africa, was assessed by the regular, monthly collection of health and production parameters in two study areas. The study areas were selected because of differences in tsetse challenge. Performance traits were used to build up an index to estimate the productivity of village N'Dama cattle. The productivity index per 100 kg cow maintained per year varied from 37.2 kg in the study area of Keneba village (with a low tstse challenge) to 21.4 kg for cattle kept near the villages of Tuba and Sambelkunda, an area which had a high tsetse challenge. Average age at first calving was 4.5 or 5.0 years depending on the study area, calving intervals were 623 or 703 days and there was an average 12% loss of body weight in adult females during the dry season. The productivity indices of village N'Dama cattle in The Gambia compare favourably with similar indices for trypanotolerant and trypanosusceptible breeds elsewhere in Africa, and show that even under harsh conditions and with high tsetse challenge, they are able to effectively produce milk and meat for the rural population.