Polyhydramnios: a warning sign in the prenatal ultrasound diagnosis of foetal malformation?

PURPOSE: To propose polyhydramnios seen during prenatal diagnosis as a warning sign of foetal malformation. PATIENTS AND METHODS: A retrospective multicentre study over a three-year period carried out in Ivory Coast and Burkina Faso. We reviewed 3903 obstetric ultrasound reports. All cases of foetal malformation and polyhydramnios were counted. The instances of foetal malformation associated with polyhydramnios were compared to those of foetal malformation without polyhydramnios and to polyhydramnios only. RESULTS: A list of 72 cases of polyhydramnios was made (equating to 1.8%). In 55 cases (76.4%), polyhydramnios was combined with foetal malformation. These were lethal abnormalities in 33 cases and non-lethal in 22 cases. In 17 cases, polyhydramnios was not associated with any foetal malformations and in eight cases, foetal malformation was discovered in the absence of polyhydramnios. Polyhydramnios had a positive predictive value of 76.4% for the presence of foetal malformation. The negative predictive value was 99.8%. Sensitivity was 87.3% and specificity was 99.5%. CONCLUSION: Polyhydramnios is a highly sensitive and specific sign for prenatal diagnosis of foetal malformation. If it is identified, then this should lead to a very careful search for foetal malformation.

The diagnostic value of indirect ultrasound signs during acute adult appendicitis.

PURPOSE: To evaluate the diagnostic value of indirect ultrasound signs during acute appendicitis. PATIENTS AND METHODS: Our retrospective study lasted 5 years, from May 2005 to April 2010. It concerned 620 cases of appendectomy performed following prior ultrasound examination of the right iliac fossa (RIF). In 448 cases, ultrasonography clearly showed the appendix, which was inflamed. The presence of indirect signs of appendix inflammation without visualisation of the appendix was confirmed by ultrasound examination in 160 cases. In 12 cases, the appendix was not visualised nor were there any indirect signs on the ultrasound image. The indirect signs involved were hypertrophy of the peritoneal fat (HPF), pain caused by compression on exploration of the right iliac fossa, and localised hypokinesia in the digestive loops (LHL). We compared the results found by ultrasonography with the operative and anatomical pathology reports. RESULTS: The positive predictive value of the indirect signs of appendicitis on the ultrasound scan was 95.8% if the three indirect signs were associated, 87.5% for the association of pain and HPF, 45.8% for the association of pain and LHL, and 25% if there was just pain. The negative predictive value of the indirect signs of appendicitis on the ultrasound scan was 57.2% if the three signs were associated, 65.9% for the association of pain and HPF and 60.7% for the association of pain and LHL, with 83.3% for pain alone. The sensitivity of the indirect signs was 83.9% if the three signs were associated, 31.8% for the association of pain and HPF, 50% for the association of pain and LHL, and 50% if there was just pain. The specificity of the indirect signs was 85.7% if the three signs were associated, 96.7% for the association of pain and HPF, 56.7% for the association of pain and LHL, and 62.5% if there was just pain. CONCLUSION: When tomodensitometry cannot be performed and the appendix is not visible on ultrasound examination, indirect ultrasound signs must be systematically sought, particularly in populations in which appendicitis are highly prevalent.

[Ultrasound and epidemiological features of ectopic pregnancy in a suburb of Abidjan (Cote d'Ivoire)]. / Profil echographique et epidémiologique des grossesses extra-utérines dans une banlieue d'Abidjan (Côte d'Ivoire).

OBJECTIVE: The aim of our study was to describe current ultrasound and epidemiological features of ectopic pregnancy in Abidjan, Côte d'Ivoire. PATIENTS AND METHODS: This prospective study was carried out over a 24-month period (February 2006 to January 2008) at Nanglé Medical Clinic, i.e., a private clinic located in Abidjan's Yopougon suburb. RESULTS: A total of 32 cases of ectopic pregnancy were discovered by suprapubic and/or endovaginal ultrasound scan. The estimated frequency of ectopic pregnancy was 1.7%. Mean patient age was 26.2 years. The main risk factors were prior history of abortion (32%) and adnexal infection (20%). Most patients (52.5%) were nulliparous. The most frequent indication for ultrasound scan was metrorrhagia. Diagnosis of ectopic pregnancy was made at the ruptured stage in 65.6% of cases and nonruptured stage in 34.4%. The presenting lesions was hematosalpinx in 40.6% of cases and embryonate ectopic gestational sac in 31.3%. Salpingectomy and salpingorrhaphy were successful in 65.6% and 34.4% of cases respectivlely. CONCLUSION: In Abidjan, ectopic pregnancy involves young nulliparous women with a prior history of abortion and adnexal infection. Ultrasound allowed early diagnosis and, consequently, tube preservation in 34.4% of cases.

[Results of the thoracic radiography profile of 247 candidates at the recruiting office of a land-transport society in Abidjan, Cote d'Ivoire]. / Resultats du bilan radiographique thoracique de 247 candidats a l'embauche dans une Societe de Transport Terrestre a Abidjan (Cote D'Ivoire).

The purpose of this prospective study done from May to July 2007 was to show the interest of systematic chest X-Ray of future bus conductors. The main abnormalities were big heart, parenchymal lesion and pleural effusion.

[A rare etiology of praevia barrier by the non gravid uterus in a duplex uterus (didelphys): ultrasound findings]. / Une étiologie rare d'obstacle praevia par l'utérus non gravide sur utérus double (didelphe): apport de l'échographie.

The Authors report a rare case of praevia barrier from a duplex uterus (didelphys). A 30 Year old pregnant woman was admitted for ultrasound examination. Her past history included two cesarean sections with a stillborn infant in one case and a live infant with psychomotor retardation in the other case. Third trimester ultrasound examination was consistent with a 36-37 weeks gestation. A 9.1 by 5.8 cm retro-cervical praevia mass was also noted deep in the pelvis. The mass was similar in appearance to myometrium. Elective cesarean section performed at 38 weeks of gestation delivered a normal healthy 2950 g male infant and revealed a second non gravid uterus corresponding to the mass seen at ultrasound. Pelvic examination confirmed a diagnosis of uterus didelphys (uterus duplex bicornis bicollis with vaginal septum) separated by a sagittal partition. The post-operative course was uneventful. Praevia barrier by a half uterus in a patient with duplex uterus is a rare condition that can easily be detected by careful ultrasound examination thus preventing complications at delivery.

[Non-tuberculous bacterial pleuropneumopathies in children in Abidjan]. / Les pleuro-pneumopathies bactériennes non tuberculeuses de l'enfant à Abidjan.

We carried out a retrospective study to investigate epidemiological and clinical aspects of patient management in a hospital environment. We studied 90 cases of non-tuberculous bacterial pleuropneumopathies in children, observed over a 5-year period, from January 1 1991 to December 31 1995, at the Pediatric Medical Unit of Yopougon University Hospital. Diagnosis was based on the association of an infectious syndrome with respiratory and digestive disorders, and was confirmed by X ray. Bacteria were isolated from pleural pus and identified in fifty-one cases. Non-tuberculous bacterial pleuropneumopathies accounted for 5.22% of all pneumopathies in children, and the sex ratio for the patients affected was 1.9. Protein and energy malnutrition, anemia, being very young and climatic factors (harmattan and rainy seasons) were identified as major risk factors. The three main bacteria identified were Staphylococcus aureus (21 cases), Streptococcus pneumoniae (19 cases) and Haemophilus influenzae (6 cases). In this series of patients, 20% of the Staphylococcus aureus strains isolated were methicillin-resistant. Patients were generally treated with a combination of penicillin A and M and aminoside, with or without a pleural drain. The outcome was favorable in 77.8% of cases, with no severe sequelae detected by X ray. Six of the children died. Bacterial pneumopathies are still common in Sub-Saharan Africa and the patient being very young is indicative of a poor prognosis.

[Pleuropulmonary staphylococcal infection in newborn infants]. / Staphylococcie pleuro-pulmonaire du nouveau-né.

Pulmonary pleural staphylococcal infection is common in sub-Saharan Africa. It is rare in temperate zones and occurs in different epidemiological conditions. In African regions, very few staphylococcal infections are hospital-acquired, with most cases resulting from infection in everyday life. Pulmonary pleural staphylococcal infection typically affects infants. The frequency of neonatal forms is unknown. We describe here in the epidemiological, clinical and therapeutic characteristics of a case of pulmonary pleural staphylococcal infection in a newborn. The symptoms of our patient were typical, involving predominantly mechanical and hematological problems. The prevention of infection in very young children and early treatment of such infections could reduce the morbidity of this disease.

[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.