[Tuberculosis of the chest wall: Report of a case at the Joseph Ravoahangy Andrianavalona Teaching Hospital, Antananarivo, Madagascar]. / La tuberculose de la paroi thoracique : À propos d'un cas au CHU Joseph Ravoahangy Andrianavalona, Antananarivo, Madagascar.

Background/rationale: Tuberculosis is a public health issue. Extra-pulmonary presentations are rare and sometimes hard to diagnose and manage. Here, we report a case of tuberculosis of the chest wall in a 28-year-old man in order to discuss the mechanism, diagnostic and therapeutic problems posed by this rare localization. Description: The patient presented with wall swelling discovered after physical effort. Imaging was in favor of an abscess or infected hematoma. The excisional surgery established the tuberculous origin which was confirmed by histology. Anti-tuberculosis treatment during 9 months completed the surgical treatment and led to the patient's recovery. Discussion/conclusion: The rarity of this localization of tuberculosis should be investigated. Etiological treatment must be instituted and regular monitoring scheduled to avoid recurrence. Conclusion: Direct-acting antivirals are effective and characterized by good tolerance in these Malagasy hepatitis C patients.

[Delayed tamponade: Four cases of rare complication of blunt chest trauma]. / Tamponnade tardive : quatre cas de complication rare du traumatisme fermé du thorax.

Delayed post-traumatic pericardial effusion is a rare condition after blunt trauma. The diagnosis of the effusion can be made by the clinical signs, which is not very specific and the cardiac echography. The etiological diagnosis remains difficult because it requires the elimination of the other causes of pericarditis. Their treatment consists in evacuating the pericardial effusion. The evolution thereafter is simple. We report four cases of patients with pericardial effusion late after a thoracic injury. Imaging the blood test, the examination of the pericardial fluid and the anatomopathological examination of the pericardium, eliminates the other etiologies.

Enquete preliminaire sur la pratique des anesthesies chez l'adulte au Centre Hospitalier Universitaire de Toamasina

Objectif: evaluer qualitativement et quantitativement l'activite anesthesique au Centre Hospitalier Universitaire (CHU) de Toamasina afin d'identifier les problemes prioritaires et les normes a recommander pour le developpement future de l'anesthesie. Methodes: Une enquete a la fois retrospective et prospective a ete realisee du 1er Janvier 2008 a 31 Juin 2008. Resultats: 1215 anesthesies ont ete recensees. Le Centre Hospitalier Universitaire compte un medecin anesthesiste reanimateur. L'anesthesie generale a represente les 96des anesthesies. L'anesthesie generale etait suivie d'une intubation tracheale dans 71;86. Le thiopental a ete le produit le plus utilise. L'anesthesie generale n'etait pas balancee. L'anesthesie locoregionale a ete realisee dans 4des anesthesies. La morbidite et la mortalite anesthesiques etaient respectivement de 18;10et 0;49. Conclusion: Ces resultats soulevent une multitude de questions quant a la pratique de l'anesthesie; surtout concernant l'insuffisance des praticiens anesthesistes et les produits anesthesiques utilises

Facteurs de mortalite par les urgences digestives dans le service de reanimation du CHU de Fianarantsoa Madagascar

Objectif: Determiner les facteurs de mortalite par les urgences digestives dans un Service de Reanimation. Methodes: Les auteurs ont retrospectivement etudie les cas des 27 deces suite a une urgence digestive entre 1er Janvier 2006 et 31 Decembre 2009; operees ou non; mais passant dans le service de reanimation chirurgicale du CHU de Fianarantsoa. Resultats: La mortalite des urgences digestives etait de 37;5. Les facteurs incrimines sont : le retard de prise en charge chirurgicale; le probleme pecuniaire des patients; la mauvaise pratique du remplissage vasculaire et l'usage de l'antibiotique non adaptee. Conclusion: Les resultats de cette etude nous suggerent une prise en charge rapide et efficace des urgences digestives

[Pheochromocytoma revealed by stroke in a child]. / Phéochromocytome révélé par un accident vasculaire cérébral chez un enfant.

Pheochromocytoma is uncommon in children. We report herein a case in a 6-year-old boy whose pheochromocytoma was revealed by cerebral ischemia as a consequence of acute-cardiac failure. Twenty-four-hour urinary catecholamines were markedly increased. Abdominal ultrasonography and computed tomography located the tumor on the left adrenal gland. After surgical excision, hypertension disappeared. Diagnosis and treatment of pheochromocytoma in children are discussed.