Indications chirurgicales d'hémostase en urgence des hémorragies di- gestives au Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona, Antananarivo

Introduction : Notre objectif est de décrire les aspects épidémiologiques, cliniques et chirurgicaux des hémorragies digestives opérées. Matériels et Méthodes : Il s'agissait d'une étude observationnelle, descriptive, rétrospective réalisée au Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona (CHUJRA) Antananarivo sur une période de sept ans allant du 1er janvier 2009 au 31 Mars 2016. Résultats : Trente cas de patients étaient opérés. L'âge de nos patients variait de 3 à 84 ans, avec une moyenne de 48,7 ans. Le sex ratio était de 2,33. L'ulcère duodénal était la cause de l'hémorragie digestive chez 16 patients (53,33%). Dans 53,33% des cas, l'indication chirurgicale était l'état de collapsus cardio-vasculaire ré¬fractaire à un remplissage vasculaire adéquat. Quatre-vingt pourcent des patients avaient bénéficié d'une suture par point en X au niveau du saigne¬ment actif. Dans 96,66% des cas, Il n'y avait pas de récidive. Un patient était décédé en peropératoire. Conclusion : Si dans la littérature, les hémos¬tases sont endoscopiques dans 98,01% et seulement 1,99% des cas relèvent de la chirurgie, dans notre étude, la réanimation constitue la base du traitement. En cas d'échec uniquement, la chirurgie est recommandée. Ainsi, la chirurgie est indiquée en deuxième intention si la réanimation est inefficace. L'exploration peut être blanche, d'où l'intérêt des examens endoscopiques

[Arteriovenous malformation of the left upper limb in stage II of Schöbinger: A case report in Madagascar]. / Malformation artérioveineuse du membre supérieur gauche au stade II de Schöbinger : à propos d'une observation à Madagascar.

Arteriovenous malformations are the most unpredictable and dangerous congenital malformations. They consist of multiple arteriovenous shunts with high flow and can progress to heart failure. They are rarely localized in the upper limb and pose therapeutic problems. We report a new case in a 27-year old woman, admitted for pulsatile pain in the left elbow. The diagnosis was made by clinical examination and ultrasonography. The surgical treatment without embolization and sclerotherapy, consisted of a large resection of the nidus without postoperative complication.

[The role of surgical treatment in the management of nonparasitic hepatic cysts in Madagascar]. / Place de la chirurgie dans la prise en charge des kystes non parasitaires du foie à Madagascar.

Non-parasitic liver cysts are rare in our country. We report the second case in a 61-year-old woman admitted for a painful epigastric mass. The diagnosis was suggested by ultrasound and confirmed by histological examination of the surgical specimen. Surgical treatment was performed through a right transverse subcostal incision and consisted of a maximal resection of the cystic wall. No complications followed. After 12 months, the patient was asymptomatic, and no recurrence had been observed.

[Prescribers' awareness about the pharmacology of the non-steroidal drugs in the capital town of Antananarivo]. / Connaissance de la pharmacologique des anti-inflammatoires non stéroïdiens par les prescripteurs de la capitale d'Antananarivo.

In order to assess prescribers' level of knowledge about the pharmacology of the non steroidian anti-inflammatory drugs (NSAIDs), we led a prospective study without randomization among the caregivers of three university teaching hospitals and three private hospitals centres of Antananarivo, capital town of Malagasy Republic. The answers to the questionnaire were coded as known or unknown. Statistical analysis (by SPSS 10.0 software for Windows) displayed Fisher's exact test and p value less than 0.05 was set as cut-off for significance. The response rate was 71% (43 over 60), mainly from physicians (62.8%). The correct posology, the non-digestive adverse effects and the adequate follow-up were the main ignored items. Analysis by logistic regression demonstrated association between medical professionals and ignorance of adequate follow-up (p=0.030), female gender and ignorance of the non-digestive adverse effects (p=0.041). In conclusion, routine prescription hides ignorance about the safe use of the drug and periodical recycling of health professionals is helpful.

[A case of acute gastric volvulus in a child]. / Un cas de volvulus aigu de l'estomac chez l'enfant.

Gastric volvulus is an abnormal rotation of the stomach around its axis. The acute form is a surgical emergency, which doesn't tolerate any therapeutic delay. We report on a case in a young girl, revealed by painful epigastric mass and distended gastric bubble on abdominal X-ray. This case was been successfully treated by detorsion and gastropexy. The clinical picture of gastric volvulus is characterised by the Borchardt triad of symptoms: upper abdominal pain, vomiting and difficulty to pass a nasogastric tube. The gastrointestinal barium series and CT-scan help to confirm the diagnosis. As was demonstrated in this case, the treatment is surgical by reducing the volvulus and fixing the stomach to prevent recurrence.

[A case of Klippel-Trenaunay-Weber syndrome of the hand: description and review of the literature]. / Un cas de syndrome de Klippel-Trenaunay-Weber de la main: description et revue de la littérature.

We report the first malagasy case of a 10 years-old child with a Klippel-Trenaunay-Weber syndrome. The patient presented with cutaneous hemangioma, varicosities and unilateral hypertrophy of soft tissues of the left hand. Arteriovenous fistula was findings by the echo-doppler. Ligature of the fistula was performed.