[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.

[Children's strangulated inguinal hernia]. / Les hernies inguinales étranglées chez l'enfant.

The inguinal hernia, malformations caused by persistence of peritonea-vaginal duct, is frequent in children. It is a benign affection as long as it is not strangled. During our five-year-retrospective study, we have found 32 cases (30 boys and 2 girls) of strangled inguinal hernia. There are 78,12% of cases under five years old. In 54%, the hernia was on the right side. Malnutrition and inguinoscrotal hernia are very exposed to strangulation. We observed obstruction syndrome in 81,25% of cases. We have to deplore one case of scrotal fistulae by intestinal necrosis and two cases of testicle necrosis. For all of our patients, the peritonea-vaginal duct was closed with ligature, associated with pre-funicular parietal refection. One case of recurrence is found in postoperative time.

[One case of abdominal actinomycosis in a malagasy child]. / Un cas d'actinomycose abdominale chez un enfant malgache.

Abdominal actinomycosis is a rare and unrecognised disease. It is a chronic granulomatous suppurating infection caused by bacterial infection. The symptomatology is not specific including a tumour like abdominal lesion fistulized to the skin with issue of characteristic yellow granules. We report a case of a 12-year old boy with an abdominal mass fistulized to the navel in whom surgical treatment needs large resection of the tumour, resection anastomosis of the ileum and temporary colostomy. The diagnosis of actinomycosis was made by histolopathological study of the surgical specimen. This case demonstrates the difficulty to make a pre-operative diagnosis. To improve the prognosis, actinomycosis needs early diagnosis and should be included in the differential diagnosis of infiltrative neoplasic abdominal masses apparently.

[Cystic cervical and mediastinal lymphangioma: a case report and review of the literature]. / Lymphangiome kystique cervico-médiastinal: à propos d'un cas et revue de la littérature.

Cervical and mediastinal cystic lymphangioma are rare and benign tumours. They looked like a lateral and cervical mass. Medical imaging allows to suspect the diagnosis but histology only may to assert it. The best therapy is surgery. Sclerosis by chemical drugs is only an alternative if surgery is not possible. A recovery is completely obtained if the whole tumour is removed.

[Madagascar: esophagogastroduodenoscopy. Descriptive analysis of 12,000 examinations and problems encountered in the tropics]. / Madagascar : la fibroscopie oeso-gastro-duodénale. Analyse descriptive de 12000 examens et problèmes rencontrés sous les tropiques.

The experience of the Digestive Endoscopy Center of the Soavinandriana Hospital in Antananarivo provides insight into not only esogastroduodenal disease in Madagascar but also technical problems involved in performing esophago-gastro-duodenoscopy in tropical areas. From September 1990 to March 1995 a total of 12000 esophago-gastro-duodenoscopy procedures were performed without complication. The main finding was duodenal ulcer which observed in 3580 cases (29.8% of patients) followed by peptic esophagitis due to gastroesophageal reflux in 555 cases and gastric ulcer in 460 cases. Esophageal cancer was detected in 16 cases and malignant gastroduodenal tumor in 82 cases including 63 adenocarcinomas and 5 digestive lymphomas. Overall 4156 procedures (34.6%) were normal and 1130 procedures (9.4%) were performed to investigate digestive tract hemorrhage. These findings document the high incidence of duodenal ulcer in Madagascar where treatment of this condition is difficult due to the high cost. This study underlines the problems encountered in operating an endoscopy department in tropical areas especially with regard to desinfection of equipment and training of endoscopists.

Erytheme noueux et tuberculose ganglionnaire. [Lettre]

Des lesions cutanees et sous-cutanees a type de nodules sous une peau erythemateuse et douloureuse sont les caracteristiques de l'erytheme noueux. Il est souvent la manifestation de la maladie systematique. Plusieurs etiologies sont relevees; en particulier la tuberculose; bien que dans 50 pour cent des cas on ne trouve pas de cause. Les auteurs rapportent le cas d'une patiente porteuse de lesions d'erytheme noueux et une tuberculose ganglionnaire sus-claviculaire dont le diagnostic a ete evoque a l'examen histopathologique et la presence de Mycobacterium tuberculosis confirmee par la culture. En cette periode de recrudescence de la maladie tuberculeuse; il est opportun de penser a cette association

[One-year follow-up of 466 nerve decompressions in 123 lepers during multidrug therapy in Madagascar]. / Résultats à un an de 466 décompressions nerveuses réalisées chez 123 lépreux en cours de polychimiotherapie à Madagascar.

Surgical decompression of nerves in patients with leprosy is a simple procedure that can be used in developing countries. At the leprosy center of Ambatoabo on the east coast of Madagascar, 466 nerve decompressions were performed on 123 subjects and results were evaluated by the same examiner 15 months later. All subjects were undergoing multidrug therapy at the time of the procedure. The decision to perform surgery was based on recent onset of sensory and motor neurologic signs and on progression or persistence of symptoms despite administration of prednisolone. Decompression led to pain relief in 100% of cases and regression of sensory disturbances in 97%. Sensory recovery in the plantar ulcers of the foot was obtained in 80% of cases and motor performance improved in 61%. These favorable results confirm the value of surgical decompression to prevent sequels of leprosy and the feasibility of this procedure in remote areas.

[Pericardial tuberculosis in Madagascar. 23 cases]. / Les péricardites tuberculeuses á Madagascar. A propos de 29 cas.

A 56 months retrospective study, from October 1990 to May 1995, at the Centre Hospitalier de Soavinandriana in Antananarivo pointed out 29 tuberculous pericarditis among the 97 pericardial effusions discovered by the echocardiography of 5600 patients. The sex-ratio was 0,81 and the mean age 38,6 years old (+/- 14,3). Hospitalization was justified by dyspnea (18 cases), thoracic pain (18 cases), lower limbs edema (6 cases) and ascitis (3 cases). Moreover, electrocardiography showed microvoltage in 18 cases and thoracic radiography showed one heart enlargement. Even if for 15 cases a pleural effusion was associated, only 2 patients had a pulmonary image suggestive of tuberculosis. Tuberculous pericarditis has been proved by the following examinations: pericardium puncture (21 cases), pericardium and pleural biopsy (respectively 11 and 13 cases), ganglionic biopsy and search of alcohol-acid-fast bacilli in sputum: 1 case. Histologic proof has been obtained 8 times out of 9 pericardial biopsies and 6 times out of 7 pleural biopsies. Bacteriological proof has been obtained 11 times by pathological samples cultivation: twice from fresh caseous material taken from the pericardium, once from 13 pleural fluids, 5 times from 6 pericardial biopsies, 3 times from 3 pleural biopsies. The patients have been put under antituberculous treatment associated with prednisone. 20 patients have been declared cured at the end of the treatment, 5 were dead and 4 were lost out of sight. Tuberculous pericarditis has become rare in developed countries but it is still challenging in Madagascar. In spite of the antituberculous treatment associated with corticoids, prognosis is severe (evolution towards pericardial constriction death.

[Peritoneal tuberculosis in Madagascar, 55 cases at the Soavinandriana Hospital Center in Antananaviro]. / La tuberculose péritoneale á Madagascar, á propos de 55 observations recueillies au Centre Hospitalier de Soavinandriana a Antananarivo.

This retrospective study conducted in Antananarivo for a 42 months period, from September 1991 to March 1994, allowed to record 55 peritoneal tuberculosis, all of them in malagasy patients. The sex ratio was 0,83 and the mean age 36 years old. Ascites puncture was done each time there was an effusion (44 cases). For all cases. For all cases, the diagnosis based on laparoscopy allowed an investigation of the liver and the peritoneum, and 10 peritoneum biopsies could be done. The tubercular bacillus has been isolated in 2 ascites fluids out of 8 incubations, and in 5 biopsies of peritoneal granulation out of 8. For 8 cases, another tubercular localization has been discovered: 5 pleurisis, 2 evolutive tuberculosis and 1 pericardial effusion. All the patients have been put under antitubercular treatment and have regained health. Peritoneal tuberculosis has become rare in the West but is still a frequent pathology mostly in young women, in Africa and up in Madagascar.