Results of thyroidectomies according to general surgeons and otolaryngologist and cervico faciale surgeons at the general Hospital of Reference of Niamey, what differences in the protocols of management?

OBJECTIVE: To evaluate the surgical management of thyroid pathologies at the Reference General Hospital. METHODS: This was a retro-prospective study over 4 years 6 months carried out in the departments of General and Digestive Surgery (GDS) and Otorhinolaryngology and Cervico Facial Surgery (ORL/FCS). It involved 182 patients who underwent thyroid surgery. RESULTS: A frequency of thyroidectomy of 9.46% was found. Females predominated with a sex ratio of 0.1. The average age of patients was 42.85 years, a standard deviation 12.80. 84.06% of patients had consulted for anterior cervical mass. EU-TIRADS score 3 represented 7,14% of cases. Heteromultinodular goiter was the main indication for thyroid surgery (59.34%). Total thyroidectomy was the most commonly performed gesture in general surgery in 88,23% (n = 105), in Otorhinolaryngology, it was in the same proportion as lobo-isthmectomy at 47.61% (n = 30). The first route was video-assisted thyroidectomy 2.2% (n = 4). The recurrent laryngeal nerve was dissected and seen in 159 cases (87.36%) and parathyroid glands were also seen and preserved in 58.24% of cases (n = 106). In immediate postoperative surgery, the main complications were unilateral recurrent paralysis with dysphonia in 3.3% (n = 6) and compressive hematoma in 2.2% (n = 4). No deaths had been recorded. CONCLUSION: Total thyroidectomy was the most performed procedure in department of General and Digestive Surgery. Routine oral calcium and vitamin D supplementation in the general surgery ward, reduces the occurrence of hypocalcemia after total thyroidectomy and allows a safe and early exit. Standardizing protocols will further reduce complications.

Adult groin hernia surgery in sub-Saharan Africa: a 20-year systematic review and meta-analysis.

PURPOSE: To realize a systematic review to evaluate groin hernia surgery for adults in sub-Saharan Africa. METHODS: We conducted a systematic review and meta-analysis, the primary objective of which was to determine the surgical techniques used for unilateral groin hernia surgery in sub-Saharan Africa. Studies published in the last 20 years were considered. A meta-analysis estimated the pooled prevalence with 95% confidence interval (CI) of mortality, chronic pain and recurrence. A subgroup analysis compared the rate of complications between complicated or uncomplicated hernia. RESULTS: We included 113 articles. The most used technique was Bassini in 40.1%, followed by Lichtenstein in 29.9% and Shouldice in 12.6%. The overall mortality rate was 0.6% (95% CI 0.4-0.9). The pooled recurrence rate was 1.4% (95% CI 1.05-1.9). The pooled rate of chronic pain was 2.7% (95% CI 1.9-3.7). We found that mortality rate for complicated hernias (6.4%) was higher compared to uncomplicated hernias (0.2%). This difference was statistically significant [p ≤ 0.001; OR = 47.7; 95 CI (27.2-83.47)]. CONCLUSION: This review showed that pure tissue repairs are the most used techniques with Bassini and Shouldice as leading procedures. The post-operative rates of recurrence and chronic pain are low. However, there is a high heterogeneity between studies than can underestimate these pooled prevalences. The consultation at complication stage remains frequent and associated with a higher mortality. Futures studies should focus on improving the quality of studies in terms of design and follow-up to increase the degree of evidence.

[State of knowledge on sleep apnea syndrome, attitudes and practices of doctors in Niamey, Niger]. / État des lieux des connaissances, attitudes et pratiques des médecins de Niamey sur le syndrome d'apnées obstructives du sommeil.

RATIONALE: Sleep apnea syndrome (SAS) is a public health problem. In African countries, it is an underdiagnosed pathology. Our objective was to assess SAS knowledge, attitudes and practices among doctors in Niamey, Niger. METHOD: A 6-month descriptive cross-sectional study was conducted from December 1, 2018 to May 31, 2019, involving 307 doctors working in health facilities in Niamey. RESULTS: Two hundred and seventy-two doctors (88.59%) responded, of whom 51.47% (n=140) were medical specialists, 32.35% (n=88) general practitioners and 16.18% (n=44) specialist doctors. Their level of knowledge was insufficient or fair in 77.94% (n=212) and 16.91% (n=46) of cases respectively. Their main source of information was the education they had received during university courses (61.03% [n=166]). The most commonly cited types of SAS were obstructive in 66.18% (n=180) of their responses and central in 30.15% (n=82). For adults, the main perceived risk factor for SAS was obesity (79.41% [n=216]) and among children, enlarged tonsils (68.75% [n=187]). For the most part, they were not familiar with the scale for assessing degree of daytime sleepiness (87.13% [n=237]) or with the baseline diagnostic examination for SAS (75.40% [n=205]). More than ¾ (n=221 or 81.25%) of the doctors never mentioned SAS to their patients and 59.93% (n=163) and 56.99% (n=155) of them referred a suspected case of SAS to an ENT specialist or a pulmonologist, respectively. Almost all of the doctors (94.85% [n=258]) wished to receive training on SAS. CONCLUSION: In a majority of cases, level of relevant knowledge was insufficient. Doctors need training on sleep apnea syndrome.

Role of exclusive laparotomy in the surgical treatment of septic complications of traumatic diaphragmatic hernia in the thorax.

Posttraumatic diaphragmatic hernias have long been known, but the variety of their clinical expression can lead to diagnostic delay and difficulties in treatment. An intrathoracic hernia of hollow abdominal viscera with subsequent necrosis and perforation is an uncommon late complication with poor prognosis. Surgical treatment is mandatory. Laparotomy is an excellent approach, making it possible to achieve therapeutic objectives for the abdomen and thorax with a short operative time and minimal complications in these patients whose hemodynamic status is often precarious. We report 2 cases of posttraumatic left diaphragmatic hernias with intrathoracic necrosis of the digestive tract, treated by laparotomy.

Management for hydatid cysts of the lung ruptured in the pleural cavity.

INTRODUCTION: Our purpose is to report our experience in the management of pulmonary hydatid cysts ruptured in the pleura. Materiel and methods: We collected all records of patients with a ruptured hydatid cyst of the lung in the pleura who underwent surgery for this in the department of thoracic surgery of the CHU Hassan II of Fes during the 6-year period that started in 2010. RESULTS: The study included 20 men and 14 women with an average age of 30.44 ± 18.4 years. Radiological findings showed a hydropneumothorax in 21 cases, hydrothorax in 10, pachypleuritis in 29, and a floating membrane in 13 cases. In all cases, pleuropulmonary decortication was associated with pericystectomy in 20 cases and parenchymal resection in 3 cases. A hydatid membrane bathing in the pleural cavity was found in 32 cases. The postoperative course was uneventful in 28 cases. CONCLUSION: Long-term follow-up should be established to detect possible recurrences or pleural dissemination, which appear to be prevented by long-term use of anthelmintic agents.

Aspergillus pyothorax: Is surgery alone sufficient?

Aspergillus is a mycelial fungus formed of filaments that penetrate the airways when its spores are inhaled. It is rarely located in the pleura. We report two cases of patients, one aged 67 years and the other 37 years, with pleural aspergillosis. The first underwent a thoracostomy, followed later by a myoplasty for closure. Pleuropulmonary decortication was performed in the second patient. The pathology examination confirmed an intrapleural aspergilloma in both patients. Antifungal treatment was not performed. The postoperative course was simple and no recurrence was noted. Based on these two cases over a 7-year period and a review of the literature, we detail the issues in this management and emphasize the interest of surgery.

INJURIES OF BOKO HARAM INSURGENCY IN SOUTH-EAST NIGER REPUBLIC.

BACKGROUND: Currently, wounds of wars, terrorism and criminality are increasing and constitute major public health problem worldwide. AIM: To present the epidemiological, clinical and therapeutic characteristics of the wounds observed during the Boko Haram (BH) insurgency in the South-east of the Republic of Niger. METHODOLOGY: This was a cross-sectional study from December 2014 to December 2016 at Diffa Regional Hospital, Diffa, Niger of individuals whose injuries were as a result of Boko Haram insurgency. RESULTS: In the period of this study, 573 injuries from Boko Haram insurgency were managed at the Regional Hospital at Diffa. The majority, 513(89.5%), were males while females constituted 60(10.5%) with a male/female ratio of 8.55. The mean age was 30,94(SD24,91) years (range 1 to 97 years). Civilian victims accounted for 379 (66.1%) while Nigerien soldiers accounted for 160(27.9%) and 34 (5.9%) were Boko Haram fighters. Firearms and explosives accounted for injuries in 489 (85.3%) and 7(1.2%) of patients respectively; 42 (7.3%) suffered injuries from a variety of traditional weapons. Injuries to limbs accounted for 361(63%) of cases and polytrauma in 65(11.34%). The main surgical management included wound debridement in 409 (71.4%), external bone fixation in 38 (6.6%), laparotomy in 30 (5.2%), thoracic drainage in 27 (4.7%), and major limb amputations in 13 (2.3%) cases.Postoperative follow-up was uneventful in 460 (80.28%) of cases; there were 29 deaths, giving a mortality rate of 5.1%. Predictors of death after injuries of Boko Haram terrorism in this study included: being civilian patients (OR = 3.38 [1.15-9.85], p=0.018), injuries to head, neck, trunk or spine (OR 3.45[1.58-7.58], p= 0.001) or the presence of polytrauma on admission (OR = 17.30 [7.72-38.80], p<0.0001). CONCLUSION: This study has shown that injuries sustained in Boko Haram insurgency in Niger were mainly firearm injuries and injuries from the use of traditional weapons, affecting mostly young civilian males. The part of the body most commonly involved were the extremities, with mainly soft tissue injuries. Wound debridement was the commonest surgical procedure performed and the mortality rate was 5.1%. Predictors of mortality were being civilian patients, injuries of head, neck, trunk or spine and polytrauma. The ICRC has played a major role in strengthening our hospital for the task of caring for the victims, in terms of provision of material resources and in the further training of our personnel.

Pentoxifylline mitigates detrimental impact of chronic nonbacterial prostatitis on sperm characteristics, reproductive hormones and histopathology in rats.

The protective role of pentoxifylline (PTX) on sperm characteristics, reproductive hormones and histopathology following carrageenan-induced chronic nonbacterial prostatitis (CNP) was investigated in male Wistar rats. Thirty-six rats were grouped into six rats per group. Group 1 (control) received saline normal. Group 2 received a single intraprostatic dose of 3% carrageenan (50 µl) on day 1 (CNP). Groups 3 and 5 received cernilton (standard drug) and PTX orally at 100 and 50 mg/kg for 14 consecutive days respectively. Groups 4 and 6 received a single dose of 3% carrageenan (50 µl) intraprostatically on day 1 followed by cernilton and PTX orally at 100 and 50 mg/kg on the eighth day for 14 consecutive days respectively. Prostatic index, serum prostatic specific antigen, malondialdehyde, testosterone and luteinising hormone levels were significantly increased (p < .05), whereas serum follicle-stimulating hormone, sperm count, motility and viability were significantly decreased (p < .05) in CNP group. Histopathology of prostate revealed leucocyte infiltration, large involutions and projection into the lumen in CNP group and these aberrations were improved by PTX. According to these findings, we concluded that PTX effectively mitigated detrimental impact of CNP on sperm characteristics, reproductive hormones and histopathology in rats.

[About two huge bilateral bronchial atypical carcinoid tumors]. / À propos de deux énormes tumeurs carcinoïdes atypiques bilatérales bronchiques.

Carcinoid tumors are well differentiated neuroendocrine tumors of low grade malignancy or attenuated malignancy. Atypical bilateral bronchial forms are rarely reported. They pose a real problem of therapeutic strategy. We report a case of a 36-year-old woman with two large bilateral atypical carcinoid tumors. She received delayed bilateral parenchymal resection with postoperative uneventful course. Through a review of the literature, we discuss the therapeutic strategy. This observation remains special for several reasons. Not only by the rarity of the bilateral and atypical forms but also for the bilateral tumor sizes which led to a difficult intraoperative anesthetic management.

[The surgery of diaphragmatic hydatidosis and their complications]. / La chirurgie des hydatidoses diaphragmatiques et leurs complications.

Primary or secondary diaphragmatic echinococcosis is rare, accounting for 1% of the thoracic locations. They may be operative discovery or by their complication, hence a variable symptomatology making this localization a particular entity. The thoracic and abdominal CT allows a complete assessment. Surgery remains the only therapeutic approach. In complicated forms an additional surgery is required for complete care. The prognosis is generally good apart from the risk of recurrence. Through a series of 4 operated patients, we focus on the clinical and therapeutic features of this pathology and its complications.

Notomelia and related neural tube defects in a baby born in Niger: case report and literature review.

INTRODUCTION: Notomelia associated with neural tube defects are rare diseases. CASE REPORT: A baby was born in Niger with multiple congenital embryonic malformations on the posterior midline. The most rostral malformation was an accessory limb (polymelia) at the level of the lumbar vertebrae composed of two long bones, a foot and three toes. Accessory male genitalia were present at the base of this malformed accessory limb which had no apparent motor or sensory innervation. The second malformation was a sacral vestigial appendage with an adjacent dermal sinus opening onto the posterior midline and extending internally to the dura through a defect of the vertebral arches. From the published literature and this particular case, we conclude that notomelia is a rare clinical sequela of a neural tube defect (NTD) and is correctly classified as a dysraphic appendage. CONCLUSION: The recent occurrence of three similar cases in the same ethnic group from Niger, three from consanguineous parents, suggests that genetic factors are likely to contribute significantly to the genesis of this syndrome, consistent with a recent report that mutation of the bovine NHLRC2 gene resulting in a V311A substitution at a highly conserved locus in the NHLRC2 protein is, when homozygous, causally associated with several forms of polymelia including notomelia, with heteropagus conjoined twinning and with other NTD-related embryonic malformations. Detailed genome-wide studies of children with dysraphic appendages are indicated.

[Patient satisfaction, an important part of care: case of a surgical department in Niger]. / Satisfaction des patients, element important dans la globalite des soins: cas d'un service des urgences chirurgicales au Niger.

INTRODUCTION: The aim of this study was to assess patient satisfaction in the surgical emergencies department at the National Hospital of Zinder, Niger. MATERIALS AND METHOD: This was a cross-sectional study focusing on patients admitted to the surgical emergency department of the National Hospital of Zinder (NHZ). The study was conducted over a period of 2 month - from July 1st to August 31st, 2015. During a face to face interview, patients were asked a series of questions. RESULTS: Of the 227 patients surveyed, 54.62% (n=124) were satisfied with their experience of the surgical emergencies department. The main factors associated with high satisfaction scores were patient reception (OR: 0.27, 95% CI=0.14 to 0.52; p <0.001), and the management of symptoms (OR: 0.28, 95 % CI=from 0.14 to 0.58; p < 0.001). Dissatisfaction factors were: waiting time before receiving treatment (OR 16.57, 95% CI=8.52 to 32.23; P <0.0001), the environment (OR: 3.89, 95% CI=2.12 to 7.12; p <0.001), accessibility (OR: 5.85, 95% CI=2.54 to 13.46, p < 0.001) and poor staff-patient communication (OR, 13.76; 95% CI 6.54 to 28.98; P <0.0001). CONCLUSION: Despite the shortcomings of the surgical emergencies department of NHZ, a good welcome and prompt patient management have been the key components associated with patient satisfaction.

INTRODUCTION: Le but de cette étude était d'évaluer la satisfaction des patients pris en charge au service des urgences chirurgicales de l'Hôpital National de Zinder, Niger. MATÉRIELS ET MÉTHODES: Il s'agissait d'une étude transversale portant sur des patients admis aux urgences chirurgicales de l'hôpital National de Zinder (HNZ). L'enquête a été réalisée sur une période de 2 mois du 1er juillet au 31 août 2015. Un questionnaire adressé aux patients était rempli à travers un entretien direct. RÉSULTATS: Sur les 227 patients retenus, 54,62% (n=124) étaient satisfaits des prestations au service des urgences chirurgicales. Les principaux éléments associés à une bonne satisfaction étaient l'accueil (OR: 0,27; IC95%= 0,14 ­ 0,52; p<0,001) et la prise en charge de la symptomatologie (OR: 0,28; IC95% = 0,14 ­ 0,58; p<0,001). Les facteurs incriminés dans l'insatisfaction étaient: le temps d'attente avant la prise en charge (OR: 16,57; IC95% = 8,52 ­ 32,23; p<0,0001), l'environnement (OR: 3,89; IC95%=2,12 ­ 7,12; p<0,001), l'accessibilité (OR: 5,85; IC95%=2,54 ­ 13,46; p<0,001) et la mauvaise communication soignant-patient (OR: 13,76; IC95% =6,54­28,98; p< 0,0001). CONCLUSION: Malgré les insuffisances du service des urgences chirurgicales de l'HNZ, un bon accueil et une prise en charge rapide, sont les éléments clés associés à la satisfaction du patient.

[What surgery for recurrent Darier-Ferrand sarcoma of the chest wall?] / Quelle chirurgie pour la forme récidivante du sarcome de Darrier-Ferrand de la paroi thoracique ?

INTRODUCTION: Dermatofibrosarcoma protuberans (Darrier-Ferrand sarcoma, DFSP) is an uncommon tumor. This sarcoma has a tendency to local recurrence, requiring a wide surgical resection. OBSERVATION: We report herein two cases of patients presenting with recurrent dermatofibrosarcoma protuberans after several surgical resections. A wide surgical resection with guided tissue regenaration has been performed in one case, whereas the second case required a skin graft. CONCLUSION: Despite a short follow-up, our aim was to highlight the local aggressiveness of the DFSP and point out its therapeutic challenge, usually requiring a wide and aggressive surgery.

[Pneumonectomy for tuberculosis destroyed lung: A series of 26 operated cases]. / Pneumonectomie pour poumon détruit post-tuberculeux : une série de 26 cas opérés.

Pneumonectomy keeps a greatest place in the treatment of tuberculosis lung destroyed despite high morbidity and mortality. The aim of our study was to analyze the results of pneumonectomy in the treatment of tuberculosis lung destroyed in our institution. METHOD: A retrospective study over a period of 5 years (2009 to 2014) was realized. Are involved in the study all patients admitted to the thoracic surgery department of CHU Hassan II with tuberculosis lung destroyed and operated during the study period. RESULTS: This is a series of 26 patients, including 17 men and 9 women treated and cured for pulmonary tuberculosis of which 2 for multiresistant tuberculosis. The average age was 38.8 years. Hemoptysis (77 %) and recurrent respiratory infections (65.4 %) were the major clinical signs. Aspergilloma have been reported on cavitary lesion in 23 % of cases and in 11.5 % pyothorax was associated. Extra-pericardial pneumonectomy was performed in 65.4 %, intra-pericardial pneumonectomy in 19.3 % and pleural-pneumonectomy in 15.3 %. The outcome was favorable in 23 patients. We noted a pyothorax on pneumonectomy cavity in 3 patients. Postoperative mortality was 7.7 %. The regularly clinical and radiological control of all patients is satisfactory with a mean of 41 months. CONCLUSION: Pneumonectomy for tuberculosis lung destroyed remains effective in young patients with an acceptable complication rate.

[Neurogenic mediastinal tumors in adults]. / Tumeurs neurogènes du médiastin de l'adulte.

INTRODUCTION: Neurogenic mediastinal tumors are tumors develop at the expense of peripheral nerve elements of the mediastinum, the sympathetic nervous tissue and paraganglia. The series that we propose has the distinction of a high frequency of malignant forms and a wealth of clinical symptomatology. METHODS: This is a retrospective study of 9 patients collected over a period of 6 years. The epidemiological aspect, clinical, radiological, surgical treatment and his results, histological diagnosis and prognosis were reviewed. RESULTS: Five women and 4 men were identified. All patients were symptomatic at diagnosis. Tumor resection was complete in 8 cases. In 3 patients, there was a malignant tumor. Two of them had received chemo-radiotherapy. The others showed good clinical progress with a mean of 35 months. CONCLUSION: Neurogenic tumors in adults are usually discovered incidentally. When the malignant forms predominate or in the presence of large tumor, the symptoms can be quite marked. In all cases the treatment based on a complete surgical resection remains the only guarantee of a good prognosis.

A case of cephalomelia discovered in a baby born in Niger.

INTRODUCTION: Subcutaneous tumors with extra limbs are very rare, and they are considered either as fetus in fetu or fetiform teratoma. CASE REPORT: We report here the case of a 6-day-old presenting a mass extending at the level of the occipital bone. This mass is developed in the extracranial region and contains two forelimbs including hands with digits. CT shows that the squamous part of the occipital bone is involved with several defects through which a part of the cerebellum herniates. The boy was operated on and the tumor was removed. The herniated region of the cerebellum has also been removed. After surgery, the boy develops normally. CONCLUSION: This type of tumor is extremely rare and is only the second case that has been reported at this exact location. This could be the so-called céphalomélie described by Isidore Geoffroy Saint-Hilaire in a duck in his famous Treatise of Teratology (1836). The cause of this malformation is still a matter for debate.

Active infection and morphometric study of Trypanosoma evansi among horses in Peninsula Malaysia.

Apart from occasional reports of clinical disease affecting horses, there is no information about Trypanosoma evansi in horses in Peninsula Malaysia. Thus, a cross-sectional study was conducted in eight states in Peninsula Malaysia to determine the active presence of T. evansi in horses. A total of 527 blood samples were obtained and examined by haematocrit centrifugation technique (HCT), Giemsa-stained thin blood smear (GSS), morphometric measurements, polymerase chain reaction (PCR) and cloning of PCR products. The results showed an overall parasitological prevalence of 0.57% (3/527, CI: 1.6-0.19%) with both HCT and GSS. Morphometric study revealed the mean total length of the trypanosomes including the free flagellum was 27.94 ± 2.63 µm. PCR successfully amplified a trypanosome specific 257 bp in 1.14% of samples (6/527, CI: 2.4-0.52%) and was confirmed by nucleotide sequences. The mean packed cell volume (PCV) for the positive cases detected by HCT was lower (23% ± 7.00) compared to the positive cases detected by PCR alone in the state of Terengganu (35% ± 4.73). In conclusion, this study showed T. evansi infection occurred in low frequency in horses in Peninsula Malaysia, and anaemia coincided with parasitaemic animals. PCR is considered as a sensitive diagnostic tool when parasitaemia is undetectable. The slight lengthier mean of parasite and anaemia may indicate a virulent strain of T. evansi circulating throughout the country. Thus, it's highly recommended to shed light on host-parasite relationship for better epidemiological understanding.

Evaluation of enhanced virgin coconut oil and senduduk (Melastoma malabathricum) as anthelmintics against caprine strongyle nematodes.

A study was conducted to evaluate the anthelmintic properties of enhanced virgin coconut oil (EVCO) and senduduk (Melastoma malabathricum) plant against strongyle nematodes in goats. Two preparations of 10% EVCO dissolved in 90% virgin coconut oil and 10% EVCO dissolved in 90% palm oil, were given orally to two groups of mixed breeds goats. The efficacy test indicated that EVCO was insufficiently active as an anthelmintic. Four concentrations of senduduk solution (1.25, 2.5, 5.0 and 10 mg ml(-1)) were compared with a control and albendazole in an in vitro test for larvicidal effect. There was no significant larval mortality using senduduk solution. An in vivo test of senduduk was conducted by comparing three groups of goats, namely control, levamisole and treatment groups that were given a daily oral dose of senduduk crude extract with 1g kg(-1) from Day 0 to Day 12 and 2 g kg(-1) from Day 13 to Day 30. This efficacy test with senduduk also gave negative results. The findings obtained indicated that EVCO and senduduk were ineffective as anthelmintics against caprinestrongyle nematodes at the concentrations used.