Human biomonitoring guidance values (HBM-GVs) for priority substances under the HBM4EU initiative - New values derivation for deltamethrin and cyfluthrin and overall results.

The European Initiative HBM4EU aimed to further establish human biomonitoring across Europe as an important tool for determining population exposure to chemicals and as part of health-related risk assessments, thus making it applicable for policy advice. Not only should analytical methods and survey design be harmonized and quality assured, but also the evaluation of human biomonitoring data. For the health-related interpretation of the data within HBM4EU, a strategy for deriving health-based human biomonitoring guidance values (HBM-GVs) for both the general population and workers was agreed on. On this basis, HBM-GVs for exposure biomarkers of 1,2-cyclohexane dicarboxylic acid diisononyl ester (DINCH), phthalates (diethyl hexyl phthalate (DEHP), di-n-butyl phthalate (DnBP), diisobutyl phthalate (DiBP), butyl benzyl phthalate (BBzP), and bis-(2-propylheptyl) phthalate (DPHP)), bisphenols A and S, pyrethroids (deltamethrin and cyfluthrin), solvents (1-methyl-2-pyrrolidone (NMP), 1-ethylpyrrolidin-2-one (NEP), N-dimethylformamide (DMF), N,N-dimethylacetamide (DMAC)), the heavy metal cadmium and the mycotoxin deoxynivalenol (DON) were developed and assigned a level of confidence. The approach to HBM-GV derivations, results, and limitations in data interpretation with special focus on the pyrethroids are presented in this paper.

Acute sigmoid volvulus: results of surgical treatment in the teaching hospitals of Bamako.

OBJECTIVE: The aim was to evaluate the results of surgical treatment of occlusion of the sigmoid colon due to volvulus. PATIENTS AND METHODS: This was a retrospective study from 1996 to 2010 of all patients undergoing surgery for sigmoid volvulus in surgical wards of the University Hospital of Bamako. RESULTS: A total of 417 patients were identified including 379 men and 38 women. The mean patient age was 45.7 ± 18.3 years. The general condition of the patients was good in 70.5% and altered in 29.5% of cases. Colonic necrosis was present in 80 patients (19.2%). Single-stage resection with immediate anastomosis was performed in 149 patients (35.73%). Two-stage surgery was performed in 268 cases (64.27%). The initial stage of the two-stage procedure was colostomy in 167 cases and simple detorsion in 101 cases. The surgical approach had an impact on mortality in patients who were in poor general condition. Single-stage surgery resulted in higher mortality (12/149; 8.05%) than two-stage surgery (5/268; 1.87%), and the difference was statistically significant (P=0.0005). CONCLUSION: Single-stage surgery for sigmoid volvulus carries a high risk of death when it is performed in patients with poor general condition. Indications for surgery must take into account the patient's general condition and the viability of the torsed sigmoid colon.

[Surgical options in the treatment of noma]. / Options chirurgicales dans la prise en charge du noma.

In the acute phase of noma, the role of surgery is minor and the treatment consists in the realisation of local or regional flaps and sometimes the management of haemorragia. For reasons social and economic reconstruction of the loss of substance should be conducted on site. The treatment consists of surgical excision of fibrous tissue, the removal of the ankylosis and the closure of the PDS by local flaps, or free pediculated. Because of the extreme variety of loss of substance (PDS) and the multiple surgical options, a systematic and eventually, the standardization of the surgical approach in the treatment of sequelae of noma is essential.

A la phase aigue du noma, le rôle de la chirurgie est mineur et consiste en des soins locaux et occasionnellement au traitement de l'hémorragie.Pour des raisons socioculturelles et économiques, la reconstruction des pertes de substance doit se dérouler sur place. Le traitement chirurgical consiste en l'excision des tissus fibreux, la levée de l'ankylose et la fermeture des PDS par des lambeaux locaux, pédiculés ou libres.A cause de l'extrême variété des pertes de substance (PDS) et des multiples options chirurgicales, une systématisation et éventuellement, une standardisation de l'approche chirurgicale dans le traitement des séquelles de noma est indispensable.

[Postoperative Pains: Evaluation Of Its Management In The Point G Teaching Hospital]. / Douleurs Postoperatoires: Evaluation De Sa Prise En Charge Au CHU Du Point G.

OBJECTIVE: To evaluate the management of postoperative pain in the Point G teaching hospital. PATIENTS AND METHODS: We carried out a prospective study, in 2008. Inclusion criteria for the personnel: be a staff member from the department of surgery or anaesthesia reanimation; willing to fill out the questionnaire. Inclusion criteria for patients: to be operated and hospitalized in one of the departments of surgery and anaesthesia reanimation. RESULTS: We collated the responses of 600 patients and 113 personnel. 92% of the patients underwent post-operative analgesia. The delay between the request and treatment of the patient was extensive in 92% of cases. The medical personnel and nursing staff had not received specific training on treating the pain in respectively 55% and 70% of cases. We noted an absence of informational support and of pre-established consensual protocols, written and validated on the management of postoperative pains. CONCLUSION: The treatment of the postoperative pains shows important shortcomings within the Point G teaching hospital and these insufficiencies are found across levels.

BUT: Evaluer la prise en charge de la douleur post opératoire au CHU du Point G. PATIENTS ET MÉTHODES: Il s'agissait d'une étude prospective réalisée en 2008. Critères d'inclusion du personnel: être agent dans l'un des services de chirurgie ou d'anesthésie réanimation, disposé à remplir le questionnaire proposé. Critères d'inclusion du patient: être opéré et hospitalisé dans l'un des services de chirurgie et d'anesthésie réanimation. RÉSULTATS: Il a été colligé 600 patients et 113 personnels. 92% des patients ont bénéficié de l'analgésie post opératoire. Le délai de traitement après la demande était long dans 92%. Les personnels médical et soignant n'ont pas reçu de formation spécifique sur la douleur dans respectivement 55% et 70%. Nous avons constaté une absence de support informationnel, de protocoles consensuels préétablis, écrits et validés sur la prise en charge post opératoire de la douleur. CONCLUSION: La prise en charge post opératoire de la douleur connait des lacunes importantes au sein du CHU du Point G et les insuffisances sont à tous les niveaux.

[Peritonitis by typhoid ileal perforation: evolutionary aspects in the Teaching Hospital of Bamako and Kati in Mali]. / Peritonite par perforation ileale d'origine typhique: aspects évolutifs dans les CHU de Bamako et de Kati au Mali.

OBJECTIVE: The objective of this study was to determine the frequency of peritonitis by typhoid ileal perforation in the teaching hospitals of Bamako and Kati. PATIENTS AND METHODS: We conducted a retrospective study over a 24 years period (1984-2007). Every patient admitted and operated in urgency for peritonitis by ileal perforation were listed and included in this study. RESULTS: During the study period, 1868 acute peritonitis were operated on in the three major health centres of Bamako and Kati. We collected data concerning 543 typhoid ileal perforations which represented 29.0% of all peritonitis. The peritonitis by typhoid perforation constituted 28.5% of the peritonitis in the teaching hospital of the Point G, 30.6% in the Gabriel Touré teaching hospital and 6.4% in the teaching hospital of Kati. Among the peritonitis by typhoid perforation, 56.7% were listed in the Point G teaching hospital, 43.0% in the Gabriel Torre teaching hospital and 0.3% in the Kati teaching hospital. Between 1984-2004 we collected data from two hundred and fifty seven (257) patients suffering from peritonitis by typhoid ileal perforation, a total of 24.4% of the peritonitis recorded. Between 2005-2007, the data for two hundred eighty six (286) patients suffering from peritonitis by typhoid ileal perforation was collected, a total of 35% of the peritonitis recorded. The typhoid ileum perforation remains the 2nd overall cause of generalized peritonitis after that of appendicular origin. CONCLUSION: Peritonitis by typhoid ileum perforation has seen a significant increase from 2004 in the teaching hospitals of Bamako and Kati.

BUT: L'objectif de ce travail était de déterminer la fréquence de la péritonite par perforation iléale d'origine typhique dans les CHU de Bamako et de Kati. PATIENTS ET MÉTHODES: Nous avons réalisé une étude rétrospective sur une période de 24 ans (1984­2007). Tous les malades admis et opérés en urgence pour une péritonite par perforation iléale ont été recensés et inclus dans cette étude. RÉSULTATS: Durant la période d'étude, 1868 péritonites aiguës ont été opérées dans les trois grandes structures de santé de Bamako et Kati. Nous avons colligé 543 perforations iléales d'origine typhique soit 29,0 % des péritonites. La péritonite par perforation typhique a constitué 28,5% des péritonites au CHU du Point G, 30,6% au CHU Gabriel Touré et 6,4% au CHU de Kati. Parmi les péritonites par perforation typhique, 56,7% ont été recensés au CHU du Point « G ¼, 43,0% au CHU Gabriel Touré et 0,3% au CHU Kati. De 1984­2004 nous avons colligé deux cent cinquante sept (257) malades souffrant d'une péritonite par perforation iléale d'origine typhique soit 24,4% des péritonites. Entre 2005­2007, deux cent quatre vingt six (286) malades ont été colligés soit une fréquence de 35%. La perforation iléale d'origine typhique reste globalement la 2ème cause de péritonite généralisée après celle d'origine appendiculaire. CONCLUSION: La péritonite par perforation iléale d'origine typhique a connu une augmentation importante à partir de 2004 dans les CHU de Bamako et de Kati.

[Postoperative peritonitis in the Surgery B department of the Point G hospital]. / Peritonites postoperatoires dans le service de chirurgie b du CHU du Point G.

OBJECTIVE: To determine the incidence of postoperative peritonitis, and describe their clinical, paraclinical and therapeutic aspects. PATIENTS AND METHODS: This was a retrospective study conducted between 1980 and 2010 in the Department of Surgery B of the Point G University Hospital. It focused on all patients who underwent surgical intra-abdominal in the Surgery B department. RESULTS: We collected 25 cases of postoperative peritonitis, 84% were male subjects. The average age of patients was 37.2 years ± 17.0. The clinical picture was dominated by abdominal pain (92%), abdominal defense (92%), and fever (84%). Abdominal ultrasound played an important role in diagnosing 72% of cases. Etiologies were dominated by anastomotic leak (32%), infection of the collection phrenic, iatrogenic perforation (28%). Interventions made at surgery were: suture of the perforation or anastomotic recovery plus peritoneal cleansing and drainage in 36% of cases, peritoneal cleansing and drainage in 36%. There were postoperative complications in five patients. The mortality rate was 4%. CONCLUSION: Postoperative peritonitis are rare in our service. When they occur their rate of morbidity and mortality are high.

BUT: Les objectifs étaient de déterminer la fréquence des péritonites postopératoires, de décrire leurs aspects cliniques, paracliniques et thérapeutiques. PATIENTS ET MÉTHODES: Il s'agissait d'une étude rétrospective réalisée entre 1980 et 2010 dans le service de de chirurgie B du CHU du Point G.Elle a porté sur tous les malades hospitalisés ayant subi une intervention chirurgicale intra abdominale en chirurgie B. RÉSULTATS: Nous avons colligés 25 cas de péritonites postopératoires dont 84% de sujet masculin. L'âge moyen des patients a été de 37,2 ans ±17,0. Le tableau clinique était dominé par la douleur abdominale (92%), la défense abdominale (92%), la fièvre (84. L'échographie abdominale a contribué au diagnostic dans 72% des cas. Les étiologies étaient dominées par la désunion anastomotique (32%), la collection infectée sous phrénique, la perforation iatrogène (28%). Les gestes réalisés à l'intervention chirurgicale étaient la suture de la perforation ou la reprise de l'anastomose plus une toilette péritonéale et un drainage dans 36%, la toilette péritonéale et drainage dans 36%. Les suites opératoires ont été compliquées chez cinq malades. La mortalité a été de 4%. CONCLUSION: Les péritonites postopératoires sont rares dans notre service. Quand elles surviennent leurs taux de morbidité et de mortalité sont élevés.

[Volvulus of sigmoid colon: surgical treatment and prognosis in the services of General Surgery of the Point G Teaching Hospital]. / Volvulus du colon sigmoïde: traitement chirurgical et pronostic dans les services de chirurgie generale du CHU du Point G.

OBJECTIVE: To study the therapeutic aspects and prognosis of volvulus of the sigmoid colon in surgical departments. PATIENTS AND METHODS: Our study was retrospective from January 2000 to December 2009 (10 years). All patients who underwent sigmoid volvulus in the Point G teaching hospital surgical departments were taken into account. RESULTS: We recorded 96 patients operated for volvulus of sigmoid over 882 cases of bowel obstruction, a rate of 10.9%. The average age was 47.2 years ± 18.9. In per-operative, there was a necrosis of the colon rate of 16.7% (14 cases). Performed surgical treatment modalities were: sigmoidectomy with primary anastomosis in 29.2% of cases (28), sigmoidectomy followed by colostomy and secondary anastomosis in 60.4% of patients (58) and 10.4% rare of simple devolvulation. The immediate postoperative period were marked by a morbidity rate of 7.3% (7 cases) and a mortality rate of 7.3% (7 cases). CONCLUSION: In spite of various therapeutic modalities of volvulus of the sigmoid colon, the rates of postoperative morbidity and mortality are rising in the general surgery of the Point G teaching Hospital.

OBJECTIF: Le but était de décrire les aspects thérapeutiques et de déterminer le pronostic du volvulus du côlon sigmoïde dans les services de chirurgie générale. PATIENTS ET MÉTHODES: Notre étude a été rétrospective allant de janvier 2000 à décembre 2009 (soit 10 ans). Tous les patients opérés dans les services de chirurgie générale du CHU du Point G pour volvulus du sigmoïde ont été pris en compte. RÉSULTATS: Nous avons enregistré 96 patients opérés pour volvulus du sigmoïde sur 882 cas d'occlusion intestinale soit une fréquence de 10,9%. La moyenne d'âge était de 47,2 ans ±18,9 ans. En per-opératoire, il y avait une nécrose de l'anse volvulée chez 16,7% (14 cas). Les modalités thérapeutiques chirurgicales effectuées ont été: la sigmoïdectomie avec anastomose immédiate dans 29,2% (28 cas), la sigmoïdectomie suivie de colostomie puis anastomose secondaire dans 60,4% (58 cas) et la dévolvulation simple dans 10,4% (10). Les suites opératoires immédiates ont été marquées par un taux de morbidité de 7,3% (7) et un taux de mortalité de 7,3% (7). CONCLUSION: En dépit des modalités thérapeutiques variées du volvulus du côlon sigmoïde, les taux de morbidité et de mortalité postopératoires restent élevés dans les services de chirurgie générale du CHU du Point G.

[Common mesentery: discovered two cases of intestinal obstruction]. / Mesentere commun: deux cas découverts dans un tableau d'occlusion intestinale.

The purpose of this study was to describe the common mesentery in its occlusive form and practice driving before this emergency. The mesentery is a common abnormality of rotation of the primitive intestinal loop or omphalomesenteric loop during embryonic development.Two cases of intestinal obstruction by strangulation were received in urgency. They were a 55 year old man who checked himself into the emergency department and a 14 year old girl brought in by her parents. These were 2 cases of acute intestinal obstruction on incomplete common mesentery. The intestine was turned to complete common mesentery in both cases. Embryologically, it is anomalies of rotation and joining of the primitive intestine that are causing the incomplete common mesentery , the source of acute intestinal obstruction due to strangulation. CONCLUSION: The common mesentery poses a diagnostic and therapeutic problem. Its symptomatology is that of occlusion by strangulation and the surgeon must note this before any obstruction.

Le but de cette étude était de décrire le mésentère commun dans sa forme occlusive et la conduite pratique devant cette situation urgente. Le mésentère commun est une anomalie de rotation de l'anse intestinale primitive ou anse omphalomésentérique, lors du développement embryonnaire.Deux cas d'occlusion intestinale par strangulation ont été reçus en urgence. Il s'agissait d'un homme de 55 ans venu de lui-même dans le service d'accueil des urgences et d'une fillette de 14 ans amenée par ses parents. Il s'agissait de 2 cas d'occlusion intestinale aiguë sur mésentère commun incomplet. L'intestin a été mis en mésentère commun complet pour les 2 cas. Embryologiquement ce sont les anomalies de rotation et d'accolement de l'anse intestinale primitive qui sont à l'origine du mésentère commun incomplet, source d'occlusion intestinale aiguë par strangulation. CONCLUSION: Le mésentère commun pose un problème diagnostique et thérapeutique. Sa symptomatologie est celle d'une occlusion par strangulation et le chirurgien doit y penser devant toute occlusion.

Adult intussusception: diagnostic pitfalls, morbidity and mortality in a developing country.

OBJECTIVE: To study diagnostic pitfalls, morbidity and mortality of adult intussusception. PATIENTS AND METHODS: Retrospective study of adult patients records operated between 1979 and 2007 with the diagnosis of adult intussusception. RESULTS: We found 41 cases of adult intussusception. The mean age was 35.2 years (standard deviation (SD)=7.1). The delay between onset and medical consultation was 15 days. The diagnosis was made pre-operatively in 11 cases. Abdominal ultrasound showed an abdominal mass in 11 cases. Ileo-ileal intussusception was most frequent (16 cases). Intussusception was secondary in 24 cases. There were seven instances of intestinal necrosis. Intestinal resection was performed in 34 cases. Surgical site infection occurred in four patients, three patients died. CONCLUSION: The pre-operative diagnosis of acute intestinal intussusception is difficult. Morbidity and mortality rates are high. Improved diagnostic investigations in developing countries could improve the prognosis of this condition.

[The size of the bile duct by echograph. A study]. / Étude par échographie des dimensions du conduit cholédoque.

UNLABELLED: The purpose of this work was to determine the size of the bile duct by echograph. The frequent injuries of the bile duct in various pathologies in particular infection, made of it a very investigated organ especially by echograph. Its size can be modified by various pathologies. So it is of interest to know about its normal size. PATIENTS AND METHOD: Sixty normal subjects, among which 29 women, were examined by echograph in the university hospital of the Point G. They were voluntary subjects with an empty stomach for 12 hours. Three different sonographers successively performed this examination according to the same protocol with an Aloka SSD 1700 device type and a Kontron Medical/Imagic Maestro. These devices were provided with a convex probe of 3.5-megahertz multifrequency and with a linear probe of 7.5-megahertz. The subjects were in dorsal position. Reference points for the display of the bile duct were the liver, the gallbladder and the pancreas. The limits of the bile duct were marked by the cursor of the echograph. The transverse diameter (in mm) of the bile duct was measured in its origin and in its ending. No subject of the sample was obese enough to hamper the visibility of the gall-bladder and the bile duct and no subject had histories of cholecystectomy. Data analysis was made using the software Ear information version 6. The difference between variables was considered as significant when P<0,05. RESULTS: Forty subjects out of 60 were between 20 and 39 years old. The transverse diameter of the bile duct was measured 38 times (63.3%) in its origin and 50 times (83.3%) in its ending. The failure of visibility of the proximal segment was 37.7% and the failure of visibility of the distal segment of the bile duct was 17.7%. The average transverse diameter of the bile duct in its origin was 2.61.4 mm; extremes were 2 and 5 mm. The average transverse diameter of the bile duct in its ending was 3.10.7 mm; extremes were 2 and 5 mm. The transverse diameter of the bile duct in its origin of the subjects was contained between 3 and 4 mm in 80% of the cases. The transverse diameter of the bile duct in its ending of the subjects was contained between 3 and 4 mm in 40% of the cases. The difference was very significant between the diameter of the bile duct in its origin and in its ending (P<10(-6)). CONCLUSION: The distal segment of the bile duct was seen more accurately than the proximal segment by echograph. The diameter of the bile duct in its ending was significantly superior to that of the bile duct in its origin.

[Factors affecting nosocomial infection in the surgery setting at the Hospital of Point "G"]. / Facteurs influencant l'infection nosocomiale en milieu chirurgical à l'Hôpital du Point "G".

Nosocomial infections are a common and increasing problem globally, and particularly in Africa. The significant economic burden of these infections on the health care system as well as their impact on patient morbidity and mortality is well recognised within the medical communities.The goal of this study was to investigate factors that influence nosocomial infection in all in-patients from the surgery wards (surgery ward A and B, Gynoeco-obstetrics, urology and intensive care) at the national hospital of Point G in Bamako, Mali. We report the number of nosocomial infection during a prospective study between June 2003 and January 2004. Of 1043 in-patients, 102 had had a nosocomial infection with a global prevalence of 9.7% (8.0-11.4). Of 1024 patients with surgery, 101 had had a nosocomial infection, a post-surgery nosocomial infection rate of 9.8% (8.1-11.5). We observed different site of nosocomial infection such as suppuration sup-aponevrotics (41.2%), parietal infection sub-aponevrotics (32.4%), urinary infection (17.6%) and organ suppuration (3.9%). Other nosocomial infection observed were pneumonia (2.9%) and catheterisation (2.0%). The nosocomial infection rate was 10.3% in male while it was 7.3% in female. The difference between male and female was not statistically significative (chi2 = 2.33, p = 0.12). Nosocomial infection was more prevalent in patients after emergency surgery (15.1%) than in scheduled surgery patients (8.5%) (chi2 = 8.15, p = 0.004). The classes III and IV of ALTEMEIER had the higher proportion of nosocomial infection (35.9%) against 4.8% for the classes I and II (chi2 = 144.95, p < 0.001). The patients with ASA score I had a lower nosocomial infection rate than patients from the intensive care unit or patients of Class II + III + IV (chi2 = 13.2, p = 0.001). Patients classified according to the National Nosocomial Infection Surveillance System (NNISS) with a score 0 had a nosocomial infection rate less than patients classified as NNISS score 1, 2 or 3 (chi2 = 82.0, p < 0.001). The study results underline the need for further investigations of the role of microbial agents and antimicrobial resistance in the outcome of patients with nosocomial infection.

[Problems with lung cancer in the pneumology service at G Barnako Hospital, Mali]. / Problematique du cancer bronchique dans leservice de pneumologie du point G Bamako Mali.

The authors report the results of a retrospective study on the bronchial cancers observed in the service of PPH of the hospital of the point G of Bamako during the time active of January 1, 1999 to December 31, 2003. The goal was to describe the epidemiological, clinical and therapeutic aspects of bronchial cancer On 669 in-patients, 36 cases of bronchial cancer were diagnosed either a prevalence of 5.36%. the average age of the patients was 54.5 years with the extreme ones going from 35 to 80 years. Our series was made up of 27 men and 9 women with a sex ratio of 3 in favor of the men. The nicotinic was the principal factor of risk (69.4%) with an average of 20,9 packages year. The mode of prevalent nicotinic was the cigarette (92%). The functional signs most frequent were the thoracic pain (72.2%); cough (56.6%); dyspnea (22.2%). The histological type was found in 19.4% of the cases, carcinomas épidermoíde were more frequents (42.9%). 93.4% of the patients had profited only from one palliative treatment. Bronchial cancer poses enormous problems with the experts of the countries under equipped. Its appalling forecast is related to the delays and insufficiencies diagnostic and therapeutic

[Etiology of pleurisy in the Service of Pneumology, Point G]. / Etiologies des pleuresies dans le service de pneumologie du point G.

This study describes epidemiologic, etiologic and evaluative aspects of Pleurisy pneumology department of Point "G". From 1st January 1998 to 31 December 2002 was realised a study about hospitalized patients in the department. Pleurisy represented 15; 9% of hospitalizations. The sex Ratio was 2,3 en for men aged of 41 years 55 of pleurisy were located on right. In 60% of cases the liquid was sero-fibrin, purulent in 25% of cases and haemorrhagic in 15%. Tuberculosis was the most frequent etiology with 37% of cases. According to liquid aspect tuberculosis represented 54, 3% of sero-fibrin pleurisy in one hand, on the other 60% of haemorrhagic pleurisy was due to cancer. The serology HIV have been realised on 89 patients and it was positive on 56% of cases. Association pleurisy/HIV tuberculosis etiology represented 56% of cases. Among 369 patients we have counted 100 deaths, 27% and 86% of these death occurred before a month of hospitalization. Even if the prevalence of neoplastic pleurisy increases, tuberculosis still the 1st etiology of pleurisy. It co-infection with HIV is the principal cause of morbidity and mortality.

[Not Available].

It is about a 77 years old man admitted for a small hemoptysia and a tuberculosis history that hemoptysia had been developing in a context of 38,5 0 c fever plus some crepitate rales in the right pulmonary area. After tuberculosis has been eliminated trough the bacilloscopy procedure, investigations of aspergillus in the splits have been negative. A pulmonary x ray revealed a retractile standard opacity in right pulmonary area. Amoxicilline based treatment has been conducted for two weeks in vain. Finally the pulmonary aspergillosis diagnosis pulmonary was then accepted following highly positive aspergillary serology.