Urgences ORL de l'enfant au CHU de Yopougon (Côte d'Ivoire)

Objectif : Décrire les caractéristiques épidémiologiques, cliniques et thérapeutiques des urgences ORL de l'enfant dans le service d'ORL-CCF du CHU de Yopougon.Patients et méthodes : Il s'agissait d'une étude prospective transversale portant sur les patients âgés de moins de quinze ans reçus en urgence sur une période de dix mois. Résultats : Cent-vingt-six (126) enfants sur 239 patients ont été reçus en urgence (52,72%). Le sexe masculin représentait 57,94% d'enfants avec un sex-ratio de 1,37. L'âge moyen était de 4,26 ans ± 3,59 (extrêmes 1 jour et 15 ans). Dans cet échantillon, 73,81% des patients ont été reçus pendant la garde en dehors des heures de consultation dont 30,95% les week-ends. Les urgences absolues représentaient 14,30% des cas. Les corps étrangers, les traumatismes externes et les tuméfactions cervicales fébriles ont été observés dans respectivement 50%, 15,08% et 7,14% des cas. La prise en charge était multi-disciplinaire dans 11,12% des cas. Elle concernait en plus de l'ORL, la pédiatrie, la neurochirurgie et la réanimation. Le traitement était médical dans 50% des cas parfois associé aux méthodes physiques (9,52%) ou médico-chirurgicales dans 26,98% des cas. Les méthodes physiques seules ont été suffisantes dans 18 cas (14,29%). Cinq abstentions thérapeutiques (3,97%) ont été répertoriées. L'évolution était favorable dans 90 cas (71,43%). Il a été noté 1 cas de décès. Conclusion : La prévention des accidents de la voie publique et la surveillance des enfants sont des mesures à prendre pour réduire la prévalence des urgences ORL dans notre pratique quotidienne

[Epidemiology and treatment of sinus mucoceles: 25 cases in Abidjan (Côte d'Ivoire)]. / Les mucoceles sinusiennes: etude epidemio-clinique et therapeutique de 25 cas colliges a Abidjan (Cote d'Ivoire).

OBJECTIVE: To determine the epidemiological, clinical and therapeutic characteristics of sinus mucoceles in Ivory Coast. MATERIALS AND METHODS: A multicenter study conducted in the three services ENT (ear, nose & throat) hospital and university centers and clinics in Abidjan from 1996 to 2012 (16 years). It involved patients who have been diagnosed clinically and radiologically with a sinus mucocele who benefited from surgical treatment. RESULTS: During the study period, 25 patients were recruited - a hospital incidence of 1.5 cases per year. A female predominance was noted with 60% of women and 40% men with a sex ratio of 0.67. Patients consulted for headache (68%), facial swelling (68%), proptosis (28%). Allergic rhinitis is the antecedent rhinologic found most commonly (32%) followed by sinusitis (12%) and nasal sinus surgery (12%). The naso-sinus CT was performed in all patients diagnosed with mucocele. Surgical excision was made by several surgical approach, the most used were the way of JACQUES and paralateronasal rhinotomy of MOURE. Pathological examination of the surgical specimen confirmed the diagnosis of sinus mucocele. The development was beset by complications such as eyelid swelling (1 case), blurred vision (1 case), unsightly surgical scar (1 case). CONCLUSION: The nasal sinus mucoceles are relatively rare benign lesions with pseudo-cystic insidious evolution. Diagnosis suspected by the clinic is confirmed by radiology. Their treatment is mainly surgical.

OBJECTIF: Déterminer les caractéristiques épidémio-cliniques et thérapeutiques des mucocèles sinusien-nes en Côte d'Ivoire. MATÉRIEL ET MÉTHODE: Il s'est agit d'une étude multicentrique menée dans les services d'ORL des trois centres hospitaliers et universitaires et les polycliniques d'Abidjan de 1996 à 2012 (16 ans). Elle a concerné les patients chez qui il a été diagnostiqué cliniquement et radiologiquement une mucocèle sinusienne et qui ont bénéficié d'une prise en charge chirurgicale. RÉSULTATS: Pendant la période d'étude, 25 patients ont été recrutés soit une incidence hospitalière de 1.5 cas par an. Il y avait une prédominance féminine avec 60% de femme et 40% d'homme soit un sex ratio de 0.67. Les patients consultaient pour des céphalées (68%), des tuméfactions faciales (68%), une exophtalmie (28%). La rhinite allergique est l'antécédent rhinologique le plus retrouvé (32%) suivi des sinusites (12%) et de la chirurgie naso-sinusienne (12%). La tomodensitométrie naso-sinusienne réalisée chez tous nos patients, a posé le diagnostic de mucocèle dans 100% des cas. L'exérèse chirurgicale a été faite par plusieurs voie d'abord dont les plus utilisées étaient la voie de JACQUES et la rhinotomie paralatéronasale de MOURE. L'examen anatomopathologique des pièces opératoires a confirmé le diagnostic de mucocèle sinusienne. L'évolution a été émaillée de complications à type de tuméfaction palpébrale (1 cas), flou visuel (1 cas), cicatrice opératoire disgracieuse (1 cas). CONCLUSION: Les mucocèles naso-sinusiennes sont des lésions bénignes pseudo-kystiques relativement rares, d'évolution insidieuse. Leur diagnostic soupçonné par la clinique est confirmé par le bilan radiologique. Leur traitement est essentiellement chirurgical.

[Hearing disorders at the candidates of the National Gendarmerie's competition, Ivory Coast].

Objective: Detect the hearing deficiencies of the candi­da­tes of the gendarmerie's competition. Material and method: Pros­pec­tive study realized over 3 years (2008-2010), in the ENT service of the Gendarmerie to Agban (Abidjan). Examination included an otoscopy and a pure tone audiometry. Results: On 23121 candidates, 1245 had a plug of earwax (5.4%). They were aged from 18 to 25 years old (average age: 22.85 years). Eardrum was pathological in 0.5 % of the cases. Prevalence of hearing loss was 1.5%. Hearing loss included sensorineural hearing loss (56.7%), deafness of transmission (29.4%) and mixed deafness (13.9%). Deafness was unilateral in 79.8% and bilateral in 20.2%. Conclusion: Result of audio­gram will be useful for tracking or assessing cases of noise-induced hearing loss attributable to military service.

Les mucoceles sinusiennes : etude epidemio-clinique et therapeutique de 25 cas colliges a Abidjan (Cote d'Ivoire)

Objectif: Determiner les caracteristiques epidemio-cliniques et therapeutiques des mucoceles sinusiennes en Cote d'Ivoire. Materiel et Methode: Il s'est agit d'une etude multicentrique menee dans les services d'ORL des trois centres hospitaliers et universitaires et les polycliniques d'Abidjan de 1996 a 2012 (16 ans). Elle a concerne les patients chez qui il a ete diagnostique cliniquement et radiologiquement une mucocele sinusienne et qui ont beneficie d'une prise en charge chirurgicale. Resu(tats: Pendant la periode d'etude; 25 patients ont ete recrutes soit une incidence hospitaliere de 1.5 cas par an. Il y avait une predominance feminine avec 60% de femme et 40% d'homme soit un sex ratio de 0.67. Les patients consultaient pour des cephalees (68%); des tumefactions faciales (68%); une exophtalmie (28%). La rhinite allergique est l'antecedent rhinologique le plus retrouve (32%) suivi des sinusites (12%) et de la chirurgie naso-sinusienne (12%). La tomodensitometrie naso-sinusienne realisee chez tous nos patients; a pose le diagnostic de mucocele dans 100% des cas. L'exerese chirurgicale a ete faite par plusieurs voie d'abord dont les plus utilisees etaient la voie de JACQUES et la rhinotomie paralateronasale de MOURE. L'examen anatomopathologique des pieces operatoires a confirme le diagnostic de mucocele sinusienne. L'evolution a ete emaillee de complications a type de tumefaction palpebrale (1 cas); flou visuel (1 cas); cicatrice operatoire disgracieuse (1 cas). Conc(us ion : Les mucoceles naso-sinusiennes sont des lesions benignes pseudo-kystiques relativement rares; d'evolution insidieuse. Leur diagnostic soupconne par la clinique est confirme par le bilan radiologique. Leur traitement est essentiellement chirurgical

[Sinonasal inverted papilloma: our experiences of diagnostic and surgical care in Côte d'Ivoire]. / Papillome inversé naso-sinusien: notre expérience de la prise en charge diagnostique et chirurgicale en Côte d'Ivoire.

OBJECTIVE: To present our experience of the diagnostic and surgical care of sino-nasal inverted papilloma. MATERIAL AND METHOD: Retrospective study over 14 years (1996-2010) realised in the ENT departments in Côte d'Ivoire. Thirteen inverted papilloma confirmed and operated, after computed tomography, were included (7 men and 6 women, from 8 to 55 years old). RESULTS: The nasal obstruction was the main symptom. Twelve inverted papilloma correspond to Krouse stage T3, and 1 case T4. Surgical removal was performed by lateral rhinotomy (8 cases), Caldwell-Luc (4 cases) and De Lima (1 case). Squamous cell carcinoma was associated in 1 case. Recurrence with malignant transformation was observed in 1 case. CONCLUSION: Surgery by external approach allowed to obtaining satisfactory results. It stays of current events in our countries under equipped. Histopathological examination of the surgical specimen must be compulsory.

[Tympanoplasty: Experience of the ENT department in Yopougon hospital (Ivory Cost)]. / La tympanoplastie: expérience du service ORL du CHU de Yopougon (Côte d'Ivoire).

PURPOSE: Perform an analysis of epidemiological, diagnostic and therapeutic aspects of tympanoplasty in Ivory Coast. MATERIALS AND METHODS: Retro and prospective study over 13 years conducted in the ENT department of Yopougon Teaching Hospital. Our study concerned 104 patients. RESULTS: The study population was dominated by young adults with an average age of 30.61 years. Chronic otitis media accounted for 80.76% of past medical history, a condition that was also the main indication (74.04%). Otoscopy pre- and intraoperative found essentially a non-marginal tympanic perforation (74.03%) and preoperative hearing assessment noted a conductive hearing loss in 72% of cases. The retroauricular surgical incision was performed in all patients. Surgical treatment consisted of a tympanoplasty type I in 76.3% of cases. The anatomical results were good in 81% of cases and functionally, 75% of our patients had interaural intensity difference of less than 20 decibels. CONCLUSION: The tympanoplasty performed in our hospital apparently gives results that are similar to those of western countries to the patients who got a post operative control.

[A specific plain X-ray in the diagnosis of elongated styloid apophysis in the Ivory Cost]. / Intérêt du profil oblique menton dégagé dans le diagnostic des apophyses styloïdes allongées en Côte d'Ivoire.

OBJECTIVES: To appreciate the value of a simple radiographic incidence and its effectiveness for the search and the measurement of elongated styloid apophysis (ESA) and to recommend it in the routine search of ESA in practice. PATIENTS AND METHOD: This prospective study was realized over a period of 3 years. It involved the study of ESA from conventional radiographic imaging; the face low incidence in comparison with an experimental incidence, the oblique profile chin lift (OPCL). 101 patients presenting with stylalgia were investigated. RESULTS: Out of the 101 patients, the low face cliché found 49 ESA having an average length of 5 cm. The OPCL allowed to identify 63 ESA, 54 of which were bilateral and 9 unilateral. It also helped identify other associated abnormalities: otitis media (5 cases), dental pathologies (4 cases), dental condensing osteitis (2 cases). The comparative analysis demonstrated a better efficiency of the OPCL in comparison to the standard incidence: the LOW FACE (Roc curve). The OPCL allowed the exposure in one incidence the styloid process and to better appreciate the lower and superior borders of the styloid process giving a better estimate of its measurements. CONCLUSION: It appears from this study that the experimental incidence, the OPCL presents a real interest in the investigation of the ESA but also in the study of the soft tissues of the pharynx, the cervical spine, and the temporo-mastoid region. It also allows the detection of other.

[A case of nasal foreign bodies by tooth migration]. / Un cas de corps étranger des fosses nasales par migration dentaire.

Foreign bodies are a frequent reason for ENT consultation especially in children. Although the nature of the foreign body can be variable, the discovery of a tooth in a nasal cavity is a rare occurrence. The authors report a case of foreign body inside the nasal cavity caused by tooth migration and discuss its pathologic, diagnostic and therapeutic aspects.

Retrospective study of the rhinoscleroma about 14 cases in ENT departments of university hospitals (Côte d'Ivoire).

PURPOSE OF STUDY: To report the epidemiological, clinical, therapeutic and evolutionary aspects of rhinoscleroma in ENT departments of university hospitals (Côte d'Ivoire). MATERIAL AND METHOD: Retrospective study of rhinoscleroma conducted in the ENT and head and neck surgery departments in Côte d'Ivoire from January 1980 to December 2008 including the cases of confirmed rhinoscleroma and the treated cases. RESULTS: Fourteen cases of rhinoscleroma were found in 28 years. The early manifestations were not specific enough so the patients were seen with clinical status with obvious disorders or physical discomfort. Treatment was medical and surgical. Medical therapy was based on streptomycin, thiopenicol or ciprofloxacin administration. Surgery consisted in removing the fibrous adhesions to correct the functional and aesthetic disorders. CONCLUSION: Rhinoscleroma has become a more and more rare disease because of the sensitivity to the new molecules. Diagnosis can be difficult and delayed because of its clinical polymorphism.

GRIP1 enhances estrogen receptor alpha-dependent extracellular matrix gene expression in chondrogenic cells.

OBJECTIVE: The role of postmenopause on the pathogenesis of cartilage degeneration has been an open question. We assessed cartilage degeneration in estrogen receptor (ER)alpha null mice and examined the role of glucocorticoid receptor-interacting protein 1 (GRIP1) in the ERalpha-dependent transcription of a type II collagen gene (col2a1) with special reference to a crosstalk with the transforming growth factor (TGF)-beta signaling pathway. METHODS: The vertebral cartilaginous endplate from female ERalpha null mice was subjected to histological analyses. Col2a1 expression of primary chondrocytes (PCs) obtained from ERalpha null mice after 17beta-estradiol (E(2)) and TGF-beta1 stimulation was examined by reverse transcription polymerase chain reaction (RT-PCR). Estrogen response element (ERE) or col2a1 promoter-enhancer luciferase reporter system was used to investigate the crosstalk among ERalpha, GRIP1, and MKK6. Col2a1 expression and glycosaminoglycan (GAG) content were measured in ATDC5 cells treated with GRIP1 small interfering RNA (siRNA). RESULTS: ERalpha deficiency clearly accelerated impairment of the vertebral cartilaginous endplate. E(2) and TGF-beta1 stimulation increased col2a1 expression in PC from wild-type mice, but not that from ERalpha null mice. The same stimulation increased the col2a1 promoter-enhancer reporter activity, and the elevated activity was decreased by dominant-negative ERalpha and p38 mitogen-activated protein kinase (MAPK) inhibitor. GRIP1 increased the E(2)-dependent ERE activation in the presence of ERalpha and constitutive-active MKK6. GRIP1 siRNA repressed col2a1 expression and GAG production in ATDC5 cells. CONCLUSIONS: Crosstalks between ERalpha/GRIP1 and TGF-beta/MKK6/p38 MAPK pathway have protective roles on cartilage metabolism via regulating the extracellular matrices expression. The finding may lead to the development of a novel therapeutic approach for cartilage degeneration.

Assessment of reproductive potential in multiple-spawning fish with indeterminate fecundity: a case study of yellow sea bream Dentex hypselosomus in the East China Sea.

This study examined the spawning season, spawning frequency and batch fecundity of yellow sea bream Dentex hypselosomus in the East China Sea to reassess the previously reported reproductive characteristics of the species. Time-course sampling showed that this species had a diurnal ovarian maturation rhythm. Late tertiary yolk-stage oocytes appeared 2 days before spawning, starting the process of germinal vesicle movement and breakdown. On the day of spawning, ovulation and subsequent spawning occurred in the early morning (0400-0800 hours). Postovulatory follicles disappeared from the ovaries within c. 24 h of ovulation. Seasonal changes in the ovarian conditions indicated that this species spawned more or less throughout the year, with the peak ranging from spring to autumn. The compositions of the developing oocytes and degenerating postovulatory follicles in the ovaries suggested that most females spawned repeatedly over 2 to 3 consecutive days during the peak of the spawning season. Somatic body condition did not have a significant effect on batch fecundity, but there was a significant relationship between batch fecundity and fork length according to spawning status. Females spawning on consecutive days were more fecund than those spawning every other day. The findings show that this species has much greater reproductive potential than previously estimated.

Effect of Divalent Ions on Electroosmotic Flow in Microchannels.

The electroosmotic flow (EOF) rate in fused silica microchannels is experimentally found to decrease when trace quantities of salts containing the divalent cations Ca(2+) and Mg(2+) are added to a constant ionic strength background electrolytic solution (BGE) flowing in a channel having negatively charged walls. Moreover, the observed effect is quantitatively different for the two ions Ca(2+) and Mg(2+). Since electrostatic interactions are identical for ions of the same valence modeled as point charges, a description of the electric double layer (EDL) based on the Poisson-Boltzmann equation alone cannot account for these experimental observations. New experimental observations on electroosmotic flow in presence of Ca(2+) and Mg(2+) are reported in this work. A site binding model that accounts for the chemical interactions of the BGE ions with the silica surface is developed. The model predictions are in good agreement with the experimental observations on divalent cations as well as data from the literature on how properties such as pH and ionic strength affect electroosmotic flow rates for a BGE with monovalent cations.

Cardiac retransplantation: a 15-year single-center clinical experience.

BACKGROUND: Cardiac retransplantation is a controversial therapy because of the shortage of donor hearts. We retrospectively reviewed the short-term and long-term outcomes after cardiac retransplantation. METHODS AND RESULTS: Twenty-eight cases (18 males, 7 females; mean age, 50.3 +/- 13.5 years) underwent cardiac retransplantation: 25 first retransplantations and 3 second retransplantations. The indications for retransplantation were primary graft failure (PGF) in 11 patients (39.3%), intractable acute cardiac rejection (IACR) in 4 patients (14.3%), and coronary allograft vasculopathy (CAV) in 13 patients (46.4%). The patients had been supported as follows: prolonged cardiopulmonary bypass (CPB; n = 3), intra-aortic balloon pumping (IABP; n = 1), intravenous inotropic support (n = 7), extracorporeal membranoxygenator (ECMO; n = 3), ventricular assist device (VAD; n = 4), and no inotropic support (n = 10). There were 8 deaths within 30 days after retransplantation (28.6%). The overall 1-, 5-, 10-, and 15-year survival rates were 46.4%, 40.6%, 32.5%, and 32.5%, respectively. Acute cardiac rejection was the most common cause of death (43.8%). Thirty-day and 1-year survival rates of IACR, PGF, and CAV were 50.0%/0%, 63.6%/45.5%, and 84.6%/68.4%, respectively. CONCLUSIONS: Long-term survival after retransplantation was acceptable for patients with CAV and PGF; however, we must select patients for retransplantation carefully if the indication is IACR, because of the poor outcome.

Proton pump inhibitors may increase the risk of delayed bleeding complications after open heart surgery if used concomitantly with warfarin.

OBJECTIVES: The American Food and Drug Administration has suggested that proton pump inhibitors increase the international normalized ratio (INR) when used concomitantly with warfarin, by being metabolized by cytochrome P450 2C19. We therefore reviewed patients taking warfarin. METHODS AND RESULTS: Two hundred and forty patients who took warfarin after surgery were divided into two groups: Group I (n = 114) had rabeprazole (10 mg/day) and Group II (n = 126) had lansoprazole (15 mg/day). The initial dose of warfarin was 3 mg and INR was initially assessed on postoperative day 4. Initial INR was significantly lower in Group I (1.66 +/- 0.87) than in Group II (2.06 +/- 1.03, P = 0.0011). Delayed cardiac tamponade and hemothorax occurred as complications in 6 and 1 patients, respectively, in Group II from 5 days to 3 months postoperatively. At the time of the occurrence of complications, the average INR increased to 3.95 (range from 3.11 to 5.86). There were no patients with delayed bleeding in Group I ( P = 0.015). CONCLUSIONS: These results suggest that lansoprazole emphasizes the effects of warfarin. Rabeprazole could be safely used concomitantly with warfarin.

Study on the introduction of hazard analysis and critical control point (HACCP) concept of the water quality management in water supply systems.

In the latest revision in 2004, the 3rd edition, the Water Safety Plans (WSP) was newly introduced into the World Health Organization (WHO) Guidelines for Drinking Water Quality. The Hazard analysis and critical control point (HACCP) is a basic concept that underlies the WSPs, and is also known as the product quality management method in the field of food and the medical manufacturing industries. In the amendments of the Drinking Water Quality Standards in Japan, water suppliers are required to reasonably achieve both safe water and efficient water quality management. Therefore, the HACCP concept is focused as an adequate management method covering a whole process of water supply systems, in a systematic way. The purpose of this study is to investigate a practical procedure in introducing the HACCP into water quality management in Japan. In comparison to conventional applications of the HACCP, unmanageable variations of raw water quality, continuous treatment and supply, and numerous standards of water quality items need to be considered. The HACCP system is expected to achieve a quick response to improvements in water quality, accountability towards consumers and a decrease in accidents.

Particularities of bacterial ecology of acute otitis media in an African subtropical country (Cote d'Ivoire).

BACKGROUND: Acute otitis media (AOM) is the commonest infectious disease of childhood. Its treatment is based on a probabilistic antibiotic therapy. OBJECTIVE: To determine the prevalence of different bacteria responsible for AOM in children in Abidjan (Côte d'Ivoire). MATERIALS AND METHODS: This is a prospective study, between November 2002 and August 2003. To identify bacterial isolates, 60 children under 15 years old with AOM were enrolled. In 52 cases, the sample was recovered by aspiration of a spontaneous otorrhea and in eight cases, it was taken by paracentesis. Nasopharyngeal swabs were cultured. Antibiotic susceptibility tests were performed on isolates. RESULTS: 75% of children were under 24 months of age. Pseudomonas aeruginosa was recovered in 31.8% of cases followed by Streptococcus pneumoniae (21%), Proteus (7.4%) and Staphylococcus (6.2%). The rate of penicillin-nonsusceptible S. pneumoniae (NSSP) was 11.8%. Resistance to erythromycin was 6%. For Pseudomonas, resistances to antibiotics were 35.5% to ceftazidim and 16% to pefloxacin, respectively, but all the strains were sensible to colistin, iminepem and ciprofloxacin. CONCLUSION: These data can modify therapeutic approaches for treatment of AOM in our country. This study should encourage surveillance of AOM microbiology.