The "pouch" of the Douglas's pouch.

Hernia is described as the protrusion of an organ into the wall of its normal containing cavity. Internal hernia (IH) involves protrusion of viscera through: a peritoneal or mesentery defect, a normal or abnormal compartment of the peritoneal cavity. Hernias occurring in the pelvis cavity are usually classified according to the fascial margins breached and include sciatic, obturator and those through the rectouterin pouch: elytrocele and enterocele. Those hernias are defined by the protrusion of a viscus through the wall of the pelvis due to weakness of the pelvic fascia and/or muscles. Pelvic hernia through the pouch of Douglas (PD) involves the genital tract in female (elytrocele and enterocele). Sometimes described in the literature as Douglas hernia, this type of hernia must be distinguished from the conventional IH. As defined before, the borders to be considered for IH is the peritoneal membrane, which is not a real solid wall but delimitates the peritoneal cavity; and there is no peritoneal defect in elytrocele or enterocele. A PubMed search for IH through a defect in the peritoneal PD revealed only five female cases, making this an extremely rare condition. To our knowledge, we have presented here the only published case in a male. This probably congenital and morphologic anomaly (defect) of pouch of Sir Douglas must be distinguished as the real "Douglas IH". Authors discuss the concept of a new and more detailed classification of IH.

[Abdominal actinomycosis mimicking an abdominal tumor. Case report in Senegal]. / Actinomycose abdominale tumorale. Une observation au Sénégal.

The purpose of this report is to describe a case of abdominal actinomycosis (Actinomyces israelii) with a pseudo-tumoral appearance in a 57-year-old Senegalese woman.

[Epidemiological, therapeutic and prognostic aspects of breast cancer: about 473 cases collected in Hopital Principal de Dakar]. / Aspects epidémiologique, thérapeutique et pronostique des cancers du sein: a propos de 473 cas colligés a l'Hôpital Principal de Dakar.

INTRODUCTION: The aims of this study were to appreciate the epidemiological, therapeutic and pronostic aspects of breast cancer. This retrospective study was carried out in gynecology service in Hopital Principal of Dakar. We collected 473 cases of breast cancer over a period of 15 years, from January 1986 to December 2001. MATERIALS AND METHODS: Only the patients having a histological diagnosis were involued. The identification of patients, their medical history, their present complaints and the different treatment performed, were registred. The actuarial method of survival was used. RESULTS: The mean age of patients was 42.5 years; the average of parity was 4.7. The patients live in Dakar in 245 cases (51.7%). We had observed 279 cases (59.1%) diagnosed between six months and twelve months. Only 74 cases (15.8%) were diagnosed less than three months. In 282 cases (60%) the disease stage was T4N1Mx in TNM classification. In 425 cases (89.89) the histological type was infiltrate canal carcinoma. The surgery had concerned 441 patients (93.2%). And 52 of them (11%) underwent conservative treatment and 309 out of them (65.2%) underwent total mastectomy associated to axillary cleaning out like Patey method. Chemotherapy had been done in 426 cases (90%), hormonotherapy in 92 cases (19.4%) radiotherapy in 83 cases (17. 5%) and surgical costiation had been performed in 42 cases (8.8%). The overall survival at 15 years was (8.5%). CONCLUSION: According to the issues of other african series we found out that our patients were young at the time of the diagnosis, We think that early diagnosis and appropriated treatment must improve the prognosis of breast cancer. The mass screening politics must be involved.

[Appendicectomy in the tropics: prospective study at Hôpital Principal in Dakar]. / Appendicectomies en milieu tropical: étude prospective à l'Hôpital Principal de Dakar.

Acute appendicitis is the most common surgical indication in Africa. It is associated with higher mortality and morbidity than in industrialized countries. The purpose of this prospective 100 case study was to evaluate diagnostic, clinical and paraclinical features as well as surgical modalities especially with regard to approach and postoperative recovery in patients that underwent surgical treatment for appendicitic syndromes over a 9-month period at our institution. Analysis of study data confirmed that surgical indications could be established based on clinical examination alone and that adjuvant investigations only delayed therapy while providing little specific, useful information. Delayed management is a specific feature of tropical areas. Surgical exposure was achieved by the MacBurney approach in 65% of cases, celioscopic approach in 18%, and median laparotomy in 17%. The benefit of the celiosocopic approach was statistically signicant in terms of resumption of eating, duration of hospitalization and incidence of postoperative complications. Mortality in this series was 0% and morbidity was 7% mainly due to parietal complications.

[Epidemiological study of HIV seroprevalence in a leprosy patient population in Senegal]. / Etude épidémiologique de la séroprévalence de l'infection par le VIH dans une population hansénienne au Sénégal.

We report the findings of an epidemiological study conducted between June 1989 and February 1990 on a population of leprosy patients in southern Senegal (Bignona major endemic disease sector). Two types of population were studied: patients living in urban areas and inmates of leprosaria. The global HIV seroprevalence (HIV 2 in all cases) of the leprosy-patient population was 1.15% (3/257): 0.8% (1/130) for the urban group and 1.5% (2/127) for the leprosaria. The seroprevalence rate does not differ significantly from that for the control group studied and for blood donors (1/221). The diagnosis of leprosy in the seropositive subjects had been established before 1980. None of them showed any sign of relapse. The immunodepression associated with the presence of HIV was only moderate: it was reflected in a lowering of the CD4 count and of the CD4/CD8 ratio, but with no clinical sign of AIDS.