[Nutritional Status Of Children Under Five During Seasonal Malaria Chemoprevention In 2018 At Kita, Mali: Household Survey]. / Statut Nutritionnel Des Enfants De 6 A 59 Mois Au Cours De La Chimio ­ Prevention Du Paludisme Saisonnier En 2018 A Kita, Mali : Enquete De Menage.

INTRODUCTION: Malaria and malnutrition are among the major causes of morbidity and mortality in children under five in Mali. This study is part of the analysis of the association between both in children under five after a seasonal malaria chemoprevention distribution campaign. METHODS: We carried out a cross-sectional household survey in rural areas after a seasonal malaria chemoprevention distribution campaign to determine the prevalence of malnutrition and parasitaemia in children under five who had passed the season of high transmission of malaria in the health district of Kita. After obtaining written consent, each child was given a physical examination, hemoglobin testing using the Hemocue machine, a thick drop and a thin smear. , A rapid diagnostic test was performed in febrile children. The data was analyzed with ENA 2020 and Stata software version 15.0. Measures of association were made using the chi-square test and a multiple logistic regression model. Odds ratios were used with a 95% confidence interval and a significance level of 0.05. RESULTS: We selected 308 children aged 6 to 59 months. The prevalence of malaria was 13.6%, it was 15%, 17% and 25% respectively for wasting, underweight and stunting. The susceptibility to malaria increased with age and that of wasting decreased with age. There was no significant relationship between malaria disease and nutritional status. CONCLUSION: There is no significant association between malaria and malnutrition in our study.

INTRODUCTION: Le paludisme et la malnutrition font partie des causes majeures de morbidité et de mortalité chez les enfants de moins de cinq ans au Mali. La présente étude s'inscrit dans le cadre de l'analyse de l'association entre le paludisme et le statut nutritionnel après une campagne de distribution de la chimio-prévention du paludisme saisonnier. MÉTHODES: Une enquête transversale auprès des ménages en milieu rural pour déterminer la prévalence de la malnutrition et de la parasitémie chez les enfants de 6 à 59 mois qui ont passé la saison de transmission dans le district sanitaire de Kita. Après l'obtention d'un consentement écrit, chaque enfant a bénéficié d'un examen clinique, d'un dosage du taux d'hémoglobine, d'une goutte épaisse. Un test de diagnostic rapide a été réalisé chez les enfants fébriles. Les données ont été analysées avec les logiciels ENA 2020 et Stata version 15.0. Les mesures de l'association ont été effectuées par l'utilisation du test de Khi deux et du modèle de régression logistique multiple. RÉSULTATS: au total308 enfants âgés de 6 à 59 mois ont été sélectionné. La prévalence du paludisme était de 13,6%, elle était 15%, 17% et 25% respectivement pour l'émaciation, l'insuffisance pondérale et le retard de croissance. La susceptibilité de faire un paludisme maladie augmentait avec l'âge et celle de l'émaciation diminuait avec l'âge. Il n'y avait pas de relation significative entre le paludisme et le statut nutritionnel. CONCLUSION: il n'y a pas d'association significative entre le paludisme et la malnutrition dans notre étude.

[Nutritional Status Of Children Under Five During Seasonal Malaria Chemoprevention In 2018 At Kita, Mali: Household Survey]. / Statut Nutritionnel Des Enfants De 6 A 59 Mois Au Cours De La Chimio ­ Prevention Du Paludisme Saisonnier En 2018 A Kita, Mali : Enquete De Menage.

INTRODUCTION: Malaria and malnutrition are among the major causes of morbidity and mortality in children under five in Mali. This study is part of the analysis of the association between both in children under five after a seasonal malaria chemoprevention distribution campaign. METHODS: We carried out a cross-sectional household survey in rural areas after a seasonal malaria chemoprevention distribution campaign to determine the prevalence of malnutrition and parasitaemia in children under five who had passed the season of high transmission of malaria in the health district of Kita. After obtaining written consent, each child was given a physical examination, hemoglobin testing using the Hemocue machine, a thick drop and a thin smear. , A rapid diagnostic test was performed in febrile children. The data was analyzed with ENA 2020 and Stata software version 15.0. Measures of association were made using the chi-square test and a multiple logistic regression model. Odds ratios were used with a 95% confidence interval and a significance level of 0.05. RESULTS: We selected 308 children aged 6 to 59 months. The prevalence of malaria was 13.6%, it was 15%, 17% and 25% respectively for wasting, underweight and stunting. The susceptibility to malaria increased with age and that of wasting decreased with age. There was no significant relationship between malaria disease and nutritional status. CONCLUSION: There is no significant association between malaria and malnutrition in our study.

INTRODUCTION: Le paludisme et la malnutrition font partie des causes majeures de morbidité et de mortalité chez les enfants de moins de cinq ans au Mali. La présente étude s'inscrit dans le cadre de l'analyse de l'association entre le paludisme et le statut nutritionnel après une campagne de distribution de la chimio-prévention du paludisme saisonnier. MÉTHODES: Une enquête transversale auprès des ménages en milieu rural pour déterminer la prévalence de la malnutrition et de la parasitémie chez les enfants de 6 à 59 mois qui ont passé la saison de transmission dans le district sanitaire de Kita. Après l'obtention d'un consentement écrit, chaque enfant a bénéficié d'un examen clinique, d'un dosage du taux d'hémoglobine, d'une goutte épaisse. Un test de diagnostic rapide a été réalisé chez les enfants fébriles. Les données ont été analysées avec les logiciels ENA 2020 et Stata version 15.0. Les mesures de l'association ont été effectuées par l'utilisation du test de Khi deux et du modèle de régression logistique multiple. RÉSULTATS: au total308 enfants âgés de 6 à 59 mois ont été sélectionné. La prévalence du paludisme était de 13,6%, elle était 15%, 17% et 25% respectivement pour l'émaciation, l'insuffisance pondérale et le retard de croissance. La susceptibilité de faire un paludisme maladie augmentait avec l'âge et celle de l'émaciation diminuait avec l'âge. Il n'y avait pas de relation significative entre le paludisme et le statut nutritionnel. CONCLUSION: il n'y a pas d'association significative entre le paludisme et la malnutrition dans notre étude.

[Role Of Imaging In The Management Of A Case Of Intrauterine Device Migration]. / Role De L'imagerie Dans La Prise En Charge D'un Cas De Migration De Dispositif Intra-Uterin.

We report a case of intrauterine device (IUD) migration in order to describe the contribution of imaging in its diagnosis. It was a 35-year-old woman received on 06/01/2018 for pelvic ultrasound for pelvic pain. Ultrasound examination revealed a hyperechoic right para-uterine tubular image. A hysterosalpingography revealed an IUD in the pelvis in extra-urine position. Surgical extraction was done without complications. Intrauterine device migration is rare in our context. The radiological means make it possible to specify its topography.

Nous rapportons un cas de migration de dispositif intra-utérin (DIU) dans le but de décrire l'apport de l'imagerie dans son diagnostic. Il s'agissait d'une dame de 35 ans reçue le 01/06/2018 pour une échographie pelvienne dans le bilan d'une douleur pelvienne. L'exploration échographique a objectivé une image hyperéchogène tubulaire para-utérine droite. Une hystérosalpingographie avait objectivé un DIU dans le bassin en position extra-urine. Uneextraction chirurgicale a été faite avec des suites simples. La migration de dispositif intra-utérin est rare dans notre contexte. Les moyens radiologiques permettent de préciser sa topographie.

[Mitral valve repair for rheumatic valve disease in children in Senegal: a review of 100 cases]. / La plastie mitrale sur valve rhumatismale chez l'enfant au Sénégal: 100 observations.

Mitral valve repair is a better therapeutic alternative than valve replacement for rheumatic valve disease in children. Repair procedures are especially well suited to developing countries where heart prostheses and life-long anti-coagulation therapy are largely unaffordable. The purpose of this study was to evaluate medium-term outcome of mitral valve repair in children in Senegal. A retrospective review was conducted in a cohort of 100 patients who underwent mitral valve repair for rheumatic mitral lesions over the 8-year period from 1999 to 2007. Mean age was 12 +/- 5 years (range, 7 to 17 years). The most common symptom of valve disease was dysypnea (stage IV in 26 cases and stage III in 74). Valve lesions were complex with anterior leaflet prolapse in 62 cases, posterior leaflet restriction in 35, commissural fusion in 30, and fusion of chordaes in 54. Repair procedures consisted of transfer and shortening of chordaes in 73 cases in association with commissurotomy in 22 cases and cleft closure in 17. Ring annuloplasty was performed in 84 patients. Hospital mortality was 2%. Postoperative morbidity was characterized by residual mitral regurgitation in four cases. Mean follow-up was 5 years. No late deaths were observed. Outcome was satisfactory in 84 patients with low-grade mitral regurgitation (grade I-II). Reduction of left ventricle diameter was statistically significant during systole and diastole, i.e., from 29.5 +/- 6.2 mm to 33.1 +/- 5.3 mm (p<0.05) and from 47.1 +/- 8.6 mm to 50.5 +/- 9.4 mm (p<0.05) respectively. Improvement in cardiac function was not significant, i.e., from 63.3 +/- 4.8% to 62 +/- 6.4% (p = 0.99). Mitral valve repair was successful in stabilizing myocardial function and remodeling the left ventricle. Outcome is dependent on careful patient selection and evaluation of lesions. Middle-term outcome is encouraging.

[Right iliac artery aneurism revealed by a left leg ulcer]. / Anévrysme de l'artère iliaque droite révélé par un ulcère de la jambe gauche.

OBJECTIVE: The aim of this study is to expose a secondary cause of venous insufficiency which surgical treatment. OBSERVATION: A 73 old man with a huge aneurism of the right common iliac artery which compressed the left common iliac vein was described. The patient had a unilateral left leg oedema and stasing ulcer. Examinations revealed an abdominal pulsate mass. Echography and T scan showed a right common iliac artery aneurysm and compression of the left iliac vein. Surgery was resected aneurism and replaced vascular prosthesis. After surgery, the unilateral left leg oedema was rapidly regressed and complete stasing ulcer healing. CONCLUSION: This case report showed difficult diagnosis and treatment of vascular disease in under development countries.

[Traumatic manubriosternal joint dislocation in adult: about two surgical cases]. / Luxation manubriosternale traumatique chez l'adulte: apropos de deux cas operes.

Traumatic manubriosternal joint dislocations are rare in adult and occur readily during a violent traumatism of the chest and/or the dorsal spine. We report two cases treated between September 1997 and August 2002 at the Surgical Emergency Department of Le Dantec Hospital. The first observation was related to a 26 year old lady. On September 27, 1997, she fell down from a tree and received all the weight of the body on her two arms. She was referred because of anterior chest pains, increasing with respiration associated with injuries of the 2 wrists. On conventional X-ray, a type II manubriosternal joint dislocation (anterior dislocation of the sternal body with respect to the manubrium) was diagnosed. The mechanism of the dislocation was indirect: flexion-compression of the sternum caused by a hyperflexion of the dorsal spine when the patient touched the ground. There was also a Pouteaux-Colles fracture of the 2 wrists. The dislocation was surgically treated: open reduction followed by manubriosternal stabilization using wires. The 2 wrists were treated by Kapandji procedure. At the 21st postoperative day, a traumatic rupture of the wires required a 2nd internal fixation of the sternum by wires. After 9 years, the patient is without complaint and the chest X-ray is normal. The second observation was that of a 19 year old young woman, referred on August 15, 2002 after a frontal crash with a car while crossing the road. She fell down on her back. She was complaining from severe posterior headaches with a normal Glasgow Scale (15), anterior chest and right hand pains. Radiological examinations showed a fracture of the occipital bone without embarrure and a type I manubriosternal joint dislocation (posterior displacement of the sternal body in relation to the manubrium) which mechanism was direct: direct shock against the sternum. There were also an isolated fracture of 4 right sided ribs and a fracture without displacement of the 3 last bones of the right metacarpus. An orthopaedic treatment was carried out for the lesions of the right hand and an abstention-monitoring suggested for the occipital fracture. The manubriosternal joint dislocation was surgically reduced and stabilized by using a braided polyester thread number 2. After 4 years, the patient is asymptomatic and the manobriosternal joint is stable. We emphasize on the scarcity and the mechanism of traumatic manubriosternal joint dislocations in adult, the frequency of associated injuries and the absence of consensus about their treatment.

[Giant compressive mediastinal lipoma: a case report]. / Lipome géant compressif du médiastin: a propos d'un cas.

Mediastinal lipoma is a rare mesenchymatous fatty tumor in child. Usually asymptomatic, it can cause asphyxiation. The authors report the case of an 18 month-baby-girl referred to us by the pediatric department for asphyxiation. The chest X ray was evocative of a mediastinal tumor. A sudden cardiorespiratory failure leads us to perform thoracotomy. A fatty tumor was found compressing the heart and the left lung. It was easily extirpated. The postoperative recovery was uneventful. Light microscopy showed a lipoma. This compressive form shows the severity of the mediastinal lipoma when it reaches a large size. The literature on this rare pathology is reviewed.

[Head and neck paragangliomas in Senegal. About 8 cases]. / Paragangliomes de la tête et du cou au Sénégal.

UNLABELLED: Paragangliomas are uncommon neoplasms with rare occurrence in the head and neck area. OBJECTIVE: The purpose of this study was to report the experience of management of these rare tumors by a team of Ear, Nose, and Throat (ENT) surgeons working in the context of a sub-Saharan country. MATERIAL AND METHODS: We conducted a retrospective study in the Ear, Nose and throat Department of a Dakar university hospital. The study concerned 8 patients with a highly vascular tumor located in the neck and temporal bone. The preoperative investigations were computed tomography scanning (CT scan) using contrast injection in 88% and Doppler ultrasonography for the patients with a neck mass. All the patients underwent surgery except one. In 2 cases, the management with a team of vascular surgeons was necessary. Histological examination of the tumor was realized in all cases. RESULTS: The tumor was located in the neck in 5 cases (62,5%) with a carotid body tumor in three patients (37,5%) and vagal location in two (25%). The temporal bone was involved in three patients with a tympano-jugular location (37,5%). All the neck masses were operated on via a unique cervical approach. The tympano-jugular tumors were treated by radical mastoidectomy in two patients. In the third patient with a tympano-jugular tumor, with important involvement of the temporal bone, only the neck extension was operated. The histological diagnosis of paraganglioma was confirmed in all patients. Radiation therapy was delivered in two patients (25%), to complete surgery in the event of extensive temporal bone tumor and exclusive in one case of an inoperable vagal tumor. The outcomes, marked early death in one patient (14%), were good in the short and mid term for the others patients. CONCLUSION: With the improvement of technological infrastructures, particularly with developing modern imaging, we have better knowledge of paragangliomas in the head and neck area, in our experience in a developing country. However, therapeutic approaches are still limited by modest humans and material resources.

[Complications of treatment of adult's groin hernia: a report of 100 cases comparative study between Bassini and Mac Vay's technics]. / Les complications per et post opératoires précoces de la cure des hernies de l'aine de l'adulte: étude comparative entre les techniques de Bassini et Mac Vay, à propos de 100 cas.

The authors report a prospective study comparing pre and immediate post operative complications of non complicated hernia of the groin in adult treated by operations based on Bassini and Mac Vay technics. It concerned a total of 100 patients made up of two groups of 50 age ranging from 13 to 84 years with an average age of 47 years of whom were 93 males and 7 females. No mortality was registered. The rate of complications was 20% in Bassini's technic and 22% in Mac Vay's technic. There were: bladder injurie, accidental skin wound incurred by the electric surgical blade, meningeal irritation, urinary retention, scrotal sac hematoma, parietal suppuration, intestinal occlusion and immediate recidivation before 6 months. As well as our study as in literature, specific complications related to both technics were rare. We could draw the conlusion that there is no significant superiority of one technic in comparison with the other one.

[Vascular dysplasia in vascular surgery in an African area: 28 cases at the Dakar teaching hospital]. / Anomalies vasculaires congenitales en chirurgie vasculaire en milieu Africain: à propos de 28 cas colligés au CHU de Dakar.

This retrospective study was conducted to analyze the anatomic and clinical data concerning vascular dysplasia in vascular surgery patients seen in an African hospital and to assess its role in treatment. Twenty-eight patients (14 women and 14 men) were treated for vascular dysplasia between 1994 and 1998. There were 8 cases of hemangioma and 20 cases of vascular malformation. Average age of patients with hemangioma was 3.23 years, with a sex ratio of 0.33. There were 4 cases of mixed hemangioma, 3 of cutaneous hemangioma, and 1 of subcutaneous hemangioma. Cervicocephalic (n=4) and limb (n=3) localizations were the most frequent. Duplex Doppler did not reveal any signs of muscle disease. Four patients underwent surgery, for an early indication in 3 and a late indication in 1. Resection suture was performed in 3 cases and resection graft in one. Mean follow-up was 85.90 days. There was one case of early suppuration. There were no cases of recurrence or late complications and the operative wounds healed well. Vascular malformations concerned 20 patients (sex ratio 1.5, average age 15.55 years) with 16 cases of venous malformation including 4 patients with Klippel Trenaunay syndrome, three with arteriovenous malformation and one with capillary angioma. CT and arteriography were obtained in all cases. Limb localizations predominated (14 patients). In-depth extension was found in 6 cases of venous malformation. Sixteen patients underwent surgery for functional indications in 7. Resection suture was performed in 11 cases. Mean follow-up was 85.90 days. There were 4 early and 2 late postoperative complications. There has been no recurrence. Anatomic and clinical polymorphism of vascular dysplasia requires multidisciplinary collaboration in which vascular surgery plays an important role in complex or complicated forms of the disease in patients attending facilities with limited resources.

[Purulent pleurisy at the surgical emergency service: retrospective study of 34 cases at Dakar Teaching Hospital]. / Pleurésies purulentes aux urgences chirurgicales: étude rétrospective de 34 cas au CHU de Dakar.

The empyema thoracis remain a current pathology in under developed countries. The aim of this study was to evaluate the incidence of empyema thoracis in the Surgical Emergency Unit, to analyze their causes, therapeutic procedures and their results. Between 1997 and 1998, 54 patients were received in urgency for empyema thoracis; 34 of them had a complete and exploitable file. Mean age was 20 years (3 weeks and 83 years) with 64.70% of children (0 to 15 years) and the sex ratio 3.25. Fever (85.70%) and cough (73.52%) were the most frequent symptoms. Twenty nine patients (85.3%) had pleural empyema and 5 a hydropneumothoracic image. Empyemas were related to pneumonia in 11 cases, associated to tuberculosis in 5 cases and were primitive in 18 cases. Bacteriological exam of the pus performed in only 18 patients had revealed a pneumococcus in 4 cases (22.23%) and was negative in 9 cases (50%). Closed chest drainage associated with antibiotics, pleural washing and respiratory kinesitherapy was done in all the cases. The average duration of hospitalisation was 24.56 days (1 to 55 days). Five deaths (14.70%) occurred. Two cases of recurrence were noted requiring a second drainage. Three cases of pachypleuritis had required a thoracotomy for pleural decortication in average time of 6 months. The duration of follow-up was 1 year. For the other 24 patients (70.58%) the evolution was good. Urgent closed chest drainage of empyema thoracis combined with antibiotics, pleural washing and respiratory kinesitherapy allows a good evolution and reduces the risk of pachypleuritis.

[Feasability of a heart valve bank in Dakar. (Preliminary study of 8 human hearts)]. / Faisabilité d'une banque d'homogreffes valvulaires cardiaque à Dakar. (Etude préliminaire sur 8 prélèvements de coeurs humains)

Authors record a preliminary study led so as to develope techniques of preparation of the cardiac homograft valves. Eight human hearts have been appropriated in the course of medico-legal autopsy. Under sterile hodd, the heart was dissected, aortic and pulmonary valves as well as a mitral valve fragment were collected for a total of 24 valvular levies. After sterlization in an antibiotic solution, valves were preserved at 4 degrees C for the mitral fragment specimen of fresh allograft and to - 196 degrees C in Nitrogen liquidates for the pulmonary and aortic valves. The control of graft quality had consisted in tests of competence during the dissection, to the evaluation of the histological study as well as tests of sterility. Cellular cultures had shown a fibroblast proliferation in 3 cases. It concerned an indeed reliable method but difficult and little sensitivity. Histological tests had shown two types of injurie: the myxoid degeneration (7 times on 8 valves) cryopreserved and a coagulative necrosis whose distribution was identical forthe two modes of conservation. Antibiotic's solution seemed to induce these injuries as do heart ischemia, and the traumatism lihleed to the great cold. The tests of sterility had shown a rate of contamination to 25 % essentially by Pseudomonas. In view of the installation of a behle of allograft bank of quality, we'll need to improve conditions of leavy, to use a freezer adaptation for progressive cryocongelation and the choice of simple method to evaluate valvular viabilty.

[Evaluation of surgical treatment of anal fistula]. / Evaluation du traitement chirurgical des fistules anales.

Second reason for consultations in proctology in our department after hemorroïds-linked illnesses, fistulas in ano constitute a chronic disease which causes therapeutic difficulties linked mainly to the futur functionning of the sphincter, especially in its most complex types. In our group of 43 patients in whom surgical exploration with stylet was the key of the diagnosis, the anorectoscopy and even less chirurgical examination were not often contributive, the fear of post-operative incontinence forced us to prefer ligation-section with rubber every time that the sphincter was involved. With our results, the majority of patients (41/43) healed in normal periods with a sufficient functionning of the anus. This result confirmed our attitude towards the sphincter: that is to save if possible.

[Duodenal ulcer: truncal vagotomy with celioscopy. Report of 53 cases]. / Ulcère duodénal: vagotomie tronculaire abdominale sous coelioscopie. A propos de 53 cas.

The recent introduction of laparoscopic surgery in the therapeutic arsenal of duodenal ulcer enabled us to carry out these interventions by abdominal route in order to appreciate the early results. It concerned a prospective study from March 1999 to August 2000 of 53 cases of which were 47 men and 6 women, aged from 16-75 years average age 52 years. Twenty six patients had pyloro-duodenal stenosis, the rest, chronic duodenal ulcer. Vagotomy was carried out on a patient on dorsal decubitus under general anesthesia with oro-tracheal intubation operator within the legs of the patient and the monitor at the right hand side. The process required four trocars depending on the morphology of the patient. A pneumoperitoneum of 3-5 litres permitted to attain the oesophagial hiatus by collapsing the pars-flaccida of the minor epiploon, the reperation of the right diaphragmatic pillar and the discovery of the posterior vagus nerve which was coagulated and sectioned. The traction of the body of the stomach towards the ombilious exposed the anterior portion of the stomach, thanks to the coagulator, the anterior branches of the vagus nerve are sectioned. Drainage by minilaparotomy terminates the intervention if only stenosis existed. Mortality was nul. The time of intervention was 35 to 135 minutes with an average of 71 minutes. The hospital stay was between 3 and 12 days with an average of 5 days. Three conversions to laparotomy (difficultdissection, liver cirrhosis, breakdown of materials), pleural wound consisted the morbidity. Two cases of re-operation due to evacuaton poorly appreciated in pre-operation period were observed. The results according to Visick criterias were: 1 : 51; II : 0; III : 0; IV: 2 patients for a follow up of 3-17 months. Vagotomy under coelioscopy is an intervention which permits to obtain results comparable to those of conventional surgery.

[Role of elastic compression in the treatment of postphlebitic leg ulcers at the University Hospital of Dakar: report of 20 cases]. / Place de la contention élastique dans le traitement des ulcères de jambe posthrombotiques au CHU de Dakar: à propos de 20 cas.

Varicose disease and venous thrombosis were reputed exceptional among black africans and almost all leg ulcers were called "tropical". We have treated 20 cases of postphlebitic ulcers in the teaching hospital of Dakar between march 1989 and december 1992. There were 12 men and 8 women. Mean age was 40 years (24 to 60 years). The initial venous thrombosis dated at mean 8 +/- 3 years. It was confirmed in a hospital in 10 cases and found in the medical history of all patients. All patients presented leg ulcers with non systematised venous varicose and trophic troubles. The ulcers treated only by dressings lasted a duration of 4 months (2 weeks to 9 months) without healing. In view of this failure we have added an ambulatory elastic contention with elastic bandage putted on at hospital after that biweekly dressing until cicatrisation followed by putting elastic socking with degressive compression. We have observed a quickly cicatrisation in mean time of 4 weeks (2 to 6 weeks) with good tolerance of socking. Only 3 patients showed recurrence. Elastic contention has a great place in the treatment of postphlebitic ulcers which are not that exceptional among black Africans.

[Surgical aspects of pulmonary aspergilloma in 24 patients]. / Aspects chirurgicaux des aspergillomes à propos de 24 malades.

From January 1991 to July 1998, 24 patients were operated for pulmonary aspergilloma. All the patients presented previous tuberculosis treated. Hemoptysis had been the revealing elements of the illness in 80% of cases. Treatment was by resection in all the cases: 13 pneumonectomy (54%) and 11 partial resections (46%). The procedures were usually difficult and hemorrhagic. The global mortality was 20%, can be explained by the high number of major resections and the unfavourable general state of health of our patients. Post operative complications are mainly due to secondary empyemas encountered in 15% of the surviving ones. The surgical resection of pulmonary aspergilloma is still difficult and risky for extended underlying parenchymal disease. Minima procedures such as speleotomy and intra cavitary aspiration technique must be indicated in patients with very poor general condition.

[Anesthesia in the pleuropulmonary complications surgery of tuberculosis: a 79 cases study]. / Anesthésie-Reanimation dans la chirurgie des complications pleuropulmonaires de la tuberculose: a propos de 79 cas.

Reported is a retrospective study carried out from Aristide Le Dantec Hospital in patients who underwent pleuropulmonary surgery after tuberculosis complication, from June 1995 to June 1999. The aim of this study was to evaluate the anaesthesiology procedures and outcomes of tuberculosis pleuropulmonary complications surgery. Seventy nine patients were studied. Their mean age was 34.63 years, and the sex ratio was 3.14. They all underwent general anaesthesia procedures with barbituric, morphinics et myorelaxants drugs. The peroperative complications noted were distributed as follow: 50 cases of haemorrhage needing transfusion, 18 cases of hypotension associated to the anaesthesia. In the intensive care period, we have noticed 30 atelectasia cases associated to a spastic bronchopathy, 3 cases of pulmonary oedema and 1 case of pulmonary infarctus. In the postoperative period, 8 cases of hemodynamic instability occurred, including 5 cases of cardiovascular collapsus treated by filling, and 2 septic shocks cases. An infectious bronchopneumopathy was noticed on 11 patients with two cases of septicaemia. The mortality rate was 6.3% (5 cases of death). The pleuropulmonary surgery in tuberculosis complication is very haemorrhagic, and therefore require an adequate preoperative preparation.

[Sternoclavicular dislocations: clinical and therapeutic study. A report of 9 cases]. / Luxations sterno claviculaires: aspects cliniques et thérapeutiques. A propos de neuf cas.

Sterno-clavicular dislocations represent an uncommon pathology in shoulder trauma. The authors describe the anatomical and clinical forms observed between January 1999 and December 2002, and evaluate the treatment process. The retrospective study addressed 9 patients (men only) with an average age of 26.6. Based on the duration of the consulting period, one could distinguish old forms from more recent ones. Diagnosis would help to see anterior forms from posterior forms. Evaluation criteria were: pain, mobility of the shoulder, visibility of the deformation of the sterno-clavicular joint. Six types of anterior dislocations were listed, including 4 recent and 2 old ones. There were 3 recent posterior forms. The anterior recent forms, which were treated in orthopedics, showed a positive evolution. As there was no functional disability, it was wiser to refrain from any treatment of the anterior old forms. The posterior forms, two of them were operated (osteosynthesis) revealed no functional deficit after treatment. However, one of the patients had a broken implant. Scanner facilitated the diagnosis of sterno-clavicular dislocations. The anterior forms, which are more frequent and benign, are different from the posterior forms, which are emergency cases due to the proximity of the aero-digestive and cardiovascular elements. Their surgical stabilization requires techniques related to ligamentoplasty rather than using osteo-synthesis equipment which may move away or break off.

[Long term course after thyroidectomy for euthyroid nodular goiter]. / Evolution à long terme après thyroïdectomie pour goitre nodulaire euthyroroïdien.

Every patient operated for nodular goiter by a partial surgery is exposed to recurrence. In order to verify this idea, the authors followed 36 patients operated on for nodulargoiterat least 10 years ago. A clinical examination for all the patients and echographic study for 24 of them allowed the detection of recurrence and the evaluation of survival and recurrence without any opotherapy. It seemed that clinical recurrence is observed in 16.65% of cases whereas echographic study revealed recurrence in 50% of patients examined. Only two patients were reoperated on. The predictive factors of the recurrence are geographic endemic origin and ethny, partial surgery and vesicular goiters. With 66.65% of survival without recurrence at 18 years without opotherapy, the authors argue about the utility of such treatment.

[Epidemiological, clinical, therapeutic and evolutionary aspects of pulmonary aspergilloma in Dakar]. / Aspects épidémiologiques, cliniques, thérapeutiques et évolutifs de l'aspergillome pulmonaire à Dakar.

INTRODUCTION: The presentation of pulmonary aspergilloma is dominated by haemoptysis, the results of medical treatment are disappointing and there is significant morbidity and mortality following surgery; the only really curative treatment. These facts emphasise the gravity of this condition. We undertook a study to estimate the current profile of the disease and its management in Senegal. PATIENTS AND METHODS: A retrospective study took place between January 2004 and September 2008 including all the cases of pulmonary aspergilloma diagnosed in private practice and\or the thoracic and cardiovascular surgery service of the Fann Hospital, Dakar. RESULTS: Thirty-five patient records were collected. The sex ratio was four males to one female. The average age of the patients was 43.7 years. All the patients had a history of pulmonary tuberculosis. Serology was positive for Aspergillus fumigatus at 22 patients out of 29 (75.86%). Histological examination of surgical biopsies confirmed the diagnosis in 88.46%. The treatment was essentially surgical with no recorded mortality. Nine cases of haemorrhage and eight of suppuration were reported. CONCLUSION: Surgery remains the reference treatment for pulmonary aspergilloma. In view of the morbidity of this condition we emphasize the importance of early screening and correct treatment of tuberculosis, particularly in endemic countries, to achieve clinical cure and prevent serious after effects.