Irreducible posterolateral elbow dislocation: A case report

Elbow dislocations are very common, particularly in the posterolateral variety. Closed reduction is usually easy. However, an irreducible elbow dislocation without associated fracture is rare. We report the case of a 21-year-old patient who presented with an isolated posterolateral irreducible elbow dislocation. Open reduction revealed the buttonhole radial head in the capsule and the complex ligaments. A significant protrusion of the radial head associated with a closed reduction failure is highly suspicious of an irreducible dislocation.

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Irreducible elbow dislocation without associated fracture is extremely rare.

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A buttonhole aspect of radial head is characteristic.

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An enormous radial head protrusion with a reduction failure made the diagnosis.

Dupuytren's disease: A reality in Black Africa

Long regarded as a disease exclusively found amongst Northern Europeans, Dupuytren's disease was seldom studied amongst Black Africans. Thus, we sought to study the impact of Dupuytren's disease, its etiological, clinical and evolutionary peculiarities on a segment of the Senegalese population. This study analyzed data derived from clinical observations carried out between January 2006 and December 2018. It involved Senegalese subjects with Dupuytren's disease, the patients' history, profession, habitus, clinical findings, therapeutic modalities and disease staging. The population included 20 men and 6 women averaging 63.5 years of age (range 45-77). None of the patients reported a family of Dupuytren's disease. Twelve patients had diabetes, 11 were smokers and 22 were engaged exclusively in manual labor. The condition was bilateral in 14 cases. Tubiana stages N, I, II, III and IV were found in 31, 15, 9, 5 and 6 rays, respectively. Conservative treatment was done in 11 patients. Surgical treatment was carried out in the other 15 patients: needle fasciotomy (N=10) including two bilateral involvement and open fasciectomy (N=7). Functional outcomes were satisfactory. Lesions were all stable in the short and medium term. Two patients had progressive lesions on a longer-term basis. Dupuytren's disease is real among Afro-descendants from Senegal even though it is seldom studied. Based on the patients' recollection of Dupuytren's disease in their families, heredity is not yet a proven factor. The early forms are more common, and the lesions remain stable for a long time.

Influence of HIV-1 and/or HIV-2 infection and CD4 count on cervical HPV DNA detection in women from Senegal, West Africa

BACKGROUND

HIV infection is associated with greater risk of precancerous lesions and cervical cancer in women. However, several factors remain unclarified regarding the association between HIV infection and HPV detection, especially among those with HIV type 2 versus type 1 infection and severely immunocompromised persons.

OBJECTIVES

To evaluate HPV overall and type-specific detection among HIV-infected and uninfected women in Senegal.

STUDY DESIGN

Detection of HPV DNA for 38 genotypes in cervical swabs using PCR-based methods was evaluated in HIV-positive (n=467) and HIV-negative (n=2139) women participating in studies in Senegal. Among HIV-1 and/or HIV-2 positive women, CD4 counts were assessed. Adjusted multivariable prevalence ratios (PR) were calculated.

RESULTS

The prevalence of any HPV DNA and multiple HPV types was greater among HIV-infected individuals (78.2% and 62.3%, respectively) compared with HIV-negative women (27.1% and 11.6%). This trend was also seen for HPV types 16 and 18 (13.1% and 10.9%) compared to HIV-negative women (2.2% and 1.7%). HIV-infected women with CD4 cell counts less than 200 cells/μl had a higher likelihood of any HPV detection (PRa 1.30; 95% CI 1.07-1.59), multiple HPV types (PRa 1.52; 95% CI 1.14-2.01), and HPV-16 (PRa 9.00; 95% CI 1.66-48.67), but not HPV-18 (PRa 1.20, 95% CI 0.45-3.24) compared to those with CD4 counts 500 cells/μl or above.

CONCLUSION

HIV-infected women, especially those most severely immunocompromised, are more likely to harbor HPV. Measures to prevent initial HPV infection and subsequent development of cervical cancer through focused screening efforts should be implemented in these high risk populations.

[Risk factors for lymphedema of the arm after mastectomy for breast cancer]

Postmastectomy lymphedema of the arm is frequently associated to different factors including axillary node involvement and local and regional treatment of breast cancer. Our aims was to identify risk factors of postmastectomy lymphedema. From a retrospective analysis of 735 breast cancers treated in our institute, we found 61 lymphedema of the arm. We then describe our study population and identify by univariate et multivariate analysis the factors significantly associated to the disease. The majority of the patients were young black African female found to have locally advanced breast cancers (88% of T3 et T4 UICC 1988), inflammatory diseases (46% of PEV 2 and 3 of Gustave ROUSSY Institute classification of inflammatory breast cancers). Ulceration is found in half of the patients, metastasis in 20%. The patients first underwent chemotherapy mainly with cyclophosphamide alone (56%). Only 59 patients (8%) had preoperative radiation. Surgery consisted mainly in modified radical mastectomy and lymph node dissection (95%). Residual disease is left in 50% of the cases. Only 35% had post-operative chemotherapy and 9% postoperative external beam radiation therapy. From that population, during the follow up, 61 patients were found to have postmastectomy lymphedema. The disease was asymptomatic in 60% of the cases and painful in 26%. 30% of all the patients spontaneously partially regressed. From univariate analysis we found 7 factors associated with lymphedema: The big size of the tumor (p = 0.005), clinically involved axillary lymph nodes (p = 0.001), metastatic disease (p = 0.0046), traditional or inadequate surgery out of the Institute (p = 0.001), lack of post-operative chemotherapy (p = 0.002), postoperative external beam radiations (p = 0.005), relapse (p = 0.002). From logistic regression analysis three independent factors were found: clinically involved axillary lymph nodes (p = 0.0267), metastasis (p = 0.0002) and local or regional relapse (p = 0.0405). In our practice we found that advanced disease, treated by traditional healers or surgery nurses who had relapsed after mastectomy and external beam radiations without chemotherapy have higher risks of lymphedema.

[Vulvar cancers. Retrospective study of 23 cases at the Cancer Institute of Dakar]

The vulvar cancer is an uncommon disease which is beginning mostly on vulvar intraepithelial neoplasma and it keeps a very bad prognostic. The purpose of this study is to report the epidemiological, the anatomo-clinic and and to discuss the treatment. We tell about 23 vulvar cancer from 1956 to 1995 which were followed at the cancer Institut of Dakar. The mean age of patients is 47 years and they are on menopause in 78.6%. The most of the tumors are ulcerate (96%). The clinical investigation find according the staging of FIGO: 15 tumors (T2), 8 tumors (T3), 6 tumors (N1), 9 tumors (N2) and 1 tumor (M1b). The surgery is the principal treatment with 6 radical vulvectomy and 17 palliative vulvectomy. The surgery was associated with radiotherapy and chemotherapy. So the vulvar cancer is uncommon in our country and concern the young wives. The vulvectomy with lymphadenectomy is the principal treatment; the prognostic still very bad because the diagnostic is often later.

[Cancers in the scars of thermal burns (apropos of 67 cases)]

Burns are very frequent. Skin cancer on burns scars are one of the known complications. The mechanisms and the risk factors of this disease are not very well known. To review the risk factors and the mechanisms of transformation of burn scars into cancer, we analyzed 67 retrospective cases of Marjolin's ulcer to describe the epidemiological features of the disease in our practice and identify the factors of relapse. Our patients are young (means age 41), mainly male (54%), with disease localized on arms and legs (88%). The initial burn was from flames (54%), charcoal or hot cooking oil (19.5%) and never from ionizing radiation. It was never a superficial burn and covered from 4 to 37% of the body surface (mean 14%). The initial treatment was medical in only 9% of cases and ended with 85% of complete healing. After 4 to 67 years of evolution, 95% of re-ulceration occurred. Abnormal lymph node and distant metastasis were diagnosed in respectively 68 and 7% of the cases. Amputation and groin dissection were respectively done in 63 and 50%. One third of patients were lost during the follow up. 25% of the cases are still alive and free of disease. We found 30% of local recurrence and 17.5% of regional recurrence. By univariate analysis we found that the factors significantly associated to loco-regional relapse are: male status (p = 0.0327), burns by cooking oil (p = 0.0118), lack of treatment during initial burn (p = 0.0001), sclerous scar (p = 0.0281), supra regional lymph nodes (p = 0.028) lack of treatment during re ulceration (p = 0.0308). Squamous cell carcinomas on burn scars are rare diseases and of bad prognosis. Mainly associated to domestic accidents they frequently occur on limbs and arms on an articulation. Metastasis is not frequent. Conservative treatment is associated with 30% of recurrence. In our practice, the relapse risk factors are male status, burns by cooking oil, lack of treatment during the initial burn, sclerous scar, supra regional lymph nodes, lack of treatment during re ulceration.