[Pediatric orbital Rosai-Dorfman disease: An unusual case]

INTRODUCTION

Rosai-Dorfman disease (RDD) is a sinus histiocytosis with massive lymphadenopathy. This rare condition is a benign disease of unknown etiology. Bilateral orbital localization of RDD is rare.

OBSERVATION

The authors report the case of a 6-year-old child who presented with bilateral orbital-palpebral masses associated with chronic cervical lymphadenopathy. There were no laboratory signs of inflammation. Serological and tuberculosis screening tests were negative. Histopathological examination of a lymph node biopsy established a diagnosis of Rosai-Dorfman disease. The patient underwent surgical excision of the orbital lesions followed by long-term corticosteroid therapy. A favorable course was observed, with no sign of recurrence after one year of follow-up.

CONCLUSION

Rosai-Dorfman disease is very rare in its bilateral orbital presentation. Histopathological diagnosis remains challenging. In Africa, the presence of chronic oculo-palpebral tumor associated with or without cervical lymphadenopathy must raise the suspicion of Rosai-Dorfman disease after ruling out tuberculosis and lymphoma.

A prospective, multi-site, cohort study to estimate incidence of infection and disease due to Lassa fever virus in West African countries (the Enable Lassa research programme)-Study protocol

BACKGROUND

Lassa fever (LF), a haemorrhagic illness caused by the Lassa fever virus (LASV), is endemic in West Africa and causes 5000 fatalities every year. The true prevalence and incidence rates of LF are unknown as infections are often asymptomatic, clinical presentations are varied, and surveillance systems are not robust. The aim of the Enable Lassa research programme is to estimate the incidences of LASV infection and LF disease in five West African countries. The core protocol described here harmonises key study components, such as eligibility criteria, case definitions, outcome measures, and laboratory tests, which will maximise the comparability of data for between-country analyses.

METHOD

We are conducting a prospective cohort study in Benin, Guinea, Liberia, Nigeria (three sites), and Sierra Leone from 2020 to 2023, with 24 months of follow-up. Each site will assess the incidence of LASV infection, LF disease, or both. When both incidences are assessed the LASV cohort (nmin = 1000 per site) will be drawn from the LF cohort (nmin = 5000 per site). During recruitment participants will complete questionnaires on household composition, socioeconomic status, demographic characteristics, and LF history, and blood samples will be collected to determine IgG LASV serostatus. LF disease cohort participants will be contacted biweekly to identify acute febrile cases, from whom blood samples will be drawn to test for active LASV infection using RT-PCR. Symptom and treatment data will be abstracted from medical records of LF cases. LF survivors will be followed up after four months to assess sequelae, specifically sensorineural hearing loss. LASV infection cohort participants will be asked for a blood sample every six months to assess LASV serostatus (IgG and IgM).

DISCUSSION

Data on LASV infection and LF disease incidence in West Africa from this research programme will determine the feasibility of future Phase IIb or III clinical trials for LF vaccine candidates.

Ebola virus disease nosocomial infections in the Democratic Republic of the Congo: a descriptive study of cases during the 2018-2020 outbreak

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Health workers were among those most affected by nosocomial Ebola virus disease (EVD) in this outbreak.

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Children had a higher case fatality rate compared with other patients with nosocomial EVD.

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Referral health facilities and privately owned health facilities had the highest number of nosocomial infections (NI).

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Clear case definition of NI is required to prompt transmission chain interruption.

Objectives

To describe the characteristics of nosocomial cases of Ebola virus disease (EVD) in the Democratic Republic of the Congo between July 2018 and May 2020 in order to inform future interventions.

Methods

Nosocomial cases of EVD were identified during outbreak response surveillance, and a retrospective analysis of cases was conducted according to demographic characteristics and type of health facility (HF).

Results

Of 3481 cases of EVD, 579 (16.6%) were nosocomial. Of these, 332 cases occurred in women (57.3%). Patients and visitors accounted for 419 cases (72.4%), of which 79 (18.9%) were aged 6–≤18 years and 108 (25.8%) were aged ≤5 years. Health workers (HWs) accounted for the remaining 160 (27.6%) nosocomial cases. The case fatality rate (CFR) for HWs (66/160, 41.3%) was significantly lower than the CFR for patients and visitors (292/419, 69.7%) (P<0.001). The CFR was higher among cases aged 6–≤18 years (54/79, 68.4%) and ≤5 years (89/108, 82.4%). Referral HFs (>39 beds) had the highest prevalence of nosocomial EVD (148/579, 25.6%). Among HFs with at least one case of nosocomial infection, 50.0% (98/196) were privately owned.

Conclusions

Nurses and traditional healers should be targeted for infection prevention and control training, and supportive supervision should be provided to HFs to mitigate EVD transmission.

Traumatismes consécutifs aux accidents de trottinettes

Les trottinettes connaissent un engouement croissant avec la mise en place des trottinettes en libre-service. Toutefois, leur usage n’est pas sans conséquence sur le risque traumatique. Cette étude a pour objectif de décrire la population et les types de lésions des usagers de trottinettes.

Matériel et méthode : Les données proviennent du registre des victimes d’accident de la circulation du département du Rhône qui inclut toute personne blessée ou tuée à la suite d’un accident de la route survenu dans le département du Rhône et pris en charge dans une structure sanitaire privée ou publique. La période étudiée concerne l’année 2019. Les informations recueillies concernent les caractéristiques individuelles, accidentelles, lésionnelles de la victime ainsi que son devenir. Les lésions sont codées grâce à l’Abbreviated Injury Scale (AIS). Les blessés graves sont définis par des lésions d’AIS 3 et plus.

Résultats : Au total, 1 186 accidents de trottinette ayant entraîné 1 197 usagers blessés ont été recensés, dont 90 % dans l’hypercentre urbain, avec un nombre d’accidents de trottinettes multiplié par 7,3 entre 2018 et 2019. Cette augmentation a été observée depuis l’été 2018 avec l’introduction de sociétés proposant des locations de trottinettes. L’accident s’est produit seul, sans antagoniste dans 77 % des cas (n = 920). Le port du casque était rare (n = 72 ; 6 %). La grande majorité (n = 869 ; 73 %) des blessés était âgée de 10 à 34 ans, et les 20 à 24 ans (n = 301) représentaient le quart de l’effectif. Pour 11 accidents, il y avait deux blessés usagers de la même trottinette. Il y avait en moyenne deux lésions par victime. Les atteintes graves (MAIS 3 et plus) représentaient 3,8 % des lésions, et il n’y avait pas de différence statistiquement significative pour les lésions graves entre trottinette électrique et trottinette à propulsion humaine (p = 0,20). Comparées aux lésions des cyclistes dont les caractéristiques des accidents sont proches, les blessures de l’extrémité céphalique prédominent chez les usagers de trottinette (37 vs 27 % ; p < 0,001).

Conclusion : Devant l’utilisation grandissante des trottinettes parmi les modes de déplacement, une évaluation scientifique des victimes de traumatismes est nécessaire pour proposer des recommandations visant à limiter les traumatismes graves. Ce travail constitue une première étape vers la surveillance épidémiologique tant en termes de recommandations que d’évolution.

Detection of kdr and ace-1 mutations in wild populations of Anopheles arabiensis and An. melas in a residual malaria transmission area of Senegal

In the central western Senegal, malaria transmission has been reduced low due to the combination of several effective control interventions. However, despite this encouraging achievement, residual malaria transmission still occurring in few areas, mainly ensured by An. arabiensis and An. melas. The resurgence or the persistence of the disease may have originated from the increase and the spread of insecticide resistance genes among natural malaria vectors populations. Therefore, assessing the status and mechanisms of insecticides resistance among targeted malaria vectors is of highest importance to better characterize factors underlying the residual transmission where it occurs. Malaria vectors were collected from three selected villages using nocturnal human landing catches (HLC) and pyrethrum spray collections (PSC) methods. An. gambiae s.l. specimens were identified at the species level then genotyped for the presence of kdr-west (L1014F), kdr-east (L1014S) and ace-1^R mutations by qPCR. An. arabiensis (69.36%) and An. melas (27.99%) were the most common species of the Gambiae complex in the study area. Among An. arabiensis population, the allelic frequency of the kdr-east (22.66%) was relatively higher than for kdr-west mutation (9.96%). While for An. melas populations, the overall frequencies of both mutations were very low, being respectively 1.12% and 0.40% for the L1014S and L1014F mutations. With a global frequency of 2%, only the heterozygous form of the G119S mutation was found only in An. arabiensis and in all the study sites. The widespread occurrence of the kdr mutation in both An. arabiensis and An. melas natural populations, respectively the main and focal vectors in the central-western Senegal, may have contributed to maintaining malaria transmission in the area. Thus, compromising the effectiveness of pyrethroids-based vector control measures and the National Elimination Goal. Therefore, monitoring and managing properly insecticide resistance became a key programmatic intervention to achieve the elimination goal where feasible, as aimed by Senegal. Noteworthy, this is the first report of the ace-1 mutation in natural populations of An. arabiensis from Senegal, which need to be closely monitored to preserve one of the essential insecticide classes used in IRS to control the pyrethroids-resistant populations.

Growth patterns and their contributing factors among HIV-exposed uninfected infants

With expanded HIV treatment and prevention programmes, most infants born to HIV‐positive women are uninfected, but the patterns and determinants of their growth are not well described. This study aimed to assess growth patterns in a cohort of HIV‐exposed uninfected (HEU) infants who participated in an experimental HIV vaccine trial and to test for associations with maternal and infant factors, including in‐utero exposure to antiretroviral therapy (ART), mode of delivery, exclusive breastfeeding, mother's education and receipt of the vaccine. Infants in the trial were seen at regular clinic visits from birth to 48 weeks of age. From the anthropometric measurements at these visits, weight‐for‐age z‐scores (WAZ), weight‐for‐length z‐scores (WLZ) and length‐for‐age z‐scores (LAZ) were computed using World Health Organization (WHO) software and reference tables. Growth patterns were investigated with respect to maternal and infant factors, using linear mixed regression models. From 94 infants included at birth, growth data were available for 75.5% at 48 weeks. The determinants of infant growth in this population are multifactorial: infant LAZ during the first year was significantly lower among infants delivered by caesarean section (p = 0.043); both WAZ and LAZ were depressed among infants with longer exposure to maternal ART (WAZ: p = 0.015; LAZ: p < 0.0001) and among infants of mothers with lower educational level (WAZ: p = 0.038; LAZ: p < 0.0001); the effect of maternal education was modified by breastfeeding practice, with no differences seen in exclusively breastfed infants. These findings inform intervention strategies to preserve growth in this vulnerable infant population.

A Melanoma-Tailored Next-Generation Sequencing Panel Coupled with a Comprehensive Analysis to Improve Routine Melanoma Genotyping

BACKGROUND

Tumor molecular deciphering is crucial in clinical management. Pan-cancer next-generation sequencing panels have moved towards exhaustive molecular characterization. However, because of treatment resistance and the growing emergence of pharmacological targets, tumor-specific customized panels are needed to guide therapeutic strategies.

OBJECTIVE

The objective of this study was to present such a customized next-generation sequencing panel in melanoma.

METHODS

Melanoma patients with somatic molecular profiling performed as part of routine care were included. High-throughput sequencing was performed with a melanoma tailored next-generation sequencing panel of 64 genes involved in molecular classification, prognosis, theranostic, and therapeutic resistance. Single nucleotide variants and copy number variations were screened, and a comprehensive molecular analysis identified clinically relevant alterations.

RESULTS

Four hundred and twenty-one melanoma cases were analyzed (before any treatment initiation for 94.8% of patients). After bioinformatic prioritization, we uncovered 561 single nucleotide variants, 164 copy number variations, and four splice-site mutations. At least one alteration was detected in 368 (87.4%) lesions, with BRAF, NRAS, CDKN2A, CCND1, and MET as the most frequently altered genes. Among patients with BRAFV600 mutated melanoma, 44.5% (77 of 173) harbored at least one concurrent alteration driving potential resistance to mitogen-activated protein kinase inhibitors. In patients with RAS hotspot mutated lesions and in patients with neither BRAFV600 nor RAS hotspot mutations, alterations constituting potential pharmacological targets were found in 56.9% (66 of 116) and 47.7% (63 of 132) of cases, respectively.

CONCLUSIONS

Our tailored next-generation sequencing assay coupled with a comprehensive analysis may improve therapeutic management in a significant number of patients with melanoma. Updating such a panel and implementing multi-omic approaches will further enhance patients' clinical management.

Erratum: Summarizing and Communicating on Survival Data According to the Audience: A Tutorial on Different Measures Illustrated with Population-Based Cancer Registry Data [Corrigendum]

[This corrects the article DOI: 10.2147/CLEP.S173523.].

Level and modalities of origin of the small saphenous vein: toward codification of the proximal approach level

PURPOSE

The proximal approach to the small saphenous vein (SSV) must be performed according to precise anatomical landmarks to respect the esthetic profile of venous insufficiency surgery. In this work, we propose the tip of the lateral malleolus and the lateral edge of the calcaneal tendon as palpable landmarks from which to easily identify the situation of this vein.

METHODS

This was a cadaveric dissection study involving 62 members of fresh and embalmed anatomical subjects. We used a horizontal line passing through the tip of the lateral malleolus and the lateral edge of the calcaneal tendon as reference marks. Once the origin of the SSV as dissected, the distances between the saphenous vein and the landmarks were measured.

RESULTS

We found that the small saphenous vein was often unique. The origin of this small saphenous vein projected, on average, to 4.40 cm from the horizontal passing through the tip of the lateral malleolus and 1.2 cm from the lateral edge of the calcaneal tendon.

CONCLUSION

These two measurements constitute the orthogonal coordinates for the situation of the small saphenous vein origin.

Summarizing and communicating on survival data according to the audience: a tutorial on different measures illustrated with population-based cancer registry data

Survival data analysis results are usually communicated through the overall survival probability. Alternative measures provide additional insights and may help in communicating the results to a wider audience. We describe these alternative measures in two data settings, the overall survival setting and the relative survival setting, the latter corresponding to the particular competing risk setting in which the cause of death is unavailable or unreliable. In the overall survival setting, we describe the overall survival probability, the conditional survival probability and the restricted mean survival time (restricted to a prespecified time window). In the relative survival setting, we describe the net survival probability, the conditional net survival probability, the restricted mean net survival time, the crude probability of death due to each cause and the number of life years lost due to each cause over a prespecified time window. These measures describe survival data either on a probability scale or on a timescale. The clinical or population health purpose of each measure is detailed, and their advantages and drawbacks are discussed. We then illustrate their use analyzing England population-based registry data of men 15-80 years old diagnosed with colon cancer in 2001-2003, aiming to describe the deprivation disparities in survival. We believe that both the provision of a detailed example of the interpretation of each measure and the software implementation will help in generalizing their use.

Pregnant women in vehicles: Driving habits, position and risk of injury

This study proposed to broadly examine vehicle use by pregnant women in order to improve realism of accident simulations involving these particular occupants. Three research pathways were developed: the first consisted in a questionnaire survey examining the driving habits of 135 pregnant women, the second obtained measurements of 15 pregnant women driving position in their own vehicle from the 6th to the 9th month of pregnancy by measuring distances between body parts and vehicle parts, and the third examined car accidents involving pregnant occupants. Results obtained indicate that between 90% and 100% of pregnant women wore their seat belts whatever their stage of pregnancy, although nearly one third of subjects considered the seat belt was dangerous for their unborn child. The measurements obtained also showed that the position of the pregnant woman in her vehicle, in relation to the various elements of the passenger compartment, changed significantly during pregnancy. In the studied accidents, no correlation was found between the conditions of the accident and the resulting fetal injury. Results reveal that pregnant women do not modify significantly the seat setting as a function of pregnancy stage. Only the distance between maternal abdomen and steering wheel change significantly, from 16 cm to 12 cm at 6 and 9 month respectively. Pregnant women are mainly drivers before 8 months of pregnancy, passengers after that. Car use frequency falls down rapidly from 6 to 9 months of pregnancy. Real crashes investigations indicate a low rate of casualties, i.e. 342 car accidents involving pregnant women for a period of 9 years in an approximately 1.7 million inhabitants area. No specific injury was found as a function of stage of pregnancy.

[Identification of anopheles breeding sites in the residual foci of low malaria transmission «hotspots» in Central and Western Senegal]

Malaria incidence has markedly declined in the Mbour, Fatick, Niakhar and Bambey districts (central and western Senegal) thanks to a scaling up of effective control measures namely LLINs (Long Lasting Insecticide Treated Net), ACTs (Artesunate Combination Therapy) and promoting care seeking. However malaria cases are now maintained by foci of transmission called hotspots. We evaluate the role of anopheles breeding sites in the identification of malaria hotspots in the health districts of Mbour, Fatick, Niakhar and Bambey. Surveys of breeding sites were made in 6 hotspot villages and 4 non-hotspot villages. A sample was taken in each water point with mosquito larvae by dipping method and the collected specimens were identified to the genus level. Additional parameters as name of the village and breeding sites, type of collection, original water turbidity, presence of vegetation, proximity to dwellings, geographic coordinates, sizes were also collected. Sixty-two water collections were surveyed and monitored between 2013 and 2014. Temporary natural breeding sites were predominant regardless of the epidemiological status of the village. Among the 31 breeding sites located within 500 meters of dwellings in hotspots villages, 70% carried Anopheles larvae during the rainy season while 43% of the 21 breeding sites located at similar distances in non-hotspot villages carried Anopheles larvae during the same period (P = 0.042). At the end of the rainy season, the trend is the same with 27% of positive breeding sites in hotspots and 14% in non-hotspots villages. The breeding sites encountered in hotspots villages are mostly small to medium size and are more productive by Anopheles larvae than those found in non-hotspot area. This study showed that the high frequency of smallest and productive breeding sites around and inside the villages can create conditions of residual transmission.

[Surgery in black grain mycetoma: about 44 patients treated at aristide le dantec hospital (Dakar, Senegal) from December 2008 to March 2013]

Black-grain mycetomas are fungal and cannot be healed by antifungals only.We conducted this study to determine the interest of carcinologic surgery only in the management of those black-grain mycetomas.We led a retrospective study concerning 44 patients over a period of 52 months. The mean age of patients was 32.5 years. The main location of mycetomas was the foot (21 cases), the ankle (10 cases), the knee (8 cases), the leg (3 cases), the chest, the back and the pulp of the fourth finger once each. The bone was affected in 21 cases. The surgery consisted in a carcinologic excision or amputation depending on the extension of the lesion and the degree of bony infringement, with ganglionic cleaning out in case of lymphadenopathy. In the average retrospect of 25.5 months, we noted 8 cases of recurrences among which 2 on the amputated patients and 6 on the patients treated by carcinologic excision. The surgery constitutes the main therapeutic issue of the fungal mycetomas.

Inactivation of Escherichia coli in a baffled pond with attached growth: treating anaerobic effluent under the Sahelian climate

This study aimed to investigate and understand the zero-level detection of Escherichia coli (E. coli) at the outlet of an improved waste stabilization pond. Wastewaters were collected from the International Institute for Water and Environmental Engineering (2iE) campus and were subjected to biological treatment. The system included two-stage Anaerobic Reactors followed by a Baffled Pond (AR-BP) with recycled plastic media as a medium for attached growth and a control pond (CP). Three vertical baffles were installed, giving four compartments in the baffled pond (BP). The research was conducted on the pilot scale from March to July 2014, by monitoring E. coli, pH, temperature, dissolved oxygen (DO) and chlorophyll-a in each compartment and at different depths. The results show that E. coli concentrations were lower in top layers of all compartments with an undetectable level in the last compartment up to 0.60 m deep. E. coli mean removal efficiencies and decay rates were achieved by significant difference in BP (4.5 log-units, 9.1 day(-1)) and CP (1.1 log-units, 1.1 day(-1)). Higher values of pH (≥9), temperature (≥32°C), DO (≥ 8 mg/L) and chlorophyll-a (≥ 1000 µg/L) were observed at the surface of BP, whereas lower values were shown at the bottom. Sedimentation combined with the synergetic effects of the physicochemical parameters and environmental factors would be responsible for the inactivation of E. coli in BP. It was concluded that the AR-BP could be applied as an alternative low-cost wastewater treatment technology for developing countries and recommended for reuse of their effluent for restricted peri-urban irrigation.

[Anterior transolecranon fracture-dislocations of the elbow in children: A case report and review of the literature]

Anterior transolecranon fracture-dislocations of the elbow are rare in children and the literature is poor in recommendations for the management of these lesions. We report a new case with a type of lesion that has not been described previously and discuss this pathology. Based on a literature review, we propose a classification into four types of anterior transolecranon fracture-dislocations of the elbow in children, thereby guiding surgical indications. We recommend reduction and synthesis using a figure-eight tension-band wire in avulsions and transverse type I and II fractures. The bone plate is the best indication in type III oblique fractures in older children.

Closed loop obstruction: pictorial essay

Closed loop obstruction occurs when a segment of bowel is incarcerated at two contiguous points. The diagnosis is based on multiple transitional zones. The incarcerated loops appear in U or C form or present a radial layout around the location of the obstruction. It's very important to specify the type of obstruction because, in patients with simple bowel obstruction, a conservative approach is often advised. On the other hand, a closed loop obstruction immediately requires a surgical approach because of its high morbidity and the risk of death in case of a late diagnosis.

Posterior approach for surgical treatment of neglected elbow dislocation

INTRODUCTION

Neglected elbow dislocations often result in contracture and functional impairment. Surgical treatment is challenging because of the accompanying triceps retraction. We wanted to share our experience in treating these neglected dislocations using the posterior approach.

PATIENTS AND METHODS

This was a consecutive, prospective study over a 4.5-year period (January 2003 to June 2007) that included all the patients who presented with a neglected elbow dislocation that was older than 21 days. We treated 22 patients (17 men, five women) with an average age of 22.8±8.2 years (range 14 to 46 years). The dislocations were 8.5±4.2 months old on average (range 2 to 17 months). Average elbow flexion was 46.0°±25.9° (10° to 90°) and the extension deficit was 19.5°±18.4° (0° to 60°) before the surgery. A paratricipital approach was used in all patients. In 14 patients, the dislocation was reduced without triceps lengthening. In eight patients, a V-Y plasty of the triceps muscle was required.

RESULTS

The average follow-up was 21 months (range 12 to 30 months). The improvement in the overall range of motion was statistically significant. Average elbow flexion was 112.7°±13.3° (60° to 130°) and the extension deficit was 26.6°±17.0° (0° to 60°). The average Mayo Clinic Elbow Performance Index score was 86 (range 50 to 100), with 14 excellent, four good, two average and two poor results. Complications included three cases of ulnar nerve paresis, which subsided within three months, and one case of superficial infection.

DISCUSSION

Although surgical treatment is challenging, the functional improvement in neglected elbow dislocations is outstanding. The best functional results can be expected when the triceps splitting approach to the elbow is not used.

LEVEL OF EVIDENCE

IV.

Prise en charge du priapisme à Dakar

Objectif

Évaluer la prise en charge des patients présentant un priapisme.

Patients et méthodes

Il s’agit d’une étude rétrospective sur quatre ans, du 1er août 2002 au 31 juillet 2006, portant sur 35 patients. Les cadres d’étude ont été les trois grands services d’urologie du Sénégal qui sont tous à Dakar. Les paramètres suivants ont été étudiés: l’âge, le temps d’évolution du priapisme, les données anamnestiques, le type hémodynamique du priapisme, les résultats du bilan paraclinique, le traitement chirurgical (la technique chirurgicale, la technique d’anesthésie), la durée d’hospitalisation, le traitement associé, les complications per- et postopératoires, les résultats immédiats et à long terme.

Résultats

L’âge moyen des patients était de 21,2 ans. Le groupe d’âge le plus représenté était celui de 20 à 30 ans. La majorité des patients (43 %) avaient une notion de drépanocytose connue. La plupart des patients (65 %) ont été pris en charge avant 24 heures d’évolution. Chez tous nos patients, le priapisme était de bas débit. Dans 50 % des cas, les patients drépanocytaires avaient une forme SS. Dans près de la moitié des cas (62 %), la technique d’anesthésie choisie a été le bloc pénien. La ponction des corps caverneux a été le moyen thérapeutique le plus utilisé (63 %). Aucune complication postopératoire majeure n’a été déplorée dans la prise en charge des patients dans notre série. Chez presque tous les patients (95 %), la détumescence durable a été notée le jour même du début du traitement ou le lendemain. Conclusion: Le priapisme, bien que rare en Afrique, est caractérisé par la prédominance de la drépanocytose comme étiologie et le délai particulièrement long de la prise en charge.

[Breast hypertrophy: preliminary study in Dakar]

The management of breast hypertrophy has become a new and increasing need in Senegal. The files of 47 patients presenting with breast hypertrophy were collated over twelve years. The mean age was 33,9 years. Three surgical techniques were used. The average sternal notch to nipple measurement was 33 cm. Surgery was performed on twenty-two patients, or 42 breast. The surgical technique of Mac Kissock was used in 50% of the cases, the inferior pedicle technique in 13.6% of the cases and the technique of Thorek in 36.4% of the cases. The average weight of tissue removed was 1.3 kg per breast. Our rate of post-operative complications was 9.5% , mostly suppurations. Close to 91% of the patients expressed being satisfied with the aesthetic result obtained. The surgery of breast hypertrophy is increasing in our activity.

[Prosthetic rehabilitation: needs in Senegalese dental offices]

Knowledge of dental prosthetic needs will develop strategies for prevention and treatment through a package of individual, community and professional policies. The aim of this study was to evaluate prosthetic needs in Senegalese dental offices. The survey was conducted among people aged 15 years and more attending Senegalese dental clinics. The mean number of missing teeth was 4.4. Only 55.3% of the sample expressed the need for dentures and 81.8% had a diagnosed need for prosthesis. A statistically significant difference was noticed between the needs diagnosed and the expressed needs (p < 0.0001). Finally, this study reveals that the need for prosthetic treatment is real in the Senegalese dental offices.

[Abdominal actinomycosis mimicking an abdominal tumor. Case report in Senegal]

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.

[Intramedullary pinning of the radius in acute Galeazzi's fractures in adults: 23 case reports]

OBJECTIFS

Consensual treatment of the Galeazzi's fracture is a plate osteosynthesis of the radius more or less associated to the confection of a plaster cast in distal radio-ulnar joint (DRUJ) dislocation. The authors are reporting in this study the clinical and functionnal results of the intra-medullary pinning of the radius in this type of fracture in adult.

METHODS

During a prospective study from January 2003 to December 2006, 23 patients (20 men and three women), average-aged of 32 years (16-70 years) presenting with a Galeazzi's fracture were treated by an intra-medullary pinning of the radius. The DRUJ dislocations were locked 17 times by a brachio-ante-brachio-palmar plaster cast in the supination position, and six times by an ulno-radial pinning. Only the 16 over-aged patients presenting with closed recent fractures were included in this study. The DRUJ dislocation was ranked according to Mansat, the radial fracture according to Müller (AO). The assessment of the treatment results used Mestdagh's criteria. In this study, each pseudarthrosis of the radius was considered as a failure.

RESULTS

The DRUJ dislocation was reparted into six sprains, eight subdislocations, and three Galeazzi's fracture equivalents. The radius fractures were simple (n=20) or wedge fractures (n=3). These fractures were located at the proximal third (n=13), middle third (n=7) and distal third (n=3). The average consolidation delay was 10 weeks (8 to16 weeks). Two pseudarthrosis have been observed and then treated by a plate osteosynthesis. At the mean follow up of 37 months (18 to 41 months), the mean score according to Mestdagh was 7.8 points, with 20 satisfying results. Nineteen patients were satisfied by their treatment; the reasons were: the esthetic care of their scar, and the good functionnal resumption, as well as before the fracture.

CONCLUSION

The intra-medullary pinning of radius in Galeazzi's fractures, in contrary to the previous studies, give good results compared to a plate osteosynthesis treatment. The systematic complementary lock by brachio-ante-brachio-palmar plaster cast during 3 to 4 weeks has balanced the stability defect that Mikic was reproaching to it. Moreover, it confers the benefits of elastic closed osteosynthesis. That less simple and less expensive method represents an alternative to a plate osteosynthesis in Galeazzi's fractures in adult, if it is well standardized.

[Management of nasolabial clefts: the issue in Dakar]

The management of patients with a cleft lip in developing countries is often the prerogative of humanitarian missions from developed countries. The goal of our work is to conduct a first epidemiological, clinical and therapeutic assessment of the management of cleft lips by a local team and to evidence the difficulties faced by us in our working conditions. In a retrospective study covering a period of about five years (January 2004 to March 2009), 205 cases of nasolabial clefts are assembled. The mean age at the time of the first visit is 17 months. A slight female predominance is observed. The majority of patients are from the capital city. A close relative with a cleft is found in 6.8% of them. In 44.9% of cases, it is a simple cleft lip. A cleft palate is associated in 47.8% of cases. Associated malformations are observed in 10.5% of cases. We operated on 110 patients. The mean age at the first surgery is two years. Millard's technique is our technique of choice. No operative mortality is observed. In 17.4% of cases, operative morbidity occurred in the form of suppuration with partial or complete early suture release. The esthetic result is satisfactory in 67.7% of cases. This management could be improved by creating a multidisciplinary team including--in addition to surgeons--dentists, speech-language pathologists, psychologists, etc.

[Paediatric head and neck burns sequelae]

The skin is the body's protective barrier and is very much exposed to assaults and thus to burns. The aim of this work is to consider the special features of cervicofacial burns sequelae in children in a sub-Saharan environment and to review their management. This retrospective study, performed in the Department of Paediatric Surgery at Aristide Le Dantec Teaching Hospital in Dakar (Senegal), examined 27 patient files dating between May 2001 and April 2008. The children’s average age at first visit was 6.7 years and the m:f sex ratio was 1.7:1. The sequelae were topographically distributed as follows: face (66.7%), neck (29.6%), scalp (11.1%). Regarding the type of sequelae observed, adhesions predominated (33.3%), followed by keloid or hypertrophic scars (25.9%), eyelid ectropions (18.5%), scalp alopecias (11.1%), chronic ulcerations (7.4%), and discolorations (3.7%).Surgical treatment was used in 55.7% of the cases: Z-plasty, followed or not followed by skin graft for adhesion treatment, as well as adhesion lysis followed by grafting for eyelid ectropion treatment. The surgical morbidity rate was 20% and no mortality was reported. Keloid scars were treated medically with intralesional corticosteroid injections. Apart from the emergency situation, cervicofacial burns in children lead to severe aesthetic and functional damage. Any improvement in prognosis in such burns depends on improvements in the quality of initial care and on raising parents' awareness of accidents in the home.

[Latarjet procedure for recurrent anterior instability of the shoulder. Report of 41 cases]

AIMS

Evaluate the technique of Bristow-Latarjet in the treatment of the recurrent dislocation of the shoulder.

PATIENTS AND METHODS

It was a continuous retrospective study on 46 cases selected in the CHU of Dakar over 11 years. From our criteria of inclusion, 41 patients were retained. There were 37 men for 4 women, whose average age at the time of the intervention was 29 years (extreme: 20 - 44 years). The management of the first episode was unsuited in 25 times. The average time of the first repetition was 10 months and its number varied between 5 and 36 episodes. The treatment of the recurrences was also misfit in 23 times. All our patients were treated according to the technique of Bristow-Latarjet. A standard immobilization Mayo clinic during 3 weeks was made with a systematic rehabilitation. The evaluation was done according to the scale of Constant with 45,6 months an average retreat.

RESULTS

We found: 7 excellent cases (17%); 14 very good cases (34%); 9 good cases (22%); 6 average cases (15%); 5 bad cases (12%). Five cases of omarthrosis (3 types II and 2 types III of Samilson-Prieto) were found like two surface cases of sepsis. There was neither post-operative recurrence nor iatrogenic nervous attack.

CONCLUSION

The recurrent anterior dislocation of the shoulder represents a frequent complication of primary dislocations of the shoulder touching especially young subjects. Stabilization by the anterior coracoid abutment according to the technique of Bristow-Latarjet led well represents one of the best techniques for its treatment.

[Urinary incontinence in woman: epidemiologic profile in Sub Saharian countries]

The objective of this study was to describe the epidemiologic profile of urinary incontinence of the African woman of three Sub Saharan African countries.

MATERIAL AND METHODS

A multicentric study summarized the epidemiological data collected in female from Nouakchott, Dakar and Ndjamena using a questionnaire. All participants filled an anonymous questionnaire including demographic data and marital status, medical, surgical, gynecological and obstetrical history and the characteristics of the urinary incontinence.

RESULTS

Overall, 3021 questionnaires were distributed, only 2070 answers (69%) could be processed. Mean age of the overall population was 28 years. Adult women aged less than 30 years accounted for 56% of the study population. The age group 30-49 years accounted for 42% of the population and only 2% of the study group had more than 50 years. The prevalence of incontinence was 367 cases over 2070 (17,7%). The types of incontinence found were: urgency in 28.6% of cases, stress incontinence in 38.4% of cases and mixed in 33% of cases. Approximately 23,9% of nulliparous and 23,5% of the multiparous had urinary incontinence. The leakage was occasional in 75% of the cases and regular in 25% of the cases. According to gravity, in 31% of cases the volume of urines lost necessitated a change of underwear. Of the women presenting urinary incontinence, 85 (23%) consulted a doctor. A psychosocial repercussion was found in 31% of the cases.

CONCLUSION

Urinary incontinence is much more frequent in our areas than it was thought to be because it was rarely acknowledged.

[Post-burn scar contractures in children in the lower limb]

Il s'agit d'une étude faisant ressortir les aspects épidémiologiques, cliniques et thérapeutiques des séquelles de brûlures du membre inférieur chez l'enfant, à propos de 42 cas colligés au service de chirurgie infantile de l'Hôpital Aristide Le Dantec (Sénégal). L'âge moyen retrouvé est de 5 ans et 3 mois, et le sex-ratio garçons/filles de 1,8/1. La brûlure thermique est causée par une flamme dans 33% des cas, par un liquide chaud dans 21% des cas, et par des braises dans 21% des cas. Les cicatrices rétractiles intéressent le genou et le creux poplité dans 47% des cas et le pied dans 45% des cas. Elles sont bilatérales dans 21% des cas, et concernent une autre localisation associée dans 21% des cas. Quant aux brides, 21% ont bénéficié d'une chirurgie, avec un délai moyen de 3 ans et 2 mois après la brûlure. Cette procédure chirurgicale consiste en une plastie en Z dans 91% des cas, à laquelle est associée une greffe de peau dans 54% des cas. Une rééducation fonctionnelle est pratiquée chez 54% des opérés. Parallèlement aux données de la littérature, nos résultats montrent que l'optimisation de la prise en charge passe par une meilleure prévention des accidents domestiques et une bonne codification thérapeutique.

[Dermatomyositis and polymyositis: 21 cases in Senegal]

Dermatopolymyositis (DPM) is a term describing a group of disorders comprising multiple distinct entities depending on interactions between genetic and environmental factor. There is a paucity of studies on DPM in black Africa. The purpose of this report is to describe epidemiological, clinical, laboratory and therapeutic aspects of dermatomyositis (DM) and polymyositis (PM) observed at the Principal Hospital in Dakar, Senegal. A retrospective review as conducted of patients hospitalized for DM and PM in Medical Departments of Principal Hospital. Diagnosis of DRM was based on the criteria of Bohan and Peter's in all cases. A series of 21 black African patients was compiled including 15 with DM and 6 with PM. Mean age was 52 years and the M/F sex ratio was 0.6. The mean delay for diagnosis was 6 weeks (range, 3 to 12 weeks). Initial signs were dermatological in 12 patients, pulmonary in one and muscular in the remaining cases. The most common dermatological sign was erythema characterized by a zebra-like aspect on the extended limbs. Erythema was frequently pruriginous with a flagellate aspect on the back. Muscular signs were observed in 18 patients and included pharyngeal manifestations in 10 patients. Amyopathic DM was not observed. Cardiac abnormalities included tachycardia (4 cases), AVB (1), ischemic lesion (1), relaxation disturbances (4), pericardial effusion (3), myocarditis (2) and pulmonary hypertension (1). The most common pulmonary manifestation was interstitial lung disease observed in 6 patients. Gastrointestinal signs were noted in 9 patients including endoscopic evidence of superficial erosion in 4 cases. Electromyography (EMG) tracings revealed myogenic disease in 14 cases including 2 associated with reduced peripheral nervous conduction speed. Severe lymphopenia was observed in 3 patients but HIV serology was negative in all cases. Paraneoplasic DM was observed in 3 cases. Death occurred in 5 cases due to the cancer-related, pulmonary and infectious complications. Based on the findings of this study, the three main features of DM and PM in Senegal are flagellated and often pruriginous erythema, cardiac and interstitial lung disease, and peripheral neural involvement.

[Total hip arthroplasty after avascular necrosis due to sickle cell disease in Senegal: series of 48 replacements]

The purpose of this study is to describe the outcome of total hip arthroplasty for management of aseptic osteonecrosis of the femoral head due to sickle cell disease. This consecutive series carried out over a 7-year period in 38 patients with a sickle-cell anaemia includes a total of 48 cemented prosthesis. The mean follow-up period was 5 years. Arthroplasty restored normal hip function (PMA score = 18) in 64% of cases. In 32% of cases the PMA score was more than 15. Pain was greatly reduced with total relief being achieved in 94% of cases. Walking ability also improved with 85% of patients having an unlimited walking distance. Radiological examination demonstrated edging on 36% of cupulas and 29% of the shafts. Complications were observed in 19% of cases. The main complications were loosening and dislocation of the prosthesis. Although the complication rate was high, functional outcomes in this series were good. These findings indicate that arthroplasty should be considered as the treatment of choice for aseptic osteonecrosis due to stage 3 and 4 sickle-cell disease in young patients. Use of uncemented implant and type of frictional torque are discussed.