Introduction: Splenectomy is the surgical removal of the spleen. It can be performed during various pathologies, ranging from abdominal trauma to hemoglobinopathies. The progress made in the knowledge of the immune fu...Introduction: Splenectomy is the surgical removal of the spleen. It can be performed during various pathologies, ranging from abdominal trauma to hemoglobinopathies. The progress made in the knowledge of the immune functions of the spleen and the fear of post-splenectomy infectious complications have favored the development of surgical or non-surgical splenic preservation techniques calling into question the dogma of splenectomy. The aim of this study was to determine the indications for splenectomy. Methodology: This was a retrospective, descriptive study lasting 5 years in the general surgery department of the Ignace Deen National Hospital. All files of splenectomized patients were included, our variables were clinical, therapeutic and progressive. Results: We collected 42 cases of splenectomies out of the 2478 surgical procedures performed, representing 1.7% of the department’s surgical activities. The average age was 44 years. The age group of 41 to 50 years was the most represented, i.e. 26% (n = 11) of cases. Sex ratio = 1. Abdominal pain was the reason for consultation in patients, i.e. 100% (n = 42) of cases. The antecedents were dominated by recurrent malaria with 52.3% (n = 22) of cases, then recurrent anemia in 21% (n = 9), and 16.7% (n = 7) had sickle cell disease. Splenomegaly was found in 31 patients, or 73.6%. Ultrasound was performed in all patients. The indications for splenectomy were: isolated splenomegaly with risk of rupture (38%, n = 16), hypersplenism (26%, n = 11) and trauma to the spleen (19.04%, n = 8). Total splenectomy was performed in all cases. The surgical consequences were favorable in 85.7%, (n = 36) with morbidity of 14% (n = 6) and mortality of 9.52% (n = 4). The average length of hospitalization was 10.4 days with extremes of 1 and 22 days. Conclusion: Splenectomy constitutes a relatively common surgical procedure in our context. The indications for splenectomy were isolated splenomegaly with risk of rupture, hypersplenism and trauma to the spleen and total splenectomy was the rule.展开更多
Aim: Evaluate the epidemiological profile of cyanotic congenital heart disease in Mali before the advent of extracorporeal circulation in the “B” Surgery Department at the Pont G University Hospital. Patients and Me...Aim: Evaluate the epidemiological profile of cyanotic congenital heart disease in Mali before the advent of extracorporeal circulation in the “B” Surgery Department at the Pont G University Hospital. Patients and Methods: This was a retrospective and descriptive study that took place from January 1, 2011 to December 31, 2017. The records of patients with cyanotic congenital heart disease in the “B” surgery department of Point G University Hospital were collected. Patients operated on for cyanotic congenital heart disease were included in this study. Non-operated patients were not included. Results: The records of 17 patients operated on for cyanotic congenital heart disease were retained. The average age of patients at the time of surgery was 5.18 years with extremes of 2 and 18 years. Boys were in the majority with 59%, i.e. a sex ratio of 1.42. Patients resided in Bamako in 82% of cases. Inbreeding was found in 35.3%. Eighty-eight percent of children were born at term and 94% had up-to-date vaccination status. The average duration of patient follow-up between diagnosis and surgical management was 5 years with extremes of 2 years and 12 years. Tetralogy of Fallot regular form was the most represented heart disease. Conclusion: Cyanogenic congenital heart disease remains the most frequent congenital pathologies in our country. They most often affect male children. Consanguinity is the most common etiological factor found. Tetralogy of Fallot regular form remains the most common.展开更多
Arteriovenous fistulas have a substantial impact on systemic hemodynamics, however their effect on extracorporeal circulation is not well understood. We report our clinical observation on the management under extracor...Arteriovenous fistulas have a substantial impact on systemic hemodynamics, however their effect on extracorporeal circulation is not well understood. We report our clinical observation on the management under extracorporeal circulation of a patient with renal insufficiency with a high-flow arteriovenous fistula. This is a 59-year-old man who was referred to us for surgical treatment of ischemic coronary artery disease in a context of anuric chronic renal failure. Hypothermia at 32°C is started from the start in CEC due to hyperflow at the level of the arteriovenous fistula. We performed two coronary artery bypasses of the marginal and IVA via the two internal thoracic arteries. The patient is hemofiltered in order to avoid hyperkalaemia and possibly avoid fluid overload related to filling per CEC. The clamping time was 71 minutes and the SCC lasted 141 minutes. There was no homologous transfusion in the operating room. It turns out that the input/output balance is zero at the end of the CEC. The postoperative course was simple.展开更多
<b><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:Verdana;"> Sigmoid colon volvulus is a medico-surgical emergency which represent...<b><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:Verdana;"> Sigmoid colon volvulus is a medico-surgical emergency which represents a common cause of colonic occlusion,</span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">it is characterized by strangulation of the sigmoid loop around its meso colic axis producing low mechanical occlusion </span></span></span><span><span><span style="font-family:" color:#c45911;"=""><a href="#ref1" target="_blank"><span style="font-family:Verdana;">[1]</span></a></span><span></span></span></span><span><span></span></span><span></span><span><span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">. Apart from this form conventionally described, the volvulus of the sigmoid colon can occur along an organoaxial axis. This form has been highlighted in the literature thanks to the diagnostic contribution of multi-detector scanners </span></span></span><span><span><span style="font-family:;" "=""><span style="color:#C45911;"><a href="#ref2" target="_blank"><span style="font-family:Verdana;">[2]</span></a></span></span></span></span><span><span></span></span><span></span><span><span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">. </span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"><b></b></span><b><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"></span></b> <span style="font-family:Verdana;">To determine the hospital frequency of sigmoid colon volvulus;to write the clinical and para-clinical aspects of sigmoid colon volvulus;write down the different treatments used for the management of sigmoid colon volvulus</span><span style="font-family:Verdana;">.</span></span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"><b></b></span><b><b><span style="font-family:Verdana;">Material and methods:</span></b><span style="font-family:Verdana;"></span></b><span style="font-family:Verdana;"> This was a retrospective and prospective study that took place from January 2008 to December 2020 in the General Surgery Department of Gabriel Touré. The retrospective phase ran from January 2008 to December 2019 and the prospective phase from January 2020 to December 2020.</span></span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"><b></b></span><b><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"></span></b><span style="font-family:Verdana;"> From January 2008 to December 2020, we collected 320 cases of patients operated on for sigmoid colon volvulus out of 7989 surgical emergencies over a 12-year period, or 3.64%. In our study, the most represented age group was between 16 and 60 years old, </span><i></i></span><i><i><span style="font-family:Verdana;">i</span></i></i></span></span><i><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">e</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"></span></span></span></i><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> 81.88%. The mean age was 42.6 ± 17.4 years with extremities of 16 and 90 years. The male sex was the most represented, 89% with a sex ratio of 8.41. The surgical history was found in 13.75% of our patients. The clinic was dominated by abdominal pain (100%), meteorism (100%), and gas and matter arrest (91.3%). The most common radiological image found in the ASP was the double jamb, </span><i><span style="font-family:Verdana;">i</span></i></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">e</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"><span style="font-family:Verdana;"> 74.69% of cases. We found sigmoid necrosis in 18.13% of cases. We found an absence of necrosis in the majority of cases, </span><i></i></span><i><i><span style="font-family:Verdana;">i</span></i></i></span></span></span><i><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">e</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"></span></span></span></i><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"><span style="font-family:Verdana;"> 91.56%. The most performed operative procedure in our patients was the RACR, </span><i></i></span><i><i><span style="font-family:Verdana;">i</span></i></i></span></span></span><i><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">e</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"></span></span></span></i><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> 75.63% of cases. The reoperation was performed in only 5.94% of our patients. Complications were grade V in 42.55% according to the Clavin Dindo classification.</span></span></span>展开更多
Introduction: Cancellation of surgical operation is a surgical operation registered in the official schedule the day before or added to the list after and not carried out on the operating day. The purpose of this work...Introduction: Cancellation of surgical operation is a surgical operation registered in the official schedule the day before or added to the list after and not carried out on the operating day. The purpose of this work was to determine the causes of cancellation of elective surgical operations in a major pediatric surgery department in Senegal. Patients and methods: It was a prospective and descriptive study of 278 patients scheduled during a period of 13 weeks. The study took place between April 3<sup>rd</sup>, 2017, and January 31<sup>st</sup>, 2018. Mean age was 2.9 years with extremes of 3 days and 15 years. The age group of 29 days to 30 months was the most represented (62.2%). Sex ratio was 1.41. Causes of cancellation were categorized into administrative and organizational causes, patient-related causes and staff-related causes. Results: Cancellation rate was 29.4%. Patient-related causes were most common (51.2%). Upper Respiratory tract infection (URTI) was commonest reason within this category (57.5%). Organizational causes (28.1%) came second and were mainly represented by the unavailability of the operating room (60.8%) related to breakdowns of anesthesia equipment. Finally, staff-related causes (20.7%) were due for most to the unavailability of the anesthesiologist (12 cases/17). Conclusion: Majority of causes that led to cancellation of elective surgical operations in our Pediatric surgery department are related to intercurrent illnesses affecting the patient, in particular URTI.展开更多
<strong>Introduction:</strong><b><span style="font-family:;" "=""> </span></b><span style="font-family:Verdana;">Scrotoschisis is a very rar...<strong>Introduction:</strong><b><span style="font-family:;" "=""> </span></b><span style="font-family:Verdana;">Scrotoschisis is a very rare congenital defect of the scrotum characterized by the exteriorization of one or two testes. We report a case of right scrotoschisis in a newborn as well as a review of the literature for an approach of probable etiology.</span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Patient and Observation:</span></b><b><span style="font-family:;" "=""> </span></b><span style="font-family:Verdana;">A newborn baby of 8 hours of life, weighing 3200</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">g was referred to our department for a right scrotal defect with exteriorization of the testis associated with fluid swelling of the left bursa. The 18-year-old mother, primiparous and primigeste followed all the prenatal consultations with eutocic delivery. After clinical investigation the diagnosis of right scrotosisis and left hydrocele was retained. Surgical treatment was carried out by primary closure after orchidopexy and exploration of the contralateral bursa, the content of which was calcified meconium bathed in a yellowish liquid. The post-operative consequences were simple.</span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><b><span style="font-family:;" "=""> </span></b><span style="font-family:Verdana;">Scrotoschisis is an extremely rare birth defect whose etiology is poorly understood. However, it could be the cause of meconium peritonitis secondary to a scarred f</span><span style="font-family:Verdana;">a</span><span style="font-family:Verdana;">tal intestinal perforation.</span>展开更多
In Mali, few studies have concerned overall mortality in general surgery, but several specific studies have concerned the different affections. Reflection on the causes of death is an inherent part of the activity of ...In Mali, few studies have concerned overall mortality in general surgery, but several specific studies have concerned the different affections. Reflection on the causes of death is an inherent part of the activity of any motivated surgical team. <strong>Objective:</strong> To analyze the rate and the main causes of mortality in the General “A” surgical department of the Point “G” CHU. <strong>Patients Method:</strong> Our study was retrospective, descriptive and covered a period of 5 years from 01/01/2014 to 12/31/2018. We collected 152 deaths for 2011 hospitalized patients. The data were collected from the files of these deaths on pre-established investigation forms. The deceased patients were classified as operative and non-operative death, death from non-cancerous and cancerous diseases, deaths occurring in emergencies and deaths in regulated surgery. <strong>Results:</strong> We recorded 152 cases of death for 2011 hospitalized patients, either an overall mortality rate of 7.55%. The average age of deaths was 44.20 years +- 17.51 years with extremes ranging from 7 years to 85 years. The sex ratio was 1.62 in favor of men. The causes of death were represented by cancerous pathologies (69 deaths or 34.67%), non-cancerous pathologies (83 deaths or 4.58%). <strong>Conclusion:</strong> The mortality rate in general surgery remains high and is mainly linked to cancerous pathologies and the delay in taking care of patients.展开更多
Introduction: Popliteal pterygium syndrome is a rare birth defect, combining craniofacial, genitourinary and musculoskeletal abnormalities. It is an autosomal dominant disease caused by a mutation in the IRF6 gene. We...Introduction: Popliteal pterygium syndrome is a rare birth defect, combining craniofacial, genitourinary and musculoskeletal abnormalities. It is an autosomal dominant disease caused by a mutation in the IRF6 gene. We report in this observation the 1<sup>st</sup> Guinean case corrected by the surgical method as well as a review of the literature for a diagnostic and therapeutic approach. Patient and observation: We present the case of a 7-day old male newborn weighing 2700 g who was received for bilateral cleft lip and palate, lower lip fossa or sinuses, bilateral popliteal pterygium, and triangular skin fold above the hallux. The patient underwent several surgical procedures aimed at correcting these abnormalities. The correction of the pterygium of the lower limbs was ensured by excision of the fibrous band, the tenoplasty in z of the calcaneal tendon on the right side and the skin plasty in z in series then immobilized by plaster splints. The immediate postoperative follow-up was straightforward. Conclusion: Popliteal pterygium syndrome is a rare congenital malformation, the diagnosis is primarily clinical. Early soft tissue lengthening surgery and serial z-skin plasty provide better correction of the knee pterygium. Correct correction of facial abnormalities gives the child a better appearance. The management of this syndrome is multidisciplinary.展开更多
<b><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:Verdana;"> Emergency medico-surgical ileosigmoid node is a rare cause of intesti...<b><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:Verdana;"> Emergency medico-surgical ileosigmoid node is a rare cause of intestinal obstruction. Diagnosis and treatment must be prompt. <b></b></span><b><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"></span></b> <span style="font-family:Verdana;">To determine the frequency of NIS, to describe the diagnostic aspects, therapeutic aspects and to analyze the postoperative effects. </span><b><b><span style="font-family:Verdana;">Methodology:</span></b><span style="font-family:Verdana;"></span></b> <span style="font-family:Verdana;">Retrospective</span> an<span style="font-family:Verdana;">d prospective study from January 2006 to December 2020 including all patients operated on for ileosigmoid node confirmed by the intraoperative diagnosis at the CHU Gabriel Touré. </span><span style="font-family:Verdana;"><b></b></span><b><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"></span></b><span style="font-family:Verdana;"> From January 2006 to December 2020 (15 years), 30 cases of ileo-sigmoid node were recorded in the service. During this period NIS accounted for 0.19% of surgeries. Abdominal pain was present in (100%) of cases, vomiting was present in 80% and cessation of materials and gas (57%). All of our patients underwent ASP and CT (1 case). All of our patients were operated on, and exploration revealed intestinal necrosis in 97%. The surgical procedures performed were colostomy according to </span><span style="font-family:Verdana;">HARTMANN (63%), anastomosis resection (16%), devolvulation (10%). Restoration of continuity was achieved in (73%). The postoperative consequences were straightforward in (80%). Morbidity was 17% including infection of the lining. Mortality was 3% (1 case). <b></b></span><b><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"></span></b> <span style="font-family:Verdana;">NIS is an emergency, the diagnosis and the management must be fast and precise.</span>展开更多
Acute appendicitis is an acute inflammation of the appendix. It is a surgical emergency. It was a prospective, descriptive and analytical study, between September 2015 and October 2021, focusing on acute appendicitis....Acute appendicitis is an acute inflammation of the appendix. It is a surgical emergency. It was a prospective, descriptive and analytical study, between September 2015 and October 2021, focusing on acute appendicitis. It is seen mainly in young subjects and in children, but not exclusively. Its diagnosis is essentially clinical. These were 124 patients operated on for acute appendicitis, with a male predominance: 78 men (62.90%) against 46 women (37.10%). The majority of patients came from Franceville (n = 66) 53.22%. The average age was 29.4 years (extremes 4 years and 54 years). The average admission time was +5.16 or -5.58 hours. Abdominal pain was the main reason for consultation. Physical signs were dominated by MAC Burney sign positivity in 91.1% of cases. Faced with certain doubtful cases, we requested an abdominal ultrasound. Phlegmonous appendicitis was the most frequent (n = 47) 45.96%. The ileocecal localization represented (n = 82) 66.12%, and other particularities in particular: Claudius AMIAND (n = 6), an appendicular duplication, appendicitis and pregnancy a case of crural appendicitis. Conventional appendectomy with burial by Mac Burney was the most used technique (n = 119) 95.42%. Anatomy pathology was rarely performed. The postoperative course was simple in 95.4% of cases. The average stay in inpatient surgery was 4.8 days. Isolated or combined antibiotic therapy was the rule. Postoperative follow-up at 1 month was systematic. Parietal suppuration was the main complication.展开更多
The objective of this study is to determine the epidemiological, clinical, paraclinical, therapeutic aspects, and the sensitivity to antibiotics for acute peritonitis at CHRAB Franceville. This was a prospective, desc...The objective of this study is to determine the epidemiological, clinical, paraclinical, therapeutic aspects, and the sensitivity to antibiotics for acute peritonitis at CHRAB Franceville. This was a prospective, descriptive and analytical study, between September 2015 and December 2021. Generalized acute peritonitis was one of the digestive surgical emergencies. There were 167 patients operated on for acute peritonitis, including 116 men (69.46%) and 51 women (30.34%). The majority of patients came from Franceville (n = 62) 37.12%. The average age was 33.4 years (extreme 4 years and 75 years). The admission time was on average +6.15 or -6.54 hours. The main etiology was acute appendicitis with (n = 122) 73.05%, followed by gastric perforations (n = 26) 15.56%, bowel perforations (n = 5) 2.99%. Some post-surgical cases (n = 4) 2.39%. Biological examinations found: hyperleukocytosis in 64.67% of cases, anemia in 52.9% of cases, and hematocrit down in 28.3% of cases. Ultrasounds found 17.36% peritoneal effusions and 12.57% acute appendicitis. The abdomen without preparation revealed 13.17% cases of pneumoperitoneum. Anatomy pathology found acute appendicitis, gastroduodenal ulcers, peritoneal tuberculosis, and peritoneal carcinomatosis. Biliary drainage choledotomy with Kher drain, supernumerary spleen splenectomy, hysterectomy. The average duration in intensive care was 6.5 days with extremes of 5 to 10 days. The average stay in inpatient surgery was 10.8 days. Isolated or combined antibiotic therapy was the rule. Postoperative follow-up at 1 month was systematic. Parietal suppuration was the main complication. We had recorded 2 cases of fistula and 4.19% of deaths.展开更多
Our objectives were to determine the frequency of breast cancer in young women, to determine the risk factors for breast cancer in young women, to detail the diagnostic process of the disease, to determine the differe...Our objectives were to determine the frequency of breast cancer in young women, to determine the risk factors for breast cancer in young women, to detail the diagnostic process of the disease, to determine the different therapeutic strategies. This was a retrospective and descriptive study going from January 2005 to December 2021, a period of 17 years. The study involved 87 women with an average age of 33.2 years. Patients consulted 66 times or 75.9% for breast mass. The size of the tumor was greater than or equal to 5 cm in 62 patients;it was localized in the supero external quadrant 41 times or 47.1%. Molecular classification revealed the following results: Luminal A 21.4%;receptive (HER2) positive 28.6%, and triple negative 42.9%. Stage II was the most represented with 47.4%. Histology found infiltrating carcinoma of non-specific type in 76 patients. The treatment was mastectomy axillary dissection in 66 patients, quadrantectomy + axillary dissection in 6 cases (6.9%) associated with radiotherapy in 6 patients, chemotherapy was performed in 79 of our patients and hormone therapy in 10 patients. Conclusion: Breast cancer is frequent in our country. Patients generally consult us at a late stage. The possibility of determining certain receptors and carrying out certain non-surgical treatments on site would improve the prognosis.展开更多
Objectives: To study the epidemio-clinical, therapeutic and evolutionary aspects of laryngeal cancers in the ENT department of the University Hospital Gabriel Toure. Materials and Methods: This was a descriptive, retr...Objectives: To study the epidemio-clinical, therapeutic and evolutionary aspects of laryngeal cancers in the ENT department of the University Hospital Gabriel Toure. Materials and Methods: This was a descriptive, retrospective study over a period of 11 years from January 2008 to December 2019. We made an exhaustive sampling of all cases of malignant tumors of the larynx in the ENT department of the University Hospital Gabriel TOURE. Variables studied: frequency, sex, age, clinic, imaging, histology, TNM classification, treatment received and follow-up time was 1 to 11 years. Result: we noted a male predominance (44 men/13 women). The average age was 52.23 years, with extremes of 32 and 74 years. Smoking was reported by 40 patients (72% of cases). The average in pack-years is 29.32 with extremes of 4 to 60 packs/ year. Alcoholism was reported by 6 patients (9% of cases). Squamous cell carcinoma was the predominant histological type (100%);extension to 2 or 3 floors was objectified in 69% of cases. Complementary radiotherapy in 26 patients after total laryngectomy. Chemotherapy was done in a neoadjuvant situation in 36 cases. Overall survival was: 52.6% at 1 year, 33.3% at 3 years;26.3% at 5 years and 12.28% at 11 years. Conclusion: Most often, late diagnosis is due to the absence of a national strategy and the underestimation of the first symptoms. Surgery coupled with radiotherapy is the treatment of choice.展开更多
Introduction: Endoscopic internal urethrotomy (EIU) is a method for stricture opening using transurethral incision by direct visualisation of the urethral channel, resulting in a widening of the urinary canal with the...Introduction: Endoscopic internal urethrotomy (EIU) is a method for stricture opening using transurethral incision by direct visualisation of the urethral channel, resulting in a widening of the urinary canal with the aim of improving the quality of bladder emptying. The aim of the study was to evaluate the indication and results of EIU in the treatment of stenosis of the male urethra in the Urology-Andrology Department of Kara Teaching Hospital. Methodology: This was a cross-sectional descriptive study with retrospective data collection in the Urology-Andrology department of Kara Teaching Hospital. It involved 21 records of patients with urethral stenosis treated by endoscopic internal urethrotomy (EIU) in the said department during the period from January 2021 to September 2023. The following variables were evaluated: age, circumstance of discovery, site, length, number, etiology of the urethral stenosis and evolution of the patients. Results: The mean age of the patients was 59.2 ± 11.7 years. Infectious etiology of stenosis was predominant with 10 patients (47.6%) followed by trauma with 5 cases (23.8%). The bulbar urethra was the most frequently observed site, with 11 cases (52.4%). The length was mostly less than 2 cm in 12 patients (57.1%). Stenosis was unique in 14 patients (66.7%). The mean postoperative follow-up time was 3.2 months. The result was immediately better in 11 patients (52.4%) and it was poor in 8 patients (38.1%) who required maintenance dilation sessions.展开更多
<strong>Introduction:</strong> The volvulus of the sigmoid colon is the twist of the sigmoid handle on its mesocolic axis, achieving a low occlusion by strangulation. <strong>Methodology:</strong&...<strong>Introduction:</strong> The volvulus of the sigmoid colon is the twist of the sigmoid handle on its mesocolic axis, achieving a low occlusion by strangulation. <strong>Methodology:</strong> The study was conducted in the surgery “A” department of the Teaching Hospital of Point G in Bamako. The study is retrospective and descriptive, over 5 years, ranging from January 2014 to December 2018. We conducted a comprehensive recruitment of all patients operated on for sigmoid volvulus during the study period. The only criterion for inclusion was patients operated on for volvulus of the sigmoid colon in the surgery “A” department of the Point G Hospital and the non-inclusion criteria were all patients operated on for other sigmoid pathologies without volvulation and patients operated on for other types of occlusions. <strong>Result:</strong> We conducted an exhaustive recruitment of 55 patients operated on for sigmoid volvulus during the study period. Sigmoid volvulus accounted for 13.75% of intestinal obstructions. The average age of patients was 48.013 ± 18.042 years with extremes of 24 years and 82 years. The age group 40 - 49 was the most represented at 21.8%. The sex ratio (M/F) was 8 in favour of male sex. The duration of the disease was less than 1-day in 50.94% of patients. There were two cases of ileo-sigmoid nodes. Immediate anastomosis resection was performed in 27 patients or 49.2% of cases. The time to restore continuity when specified was between 60 - 90 days and the median incision was the most common route of recovery at 80.8% of cases. The average length of hospitalization was 9 days with extremes of 2 days and 42 days. The morbidity rate was 7.3%. In our study we had 3 deaths or 5.5% of the cases. <strong>Conclusion:</strong> The volvulus of the sigmoid colon is the twist of the sigmoid handle on its mesocolic axis, achieving a low occlusion by strangulation. The volvulus of sigmoid is a serious surgical emergency that requires early diagnosis and management. In Mali, there is no validated consensus for the choice between immediate anastomosis resection if possible and multi-stage surgery. The purpose of this study is to evaluate the different surgical approaches carried out in the surgery “A” department of the Point G Hospital.展开更多
<strong>Introduction:</strong> Although its incidence has tended to decrease for several years, stomach cancer remains one of the most frequently diagnosed cancers worldwide. Globally, gastric cancer is th...<strong>Introduction:</strong> Although its incidence has tended to decrease for several years, stomach cancer remains one of the most frequently diagnosed cancers worldwide. Globally, gastric cancer is the 4<sup>th</sup> most common cancer in men, the 5<sup>th</sup> in women, and the third leading cause of cancer death in men, the 5<sup>th</sup> in women. <strong>Patients and Methods:</strong> This was an analytical, prospective and descriptive study. <strong>Study Framework:</strong> Our study took place in the “A” surgery department of the Point “G” Hospital in Bamako. <strong>Study Period:</strong> August 1, 2003 to August 31, 2005. The design and preparation phase of the fact sheet lasted 1 month. The data collection phase lasted 18 months. All the patients who consulted for gastric tumor had a record. The follow-up phase of the patients lasted 6 months during which the patients were followed by appointment, by contact person or seen at home. Data entry and analysis were conducted with Epi-Info software (version 6.0). <strong>Inclusion Criteria:</strong> All patients hospitalized for gastric cancer in the “A” surgery department of the Point “G” Hospital. <strong>Result:</strong> The distribution of patients according to the evolutionary stage TNM was: Stage IV (50 cases, or 64.94%);Stage III (21 cases, or 27.27%);Stage II (6 cases, or 7.79%). In our series the average age was 59 with extremes of 20 to 85 years. The most represented age group was 46 - 65 years. Men were 60 cases (77.90%) 17 cases for women (22.10%). The sex ratio was 3.53 in favor of men. All 77 patients were recruited during the outpatient clinic, including 55 patients referred by a physician and 20 patients who came by themselves. Esogastroduodenal fibroscopy was performed in all of our patients. The tumor was localized: to the cardia in 10 cases;cardiac fundus in 2 cases;antrum in 24 cases;antro-pyloric in 28 cases;Pylorus in 1 case;great curvature in 5 cases;small curvature in 2 cases. Postoperative complications were: parietal infection in 12 cases or 17.40%;digestive fistula in 3 cases and evisceration is 1.40%. The overall three-month survival rate was 51.90% and at 6 months was 48.10%. <strong>Conclusion:</strong> Stomach cancer is the most common digestive cancer in Mali. In Africa the diagnosis is usually late and the R1 lymph node dissections remain the basic technique, despite the results obtained in the Japanese series. The results of several major series argue for their effectiveness in improving patient survival.展开更多
<strong>Introduction:</strong> Appendicular peritonitis is a complication of acute appendicitis characterized by the spread of the infectious process in the peritoneal cavity thus achieving wide spread or ...<strong>Introduction:</strong> Appendicular peritonitis is a complication of acute appendicitis characterized by the spread of the infectious process in the peritoneal cavity thus achieving wide spread or localized purulent peritonitis;it’s a medico-surgical emergency. Our objectives are to determine the frequency, describe the clinical, therapeutic and prognostic aspects of peritonitis by appendicular perforations. <strong>Patients-Method:</strong> This was a 24-month retro, prospective, descriptive study from January 1, 2018 to December 31, 2019;conducted in the Bougouni Reference Health Center Surgery Unit. All patients of appendicular peritonitis at the Bougouni Reference Health Centre were included. <strong>Results:</strong> During the study period, 68 cases of generalized acute peritonitis including 30 appendicular peritonitis cases were collected. Appendicular peritonitis accounted for 44.1% of surgical procedures. Males accounted for 71.0% with a sex ratio of 1.2 at risk of men, the average age was 26.07 years. Abdominal pain and vomiting were the reasons for consultation in 86.7% and 76.7% of cases. Physical examination was used in most cases to make the diagnosis. X-ray of the abdomen without preparation, and abdominal ultrasound were performed systematically. Surgical treatment consisted of an appendectomy with peritoneal toilet followed by drainage. The average length of hospitalization was 8.8 days with extremes of 1 - 44 days. Hospital mortality was 3.3%;morbidity and high mortality were related to delayed consultation. <strong>Conclusion:</strong> Appendicular generalized acute peritonitis is a medical-surgical emergency with a high mortality rate associated with delayed management.展开更多
<strong>Introduction:</strong> Hemorrhoidal disease is the most common condition in proctology: it is defined by signs or symptoms attributed to hemorrhoids. There is no parallel between the extent of hemo...<strong>Introduction:</strong> Hemorrhoidal disease is the most common condition in proctology: it is defined by signs or symptoms attributed to hemorrhoids. There is no parallel between the extent of hemorrhoidal anatomical disease and the symptoms described by patients. Our objective was to assess the incidence of hemorrhoidal disease, to diagnose it and to propose therapeutics. <strong>Patients and Method:</strong> This was a prospective and descriptive study based on a pre-established protocol that had taken place over a 12-month period. All patients (92 cases) underwent a general examination and a proctological examination. Anoscopy has often been associated with rectoscope with or without biopsy of the rectal mucosa. The inclusion criteria were the finding of hemorrhoidal disease, associated or not with other proctological diseases and the criteria for non-inclusion was any other anorectal pathology. <strong>Results:</strong> Among our patients there were 69 men or 75% of cases and 23 women or 25% of cases. The sex ratio was 3 in favor of men, the average age was 35.42. The duration of progression of the disease was between 0 - 2 years in 59.78%. Constipation (60 cases or 66.3%) and diarrhea (60 cases or 22.8%) were the factors that triggered the disease. Hemorrhoids with 3 packets were the most common (49 cases or 53.26%). 56 patients were treated medically and 36 patients were operated on. The surgical technique was simple hemorrhoidectomy according to MILLIGAN and MORGAN. It was associated with a fissurectomy in 8.33% of cases, a fistulectomy in 13.90% of cases or a thrombectomy in 33.33%. Early surgical sequels were dominated by pain in all patients, rectorragie, and urine retention. We did not deplore any deaths. <strong>Conclusion:</strong> Hemorrhoidal disease is an anatomoclinical entity that is still poorly elucidated and no direct link between the nature of the lesions and symptomatology can be established.展开更多
Background: Surgical site infections (SSIs) remain a challenging medical problem, especially in cardiac surgery patients. There is a lack of studies evaluating the rate of and outcomes of SSIs following cardiac surger...Background: Surgical site infections (SSIs) remain a challenging medical problem, especially in cardiac surgery patients. There is a lack of studies evaluating the rate of and outcomes of SSIs following cardiac surgeries in Saudi Arabia. Aims: This study aimed to determine the incidence of SSIs after adult cardiac surgeries that were done in Madinah Cardiac Center, Saudi Arabia. Further, to identify the outcomes and risk factors contributing to death among surgical site infection patients. Methods: This was a 6-year, single-center, retrospective cohort study that included 93 consecutive patients who underwent adult cardiac surgery between August 2016 and August 2022. All adult patients aged 18 years or older who had clinical evidence of postoperative surgical wound infection were included. Preoperative, operative, and postoperative data (early and late) were collected from medical records. Microbiological culture reports and clinical outcomes were also recorded. Results: The study revealed a 9.1% (93/1021) incidence rate of SSIs. Of the 93 patients with SSIs, 60 had superficial incisional infections and 33 had deep infections with incidence rates of 5.9% and 3.2%, respectively. In-hospital mortality due to SSI was recorded in 4 out of 93 patients with an incidence rate of 4.3%. There was a significant association between the in-hospital mortality and the type of SSIs (p = 0.014). All non-survivors had deep SSIs. The type of cardiac surgery also showed a significant association with the in-hospital mortality (p = 0.017). Furthermore, the median duration of antibiotic administration was significantly longer in the non-survivors than in the survivors (72.5 vs 17, respectively, p Conclusions: In conclusion, the incidence of surgical wound infections following cardiac surgery is not low (9.1%);of which 3.2% were deep infections. The in-hospital mortality rate after treatment of SSIs was fortunately low (4.3%), and all non-survivors had deep SSIs. The non- survivors showed a significantly longer duration of antibiotics administration than survivors. Combined CABG and valve procedures showed a higher mortality rate (75%) than the isolated procedures.展开更多
In Mali, breast cancer remains a real health problem in the absence of an adequate and adapted health policy for their early diagnosis and their often late or even non-existent treatment. Objectives: This study aimed ...In Mali, breast cancer remains a real health problem in the absence of an adequate and adapted health policy for their early diagnosis and their often late or even non-existent treatment. Objectives: This study aimed to study the epidemiological, diagnostic, and therapeutic aspects of breast cancer to write the clinical aspects of breast cancer in the gynecology-obstetrics department of the CHU Gabriel Touré from 2020 to 2022. Methodology: This was a retrospective and descriptive study of 219 cases of breast cancer that were diagnosed in the gynecology and obstetrics department of the CHU Gabriel Touré in Bamako, from 2020 to 2022. Results: The annual frequency was 77.2 cases per year, the average age 45.55 years with extremes of 16 to 85 years;housewives represented 92.7%;multiparas were reported at 57%. Considering the history, the personal history of benign breast pathology was 55.6%. Regarding the localization, the left breast was the most affected with 53.9%, and the tumor was found in the supero-external quadrant in 53.9%. The cancer was metastatic in 81.28%. The diagnosis biopsy + histology contributed to 98.6%. The histological type was invasive carcinoma of non-specific type in 95%. As for the histoprognostic grade of SBR studied, grade II was predominant at 46%, grade III at 34.95%. The therapeutic strategy was chemotherapy in 83.1%. Neoadjuvant chemotherapy followed by surgery in 10%, primary surgery in 6.4%, radiotherapy in 0.5%. Conclusion: The major challenges in the fight against breast cancer in Mali remain a better organization of the system for early diagnosis, the establishment of a screening program, early diagnosis in women from the age of 40 and also adequate care.展开更多
文摘Introduction: Splenectomy is the surgical removal of the spleen. It can be performed during various pathologies, ranging from abdominal trauma to hemoglobinopathies. The progress made in the knowledge of the immune functions of the spleen and the fear of post-splenectomy infectious complications have favored the development of surgical or non-surgical splenic preservation techniques calling into question the dogma of splenectomy. The aim of this study was to determine the indications for splenectomy. Methodology: This was a retrospective, descriptive study lasting 5 years in the general surgery department of the Ignace Deen National Hospital. All files of splenectomized patients were included, our variables were clinical, therapeutic and progressive. Results: We collected 42 cases of splenectomies out of the 2478 surgical procedures performed, representing 1.7% of the department’s surgical activities. The average age was 44 years. The age group of 41 to 50 years was the most represented, i.e. 26% (n = 11) of cases. Sex ratio = 1. Abdominal pain was the reason for consultation in patients, i.e. 100% (n = 42) of cases. The antecedents were dominated by recurrent malaria with 52.3% (n = 22) of cases, then recurrent anemia in 21% (n = 9), and 16.7% (n = 7) had sickle cell disease. Splenomegaly was found in 31 patients, or 73.6%. Ultrasound was performed in all patients. The indications for splenectomy were: isolated splenomegaly with risk of rupture (38%, n = 16), hypersplenism (26%, n = 11) and trauma to the spleen (19.04%, n = 8). Total splenectomy was performed in all cases. The surgical consequences were favorable in 85.7%, (n = 36) with morbidity of 14% (n = 6) and mortality of 9.52% (n = 4). The average length of hospitalization was 10.4 days with extremes of 1 and 22 days. Conclusion: Splenectomy constitutes a relatively common surgical procedure in our context. The indications for splenectomy were isolated splenomegaly with risk of rupture, hypersplenism and trauma to the spleen and total splenectomy was the rule.
文摘Aim: Evaluate the epidemiological profile of cyanotic congenital heart disease in Mali before the advent of extracorporeal circulation in the “B” Surgery Department at the Pont G University Hospital. Patients and Methods: This was a retrospective and descriptive study that took place from January 1, 2011 to December 31, 2017. The records of patients with cyanotic congenital heart disease in the “B” surgery department of Point G University Hospital were collected. Patients operated on for cyanotic congenital heart disease were included in this study. Non-operated patients were not included. Results: The records of 17 patients operated on for cyanotic congenital heart disease were retained. The average age of patients at the time of surgery was 5.18 years with extremes of 2 and 18 years. Boys were in the majority with 59%, i.e. a sex ratio of 1.42. Patients resided in Bamako in 82% of cases. Inbreeding was found in 35.3%. Eighty-eight percent of children were born at term and 94% had up-to-date vaccination status. The average duration of patient follow-up between diagnosis and surgical management was 5 years with extremes of 2 years and 12 years. Tetralogy of Fallot regular form was the most represented heart disease. Conclusion: Cyanogenic congenital heart disease remains the most frequent congenital pathologies in our country. They most often affect male children. Consanguinity is the most common etiological factor found. Tetralogy of Fallot regular form remains the most common.
文摘Arteriovenous fistulas have a substantial impact on systemic hemodynamics, however their effect on extracorporeal circulation is not well understood. We report our clinical observation on the management under extracorporeal circulation of a patient with renal insufficiency with a high-flow arteriovenous fistula. This is a 59-year-old man who was referred to us for surgical treatment of ischemic coronary artery disease in a context of anuric chronic renal failure. Hypothermia at 32°C is started from the start in CEC due to hyperflow at the level of the arteriovenous fistula. We performed two coronary artery bypasses of the marginal and IVA via the two internal thoracic arteries. The patient is hemofiltered in order to avoid hyperkalaemia and possibly avoid fluid overload related to filling per CEC. The clamping time was 71 minutes and the SCC lasted 141 minutes. There was no homologous transfusion in the operating room. It turns out that the input/output balance is zero at the end of the CEC. The postoperative course was simple.
文摘<b><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:Verdana;"> Sigmoid colon volvulus is a medico-surgical emergency which represents a common cause of colonic occlusion,</span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">it is characterized by strangulation of the sigmoid loop around its meso colic axis producing low mechanical occlusion </span></span></span><span><span><span style="font-family:" color:#c45911;"=""><a href="#ref1" target="_blank"><span style="font-family:Verdana;">[1]</span></a></span><span></span></span></span><span><span></span></span><span></span><span><span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">. Apart from this form conventionally described, the volvulus of the sigmoid colon can occur along an organoaxial axis. This form has been highlighted in the literature thanks to the diagnostic contribution of multi-detector scanners </span></span></span><span><span><span style="font-family:;" "=""><span style="color:#C45911;"><a href="#ref2" target="_blank"><span style="font-family:Verdana;">[2]</span></a></span></span></span></span><span><span></span></span><span></span><span><span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">. </span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"><b></b></span><b><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"></span></b> <span style="font-family:Verdana;">To determine the hospital frequency of sigmoid colon volvulus;to write the clinical and para-clinical aspects of sigmoid colon volvulus;write down the different treatments used for the management of sigmoid colon volvulus</span><span style="font-family:Verdana;">.</span></span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"><b></b></span><b><b><span style="font-family:Verdana;">Material and methods:</span></b><span style="font-family:Verdana;"></span></b><span style="font-family:Verdana;"> This was a retrospective and prospective study that took place from January 2008 to December 2020 in the General Surgery Department of Gabriel Touré. The retrospective phase ran from January 2008 to December 2019 and the prospective phase from January 2020 to December 2020.</span></span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"><b></b></span><b><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"></span></b><span style="font-family:Verdana;"> From January 2008 to December 2020, we collected 320 cases of patients operated on for sigmoid colon volvulus out of 7989 surgical emergencies over a 12-year period, or 3.64%. In our study, the most represented age group was between 16 and 60 years old, </span><i></i></span><i><i><span style="font-family:Verdana;">i</span></i></i></span></span><i><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">e</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"></span></span></span></i><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> 81.88%. The mean age was 42.6 ± 17.4 years with extremities of 16 and 90 years. The male sex was the most represented, 89% with a sex ratio of 8.41. The surgical history was found in 13.75% of our patients. The clinic was dominated by abdominal pain (100%), meteorism (100%), and gas and matter arrest (91.3%). The most common radiological image found in the ASP was the double jamb, </span><i><span style="font-family:Verdana;">i</span></i></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">e</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"><span style="font-family:Verdana;"> 74.69% of cases. We found sigmoid necrosis in 18.13% of cases. We found an absence of necrosis in the majority of cases, </span><i></i></span><i><i><span style="font-family:Verdana;">i</span></i></i></span></span></span><i><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">e</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"></span></span></span></i><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"><span style="font-family:Verdana;"> 91.56%. The most performed operative procedure in our patients was the RACR, </span><i></i></span><i><i><span style="font-family:Verdana;">i</span></i></i></span></span></span><i><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">e</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><i><span style="font-family:Verdana;">.</span></i></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"></span></span></span></i><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> 75.63% of cases. The reoperation was performed in only 5.94% of our patients. Complications were grade V in 42.55% according to the Clavin Dindo classification.</span></span></span>
文摘Introduction: Cancellation of surgical operation is a surgical operation registered in the official schedule the day before or added to the list after and not carried out on the operating day. The purpose of this work was to determine the causes of cancellation of elective surgical operations in a major pediatric surgery department in Senegal. Patients and methods: It was a prospective and descriptive study of 278 patients scheduled during a period of 13 weeks. The study took place between April 3<sup>rd</sup>, 2017, and January 31<sup>st</sup>, 2018. Mean age was 2.9 years with extremes of 3 days and 15 years. The age group of 29 days to 30 months was the most represented (62.2%). Sex ratio was 1.41. Causes of cancellation were categorized into administrative and organizational causes, patient-related causes and staff-related causes. Results: Cancellation rate was 29.4%. Patient-related causes were most common (51.2%). Upper Respiratory tract infection (URTI) was commonest reason within this category (57.5%). Organizational causes (28.1%) came second and were mainly represented by the unavailability of the operating room (60.8%) related to breakdowns of anesthesia equipment. Finally, staff-related causes (20.7%) were due for most to the unavailability of the anesthesiologist (12 cases/17). Conclusion: Majority of causes that led to cancellation of elective surgical operations in our Pediatric surgery department are related to intercurrent illnesses affecting the patient, in particular URTI.
文摘<strong>Introduction:</strong><b><span style="font-family:;" "=""> </span></b><span style="font-family:Verdana;">Scrotoschisis is a very rare congenital defect of the scrotum characterized by the exteriorization of one or two testes. We report a case of right scrotoschisis in a newborn as well as a review of the literature for an approach of probable etiology.</span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Patient and Observation:</span></b><b><span style="font-family:;" "=""> </span></b><span style="font-family:Verdana;">A newborn baby of 8 hours of life, weighing 3200</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">g was referred to our department for a right scrotal defect with exteriorization of the testis associated with fluid swelling of the left bursa. The 18-year-old mother, primiparous and primigeste followed all the prenatal consultations with eutocic delivery. After clinical investigation the diagnosis of right scrotosisis and left hydrocele was retained. Surgical treatment was carried out by primary closure after orchidopexy and exploration of the contralateral bursa, the content of which was calcified meconium bathed in a yellowish liquid. The post-operative consequences were simple.</span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><b><span style="font-family:;" "=""> </span></b><span style="font-family:Verdana;">Scrotoschisis is an extremely rare birth defect whose etiology is poorly understood. However, it could be the cause of meconium peritonitis secondary to a scarred f</span><span style="font-family:Verdana;">a</span><span style="font-family:Verdana;">tal intestinal perforation.</span>
文摘In Mali, few studies have concerned overall mortality in general surgery, but several specific studies have concerned the different affections. Reflection on the causes of death is an inherent part of the activity of any motivated surgical team. <strong>Objective:</strong> To analyze the rate and the main causes of mortality in the General “A” surgical department of the Point “G” CHU. <strong>Patients Method:</strong> Our study was retrospective, descriptive and covered a period of 5 years from 01/01/2014 to 12/31/2018. We collected 152 deaths for 2011 hospitalized patients. The data were collected from the files of these deaths on pre-established investigation forms. The deceased patients were classified as operative and non-operative death, death from non-cancerous and cancerous diseases, deaths occurring in emergencies and deaths in regulated surgery. <strong>Results:</strong> We recorded 152 cases of death for 2011 hospitalized patients, either an overall mortality rate of 7.55%. The average age of deaths was 44.20 years +- 17.51 years with extremes ranging from 7 years to 85 years. The sex ratio was 1.62 in favor of men. The causes of death were represented by cancerous pathologies (69 deaths or 34.67%), non-cancerous pathologies (83 deaths or 4.58%). <strong>Conclusion:</strong> The mortality rate in general surgery remains high and is mainly linked to cancerous pathologies and the delay in taking care of patients.
文摘Introduction: Popliteal pterygium syndrome is a rare birth defect, combining craniofacial, genitourinary and musculoskeletal abnormalities. It is an autosomal dominant disease caused by a mutation in the IRF6 gene. We report in this observation the 1<sup>st</sup> Guinean case corrected by the surgical method as well as a review of the literature for a diagnostic and therapeutic approach. Patient and observation: We present the case of a 7-day old male newborn weighing 2700 g who was received for bilateral cleft lip and palate, lower lip fossa or sinuses, bilateral popliteal pterygium, and triangular skin fold above the hallux. The patient underwent several surgical procedures aimed at correcting these abnormalities. The correction of the pterygium of the lower limbs was ensured by excision of the fibrous band, the tenoplasty in z of the calcaneal tendon on the right side and the skin plasty in z in series then immobilized by plaster splints. The immediate postoperative follow-up was straightforward. Conclusion: Popliteal pterygium syndrome is a rare congenital malformation, the diagnosis is primarily clinical. Early soft tissue lengthening surgery and serial z-skin plasty provide better correction of the knee pterygium. Correct correction of facial abnormalities gives the child a better appearance. The management of this syndrome is multidisciplinary.
文摘<b><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:Verdana;"> Emergency medico-surgical ileosigmoid node is a rare cause of intestinal obstruction. Diagnosis and treatment must be prompt. <b></b></span><b><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"></span></b> <span style="font-family:Verdana;">To determine the frequency of NIS, to describe the diagnostic aspects, therapeutic aspects and to analyze the postoperative effects. </span><b><b><span style="font-family:Verdana;">Methodology:</span></b><span style="font-family:Verdana;"></span></b> <span style="font-family:Verdana;">Retrospective</span> an<span style="font-family:Verdana;">d prospective study from January 2006 to December 2020 including all patients operated on for ileosigmoid node confirmed by the intraoperative diagnosis at the CHU Gabriel Touré. </span><span style="font-family:Verdana;"><b></b></span><b><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"></span></b><span style="font-family:Verdana;"> From January 2006 to December 2020 (15 years), 30 cases of ileo-sigmoid node were recorded in the service. During this period NIS accounted for 0.19% of surgeries. Abdominal pain was present in (100%) of cases, vomiting was present in 80% and cessation of materials and gas (57%). All of our patients underwent ASP and CT (1 case). All of our patients were operated on, and exploration revealed intestinal necrosis in 97%. The surgical procedures performed were colostomy according to </span><span style="font-family:Verdana;">HARTMANN (63%), anastomosis resection (16%), devolvulation (10%). Restoration of continuity was achieved in (73%). The postoperative consequences were straightforward in (80%). Morbidity was 17% including infection of the lining. Mortality was 3% (1 case). <b></b></span><b><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"></span></b> <span style="font-family:Verdana;">NIS is an emergency, the diagnosis and the management must be fast and precise.</span>
文摘Acute appendicitis is an acute inflammation of the appendix. It is a surgical emergency. It was a prospective, descriptive and analytical study, between September 2015 and October 2021, focusing on acute appendicitis. It is seen mainly in young subjects and in children, but not exclusively. Its diagnosis is essentially clinical. These were 124 patients operated on for acute appendicitis, with a male predominance: 78 men (62.90%) against 46 women (37.10%). The majority of patients came from Franceville (n = 66) 53.22%. The average age was 29.4 years (extremes 4 years and 54 years). The average admission time was +5.16 or -5.58 hours. Abdominal pain was the main reason for consultation. Physical signs were dominated by MAC Burney sign positivity in 91.1% of cases. Faced with certain doubtful cases, we requested an abdominal ultrasound. Phlegmonous appendicitis was the most frequent (n = 47) 45.96%. The ileocecal localization represented (n = 82) 66.12%, and other particularities in particular: Claudius AMIAND (n = 6), an appendicular duplication, appendicitis and pregnancy a case of crural appendicitis. Conventional appendectomy with burial by Mac Burney was the most used technique (n = 119) 95.42%. Anatomy pathology was rarely performed. The postoperative course was simple in 95.4% of cases. The average stay in inpatient surgery was 4.8 days. Isolated or combined antibiotic therapy was the rule. Postoperative follow-up at 1 month was systematic. Parietal suppuration was the main complication.
文摘The objective of this study is to determine the epidemiological, clinical, paraclinical, therapeutic aspects, and the sensitivity to antibiotics for acute peritonitis at CHRAB Franceville. This was a prospective, descriptive and analytical study, between September 2015 and December 2021. Generalized acute peritonitis was one of the digestive surgical emergencies. There were 167 patients operated on for acute peritonitis, including 116 men (69.46%) and 51 women (30.34%). The majority of patients came from Franceville (n = 62) 37.12%. The average age was 33.4 years (extreme 4 years and 75 years). The admission time was on average +6.15 or -6.54 hours. The main etiology was acute appendicitis with (n = 122) 73.05%, followed by gastric perforations (n = 26) 15.56%, bowel perforations (n = 5) 2.99%. Some post-surgical cases (n = 4) 2.39%. Biological examinations found: hyperleukocytosis in 64.67% of cases, anemia in 52.9% of cases, and hematocrit down in 28.3% of cases. Ultrasounds found 17.36% peritoneal effusions and 12.57% acute appendicitis. The abdomen without preparation revealed 13.17% cases of pneumoperitoneum. Anatomy pathology found acute appendicitis, gastroduodenal ulcers, peritoneal tuberculosis, and peritoneal carcinomatosis. Biliary drainage choledotomy with Kher drain, supernumerary spleen splenectomy, hysterectomy. The average duration in intensive care was 6.5 days with extremes of 5 to 10 days. The average stay in inpatient surgery was 10.8 days. Isolated or combined antibiotic therapy was the rule. Postoperative follow-up at 1 month was systematic. Parietal suppuration was the main complication. We had recorded 2 cases of fistula and 4.19% of deaths.
文摘Our objectives were to determine the frequency of breast cancer in young women, to determine the risk factors for breast cancer in young women, to detail the diagnostic process of the disease, to determine the different therapeutic strategies. This was a retrospective and descriptive study going from January 2005 to December 2021, a period of 17 years. The study involved 87 women with an average age of 33.2 years. Patients consulted 66 times or 75.9% for breast mass. The size of the tumor was greater than or equal to 5 cm in 62 patients;it was localized in the supero external quadrant 41 times or 47.1%. Molecular classification revealed the following results: Luminal A 21.4%;receptive (HER2) positive 28.6%, and triple negative 42.9%. Stage II was the most represented with 47.4%. Histology found infiltrating carcinoma of non-specific type in 76 patients. The treatment was mastectomy axillary dissection in 66 patients, quadrantectomy + axillary dissection in 6 cases (6.9%) associated with radiotherapy in 6 patients, chemotherapy was performed in 79 of our patients and hormone therapy in 10 patients. Conclusion: Breast cancer is frequent in our country. Patients generally consult us at a late stage. The possibility of determining certain receptors and carrying out certain non-surgical treatments on site would improve the prognosis.
文摘Objectives: To study the epidemio-clinical, therapeutic and evolutionary aspects of laryngeal cancers in the ENT department of the University Hospital Gabriel Toure. Materials and Methods: This was a descriptive, retrospective study over a period of 11 years from January 2008 to December 2019. We made an exhaustive sampling of all cases of malignant tumors of the larynx in the ENT department of the University Hospital Gabriel TOURE. Variables studied: frequency, sex, age, clinic, imaging, histology, TNM classification, treatment received and follow-up time was 1 to 11 years. Result: we noted a male predominance (44 men/13 women). The average age was 52.23 years, with extremes of 32 and 74 years. Smoking was reported by 40 patients (72% of cases). The average in pack-years is 29.32 with extremes of 4 to 60 packs/ year. Alcoholism was reported by 6 patients (9% of cases). Squamous cell carcinoma was the predominant histological type (100%);extension to 2 or 3 floors was objectified in 69% of cases. Complementary radiotherapy in 26 patients after total laryngectomy. Chemotherapy was done in a neoadjuvant situation in 36 cases. Overall survival was: 52.6% at 1 year, 33.3% at 3 years;26.3% at 5 years and 12.28% at 11 years. Conclusion: Most often, late diagnosis is due to the absence of a national strategy and the underestimation of the first symptoms. Surgery coupled with radiotherapy is the treatment of choice.
文摘Introduction: Endoscopic internal urethrotomy (EIU) is a method for stricture opening using transurethral incision by direct visualisation of the urethral channel, resulting in a widening of the urinary canal with the aim of improving the quality of bladder emptying. The aim of the study was to evaluate the indication and results of EIU in the treatment of stenosis of the male urethra in the Urology-Andrology Department of Kara Teaching Hospital. Methodology: This was a cross-sectional descriptive study with retrospective data collection in the Urology-Andrology department of Kara Teaching Hospital. It involved 21 records of patients with urethral stenosis treated by endoscopic internal urethrotomy (EIU) in the said department during the period from January 2021 to September 2023. The following variables were evaluated: age, circumstance of discovery, site, length, number, etiology of the urethral stenosis and evolution of the patients. Results: The mean age of the patients was 59.2 ± 11.7 years. Infectious etiology of stenosis was predominant with 10 patients (47.6%) followed by trauma with 5 cases (23.8%). The bulbar urethra was the most frequently observed site, with 11 cases (52.4%). The length was mostly less than 2 cm in 12 patients (57.1%). Stenosis was unique in 14 patients (66.7%). The mean postoperative follow-up time was 3.2 months. The result was immediately better in 11 patients (52.4%) and it was poor in 8 patients (38.1%) who required maintenance dilation sessions.
文摘<strong>Introduction:</strong> The volvulus of the sigmoid colon is the twist of the sigmoid handle on its mesocolic axis, achieving a low occlusion by strangulation. <strong>Methodology:</strong> The study was conducted in the surgery “A” department of the Teaching Hospital of Point G in Bamako. The study is retrospective and descriptive, over 5 years, ranging from January 2014 to December 2018. We conducted a comprehensive recruitment of all patients operated on for sigmoid volvulus during the study period. The only criterion for inclusion was patients operated on for volvulus of the sigmoid colon in the surgery “A” department of the Point G Hospital and the non-inclusion criteria were all patients operated on for other sigmoid pathologies without volvulation and patients operated on for other types of occlusions. <strong>Result:</strong> We conducted an exhaustive recruitment of 55 patients operated on for sigmoid volvulus during the study period. Sigmoid volvulus accounted for 13.75% of intestinal obstructions. The average age of patients was 48.013 ± 18.042 years with extremes of 24 years and 82 years. The age group 40 - 49 was the most represented at 21.8%. The sex ratio (M/F) was 8 in favour of male sex. The duration of the disease was less than 1-day in 50.94% of patients. There were two cases of ileo-sigmoid nodes. Immediate anastomosis resection was performed in 27 patients or 49.2% of cases. The time to restore continuity when specified was between 60 - 90 days and the median incision was the most common route of recovery at 80.8% of cases. The average length of hospitalization was 9 days with extremes of 2 days and 42 days. The morbidity rate was 7.3%. In our study we had 3 deaths or 5.5% of the cases. <strong>Conclusion:</strong> The volvulus of the sigmoid colon is the twist of the sigmoid handle on its mesocolic axis, achieving a low occlusion by strangulation. The volvulus of sigmoid is a serious surgical emergency that requires early diagnosis and management. In Mali, there is no validated consensus for the choice between immediate anastomosis resection if possible and multi-stage surgery. The purpose of this study is to evaluate the different surgical approaches carried out in the surgery “A” department of the Point G Hospital.
文摘<strong>Introduction:</strong> Although its incidence has tended to decrease for several years, stomach cancer remains one of the most frequently diagnosed cancers worldwide. Globally, gastric cancer is the 4<sup>th</sup> most common cancer in men, the 5<sup>th</sup> in women, and the third leading cause of cancer death in men, the 5<sup>th</sup> in women. <strong>Patients and Methods:</strong> This was an analytical, prospective and descriptive study. <strong>Study Framework:</strong> Our study took place in the “A” surgery department of the Point “G” Hospital in Bamako. <strong>Study Period:</strong> August 1, 2003 to August 31, 2005. The design and preparation phase of the fact sheet lasted 1 month. The data collection phase lasted 18 months. All the patients who consulted for gastric tumor had a record. The follow-up phase of the patients lasted 6 months during which the patients were followed by appointment, by contact person or seen at home. Data entry and analysis were conducted with Epi-Info software (version 6.0). <strong>Inclusion Criteria:</strong> All patients hospitalized for gastric cancer in the “A” surgery department of the Point “G” Hospital. <strong>Result:</strong> The distribution of patients according to the evolutionary stage TNM was: Stage IV (50 cases, or 64.94%);Stage III (21 cases, or 27.27%);Stage II (6 cases, or 7.79%). In our series the average age was 59 with extremes of 20 to 85 years. The most represented age group was 46 - 65 years. Men were 60 cases (77.90%) 17 cases for women (22.10%). The sex ratio was 3.53 in favor of men. All 77 patients were recruited during the outpatient clinic, including 55 patients referred by a physician and 20 patients who came by themselves. Esogastroduodenal fibroscopy was performed in all of our patients. The tumor was localized: to the cardia in 10 cases;cardiac fundus in 2 cases;antrum in 24 cases;antro-pyloric in 28 cases;Pylorus in 1 case;great curvature in 5 cases;small curvature in 2 cases. Postoperative complications were: parietal infection in 12 cases or 17.40%;digestive fistula in 3 cases and evisceration is 1.40%. The overall three-month survival rate was 51.90% and at 6 months was 48.10%. <strong>Conclusion:</strong> Stomach cancer is the most common digestive cancer in Mali. In Africa the diagnosis is usually late and the R1 lymph node dissections remain the basic technique, despite the results obtained in the Japanese series. The results of several major series argue for their effectiveness in improving patient survival.
文摘<strong>Introduction:</strong> Appendicular peritonitis is a complication of acute appendicitis characterized by the spread of the infectious process in the peritoneal cavity thus achieving wide spread or localized purulent peritonitis;it’s a medico-surgical emergency. Our objectives are to determine the frequency, describe the clinical, therapeutic and prognostic aspects of peritonitis by appendicular perforations. <strong>Patients-Method:</strong> This was a 24-month retro, prospective, descriptive study from January 1, 2018 to December 31, 2019;conducted in the Bougouni Reference Health Center Surgery Unit. All patients of appendicular peritonitis at the Bougouni Reference Health Centre were included. <strong>Results:</strong> During the study period, 68 cases of generalized acute peritonitis including 30 appendicular peritonitis cases were collected. Appendicular peritonitis accounted for 44.1% of surgical procedures. Males accounted for 71.0% with a sex ratio of 1.2 at risk of men, the average age was 26.07 years. Abdominal pain and vomiting were the reasons for consultation in 86.7% and 76.7% of cases. Physical examination was used in most cases to make the diagnosis. X-ray of the abdomen without preparation, and abdominal ultrasound were performed systematically. Surgical treatment consisted of an appendectomy with peritoneal toilet followed by drainage. The average length of hospitalization was 8.8 days with extremes of 1 - 44 days. Hospital mortality was 3.3%;morbidity and high mortality were related to delayed consultation. <strong>Conclusion:</strong> Appendicular generalized acute peritonitis is a medical-surgical emergency with a high mortality rate associated with delayed management.
文摘<strong>Introduction:</strong> Hemorrhoidal disease is the most common condition in proctology: it is defined by signs or symptoms attributed to hemorrhoids. There is no parallel between the extent of hemorrhoidal anatomical disease and the symptoms described by patients. Our objective was to assess the incidence of hemorrhoidal disease, to diagnose it and to propose therapeutics. <strong>Patients and Method:</strong> This was a prospective and descriptive study based on a pre-established protocol that had taken place over a 12-month period. All patients (92 cases) underwent a general examination and a proctological examination. Anoscopy has often been associated with rectoscope with or without biopsy of the rectal mucosa. The inclusion criteria were the finding of hemorrhoidal disease, associated or not with other proctological diseases and the criteria for non-inclusion was any other anorectal pathology. <strong>Results:</strong> Among our patients there were 69 men or 75% of cases and 23 women or 25% of cases. The sex ratio was 3 in favor of men, the average age was 35.42. The duration of progression of the disease was between 0 - 2 years in 59.78%. Constipation (60 cases or 66.3%) and diarrhea (60 cases or 22.8%) were the factors that triggered the disease. Hemorrhoids with 3 packets were the most common (49 cases or 53.26%). 56 patients were treated medically and 36 patients were operated on. The surgical technique was simple hemorrhoidectomy according to MILLIGAN and MORGAN. It was associated with a fissurectomy in 8.33% of cases, a fistulectomy in 13.90% of cases or a thrombectomy in 33.33%. Early surgical sequels were dominated by pain in all patients, rectorragie, and urine retention. We did not deplore any deaths. <strong>Conclusion:</strong> Hemorrhoidal disease is an anatomoclinical entity that is still poorly elucidated and no direct link between the nature of the lesions and symptomatology can be established.
文摘Background: Surgical site infections (SSIs) remain a challenging medical problem, especially in cardiac surgery patients. There is a lack of studies evaluating the rate of and outcomes of SSIs following cardiac surgeries in Saudi Arabia. Aims: This study aimed to determine the incidence of SSIs after adult cardiac surgeries that were done in Madinah Cardiac Center, Saudi Arabia. Further, to identify the outcomes and risk factors contributing to death among surgical site infection patients. Methods: This was a 6-year, single-center, retrospective cohort study that included 93 consecutive patients who underwent adult cardiac surgery between August 2016 and August 2022. All adult patients aged 18 years or older who had clinical evidence of postoperative surgical wound infection were included. Preoperative, operative, and postoperative data (early and late) were collected from medical records. Microbiological culture reports and clinical outcomes were also recorded. Results: The study revealed a 9.1% (93/1021) incidence rate of SSIs. Of the 93 patients with SSIs, 60 had superficial incisional infections and 33 had deep infections with incidence rates of 5.9% and 3.2%, respectively. In-hospital mortality due to SSI was recorded in 4 out of 93 patients with an incidence rate of 4.3%. There was a significant association between the in-hospital mortality and the type of SSIs (p = 0.014). All non-survivors had deep SSIs. The type of cardiac surgery also showed a significant association with the in-hospital mortality (p = 0.017). Furthermore, the median duration of antibiotic administration was significantly longer in the non-survivors than in the survivors (72.5 vs 17, respectively, p Conclusions: In conclusion, the incidence of surgical wound infections following cardiac surgery is not low (9.1%);of which 3.2% were deep infections. The in-hospital mortality rate after treatment of SSIs was fortunately low (4.3%), and all non-survivors had deep SSIs. The non- survivors showed a significantly longer duration of antibiotics administration than survivors. Combined CABG and valve procedures showed a higher mortality rate (75%) than the isolated procedures.
文摘In Mali, breast cancer remains a real health problem in the absence of an adequate and adapted health policy for their early diagnosis and their often late or even non-existent treatment. Objectives: This study aimed to study the epidemiological, diagnostic, and therapeutic aspects of breast cancer to write the clinical aspects of breast cancer in the gynecology-obstetrics department of the CHU Gabriel Touré from 2020 to 2022. Methodology: This was a retrospective and descriptive study of 219 cases of breast cancer that were diagnosed in the gynecology and obstetrics department of the CHU Gabriel Touré in Bamako, from 2020 to 2022. Results: The annual frequency was 77.2 cases per year, the average age 45.55 years with extremes of 16 to 85 years;housewives represented 92.7%;multiparas were reported at 57%. Considering the history, the personal history of benign breast pathology was 55.6%. Regarding the localization, the left breast was the most affected with 53.9%, and the tumor was found in the supero-external quadrant in 53.9%. The cancer was metastatic in 81.28%. The diagnosis biopsy + histology contributed to 98.6%. The histological type was invasive carcinoma of non-specific type in 95%. As for the histoprognostic grade of SBR studied, grade II was predominant at 46%, grade III at 34.95%. The therapeutic strategy was chemotherapy in 83.1%. Neoadjuvant chemotherapy followed by surgery in 10%, primary surgery in 6.4%, radiotherapy in 0.5%. Conclusion: The major challenges in the fight against breast cancer in Mali remain a better organization of the system for early diagnosis, the establishment of a screening program, early diagnosis in women from the age of 40 and also adequate care.
