Aristide Le Dantec Hospital Research Articles

Le prolapsus de la muqueuse urétrale chez la fillette: à propos de 12 cas et revue de la littérature

ObjectivesTo report on the epidemiological, diagnostic, and therapeutic aspects of urethral prolapse. Patients and methodsThe current study is a descriptive cross-sectional study over a period of 8 years (January 2006-December 2013). It was conducted on 12 patients aged under 16 and managed for urethral prolapse in the pediatric surgery department of the hospital Aristide Le Dantec. We studied the following variables: frequency, age, predisposing factors, clinical signs and investigations, treatment and evolution. ResultsOur annual incidence was 1.5 cases. The average age for our patients was 4.02 years. Genital hemorrhage (11 cases) was the main reason for consultation followed by dysuria (8 cases). Physical examination revealed a circular swelling below the clitoris with a cathétérisable opening in its center in all our patients. Urine analysis and culture performed in 10 patients revealed a germ in 2 cases. Surgical resection of the prolapsed mucosa was performed in all of our patients and was associated with a muco-cutaneous suture in 7 cases. The outcome was always favorable. ConclusionUrethral prolapse is a rare disease. Its diagnosis is clinical. Surgical excision is the radical treatment of urethral prolapse and is associated with a favorable outome.

Traumatic diaphragmatic injuries: epidemiological, diagnostic and therapeutic aspects.

IntroductionDiaphragmatic injuries include wounds and diaphragm ruptures, due to a thoracoabdominal blunt or penetrating traumas. Their incidence ranges between 0.8 and 15 %. The diagnosis is often delayed, despite several medical imaging techniques. The surgical management remains controversal, particularly for the choice of the surgical approach and technique. The mortality is mainly related to associated injuries. The aim of our study was to evaluate the incidence of diaphragmatic injuries occuring in thoraco-abdominal traumas, and to discuss their epidemiology, diagnosis and treatment.Patients and methodsWe performed a retrospective study over a period of 21 years, between January 1994 and June 2015 at the Department of General Surgery of the Aristide Le Dantec hospital in Dakar, Senegal. All patients diagnosed with diaphragmatic injuries were included in the study.ResultsOver the study period, 1535 patients had a thoraco-abdominal trauma. There were 859 cases of blunt trauma, and 676 penetrating chest or abdominal trauma. Our study involved 20 cases of diaphragmatic injuries (1.3 %). The sex-ratio was 4. The mean age was 33 years. Brawls represented 83.3 % (17 cases). Stab attacks represented 60 % (12 cases). The incidence of diaphragmatic injury was 2.6 %. The wound was in the thorax in 60 % (seven cases). Chest radiography was contributory in 45 % (nine cases). The diagnosis of wounds or ruptures of the diaphragm was done preoperatively in 45 % (nine cases). The diaphragmatic wound was on the left side in 90 % (18 cases) and its mean size was 4.3 cm. The surgical procedure involved a reduction of herniated viscera and a suture of the diaphragm by “X” non absorbable points in 85 % (17 cases). A thoracic aspiration was performed in all patients. Morbidity rate was 10 % and mortality rate 5 %.ConclusionThe diagnosis of diaphragmatic rupture and wounds remains difficult and often delayed. They should be kept in mind in any blunt or penetrating thoraco-abdominal trauma. Diaphragmatic lesions are usually located on the left side. Surgery is an efficient treatment.

Cancers de la prostate de score de Gleason supérieur ou égal à 8: Evaluation de la survie des patients

ObjectivesTo evaluate the oncological outcomes of patients treated for prostate cancer Gleason score ≥ 8 using as criteria: total PSA, overall survival and progression-free survival. Patients and methodsThis was a retrospective study in the Urology-andrology department of the Aristide Le Dantec hospital in Dakar, from 1st June 2010 - to October 31, 2014. We compiled the data of 30 patients with prostate cancer with a Gleason score ≥ 8. The treatments used were hormonal therapy and radical prostatectomy. ResultsThe median initial PSA level was 97.7ng/ml (2-32,047ng/ml). Prostate cancer was found in the metastatic phase in over half the cases (83.3%). The treatment was hormonal in 82.8% of cases. Median survival was 14 months and the average overall survival time was 13.18 months. The overall survival of the standard 6, 12, and 24 months was respectively 72.7, 54.5 and 0.9%. PFS at 3, 14 and 21 months was respectively 50, 16.7 and 8.3%. ConclusionProstate cancer with Gleason score ≥ 8 has a poor prognosis in our practice.

Aspects actuels de l’amibiase hépatique à Dakar. A propos de 48 observations

Hepatic amebiasis is the most common extraintestinal location of amebiasis. Common in the medical services of Dakar in the years 1970 to 1980, its incidence decreased recently. To determine the epidemiological, diagnostic, therapeutic and outcome features of hepatic amebiasis in the medical clinic of the Universitary Hospital Aristide Le Dantec of Dakar. It was a longitudinal study of 56 months in two parts: retrospective (January 2009- December 2011) and prospective (January 2012-August 2013). We included all patients with hepatic amebiasis confirmed by positive serology and those having « chocolate » appearance of pus with a good evolution under amebiasis treatment. We included 48 patients (prevalence 0.72 %). There were 40 men (sex-ratio = 5). The mean age of patients was 39 years (range 18 years - 66 years). The main clinical manifestations were abdominal pain (100%), hepatomegaly (87.5%) and fever (81.3%). Amebic serology was positive in 96.9 % of cases. The pus was chocolate in 77.4 % of cases. The main complications were represented by perforation (4 cases) and severe sepsis (5 cases). Metronidazole was prescribed in all patients. Medical treatment was instituted alone in 30 patients (62.5 %). It was associated with needle-aspiration in 3 cases (6.25 %) and percutaneous drainage in 15 cases (31.25 %). The outcome was favorable in 40 patients (83.3 %). Prevalence of hepatic amebiasis is decreasing in Universitary Hospital Aristide Le Dantec of Dakar.

Idiopathic Adult Nephrotic Syndrome: A Clinicopathological Study and Response to Steroid in a Sub-Saharan African Country

Introduction: Idiopathic nephrotic syndrome represents 25% to 30% of glomerulonephritis in adults. These glomerulonephritides are responsible of about the half of chronic kidney failure examined as well in United States as in Europe or Africa. The aim of this study was to determine the anatomoclinic, therapeutic and progression patterns of idiopathic nephritic syndrome in Dakar. Patients and Methods: It is a retrospective ten-year study in the nephrology department of Aristide Le Dantec Hospital. Patients with idiopathic nephrotic syndrome were included. We analyzed anatomoclinic, therapeutic and progression data of idiopathic nephrotic syndrome. Results: On 202 patients with nephrotic syndrome, 156 (77%) were primitive. The mean age was 29.7 ± 12 years with a sex ratio of 2.4. Edema was found in 98 patients (62.8%) and hypertension in 63 patients (40%). The mean proteinuria was 6.8 ± 4.8 g/24h. Histologic lesions found at renal biopsy were focal segmental glomerulosclerosis in 71 patients (45.5%), minimal change disease in 68 patients (43.5%) and membranous nephropathy in 8 patients (5%). 134 patients (85.8%) received steroids alone, 12 patients (7.6%) received cyclophosphamide and 4 patients (2.5%) azathioprine in association with steroids. 44 patients (28.2%) reached remission. The factors of poor prognosis were: age, above 40 years, proteinuria above 10 g/24h, existence of renal failure at admission, absence of use of steroids therapy. Conclusion: This study shows that idiopathic nephrotic syndrome is frequent in our country with a prevalence of 77%. The most common lesion found at the renal biopsy is the focal segmental glomerulosclerosis. Remission is found only in 28% which is very low. 33% of patients progress towards chronic kidney disease due to the lack of early diagnosis and the use of traditional medicine.

Scooter accidents in children at Aristide Le Dantec, Unversity Hospital of Dakar: a study of 74 cases

IntroductionLes accidents de scooter sont de plus en plus fréquents à Dakar. Le but de ce travail est de rapporter les aspects épidémiologiques et lésionnels des ces accidents chez l'enfant à Dakar.MéthodesUne étude rétrospective et descriptive a été menée dans le Service de Chirurgie Pédiatrique du CHU Aristide Le Dantec de Dakar entre le 1er janvier 2009 et le 31 décembre 2011. Nous avons étudié divers paramètres dont la fréquence, les aspects sociodémographiques et lésionnels.RésultatsLes accidents de scooter représentaient 12% des accidents de la voie publique. Ils étaient fréquents entre 12 heures et 14 heures (27%) et entre 18 heures et 20 heures (28,4%). Ils pouvaient survenir tous les jours et étaient fréquents pendant les mois d'avril (17,6%) et de juin (13,5%). Ils survenaient essentiellement dans la périphérie de Dakar (78%). La tranche de 3 à 8 ans (60,8%) était la plus touchée. Le sexe masculin était prédominant (sexe ratio de 1,5). Les piétons étaient les plus vulnérables (93,2%). La chute était le mécanisme dominant (98,7%). Les lésions touchaient surtout le membre inférieur (51,1%) et étaient constituées essentiellement de fracture.ConclusionLa fréquence des accidents de scooter chez l'enfant est liée à l'urbanisation galopante et à l'accroissement du parc automobile dans une presqu’île. Les victimes sont essentiellement des piétons et présentent le plus souvent des fractures.

Evolutionary Aspects of Electrocardiographic and Echocardiographic Manifestations in Systemic Lupus Erythematosus: Descriptive Longitudinal Study about 25 Cases in 18-Month Monitoring

Introduction: Systemic lupus erythematosus is a major systemic autoimmune disease of unknown cause. It can affect all organs and especially the heart with different proportions. The aim of this study was to determine the evolving electrocardiographic and echocardiographic features in systemic lupus erythematosus. Methodology: This study was carried out at the cardiology and dermatology Aristide Le Dantec Hospital. This is a descriptive longitudinal study conducted from January 2013 to October 2014. We included SLE patients who had at least two echocardiograms and electrocardiograms performed at least 3 months apart. Anamnestic information, electrocardiographic and echocardiographic features were reported on a pre-established survey form. Data were entered using Epi -info software version 3.5.1. Results: We included 25 patients. It was mentioned a female predominance (88%). The average age of patients was 35.5 years. All patients had dermatological signs of systemic lupus erythematosus. Cardiac events were found on clinical examination in 20% of cases. Sixty four percent (64%) of patients had an abnormal electrocardiogram dominated by left ventricular hypertrophy (24%). During 18 months of follow-up, we noted some electrocardiographic changes in 16% of cases. Ultrasound abnormalities were found in 40% of patients: 8% presented a slight expansion of the OG, a patient had impaired left ventricular function with the presence of a spontaneous contrast intra VG and increased filling pressures. Right ventricular function was impaired in one patient. Other abnormalities were found: 12% of aneurysm of the interatrial septum, 4% of atrial septal defect and 4% of pericardial detachment. Conclusion: Cardiovascular violations are fairly common in SLE patients. A study on a large sample and longterm could better assess cardiovascular complications in SLE patients and how they occurred.

EVALUATION DE LA PRISE EN CHARGE DE L’HYPOSPADIAS AU SERVICE DE CHIRURGIE PEDIATRIQUE DU CHU ARISTIDE LE DANTEC DE DAKAR: A PROPOS DE 39 CAS

Objective: To evaluate the outcomes of hypospadias surgery in our African context of practice. Patients and Methods: This is a retrospective study on 39 cases of hypospadias. This sample was collected over a period of 5 years from 1 June 2005 to May 31, 2010 at the department of paediatric surgery of Aristide Le Dantec Hospital in Dakar. Results: The average age of our patients was 4 years (6 months-14 years). Sixty nine percent of patients were older than 2 years. Hypospadias was anterior in 24 cases, middle in 13 cases and posterior in 2 cases. On the therapeutic level, all patients underwent a one stage repair. The surgical techniques most used were those of Mathieu (48.7%) and Duplay (23.1%). The stitches used for the urethroplasty was the PDS (5/0 to 7/0) in 10% of cases. The mean duration of urine drainage from the bladder was 4 days (3 and 7 days).The therapeutic results were considered good in 33.3% of cases, fair in 41% of cases and poor in 25.7% of cases. 53.8% of patients had complications, among those complications; urethro-cutaneous fistula was the most frequent with 57.1% of cases. Conclusion: The management of hypospadias in our working conditions is not yet satisfactory. Improving our results would be through improvement in technics and training of paediatric urologists involved in this type of surgery. Keys words: hypospadias children surgery results.

PROGNOSTIC FACTORS OF NON-HODGKIN LYMPHOMA: RETROSPECTIVE STUDY IN UNIT BLOOD SERVICE OF THE INTERNAL MEDICINE DANTEC IN DAKAR (SENEGAL)

INTRODUCTION: The non-Hodgkin's lymphoma is the monoclonal proliferation of B and T lymphocyte cells, responsible for the development of tumors in lymphoid organs. The objective of this study was to describe the prognostic factors for NHL and their impact in the care of patients METHODOLOGY: This is a descriptive retrospective study on patients hospitalized files Medical Clinic I of the Aristide Le Dantec Hospital from January 2005 to December 2009. Were included in the study, patients for whom diagnosis of non-Hodgkin lymphoma was made on the basis of the results of histological and / or immuno-phenotypic examination of the biopsy specimen. Prognostic factors were studied and classified according to the prognostic scores in order to assess their impact on patient survival. Data analysis was done thanks to the IPSS software and the significance level was set at p ≤ 5%. RESULTS: NHL 44 cases represented on all patients hospitalized for haematological malignancies during this period, a prevalence of 45.4%. We have noted an increase in the incidence of NHL 2005 to 2009. The sex ratio was 2.6 / 1 and the mean age was 46.77 years [17-78 years]. Among the general symptoms, fever and weight loss were in the forefront (61.4% of patients) and lymph nodes were the most frequent physical signs (75%) followed by splenomegaly (47.7%). anemia was found in 72.7% of cases, leukocytosis in 45.5% of cases and thrombocytopenia in 47.7% of patients. Thirty-seven point four percent of patients were classified stage IV Ann Arbor at diagnosis. The presence of general signs scalability B was observed in 70% of patients. Regarding the prognostic factors, the International Prognostic Index (IPI) was studied in 43.2% of patients (n = 19) patients showed that 16% (n = 3) were IPI 1; 37% (n = 7) had an intermediate risk (IPI 3 and 4) and the remaining 10% were high risk (IPI 4). The IPI adjusted for age (aaIPI), noted a correlation of the IPI with certain age groups (50 and 60 years, p = 0.00001, 60 and 70, p = 0.00001). All patients were classified LLC Binet stage C and FLIPI was low (1-2). Evolution were marked by a 100% survival for low-risk patients (with a statistically significant correlation between survival and IPI 1: p <0.00001) and a death rate of 100% for high-risk patients (p <0.00001). The evolution was marked by a prolonged clinical and laboratory remission in 61.3% of cases, 11.4% of patients lost to 27.4% of deceased patients. CONCLUSION: Poor prognostic factors for lymphomas are mainly represented by the advanced Ann Arbor, international prognostic index (IPI) high and the presence of clinical signs of disease progression of the dice inclusion.

Déshydratation et malnutrition : deux facteurs de risque de décès indépendants chez l’enfant sénégalais hospitalisé

Inpatient mortality is an indicator of the quality of care. We analyzed the mortality of under 5-year-old hospitalized children in the pediatric ward of Aristide Le Dantec Hospital for updating our data 10 years after our first study. We analyzed the data of the children hospitalized between 1 January and 31 December 2012. For each child, we collected anthropometric measurements converted to a z-score related to World Health Organization growth data. Logistic regression-generating models built separately with different anthropometric parameters were used to assess the risk of mortality according to children's characteristics. Data from 393 children were included. The overall mortality rate was 10% (39/393). Using logistic regression, the risk factors associated with death were severe wasting (odds ratio [OR]=8.27; 95% confidence interval [95% CI]) [3.79-18], male gender (OR=2.98; 95% CI [1.25-7.1]), dehydration (OR=5.4; 95% CI [2.54-13.43]) in the model using the weight-for-height z-score; male gender (OR=2.5; 95% CI [1.11-5.63]), dehydration (OR=8.43; 95% CI [3.83-18.5]) in the model using the height-for-age z-score; male gender (OR=2.7; 95% CI [1.19-6.24]), dehydration (OR=7.5; 95% CI [3.39-16.76]), severe deficit in the weight-for-age z-score (OR=2.4; 95% CI [1.11-5.63]) in the model using the weight-for-age z-score; and male gender (OR=2.5; 95% CI [1.11-5.63]) and dehydration (OR=8.43; 94% CI [3.83-18.5]) in the last model with mid-upper arm circumference (MUAC). Dehydration and malnutrition were two independent risk factors of death. The protocols addressing dehydration and malnutrition management should be audited and performed systematically for each child's anthropometric measurements at admission.

Problematic of Vascular Access for Hemodialysis in Sub-Saherienne Africa: Experience of Dakar

Aim: Vascular access is important for a good survive in hemodialysis. It can be temporary or permanent, and needs particular attention because of possible complications, especially infectious. We conducted a study to determine the type and the outcome of vascular access in two hemodialysis units in Dakar. Materials and Methods: A multicenter retrospective study was conducted from the 1st January 2005 to 10 September 2010 in two hemodialysis centers: Hospital Aristide Le Dantec and the MDTC (Multifunctional Diagnosis and Treatment Center) of Dakar. All the patients- regularly dialyzed since at least three months in these centers were included. Results: Sixty five patients were included. The mean age was 50.2 years with a sex ratio of 1.7. The mean duration in hemodialysis was 23.2 month. Only five patients (7.80%) had an AVF before starting in hemodialysis. Sixty patients (92.2%) started dialysis with a central venous catheter. Among them, 49 (81.6%) had a double lumen femoral catheter and 11 had a jugular one with 4 tunneled. Complications of vascular access were noted for 23 patients (39.7%) with 12 infections. Blood culture was positive for Staphylococcus Aureus in seven cases. Seven patients presented lower limb thrombophlebitis. Thrombosis of the catheter was noted in four patients. Radial arterio-venous fistula (AVF) was the first intention permanent access in 41 cases (64.1%) followed by cephalic AVF in 14 cases (21.9%) and basilic AVF in 9 (14%). AVF complications were presented in 56.9% of case (40 patients). Most of them was early defect in 18 cases (27.7%), thrombosis in 9 (13.8%) and stenosis in 5 (7.7%). Radial AVF infection to Staphylococcus Aureus was noted in 3 cases, and one pseudo aneurysm was noted. Conclusion: Vascular access for hemodialysis is a great problem in Senegal. More than two third of our patients start dialysis on venous catheters, this is far from the clinical practice guidelines.

Kimura’s Disease: A Case Report and Literature Review

Kimura’s disease, common pathology in the East, responsible of chronic neck swelling is rarely reported in sub-Saharan Africa. We reported a case which was observed in the internal medicine department of Aristide Le Dantec hospital in Dakar. This was a young 15-year-old, with no particular disease history, who had recurrent non-inflammatory swelling next to the left zygomatic bone associated with itching. Biology revealed an inflammatory syndrom, eosinophilia and increased serum IgE. The histological examination of the mass biopsy concluded to Kimura disease. The corticosteroid has reduced the size of the mass within a few weeks of treatment. Kimura’s disease is unknown in our regions. His painless character and chronic evolution delay the time of diagnosis. This case proves the reality of this disease, which must find a place in the diagnosis approach of cervical swelling.

Factors Related to Depression in Patients Undergoing Hemodialysis Due to Renal Failure in Senegal

Depression is often encountered with chronic diseases such as renal failure, for which the prognosis has been improved by hemodialysis. The occurrence of depression with these chronic ailments is related to several factors. The aim of this work was to identify risk factors for depression in a population of patients undergoing hemodialysis due to renal failure. We conducted a cross-sectional descriptive study from 1st January 2012 to 31st May 2014 in the setting of the hemodialysis unit of the Nephrology Department of the Aristide Le Dantec Hospital in Dakar, Senegal. The study population was comprised of chronic hemodialysis patients who had freely and unequivocally provided their informed consent. The self-reporting Beck Depression Inventory (BDI) short-form for depression was used. This short-form version of the BDI was a tool designed to allow the practitioner to perform a rapid assessment of depression. It consisted of 13 items. After administering this assessment, we also collected all the epidemiological and clinical data for this patient population using a pre-established form. Eight-three patients were recruited during the course of the study. These comprised 39 males (47%) and 44 females (53%), i.e. a sex ratio of 0.88. The mean age was 44.73 years, ranging from 18 to 79. The incidence of depression, according to the shortform BDI, for this population was 57.8%. The duration of the dialysis treatment and a diabetic background constituted the principal factors that correlated significantly with depression. Depression correlated neither with age, gender, nor marital status. Professional engagement, level of education, socioeconomic status and prior incidences of depression also did not correlate with the occurrence of depression. In this study, depression affected more than half of the individuals with renal failure. The principal risk factors were the duration of the dialysis treatment and a diabetic background.

Tuberculosis among Chronic Hemodialysis Patients: A Senegalese Single Center Experience

Summary: Tuberculosis is a common infectious disease in chronic hemodialysis due to alteration of the immune system associated with chronic kidney disease. The objectives of this study are to determine the prevalence of tuberculosis in chronic hemodialysis patients and to identify its diagnostic and therapeutic difficulties. Methods and patients: This was a descriptive retrospective study over a period of 20 years (1994-2014). It includes the records of periodic hemodialysis patients in the Nephrology Department of the Aristide Le Dantec University Teaching Hospital in Dakar which clinical symptoms and laboratory favor tuberculosis. Results: Of 258 chronic hemodialysis patients treated in Hospital Aristide Le Dantec hemodialysis center, 29 cases (11.4%) of tuberculosis disease are diagnosed. The mean age is 43.21 ± 12.48 years, and the sex-ratio is 0.8. The median time to onset of tuberculosis after initiation of hemodialysis is 22.86 ± 28.86 months. The diagnosis of tuberculosis is sure only in 17% of cases. Extra-pulmonary sites are found in 79% of cases. The average duration of treatment is 9.39 ± 1.64 months (6 - 13 months). Various treatment protocols are adopted. Mortality is 21%, 50% due to disseminated tuberculosis. Conclusion: The diagnosis of tuberculosis in the chronic hemodialysis patients is often difficult due to the atypical symptoms, the frequency of extra-pulmonary location and the lack of evidence of sure diagnosis.

PERFORATION GASTRIQUE INHABITUELLE PAR CORPS ETRANGERS METALLIQUES

Digestive foreign bodies are rare situations in adults outside a psychiatric context. Gastric perforation by metallic foreign bodiesis exceptional. Aim: To report a case of gastric perforation by multiple foreign bodies on psychiatric field. Observation: There was a patient of 28 years, followed for psychiatric illness, admitted to surgical emergencies of Aristide Le Dantec Hospital for acute abdomen. Physical examination had found a syndrome of peritoneal irritation on psychiatric table. Biology had shown leukocytosis and hemoconcentration. Radiography of the abdomen without preparation was objectified more opaque images, especially epigastric level. Surgical exploration showed a gastric perforation, peritoneal effusion, fifty coin and other miscellaneous items in the gastric cavity. The patient underwent extraction of foreign bodies, a biopsy of the banks of the perforation, a suture of the perforation with abdominal epiploplasty and toilet. The postoperative course was uneventful. Histological biopsy result returned Benin. The psychiatric opinion was in favor of a personality disorder Borderline category. Conclusion: digestive perforations on foreign bodies are extremely rare in adults where they often occur on psychiatric grounds. They are even rarer when foreign bodies responsible are many and varied. Keywords: foreign body, digestive perforation, psychiatric illness.

Complications urologiques de la chirurgie pelvienne au CHU Aristide Le Dantec de Dakar

ObjectivesTo determine the pelvic surgical operations resulting in urological injuries, to assess the different types of injuries and describe their management in the University Hospital Aristide Le Dantec of Dakar. Material and methodsWe did a retrospective study covering a period of eight years, reviewing the files of all patients who had urological injuries after pelvic surgery. The parameters studied were: age, the type of injury, the timing of diagnosis, the intervention responsible for the injury, the outcome after treatment. ResultsTwenty nine cases of urological injuries were diagnosed. The average age of our patients was 34,2 years +/-8,5 years; there was only one male patient. The average time to diagnosis was about seven weeks, and in 8 patients the diagnosis of injury was possible immediately. Caesarian section and hysterectomy were the predominant procedures responsible for injuries (37,93% and 34,48%, respectively). Section of ureter and vesicovaginal fistula represented 51,72% of all injuries (15 cases). The Results of reconstructive surgery where favorable in 82,75%(n=24), two patients died after surgery of the complication. ConclusionThe most frequent injuries were section of ureter and vesicovaginal fistula, often caused by gynecologic surgery.

Perforations digestives traumatiques : aspects anatomo-cliniques

AimsTo describe epidemiological and clinicopathological aspects of digestive traumatic perforations.Materials and methodsThis is a retrospective study of 9 years (January 1997 to December 2005) with a follow up of patients over 5 years. We were interested in the patients admitted to the surgical emergency unit of Aristide Le Dantec Hospital in Dakar for abdominal trauma with a digestive tract wound. All patients had undergone surgery which allowed confirmation of the gastrointestinal perforation.We studied the mechanism of injury, the circumstances of onset, the clinical presentation, the results of imaging and the location of the gastrointestinal lesion.ResultsThere were 55 patients, all males. The average age was 27 years. The mechanism was closed abdominal trauma in 21.8% of cases (n = 12) and open abdominal trauma in 78.2% of cases (n = 43). The circumstances of occurrence were brawls in 58.2% of cases (n = 32). The acute generalized peritonitis was predominating. Radiography of the abdomen without preparation showed pneumoperitoneum in a third of cases. The small intestine was the segment the most affected. A lesion from another intra-abdominal organ existed in 20% of cases (n = 11).ConclusionTraumatic bowel injuries occur more often in open injuries of the abdomen and the small intestine is the most wounded segment.

Clinical and pathological kidney aspects of sickle cell anemia at Dakar: study of 11 cases of renal biopsies

Few studies are devoted to the practice of renal biopsy in sickle cell nephropathy; our objective was to determine the histological and evolutionary patterns of renal lesions in sickle cell patients who underwent renal biopsy in Dakar. Methods:This was a retrospective multicentric study (conducted from December 2009 to August 2011) on renal biopsies performed on sickle cell anaemic patients at the Nephrology Department of Teaching Hospital Aristide Le Dantec and the Albert Royer Childrens Hospital. The histological, therapeutic and evolutionary data were analysed. From the 292 total renal biopsies, 11 (3.80%) were performed on sickle cell patients (6SS, 1SBth + 4 AS) with a mean age of 23.1 [13-51 years]. Nephrotic syndrome was the indication of renal biopsy in all cases. Focal segmental glomerulosclerosis was the most frequent histological finding (five cases), followed by a combination of various specific lesions (hypertrophy of glomerular and peritubular capillaries), minimal glomerular lesions (three cases), membranoproliferative glomerulonephritis (two cases) and extra-membranous glomerulonephritis (one case). Complete remission after treatment was achieved in seven cases and one patient expired. Three patients did not continue with follow-up appointments. Conclusions:Renal biopsy is not very frequent in the course of sickle cell anaemia and in most cases it is performed because of nephrotic syndrome. The histological findings are diverse with a predominance of focal segmental glomerulosclerosis.

Spontaneous bacterial peritonitis in Dakar, Senegal: study of 55 patients with cirrhosis.

To report the prevalence of spontaneous bacterial peritonitis (SBP) and its clinical and laboratory features in patients with cirrhosis followed at the Aristide Le Dantec Hospital in Dakar (Senegal). From May through December, 2010, we prospectively included patients with cirrhosis and a first episode of ascites on clinical examination. Diagnostic abdominal paracentesis was performed in all cases to determine the macroscopic appearance of the fluid, protein concentration, and cell count, and to culture the ascitic fluid in a blood culture bottle. SBP was diagnosed when the fluid contained more than 250 polymorphonuclear leukocytes per cubic millimeter of fluid. The data were analyzed with Epi-Info software, version 3.5.2. Comparisons used Fisher's exact and Chi-square tests, with significance set at p < 0.05. The study included 55 patients with cirrhosis, with a mean age of 45 years and a male/female sex ratio of 1.89 (36 men). The prevalence of SBP was 27.3%. Factors significantly associated with SBP were female gender, malnutrition, turbid appearance of the ascites, and neutrophilia. In samples from patients with SBP, the mean protein concentration was 20.7 g/L, the white cell count was 1797/mm(3), and the neutrophil count 1,102/mm(3). Ascitic fluid culture was positive in 20% of the SBP cases (n=3). In Dakar, cirrhosis is found especially in young adults, and the prevalence of SBP in our population was 27.3%. Improved technical equipment would improve the hospital's ability to determine the causes of cirrhosis and identify the various germs responsible for SBP.

Therapeutic Aspects of Chronic Bone Infections and Management Challenges

This study aims to investigate various aspects of the treatment of chronic bone infections and the challenges in their management. The characterization of treatment of 73 patients with chronic bone infection was reported. The four management challenges including consultation delay, immune depression, extreme variety of clinical manifestations and non-use of CT or MRI were discussed in this study. We conducted a retrospective study at Aristide Le Dantec Hospital on 90 cases of chronic bone infection in 73 patients. The mean duration of symptoms before consultation was 36 months. More than half of the patients had a productive fistula at the first consultation. Sickle cell anemia was found in 6 patients. Multiple lesions were found in 10 patients; and long bones were affected in 90% of cases. The bacterial culture was positive in 93.15%. Staphylococcus aureus was the most isolated germ (68.35%). Seventy-two out of seventy-three patients were operated on. The procedure depended on anatomical and radiological lesions. Surgical treatment was associated with antibiotherapy which was firstly probabilistic and secondarily adapted to the results of bacterial culture. A favorable trend was found in 41 patients (56.16%). 32 cases of adverse effects were noted (43.83%), and 27 patients had recurrence after a favorable outcome. Several complications and sequelae were observed demonstrating the tenacity of these chronic infections.