Main Reason For Consultation Research Articles

Maxillary Ameloblastoma, Epidemiological Aspects and Treatment at the Yalgado Ouedraogo University Hospital (Burkina Faso)

Purpose: To report any epidemiological, anatomo-clinical and therapeutic aspects of maxillary ameloblastoma at the Yalgado Ouedraogo University Hospital (CHU-YO). Materials and Method: This was a descriptive and retrospective study covering the period ranging from January 1, 2010 to December 31, 2016. All patients received in the stomatology department for maxillary ameloblastoma with histological confirmation were included in the study. Consultation registers were used as the basis for data collection. Results: In our study, 50 cases were reported, i.e. an incidence of 7.14 cases per year. The mean age was 30.16 years with a sex ratio of 0.56. Housewives were the most affected and the average time to consultation was 2.5 years. The site of the tumor was in the majority of cases the mandible 82%, with swelling as the main reason for consultation. X-rays showed a predominance of monogeodic images in 56% of the cases. Conservative surgery was performed in 56% of the cases. Conclusion: Ameloblastoma is common in our area, characterized by delayed consultation. Strengthening of the technical facilities and awareness campaigns for the populations for early consultation are required.

Post-Infectious Acute Glomerulonephritis in Child: Epidemiological, Clinical and Evolutionary Aspects in Gabriel Touré Teaching Hospital in Mali

Introduction: Acute post-infectious glomerulonephritis (APIGN) can be serious due to its complications that still occur in our countries. In this work, we aimed to study the epidemiological, clinical, biological and evolutionary aspects of APIGN. Patients and methods: We conducted a retrospective, descriptive study from January 1st, 2015 to December 31st, 2017 in the pediatric ward of the Gabriel Touré Teaching Hospital in Bamako. All children hospitalized for APIGN were included. Results: In two years, we included 10 children aged 7 years old on average; all from low socioeconomic backgrounds. The sex ratio was 1.5. On average, the children spent 15.8 days before our consultation. Edema was the main reason for consultation. We found a history of infection and high blood pressure in 30% each, and renal failure in 10% of the children. Hematuria and proteinuria were detected in 100% and 90%, respectively. Hypocomplementemia was observed in 66.6%. One third of the children had a positive antistreptolysin O. The average duration of hospital stay was 11.2 days. The evolution was favorable in 90%. Kidney failure was the leading cause of death. Conclusion: Acute post-infectious glomerulonephritis is still a reality in our context. Emphasis should be put on its prevention by improving the hygienic conditions, detection and the management of infections.

Arteriovenous Malformations: Clinical Aspects and Surgical Results

Arteriovenous malformations (AVM) are vascular malformations, broadband, formed of arterial and venous dysmorphic vessels interconnected directly without transition in a capillary bed. Arteriovenous malformation surgery is particularly demanding owing to the need to control bleeding. This is probably one of the most critical moments of arteriovenous malformation surgery. The purpose of this study is to analyzed the clinical aspects and evaluate the results of surgery in the treatment of these AVMs. This is a retrospective and descriptive study that took place in Dakar over a period from January 2004 to December 2017 on patients operated for arteriovenous malformations. The total number of our series was 11 cases. These AVMs represented 32.35% of all tumors and vascular malformations operated during this period. The mean age at surgery was 25 years old [1 year-56 years old]. A male predominance was noted with 7 male to 4 female (sex ratio 1.75). The average time of consultation was 8.3 years [1 months-30 months]. The main reason for consultation was the appearance of a mass in 11 cas. We noted a notion of traumatism or recent surgery were done in 4/11 before the onset of symptoms. The location of the lesions was at the head or the face (5 cases), neck (1 case), the upper member (2 cases), the lower member (3 cases). No multiple location were noted. After physical examination, two patients were classified Schobinger stage 1, stage 2 in 7 cases, 2 cases in stage 3. No patient was classified stage 4. The vascular Doppler ultrasound was performed in 10 cases (91%) and allowed to confirm the diagnosis in 10 cases. The CT angiography was performed in 8 cases (73%). It elicited the feeding artery and draining veins, the number of nidus and topography. We found 6 truncal AVM and 5 extratruncal including 4 limited. A first embolization was performed in 2 cases (18.2%). A one-stage surgery was performed in 7 cases and two times in 4 cases. The average hospital stay was 15 days [3 days-60 days]. The average healing time was 18 days [15 days-30 days]. Operative mortality as early mortality was zero. Late mortality was zero. The average follow-up time was 50.3 months [2 months-96 months]. In recent years, the multidisciplinary approach of tumors and vascular malformations has made important advances in the delineation of nosological frameworks and in the understanding of the natural history and structure of these complex lesions. This is why the treatment of these AVMs requires a multidisciplinary consultation exchange between vascular surgeons, plastic surgeons, interventional radiologists and anesthetists.

Epidemio-Clinical Profile of Skin Conditions in Pediatric Dermatology Consultation of the University Hospital of Treichville

Introduction: Dermatoses are common in the pediatric population. They have certain particularities such as the prevalence of the diaper dermatitis and genetic disorders. Paediatric dermatological problems are common, with some conditions requiring specialist consultation. Often appropriate diagnosis and therapy are sometime delayed in certain countries. Few studies have focused on pediatric aspects of skin diseases in C?te d’Ivoire. We initiated this work to contribute to a better knowledge of pediatric skin conditions in our work context. Material and Methods: This is a cross-sectional prospective, descriptive and analytical study carried out in the Dermatology Department of the University Hospital of Treichville from January 2015 to December 2017. Data from the study were collected on a survey card that included socio-demographic characteristics and clinical aspects. All children with cutaneous and mucosal disease seen in pediatric dermatology consultation have been taken into account in the study. Results: 11,487 patients were seen in dermatology consultation during the period of our study with only 302 children, a prevalence of 2.6%. The sex ratio was 0.9. The main reason for consultation was pruritus (22.65%). In 63.9% of the cases the child was referred by a family member whereas more than 1/3 of the children (39.07%) had previously been consulted by a pediatrician. Among children referred with a skin diagnosis, the half had a correct diagnosis The most prevalent disorders by category were dermatitis (57.9%) and infections (29.5%). Multiple diagnosis were made in 9.27% of the patients. The most common pathologies encountered were prurigo (23.2%), scabies (12.9%) and atopic dermatitis (9.6%). The lesions were mainly located on the head (23.31%) and the lower limbs (20.51%). In almost all cases (99.3%), the diagnosis was essentially clinical. Conclusion: Pediatric dermatoses are numerous and varied. They are dominated by Prurigo and Scabies. This study invites for close collaboration between pediatricians and dermatologists in order to optimize their therapeutic management. The knowledge of this spectrum of pediatric skin diseases would be useful for future health planning in order to reduce disease burden.

Childhood Heart Disease in Côte d’Ivoire: Retrospective Multicentric Study about 228 Cases

Introduction: In Cote d’Ivoire, the paediatrician has to face a diagnosis and management problem in front of pediatric heart disease, with consequent a high lethality. Objective: To describe the epidemiological, diagnostic, therapeutic and progressive aspects of childhood cardiopathy for the improvement of prognosis and professional practice. Materials and methods: This was a multicenter retrospective and descriptive study conducted from January 2011 to March 2016 in two main hospitals universities, one located in Abidjan and the other in Bouaké. It concerned children aged 0 to 15 admitted for cardiac disease diagnosed on clinical and/or echocardiographic arguments. The variables studied were the epidemiological, diagnostic, therapeutic and evolutionary aspects. Results: A total of 49.760 admissions including 228 infantile heart disease cases (congenital 113, acquired 51, indeterminate 64) are overall prevalence of 4.6‰. They involved 106 boys and 122 girls. In 74.6% of cases, the age was between 0 and 2 years. Respiratory distress 73.7% was the main reason for consultation. The main congenital heart diseases (CHD) are ventricular septal defect (VSD) (31%), atrial septal defect (ASD) (20.4%), atrioventricular canal (AVSD) (12.4%) and tetralogy of Fallot (TOF) (11.5%). As for acquired forms (AHD), rheumatic mitral insufficiency (41.2%) and tuberculous pericarditis (15.7%) were the two main causes. Treatment progress is marked by stabilization (71.1%) and death (14%). Death was significantly associated with low socioeconomic status (p = 0.01) and with complication (p 0.001). Conclusion: Infantile heart diseases are relatively less frequent and serious in Cote d’Ivoire. To improve the prognosis, close collaboration between the pediatrician and the cardiologist is required for early diagnosis and management.

Primary healthcare providers' practices related to non-malarial acute febrile illness in Burkina Faso.

In Africa, fever is the main reason for consultation, with malaria playing a prominent role. Studies have reported that the widespread use of rapid diagnostic tests for malaria, implemented since 2010, has revealed an increasing proportion of non-malaria acute febrile illnesses (NMAFI). It is an important public health issue because evidence shows that mortality is higher among patients presenting with non-malarial fever than among those with malaria. This cross-sectional study assessed the professional practices of healthcare providers in the management of NMAFI in urban and rural sites in Burkina Faso. Data was collected from 286 healthcare providers through a questionnaire based on the clinical situation in 2014. Factors have been associated using a hierarchical linear mixed model with random intercepts to model dependence of outcomes for healthcare providers working on the same site. Survey results showed limited knowledge about management of NMAFI, global survey score on General Practice Indicator being 60% (36.02/60.00). This gap was more evident at the admission and diagnosis level. The study's population from rural areas had better survey score than that of urban areas concerning the respect of adequacy diagnosis, treatment and use of antibiotics in NMAFI, 15.71 vs 13.93 mean score (p=0.01) (75 vs 66% on a 0 to 100% scale, with 100% being the best). Overall, more educated participants performed relatively better. A total of 46% (134/286) of participants felt that they needed training in at least one of the fever-related issues. Increased awareness and knowledge of management for NMAFI are urgently required in Burkina Faso. This must be done through regular supervision and training courses targeted specifically at primary healthcare providers.

Incidencia del duelo en la ruptura amorosa en estudiantes universitarios en un Centro de Crisis, Emergencias y Atención al Suicidio (CREAS)

The loving couple is the union of two beings that live intertwined steps through time, which determine the degree of intimacy and rapprochement. This relationship will be affected by the previous experiences of each one and by expectations they have about the relationship. Because it is an interaction between two individuals with different personal characteristics, there is the possibility that the relationship enters into conflict and fractures, breaking the bond of love, creating suffering. The purpose of this paper was to determine the incidence of breakup as the main reason of consultation at CREAS among a sample of college students of different schools. We also suggest techniques that therapists can use when working with students that request psychotherapy services. The results showed that 59.615% students reported a breakup as the main reason for consultation. Of this total, 46.923% were women and 12.692% men. 66.538% belong to the school of psychology. Findings may be related to the fact that psychology students have greater sensitivity to solve their problems. It is suggested to emphasize training in coping styles and problem solving from the cognitive-behavioral model.

Orthodontic-surgical treatment of a class II division 1 patient. Case report

The objective of this case report was to show the correction of a class II division 1 malocclusion in an adult patient. A female patient of 20 years of age attended the Orthodontics Clinic of the Division of Postgraduate Studies and Research of the Odontology Faculty at the National Autonomous University of Mexico. Her main reason for consultation was: «When I removed the wisdom teeth I was told that I could have orthognathic surgery but fi rst I needed braces»; this in order to correct the dentofacial disharmony. Upon facial clinical examination, the patient presented a mesofacial biotype with competent lips; vertically she presented an increased lower third. Her profile was convex with deficient chin projection. Intraorally, the patient exhibited upper and lower crowding, molar and canine class II, considerably increased overbite and overjet as well as noncoincident dental midlines. The cephalometric diagnosis showed a skeletal class II due to maxillary protrusion. It was suggested an orthodontic-surgical treatment in three phases: presurgical, surgical and postsurgical. In the presurgical phase the patient was decompensated in order to prepare her for surgery. During the surgical phase, mandibular sagittal osteotomies were performed to advance the mandible in combination with an advancement genioplasty. During the post-surgical phase, ideal occlusal relationships were achieved in terms of canine classes, overbite, overjet, dental midlines and fi nal detailing of the case. Through the treatment, the occlusion and facial harmony of the patient were improved.

Pancreatic Cancer: Epidemiological, Clinical and Therapeutic Aspects in Abidjan (Ivory Coast)

Aim: The aim was to study the epidemiological, clinical and therapeutic aspects of pancreatic cancers in Ivory Coast. Materials and methods: A retrospective multi-center and multidisciplinary study aimed at describing sixteen years and four months from January 1, 2000 to April 30, 2016 in several hospitals in the city of Abidjan taking charge of pancreatic cancers (hepato-gas troenterology services of the universities hospitals of Cocody and Yopougon), internal medicine departments of University Hospital of Treichville and Abidjan Military Hospital, the department of oncology of the university hospital center of Treichville, private clinics (DANGA, PISAM and GMP), the COBA center in Treichville. The diagnosis of cancer was based on either histological criteria or a set of clinical and paraclinical arguments. Patients whose files did not include imaging were excluded from this study. The following parameters were collected: age, sex, reason for consultation, physical signs, personal and family antecedents, tumor characteristics, delay in diagnosis and the nature of the treatment administered. Results: We have observed 150 cases of pancreatic cancer. The mean age of patients was 59.09 years with extremes ranging from 24 years to 88 years. Our study population consisted of 98 men and 52 women (sex ratio 1.88). Risk factors were dominated by diabetes 20.7%. Epigastralgia is the main reason for consultation (48%). The tumor was localized at the cephalic level in 84.67%. In 13 cases the diagnosis was histological and was dominated by adenocarcinoma (100%). The majority of our patients was seen at an advanced stage of the disease: stage IV (74.56%). The average time to diagnosis was 2.76 months. Fourteen of our patients (9.33%) had benefited surgery. This was curative surgery in 35.71% (n = 5) and palliative in 64.29% (n = 9). Among those who benefited from this curative surgery, three died two months after surgery and two lost to follow-up. The majority (90.67%) of our patients had received symptomatic treatment. Conclusion: Pancreatic cancer is an appalling cancer with a very bad and late diagnosis because of its insidious symptomatology. Most of the time, tumors had already metastasized before diagnosis, so the treatment is often symptomatic.

Prévalence de la dysfonction erectile en urologie

Erectile dysfunction is defined as persistent or recurrent inability of a man to achieve or maintain an adequate penile erection to allow sexual activity.The overall objective of this study was to estimate the prevalence of erectile dysfunction in patients consulting in urology.The analysis included 228 patients consulting in urology at Marrakech university hospital. The average age of patients was 45±15 years. The main reason for consultation, indicated by 34.4% of patients was lower urinary tract symptoms (LUTS). The prevalence of sexual disorders was generally estimated at 32.9% (95% CI=[29.8%, 40.5%]) and erectile dysfunction in particular from 31.5% (95% CI=[27%, 39, 9%]). The prevalence increased significantly (p<0.05) with age (37.1% for the age group [50–59] and 40.3% for the [60–70]) after 40 years. The form of moderate intensity was more frequent (41.7%). Among patients with erectile dysfunction, 31, 5% found it “completely unbearable”. However, only 11.8% consulted for sexual dysfunction. Our results show that erectile dysfunction is a common health problem, but rarely discussed by patients. This situation deserves more involvement of health providers in urology in dealing with early diagnosis and adequate management strategy.

Skeletal class III with laterognathia and lower facial third asymmetry. Surgical-orthodontic treatment

Female patient, 16 years of age, who attended the Department of Orthodontics at the National Autonomous University of Mexico. The main reason for consultation was: «I have a deviated jaw». Upon facial clinical examination, from the front view an oval and elongated face may be noted as well as an increased lower third, the chin deviated to the right, the facial midline did not match the dental midline, a non-consonant neutral smile and a 60% exposure of the incisor clinical crowns. On a lateral view: a straight profi le, competent lips, acute nasolabial angle and increased mentocervical length may be observed. Intraorally there is an ovoid-shaped arch, non-coincident dental midlines, crowded teeth, anterior and posterior right crossbite, absence of the first upper molars (nonassessable molar relationship) right and left canine class III, -2 mm overjet and a 2 mm overbite. Radiographic records included a lateral headfilm, a posteroanterior radiograph and a panoramic radiograph as well. The cephalometric analysis revealed a skeletal Class III due to mandibular prognathism, a neutral growth pattern, proclined upper incisors and lower incisor retroclination. The posteroanterior radiograph showed a discrepancy of the maxillo-mandibular line of 4o and a postural asymmetry of 5o. In the panoramic radiograph asymmetric mandibular ramus, ACJ at alveolar crest level, 2:¼ root-crown ratio, upper and lower third molars, absence of the first upper molars and maxillary lateral incisor root with endodontic treatment may be noted. Functionally, the patient presented without any apparent TMJ problems. Treatment consisted of three phase: pre-surgical orthodontic phase, surgical phase and post-surgical orthodontic phase. The objectives were: to correct in all three planes of space the skeletal disharmony presented by the patient, to provide functional occlusion and optimal facial and dental aesthetics as well as joint stability and periodontal health.

Trends in Utilization of Palliative Care by General Surgery Services (S770)

•Evaluate the trends for consults to Palliative Medicine by surgical services.•Evaluate the end of life care for surgical patients over time. Palliative Care (PC) focuses on symptom relief and quality of life improvement for patients, but it is often thought to be synonymous with end-of-life (EOL) care. The America Board of Surgeons has endorsed the incorporation of palliative principles into surgical care. To determine the trends of utilization of Palliative Care consultation by surgical services over time. A single institution retrospective chart review was utilized from 2006-2013. Patients on inpatient surgical service (general, vascular, cardiothoracic, transplant surgery) and who had a PC consult were identified. Charts were evaluated for patient demographics, admission and medical/surgical information, consult reason and disposition. Of the 358 consults the majority of the diagnoses were cancer-related (47.5%), 13.4% cardiac-related, and 13.7% vascular-related. The main reasons for PC consultation were clarifying goals of care, EOL issues and symptom management, with an increase in the number of consults over time. Discharge disposition included 30.2% dying in hospital, 17.3% to home hospice, 12.0% to hospice, and the remainder to home or rehab. 46.3% of the patients who died in hospital had a PC consult within a day of death. Since the initiation of a Palliative Care consult service at our hospital there has been an increase in the utilization of their services by surgical services. The main reason for consultation has been for goals of care and EOL care with an increase in consultation for assistance with symptom management. There continues to remain a significant portion of patients who died in the hospital with a significant portion of the consults placed late in the hospital course, specifically within a day of death.

Breast cancer in men: about 40 cases and literature review

Le cancer du sein chez l'homme est une affection rare représentant environ 1% de tous les cancers du sein et moins de 1% de l'ensemble des néoplasies masculines. L'objectif de notre étude est de décrire les différents aspects cliniques, histologique, pronostic et thérapeutiques de cette tumeur rare afin de contribuer à l'amélioration de la prise en charge de cette affection. Il s'agit d'une étude rétrospective portant sur 40 patients colligés au Centre Mohamed VI pour le traitement des cancers de Casablanca de Janvier 2000 à Décembre 2012. L'âge médian a été de 62 ans, le délai moyen de consultation a été de 12 mois, l'autopalpation d'un nodule péri aréolaire a été le principal motif de consultation dans 90% des cas. Le carcinome canalaire infiltrant a été le type histologique prédominant dans 90% des cas. La prise en charge thérapeutique multimodale a consisté en une mastectomie suivie d'un traitement adjuvant à type de chimiothérapie, radiothérapie et/ou hormonothérapie en fonction du stade de la tumeur et des caractéristiques histologiques. Le suivi moyen a été de 38 mois, l'évolution a été caractérisée par une rémission complète chez 16 patients (soit 40%), rechute locale chez 3 patients (soit 7.5%) et par une rechute métastatique chez 5 patients (soit 12.5%). Le site métastatique le plus fréquent a été l'os (62%), suivi par le poumon et le foie. Le décès était survenu chez 10 patients (25%). Le cancer du sein chez l'homme présente des similitudes avec le cancer mammaire chez la femme. Mais il présente aussi beaucoup de particularités, d'où l'intérêt de mener des études prospectives randomisés à plus large échelle afin d'améliorer la prise en charge et le pronostic de cette affection dont l'impact psychosociale est considérable.

The correlation between preoperative erythrocyte sedimentation rate and postoperative outcome in adult cardiac surgery.

IntroductionOver the past decades, it has been recommended that preoperative assessment mainly relies on history and physical examination rather than unnecessary laboratory tests. In Iranian hospitals, erythrocyte sedimentation rate (ESR) has been routinely measured in most of the patients awaiting major surgery, which has in turn exacted heavy costs on the health system. Therefore, the aim of the present study was to assess the preoperative routine measurement of ESR in such patients.Materials and methodsThis is a retrospective study, in which we evaluated the medical files of 620 patients. Patients older than 18 years, who had undergone elective heart surgery in our hospital in 2014, were included in the study. The data associated with demography, heart disease diagnosis, type of surgery, significant preoperative tests, delay or postponing of surgery and the reason for it, type and characteristics of the subspecialty consultation, and finally, postoperative complication and mortality rate were collected and analyzed. The patients were categorized into four groups according to ESR value: normal (<15 mm/h in females or <20 mm/h in males), moderately increased (<40 mm/h), severely increased (≥40 mm/h), and not measured.ResultsOf the 620 patients’ files, 402 were of males and 218 were of females. Demographic values and preoperative characteristics were similar in the four groups. A total of 105 consultations were given to 79 patients preoperatively, where only in five cases, the elevation in ESR was the main reason for consultation. In no other cases did the consultations result in new diagnoses. Overall, postoperative complication and mortality rate were the same in all four groups; in severely increased ESR group, on the other hand, the need for long periods of intensive care unit (ICU) and hospital stays was higher than that of other groups.ConclusionIt is concluded that elevated preoperative ESR does not cancel or defer the surgery, nor does it help diagnose a new, previously undiagnosed disease. Furthermore, it does not generally affect postoperative morbidity or mortality rate unless increased to ≥40 mm/h, where it can increase postoperative ICU and hospital stay. Ultimately, routine preoperative ESR measurement in patients is not conducive to elective heart surgery.

Epidemiological, clinical aspects and management of urethral stenosis in adult patients in a District Hospital in Ngaoundéré, Cameroon

IntroductionL'objectif était de déterminer les aspects épidémiologiques, cliniques et prise en charge de la sténose de l’urètre à l’Hôpital Protestant de Ngaoundéré (HPN).MéthodesUne étude rétrospective a été conduite, basée sur la revue des dossiers des patients hospitalisés pour sténose urétrale dans l’unité urologique de l’HPN, d’une période d’un an (janvier 2013 à janvier 2014). Seuls les dossiers complets étaient inclus.Résultats57 patients ont été retenus sur les 69 dossiers enregistrés dont tous était de sexe masculin. L’âge moyen était 52,6 ans (19 ans à 85 ans). La tranche d’âge la plus représentée était celle de 41 à 60 ans. La sténose urétrale représentait 0,6% des consultations externes, 11,36 % des hospitalisations en chirurgie, et 6,96% des interventions chirurgicales dans cette structure sanitaire. La dysurie (70, 17%) était le principal motif de consultation. Les étiologies étaient d’origines infectieuses (52,63%), traumatiques (26,32%) et iatrogènes (21,05%). L’ECBU réalisé sur tous les patients a permis d’isoler les gonocoques(14,03%) et Escherichia coli (21,05%), le reste de culture était stérile (64,91%). L’Uretro-Cystographie Rétrograde (UCR) a été réalisée sur 28 patients (49,12%), dont 26 cas était des rétrécissements antérieurs (92,85%). L’Urétrotomie Interne Endoscopique (UTI) était le geste chirurgical le plus réalisé (58%). La sténose était le plus souvent localisée au niveau des régions bulbaires et péno-bulbaires. Le taux de guérison était de 87,73% contre 12,27% de récidives.ConclusionLa sténose urétrale est fréquente en Urologie de l’HPN mais les patients consultent souvent en stade compliqué. L’urétrotomie interne endoscopique a montré des résultats plausibles.

Male Infertility as a Circumstance of Discovery of Adult Cryptorchidism: A Retrospective Analysis from the Region of Thies

Introduction: The aim of this work is to study the clinical aspects and the impact of cryptorchidism on male infertility in the region of Thies. Patients and methods: This is a retrospective study involving 28 patients followed up at the Saint Jean de Dieu, Barthimée and Tivaouane hospitals of the region of Thies between January 2007 and December 2016. Results: Among the 223 patients followed up for the undescended testicle, 13% (n = 28) were adults or at least 15 years old. 71% (n = 20) were married. Fourteen patients were followed up for primary infertility lasting for a period of time averaging 7 years. The mean age of the patients was 28 years (range: 17 years and 45 years). Cryptorchidism was unilateral in 82% (n = 23) and bilateral in 18% (n = 5). The mean delay of consultation varied from 1 to 13 years. The main reason for consultation was couple infertility (50%). The semen analysis was requested in all our patients. The levels of FSH, LH and testosterone were measured by immunoassay for the patients with azoospermia (n = 9). We noticed 2 cases of hypotestosteronemia and 3 cases of increased FSH serum level. Computed Tomography scans (CT) were performed in 28.5% of patients (n = 8) and ectopic testicles were found very high in the inguinal area in 5 cases. The open inguinal approach was used. In perioperative period, the testicle was found, high in the inguinal region in 5 patients (17.8% of the cases) and low in inguinal region in 19 patients (67.8%). In 4 cases the testicle was in abdominal position. The testicle was atrophied in 53.5% of the patients (n = 15) and 8 patients presented testicular hypotrophy. An orchidectomy was performed in 1 patient in whom it was impossible to lower the atrophied testicle. The postoperative period was uneventful and simple. The mean follow-up duration after the operation was 36 months (12 - 60 months).

Benign tumors of the breast in the department of senology at the University Hospital Aristide Le Dantec, Dakar (Senegal)

IntroductionL'objectif était d'identifier les aspects épidémiologiques, cliniques et thérapeutiques des tumeurs bénignes du sein suivies à l'unité de sénologie du centre hospitalier universitaire Aristide Le Dantec de Dakar.MéthodesIl s'agissait d'une étude transversale, descriptive et analytique, portant sur 220 patientes suivies à l'unité de sénologie du Centre Hospitalier Universitaire Aristide Le Dantec de Dakar durant la période allant du 1er janvier 2008 au 31 décembre 2013.RésultatsDeux cent vingt patientes parmi 984 consultantes présentaient une tumeur bénigne du sein (22,5%). Les tumeurs bénignes du sein représentaient 58,2% de la pathologie tumorale. L'âge moyen était de 24 ans. La tranche d'âge de 11 à 30 ans était la plus représentée soit 70%. La quasi-totalité était en âge d'activité génitale (95%), 58,6% étaient nulligestes. Le motif principal de consultation était une masse mammaire dans 94,5% des cas. Le côté gauche était le plus souvent concerné (49,5%) surtout au quadrant supéro-externe (41,6%). L'échographie était réalisée chez 145 patientes soit 65,9 % des cas. La cytologie retrouvait une hyperplasie épithélio-conjonctive dans la quasi-totalité des cas soit 96,1%. L'histologie réalisée chez 44 femmes confirmait la nature histologique des lésions. L'adénofibrome et les états fibro-kystiques étaient les diagnostics les plus retenus avec respectivement 86,3% et 5,9%. Une tumorectomie a été réalisée chez 28 patientes soit 12,7%, toutes tumeurs confondues. La majorité était suivie sur une durée inférieure à 3 mois avec une évolution favorable de la maladie.ConclusionLes tumeurs bénignes du sein sont très fréquentes à en consultation de sénologie. La démarche diagnostique recommandée associe la triade clinico-radio-cytologique et, en cas de doute ou de discordance, une biopsie ou exérèse chirurgicale est incontournable. La prise en charge pas toujours chirurgicale, est fonction de la nature de la tumeur.

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.

Outcomes of a pilot study in chiropractic practices in Western Australia.

BackgroundThis paper reports the quantitative outcomes of a mixed-methods pilot study of the characteristics and demographics of chiropractic practices and patients in Western Australia.MethodsThis was a mixed-methods data transformation model (qualitative to quantitative) pilot study. A non-random sample of chiropractic practices across Western Australia was recruited and data collected anonymously from consecutive new patients using an online platform. Data covered practice and patient demographics and characteristics, alongside quality of life measures. A descriptive quantitative analysis characterised the sample, and the patient population was stratified by main reason for presentation to compare characteristics according to the presence of secondary complaints. Odds ratios were calculated to estimate the odds of a secondary complaint for various combinations of main complaints, from univariate logistic regression models.ResultsOf the 539 registered practitioners in WA in July 2014, 33 agreed to participate, from 20 different practices. Ten participating practices provided data on 325 adult new patients. The recruited practices (metropolitan n = 8, regional n = 2) had a positive response rate of 79.7 % (n = 301 metropolitan and n = 24 regional patients), mean age 36.3 years (range 18–74) (53.2 % female). Spinal problems were reported as the main reason for consultation by 67 % and as secondary reasons by 77.2 % of patients. People presented primarily for health maintenance or a general health check in 11.4 %, and as a secondary reason 14.8 %. There were 30 % of people below societal norms for the SF-12 Physical Component Score (mean 47.19, 95 % CI; 46.27–48.19) and 86 % for the Mental Component Score (mean 36.64, 95 % CI; 35.93-37.65), Pain Impact Questionnaire mean scores were 54.60 (95 % CI; 53.32–55.88).ConclusionsPatients presented to chiropractors in Western Australia with a fairly wide range of conditions, but primarily spinal and musculoskeletal-related problems. A significant proportion of patients had associated, or found to be at risk of, depression. Consequently, there are responsibilities and opportunities for chiropractors with respect to providing care services that include health promotion and well-being education related to musculoskeletal/spinal and mental health. This pilot study supports the feasibility of a future confirmatory study where the potential role of chiropractors in spinal/musculoskeletal health management may be explored.Trial registration ACTRN12616000434493: Australian New Zealand Clinical Trials Registry (ANZCTR), Registered 5 April 2016, First participant enrolled 01 July 2014 Retrospectively Registered.

Surgical-orthodontic treatment for skeletal class III correction. Case report

A 21-year-old patient attended the Orthodontics Clinic of the Division of Postgraduate Studies and Research at the Faculty of Dentistry, UNAM. The main reason for consultation was a crossbite. Upon facial assessment, in the frontal view, a dolichofacial face, a positive smile, hypertonic chin, thick lips, matching dental and facial midlines and lip incompetence were observed. Intraorally she presented mild dental crowding, dental rotations, matching dental midlines, square-shaped arches, bilateral class III molar and canine relationship, posterior cross bite on the left side and an edge to edge bite. Model analysis showed an upper tooth-bone discrepancy of -2 mm and in the lower arch, -3.5 mm. Overbite was 0 mm and overjet, 0 mm.