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Comparative Study between Patients Treated with Conventional Radiotherapy and IMRT with Chemotherapy for Stage III - IVA Nasopharyngeal Carcinoma: A Single Institution Retrospective Report

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Journal of Cancer Therapy 2023年第12期14卷 451-464页

作者： Mamady Keita Juan li Malick Bah Mamadou Aliou Diallo alhassane ismaël touré Abou Camara Bangaly Traoré Abdoulaye Keita Wenbing Shen Department of Radiotherapy The Fourth Affiliated Hospital of Hebei Medical University Shijiazhuang China Cancer Department of Donka National Hospital Conakry Guinea Faculty of Health Sciences and Techniques of Gamal Abdel Nasser University of Conakry Conakry Guinea Department of ENT-CFS Donka National Hospital Conakry Guinea

Introduction: Nasopharyngeal carcinomas are the most radiation-sensitive tumours, and radiotherapy alone provides better local control. Objectives: To evaluate the clinical efficacy and acute and late toxicities of two different treatment regimens for locally advanced nasopharyngeal carcinoma. Methods: From 2014 to 2017, 150 cases of stage III and 68 cases of stage IVA nasopharyngeal carcinoma were treated. Of these, 137 received conventional radiotherapy plus chemotherapy, and 81 received intensity-modulated radiotherapy plus chemotherapy. Chemotherapy was given either as induction, concurrent or adjuvant therapy. Survival rates were calculated according to Kaplan Meier and compared with the log-rank test. The RTOG or EORTC criteria were used to assess acute and late toxicities. Results: The median follow-up time was 21.5 months, and the 2-year locoregional relapse-free survival, distant metastases-free survival, and overall survival rates in the conventional radiotherapy plus chemotherapy group were 76%, 71% and 77%, respectively;in the intensity-modulated radiotherapy plus chemotherapy group, they were 97%, 84%, and 100%, respectively. The difference in survival between the two groups was significant (χ2 = 5.06, P = 0.028). The incidence of grade 2 and 3 xerostomia one year after radiotherapy was 45.1% and 30.9% versus 33.3% and 0%. Conclusion: Compared with conventional radiotherapy plus chemotherapy, intensity-modulated radiotherapy plus chemotherapy offers better locoregional relapse-free survival and overall survival in patients with stage III and IVA nasopharyngeal carcinoma, and may significantly reduce the occurrence of radiation-induced xerostomia.

关键词： Nasopharyngeal Carcinoma Conventional Radiotherapy Intensity Modulated Radiotherapy Chemotherapy Prognosis

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Postoperative Complications in the General Surgery Department of the Cs Ref of Commune I of the District of Bamako Mali

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Surgical Science 2024年第6期15卷 409-419页

作者： Tounkara Cheickna Samake Hamidou Dembele lamine Diarra Issaka Togola Modibo Sanogo Modibo Dembele Bakary Tientigui Traore alhassane Togo Adégné Pierre Kante lassana Department of General Surgery Reference Health Center of Commune I of Bamako Bamako Mali Directorate of Social and Health Services of the Armies Bamako Mali Department of General Surgery CHU Gabriel Tour Bamako Mali

Postoperative complications represent important indicators for the quality of surgical care. The objectives of this work were to study post-operative complications in the general surgery department of the Cs ref of commune I in Mali, to determine the frequency of post-operative complications, to identify the factors of occurrence, to describe the clinical aspects, diagnostic and therapeutic in order to assess the additional cost linked to post-operative complications. This study was prospective, carried out in the general surgery department on 300 cases of surgical interventions. It covered all patients aged at least 15 years, operated on and hospitalized or not, and who presented complications during the 30 days postoperatively. Patients under the age of 15 were not included (our general surgery department is not a pediatric surgery department). We collected 300 patients among whom 199 (66.33%) were men and 101 (33.66%) women, i.e. a sex ratio = 1.9. The average age was 38 years with extremes of 15 and 87 years. The main initial diagnoses were: acute appendicitis, peritonitis, occlusions, wall hernias, hemorrhoids, uterine prolapse, uterine myomas, ovarian cysts and acute cholecystitis. Emergencies represented 43% (N = 129) of interventions with 6.98% post-operative complications (POC). Postoperative complications were dominated by surgical site infections, 75% of cases (N = 20), wall hemorrhage 5% (N = 1), testicular necrosis 5% (N = 1) and testicular calcification 5% (N = 1), wire rejection 5% (N = 1) and death 5% (N = 1). The management of postoperative complications was surgical in 95% and medical in 100%. Their occurrence extended the hospital stay by 3.65 days and increased the average cost of care by 60541.85 CFA francs. The mortality index lowered by efficient management of complications (IMAGE) calculated in relation to deaths was 95% of cases. Anemia, ASA score ≥ III, Alteimeir II and IV classes, duration of surgery and post-operative hospitalization were factors contributing to post-operative complica

关键词： Complications Post Opératoires Chirurgie Cs Ref CI Bamako Mali

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Post Antibiotic Grade IV Anaphylaxis: A Case Report from the Emergency Department of Chu Donka

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Open Journal of Emergency Medicine 2023年第3期11卷 110-114页

作者： Amadou Yalla Camara Abdoulaye touré Ernest Ahounou Almamy Bangoura M’mah lamine Camara Thierno Sadou Diallo alhassane Barry Boubacar Atigou Dramé Joseph Donamou Medical and Surgical Emergency Department CHU-Donka National Hospital Conakry Guinea Anesthesia and Intensive Care Unit Ignace Deen National Hospital Conakry Guinea Department of Anaesthesia and Intensive Care Donka National Hospital Conakry Guinea Department of Anaesthesia and Intensive Care HKM National University Hospital Cotonou Benin

Anaphylaxis is a serious systemic reaction that is part of the general pattern of potentially fatal hypersensitivity reactions requiring immediate management. We report the case of a patient presenting to emergency with signs of malaria and pneumonia who was diagnosed with grade 4 anaphylaxis following antibiotic injection in the emergency department. The patient was 30 years old, with no previous history of anaphylaxis, and presented to the emergency department with fever, dry cough, headache and dizziness associated with prostration. Physical examination showed stable hemodynamics (BP = 110/80 mmHg, HR = 95 p/min,) and respiratory function with SpO2 = 98%, HR = 22 c/min and crepitus rales at the base of the lungs. The laboratory work-up carried out in the emergency department revealed a biological inflammatory syndrome associated with hyperleukocytosis of 11,260/mm3, a positive thick drop with GE(+) dp = 1183 T/microlitre;blood glucose = 0.83 g/l;Covid 19 RDT = (negative). A diagnosis of malaria and pneumonia was made and antibiotic therapy (ceftriaxone) and artesunate were indicated. During the injection of ceftriaxone 1 g, the patient became agitated, followed by cardiorespiratory arrest, confirming the diagnosis of stage 4 anaphylaxis. Treatment consisted of stopping the ceftriaxone injection, external cardiac massage and ventilation, intravenous adrenaline and vascular filling, which enabled the patient to recover and stabilize. The diagnosis of anaphylaxis is clinical. Early administration of adrenaline is the mainstay of treatment.

关键词： Grade 4 Anaphylaxis Adrenaline Antibiotics Emergencies

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Urinary Sphincter Disorders of Neurological Origin: Prognostic Aspects in the Neurology Department of the Ignace Deen National Hospital

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Open Journal of Urology 2023年第3期13卷 92-99页

作者： Mohamed Asmaou Bangoura Mohamed lamine touré Mohamed Traoré Aliou Talibé Diallo Mamadou Oury Mané alhassane Fadiga Gouled Houssein Moussa Karinka Diawara Ibrahima Siré Diallo Cissé Fodé Abass Neurology Department CHU of Conakry Conakry Guinea

Introduction: Complications of Urinary sphincter disorders of neurological origin can be life threatening. The objective of this study was to describe the prognosis of urinary sphincter disorders during neurological conditions. Methods: This was a six-month analytical study conducted at the neurological unit of the Hôpital national Ignace Deen. Including patients with urinary sphincter disorders following a neurological condition;Chi-square, Fischer, and Student’s t-tests were used for variables with a p value less than 0.10 and then included in a logistic model with a significance level set at 0.05 and a 95% confidence interval. Results: We collected 1081 patients among whom, 324 presented, that is to say a frequency of 30%, which concerned subjects aged 57.3 ± 16.4 years with a slight female predominance 50.3%. Urinary incontinence (80.6%) was associated with complications such as urinary tract infection with a high proportion of cerebral damage (92.3%). HIV infection (P = 0.015), bedsores (P = 0.049), and inhalation pneumonia (P = 0.001) were the main poor prognostic factors. Conclusion: Urinary sphincter disorders are elements of poor prognosis, both vital and functional, concerning elderly subjects with a predominance of urinary incontinence. HIV infection, bedsores, pneumopathy are poor prognostic factors.

关键词： Urinary Sphincter Disorders Incontinence Retention Neurology

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Epidemiological, Clinical, and Therapeutic Characteristics of Acute Appendicitis at the Reference Health Center in Commune I of the District of Bamako Mali

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Surgical Science 2023年第10期14卷 637-645页

作者： Cheickna Tounkara Hamidou Samake Daye Kaloga Bagayoko Barthélémy Poudiougou Modibo Togola Sékou Koumare Bakary Tientigui Dembele alhassane Traore Pierre Adégné Togo lassana Kante Zimogo Zié Sanogo Department of General Surgery of Cs Ref CI Bamako Mali Directorate of the Social Health Service of Arms of Mali Bamako Mali Department of General Surgery CHU Point-G Bamako Mali Department of General Surgery of CHU Gabriel touré Bamako Mali

Acute appendicitis is the most common abdominal surgical emergency. This work is a prospective study from January 2012 to December to analyze the epidemiological, clinical and therapeutic aspects of acute appendicitis in the Cs ref of commune I of the district of Bamako and the results obtained were then compared with those reported in other countries. Our study included 72 patients. The appendectomy surgical specimens were the subject of an anatomical pathology study at Point G University Hospital in Bamako in Mali, 1.4% of cases of which were healthy. All our operated patients received antibiotics (mono or dual antibiotics) with a post-operative hospitalization duration of 1.5 (36 hours) days on average. We recorded 6 complications such as parietal suppuration, i.e. 8.33% of cases. No 5th day syndrome or late complications were noted. The average length of hospitalization was 36 hours. Abdominal ultrasound;used as an additional examination was carried out in 55 of our patients or 76.39% of cases. We have not recorded any deaths. Raising awareness among patients about the dangers of complications motivated patients to undergo surgery as soon as possible.

关键词： Acute Appendicitis Epidemiology Clinic and Therapy Surgery Csref CI Mali

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Intestinal Invagination in Adults: About a Case at the “Mother-Child” Hospital le luxembourg in Mali

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Surgical Science 2023年第9期14卷 583-589页

作者： Cheickna Tounkara Oumar Amadou Malle Amara Coulibaly A. Boubacar Maiga Sory Ibrahim Diawara Kassim Kayentao Bakary Tientigui Dembele alhassane Traore Adégné Pierre Togo lassana Kante Department of general surgery of the Hospital “Mother Child” le luxembourg Bamako Mali University of Sciences of Techniques and Technologies of Bamako Mali (USTTB) Bamako Mali Department of General Surgery of the CHU Gabriel touré Bamako Mali

Intussusception is a pathology of infants and young children. Its occurrence in adults is very unusual. In the vast majority of cases, it is secondary to a benign or malignant tumor. Small bowel malignancies are relatively rare, 1% - 5% of malignant tumors of the gastrointestinal tract. Acute intussusception, a rare pathology in adults, often presents with non-specific symptoms. Contrary to children, the organic origin remains preponderant in the elderly, where the origin of neoplasia must be suspected in first intention. We report the case of a 49-year-old patient admitted urgently from the luxembourg “Mère Enfant” hospital center in Bamako, Mali, for an occlusive syndrome. Several abdomino-pelvic ultrasounds were performed in several clinics with mixed conclusions: Hydro-aeric distension and a cessation of matter and gas without a clearly visible mass (04/09/2022);Demonstration of the central hydro-aeric levels wider than high containing fine and regular folds corresponding to connivents whose aspect is in factor of left acute small intestine occlusion, to be completed by the surgical opinion (06/09/2022) and a third ultrasound showed a normal appearance of the liver, gallbladder, kidneys, pancreas, spleen, bladder and prostate;diffuse aero-colic distention without lesion of secondary appearance (21/11/2022). A frontal standing ASP dated 11/25/2022 showed hail-like hydro-aeric levels. Surgical management consisted of an open oncological resection of an obstructive bowel tumor with ileo-ileal invagination. The anatomopathological and immunohistochemical study of the surgical specimen concluded to diffuse small cell non-Hodgkin’s lymphoma, without vascular embolism. The resection limits pass into the healthy zone.

关键词： Acute Intestinal Intussusception Organic Etiology Digestive lymphoma Mali

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Appendicular Abscess in General Surgery at the Bocar Sidi Sall University Hospital in Kati

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Surgical Science 2020年第12期11卷 479-485页

作者： Abdoulaye Diarra Koniba Keita Amadou Traoré Assitan Koné Idrissa Tounkara Issa Traore Souleymane Thiam Fadima K. Tall Daouda Diallo Madiassa Konate Aboubacar Koné Deborah Sanra Sanogo ismaël Konare alhassane Traoré Adégné Togo Department of General Surgery CHU of Kati Kati Mali General Surgery Department CHU Gabriel Touré Bamako Mali Department of Anesthesia and Resuscitation CHU of Kati Kati Mali Gastroenterology Department Point G Hospital Bamako Mali

Introduction: Appendicular abscess is a progressive complication of acute appendicitis in which the spread of infection is contained by the greater omentum and the slender loops resulting in the formation of a true septate abscess of the large peritoneal cavity. Materials and Methods: This was a retrospective study from January 2010 to December 2019 carried out at the Bocar Sidi Sall University Hospital in Kati (CHU BSS in Kati) in general surgery. It concerned all patients operated on for appendicular abscess in the department. Results: 75 cases of appendicular abscess were collected, which represented 5.76% of surgical emergencies and 25% of acute appendicitis. The average age of the patients was 29 years. The male sex represented 67% of our patients with a sex ratio of 2. The average consultation time was 5 days. Abdominal pain was noted in all patients. It was localized in the right iliac fossa in 80% (n = 60) and diffuse in 2.7% of cases (n = 2). It was accompanied by nausea and vomiting in 93% of cases (n = 70), urinary disorders in 20% (n = 15), fever in 94% (n = 71), cessation of materials and gas in 1.33% (n = 1). Abdominal ultrasound was performed in 86% (n = 65). It made it possible to suggest a peri-appendicular effusion. Biological examination revealed a neutrophilic hyperleukocytosis greater than 20,000/mm3 in 47 patients, or 63%. All the patients were operated on by laparotomy (Marc Burney or midline subumbilical) under general anesthesia. The length of hospitalization was 6 days. We have not recorded any deaths. Morbidity was 8% (n = 6) represented by parietal suppuration. The postoperative course was straightforward in 92% of cases (n = 69). Conclusion: Appendicular abscess is a frequent medico-surgical emergency, the prognosis of which depends greatly on early diagnosis and adequate and immediate management.

关键词： Appendicular Abscess Surgery Kati Mali

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Appendicular Peritonitis in the General Surgery Department of Gabriel tourE CHU

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Surgical Science 2022年第1期13卷 9-14页

作者： Maïga Amadou Diakité Ibrahima Bah Amadou Diallo Aly Boubacar Traoré Bathio Moussa Diassana Sidibé Boubacar Yoro Koné Tani Doumbia Arouna Adama Traoré Amadou Saye Zakari Saadé Oumou Hélène Kanté lassana Konaté Madiassa Dembélé Souleymane Samaké Moussa Dembélé Bakary Tientigui Traoré alhassane Togo Adégné Service de chirurgie générale H&#244pital de Sikasso Sikasso Mali Service de chirurgie générale CHU Gabriel Tour&#233 Bamako Mali

The appendicular peritonitis is complications of acute appendicitis which are characterized by the diffusion of the infectious process to the peritoneal cavity thus carrying out a generalized or located purulent peritonitis. It can appear from the start or follow the stage of appendicular abscess. Our objectives were to determine the frequency, to describe the clinic and para clinic aspects, to identify the principal germs and their sensitivities to antibiotics and to describe the operative continuations. Our prospective and descriptive study focused on patients treated for appendicular peritonitis, from January 1st to December 31st 2016, in the General Surgery Department of the Hospital of Sikasso. During the period of our study, 31 cases of appendicular peritonitis were collected, which le="font-family:Verdana;">le="font-family:Verdana;">le="font-family:Ver

关键词： Appendicular Peritonitis Surgical Emergencies Hospital of Sikasso

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Volvulus of Colon Sigmoide in the General Surgery Department of Chu Gabriel toure

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Surgical Science 2022年第1期13卷 46-52页

作者： Maïga Amadou Diakité Ibrahima Bah Amadou Diallo Aly Boubacar Traoré Bathio Moussa Diassana Sidibé Boubacar Yoro Koné Tani Doumbia Arouna Adama Traoré Amadou Saye Zakari Diallo Mamadou Konaté Moussa Saadé Oumou Hélène Kanté lassana Konaté Madiassa Dembélé Souleymane Samaké Moussa Dembélé Bakary Tientigui Traoré alhassane Togo Adégné General Surgery Department University Hospital Bamako Mali General Surgery Department Sikasso Hospital Sikasso Mali Reference Center of Commune VI Bamako Mali

Introduction: Sigmoid colon volvulus is a medico-surgical emergency which represents a common cause of colonic occlusion, it is characterized by strangulation of the sigmoid loop around its meso colic axis producing low mechanical occlusion [1]. 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 [2]. Objective: 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.

关键词： Sigmoid Volvulus General Surgery Department

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Fascist leg Necrosis at the Bocar Sidi Sall University Hospital (BSS) in Kati (Mali)

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Surgical Science 2022年第3期13卷 119-123页

作者： Abdoulaye Diarra Assitan Koné Amadou Traoré Koniba Kéïta Idrissa Tounkara Tounkara Issa Traoré Oumou Traoré Boubacar Karembé Madiassa Konaté Oulématou Coulibaly Modibo Togola Daouda Diallo alhassane Traoré Bkary Tientigui Dembélé Ibrahim Diakité Adégné Togo Department of General Surgery Kati University Hospital Kati Mali Department of General Surgery CHU Gabriel touré Bamako Mali Department of Anesthesia and Resuscitation CHU of Kati Kati Mali

Necrotizing fasciitis is a bacterial dermo-hypodermitis of necrotizing type with involvement of the superficial fascia of the muscles. We report the case of a 50-year-old patient with necrotizing fasciitis of the left leg following erysipelas. Clinical Case: A 50-year-old patient, received at the emergency department for necrotizing wound of the left leg, evolving for 25 days. The examination of the patient made it possible to find: an alteration of the general condition with a WHO score classified stage II. A necrotizing wound of the lower 2/3 of the left leg and the dorsal side of the left foot allowing pus to flow in places, the pedious pulse was well perceived, lymphadenopathy at the root of the homolateral thigh. The complete blood count made it possible to objectify a predominantly neutrophil hyperleukocytosis greater than 10,000/mm3. We first carried out a complete debridement of the necrotic tissues, in a second time we took the patient back to do the autocutaneous graft. The surgical follow-up was simple. Conclusion: Necrotizing fasciitis is a serious infection, management is multidisciplinary.

关键词： Necrotizing Fasciitis lower limb Kati Mali

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