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Interest of Transcranial Doppler (TCD) in Emergency in Traumatic Brain Injury Patients at Gabriel Touré University Hospital, Bamako, Mali

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Open Journal of Emergency Medicine 2024年第3期12卷 114-121页

作者： Abdoulhamidou Almeimoune Moustapha Mangane madane thierno diop Mahamadoun Coulibaly Amadou Gamby Dramane Sanogo Alfousseini Soumare Adama Coulibaly Ababacar Salaha Harouna Sangaré Diango Djibo Mahamane Department of Intensive Care Anesthesia and Emergency Medicine CHU Gabriel Toure Bamako Mali Faculty of Medicine and Odontostomatology University of Sciences Techniques and Technology of Bamako Bamako Mali Department of Intensive Care Anesthesia CHU Luxembourg Luxembourg City Luxembourg

Introduction: Transcranial Doppler is a simple, non-invasive and inexpensive examination which allows the assessment of cerebral perfusion. In countries with limited resources, which do not have a means of monitoring intracranial pressure, this examination offers hope of survival for patients with traumatic brain injury. This study was designed to investigate the incidence of early cerebral circulation abnormalities after traumatic brain injury using transcranial Doppler (TCD). Methodology: A descriptive and analytical study was conducted over one year, including patients with traumatic brain injury and an initial Glasgow Coma Scale (GCS) score of less than 15. Non-inclusion criteria: Stroke, brain tumor, cerebral abscess. Exclusion criteria: Inadequate insonation window. Results: Out of 854 traumatic brain injury patients admitted to the emergency department, 112 were included in the study. The average age was 30.14 years, with a sex ratio of 4.1. Initially, 83.5% had moderate traumatic brain injury, and 12.1% had severe traumatic brain injury. Brain CT scans were performed in 95.7% of the patients. Edematous-hemorrhagic contusion was observed in 95% of the patients. On initial TCD, the pulsatility index in the middle cerebral artery was greater than 1.3 in 49.4% of the patients. Diastolic velocity was less than 20 cm/s in 46.4% of cases, and mean velocity was greater than 150 cm/s in 8.7% of cases. In this group, low diastolic velocity indicated cerebral hypoperfusion suggestive of intracranial hypertension. When the pulsatility index was greater than 1.9, no patient had a normal diastolic velocity. Among patients with severe traumatic brain injury, 61.5% had an abnormal pulsatility index compared to 42.3% of patients with moderate traumatic brain injury. Conclusion: TCD is a simple tool for analyzing intracerebral hemodynamics.

关键词： Traumatic Brain Injury TCD Neuroresuscitation Sub-Saharan Africa

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Cancer on the Testicle Not Descended to the Urology Department of the Gabriel TouréUHC: About a Case

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Open Journal of Urology 2018年第8期8卷 257-262页

作者： Mamadou Tidiani Coulibaly Amadou Berthé Lahassana dit Tiemoko Coulibaly Cissé Dramane thierno madane diop Issa Amadou Zanafon Ouattara Urology Department of CHU Gabriel Touré Bamako Mali

Testicular cancers are tumours of the young adult (15 - 35 years), and it is a rather rare pathology in African black. However, the risk of developing these cancers becomes higher if the testicle does not descend. In our context, these undescended testicles often go unnoticed, which poses the problem of surveillance. We report a case in a patient of 24 years who consulted for pain plus hypogastric mass, in whom at the end of the clinical, paraclinical and surgical investigations we retained the diagnosis of seminoma of the right testicle. This is the first case in our daily practice. Conclusion: The rarity of tumours on the undescended testicle should not cause their diagnosis to be misunderstood because of the seriousness of cases diagnosed late.

关键词： Esticle Cancer Undescended

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Management and Outcome of Acute Subdural Hematoma in Gabriel TouréHospital

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Open Journal of Emergency Medicine 2022年第1期10卷 48-53页

作者： Youssouf Sogoba Drissa Kanikomo Quenum Kouassi Jean Marie Kisito Moussa Diallo Bakary Dembélé Boubacar Sogoba Djènè Kourouma Izoudine Blaise Koumaré Seybou Hassane Diallo Hamidou Almeimoune Moustapha Mangané thierno madane diop Oumar Coulibaly Mamadou Salia Diarra Mahamadou Dama Oumar Diallo Youssoufa Maiga Djibo Mahamane Diango Department of Neurosurgery Gabriel Touré Teaching Hospital Bamako Mali Neurosurgeon University of Parakou Parakou Benin Department of Neurology Gabriel Touré Teaching Hospital Bamako Mali Department of Emergency Care Gabriel Touré Teaching Hospital Bamako Mali Department of Neurosurgery H&#244 pital du Mali Bamako Mali Department of Neurosurgery H&#244 pital Luxambourg Bamako Mali

Background: Traumatic Brain Injury (TBI) is a major health problem worldwide. It is the main cause of trauma mortality. Acute subdural hematoma (ASDH) has a reputation for being the most serious of all posttraumatic head injuries. Its frequency is estimated to be 1% to 5% of all head injuries and 22% of severe head injuries. The aim of this study was to assess the epidemiological, clinical and prognosis aspects of ASDH in our department. Material and Methods: This prospective study, from January to December 2019, included 57 patients admitted to the Gabriel Touré Teaching Hospital for ASDH. Patients underwent detailed clinical and radiological evaluation and ASDH was diagnosed by non-contrast computed tomography (CT) scan. Functional outcome was evaluated 6 months after injury by Glasgow Outcome Scale. Results: During the study period, 662 patients were admitted for TBI including 57 (8.61%) cases of ASDH. The mean age was 34 years with extremes of 2 and 77 years. There was a male predominance with 52 (91.2%). The main cause of trauma was motor vehicle accidents in 38 (66.6%) patients. According to the Glasgow coma scale (GCS), 33 (57.9%) patients were classified mild (Table 2). The thickness of the hematoma was more than 1 cm in 13 (22.8%) patients and less than 1 cm in 44 (77%) patients. Surgical treatment was performed in 13 (22.8%) patients. The outcome was favorable in 30 (52.6%) patients and the mortality rate was 33.3%. Conclusion: ASDH remains a difficult challenge because of the high mortality. The mortality rate remains high particularly in patient with poor GCS score at admission.

关键词： Acute Subdural Hematoma Traumatic Brain Injury Outcome

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Abdominoperineal Resection in Rectal Cancer in General Surgery Department at Gabriel Toure University Hospital

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Surgical Science 2019年第1期10卷 16-23页

作者： Amadou Traore Abdoulaye Diarra Madiassa Konate Souleymane Thiam Soumaila Keita Tani Kone Boubacar Karembe Assitan Kone Boubacar Sidibe Amadou Bah Amadou Maiga Ibrahim Diakite Bakary Tientigui Dembele Alhassane Traore Adegne Togo Lassana Kante Moussa Samake Moustapha Issa Mangane thierno madane diop Mamadou Salia Diarra Adama Diakite Gangaly Diallo Gabriel Toure University Hospital BamakoMali

The objectives: Were to determine the hospital frequency of abdominoperineal resection (APR);to determine mortality and morbidity rates and to assess oncologic outcomes. Method and patients: We performed a retrospective study between 2008 and 2013 in general surgery department at Gabriel Toure University Hospital (UH) which included all patients admitted for rectal cancer confirmed by pathological examination, and having undergone an APR. Results: We have collected 17 cases which accounted for 65.38% of curative resections of rectal cancer. The sex-ratio was 0.89 and the averageage was 49.53 years. The average tumor distance from the anal verge was 4.59 ± 1.7 cm. All patients had adenocarcinoma of the rectum. The histopathologic grade was well in 7 cases, moderate and poor in 5 cases each. According to the pathologic TNM classification, 13 patients were classified T4, 14 patients N+. APR was associated with hysterectomy and partial colpectomy in 4 cases. The average duration of interventions was 202.06 ± 25.68 minutes. The average duration of hospitalization was 18.24 ± 04.89 days. The postoperative mortality and morbidity rates were 5.88% and 29.42%, respectively. Local recurrence was observed in 6 patients and liver metastasis in 2 patients. The overall survival rate was 37.5% at 2 years and 18.75% at 5 years. Conclusion: APR still occupies an important place in our practice. Our results could be improved by the recent introduction of neoadjuvant radio chemotherapy in Mali.

关键词： Abdominoperineal Cancer Mali Rectum Resection Surgery

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Anesthetic Activities of Scheduled Surgery at CHU Gabriel Touré

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Open Journal of Anesthesiology 2021年第5期11卷 164-174页

作者： Mangané Moustapha Almeimoune Abdoul Hamidou diop thierno madane Soumaré Alfousseini Koita Siriman Sanogo Dramane Gamby Amadou Siadaly Babaya Dembelé Aladji Seydou Diango Djibo Mahamane Department of Anesthesiology and ICU H&ocirc pital Gabriel Touré Bamako Mali Department of Anesthesiology and ICU H&ocirc pital Gabriel Touré Bamako Mali Department of Anesthesiology H&ocirc pital IOTA Bamako Mali Department of Anesthesiology and ICU H&ocirc pital Mè re-Enfant Bamako Mali

Concept: We opted for this study because the hospital unit Gabriel Touré was renovated with 7 surgical specialties. Our study was the very last study before the advent of coronavirus disease 2019 (COVID 19). Goal: Evaluate the anesthetic activities of the planned surgery at the University Hospital Center CHU Gabriel Touré. Method and Material: This was a descriptive prospective study carried out in the cold operating theater of the CHU Gabriel Touré from January to December 2018. It focused on all patients operated on for regulated surgery and who had benefited from anesthesia. Our data was entered and analyzed on SPSS 25 software. Word processing performed on Microsoft WORD® 2016 and graphics on Microsoft EXCEL® 2016. Results: During the study period 1700 patients were operated on in the operating room for scheduled surgery. The age range of 0 to 5 years accounted for (14.8%). The average age was 6.64 years;male predominance (52.6%) of operated patients with a sex ratio of 1.1. A history of general anesthesia was found in 62.1%. The classification of the American Anesthesia Society (ASA) ASA1 class represented 92.7%. Tonsillitis was the most common operative diagnosis (9.5%). Hernia cures and eventrations were the most common surgical technique (11.8%). General anesthesia was achieved in 65.3% of patients. Hypotension was the most common adverse event in the operating room, 44.5%. The intraoperative mortality was 0.11%. Conclusion: Our study covered the entire population anesthetized. It provided an update on the practice of anesthesia in the intensive care unit anesthesia. General anesthesia was the most used technique;a predominance of cardiovascular adverse events, occurring more often in induction and mainly favorable outcome with mortality intraoperative 0.11%. A growing presence of MAR and DES who had performed more than 30% of anesthesia.

关键词： Anesthetic Activities CHU Gabriel Touré Bamako

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The Polytraumatized in the Emergency Hosting Service and the Service of Resuscitation Gabriel TouréMali

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Surgical Science 2018年第4期9卷 157-163页

作者： diop thierno madane Magane Moustapha Issa Almeimoune Abdoulhamidou Dembélé AlajiSeidou Dabo Aminata Ouattara Kassoum Dembélé Bakary Tientigui Traoré Alhassane Togo Adegné Diango Mahamane Djibo Department Anesthesia-Intensive Care and Emergency Gabriel Toure University Hospital Bamako Mali Anesthesia Department Ophthalmological Institute West African University Hospital Bamako Mali General Surgery Department Gabriel Toure University Hospital Bamako Mali

Summary: Polytrauma is the leading cause of death in the under-40 population. They are accompanied by major morbidity with severe sequelae. The polytraumatized is defined as a serious trauma with several bodily injuries, at least one of which is life-threatening in the very short term. The initial hospital care must not barely delay and directly affect the prognosis. In developing countries, the absence of pre-hospital medicine means that mortality is still very high, which leads us to initiate this work, which aims to study the epidemiological and clinical aspects of polytrauma in emergency and in resuscitation of Gabriel Toure University Hospital. Material and Methods: This was a retrospective study that took place over a period of ten (10) months from February to November 2016. We included all patients received for polytrauma emergency hosting service. The data were collected using a surveycard. Results: During our study period, we collected a total of 200 polytraumatized cases out of a total of 16,141 patients admitted to the emergency hosting service, a prevalence of 1.3%. The age group of 20 - 29 years was the most represented with average age of 32.39 years. The male sex was predominant with 65% with a sex ratio of 1.9. The students were the most represented with 24%. The trauma occurred at 22.5% between 8:00 and 12:00 am, the public road was the main place of the trauma with 57.5% of the cases. Two-wheeled vehicles were involved in the accident in 68.9% of cases. The delay between trauma and admission was minus 6 hours in 70.5% of cases, 15.5% had a Glasgow lessthan 8% and 44.5% PAS Conclusion: The polytrauma is clinical situation putting the patients vital prognosis at stake. The haemorrhage is the origin of the student mortality. The installation of rigorous diagnostic system and a pre-hospital medicine will reduce the morbi-mortality.

关键词： Polytraumatized Emergency Resuscitation Bamako Mali

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Hydroelectrolytic Disorders in Cerebroleted Patients in the Intensive Care Unit of Gabriel TouréTeaching Hospital

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Neuroscience & Medicine 2020年第2期11卷 45-51页

作者： diop thierno madane Mangané Moustapha Issa Almeimoune Abdoul Hamidou Mariko Mahamane Beye Seydina Alioune Dembele Alaji Seidou Coulibaly Mahamadoun Ouattara Kassoum Kaloga Mahamane Asseye Siriman Koita Ebongue Sandrine Diango Djibo Mahamane Department of Anesthesia-Intensive Care and Emergency Gabriel Toure Teaching Hospital Bamako Mali Department of Imagery Luxembourg Teaching Hospital Bamako Mali Department of Anesthesia-Intensive Care and Emergency PG Teaching Hospital Bamako Mali Anesthesia Department Ophthalmological Institute West African University Hospital Bamako Mali Department of Anesthesia-Intensive Care and Emergency Luxembourg Teaching Hospital Bamako Mali

A cerebrole is a patient with a neurological deficit of central origin;these patients very often present disorders of the ion concentration, hence the need for hospitalization in intensive care. The aim of our study was to study hydro-electrolyte disorders in brain-damaged patients, to describe the clinical aspects, to identify the contributing factors and to determine the prognosis of these patients in the intensive care unit of gabriel touré teaching hospital. Material and Methods: It was a prospective cross-sectional study, descriptive of a period of 11 months going from June 2015 to April 2016 in the intensive care unit of CHU Gabriel TOURE we included all the cerebral patients admitted in intensive care in which hydro-ionic disorders have detected on arrival or during hospitalization. Data were collected through transfer sheets, a survey sheet and medical records. Data entry and analysis were done respectively on SPSS software (version 19) and Microsoft Word Starter 2010 software. Results: During our study, out of 450 hospitalization patients, we identified 110 brain-damaged patients and 75 patients were retained in our study, i.e. a prevalence of 16.6%. Male was predominant with 72% with a sex ratio of 2.5 the age group 20 - 50 years was majority with 45.3%, the average age was 38.49 years. The majority of patients (58.7%) were admitted from the emergency department. The most common reason for admission was impairment of consciousness in 94.7% (Table 1) of cases and the Glasgow admission score was less than or equal to 8 in 58.7% (Table 1) of patients. Hydro-electrolyte disturbances were present in 93.3% of patients on admission. Hyponatremia was the most common disorder with 56% (42 cases). Followed by hyperkalaemia 10.7% (8 cases), hypernatremia 9.3% (7 cases), at hypocalcemia 9.3% (7 cases), associated disorders 8% (6 cases). Brain CT was performed in 52% of the patients. In our study, malaria was the most common etiology o

关键词： Hydro-Electrolyte Disorders Cerebroleses Resuscitation Teaching Hospital Gabriel Toure

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Prevalence and Factors Associated with the Anxio-Depressive Symptoms of the Families of Patients in Intensive Care Unit at Gabriel Toure University Hospital, Bamako, Mali

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Neuroscience & Medicine 2018年第3期9卷 150-158页

作者： Almeimoune Abdoulhamidou Mangane Moustapha diop madane thierno Démbele Seydou Aladji Kassogue André Sogoba Youssouf Dabo Aminata Diallo Daouda Diallo Boubacar Souleymane Coulibaly Diallo H. Seybou Maiga Youssoufa Diango Djibo Mahamane Department of Anesthesiology and ICU H&#244 pital Gabriel Touré Bamako Mali Department of Neurosurgery H&#244 pital Gabriel Touré Bamako Mali Department of Anesthesiology and ICU H&#244 pital Point G Bamako Mali Psychatric service H&#244 pital Pint G Bamako Mali

Introduction: Hospitalization in intensive care is a source of stress and anxiety for close to the patients. Anxio-depressive symptoms appear to be common in intensive care and their prevalence is poorly evaluated. The objective of this study was to evaluate the prevalence of anxio-depressive symptoms in families. Materials and method: Observational prospective study in families of patients hospitalized in the intensive care unit for a period of 5 months. Symptoms of anxiety and depression were measured using Hospital Anxiety and Depression Scale (HADS) during hospitalization. Anxiety and depression were defined by a score greater than 10. Factors associated with the onset of anxious-depressive symptoms were sought. The prevalence of post-traumatic stress disorder in close relatives was measured by the Impact Event Scale-Revised scale (IES-R). Results: A total of 107 patients were admitted to the intensive care unit, of which 49 families agreed to participate in our study. Overall mortality was 32.2% during this period. Fifty-eight (58) patients were not included for the following reasons: death or hospitalization of less than 48 hours, refusal of families, institution, and lack of parents speaking French. Forty-nine (49) relatives completed the HADS questionnaire. Forty-three families completed the IES-R questionnaire, a return rate of 87.7%. The prevalence of anxiety was 61.2% among parents in early hospitalization. The level of anxiety was significantly associated with male parents (p = 0.035) and those with lower education (p = 0.046). The prevalence of depressive symptoms in parents was evaluated 53% at D3. Education level (p = 0.048) and male parents (p = 0.048) appeared to be a significant depression factor. The prevalence of post-traumatic stress disorder was 55.1% among the relatives of the patients. The lack of co-morbidity in admission patients was significantly associated with the occurrence of post-traumatic stress disorder in the family. Conclusion: Th

关键词： Anxiety Depression Resuscitation Patient Families Quality Approach

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Evisceration of the Small Bowel in the Vagina Following Endo-Uterine Maneuvers for Clandestine Abortion (APC) at CHU Gabriel Touré, Bamako, Mali

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Surgical Science 2018年第4期9卷 148-152页

作者： Dabo Aminata diop thierno madane Dembélé Bakary Tientigui Coulibaly Mahamadoun Doumbia Arouna Manganémoustapha Issa Abdoul Hamidou Almeimoune Traoré Alhassane Togo Adégné Téguété Ibrahima Django Djibo Mahamane Diallo Gangaly Universal Resuscitation Service at Gabriel Touré Teaching Hospital Bamako Mali General Surgery Service of CHU Gabriel Touré Bamako Mali Department of Obstetric Gynecologyof CHU Gabriel Touré Bamako Mali

Intra-uterine manual aspiration is the recommended maneuver for abortive endo-uterine evacuation. It must be performed in a medical setting for therapeutic purposes, while respecting its contraindications and asepsis rules essential for its implementation. The ignorance of anatomical structures by the authors of clandestine abortions is marked by the presence of utero-adnexal lesions, digestive lesions and vesical lesions or evisceration by the vagina. Vaginal evisceration of the small bowel is a rare and serious complication of manual intrauterine aspirations and induced abortions. Their late diagnosis and clandestine practice are responsible for unpredictable severe secondary complications and remain an important cause of morbidity and mortality. The development of a policy of continuous training of agents on the technique of manual intrauterine aspiration, broad information on contraceptive methods and a multidisciplinary, rapid and adequate management of complications will provide minimum morbidity and mortality. Conclusion: Abortion is a serious source of life-threatening complications.

关键词： Evisceration Abortion Surgery Mali

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Chest Trauma at the Emergency Department of the Gabriel TouréUniversity Hospital Bamako, Mali

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Open Journal of Emergency Medicine 2021年第2期9卷 18-24页

作者： Almeimoune Abdoulhamidou diop madane thierno Mangane Moustapha Démbele Seidou Alaji Coulibaly Mahamadoun Sogoba Youssouf Abdoulaye Chiad Mahamadoun Cisse Harouna Sangare Sidy Yattara Ogalat Enyengue Murielle Ingrid Kassogue André Diallo Boubacar Amadou Bah Madiassa Konaté Yoro B. Sidibe Diango Djibo Mahamane Department of Anesthesia Resuscitation and Emergency Medicine at CHU Gabriel Toure Bamako Mali Bamako Faculty of Medicine and Odontostomatology Bamako Mali Resuscitation Anesthesia Service CHU IOTA Bamako Mali Anesthesia and Intensive Care Unit CHU Luxembourg Bamako Mali Neurosurgery Department The Gabriel Touré University Hospital Bamako Mali Emergency Department The Hospital of Mali Bamako Mali Department of Anesthesia Resuscitation and Emergency Medicine at CHU Point G Bamako Mali General Surgery Department The University Hospital of Gabriel Toure Bamako Mali

In Mali, chest injuries remain a real public health problem and are associated with heavy morbidity and mortality. Faced with a resurgence of urban civil violence and the explosion of road accidents, we decided to conduct this study in order to describe the epidemiological, clinical and therapeutic aspects of thoracic trauma in the emergency department. Method and Material: This is a descriptive prospective study over a period of one year in the emergency department of the CHU Gabriel Touré. Including all patients admitted for thoracic trauma. Analysis and Entry: Data were entered and analyzed on SPSS software version 20.0. The test was significant for a p value Results: We recorded 21,090 appeals in our structure among which 1284 patients were suspected of thoracic trauma. The diagnosis of thoracic trauma was retained in 119 (0.56%) patients. All patients were transported to the emergency room without prehospital medicalization. Clinical presentation was dominated by dyspnea in 54.6% of patients, however pain was the almost constant symptom in conscious victims. Various traumatic mechanisms had caused these lesions of the thorax, of which road traffic accidents represented half of the causes, followed by urban civil violence in 28.6% of patients. Landslides and falls from a great height were responsible for 19.5% of chest injuries. Open chest trauma was the type of lesion found in a third of the cases. This type of injury was exclusively due to blows and injuries during the brawls. Standard chest radiography was performed as the first intention in 60% of patients compared to 10.9% for the pleuropulmonary ultrasound. Thirteen patients required ventilatory assistance after orotracheal intubation. The average length of stay was 65.23 hours. During the period of our study, the overall mortality was 1.85% in the emergency departments with a lethality specific to chest trauma of

关键词： Chest Trauma Emergencies Bamako Mali

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