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Male Breast Cancer: Diagnostic and Prognostic Features in Mali

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Journal of Cancer Therapy 2022年第2期13卷 71-79页

作者： Iriss A. Darar Zakari Saye Bourama Diarra madiassa konaté Amadou Traoré Seydou Pamateck Abdillahi I. Ismail Arouna Adama Doumbia Boubacar Karembé Bakary Tientigui Dembélé Lassana Kanté Drissa Traoré Zimogo Zié Sanogo Alhassane Traoré Adégné Togo Department General Surgery CHU Gabriel Toure Bamako Mali

Introduction: Male breast cancer is rare;representing 1% of breast cancers and less than 1% of all male neoplasia worldwide. We here analyzed the clinical, histological, therapeutic and prognostic characteristics of male breast cancer in Bamako, Mali. Patients and methods: A retrospective descriptive study was conducted on 14 male patients with breast cancer who visited two university hospitals in Bamako (Hospital Gabriel TOURE and Hospital du Point G) in Mali, from January 2005 to December 2018. Results: Male breast cancer represented 0.63% of all breast cancers and 0.23% of all male cancers. The following was observed: the mean age of 53 years (range: 23 - 82);a family history of cancer in 2;breast pain in 9;the average time to consultation of 8 years (6 - 24);gynecomastia found in 1;the tumor palpable in all 14 (size of 5 cm [3 - 10]);ulceration in 5. The most common histological type was non-specific infiltrating carcinoma with 92.8%. SBR II grade was found in 78.5% of cases. Of 8 patients with immunohistochemistry, hormone receptor positive was in 13 and Her2 positive was in 5. Metastases were found in 4, 2 pulmonary and 2 hepatic. Treatment: Neoadjuvant chemotherapy in 21.4%;radical surgery in 13 cases;surgery + radiotherapy in 2;surgery + hormonal therapy in 4. After an average follow-up of 36 months, 1 patient developed a lung metastasis and another patient had a lymph node recurrence. Conclusion: Male breast cancer was detected at relatively later stages. Physicians must be aware of this condition.

关键词： Breast Cancer Diagnostic Aspect Male Mali Therapeutic Aspect

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

Giant Lactant Adenoma: About a Case

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Surgical Science 2022年第12期13卷 561-565页

作者： Amadou Bah Amadou Maiga Boubacar Y. Sidibé Ibrahim Diakité Tani Koné Zakari Saye Arouna Doumbia Amadou Traoré madiassa konaté Pierre Coulibaly Amadou A. Traoré Bakary T. Dembélé Lassana Kanté Boubacar Karembé Assitan Koné Andre Kassogue Amidou Almeimoune Adegne Togo General Surgery Department CHU Gabriel Touré Bamako Mali Resuscitation Anesthesia Department CHU Gabriel Touré Bamako Mali

Affecting young women, lactating adenoma is a rare benign tumor of the breast. It is seen mainly in the third trimester of pregnancy and in the postpartum period. Clinically, it is a solid mass, mobile typically benign but its character of rapid evolution is reminiscent of phyllodes tumors, sarcomas and galactoceles. The definitive diagnosis is histological. We report a case of lactating adenoma in a 26-year-old lactating woman, third procedure, second pare, with a history of tumor resection of the outer quadrants of the left breast, 9 months ago, whose histology evoked a fibrotic disease, cystic breast associating non-specific subacute mastitis with suppuration. Received for recurrence of a tumor in the left breast which was the site of a polylobed mass of about 10/5 cm occupying 3/4 of the breast with mobile ipsilateral axillary adenopathies. A micro tru-cut biopsy was performed and the histology was in favor of a lactating breast adenoma with no signs of malignancy. She underwent surgical excision, the consequences of which were simple.

关键词： Lactating Adenoma Breast Histological Malignancy Surgical Excision

Acute Peritonitis Generalized at the Koutiala Reference Health Center, Mali: Epidemiological, Etiological and Therapeutic Aspects

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Surgical Science 2020年第6期11卷 111-116页

作者： Mahamadou Coulibaly Birama Togola Traoré Drissa Bréhima Bengaly Souleymane Sanogo Drissa Ouattara Diallo Siaka madiassa konaté Nouhoum Ongoiba Faculty of Medicine University of Science Technique and Technologies of Bamako Bamako Mali Department of Surgery Koutiala Hospital Bamako Mali Department of Surgery University Hospital Center Point G Bamako Mali Department of General Surgery CHU Gabriel Touré Bamako Mali

History: In Mali, several studies have been carried out on acute peritonitis but in the Koutiala circle it is a first. Aim: To evaluate the epidemiological, etiological and therapeutic aspects of generalized acute peritonitis at the Koutiala reference health center. Method: This was a 14-month prospective and descriptive study from August 1, 2017 to November 30, 2019, covering all patients admitted and operated for generalized acute peritonitis. The parameters studied were age, sex, frequency, clinical aspects, etiologies, treatment and postoperative operations. Result: The number was 93 cases, 72 men and 21 women. The average age was 34.2 years (Extremes: 2 - 75 years). The hospital frequency was 2.0%. The incidence rate of generalized acute peritonitis in the circle was 12.4 cases per 100,000 population. The clinical picture was still of peritonitis. The Widal-Félix serology was positive in 19 cases. Perioperative bacteriological sampling was systematic. The etiologies were dominated by digestive perforations in 81 cases (87%) of which 33 were located at the ileal level, postoperative peritonitis (6 cases) and ruptured pyocholecyst (2 cases). There were also 3 cases of primary peritonitis and 1 case of gynecological peritonitis. Excision-suturing was the most used surgical technique with 35.5% (n = 33). Postoperatively, we identified 10 cases of parietal suppuration (10.8%), 6 cases of postoperative peritonitis (6.5%), 2 cases of external digestive fistula (2.2%) and 7 cases of death (7.5%). Conclusion: Acute peritonitis occupies second place in abdominal surgical emergencies in the Koutiala circle. The etiologies are multiple and varied and are dominated by the ileal perforation which is secondary to typhoid fever more often. In most cases the surgical treatment is done by excision-suturing of the perforation. Mortality and morbidity remain high.

关键词： Generalized Acute Peritonitis Emergency Koutiala

Traumatic Diaphragmatic Injury at Gabriel Toure University Hospital, Mali

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Surgical Science 2022年第3期13卷 110-118页

作者： Amadou Traoré madiassa konaté Abdoulaye Diarra Idrissa Tounkara Mohamed Traoré Arouna Doumbia Amadou Bah Boubacar Yoro Sidibé Amadou Maïga Tani Koné Boubacar Karembé Zakari Saye Koniba Kéita Yacouba Bouaré Assitan Koné Ibrahim Diakité Lassana Kanté Bakary Tientigui Dembélé Alhassane Traoré Adégné Togo General Surgery Department of Gabriel Touré University Hospital Bamako Mali Surgery Department of Kati University Hospital Kati Mali Reference Health Center of Commune II Bamako Mali Reference Health Center of Commune III Bamako Mali

Traumatic diaphragmatic injury (TDI) is rare and is most often the result of a traffic road accident (TRA) or an assault. We initiated this study with the aims of determining the epidemiological, clinical and therapeutic aspects of TDI at Gabriel Toure University Hospital. This was a retrospective study from January 1999 to June 2021 that included all patients who presented a diaphragmatic injury consecutive to abdominal and/or thoracic trauma. In 22 years and 6 months, 46 cases of TDI were collected. They represented 0.17% of hospitalizations, 0.26% of surgical emergencies and 5.5% of thoraco-abdominal traumas. The average age was 31.69 years with a sex ratio of 3.2. Criminal stabbings accounted for 56.5% and TRA for 19.6%. Penetrating injuries accounted for 78.3% of cases. The parietal lesion was thoracic in 21 cases (45.7%), abdominal in 19 cases (41.3%) and thoraco-abdominal in 6 cases (13%). The chest X-ray, performed in 15 patients, showed an intrathoracic gas bubble (4 cases) and hemothorax (6 cases). Diagnosis of diaphragmatic lesion was preoperative in 21.7% (10 cases). The diaphragmatic breach was on the left side in 65.2% (30 cases) and the average size was 3.17 cm. Laparotomy was performed in 89.1%, thoracotomy in 4.4% and thoraco-laparotomy in 6.5% of cases. The surgical procedure consisted of reduction of the herniated viscera in 15.2% (7 cases) and closure of the diaphragmatic breach with non-absorbable sutures in 82.6% (36 cases). Chest tube drainage was performed in 73.9%. The average length of hospital stay was 9.8 days. Mortality was 13.04%. Conclusion: Traumatic diaphragmatic injury is rare but its frequency is increasing in our country. It most often affects the young man victim of assault or TRA. This type of trauma is rarely isolated;you have to think about it in case of any thoraco-abdominal trauma. The treatment is surgical. The prognosis depends on the severity of the associated lesions.

关键词： Diaphragmatic Injury Trauma Surgery Gabriel Toure

Epidemiological Profile of Intestinal Obstructions in Koutiala, Mali: About 65 Cases

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Surgical Science 2020年第6期11卷 117-121页

作者： Mahamadou Coulibaly Drissa Traoré Birama Togola Souleymane Sanogo Bréhima Bengaly Drissa Ouattara Siaka Diallo madiassa konaté Nouhoum Ongoiba Faculty of Medicine University of Science Technique and Technologies of Bamako Bamako Mali Department of Surgery Koutiala Hospital Bamako Mali Department of Surgery University Hospital Center Point G Bamako Mali Department of General Surgery CHU Gabriel Touré Bamako Mali

Aim: To assess the epidemiological profile of intestinal obstructions at the Koutiala district hospital. Patients and Method: This was a prospective and descriptive study taking place from August 1, 2017 to April 30, 2020. The files of patients with acute intestinal obstruction in the general surgery department of the Koutiala district hospital were collected. In this study, patients operated on for acute intestinal obstruction were included. Non-operated patients were not included in the study. Result: The records of 65 patients operated on for acute intestinal obstruction were collected. The mean age was 32 ± 22 with extremes of 1 year and 94 years. 7 infants (10.8%) and 1 4-year-old child (1.5%) were identified. The 16 to 59 age group was more common. Males were the majority with 70.8% (n = 46). The sex ratio was 2.4. The rate of bowel obstruction in the general population in the circle was 8.1 cases per 100,000 population. According to provenance, patients came from inside the circle (rural areas) in 87.7% of the cases (n = 57) and from the city of Koutiala in 12.3% (n = 8). 33.9% of our patients had undergone laparotomy (n = 22). Patients consulted urgently in 93.8%. The etiologies are dominated by post-operative straps (33.8%) and volvulus (24.6%). We noted 12 cases of intestinal necrosis. Postoperative morbidity was 13.8% of cases (n = 9) and mortality of 6.1% of cases (n = 4). Conclusion: Bowel obstruction is one of the most frequent surgical emergencies in our circle. They most often affect young subjects and young adult males. The etiologies are dominated by the post-operative flanges. Complications remain elevated.

关键词： Epidemiology Intestinal Obstruction Koutiala

Total Thrombosis of Bifurcated Endoprosthesis: A Rare Complication of Endovascular Treatment of Abdominal Aortic Aneurysm

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Surgical Science 2019年第9期10卷 338-345页

作者： Birama Togola Bréhima Bengaly madiassa konaté Laurent Muller Olivier Szymoniak Mahamadou Coulibaly Drissa Traoré Bréhima Coulibaly Skaiste Vaitkevicienne Michel Peret Nouhoum Ongoiba Jean Louis Debrux Department of Surgery “B” CHU Point “G” Bamako Mali Department of General Surgery Hospital Gabriel Touré Bamako Mali Department of Vascular and Thoracic Surgery of CH Cholet France Department of Vascular Surgery in Park Polyclinic of Cholet Cholet France Department of Thoracic and Cardiovascular Surgery Angers CHU Angers France

Background: Aortic stents are a therapeutic alternative to open surgery of abdominal aortic aneurysms. We report a case of treatment of an abdominal aortic aneurysm with a bifurcated stent, complicated by total thrombosis. Aim: The purpose of this presentation was to understand the causes, mechanisms, incidents and accidents that contributed to this complication. Case Presentation: A 48-year-old man patient with a history of high blood pressure, ischemic heart disease, chronic obstructive pulmonary disease, who was found during a surveillance check-up, an infra-renal abdominal aorta aneurysm measured at 56 mm in diameter, asymptomatic but progressive. The indication of an endovascular treatment by the placement of a bifurcated prosthesis was posed and accepted. Thrombosis of the two limbs was intra-operative, upper-end migration without endoleak at 4 months postoperative, total thrombosis of the stent at 13 months postoperatively. Explantation of the stent followed by aortobi-iliac bypass was finally performed in the 15th month. Conclusion: The cardiopulmonary antecedents, the anatomical and evolutionary characteristics of the aneurysm could have played a role in the occurrence of the complications observed in this patient.

关键词： Aneurysm Abdominal Aorta Endovascular Complications Stent Thrombosis

Operating Site Infections at General Surgery Department of Gabriel Toure Training Hospital

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Surgical Science 2015年第2期6卷 59-64页

作者： Bakary Tientigui Dembélé Alhassane Traoré Adégné Togo Lassana Kanté Ibrahim Diakité Bourama Diarra Amadou Traoré madiassa konaté Boubacar Karembé Yacaria Coulibaly Mamby Keita Souleymane Diallo Souleymane Diallo Gangaly Diallo Faculty of Medicine and Odonto-Stomatology Bamako Mali Department of General Surgery CHU Gabriel Touré Bamako Mali Department of Biology and Laboratory CHU Gabriel Touré Bamako Mali

The operating site infections constitute the major postoperative issue in surgery. Our objectives were to determine the hospital frequency, the risk factors, the involved germs as well as the cost generated by the operating site infections. Method: Our three months prospective survey run from September the 1st to November the 30th 2013 has included all department patients being operated on and hospitalized. The criteria have been set by CDC d’Atlanta. Results: 374 files were involved, among them 229 (61.2%) were emergencies and 145 (38.8%) were scheduled. The average age was 41 (extremes 7 and 95 standard deviation 17.46), the sex ratio 1.67. The infective risk according to Altmeier has found 17.5% type 1, 25.1% type 2, 11.2% type 3 and 46.3% type 4;according to NNISS, 96 (25.7) were NNISS 0;94 (51.9%) NNISS 1;80 (21.4%) NNISS 2;and 4 (1.1%) NNISS. In the Altmeier class I have not got antibiotic before infection signs appearances. Our overall rate of operating site infections was 7.9% (29 cases), with 24 (82.8%) emergency cases. According to Altmeier’s class of infective risk, the rate of operating site infections was 1.54% making 1 out of 65 type I patients;4.3% making 4 out of 93 type II patients;11.9% making 5 out of 42 type III patients;10.9% making 19 out of 174 type IV patients. According to NNISS, the infective risk has been assessed and was 2.08% for score 0, we have got 8.25% score 1, and 12.5% for score 2, and 25% for score 3. The bacteriology has been dominated by Escherichia colii(51.7), Proteus mirabilisi(13.8), and Klebsiella pneumoniaei(10.34). The germs have been resistant to the combination Amoxicillin-clavulanic Acid between 50% and 87% of cases. The most active antibiotics on the germs have been Cephalosporin, Polypeptides, and aminoglycosides. The hospital stay has been delayed to 12 days on average by operating site infections, making 2.5 times greater than those uninfected. The infection has increased the cost of management around 600 Euro.

关键词： Infections Operating Sites Bamako

Post-Operative Peritonitis: Diagnostic Problems, Morbidity and Mortality in Developing Countries

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Surgical Science 2014年第8期5卷 363-367页

作者： Alhassane Traoré Bakary Tientigui Dembélé Adégné Togo Lassana Kanté madiassa konaté Ibrahima Diakité Simo Notue Fabienne Laurence Boubacar Karembé Abdoulaye Diarra Amadou Traoré Mahamane Djibo Diango Gangaly Diallo Department of General Surgery CHU Gabriel Touré Bamako Mali Faculty of Medicine and Odonto-Stomatology Bamako Mali

Goal: To study the diagnostic difficulties and post-operative morbidity and mortality of peritonitis. Patients and Methods: Retrospective study about the records of adult patients operated on between 1999 and 2013 whose diagnosis of post-operative peritonitis was made. Results: We achieved 23,573 lanterns and recorded 148 cases of postoperative peritonitis or 0.62%. The medium age was 37.1 ± 17.7 years and the sex ratio was 1.2. The delay between the initial intervention and reoperation was less than 5 days. Factors occurrence of postoperative peritonitis were those related to the initial surgery: septic context 70.8%, emergency surgery 81.1% under the seat mesocolic 25% and 20.3% initial surgical technique. The diagnosis was made preoperatively in 62.2% (n = 92). Ultrasound has found an effusion in 29.7% (n = 44). Cytobactériologic review identified germs in 85.1% (n = 126) and sterile in 12.9% of patients (n = 22). The most frequent etiologies were: 22.9% anastigmatic leak (n = 34), the phoenix abscess in 17.6% (n = 26), iatrogenic perforation 13.5% (n = 20) and digestive fistula 25% (n = 37). Other causes were the stoical necrosis 12.2% (n = 18) and evisceration 8.8% (n = 13). We performed a digestive stoma in 61% (n = 89), a closure of the abdomen bolsters in 8.8% (n = 13), a suture in iatrogenic perforation in 13.5% (n = 20) and washing with drainage in patients with phoenix abscess in 17.6% (n = 26). Morbidity was 22.3% and 53.4% mortality. Conclusion: The diagnosis of post-operative peritonitis is difficult in a developing country. Morbidity and mortality is high. Improved diagnostic tools are needed.

关键词： Peritonitis Postoperative Morbidity and Mortality Surgery